Clinical and volumetric analysis of peri‐implant soft tissue augmentation using an acellular dermal matrix: A prospective cohort study

Abstract

Background The role of keratinized mucosa in promoting peri‐implant health is controversial, however recent evidence support the use of soft tissue augmentation procedures around dental implants. Soft tissue substitutes have been proposed to replace autogenous connective tissue grafts, therefore the aims of this study are to report clinical and volumetric three‐dimensional changes in mucosal thickness (MT) 1 year after treatment with an acellular dermal matrix (ADM). Methods Soft tissue augmentation was performed at second‐stage surgery in the premolar maxillary area with an ADM. MT was assessed prior to implant placement and 1, 6, and 12 months after treatment. Digital linear and volumetric measurements were recorded at baseline and after 1 and 12 months. Furthermore, clinical parameters (Probing Pocket Depths, Bleeding On Probing, Plaque Index) and marginal bone loss were also recorded. Esthetic outcomes of treatment were evaluated objectively using the Pink Esthetic Score and through patient reported outcomes. Results Twelve patients were enrolled in this prospective study. Post‐hoc analysis of the assessments with Tukey's honestly significant difference adjustment revealed that the MT had increased significantly from baseline to 1 month (P < 0.001), 6 months (P < 0.001) and 12 months (P < 0.001), and remained stable between 6 months and 12 months (P > 0.05). Based on the volumetric evaluation, a shrinkage of 23.31% occurred from 1 month to 12 months (P > 0.05). Conclusions A significant increase in MT was reported after 1 year, with a mean gain of 1.25 mm. Soft tissues were stable, with no statistically significant differences between 6 months and 1 year.

Volumetric changes at implant sites: A systematic appraisal of traditional methods and optical scanning‐based digital technologies

“…In particular, in one study the calibration included performing all the measurements twice with an interval of 1 week (Sapata et al, 2018), while in another study the examiner had to repeat the measurements three times every other week on five randomly chosen participants (Wang et al, 2019). The coefficient of reproducibility was reported in six studies, ranging from 0.8 to 0.93 (Borges et al, 2020; Papi et al, 2020; Parvini et al, 2020; Sapata et al, 2018; van Nimwegen et al, 2018; Wang et al, 2019; Table 1). Additionally, in ten studies, the operator who had performed the volumetric analysis had been blinded to the interventions (Borges et al, 2020; Clementini et al, 2020; Fischer et al, 2019; Rojo et al, 2018, 2020; Sanz Martin et al, 2016; Sapata et al, 2018; Thoma et al, 2020; Wang et al, 2019; Zeltner et al, 2017).…”

“…Thirty‐two of the included studies (Basler et al, 2018; Benic et al, 2017; Bertl et al, 2017; Bittner et al, 2020; Borges et al, 2020; Cabanes‐Gumbau et al, 2019; Canullo et al, 2018; Clementini et al, 2020; De Bruyckere et al, 2020; Eeckhout et al, 2020; Fischer et al, 2019; Friberg & Jemt, 2012; Galarraga‐Vinueza et al, 2020; Hinze et al, 2018; Hosseini et al, 2020; Huber et al, 2018; Jiang et al, 2020; Papi et al, 2020; Parvini et al, 2020; Rojo et al, 2018, 2020; Sanz Martin et al, 2016; Sanz‐Martin et al, 2019; Sapata et al, 2018; Schneider et al, 2011; Thoma et al, 2020; Tian et al, 2019; van Nimwegen et al, 2018; Wang et al, 2019; Wei et al, 2019; Wittneben et al, 2016; Zeltner et al, 2017) assessed volumetric changes with optical scanning‐based digital technologies. Among them, four studies also assessed mucosal thickness (MT) changes with transgingival piercing methods (Hosseini et al, 2020; Huber et al, 2018; Papi et al, 2020; Thoma et al, 2020).…”

“…Twenty‐one studies (Basler et al, 2018; Benic et al, 2017; Bittner et al, 2020; Canullo et al, 2018; Clementini et al, 2020; De Bruyckere et al, 2020; Eeckhout et al, 2020; Fischer et al, 2019; Friberg & Jemt, 2012; Hinze et al, 2018; Hosseini et al, 2020; Huber et al, 2018; Sanz Martin et al, 2016; Sanz‐Martin et al, 2019; Sapata et al, 2018; Schneider et al, 2011; Thoma et al, 2020; van Nimwegen et al, 2018; Wang et al, 2019; Wittneben et al, 2016; Zeltner et al, 2017) reported generating 3D digital models from constructed dental casts obtained with different impression materials (including silicone, alginate, polyether, and polyvinyl siloxane) with the use of desktop 3D optical scanners (indirect technique). The other eleven studies (Bertl et al, 2017; Borges et al, 2020; Cabanes‐Gumbau et al, 2019; Galarraga‐Vinueza et al, 2020; Jiang et al, 2020; Papi et al, 2020; Parvini et al, 2020; Rojo et al, 2018, 2020; Tian et al, 2019; Wei et al, 2019) had obtained the 3D digital models with the use of intra‐oral scanners (direct technique). Among them, six studies reported that a short‐span area was scanned (Galarraga‐Vinueza et al, 2020; Parvini et al, 2020; Rojo et al, 2018, 2020; Tian et al, 2019; Wei et al, 2019), while other articles did not provide information regarding the size of the scanned area.…”

“…Among them, six studies reported that a short‐span area was scanned (Galarraga‐Vinueza et al, 2020; Parvini et al, 2020; Rojo et al, 2018, 2020; Tian et al, 2019; Wei et al, 2019), while other articles did not provide information regarding the size of the scanned area. The method of digital model superimposition was automated (using an algorithm of the software) in fourteen studies (De Bruyckere et al, 2020; Eeckhout et al, 2020; Fischer et al, 2019; Hinze et al, 2018; Huber et al, 2018; Sanz Martin et al, 2016; Sanz‐Martin et al, 2019; Schneider et al, 2011; Thoma et al, 2020; Tian et al, 2019; van Nimwegen et al, 2018; Wang et al, 2019; Wei et al, 2019; Zeltner et al, 2017), and ‘hybrid’/semi‐automated (by selecting reproducible points prior to the algorithm or by using a semiautomatic algorithm first followed by manual alignment) in eleven studies (Basler et al, 2018; Bertl et al, 2017; Borges et al, 2020; Clementini et al, 2020; Galarraga‐Vinueza et al, 2020; Jiang et al, 2020; Papi et al, 2020; Parvini et al, 2020; Rojo et al, 2018, 2020; Sapata et al, 2018), with the remaining articles that did not specify this aspect. Three studies reported the amount of range of errors/tolerance between the two STL files during the superimposition (Bertl et al, 2017; Tian et al, 2019; Wei et al, 2019).…”

“…Table 1 includes the study design, intervention, types of impression materials, casts, digital scanners, and the utilized software for generating and analysing the 3D digital models. Twelve studies reported that the examiner was calibrated in terms of reproducibility of the volumetric analysis 3D measurements (Borges et al, 2020; Clementini et al, 2020; Fischer et al, 2019; Galarraga‐Vinueza et al, 2020; Hinze et al, 2018; Papi et al, 2020; Parvini et al, 2020; Sanz Martin et al, 2016; Sanz‐Martin et al, 2019; Sapata et al, 2018; van Nimwegen et al, 2018; Wang et al, 2019). In particular, in one study the calibration included performing all the measurements twice with an interval of 1 week (Sapata et al, 2018), while in another study the examiner had to repeat the measurements three times every other week on five randomly chosen participants (Wang et al, 2019).…”