Soft tissue augmentation of ridge defects in the maxillary anterior area using two different methods: a randomized controlled clinical trial

Abstract

OBJECTIVES: To test whether or not vascularized interpositional periosteal-connective tissue grafts are as successful as free subepithelial connective tissue grafts in augmenting volume defects in the anterior maxilla. MATERIAL AND METHODS: Twenty subjects with Seibert class 1 ridge defects in the anterior maxilla were randomly, equally assigned to augmentation by vascularized interpositional periosteal-connective tissue graft (test) or free subepithelial connective tissue graft (control). Clinical periodontal parameters at teeth adjacent to the gap were recorded, and conventional impressions were taken prior to surgery (baseline = t0 ) and 1 (t1 ), 3 (t3 ) and 6 (t6 ) months after surgery. The casts were optically scanned, digitized and analyzed for ridge contour changes in the augmented area. Data were subjected to nonparametric statistics. RESULTS: The contour changes in labial distance between baseline and follow-up for the control group were (median, range) 1 mm, 0.37-1.45 (t0 -t1 ); 1.18 mm, 0.39-1.40 (t0 -t3 ); and 0.63 mm, 0.28-1.22 (t0 -t6 ) and for test group 1.21 mm, 0.74-2.47 (t0 -t1 ); 1.26 mm, 0.50-1.71 (t0 -t3 ); and 1.18 mm, 0.16-1.75 (t0 -t6 ). Significantly less shrinkage of the graft was observed in the test group after 6 months (P = 0.03). Clinical periodontal parameters at the neighboring teeth were stable over the follow-up period and did not differ between groups. CONCLUSIONS: Augmentation of single tooth gaps with moderate ridge defects in the anterior maxilla was successfully performed using both techniques. However, after 6 months, sites treated by the pediculated graft were superior in maintaining the initially augmented volume and showed less shrinkage of the graft. This could be attributed to better perfusion of the pediculated graft. Abstract:Objectives: To test whether or not vascularized interpositional periosteal-connective tissue grafts are as successful as free subepithelial connective tissue grafts in augmenting volume defects in the anterior maxilla.Material and Methods: 20 subjects with Seibert class 1 ridge defects in the anterior maxilla were randomly, equally assigned to augmentation by vascularized interpositional periostealconnective tissue graft (test) or free subepithelial connective tissue graft (control). Clinical periodontal parameters at teeth adjacent to the gap were recorded and conventional impressions were taken prior to surgery (baseline=t0) and 1 (t1), 3 (t3) and 6 (t6) months after surgery. The casts were optically scanned, digitized and analyzed for ridge contour changes in the augmented area. Data were subjected to non-parametric statistics.Results: The contour changes in labial distance between baseline and follow-up for the control group were (median; range) 1mm; 0.37-1.45 (t0-t1), 1.18mm; 0.39-1.40 (t0-t3) and 0.63mm; 0.28-1.22 (t0-t6) and for test group 1.21mm; 0.74-2.47 (t0-t1), 1.26mm; 0.50-1.71 (t0-t3) and 1.18mm; 0.16-1.75 (t0-t6). Significantly less shrinkage of the graft was observed in the test group after 6 months (p=0.03). Clinical...

Soft tissue volume alterations after connective tissue grafting at teeth: the subepithelial autologous connective tissue graft versus a porcine collagen matrix – a pre‐clinical volumetric analysis

“…, Akcali et al. ). In this study, attached peridental soft tissues were augmented to simulate a mucosal soft tissue volume augmentation procedure.…”

“…Akcali et al. reported of a soft tissue thickness increase after grafting with a free SCTG of edentulous ridges of (median, range) 1 mm, 0.37–1.45 measured directly after soft tissue augmentation and 0.63 mm, 0.28–1.22 after 6 months of healing. The vascularized inter‐positional periosteal‐connective tissue graft showed significant higher thickness increases than the free SCTG (1.21 mm, 0.74–2.47 (after augmentation); 1.18 mm, 0.16–1.75 (after 6 month)).…”

“…, Akcali et al. ). Subepithelial connective tissue grafts (SCTG) are currently the gold standard of care for soft tissue volume augmentation procedures (Sanz & Simion , Thoma et al.…”

“…, Akcali et al. ). The usage of collagen matrices as alternative cannot be recommended at this time point due to the lacking evidence about the volume loss that occurs during integration and degradation and the uncertainty of the volumetric long‐term stability of augmented soft tissues (Thoma et al.…”

Strategies for alveolar ridge reconstruction and preservation for implant therapy

“…There are two methods for collecting connective tissue, namely, those for vascularized interpositional periosteal-connective tissue and for free subepithelial connective tissue. A randomized controlled clinical trial by Akcalı et al demonstrated that both soft tissue augmentation techniques were effective in increasing the volume of defective alveolar ridge in the anterior maxilla [72]. However, after 6 months, sites treated with a pediculated graft were superior in terms of maintaining the initially augmented volume and showed less shrinkage of the graft.…”