Peri-implant Soft Tissue Thickness Research Articles

Treatment of esthetic complications with peri-implant soft tissue: A description of the "apical approach" surgical technique and presentation of two clinical cases.

Peri-implant soft tissue deformities are an increasingly common phenomenon in the esthetic zone. While the most widely studied esthetic complications are peri-implant soft tissue dehiscences, there are other esthetic concerns in routine clinical practice that require investigation and treatment. Against this backdrop, this report on two clinical cases aimed to describe a surgical approach using the apical access technique for treatment of peri-implant soft tissue discoloration and fenestration. In both clinical scenarios the defect was accessed via a single horizontal apical incision, without removing the cement-retained crowns. A bilaminar technique using apical access with a simultaneous connective tissue graft seems to offer promising results for the treatment of peri-implant soft tissue deformities. After the 12-month reevaluation, an increase in peri-implant soft tissue thickness was observed, resolving the pathologies presented.

Effect of the buccal fat pad in the prevention of zygomatic implant surgery postoperative complications: A pilot study.

Zygomatic implants have been used to treat severe atrophy maxilla. Since its description, the technique has been improved in order to reduce patient morbidity as well as prosthesis rehabilitation time. Despite the improvements in the procedure, zygomatic implant treatments still have complications related to the peri-implant soft-tissue; a probing depth greater than 6 millimeter (mm) and a prevalence of bleeding on probing of 45% have been described. The mobilization of the buccal fat has been used to manage different oral and maxillofacial soft-tissue pathologies. The aim of this study was to assess whether the buccal fat pad might prevent mucosal dehiscence and avoid potential postoperative complications when is placed covering the body part of the zygomatic implants. In this pilot study, 7 patients were enrolled and a total of 28 zygomatic implants were placed and evaluated during a 12-month follow-up period. Surgical sites were randomly divided into two groups before implant placement: control group (A; in which no buccal fat pad was applied) and experimental group (B). Peri-implant soft tissue thickness difference, pain using a Visual Analog Scale (VAS), swelling, hematoma, buccal soft tissue healing and sinusitis, were evaluated. The implant survival rate was determined according the Aparicio success criteria and compared between the control and experimental procedure. A nonstatistical difference was found between groups regarding to pain. The experimental group showed higher soft-tissues thickness (p= 0.03) and the implant survival rate was 100% in both groups. The mobilization of the buccal fat pad to cover the body of the zygomatic implants increases peri-implant soft-tissue thickness, without increasing the postoperative pain.

Changes in Peri-Implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft. Part III: A Case Series Using a Novel, Hybrid Implant Design with a Subcrestal Angle Correction.

This comparative case series presents 16 consecutively placed and temporized immediate implants in the maxillary esthetic zone. The implants have a novel, inverted body-shift design, intended to achieve high levels of primary stability via the tapered apical portion. The coronal narrow cylinder provides greater space between the implant platform and facial socket wall and adjacent teeth/implants, allowing a greater opportunity for augmentation. The restorative platform also features a subcrestal angle correction, which facilitates screw retention. The wider, facial platform-shift thus creates more room for augmentation via dual-zone bone grafting and the application of a dermal allograft, which yields greater soft tissue thickness after initial healing. This case series aimed to evaluate soft tissue thickness and compare the results to two previously published cohorts where implant design served as the only variable between groups.

Clinical decision-making of anterior implant abutment.

Abutment is an important component serving as a connecting link between the implant and the implant-supported prosthesis. In accordance with mechanical, biological, and other conventional norms, it can compensate the deviation between the implant and the prosthesis, which plays a significant role in maintaining the health of peri-implant tissue and the longevity, stability, and effectivity of prosthesis. However, choosing an anterior implant abutment correctly and conveniently is challenging, given the great variety of anterior abutment in clinical practice. Through virtual implant design, the correct implant site was compared and selected, and the supra-target prosthesis was coordinated before and after the operation. The implant level vertical of height of target restoration space (I) was measured to predict the availability and the retentive method of the implant restoration. After implantation, the primary selection of abutment type was selected according to the implant system (S), screw access position, and retentive method of the prosthesis. The final selection of abutment is accomplished by combining the measured values of peri-implant soft tissue thickness (T), gingival height (GH), and long axis of implant (L). Furthermore, the concepts and the classified applications of custom abutment were discussed in detail in this paper. The plan's main control variables L, I, GH, T, and S compose the words Lights, so this plan can be abbreviated as the anterior abutment decision tree. The decision tree has good decision-making efficiency and high clinical accessibility.

The Buccally Displaced Palatal (BDP) Flap to Increase Quantity and Thickness of Peri-implant Soft Tissue.

Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth.

Efficacy of soft tissue augmentation procedures on tissue thickening around dental implants: A systematic review and meta-analysis.

The first focused question (FQ1) was: What is the efficacy of connective tissue graft (CTG), as compared to the absence of soft tissue grafting procedure, in terms of gain in peri-implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? The second focused question (FQ2) was: What is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri-implant STT reported by RCTs or CCTs? A manual and electronic search was performed for each question to identify RCTs and CCTs published up to July 2020. The primary outcome variable was changes in peri-implant STT and secondary outcomes were marginal bone level (MBL), clinical parameters for the diagnosis of peri-implant health, changes in the position of peri-implant soft tissues, esthetic outcomes, and patient-related outcome measures (PROMs). For primary and secondary outcomes, data reporting mean values and standard deviations for each study were extracted. Weighted mean differences (WMDs) or standardized mean differences as well as 95% confidence intervals (CIs) and prediction intervals (PIs) were calculated. Eight trials were included to answer the first focused question and eight to answer the second one, providing data for 254 and 192 patients, respectively. For the first focused question, a statistically significant difference of 0.64mm in STT was found in favor of the grafted group (n=8; 95% CI [0.16; 1.13]; 95% PI [-1.06; 2.35]; p=.01). Moreover, sites treated with CTG exhibited statistically significant less recession than implants without a graft (n=4; WMD=0.50mm; 95% CI [0.19; 0.80]; 95% PI [-0.70; 1.69]; p<.001). For the second focused question, the meta-analysis showed a statistically significant gain of STT in the CTG group when compared to soft tissue substitutes (n=8; WMD=0.51mm; 95% CI [0.28; 0.75]; 95% PI [-0.09; 1.12]; p<.001). Furthermore, the use of CTG resulted in significantly higher pink esthetic score values (n=3; WMD=1.02; 95% CI [0.29; 1.74]; 95% PI [-3.67; 5.70]; p=.01) and less recession (n=2; WMD=0.50mm; 95% CI [0.10; 0.89]; 95% PI [not estimable]; p=.014) when compared to soft tissue substitutes. No statistically significant differences between groups were observed for any of the following secondary variables: MBL, clinical parameters for the diagnosis of peri-implant health, position of the interproximal tissues, keratinized mucosa or PROMS (p > 0.05), except for medication intake, which was significantly higher when using CTG as compared to soft tissue substitutes (n=2; WMD=1.68; 95% CI [1.30; 2.07]; 95% PI [not estimable]; p<.001). Soft tissue augmentation procedures are efficacious on soft tissue thickening and, in particular, CTG demonstrated a significant STT gain when compared to no graft or soft tissue substitutes.

Evaluation of free connective tissue graft and collagen matrix clinical effectiveness to increase soft tissue thickness around dental implants

Relevance. Implant-supported prostheses are currently one of the most popular rehabilitation methods in partially or fully edentulous patients. Peri-implant soft tissue thickness is one of the principal determinants to achieve an aesthetic result and prevent the development of mucositis and peri-implantitis.Material and methods. The study included 30 partially edentulous patients with a lack of soft tissue thickness in the planned surgery site. 15 patients underwent augmentation using a collagen matrix (group 1) and 15 patients – with a free connective tissue graft (group 2). The primary endpoint was the assessment of soft tissue thickness gain three months after the surgery. The secondary endpoints were the thickness assessment of keratinized attached gingiva (three months after the surgery), swelling and pain severity (on the 1st, 3rd, 5th, 7th day, 1 and 3 months after the surgery) and quality of life evaluation (OHIP-14) (before the surgery, seven days and three months after the surgery).Results. The soft tissues thickness gain was 1.181 ± 0.11 mm in group 1, 1.55 ± 0.11 mm – in group 2. The surgery took 8.4 minutes less (from 3.737 to 13.06) in group 1 than in group 2. The swelling assessment on the next day after surgery showed that the mean value was 2.73 ± 0.3 in group 1, 1.87 ± 0.74 – in group 2 (р = 0.0139). There were no statistically significant differences in the change in the width of the keratinized attached gingiva, pain syndrome and changes in patients' quality of life (p &gt; 0.05)Conclusion. Collagen matrix, like a free connective tissue graft, is an effective way to increase the soft tissue thickness around dental implants.

3D volumetric analysis at implant sites after soft tissue augmentation

Background. The role of soft tissues in the survival of dental implants remains one of the most discussed problem of the modern dentistry. Two main parameters such as the width of the keratinized gingiva and thickness of the peri-implant tissues are known to play an important role in the stability of the dental implants. Soft tissues thickness is necessary to achieve an aesthetic long-term stable result. Different methods for increasing soft tissue thickness are described in the literature.Materials and methods. Study included 30 patients with insufficient peri-implant soft tissue thickness. All patients underwent buccal soft tissue thickness augmentation by two different methods: collagen matrix (1 group) and free connective tissue graft (2 group). In the study we evaluated the amount of soft tissue thickness gain by using volumetric 3D- analysis.Results. The amount of soft tissue thickness before surgery was 1,63±0,7 mm in the 1 group, 1,61±0,7 mm in the 2 group. Three months after surgery the amount of soft tissue gain was 1,18±0,11 mm in the 1 group, 1,55 ±0,11 mm in the 2 group.Conclusion. The use of a free connective tissue graft as well as a collagen matrix is an effective method for increasing the thickness of soft tissues in the peri-implant area.

Clinical and histological evaluation of the use of acellular dermal matrix (ADM) membrane in peri-implant vertical soft tissue augmentation: A controlled clinical trial.

The aim of this study was to clinically and histologically evaluate the efficacy of using acellular dermal matrix (ADM) for peri-implant vertical soft tissue augmentation at implant placement. Twenty patients were enrolled in this study. According to the initial thickness of vertical soft tissue, patients were assigned into the ADM group (≤2mm) or the control group (>2mm) prior to implant surgery +ADM grafting or implant surgery alone. Second-stage surgery was carried out 3months later, and a small piece of ridge membrane was harvested for histological and immunohistochemical evaluation. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF)-BB in peri-implant crevicular fluid (PICF) were also assessed 1week, 1month, and 5months after second-stage surgery. Clinical parameters were recorded to evaluate peri-implant health at 1week and 3months after implant restoration. All 20 implants healed uneventfully and successfully. Soft tissue thicknesses were comparable in the two groups at second-stage surgery (3.20±0.42mm vs. 3.50±0.58mm). In the ADM group, the mean increase in soft tissue thickness was 1.85±0.34mm. Histological and immunohistochemical outcomes showed no differences between the two groups. VEGF and PDGF-BB levels in PICF were significantly lower in the ADM group 1week after second-stage surgery (p<.01), yet they decreased in both groups later. The difference between the groups had disappeared by 5months after second-stage surgery. The clinical peri-implant parameters were good and stable by the end of the study (3months after restoration). Our results suggested that using ADM at implant placement was effective in increasing the thickness of peri-implant vertical soft tissue and achieved comparable clinical and histological performance to the control group. However, the incremental soft tissue showed inferior angiogenic ability in the early stage of wound healing.

Outcomes of a 1-Year Prospective Single-Arm Cohort Study Using a Novel Macro-Hybrid Implant Design in Extraction Sockets: Part 1.

A novel macro-hybrid implant design was introduced to afford high apical primary stability and more coronal space to preserve the circumferential extraction socket architecture. This study presents 1-year data from a prospective single-arm cohort study. The data was distilled based on the following criteria: (1) single-tooth immediate tooth replacement therapy (ITRT) in the maxillary anterior and premolar regions in intact (Type 1) extraction sockets that were (2) treated with the dual-zone grafting technique. The clinical and radiographic outcomes of 48 ITRT implants were evaluated. The mean ± SD labial plate dimension changes were 0.33 ± 0.41 mm at the implant abutment interface (L1) and 0.34 ± 0.40 mm at 5.0 mm below (L2). The mean labial plate dimension (thickness) at the 1-year recall was 2.27 ± 0.88 mm (L1) and 1.95 ± 0.95 mm (L2). At ITRT, the ridge contour at the free gingival margin and 3.0 mm below it were 7.54 ± 0.93 mm and 9.44 ± 2.36 mm, respectively; after final restoration delivery, the corresponding values were 7.45 ± 0.95 mm and 10.23 ± 2.30 mm, respectively. The peri-implant soft tissue thickness (PISTT) at the time of implant-level impression-making was 3.29 ± 0.73 mm, with an average Pink Esthetic Score of 12.79. A macro-hybrid implant design showed high levels of primary stability (~60 Ncm), stable ridge contour at 1 year, a labial plate dimension between 1.5 and 2.0 mm, and PISTT > 3.0 mm, which may be a critical factor in providing stable, long-term esthetic outcomes.

Immediate Tooth Replacement Therapy in Postextraction Sockets: A Comparative Prospective Study on the Effect of Variable Platform-Switched Subcrestal Angle Correction Implants.

Immediate tooth replacement therapy (ITRT), ie, immediate implant placement and provisional restoration in postextraction sockets, has been shown to achieve favorable outcomes in reference to soft tissue stability and esthetics. However, avoiding socket perforation with uniaxial implants in the anterior maxilla can be challenging due to the inherent anatomy. Dual or co-axis subcrestal angle correction (SAC) implants have been developed to change the restorative angle of the clinical crown restoration subcrestally at the implant-abutment interface to enhance the incidence of screw-retained definitive restorations. An additional benefit of this macrodesign implant feature is variable platform switching (VPS) that increases soft tissue gap distance above the implant platform. The purpose of this prospective study on ITRT in maxillary anterior postextraction sockets was to investigate the effect of SAC with VPS (SAC/VPS) compared to conventional platform-switch-design implants (PS) relative to ridge dimension stability and peri-implant soft tissue thickness. A total of 29 patients had undergone ITRT and received either a PS or SAC/VPS implant; previously described measurements were made compared to the contralateral natural tooth sites. When the comparison of buccal soft tissue thickness was made, SAC/VPS showed a greater increase compared to PS (3.12 mm vs 2.39 mm, respectively) with statistical significance (P = .05). The increase was independent from periodontal phenotype. Therefore, SAC/VPS may increase peri-implant soft tissue thickness and help minimize recession following ITRT.

Titanium-Prepared Platelet-Rich Fibrin Versus Connective Tissue Graft on Peri-Implant Soft Tissue Thickening and Keratinized Mucosa Width: A Randomized, Controlled Trial

The health of peri-implant tissues is associated with the peri-implant soft tissue thickness (STT) and keratinized tissue width (KTW). Resorptive changes in the crestal bone around implant sites will be affected by the STT. The present randomized prospective study compared the effectiveness of titanium-prepared platelet-rich fibrin (T-PRF) with that of connective tissue graft (CTG) on peri-implant STT, KMW, and crestal bone level. Through simultaneous augmentation of the soft tissue using T-PRF or CTG, 30 implants were placed in 30 patients. The implants were placed in thin, soft tissue areas and thickened simultaneously with a T-PRF membrane in the test group and a CTG in the control group. During surgery (T0) and at 3months postoperatively (T1), the KTW and peri-implant STT were measured at 3 points: occlusal part of the alveolar crest (OAC), midbuccal mucosa level (MBML), and 1mm above the mucogingival junction (MGJ1). The crestal bone changes were evaluated from a periapical radiograph at 3months postoperatively. The baseline STT and KTW measurements showed no significant differences between the 2 groups (P<.05). Comparison of the T0 and T1 measurements from the 2 groups showed a significant increase in KTW and STT (P<.001). Compared with the test group, the control group showed a highly significant increase in the peri-implant STT at the MBML, MGJ1, and KTW levels (P<.05). No significant difference was found between the 2 groups in terms of the OAC changes (P>.05). No crestal bone loss was observed in any of the dental implants. Both groups experienced a greater increase in peri-implant STT at the OAC level, and T-PRF can be considered as an autogenous alternative to CTG. Also, peri-implant STT might prevent crestal bone resorption in the osseointegration period.

Changes in Peri-implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft. Part II: A Comparative Retrospective Case Series Using a Subcrestal Angle Correction Implant Design.

Immediate tooth replacement therapy (ITRT) in the maxillary anterior sextant is an increasingly frequent treatment option sought by patients and performed by clinicians worldwide. Achieving long-term results that are predictable, stable, esthetic, and healthy is the ultimate goal. This trend also lends itself to minimally invasive surgery as well as defining the procedure to a singular surgical intervention. Preserving and augmenting hard and soft tissues at the time of immediate implant placement provides the best opportunity to achieve these goals. Incorporating an implant with a subcrestal angle correction [SAC] or biaxial feature facilitates screw-retention of both provisional and definitive restorations through the cingulum portion of the crown. Compared to uniaxial implants, these implants also feature an extended or variable platform switch [VPS] facially. Measurements of the peri-implant soft tissue thickness 2.0 mm apical to the facial free gingival margin were compared between two groups of 15 consecutively treated patients with different implant designs to evaluate the effect of SAC/VPS for ITRT. The null hypothesis was that there is no difference between uniaxial and biaxial implants with bone grafting and dermis allograft. These authors contend that using a combined hard and soft tissue grafting approach along with SAC/VPS biaxial implants has a synergistic effect on increasing peri-implant soft tissue thickness compared to uniaxial implants.

Efficacy of Xenogeneic Collagen Matrix to Augment Peri-Implant Soft Tissue Thickness Compared to Autogenous Connective Tissue Graft: A Systematic Review and Meta-Analysis.

Several approaches for increasing peri-implant mucosal thickness have been proposed, including autogenous, allogeneic, and xenogeneic grafts. The objective of this meta-analysis was to analyze whether xenogeneic matrices are viable alternatives to autogenous soft tissue grafts in peri-implant soft tissue augmentation. A systematic search was performed to select randomized clinical trials that compared connective tissue grafts and xenogeneic collagen matrices. The primary outcomes were the mucosal thickness and keratinized mucosa changes, while the secondary outcomes were patient morbidity, painkiller consumption, and surgical time required for the procedure. Seven randomized clinical trials were included for the final evaluation with a total number of 218 implant sites (108 in the connective tissue graft group, 110 in the collagen matrix group) with 3 to 12 months (mean: 6 months) follow-up period. Results showed mucosal thickness increase in both buccal and crestal sites, but it did not yield statistical significance. The keratinized mucosa gain difference was only -0.06 mm (95% CI [-30.0, 0.18]) between the treatments. The postsurgical discomfort, increased consumption of painkillers, and reduction of treatment time (15.46 minutes less) differed significantly in favor of the collagen matrix group. Within the limits of this study, it can be concluded that collagen matrix and connective tissue graft are equivalent in peri-implant soft tissue augmentation.

Improvement of Quality of Life with Implant-Supported Mandibular Overdentures and the Effect of Implant Type and Surgical Procedure on Bone and Soft Tissue Stability: A Three-Year Prospective Split-Mouth Trial.

In fully edentulous patients, the support of a lower dental prosthesis by two implants could improve the chewing ability, retention, and stability of the prosthesis. Despite high success rates of dental implants, complications, such as peri-implantitis, do occur. The latter is a consequence of crestal bone loss and might be related to the implant surface and peri-implant soft tissue thickness. The aim of this paper is to describe the effect of implant surface roughness and soft tissue thickness on crestal bone remodeling, peri-implant health, and patient-centered outcomes. The mandibular overdenture supported by two implants is used as a split-mouth model to scrutinize these aims. The first study compared implants placed equicrestal to implants placed biologically (i.e., dependent on site-specific soft tissue thickness). The second clinical trial compared implants with a minimally to a moderately rough implant neck. Both studies reported an improvement in oral health-related quality of life and a stable peri-implant health after three years follow-up. Only equicrestal implant placement yielded significantly higher implant surface exposure, due to the establishment of the biologic width. Within the limitations of this study, it can be concluded that an implant supported mandibular overdenture significantly improves the quality of life, with limited biologic complications and high survival rates of the implants.

Periimplant soft tissue volume changes after connective tissue grafting. The autologous connective tissue graft vs. the porcine collagen matrix. A clinical follow‐up case series

Background The thickness of peri-implant soft tissue is very important in the high risk esthetic area. Especially in advanced cases, i.e. high lip line, thin gingival biotype, loss of soft or hard tissues or bony atrophy, soft tissue grafting can be indicated in order to avoid gingival recession and periimplantitis. Gold standard is the autologous subepithelial connective tissue graft (SCTG) of the palate. To avoid tissue removal, porcine collagen matrices have been introduced as possible alternatives. Aim/Hypothesis This clinical study evaluates a porcine collagen matrix (CM) in comparison to the subepithelial connective tissue graft (SCTG) from the palate for soft tissue thickening around implants with a 3D follow- up. Material and Methods Patients (n = 12) were included after implant placement in the esthetic area with buccal tissue deficit. At the time point of implant exposure, buccal soft tissue were either thickened with the CM (n = 6) or the SCTG (n = 6). Impressions with a scan optimized vinylsiloxanether (Identium® Scan, Kettenbach GmbH, Eschenburg, Germany) were taken before augmentation (i), after surgery (ii), after 10 (iii), 30 (iv), 90 (v) and 180 days (vi). The impressions were optically scanned with a high precision scanner (Atos II Triple Scan, GOM GmbH, Braunschweig, Germany). The acquired data was visualized and superimposed with the ATOS Professional software (GOM GmbH, Braunschweig, Germany). The region of interest (ROI) was defined at the buccal area from the margin of the suprastructure to the mucogingival junction at the implant site and to the 2 adjacent teeth (primary outcome variable- volume increase in mm3+ secondary outcome variables- volume increase in%, mean and maximum thickness increases in mm. Results The evaluation of the region of interest at the different time points showed that there was a volume increase in both groups after surgery. After ten days, volume further increased in the SCTG group (183.88 mm3 = 139.03%) compared to the CM group (80.74 mm3 = 71.03%). This was a thickness increase (mm) of 2.31 mm in the SCT group and 1.12 mm in the CM group. Volume and thickness decreased in both groups over time (6 months- SCTG- 61.75 mm3 = 43.61%+ CM- 19.56 mm3 = 18.24%). This resulted in a thickness increase of 0.3 mm in the CM and 0.8 mm in the SCTG group with statistically significant difference after 6 months. Conclusions and Clinical Implications After 6 months, soft tissues thickness gain with the use of the porcine collagen matrix was significantly lower than with the use of the autologous subepithelial connective tissue graft. The SCTG still remains the gold standard for such procedures.

Changes in Peri-implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft: A Case Series of 15 Consecutive Patients.

Immediate implant placement and provisional restoration has become a popular and well-supported method of tooth replacement in the maxillary anterior dentition. Aside from achieving osseointegration, esthetic demands have grown with better understanding of the behavior of hard and soft tissues following this mode to therapy. Stability of gingival contours, texture of the surrounding tissues, and blending of prosthetic components with the natural dentition are critical for successful outcomes to be maintained long-term. Increasing soft tissue thickness at the time of therapy plays an important role in this regard. A technique combining the proven principles of immediate implant placement and provisional restoration with hard and soft tissue augmentation using nonautogenous materials is demonstrated with comparisons to nongrafted, temporized historical controls.

Flapless Postextraction Socket Implant Placement, Part 3: The Effects of Bone Grafting and Provisional Restoration on Soft Tissue Color Change-A Retrospective Pilot Study.

This article presents the results of a soft tissue color study on flapless immediate implant therapy from a sample of 23 patients who received either a provisional restoration alone or with bone grafting. The gingival color in clinical photographs was measured for the implant and for the contralateral tooth site at 2.0 and 5.0 mm below the free gingival margin using Photoshop software (Lightroom CC, Adobe). The average color difference (ΔE) values for the two groups were 2.6 and 2.4 at 2.0 mm and 1.9 and 2.5 at 5.0 mm from the free gingival margin, respectively. Approximately 80% of the sites were below the visibly perceptible threshold (ΔE = 3.1 ± 1.5) and not detectable by the human eye. The use of provisional restorations has shown positive outcomes on the stability of peri-implant soft tissue thickness and lower ΔE values. Further research is required to assess esthetic outcomes inclusive of color change relative to the clinical treatment rendered.

Flapless Postextraction Socket Implant Placement: The Effects of a Platform Switch-Designed Implant on Peri-implant Soft Tissue Thickness-A Prospective Study.

This paper presents the results of a prospective study on the clinical effect of grafting the buccal gap with platform switching, following flapless tooth extraction and immediate implant placement and provisional restoration, on (1) alterations in buccolingual ridge dimension and (2) midfacial peri-implant soft tissue thickness. Fifty-six patients were placed in one of four treatment groups: (1) a non-platform-switching implant (Non-PS, n = 14); (2) a non-platform-switching implant and bone graft (BG/Non-PS, n = 14); (3) a platform-switching implant (PS, n = 15); and (4) a platform-switching implant and bone graft (BG/PS, n = 13). Buccolingual ridge dimensional change and peri-implant soft tissue thickness at 2 mm below the free gingival margin were measured. Both PS and BG/PS groups showed an increase in buccolingual dimension compared to the contralateral natural tooth site as well as peri-implant soft tissue thickness of > 2.5 mm, clinically. Platform switching was associated with significantly greater midfacial soft tissue thickness than bone grafting (mean ± standard deviation: 2.17 ± 0.04 for Non-PS and 3.55 ± 0.14 for PS). Using platform-switched implants, in conjunction with immediate implant placement and immediate provisional restoration, was associated with a significantly greater stability of ridge dimension and peri-implant soft tissue thickness than using non-platform-switched implants when measured 12 months after placement of the final restoration. Platform switching may help achieve preservation of ridge dimension and enhance the stability of peri-implant soft tissue following immediate implant placement and provisional restoration without bone grafting. Further research is required to assess the long-term outcome.

Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial.

Peri-implant soft tissue may be critical to prevent inflammation and promote gingival margin stability. The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus connective tissue graft (CTG) to increase buccal soft tissue thickness at implant site. Soft tissue augmentation with XCM (test) or CTG (control) was performed at 60 implants in 60 patients at the time of implant uncovering. Measurements were performed by a blinded examiner at baseline, 3 and 6months. Outcome measures included buccal soft tissue thickness (GT), apico-coronal keratinized tissue (KT), chair time and post-operative discomfort. Visual Analogue Scale (VAS) was used to evaluate patient satisfaction. After 6months, the final GT increase was 0.9±0.2 in the XCM group and 1.2±0.3mm in the CTG group, with a significant difference favouring the control group (0.3mm; p=.0001). Both procedures resulted in similar final KT amount with no significant difference between treatments. XCM was associated with significant less chair-time (p<.0001), less post-operative pain (p<.0001), painkillers intake (p<.0001) and higher final satisfaction than CTG (p=.0195). CTG was more effective than XCM to increase buccal peri-implant soft tissue thickness.