title: Treatment of Labial Soft Tissue Recession Around Dental Implants in the Esthetic Zone Using Guided Bone Regeneration With Mineralized Allograft: A Retrospective Clinical Case Series.
abstract: OBJECTIVE
  Soft tissue augmentation procedures are often performed to correct gingival recession on the facial aspects of implants in the esthetic zone. This retrospective clinical case series reports on the use of guided bone regeneration (GBR) and a coronal advancement flap with a resorbable membrane and allograft.
  
  
  METHODS
  We analyzed the records of 14 patients (7 men and 7 women) with a mean age of 36.78 years (SD, 13.9 years) who were treated for soft tissue recessions around implant-supported restorations in the maxillary central or lateral incisor location. Implant diameters ranged from 3.3 to 4.7 mm. All patients had bone loss confined to the labial surface of the implant. A solvent-dehydrated particulate mineralized allograft (Puros Cancellous Bone Allograft; Zimmer Biomet Dental, Palm Beach Gardens, FL) and a resorbable membrane (CopiOs Pericardium; Zimmer Biomet Dental) were used in a GBR surgical procedure in combination with a roughened titanium tenting screw placed 3 to 4 mm below the implant platform to restore unesthetic defects in the anterior maxilla.
  
  
  RESULTS
  All postoperative tissue changes from their preoperative states were statistically significant (P < .05, Wilcoxon signed rank test). Mean preoperative crestal bone thickness (measured 2 mm from crest) and mid-implant buccal bone thickness increased by 1.84 mm (SD, 0.89 mm; 95% confidence interval [CI], 1.32 to 2.35 mm) and 2.07 mm (SD, 0.81 mm; 95% CI, 1.60 to 2.53 mm), respectively, approximately 1 year after treatment (P < .001). Significant mean increases of 1.28 mm (SD, 0.53 mm; 95% CI, 0.97 to 1.58 mm), 1.29 mm (SD, 0.81 mm; 95% CI, 0.82 to 1.75 mm) and 1.23 mm (SD, 0.53 mm; 95% CI, 0.92 to 1.53 mm) also were noted in soft tissue thickness, keratinized tissue width, and gingival height, respectively (P < .001).
  
  
  CONCLUSIONS
  Use of the allograft and xenogeneic membrane effectively increased alveolar hard and soft tissue dimensions in the esthetic zone of the anterior maxilla. Future prospective clinical trials with a control group are needed to compare this technique with conventional methods such as connective tissue graft.
authors.affiliation: Clinical Associate Professor, Department of Oral & Maxillofacial Surgery, Herman Ostrow School of Dentistry of USC, Los Angeles County/USC Medical Center, Los Angeles, CA; and Private Practice in Oral and Maxillofacial Surgery, Whittier, CA. Electronic address: leb97201@yahoo.com.
authors.forename: Bach
authors.initials: B
authors.lastname: Le
authors.affiliation: Associate Clinical Teacher, Warwick Medical School, University of Warwick, Coventry, UK; and Visiting Professor (Orthodontics), Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Ali
authors.initials: A
authors.lastname: Borzabadi-Farahani
authors.affiliation: Resident, Department of Oral & Maxillofacial Surgery, Herman Ostrow School of Dentistry of USC, Los Angeles County/USC Medical Center, Los Angeles, CA.
authors.forename: Brady
authors.initials: B
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D064591:Allografts; D016025:Bone Transplantation / Q000379:methods*; D015921:Dental Implants / Q000009:adverse effects*; D005260:Female; D005889:Gingival Recession / Q000209:etiology* / Q000628:therapy*; D048091:Guided Tissue Regeneration / Q000379:methods*; D006801:Humans; D007180:Incisor; D008297:Male; D008437:Maxilla; D008567:Membranes, Artificial; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants; D008567:Membranes, Artificial