Effect of connective tissue grafting on buccal bone changes based on cone beam computed tomography scans in the esthetic zone of single immediate implants: A 1-year randomized controlled trial.

BACKGROUND: Connective tissue grafting has a beneficial effect on the peri-implant mucosa, but the effect of grafting the buccal mucosa on buccal bone thickness (BBT) has not been investigated, although BBT is proposed to be a key factor for the soft-tissue contour. The aim of this trial was to assess the outcome of a connective tissue graft (CTG) in the esthetic zone of single immediate implants on the change of BBT according to cone beam computed tomography (CBCT) scan analysis. METHODS: In a 1-year randomized controlled trial, 60 patients received an immediately placed implant and provisionalization, either combined with CTG (test group) or without CTG (control group). CBCTs were taken preoperatively (Tpre ) and 1 year after definitive restoration (T2 ). Any change in BBT was assessed at different implant levels. Additionally, the change in mid-buccal mucosal level (MBML) and approximal marginal bone level were assessed. RESULTS: Fifty-five patients were available for statistical analysis (test group, n = 28; control group, n = 27). At T2 , the average change in BBT was significantly larger in the test group (-0.84 ± 0.61 mm) than in the control group (-0.46 ± 0.54 mm, P = 0.02). A MBML gain of 0.07 ± 0.85 mm in the test and a MBML loss -0.52 ± 1.16 mm in the control group was observed at T2 . Average loss of marginal bone was 0.05 ± 0.33 mm and 0.01 ± 0.38 mm, respectively. CONCLUSIONS: The application of CTG in the esthetic zone of immediately placed and provisionalized implants is accompanied with more loss of BBT, but at the same time better maintains the mid-buccal mucosal level.

Immediate placement and provisionalization of implants in the aesthetic zone with or without a connective tissue graft: A 1-year randomized controlled trial and volumetric study.

OBJECTIVE: To volumetrically compare peri-implant mid-facial soft tissue changes in immediately placed and provisionalized implants in the aesthetic zone, with or without a connective tissue graft. MATERIAL AND METHODS: Sixty patients were included. All implants were placed immediately after extraction. After randomization, in one group, a connective tissue graft (test group, n = 30) was inserted at the buccal aspect of the implant. The other group (control group, n = 30) received no connective tissue graft. Clinical parameters, digital photographs and conventional impressions were obtained before extraction (Tpre ) and at 12 months following definitive crown placement (T12 ). The casts were digitized by a laboratory scanner, and a volumetric analysis was performed between Tpre and T12 . RESULTS: Twenty-five patients in each group were available for analysis at T12 . Volumetric change, transformed to a mean (±SD) change in thickness, was -0.68 ± 0.59 mm (test) and -0.49 ± 0.54 mm (control) with a non-significant difference between groups (p = .189). The mid-facial mucosa level was significantly different between both groups (p = .014), with a mean (±SD) change of +0.20 ± 0.70 mm (test) and -0.48 ± 1.13 mm (control). The Pink Esthetic Score was similar between both groups. CONCLUSIONS: The use of a CTG in immediately placed and provisionalized implants in the aesthetic zone did not result in less mucosal volume loss after 12 months, leading to the assumption that a CTG cannot fully compensate for the underlying facial bone loss, although a significantly more coronally located mid-facial mucosa level was found when a CTG was performed.

Treatment Outcome of Two Adjacent Implant-Supported Restorations with Different Implant Platform Designs in the Esthetic Region: A Five-Year Randomized Clinical Trial.

PURPOSE: The aim of this study was to evaluate the peri-implant soft and hard tissues and satisfaction in patients with two adjacent implant-supported restorations in the esthetic region, treated with two adjacent implants with a scalloped or flat platform. MATERIALS AND METHODS: The randomized clinical trial consisted of 40 patients allocated to either a scalloped implant group consisting of 20 patients or a flat implant group of 20 patients. Clinical and radiographic examinations were performed during a 5-year followup period, and patient satisfaction during the same period was assessed. RESULTS: The scalloped implant group showed significantly more marginal bone loss (scalloped: 3.2 ± 1.1 mm; flat: 1.5 ± 0.8 mm) and significantly greater bone loss at the interimplant bone crest (scalloped: 2.4 ± 1.0 mm; flat: 1.3 ± 1.0 mm). Furthermore, peri-implant soft tissues showed significantly more bleeding when provided with scalloped implants than with flat implants. Papilla index scores were low in both groups. Patient satisfaction was high in both groups. CONCLUSION: More bone loss and compromised interimplant papilla regeneration were noted around scalloped implants in the first year, and stable results were observed in the subsequent 4 years with both systems. Scalloped implants seem to offer no benefit when compared to conventional flat implants in the esthetic region.