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

Abstract

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.

The effect of soft tissue augmentation on the clinical and radiographical outcomes following immediate implant placement and provisionalization: a systematic review and meta-analysis

“…Autogenous bone [ 46 ], a combination of autogenous bone mixed with bone xenograft [ 43 ], bone xenograft alone [ 41 , 42 , 47 ] bone xenograft with collagen membrane [ 44 ], or a mixture of allograft and xenograft [ 45 ] were used to fill the buccal gap. The implants were placed 4 mm apical to the facial gingival margin in one study [ 44 ], 3 mm apical in three studies [ 41 , 43 , 47 ],, and were placed 2 mm apical in another study [ 45 ].…”

“…The provisional restorations were designed to be screw-retained in three studies [ 43 , 44 , 47 ] while one study used a cement-retained design [ 41 ] and two utilized both [ 44 , 46 ] according to the implant position. One study provided no information on the design of the provisional restoration [ 45 ].…”

“…One study provided no information on the design of the provisional restoration [ 45 ]. The provisional restoration was maintained for 6 months in two studies [ 41 , 44 ] and for 3 months in four studies [ 42 , 43 , 46 , 47 ].…”

“…A variety of methods were used to measure the soft tissue outcomes, including standardized photographs [ 43 , 44 ], direct clinical measurements on the patient [ 45 , 46 ] standardized measurements of the dental casts [ 41 ], and standardized photographs of the dental casts [ 42 ]. Only one study [ 43 ] reported a case of implant loss in both the test and control groups, while all other studies included in the meta-analysis reported a survival rate of 100%.…”

“…Zuiderveld et al reported that they adopted the sealed, opaque envelope method of randomizing patients, but no information was added on how the randomization lists were managed, and if those lists were hidden from the operators in charge of enrollment [ 43 ]. Therefore, we believe it to be at medium risk of bias.…”