Enhancement of the Gingival Thickness Around Immediate Implants Using a Porcine Collagen Matrix Compared to Autogenous Palatal and Tuberosity Mucosa

Abstract

Immediate implants have become a popular and reliable treatment option for missing teeth saving time and presenting a more satisfactory option to the patient. After extracting of a tooth, many changes take place in the socket during the succeeding 12 months of surgery leading to reduction in the ridge width of the ridge by 50%. The tooth is anchored to the jaw by means of the bundle bone that loses its nutrition and function after tooth extraction. The final position of the crestal bone and soft tissue levels around the immediate implant will affect the final esthetic outcome. Augmentation of the soft tissues with autogenic or synthetic grafts is broadly used to enhance tissue volume and the amount of keratinized gingiva, in addition to improving aesthetic outcomes. The aim of this study was to study the effect of Mucograft in enhancing the gingival thickness around immediate implants in comparison to palatal and tuberosity connective tissue grafts. 30 patients (7 males and 23 females) from the out patients clinic of Oral Medicine, Diagnosis and Periodontology Department, Faculty of Dentistry, Ain Shams University were included in this study. The study protocol was approved by the ethical committee of the faculty of dentistry, Ain Shams University. The patients were divided into 3 groups, where group A received an immediate implant and palatal SCTG placed in a split-thickness envelope prepared on the facial surface of the implant, group B received an immediate implant and tuberosity SCTG placed in a split-thickness envelope prepared on the facial surface of the implant, while group C received an immediate implant and Mucograft placed in a split-thickness envelope prepared on the facial surface of the implant. 3 months after implants placement, the abutment were screwed and porcelain fused to metal crowns were fused to the abutment. However, only 24 patients completed the 6 month follow up of the study with 8 patients in each of the three groups. Clinical evaluations were obtained at baseline, 3 months and 6 months. The clinical parameters included papillary bleeding index (PBI), gingival index (GI), and probing depth (PD). Esthetic outcome was measured using Pink Esthetic Score (PES) and White Esthetic Score (WES). Direct measurement of the gingival thickness thickness using an endodontic file with stopper was applied at 2, 4 and 6 mm from the FGM. Indirect measurement of the facial-palatal ridge dimensional changes (FPRDC) on gypsum casts was also applied at 0,1,2,3,5,7 and 9 mm from the FGM. CBCT was used to measure the difference in the gingival thickness before and after implant and graft application at 2, 4 and 6 mm from the FGM. In the addition the changes in the facial bone height was measured at baseline and at 6 months follow up. The current study shows that immediate implants have a high success rate (100%) when placed in fresh extraction sockets. There was no difference between the three groups concerning the ossiointegration of the placed implants. No statistical difference in the PBI and GI was shown in the 3 groups throughout the 6 months follow up. On the other hand there was reduction in the facial probing depth in autogenous. Direct measurement of the gingival thickness reflected an increase in the gingival thickness in the 3 groups at 2, 4 and 6 mm from the FGM. However there was a significant difference in the average gingival thickness in favor of autogenous palatal and tuberosity groups. Indirect measurements using the gypsum cast reveled increase in groups A and B, while group C showed reduction