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Influence of timing on horizontal stability of connective tissue grafts at single implants- a pilot study
EAO Online Library. Maridati P. Oct 9, 2018; 232730
Paolo Carlo Maridati
Paolo Carlo Maridati
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Abstract
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The lack of buccal convexity has been identified as one of the most frequent soft tissue complication following single implant treatment. Therefore, soft tissue augmentation procedures have been recommended to enhance the quality and quantity of buccal soft tissues, including connective tissue graft (CTG). Conversely, the correct timing protocol for peri-implant plastic surgery is still debated.To compare immediate versus delayed soft tissue augmentation at the buccal aspect of single implants by means of CTG in terms of mucosal thickness (MT) and horizontal stability over a 12-month follow-up period.Periodontally healthy non-smoking patients with a single implant in the posterior maxilla presenting < 2 mm of keratinized mucosa at the buccal aspect were enrolled. Patients were randomly divided into two groups according to the timing of soft tissue augmentation procedure- simultaneous implant placement and CTG (Group A), or implant placement and CTG after 4 months (Group B). In both groups, a split-thickness flap was elevated and the CTG was stabilized to the underlying periosteum with 6-0 resorbable sutures. The flap was then sutured tightly adapted to the healing abutment in a coronal position to cover the CTG without tension. A resin stent was fabricated with a reference slot drilled at the mid-buccal area of the implant site to allow reproducible measurements. Endodontic files and related silicone stoppers were used to register the mucosal thickness before and after implant placement, and at 1, 2, 3, 4, 6, 9, and 12 months post-implantation. Data were submitted to Shapiro-Wilk normality test (P > 0.05). Independent samples t-test was used to compare the MT between Group A and B at each time-point. Changes over time in MT were evaluated using one-way ANOVA. Overall, the MT was evaluated at the buccal aspect of 14 implants placed in 14 patients, 6 in Group A and 8 in Group B. All implants were inserted with an insertion torque value >= 35 Ncm. During the entire study period, the mean MT was higher in Group A as compared to Group B. At each time point, this difference was not statistically significant (P > 0.05). The intra-group comparison of MT at different time-points yielded non-statistically significant differences in both groups (P = 0.96 and P = 0.99 for Group A and Group B respectively).Within the limitations of the present pilot study, it might be concluded the MT at the buccal aspect of single implants is not influenced by the timing of soft tissue augmentation procedures and remains stable over a 1-year period. These results suggest the possibility to reduce the number of surgeries and thus the overall treatment time and the patient morbidity by augmenting the soft tissues simultaneously with implant insertion in case of implants with an adequate primary stability.
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