Horizontal stability of connective tissue grafts at the buccal aspect of single implants: a 1-year prospective case series.

Abstract

To clinically evaluate the horizontal stability of a connective tissue graft (CTG) at the buccal aspect of single implants (1); to compare actual gingival thickness between thin and thick gingival biotype (2). Periodontally healthy non-smoking patients with a single implant in the anterior maxilla (15-25) were selected for a prospective case series. All demonstrated a horizontal alveolar defect and were in need of contour augmentation by means of CTG for aesthetic reasons. Patients were enrolled 3 months after implant surgery and had been provided with a provisional screw-retained crown. CTG was inserted in the buccal mucosa via the envelope technique using one intrasulcular incision. An ultrasonic device was used to evaluate mucosal thickness (MT) at the buccal aspect. MT was assessed at t0 (before CTG), t1 (immediately after CTG), t2 (2 weeks after CTG = suture removal), t3 (3 months after CTG = permanent crown installation) and t4 (1 year after implant placement). The gingival biotype was categorized as thin or thick based on the transparency of a periodontal probe through the soft tissues while probing the buccal sulcus of the contra-lateral tooth. Gingival thickness (GT) was measured at the contra-lateral tooth using the same ultrasonic device. Thirty-seven patients (19 men, 18 women; mean age 38) met the selection criteria and consented to the treatment. Mean soft tissue gain immediately after CTG was on average 1.07 mm (SD 0.49). What remained of this tissue gain after 1 year was on average 0.97 mm (SD 0.48; 90.5%). Hence, mean soft tissue loss amounted to 0.10 mm (SD 0.23; 9.5%; p = 0.015) with no significant difference between patients with a thin or thick biotype (p ≥ 0.290). Patients with a thin biotype had a mean GT of 1.02 mm (SD 0.21), whereas GT was on average 1.32 mm (SD 0.31) in subjects with a thick biotype (p = 0.004). Connective tissue graft substantially thickens the peri-implant mucosa with acceptable stability over a 1-year period.