Soft Tissue Augmentation Around Immediate Implants In The Esthetic Zone

Study Overview
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Brief Summary
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Following tooth loss, a considerable reduction in hard- and soft-tissue volume can be expected (Tan WL, et al., 2012), (AraujoMG, et al., 2015). In the anterior maxilla, tissue loss can make future implant restorations more challenging and less predictable in terms of achieving and maintaining favorable soft-tissue-emergence profiles. Even with careful implant planning and placement, marginal gingival recession of 0.5-1 mm has been a common finding with single-tooth implants (Nisapakultorn K, et al., 2010), (Suphanantachat S, et al., 2012). This is partly attributed to bone remodeling after implant surgery, and occurs regardless of implant-placement protocol used (Hof M, et al., 2015).

Detailed Description
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The dome technique addresses the placement of the CT, as it is layered over the implant and takes the shape of an inverted dome. The advantage of the dome CT technique is that it allows for both buccal and coronal augmentation of local soft tissue, while maximizing blood supply to the area by using tunneling-technique principles. It enhances and augments the peri-implant tissue foundation for a favorable facial and interproximal restorative emergence profile. As this technique does not involve raising an independent buccal flap, the gingival tissue of the adjacent teeth is not compromised, and thus the risk of recession and formation of black triangles on the adjacent teeth is minimized.

Official Title
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Soft Tissue Augmentation Using The Dome Technique Around Immediate Implants In The Esthetic Zone. A Case Series

Conditions
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Recession, Gingival

Intervention / Treatment
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* Procedure: connective tissue grafting by Dome Technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with healthy systemic condition Patients aged from 20 to 45 years old Availability of bone apical and palatal to the socket to provide primary stability. Presence of adequate gingival architecture with the surrounding dentition Patient provides an informed consent Adequate Inter-arch space for implant placement Favorable occlusion (no traumatic occlusion) Good oral hygiene Accepts 6-month follow-up period Exclusion Criteria: Patients with signs of acute infection related to the area of interest Patients with habits that may jeopardize the implant longevity and affect the results of the study such as para-functional habits Current and former smokers Pregnant females HIV or Hepatitis; 5/Physical handicaps that would interfere with the ability to perform adequate oral hygiene Alcoholism or chronic drug abuse; 7/ Heavy smokers >10/cigarettes per day

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: single arm groups
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: single am<br>single arm , superiority trial , tunneling technique in connective tissue graft around dental implants | Procedure: connective tissue grafting by Dome Technique<br>* The dome technique addresses the placement of the CT, as it is layered over the implant and takes the shape of an inverted dome<br>* Other names: Dome technique;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pink esthetic score (PES) | The PES is based on seven variables mesial papilla, distal papilla, soft - tissue level, soft tissue contour, alveolar process deficiency, soft tissue color and texture . The PES is based on seven variables mesial papilla, distal papilla, soft - tissue level, soft tissue contour, alveolar process deficiency, soft tissue color and texture . it's numerical | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gingival Thickness | Will be measured using an anesthetic needle with a rubber stopper, trans-gingivally piercing tissues horizontally perpendicular to the long axis of the tooth implant until it contacts bone | 6 months | 
| Post - Surgical Patient Satisfaction | A 3 - item questionnaire is asked and the patients shall use a 7point answer scale | 6 months |