title: Clinical and Aesthetic Outcome with Post-Extractive Implants with or without Soft Tissue Augmentation: A 2-Year Randomized Clinical Trial.
abstract: BACKGROUND
  The aesthetic outcome of an implant-supported restoration is first of all dependent on the soft tissue volume. Because the labial bone plate resorbs in every direction after tooth extraction, even when an implant is placed immediately, most patients end up with compromised aesthetics.
  
  
  METHODS
  In this parallel-designed, randomized clinical trial, participants were randomly assigned to the test group (immediate load post-extractive implant treated with subepithelial connective tissue graft placed using the tunnel technique in the labial area) and control group (immediate load post-extractive implant treated without raising a flap) with an allocation ratio of 1:1. Both groups received deproteinized bovine bone mineral. Patients were observed at baseline, crown insertion, 1-year follow-up, and 2-year follow-up. Clinical, radiological and aesthetic parameters were recorded to assess primary treatment outcomes. A random permuted block system was blindly generated ensuring uniformity of the patient allocation during the trial by randomly distributing three participants to the test and three participants to the control group every six treated patients.
  
  
  RESULTS
  At the 2-year examination, all 47 implants were successfully integrated, demonstrating stability and healthy peri-implant soft tissues as documented by standard clinical parameters. The results showed a soft tissue remodeling of -10% in thickness and -18% in highness in the non-grafted group, whereas in the grafted group there was a gain of 35% in thickness and a slight reduction of -11% in highness. Test group reported an increase of aesthetic result (mean pink aesthetic score [PES] 8) compared with control group (mean PES 6.65).
  
  
  CONCLUSIONS
  This prospective study demonstrates the effectiveness of placing a soft tissue graft at the time of immediate implant placement in the aesthetic zone. At the 2-year follow-up, test group revealed a better aesthetic outcomes and stable facial soft tissues compared with control group.
authors.affiliation: Orthodontics Department, Genoa University, Genova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Migliorati
authors.affiliation: Oral Surgery Departments, Gallarate, Milan, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Amorfini
authors.affiliation: Department of Health Sciences, Section of Biostatistics, Genoa University, Genova, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.affiliation: Orthodontics Department, School of Dentistry, Genoa University, Genova, Italy.
authors.forename: Armando Silvestrini
authors.initials: AS
authors.lastname: Biavati
authors.affiliation: School of Dentistry, Genoa University, Genova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Benedicenti
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001842:Bone and Bones; D002417:Cattle; D003758:Dental Implantation, Endosseous / Q000379:methods*; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000009:adverse effects*; D007558:Italy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013524:Surgical Flaps / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: extraction socket; flapless implant surgery; randomized controlled trial; single-tooth implants; soft tissue grafting