Effect of connective tissue grafting on buccal bone changes based on cone beam computed tomography scans in the esthetic zone of single immediate implants: A 1-year randomized controlled trial

Elise G Zuiderveld, Wouter G van Nimwegen, Henny J A Meijer, Ronald E Jung, Sven Mühlemann, Arjan Vissink, Gerry M Raghoebar, Elise G Zuiderveld, Wouter G van Nimwegen, Henny J A Meijer, Ronald E Jung, Sven Mühlemann, Arjan Vissink, Gerry M Raghoebar

Abstract

Background: Connective tissue grafting has a beneficial effect on the peri-implant mucosa, but the effect of grafting the buccal mucosa on buccal bone thickness (BBT) has not been investigated, although BBT is proposed to be a key factor for the soft-tissue contour. The aim of this trial was to assess the outcome of a connective tissue graft (CTG) in the esthetic zone of single immediate implants on the change of BBT according to cone beam computed tomography (CBCT) scan analysis.

Methods: In a 1-year randomized controlled trial, 60 patients received an immediately placed implant and provisionalization, either combined with CTG (test group) or without CTG (control group). CBCTs were taken preoperatively (Tpre ) and 1 year after definitive restoration (T2 ). Any change in BBT was assessed at different implant levels. Additionally, the change in mid-buccal mucosal level (MBML) and approximal marginal bone level were assessed.

Results: Fifty-five patients were available for statistical analysis (test group, n = 28; control group, n = 27). At T2 , the average change in BBT was significantly larger in the test group (-0.84 ± 0.61 mm) than in the control group (-0.46 ± 0.54 mm, P = 0.02). A MBML gain of 0.07 ± 0.85 mm in the test and a MBML loss -0.52 ± 1.16 mm in the control group was observed at T2 . Average loss of marginal bone was 0.05 ± 0.33 mm and 0.01 ± 0.38 mm, respectively.

Conclusions: The application of CTG in the esthetic zone of immediately placed and provisionalized implants is accompanied with more loss of BBT, but at the same time better maintains the mid-buccal mucosal level.

Keywords: cone-beam computed tomography; connective tissue; dental implants; single-tooth.

Conflict of interest statement

All authors report no conflict of interest. This study was supported by an unrestricted grant from Nobel Biocare Services AG, Gothenburg, Sweden (by means of implant materials, research grant: 2012‐1135).

© 2020 The Authors. Journal of Periodontology published by Wiley Periodicals, Inc. on behalf of American Academy of Periodontology.

Figures

FIGURE 1
FIGURE 1
The planning implant is aligned with the implant in the CBCT image using MIRIT to obtain the exact coordinates for the procedure
FIGURE 2
FIGURE 2
The planning implant is superimposed precisely over the implant in the CBCT image according to the previously obtained coordinates. Each millimeter measurement (M0‐M5) is marked along 5 mm of the axis of the implant, starting at the neck of the implant
FIGURE 3
FIGURE 3
Alignment of CBCT image DICOM files from Tpre and T1 and alignment of the planning implant according to the coordinates of the prospective position of the implant in the CBCT image taken at Tpre, with the failing tooth still in place
FIGURE 4
FIGURE 4
CONSORT flow diagram

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