Immediate placement and provisionalization of implants in the aesthetic zone with or without a connective tissue graft: A 1-year randomized controlled trial and volumetric study

ObjectiveTo volumetrically compare peri-implant mid-facial soft tissue changes in immediately placed and provisionalized implants in the aesthetic zone, with or without a connective tissue graft. Material and methodsSixty patients were included. All implants were placed immediately after extraction. After randomization, in one group, a connective tissue graft (test group, n=30) was inserted at the buccal aspect of the implant. The other group (control group, n=30) received no connective tissue graft. Clinical parameters, digital photographs and conventional impressions were obtained before extraction (T-pre) and at 12months following definitive crown placement (T-12). The casts were digitized by a laboratory scanner, and a volumetric analysis was performed between T-pre and T-12. ResultsTwenty-five patients in each group were available for analysis at T-12. Volumetric change, transformed to a mean (SD) change in thickness, was -0.68 +/- 0.59mm (test) and -0.49 +/- 0.54mm (control) with a non-significant difference between groups (p=.189). The mid-facial mucosa level was significantly different between both groups (p=.014), with a mean (+/- SD) change of +0.20 +/- 0.70mm (test) and -0.48 +/- 1.13mm (control). The Pink Esthetic Score was similar between both groups. ConclusionsThe use of a CTG in immediately placed and provisionalized implants in the aesthetic zone did not result in less mucosal volume loss after 12months, leading to the assumption that a CTG cannot fully compensate for the underlying facial bone loss, although a significantly more coronally located mid-facial mucosa level was found when a CTG was performed.