Tissue changes at implant sites in the anterior maxilla with and without connective tissue grafting: A five-year prospective study

Objectives To evaluate the biological and aesthetic outcome of connective tissue grafting around single-tooth implant replacements in the anterior maxilla after five years. Materials and methods Nineteen patients (mean age: 22) received 33 implants in combination with bone grafts. After healing, 10 implant sites received facial connective tissue grafts harvested from the palate (test group). The remaining 23 implant sites without soft tissue grafts were used as a control group. The biological outcomes included survival rate, complications, marginal bone level, keratinized mucosa height and soft tissue level. The aesthetic outcomes included soft tissue thickness, spectrophotometric colour of mucosa, 3D facial dimensional changes and professional reported aesthetic outcomes. All data were recorded preoperatively and postoperatively after six months and one, three and five years. Results After five years, the survival and success rate of implants was 100% and 93.9% (one aesthetic and one biological complication). The soft tissue level changed significantly more towards the incisal direction in the test than in the control group from one to five years of observation (p = .024). The facial dimension increased significantly more in the test group than in the control group (3 mm marginally: p = .010). The subjective evaluation of mucosa colour was significantly better in the test versus control group (p = .035). Other biological and aesthetic parameters were not significantly different between the test and control group. Conclusion Augmentation using a connective tissue graft may result in better mucosal colour match and more facial dimensional gain compared to implant sites without soft tissue grafting.