The effect of implant placement and simultaneous soft tissue augmentation in the esthetic zone using either connective tissue autograft or acellular dermal matrix allograft on peri-implant hard and soft tissue healing.

Aims. The primary aims of this randomized, controlled, blinded clinical trial were to compare the hard and soft tissue response following either a connective tissue (CT) or acellular dermal matrix (ADM) graft placed simultaneously with a laser-grooved implant. Methods. Twenty-five patients received a single tooth implant in the maxillary anterior that was bordered by two teeth. Patients were randomly selected, using to coin toss, to receive either an ADM (test) or a CT (control) graft. At the 2-month appointment, the implant was uncovered and a lab-fabricated provisional was placed. At the 4-month appointment, following 2 months of tissue shaping, a fixture level impression was obtained to capture the emergence profile. The final restoration was constructed and placed. Subjective and objective evaluations of the implant esthetics were obtained at the 6-month follow-up. Results. Soft tissue thickness at the crest for the CT group and ADM groups at 4 months was 2.8 mm and 2.9 mm respectively. ADM showed a greater increase in thickness than CT, but the gain was not statistically significant. Facial recession at 6 months for the CT group was 0.3 ± 0.4 mm and ADM group was 0.5 ± 0.5 mm (p \u3e 0.05). Gingival margin harmony was 64% (9 of 14) for the CT group and 45% (5 of 11) for the ADM group. Papilla harmony was achieved in 36% (5 of 14) of cases in the CT group and 27% (3 of 11) for the ADM group. Using the Jemt papilla index, the ADM group had 2: 50% papilla fill in 100% of sites (22 of 22) while the CT group had 93% (26 of 28) of sites. Implant platform to osseous crest, at 6 months, for the CT group was -0.4 ± 0.4 mm for the mesial and -0.2 ± 0.3 mm for the distal (p \u3c 0.05). The ADM group was -0.3 ± 0.5 mm for the mesial (p \u3c 0.05) and -0.2 ± 0.4 mm for the distal. The Pink Esthetic Score was 11.6 ± 1.5 for the CT group and 11.7 ± 1.6 for the ADM group. The White Esthetic score was 8.2 ± 1.3 mm for the CT group and 8.7 ± 1.5 mm for the ADM group. Patient\u27s subjective esthetic scores showed patients were equally satisfied with both treatment groups. Conclusions. Facial recession and gingival margin harmony were similar for both treatment groups. Jemt papilla index scores and papilla harmony were similar for both groups. Loss of osseous crest on the mesial and distal of the implants was similar in both treatment groups and was greatest between times 2 to 6 months. Subjective patient assessment of esthetics using the Visual Analog Scale was similar for CT and ADM groups