The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 11 ( November, 2021 ) > List of Articles


Comparative Evaluation of Different Soft Tissue Coverage Techniques at Immediate Implant Sites: A Cohort Study

Soumya Anugraha Rajan, Biniraj Kannanganatt Ramabhadran, Rishi Emmatty, Tony P Paul, Priya Jose, Divyasree Kochilat Ameyaroy, Preena Thalakottukara Variath, Mary Joseph

Keywords : Bone grafting, Buccally advanced flap, Connective tissue graft, Mucosal phenotype, Platelet-rich fibrin

Citation Information : Rajan SA, Ramabhadran BK, Emmatty R, Paul TP, Jose P, Ameyaroy DK, Variath PT, Joseph M. Comparative Evaluation of Different Soft Tissue Coverage Techniques at Immediate Implant Sites: A Cohort Study. J Contemp Dent Pract 2021; 22 (11):1268-1274.

DOI: 10.5005/jp-journals-10024-3208

License: CC BY-NC 4.0

Published Online: 24-02-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objective: To compare the mucosal thickness, width of attached gingiva, and extent of coverage achieved with the usage of connective tissue graft, platelet-rich fibrin (PRF) membrane and buccally advanced flap along with bone grafts in the closure of immediate implant site. Materials and methods: Twenty-one sites requiring immediate implants were randomly divided into three groups of seven samples each. The techniques comprised bone grafting in jumping space along with either buccally advanced flap (group A), PRF membrane (group B), or connective tissue graft (group C) to cover the socket. In each group, the extent of socket coverage, mucosal phenotype, and width of attached mucosa achieved were assessed after 3 months and intercompared with initial measurements to identify the best technique in achieving primary tissue closure of immediate implant sites. Results: Comparative assessment of gain in attached mucosal width had a remarkable difference in all the groups but exhibited no statistical significance among the groups compared. Also, comparative assessment of mucosal thickness and the extent of socket coverage equally indicated a clinical significance among all groups, but failed to achieve any statistical significance. Conclusion: All the three techniques were found to be equally effective in achieving additional width of attached mucosa around implants, coverage of mucosa at osteotomy sites, and a thicker mucosal phenotype at implant sites. In comparison with one another, no single technique was found to be advantageous over the other. Clinical significance: The commonly used three techniques for socket coverage following the immediate implant placement has been proven to be equally effective. Thus, the selection of the technique to meet the objective of complete closure of an extraction socket along with implant platform is left open to operator skill and operation site, which should consider least traumatic and most feasible technique.

  1. Buser D, Sennerby L, De Bruyn H. Modern implant dentistry based on osseointegration: 50 years of progress, current trends and open questions. Periodontol 2000 2017;73(1):7–21. DOI: 10.1111/prd.12185.
  2. Jyothi SG, Triveni MG, Mehta DS, et al. Evaluation of single-tooth replacement by an immediate implant covered with connective tissue graft as a biologic barrier. J Indian Soc Periodontol 2013;17(3):354–360. DOI: 10.4103/0972-124X.115666.
  3. Ataullah K, Che LF, Peng LL, et al. Implant placement in extraction sockets: a short review of the literature and presentation of a series of three cases. J Oral Impl 2008;34(2):97–106. DOI: 10.1563/1548-1336(2008)34[97:IPIESA]2.0.CO;2.
  4. Esfahrood ZR, Kadkhodazadeh M, Talebi Ardakani MR. Gingival biotype: a review. Gen Dent 2013;61(4):14–17. PMID: 23823337.
  5. Seibert JL, Lindhe J, Textbook of clinical periodontology. 2nd ed. In: Lindhe J, editor. Aesthetics and periodontal therapy. Copenhangen, Denmark: Munksgaard; 1989. p. 477–514.
  6. Becker W, Goldstein M. Immediate implant placement:treatment planning and surgical steps for successful outcome. Periodontol 2000. 2008;47:79–89. DOI: 10.1111/j.1600-0757.2007.00242.x.
  7. Rosenquist B. A comparison of various methods of soft tissue management following the immediate placement of implants into extraction sockets. Int J Oral Maxillofac Implants 1997;12(1):43–51. PMID: 9048453.
  8. Rojo R, Prados-Frutos JC, Manchon A. Soft tissue augmentation techniques in implants placed and provisionalized immediately: a systematic review. Biomed Res Int 2016;1–12. DOI: 10.1155/2016/7374128.
  9. Friedman MT, Barber PM, Mordan NJ, et al. The plaque free zone in health and disease: a scanning electron microscope study. J Periodontol 1992;63(11):890–896. DOI: 10.1902/jop.1992.63.11.890.
  10. Jansen JA, De Wijn JR, Wolters Lutgerhorst JM, et al. Ultrastructural study of epithelial cell attachment to implant materials. J Dent Res 1985;64:891–896. DOI: 10.1177/00220345850640060601.
  11. Mehta H, Shah S. Management of buccal gap and resorption of buccal plate in immediate implant placement: a clinical case report. J Int Oral Health 2015;7:72–75. PMID: 26225110; PMCID: PMC4516068.
  12. Coomes AM, Mealey BL, Huynh BG, et al. Buccal bone formation after flapless extraction: a randomized, controlled clinical trial comparing recombinant human bone morphogenetic protein 2/absorbable collagen carrier and collagen sponge alone. J Periodontol 2014;85:525–535. DOI: 10.1902/jop.2013.130207.
  13. Boora P, Rathee M, Bhoria M. Effect of platelet rich fibrin on peri-implant soft tissue and crestal bone in one-stage implant placement: a randomized controlled trial. J Clin Diagn Res 2015;9(4):18–21. DOI: 10.7860/JCDR/2015/12636.5788.
  14. Irinakis T. Rationale for socket preservation after extraction of a single-rooted tooth when planning for future implant placement. J Can Dent Assoc 2006;72(10):917–922. PMID: 17187706.
  15. Choukroun J, Diss A, Simonpieri A, et al. Platelet-rich fibrin: a second-generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101(3):56–60. DOI: 10.1016/j.tripleo.2005.07.011.
  16. Edel A. Clinical evaluation of free connective tissue grafts used to increase the width of keratinized gingiva. J Clin Periodontol 1974;1(4):185–196. DOI: 10.1111/j.1600-051x.1974.tb01257.x.
  17. Castro Y, Grados S, Grados S. Peri-implant soft tissue augmentation with a porcine collagen matrix. J Oral Res 2014;3:244–248. DOI: 10.17126/joralres.2014.055.
  18. Adibrad M, Shahabuei M, Sahabi M. Significance of the width of keratinized mucosa on the health status of the supporting tissue around implants supporting overdentures. J Oral Implantol 2009;35(5):232–237. DOI: 10.1563/AAID-JOI-D-09-00035.1.
  19. Bassetti RG, Stahli A, Bassetti MA, et al. Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review. Clin Oral Investig 2016;21(1):53–70. DOI: 10.1007/s00784-016-2007-9.
  20. Frisch E, Ratka-Kruger P, Ziebolz D. A new technique for increasing keratinized tissue around dental implants: the partially epithelialized free connective tissue graft. retrospective analysis of a case series. J Oral Implantol 2015;41:467–472. DOI: 10.1563/AAID-JOI-D-13-00006.
  21. Souza OMM, Neri JFA, Topazio L, et al. Influence of tissue biotype in the morphoesthetic functional behavior of the periimplant tissue: a literature review. Dental Press Implantol 2012;6(2):56–66.
  22. Noelken R, Geier J, Kunkel M, et al. Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla. Clin Implant Dent Relat Res 2018;20:674–682. DOI: 10.1111/cid.12643.
  23. Bassetti M, Kaufmann R, Salvi GE, et al. Soft tissue grafting to improve the attached mucosa at dental implants: a review of the literature and proposal of a decision tree. Quintessence Int 2015;46(6):499–510. DOI: 10.3290/j.qi.a33688.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.