Within the limitations of superimposed CBCT images, GBR and CTG are effective to re-establish convexity at the buccal aspect of single implants in the short term.

Aim: To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of changes over time in buccal soft tissue profile (BSP) when applied at single implant sites.Materials and methods: Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi-centre randomized controlled trial.All sites had a bucco-palatal bone dimension of at least 6 mm and received a single implant and immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX: Geistlich Fibro-Gide ® , Geistlich Pharma AG, Wolhusen, Switzerland) to increase buccal soft tissue thickness.Primary outcome was increase in BSP at T1 (immediately after operation) and T2(3 months) based on superimposed digital surface models. Secondary parameters included patient-reported clinical and aesthetic outcomes.Results: Thirty patients were included per group (control: 50% females, mean age 50; test: 53% females, mean age 48). Even though surgeons applied thicker grafts when using CMX, sites treated with CMX demonstrated 0.78 mm (95% CI 0.41-1.14) more shrinkage between T1 and T2 than sites treated with CTG. The final increase in BSP was 1.15 mm (95% CI 0.88-1.43) for CTG and 0.85 mm (95% CI 0.58-1.13) for CMX. The mean difference of 0.30 mm (95% CI À0.01 to 0.61) at T2 in favour of CTG was of borderline significance (p = .054). There were no significant differences between the groups in terms of post-operative bleeding (p = .344), pain (p = .331), number of analgesics taken (p = .504), oedema (p = .227), and pink aesthetic score (p = .655). VAS for post-operative haematoma was 6.56 (95% CI 0.54-12.59) lower for CMX, and surgery time could be reduced by 9.03 min (95% CI 7.04-11.03) when applying CMX. However, CMX resulted in significantly more marginal bone loss (0.38 mm; 95% CI 0.15-0.60), deeper pockets (0.30 mm; 95% CI 0.06-0.54), and more mid-facial recession (0.75 mm; 95% CI 0.39-1.12) than CTG.Clinical trial registration: This study was registered in ClinicalTrials.gov (NCT04210596).

Background: Xenogeneic soft tissue substitutes are currently being investigated as an alternative to subepithelial connective tissue grafts (CTG) with the intention to avoid postoperative morbidity associated with autologous grafting. The aim of the present study was to volumetrically evaluate the effectiveness and mid-long-term stability of a porcine-derived collagen matrix (PDCM) (Mucoderm®, Botiss gmbh, Berlin, Germany) in increasing soft tissue volume at the buccal aspect of molar implant sites. Methods: Periodontally healthy non-smoking patients with a single tooth gap in the molar area were selected for a prospective case series. All sites had a bucco-oral bone dimension of at least 8 mm and demonstrated a horizontal alveolar defect. A wide diameter implant was placed under the elevated buccal flap and a PDCM was applied. The primary outcome was the linear increase in buccal soft tissue profile (BSP) within a well-defined area of interest. This was performed with designated software (SMOP; Swissmeda AG, Zurich, Switzerland) on the basis of superimposed digitalized study casts taken before surgery (T0), immediately after surgery (T1), at three months (T2), one year (T3) and three years (T4). Secondary outcomes were alveolar process deficiency and clinical parameters. Results: Fourteen out of 15 treated patients attended the three-year re-assessment (four females; mean age 51.4 years). Mean linear increase in BSP at T1 was 1.53 mm (p = 0.001). The PDCM showed substantial resorption at T2 (1.02 mm or 66.7%) (p = 0.001). Thereafter, a 0.66 mm volume gain was observed (p = 0.030), possibly due to the installation of a permanent crown displacing the soft tissues to the buccal aspect. This resulted in a linear increase in BSP of 1.17 mm (76.5%) at T4. Alveolar process deficiency significantly reduced over time (p = 0.004). However, 50% of patients still demonstrated a slight (6/14) or obvious (1/14) alveolar process deficiency at study termination. Implants demonstrated healthy clinical conditions. Conclusions: The PDCM demonstrated marked resorption during the early stages of healing. Due to the matrix thickening the tissues, and the permanent crown displacing the tissues, 76.5% of the initial increase in BSP could be maintained over a three-year period. Half of the patients failed to show perfect soft tissue convexity at the buccal aspect.

Objectives: To assess the effect of grafting the gap (SG) between the implant surface and alveolar socket on hard and soft tissue changes following single immediate implant placement (IIP).Materials and Methods: Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to August 2021. Randomized controlled trials (RCTs) comparing IIP with and without SG were included for a qualitative analysis. Meta-analyses were performed when possible.Results: Out of 3627 records, 15 RCTs were selected and reported on 577 patients who received 604 single immediate implants (IIP + SG: 298 implants in 292 patients; IIP: 306 implants in 285 patients) with a mean follow-up ranging from 4 to 36 months. Two RCTs showed low risk of bias. Meta-analysis revealed 0.59 mm (95% CI [0.41; 0.78], p < 0.001) or 54% less horizontal buccal bone resorption following IIP + SG when compared to IIP alone. In addition, 0.58 mm (95% CI [0.28; 0.88], p < 0.001) less apical migration of the midfacial soft tissue level was found when immediate implants were installed with SG. A trend towards less distal papillary recession was found (MD 0.60 mm, 95% CI [À0.08; 1.28], p = 0.080) when SG was performed, while mesial papillae appeared not significantly affected by SG. Vertical buccal bone changes were also not significantly affected by SG. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes, pink esthetic score, marginal bone level changes, probing depth and bleeding on probing.Based on GRADE guidelines, a moderate recommendation for SG following IIP can be made.Conclusion: SG may contribute to horizontal bone preservation and soft tissue stability at the midfacial aspect of immediate implants. Therefore, SG should be considered as an adjunct to IIP in clinical practice.

Aim: To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of increase in buccal soft tissue profile (BSP) at 1 year when applied at single implant sites.Materials and Methods: Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi-centre randomized controlled trial.All sites had a bucco-palatal bone dimension of at least 6 mm, received a single implant and an immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX) to increase buccal soft tissue thickness. The primary outcome was the increase in BSP at 1 year when compared with the pre-operative situation based on superimposed digital surface models.The changes in BSP over time were registered at a buccal area of interest reaching from 0.5 mm below the soft tissue margin to 4 mm more apical. Secondary outcomes included patient-reported, clinical and aesthetic outcomes.Results: Thirty patients were included per group (control: 50% females, mean age 50.1; test: 53% females, mean age 48.2). The increase in BSP at 1 year was 0.98 mm (98.3% confidence interval [CI]: 0.75-1.20) for CTG and 0.57 mm (98.3% CI: 0.34 to 0.79) for CMX. The mean difference of 0.41 mm (98.3% CI: 0.12 to 0.69) in favour of CTG was significant (p < .001). Based on an arbitrarily chosen threshold for success of 0.75 mm increase in BSP, 89.7% of the patients in the control group and 10% of the patients in the test group were successfully treated (odds ratio = 77.90; 95% CI: 13.52 to 448.80; p < .001). Sites treated with CMX demonstrated 0.89 mm (98.3% CI: 0.49 to 1.30) more shrinkage between postop and 1 year than sites treated with CTG. In addition, CMX resulted in significantly more marginal bone loss (0.39 mm; 95% CI: 0.05 to 0.74; p = .026) than CTG. There were no significant differences between the groups in terms of patients' aesthetic satisfaction (p = .938), probing depth (p = .917), plaque (p = .354), bleeding on probing (p = .783), midfacial recession (p = .915), Pink Esthetic Score (p = .121) and Mucosal Scarring Index (p = .965).Conclusions: CTG remains the gold standard to increase soft tissue thickness at implant sites. Clinicians need to outweigh the benefits of CMX against considerable resorption of the graft. This study was registered in ClinicalTrials.gov (NCT04210596).