A 3-Year Prospective Study on a Porcine-Derived Acellular Collagen Matrix to Re-Establish Convexity at the Buccal Aspect of Single Implants in the Molar Area: A Volumetric Analysis

Célien Eeckhout, Eline Bouckaert, Dagmar Verleyen, Thomas De Bruyckere, Jan Cosyn, Célien Eeckhout, Eline Bouckaert, Dagmar Verleyen, Thomas De Bruyckere, Jan Cosyn

Abstract

Background: Xenogeneic soft tissue substitutes are currently being investigated as an alternative to subepithelial connective tissue grafts (CTG) with the intention to avoid postoperative morbidity associated with autologous grafting. The aim of the present study was to volumetrically evaluate the effectiveness and mid-long-term stability of a porcine-derived collagen matrix (PDCM) (Mucoderm®, Botiss gmbh, Berlin, Germany) in increasing soft tissue volume at the buccal aspect of molar implant sites.

Methods: Periodontally healthy non-smoking patients with a single tooth gap in the molar area were selected for a prospective case series. All sites had a bucco-oral bone dimension of at least 8 mm and demonstrated a horizontal alveolar defect. A wide diameter implant was placed under the elevated buccal flap and a PDCM was applied. The primary outcome was the linear increase in buccal soft tissue profile (BSP) within a well-defined area of interest. This was performed with designated software (SMOP; Swissmeda AG, Zurich, Switzerland) on the basis of superimposed digitalized study casts taken before surgery (T0), immediately after surgery (T1), at three months (T2), one year (T3) and three years (T4). Secondary outcomes were alveolar process deficiency and clinical parameters.

Results: Fourteen out of 15 treated patients attended the three-year re-assessment (four females; mean age 51.4 years). Mean linear increase in BSP at T1 was 1.53 mm (p = 0.001). The PDCM showed substantial resorption at T2 (1.02 mm or 66.7%) (p = 0.001). Thereafter, a 0.66 mm volume gain was observed (p = 0.030), possibly due to the installation of a permanent crown displacing the soft tissues to the buccal aspect. This resulted in a linear increase in BSP of 1.17 mm (76.5%) at T4. Alveolar process deficiency significantly reduced over time (p = 0.004). However, 50% of patients still demonstrated a slight (6/14) or obvious (1/14) alveolar process deficiency at study termination. Implants demonstrated healthy clinical conditions.

Conclusions: The PDCM demonstrated marked resorption during the early stages of healing. Due to the matrix thickening the tissues, and the permanent crown displacing the tissues, 76.5% of the initial increase in BSP could be maintained over a three-year period. Half of the patients failed to show perfect soft tissue convexity at the buccal aspect.

Keywords: collagen matrix; dental implant; single tooth; soft tissue augmentation; soft tissue substitute.

Conflict of interest statement

The authors declare no conflict of interest. Cosyn has collaboration agreements with Nobel Biocare (Kloten, Switzerland) and Straumann (Basel, Switzerland).

Figures

Figure 1
Figure 1
(A) Intra-operative view: the porcine-derived collagen matrix (PDCM) (Mucoderm®, Botiss gmbh, Berlin, Germany) was trimmed to the desired shape and size and then positioned under the elevated buccal flap. (B) In case of advanced horizontal defects, the PDCM was folded in half and secured with resorbable sutures.
Figure 2
Figure 2
The digital surface model at T0 (yellow) and the digital surface model at T4 (blue) were superimposed. The area of interest (black box), located at the buccal aspect of the grafted area, was determined on the T4 model with the definitive crown in situ.
Figure 3
Figure 3
(A) Occlusal view of the digital surface model at T0 showing a Seibert Class I defect; (B) T0 digital surface model with volumetric changes in the area of interest between T0 and T4; (C) Cross- section through the superimposed digital surface models in the center of the grafted area at the different time points.
Figure 4
Figure 4
Line chart with the mean linear increase in buccal soft tissue profile (BSP) and 95% confidence interval (CI) at the different time points.
Figure 5
Figure 5
Bar chart on alveolar process deficiency at T0 (pre-op, n = 15), T1 (immediately post-op, n = 15), T2 (3 months, n = 14), T3 (1 year, n = 11) and T4 (3 years, n = 14).
Figure 6
Figure 6
Clinical cases at T4 demonstrating (A) no alveolar process deficiency; (B) slight alveolar process deficiency; (C) obvious alveolar process deficiency.
Figure 7
Figure 7
Radiographic follow-up of a NobelActive® Wide Platform implant: (A) following implant placement; (B) after 3 months; (C) after 1 year; (D) after 3 years.

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