title: Facial gingival tissue stability after connective tissue graft with single immediate tooth replacement in the esthetic zone: consecutive case report.
abstract: OBJECTIVE
  The present consecutive case report evaluated facial gingival tissue stability after immediate tooth replacement with connective tissue grafting in the esthetic zone. The implant success rate and peri-implant tissue response were also recorded.
  
  
  METHODS
  A total of 20 consecutive patients with a mean age of 52.3 years (range 28 to 71), who had undergone 20 single immediate tooth replacement with connective tissue grafting, were evaluated clinically and radiographically at the preoperative examination, immediately after implant placement and provisionalization with connective tissue grafting, and at the latest follow-up appointment. The data were analyzed using the t test and Wilcoxon signed rank test at a significance level of alpha = .05.
  
  
  RESULTS
  At the preoperative examination, a thick gingival biotype was observed in 8 patients and a thin gingival biotype in 12. At a mean follow-up of 2.15 years (range 1 to 4), all implants were functioning and exhibited a thick biotype. At the latest follow-up appointment, no significant differences (P > .05) were found between the initially thick and thin gingival biotypes in the mean mesial marginal bone level changes (-0.53 versus -0.55 mm), the mean distal marginal bone level changes (-0.50 versus -0.44 mm), and the mean facial gingival level changes (+0.23 mm versus +0.06 mm). The frequency distribution of the papilla index score showed that peri-implant papillae were well preserved at the latest follow-up visit.
  
  
  CONCLUSIONS
  With proper 3-dimensional implant positioning and bone grafting into the implant-socket gap, the facial gingival level can be maintained after connective tissue grafting with single immediate tooth replacement, regardless of the initial gingival biotype, indicating that the thin gingival biotype can be converted to the thick gingival biotype morphologically and behaviorally with this procedure. Nevertheless, careful patient selection and treatment planning, as well as immaculate execution by skillful clinicians, are required to achieve a successful result.
authors.affiliation: Department of Restorative Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA 92354, USA. jkan@llu.edu
authors.forename: Joseph Y K
authors.initials: JY
authors.lastname: Kan
authors.forename: Kitichai
authors.initials: K
authors.lastname: Rungcharassaeng
authors.forename: Taichiro
authors.initials: T
authors.lastname: Morimoto
authors.forename: Jaime
authors.initials: J
authors.lastname: Lozada
mesh_terms: D000328:Adult; D000368:Aged; D003238:Connective Tissue / Q000637:transplantation*; D003758:Dental Implantation, Endosseous; D019250:Dental Implants, Single-Tooth; D005260:Female; D005881:Gingiva / Q000033:anatomy & histology* / Q000637:transplantation; D005889:Gingival Recession / Q000601:surgery*; D006801:Humans; D007180:Incisor; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D020390:Tooth Socket / Q000601:surgery*; D016896:Treatment Outcome