The use of connective tissue graft in immediate implant placement at the esthetic areas

: 6 months results from a prospective cross section clinical trial

Abstract

Introduction: It has become evident in recent decades that, after tooth extraction, dimensional changes occur in the local volume of the maxilla that are inevitably produced due to the reduction of hard and soft tissues, regardless of the dental structure, that compromises the aesthetic result. When the thickness of the peri-implant hard and soft tissues is reduced by tooth ex-traction, an attempt can be made to maintain the volume of the site by compensating for the loss of material by thickening the soft tissue with the help of connective grafts. This study aims to evaluate and quantify the dimensional and volumetric alterations of peri-implant tissues in patients treated with immediate implants and customized healing abutments, with the use of connective tissue grafts at the early healing stage, in the anterior maxillary sector. Materials and methods:
The type of research that was carried out is a convenience sample that forms part of a prospective randomized clinical trial, in which it was necessary to select 32 patients with the need for extraction of teeth in the anterior maxillary area and their subsequent rehabilitation, attended in a private clinic by a Specialist in Oral Surgery. The selection of patients was divided into two groups, one in which the treatment included the use of a connective tissue graft after implant placement and the other in which it did not. Clinical observations and data collection were performed in both groups before, after surgery and at subsequent time points after surgery and included the assessment of the buccal bone plate thickness (BT) and the distance between the implant and the buccal bone plate (BID). Digital impressions were taken before extraction at T0, at 1-month (T1) and at six-months (T2) after implant insertion. The digital models were superimposed with the aid of a computer software to measure the dimensional alterations between the two groups and linear buccal changes (MBC) and volumetric variables like the Buccal Volume variation (BVv). Results:
A total of 32 patients with a mean age of 47.69±10.822 years were included in the study. It was observed that for the parameters MBC (mm), MBPC (mm), BVv (mm3), BVv (%), TVv (mm3) and TVv (%), the results did not show statistically significant differences in the variations between the studied groups. However, when the characterization of the relative variation of BV was analyzed, it was concluded that in all studied variables, the interaction between the group (control/test) and the BT measurement (≤ 1 mm / > 1 mm) was significant in patients with BT less than 1 mm. Conclusion: This clinical study demonstrates that the use of connective tissue grafts in immediate implants with customized healing abutments is favorable in the prevention of alveolar tissue alterations, more specifically in patients with a thin buccal bone plate morphotype.

Date of Award	19 Jul 2022
Original language	English
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Tiago Borges (Supervisor)