Esthetics and bone changes of immediate implants with or without vascularized interpositional periosteal connective tissue grafting: A 2-year randomized controlled trial.

Abstract

To compare esthetics at single immediately placed implants with and without soft tissue augmentation. Patients with non-restorable maxillary teeth in the esthetic zone were assigned into 2 groups: immediately placed implants with simultaneous vascularized interpositional periosteal connective tissue grafting (VIP-CTG) or non-grafted immediately placed implants (NG). The outcomes included: pink esthetic score (PES), gingival thickness, keratinized tissue width, buccal bone changes, marginal bone loss, pain, and satisfaction. Eighteen implants were included. At 2 years the mean value for PES was 12 ± 3.2 for the VIP-CTG and 12.9 ± 1.3 for the NG (p=.855). Mucosal thickness and keratinized tissue width showed no statistically significant difference between the two groups (p=.253) and (p=.931) respectively. Clinically buccal bone showed mean bone loss of 2.03 ± 1.57 mm for VIP-CTG and 1.09 ± 1.3 mm for NG (p=.247) and radiographically showed 1.67 ± 0.84 mm at the VIP-CTG and 1.16 ± 0.47 mm at the NG (p=.118). No statistically significant difference between both groups was demonstrated regarding marginal bone level changes (p=.142), pain (p=.622), or satisfaction (p=.562) at any time point. Simultaneous soft tissue grafting with immediate implant placement did not provide a more favorable outcome regarding esthetics or alveolar bone preservation effect. Undisturbed healing with the least surgical intervention seems to provide more favorable outcomes.