Soft tissue augmentation of ridge defects in the maxillary anterior area using two different methods: a randomized controlled clinical trial

Abstract

To test whether or not vascularized interpositional periosteal-connective tissue grafts are as successful as free subepithelial connective tissue grafts in augmenting volume defects in the anterior maxilla. Twenty subjects with Seibert class 1 ridge defects in the anterior maxilla were randomly, equally assigned to augmentation by vascularized interpositional periosteal-connective tissue graft (test) or free subepithelial connective tissue graft (control). Clinical periodontal parameters at teeth adjacent to the gap were recorded, and conventional impressions were taken prior to surgery (baseline = t(0)) and 1 (t(1)), 3 (t(3)) and 6 (t(6)) months after surgery. The casts were optically scanned, digitized and analyzed for ridge contour changes in the augmented area. Data were subjected to nonparametric statistics. The contour changes in labial distance between baseline and follow-up for the control group were (median, range) 1 mm, 0.37-1.45 (t(0)-t(1)); 1.18 mm, 0.39-1.40 (t(0)-t(3)); and 0.63 mm, 0.28-1.22 (t(0)-t(6)) and for test group 1.21 mm, 0.74-2.47 (t(0)-t(1)); 1.26 mm, 0.50-1.71 (t(0)-t(3)); and 1.18 mm, 0.16-1.75 (t(0)-t(6)). Significantly less shrinkage of the graft was observed in the test group after 6 months (P = 0.03). Clinical periodontal parameters at the neighboring teeth were stable over the follow-up period and did not differ between groups. Augmentation of single tooth gaps with moderate ridge defects in the anterior maxilla was successfully performed using both techniques. However, after 6 months, sites treated by the pediculated graft were superior in maintaining the initially augmented volume and showed less shrinkage of the graft. This could be attributed to better perfusion of the pediculated graft.