Facial implant gingival level and thickness changes following maxillary anterior immediate tooth replacement with scarf‐connective tissue graft: A 4–13‐year retrospective study

Abstract

Objective A scarf‐shaped connective tissue graft can be placed at the facial and proximal aspect of the peri‐implant soft tissue zone during immediate implant placement and provisionalization (IIPP) procedures in the esthetic zone to optimize implant esthetics without the need of flap reflection. This retrospective study evaluated soft tissue stability after scarf‐connective tissue graft (S‐CTG) in conjunction with IIPP procedures in the esthetic zone. Materials and Methods Patients who received IIPP with S‐CTG with a minimum 1‐year follow‐up were evaluated. Mid‐facial gingival level (MFGL) change and mid‐facial gingival thickness (MFGT) change were measured and compared at the pre‐op (T0), IIPP + S‐CTG surgery (T1), follow up appointment with MFGT measurement (T2), and latest follow‐up appointment (T3). Implant success rate and graft necrosis were also recorded. Results A total of 22 IIPP and S‐CTG procedures in 20 patients were evaluated in the study. After a mean follow‐up of 8.2 years (3.9–13.4) (T3), all implants remained osseointegrated (22/22 [100%]), with statistically insignificant mean midfacial gingival level change of −0.19 mm (−1.5 to 0.8). Statistically significant difference in midfacial gingival thickness (MFGT) was noted (2.5 mm [1.8–3.5 mm]) after a mean follow‐up time (T2) of 2.3 years (1–8.6) when compared with MFGT at baseline (1.1 mm [0.6–1.3 mm]) (T1). Necrosis of S‐CTG during initial healing phase was noted in 9% (2/22) of the sites. Conclusions Within the confines of this study, scarf‐connective tissue graft at time of immediate implant placement and provisionalization can thicken the gingiva and maintain the gingival level at the critical soft tissue zone. Clinical Significance Managing the soft tissue zone is as important as that of the hard tissue zone for peri‐implant esthetics. Connective tissue graft is one of the methods that can enhance the final esthetic outcomes. This retrospective study has demonstrated that Scarf‐CTG technique is an effective treatment modality to maintain soft tissue stability.

Orthodontic tooth extrusion to regenerate missing papilla adjacent to maxillary anterior single implants: A 2‐ to 7‐year retrospective study

“…This prolonged retention time allowed for the maturation of the newly developed gingiva and especially the repositioned bone which may have minimized the orthodontically erupted tooth from relapsing. 30 The results of this study seemed to confirm this notion, as there was little to no orthodontic relapse (0.01 ± 0.17 mm) between T 1 and T 2 (34.1 months) . Furthermore, the minimal mean proximal bone level change (À0.07 ± 0.16 mm) between T 1 and T 2 also demonstrated mid-term stability of the proximal bone regeneration with orthodontic eruption.…”

“…In this study, the mean combined orthodontic eruption and retention time (14.3 months) is longer than the recommended 2 to 6 months. This prolonged retention time allowed for the maturation of the newly developed gingiva and especially the repositioned bone which may have minimized the orthodontically erupted tooth from relapsing 30 . The results of this study seemed to confirm this notion, as there was little to no orthodontic relapse (0.01 ± 0.17 mm) between T 1 and T 2 (34.1 months) .…”

“…A periodontal probe was placed at the mid-facial aspect of the sulcus epithelium, and the gingival phenotype was categorized as thin if the outline of the underlying probe could be seen through the gingiva, or as thick if the probe could not be seen through. 4,40,41…”

“…In 1993, the concept of implant site development using orthodontic forced eruption on periodontally compromised teeth for bone regeneration was first advocated 22 . Later, the term “orthodontic extraction” was introduced whereby teeth were extruded to the point of extraction, 23 followed by numerous papers validating the effectiveness of orthodontic extrusion to increase both hard and soft tissue volume 24–32 . In 2014, a diagnostic periodontal classification was proposed by evaluating the pre‐treatment anatomy indicating the hard and soft tissue response to orthodontic extrusion 33 .…”

“…22 Later, the term "orthodontic extraction" was introduced whereby teeth were extruded to the point of extraction, 23 followed by numerous papers validating the effectiveness of orthodontic extrusion to increase both hard and soft tissue volume. [24][25][26][27][28][29][30][31][32] In 2014, a diagnostic periodontal classification was proposed by evaluating the pretreatment anatomy indicating the hard and soft tissue response to orthodontic extrusion. 33 Recently, different techniques have been described to maneuver around complications resulting from the improper use of orthodontic mechanics.…”