Efficacy of soft tissue augmentation in the maxillary esthetic region: A 5-year randomized controlled trial.

Abstract

BACKGROUND Soft tissue grafting at dental implant sites has been proposed to enhance esthetic outcomes. A xenogeneic collagen matrix (XCM) was introduced as an alternative grafting material to connective tissue. Only short-term results are yet available. METHODS Sixty patients were treated in a randomized controlled trial with a connective tissue graft (n = 20, CTG group), an XCM (n = 20, XCM group), or received no graft (n = 20, NG group). The grafts were placed at the time of implant placement in a preserved alveolar ridge. The primary outcome was a change in mid-buccal mucosal level (MBML) after 5 years (T60). Secondary outcomes were marginal bone level, clinical peri-implant parameters, esthetics, and patient satisfaction. RESULTS At T60, mean changes in MBML were -0.41 ± 1.20 mm, -0.30 ± 1.22 mm, and -0.61 ± 1.72 mm in the CTG, XCM, and NG groups (p = 0.78), respectively. Also, regarding the secondary outcome variables, no significant between-group differences were observed. CONCLUSIONS Soft tissue grafting at single implant placement after alveolar ridge preservation, either with a CTG or XCM, does not result in a better esthetic outcome and should not be considered as a standard procedure. PLAIN LANGUAGE SUMMARY Implant placement in case of a failing tooth is a favorable treatment option. However, since the extraction socket is often associated with a large bone defect, alveolar ridge preservation with bone grafts prior to implant placement is often needed. To compensate for possible soft tissue defects, the application of a CTG or an XCM has been proposed. The question has arisen whether the use of an XCM will give a better outcome than a CTG. Furthermore, are both soft tissue augmentation therapies accompanied by a better esthetic result than performing no soft tissue therapy at all? Therefore, a 5-year study was carried out in which 60 patients with a failing tooth in the frontal region of the upper jaw were treated with removal of the tooth and restoring the gap with bone graft and sealing the socket with mucosagraft from the tuberosity region. At the time of implant placement 5 months thereafter, 20 patients received a CTG, 20 patients received an XCM, and 20 patients no soft tissue therapy. After 5 years, it appeared that there was no difference between the 3 soft tissue treatment procedures. Thus, implant placement combined with soft tissue grafting in preserved alveolar ridges does not result in a better esthetic outcome.