CBCT assessment of marginal bone loss and pink esthetic outcomes following peri-implant soft tissue augmentation with fascia lata allograft, platelet-rich fibrin, and connective tissue graft: a randomized controlled trial

Comparative efficacy of fascia lata allograft, platelet-rich fibrin, and connective tissue graft for peri-implant soft tissue augmentation: a randomized controlled clinical trial

Adequate peri-implant soft tissue thickness and keratinized mucosa width are crucial for implant health and aesthetics. Autogenous subepithelial connective tissue grafts (CTG) are the gold-standard for augmenting thin biotypes, but they require a second surgical site. This trial evaluated whether a human fascia lata allograft (FLA) or platelet-rich fibrin (PRF) membrane could comparably enhance peri-implant soft tissue phenotype and serve as less invasive alternatives of CTG. Forty-five patients with a thin gingival phenotype (≤ 1 mm thickness) requiring upper anterior implant were randomly assigned to receive soft tissue augmentation with either (1) FLA allograft, (2) PRF membrane, or (3) CTG (control). Interventions were applied concurrently with implant placement in a standardized manner. Gingival thickness (GT) and keratinized tissue width (KTW) were measured at baseline and 6 months using transgingival probing and clinical indices. Labial bone thickness was assessed by cone-beam CT at implant placement and 6 months. Forty-five enrolled patients completed the study. All treatment modalities showed improvements in gingival and bone parameters, with the connective tissue graft consistently demonstrating the greatest gains. The median keratinized tissue width increased to 4.00 mm in the Connective Tissue Graft group, slightly higher than the Fascial Lata Allograft and Platelet-Rich Fibrin groups (3.75 mm). Gingival thickness showed significant increases in all groups, with the Connective Tissue Graft reaching 2.15 mm, followed by Fascia Lata Allograft (1.80 mm) and Platelet-Rich Fibrin (1.55 mm). Labial bone thickness also increased, with the Connective Tissue Graft achieving the highest mean value of 2.300 mm, and after 6 months, significant gains were observed in both this group (p = 0.032) and in the Platelet-Rich Fibrin group (p = 0.044), while Fascia Lata Allograft showed a smaller, non-significant increase. Both fascia lata allograft (FLA) and PRF improved peri-implant soft tissue parameters, however the connective tissue graft (CTG) remains the gold standard for achieving the greatest thickness and best aesthetic results. FLA is a promising alternative that avoids a second surgical site with comparable outcomes, whereas PRF offers faster healing but lacks the volume necessary for significant tissue modification.

Soft-Tissue Augmentation During Implant Placement in the Aesthetic Zone: Clinical, Radiographic, Histological and Patient-Reported Outcomes From a Randomised Controlled Trial Using Connective Tissue Graft and a Volume-Stable Collagen Matrix.

STA significantly increased STT but did not prevent buccal bone remodelling, and both augmentation approaches were associated with increased STT compared with no augmentation.

Clinical outcomes of free gingival graft, xenogeneic collagen matrix, and acellular dermal matrix for peri-implant keratinized mucosa augmentation: a randomized controlled trial

A novel split flap-roll technique for peri-implant soft tissue augmentation in the esthetic zone: A clinical case report.

BACKGROUND Peri-implant soft tissue thickness is a critical determinant of esthetic outcomes and long-term implant stability, particularly in the anterior maxilla. METHODS A 28-year-old systemically healthy male presented with a missing maxillary central incisor and a thin gingival biotype. Following implant placement, a modified split flap-roll technique was performed. The surgical approach involved splitting the flap into epithelial and connective tissue components, followed by mobilization and rolling of the connective tissue into a labial pouch to enhance tissue thickness. RESULTS Soft tissue thickness increased from less than 2 mm pre-operatively to approximately 4 mm at 3 months, with stable maintenance of approximately 3 mm at 9 months. Improved gingival contour, emergence profile, and uneventful healing were observed throughout the follow-up period. CONCLUSION The modified split flap-roll technique may serve as an alternative approach for peri-implant soft tissue augmentation. Within the limitations of this case report, favorable clinical outcomes were observed; however, further controlled studies are required to establish its predictability and clinical effectiveness. CLINICAL SIGNIFICANCE Modification of an existing roll flap technique Eliminates the need for a secondary donor site Allows soft tissue augmentation using a pedicled approach May provide an alternative option in selected cases KEY POINTS: The modified split flap-roll technique increased peri-implant soft tissue thickness from less than 2 mm to approximately 4 mm at 3 months, with stable maintenance at 9 months. The technique utilizes a pedicled connective tissue component, eliminating the need for a secondary donor site and potentially reducing patient morbidity. This approach may provide an alternative soft tissue augmentation option for selected esthetic-zone implant cases. PLAIN LANGUAGE SUMMARY Dental implants placed in the front part of the upper jaw require healthy and adequate gum tissue to achieve a natural appearance and long-term stability. In some patients, the gum tissue around an implant is thin, which can affect both esthetics and treatment outcomes. This case report describes a modified surgical technique used to increase the thickness of the soft tissue around a dental implant without taking tissue from another area of the mouth. A 28-year-old patient with a missing upper front tooth and thin gum tissue underwent implant placement combined with a split flap-roll procedure. During surgery, tissue from the same surgical site was carefully separated, rolled, and repositioned to create additional volume around the implant. The soft tissue thickness increased from less than 2 mm before treatment to approximately 4 mm after 3 months and remained stable at approximately 3 mm after 9 months. Healing was uneventful, and the final esthetic result showed improved tissue contour and implant appearance. This technique may offer a less invasive alternative to conventional connective tissue graft procedures while avoiding the discomfort associated with a second surgical donor site.

Prefabricated CAD/CAM zirconia membrane versus contour augmentation with early implant placement in the anterior maxilla: a randomized controlled clinical trial

Horizontal ridge deficiencies in the anterior maxilla frequently compromise ideal implant positioning and esthetic outcomes. This randomized controlled clinical trial evaluated the clinical performance of customized CAD/CAM zirconia membranes compared with conventional collagen membranes for guided bone regeneration (GBR) performed simultaneously with early implant placement. Twenty systemically healthy patients requiring single-tooth replacement in the anterior maxilla underwent early implant placement (4–8 weeks after tooth extraction) combined with simultaneous contour augmentation using a composite graft of autogenous bone and deproteinized bovine bone mineral (1:1). Participants were randomly assigned to receive either a customized CAD/CAM zirconia membrane (test group, n = 10) or a double-layer collagen membrane (control group, n = 10). The primary outcome was horizontal bone gain (HBG) at 6 months, assessed by standardized CBCT superimposition. Secondary outcomes included soft tissue healing evaluated using the Modified Wound Healing Index (MWHI), membrane exposure (wound dehiscence), and patient-reported postoperative pain assessed using a visual analogue scale (VAS). All implants survived during the 6-month follow-up period (100% survival rate). Mean HBG was 6.18 ± 0.60 mm in the test group and 5.85 ± 0.37 mm in the control group, with no statistically significant difference between groups (p = 0.158). Membrane exposure occurred in all patients receiving customized zirconia membranes (10/10, 100%), whereas no membrane exposure was observed in the collagen membrane group (0/10, 0%). Despite the higher exposure rate, graft stability and horizontal bone regeneration were not adversely affected. Soft tissue healing was significantly more favorable in the collagen membrane group. Postoperative pain decreased significantly over time in both groups, with no significant intergroup differences. Customized CAD/CAM zirconia membranes achieved horizontal bone augmentation comparable to conventional collagen membranes when used for simultaneous GBR during early implant placement. Although customized zirconia membranes were associated with a substantially higher membrane exposure rate, regenerative outcomes and implant survival remained unaffected, indicating that customized rigid barriers may represent a predictable alternative for horizontal ridge augmentation while offering potential advantages in surgical precision and procedural efficiency. Trial registration: ClinicalTrials.gov NCT06987149.

Comparative evaluation of dimensional changes achieved and osteopontin level in peri-implant crevicular fluid after sinus crestal floor elevation using piezosurgery and concentrated growth factor with or without allograft: a randomized clinical trial

Background: Limited residual bone height in the posterior maxilla often necessitates sinus floor elevation before implant placement. Piezosurgery-assisted crestal sinus floor elevation offers a minimally invasive approach with reduced membrane-related complications. Concentrated growth factor (CGF) has been proposed to enhance bone regeneration; however, the additional benefit of combining CGF with allograft remains unclear. This randomized clinical trial compared radiographic, clinical, and biochemical outcomes following crestal sinus floor elevation using CGF with or without demineralized freeze-dried bone allograft (DFDBA). Methods: Twenty posterior maxillary implant sites requiring indirect sinus floor elevation were randomly allocated into two groups (n=10 each): group A, piezosurgery-assisted crestal sinus elevation with CGF + DFDBA; and group B, CGF alone. Simultaneous implant placement was performed in all sites. Vertical bone height (VBH) and bucco-palatal width (BPW) were assessed using cone-beam computed tomography at baseline and 6 months. Implant stability quotient (ISQ) was measured at baseline and 3 months. Osteopontin (OPN) levels in peri-implant crevicular fluid were evaluated at 15, 45, and 90 days using enzyme-linked immunosorbent assay. Results: Both groups demonstrated significant increases in vertical bone height and implant stability over time (p<0.05). Group A showed significantly greater vertical bone gain at 6 months compared with group B (p<0.05). Bucco-palatal width remained relatively stable in both groups, although a significant reduction was observed in group B. OPN levels increased progressively in both groups during healing and were significantly higher in group A at all-time intervals (p<0.05). Conclusions: Piezosurgery-assisted crestal sinus floor elevation using CGF, with or without allograft, resulted in favorable clinical and radiographic outcomes. The addition of DFDBA to CGF yielded greater vertical bone gain and higher OPN levels, suggesting enhanced regenerative activity during early healing.