Esthetics and bone changes of immediate implants with or without vascularized interpositional periosteal connective tissue grafting: A 2-year randomized controlled trial

ObjectivesTo compare esthetics at single immediately placed implants with and without soft tissue augmentation. Materials and MethodsPatients with non-restorable maxillary teeth in the esthetic zone were assigned into 2 groups: immediately placed implants with simultaneous vascularized interpositional periosteal connective tissue grafting (VIP-CTG) or non-grafted immediately placed implants (NG). The outcomes included: pink esthetic score (PES), gingival thickness, keratinized tissue width, buccal bone changes, marginal bone loss, pain, and satisfaction. ResultsEighteen implants were included. At 2 years the mean value for PES was 12 +/- 3.2 for the VIP-CTG and 12.9 +/- 1.3 for the NG (p = .855). Mucosal thickness and keratinized tissue width showed no statistically significant difference between the two groups (p = .253) and (p = .931) respectively. Clinically buccal bone showed mean bone loss of 2.03 +/- 1.57 mm for VIP-CTG and 1.09 +/- 1.3 mm for NG (p = .247) and radiographically showed 1.67 +/- 0.84 mm at the VIP-CTG and 1.16 +/- 0.47 mm at the NG (p = .118). No statistically significant difference between both groups was demonstrated regarding marginal bone level changes (p = .142), pain (p = .622), or satisfaction (p = .562) at any time point. ConclusionSimultaneous soft tissue grafting with immediate implant placement did not provide a more favorable outcome regarding esthetics or alveolar bone preservation effect. Undisturbed healing with the least surgical intervention seems to provide more favorable outcomes.