Management of Thick and Thin Periodontal Phenotypes for Immediate Dental Implants in the Esthetic Zone: A Controlled Clinical Trial

Tatum, Catherine L; Saltz, Adam E; Prihoda, Thomas J.; DeGroot, Bradley S.; Mealey, Brian L.; Mills, Michael P.; Huynh‐Ba, Guy

doi:10.11607/prd.4317

Cited by 9 publications

(22 citation statements)

References 6 publications

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“…In contrast, mid‐facial recession was more than double in patients with a thin gingival biotype who did not receive CTG. This has also been confirmed in a recent study (Tatum et al, 2020). All this suggests that by adding a CTG to thin gingival biotype sites, one may achieve similar outcomes as IIP at thick gingival biotype sites.…”

Section: Discussionsupporting

confidence: 84%

Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

Seyssens

Lat

Cosyn

2020

J Clinic Periodontology

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ObjectivesTo assess the effect of connective tissue graft (CTG) in terms of vertical mid‐facial soft tissue change when applied at the buccal aspect following single immediate implant placement (IIP).Materials and methodsTwo independent reviewers conducted an electronic literature search in PubMed, Web of Science, EMBASE and Cochrane databases as well as a manual search to identify eligible clinical studies up to January 2020. Randomized controlled trials (RCTs) and non‐randomized controlled studies (NRSs) comparing IIP with CTG and without CTG over a mean follow‐up of at least 12 months were included for a qualitative analysis. Meta‐analyses were performed on data provided by RCTs.ResultsOut of 1814 records, 5 RCTs and 3 NRSs reported on 409 (IIP + CTG: 246, IIP: 163) immediately installed implants with a mean follow‐up ranging from 12 to 108 months. Only 1 RCT showed low risk of bias. Meta‐analysis revealed a significant difference in terms of vertical mid‐facial soft tissue change between IIP + CTG and IIP pointing to 0.41 mm (95% CI [0.21; 0.61], p < .001) in favour of soft tissue grafting. This outcome was clinically relevant since the risk for ≥1 mm asymmetry in mid‐facial vertical soft tissue level was 12 times (RR 12.10, 95% CI [2.57; 56.91], p = .002) lower following IIP + CTG. Soft tissue grafting also resulted in a trend towards less bleeding on probing (MD 17%, 95% CI [−35%; 1%], p = .06). Meta‐analyses did not reveal significant differences in terms of pink aesthetic score, marginal bone level change and probing depth. Results were inconclusive for horizontal mid‐facial soft tissue change and papilla height change. Based on GRADE guidelines, a moderate recommendation for the use of a CTG following IIP can be made.ConclusionCTG contributes to mid‐facial soft tissue stability following IIP. Therefore, CTG should be considered when elevated risk for mid‐facial recession is expected in the aesthetic zone (thin gingival biotype, <0.5 mm buccal bone thickness).

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Section: Discussionsupporting

confidence: 84%

Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

Seyssens

Lat

Cosyn

2020

J Clinic Periodontology

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“…However, it is not clear in literature, if only delicate clinical indications (such as thin periodontal biotypes) benefit from additional soft tissue grafting. Clinical studies suggest that in a particular group of patients with a thin periodontal biotype, midfacial recession occurs more frequently and that these patients would benefit more from additional soft tissue grafting (Bittner et al, 2020;Kan et al, 2011;Migliorati et al, 2015;Tatum et al, 2020) et al, 2020).…”

Section: Pico2mentioning

confidence: 99%

Influence of soft tissue augmentation procedures around dental implants on marginal bone level changes—A systematic review

Fickl

Kröger

Dietrich

et al. 2021

Clinical Oral Implants Res

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Objectives This systematic review assessed the influence of soft tissue augmentation procedures on marginal bone level changes in partial or fully edentulous patients. Material and Methods We identified three relevant PICO questions related to soft tissue augmentation procedures and conducted a systematic search of four major electronic databases for clinical studies in systemically healthy patients receiving at least one dental implant and a minimum follow‐up of one year after implant placement. The primary outcome was mean difference in marginal bone levels, and secondary outcomes were clinical and patient‐related outcomes such as thickness of peri‐implant mucosa, bleeding indices, and Pink Esthetic Score. Results We identified 20 publications reporting on 16 relevant comparisons. Studies varied considerably and thus only two meta‐analyses could be performed. This systematic review showed that: Soft tissue augmentation either for augmentation of keratinized mucosa or soft tissue volume inconsistently had an effect on marginal bone level changes when compared to no soft tissue augmentation, but consistently improved secondary outcomes. The combination soft and hard tissue augmentation showed no statistically significant difference in terms of marginal bone level changes when compared to hard tissue augmentation alone, but resulted in less marginal soft tissue recession as shown by a meta‐analysis. Soft or hard tissue augmentation performed as contour augmentations resulted in comparable marginal bone level changes. Conclusions Peri‐implant soft and hard tissues seem to have a bidirectional relationship: “Bone stands hard, but soft tissue is the guard”.

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“…In all delayed implant placement studies, the implants were placed in healed sites ≥4 months after tooth extraction. Of the 7 included CCTs, 2 reported immediate implant placement and delayed restoration (Tatum et al., 2020) and immediate implant placement and immediate restoration (Cosyn et al., 2016) and 5 reported delayed implant placement (Fenner et al., 2016; Hosseini et al., 2020; Kato et al., 2018; Kobayaski et al., 2020; Zuiderveld et al., 2019). The last study was a prospective case series following alveolar ridge preservation (ARP), delayed implant placement and SCTG (Eghbali et al., 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Besides the favourable primary outcomes of soft tissue grafting on the stability of the mid‐buccal mucosal level, the peri‐implant tissues were healthy, the loss of marginal bone was minor and the PES was favourable. The PES showed significantly higher scores after immediate implant placement with SCTG (Frizzera et al., 2019; Migliorati et al., 2015; Tatum et al., 2020). This observation contradicts Zuiderveld, Meijer, den Hartog, et al., (2018) findings, who reported better PES scores when no SCTG was applied.…”

Section: Discussionmentioning

confidence: 99%

“…Two cases of peri-implantitis were reported (Eghbali et al, 2018;Puzio et al, 2018). The patients generally described the treatment as highly satisfactory, and the approaches for professional evaluation between the groups were similar (Frizzera et al, 2019;Rojo et al, 2020;Tatum et al, 2020;Thoma et al, 2020;Zuiderveld, Meijer, den Hartog, et al, 2018;Zuiderveld et al, 2019). Standardized approaches for professional evaluation (PES/WES) were not frequently used, thus impairing a possible meta-analysis.…”

Section: Complicationsmentioning

confidence: 99%

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Linear and profilometric changes of the mucosa following soft tissue augmentation in the zone of aesthetic priority: A systematic review and meta‐analysis

Raghoebar

Korfage

Meijer

et al. 2021

Clinical Oral Implants Res

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Objectives To assess the outcomes of soft tissue augmentation, in terms of change in level and thickness of mid‐buccal mucosa, at implants sites in the zone of the aesthetic priority. Material and Methods MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched (last search on 1 June 2020). Inclusion criteria were studies reporting outcomes of different materials and timing of grafting in patients undergoing soft tissue augmentation at implant sites in the aesthetic zone with a follow‐up of ≥1 year after implant placement. Outcome measures assessed included changes in level and thickness of mid‐buccal mucosa, implant survival, peri‐implant health and patients’ satisfaction. Results Eighteen out of 2,185 articles fulfilled the inclusion criteria. Meta‐analysis revealed a significant difference in vertical mid‐buccal soft tissue change (0.34 mm, 95% CI: 0.13–0.56, p = .002) and mid‐buccal mucosa thickness (0.66 mm, 95% CI: 0.35–0.97, p < .001) following immediate implant placement in favour of the use of a graft versus no graft. Mean difference in mid‐buccal mucosa level following delayed implant placement (0.17 mm, 95% CI: 0.01–0.34, p = .042) was also in favour of the use of a graft versus no graft. With regard to mucosa thickness, the use of a graft was not in favour compared with no graft following delayed implant placement (0.22 mm, 95% CI: −0.04–0.47, p = .095). Observed changes remained stable in the medium term. Conclusion Soft tissue augmentation in the zone of the aesthetic priority results in less recession and a thicker mid‐buccal mucosa following immediate implant placement and less recession in mid‐buccal mucosa following delayed implant placement compared with no graft.

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Management of Thick and Thin Periodontal Phenotypes for Immediate Dental Implants in the Esthetic Zone: A Controlled Clinical Trial

Cited by 9 publications

References 6 publications

Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

Influence of soft tissue augmentation procedures around dental implants on marginal bone level changes—A systematic review

Linear and profilometric changes of the mucosa following soft tissue augmentation in the zone of aesthetic priority: A systematic review and meta‐analysis

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