Impact of Soft Tissue Grafts on Tissue Alterations After Immediate Tooth Replacement
Condition: Tooth Socket; Dental Implants
Study type: Interventional
Phase: Phase 4

Summary: 
      This study evaluates the impact of soft tissue grafts on soft tissue recession following
      immediate implant, provisional and bone graft placement in compromised sockets. One third of
      the patients received a collagen matrix (CM group), another third received a connective
      tissue graft removed from the palate (CTG group) and the final third did not receive any soft
      tissue graft (CTL group).
    

Detailed description: 
      Preventing soft tissue recession following flapless immediate implant and provisional
      placement (IIPP) in sockets with facial bone dehiscences is a challenge, mainly in esthetic
      areas. This study evaluated the impact of soft tissue grafts on peri-implant alterations
      after 1-year follow-up. Twenty-four patients with one single failing maxillary incisor
      presenting facial bone dehiscence and receiving IIPP were randomly divided in three groups
      (n= 8 in each group): Control (CTL); Collagen Matrix (CM); Connective tissue graft (CTG). In
      addition to soft tissue grafts, all groups were treated with collagen membrane and
      deproteinized bovine bone mineral containing 10% of porcine collagen. Clinical, photographic
      and tomographic analyses were performed at baseline, 6 and 12 months after surgery to
      evaluate tissue alterations.
    

Intervention name(s): Connective tissue graft; Collagen matrix graft; Immediate implant; Tooth extraction; Immediate restoration; Bone regeneration; Post operative medication; Definitive prosthesis; No soft tissue graft
Intervention type(s): Biological; Biological; Device; Procedure; Device; Biological; Drug; Device; Other
Intervention description(s): A 1.5 mm thick soft tissue graft removed from the palate with determined dimensions. The recipient site was prepared by performing laterally a delicate elevation of the facial tissue avoiding the mesial and distal papilla. The soft tissue graft length was equal to the horizontal distance between the two papillas and its length was set at 6 mm. Soft tissue grafts were placed at the level of the gingival margin and stabilized with simple interrupted sutures.; A 15x20 mm collagen matrix trimmed according to determined dimensions. The recipient site was prepared by performing laterally a delicate elevation of the facial tissue avoiding the mesial and distal papilla. The soft tissue graft length was equal to the horizontal distance between the two papillas and its length was set at 6 mm. Soft tissue grafts were placed at the level of the gingival margin and stabilized with simple interrupted sutures.; A conical implant with a morse-taper connection with moderate roughness implant surface was properly installed in the ideal tridimensional position with its platform placed 4 mm below the facial gingival margin. After tooth extraction and dental implant installation with a torque > 32 Ncm patients were randomized into three groups (8 patients per group): 1- No soft tissue graft, Control group (CTL); 2- Collagen Matrix group (CM); 3- Connective tissue graft group (CTG).; Compromised tooth was gently removed and the socket was debrided thoroughly, cleansed and inspected. The socket's palatal and apical bone was sequentially drilled. All surgeries were performed by the same surgeon and were individually planned according to the clinical and tomographic evaluation. Implant diameter was set as 3.5 mm and its length was selected according to the quantity of bone available apically to the fresh alveolar socket.; A titanium abutment was installed in the dental implant with manual torque and a prefabricated tooth shell was relined with resin material to fabricate cement or screw retained interim restoration. All interim restorations were installed in infra-occlusion matching the adjacent teeth color and form, with light proximal contacts and presented a subgingival concave contour.; All sites received a non-cross linked collagen membrane and deproteinized bovine bone mineral containing 10% of porcine collagen.; Postoperative instructions were given, antibiotics were prescribed for 7 days (amoxicillin 500 mg t.i.d), analgesics to relieve from pain (Paracetamol 750 mg) and chlorhexidine 0.12% rinse twice a day for 15 days. Complementary, the patients were instructed to avoid chewing in the anterior region and to follow a soft diet.; Definitive implant-supported restorations were performed 6 months after dental implant placement.; No soft tissue graft was used
Other intervention name(s): autogenous subepithelial connective tissue graft; heterogenous graft; Bio-Oss Collagen®; Bio-Gide®; Amoxicillin; Paracetamol; Chlorhexidine; Zirconia abutment and ceramic crown installation
Intervention MeSH terms: Amoxicillin; Chlorhexidine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: gingival recession; immediate implant and provisional placement; bone graft; connective tissue graft; collagen matrix