title: Increasing volume of vestibular soft tissues in flapless implant surgery through a modified connective punch technique: a controlled clinical trial.
abstract: The aim of this article is to make a comparative assessment between the modification of the soft-tissue profile, around the healing cap screws (HCSs), following both the traditional flapless surgery (TFS) and a new modified flapless surgery, named Modified Connective Tissue Punch (MCTP) technique.
  
  
  
  8 patients (3M and 5F) (mean age 54.25±11.247 years) were enrolled in this study. Sixteen two-piece implants were placed on upper jaws, 2 for each patient, 8 with TFS and 8 with MCTP technique. In each patient the implants were placed in edentulous areas, of 2 or 3 adjacent teeth long. MCTP technique was performed on the front implant site (FIS) while the TFS was performed on the rear implant site (RIS). All implants were inserted and covered with healing cap screws (HCSs). Alginate impressions were carried out at the moment of the surgery, at 1 month and 4 months post-operative. Plaster models were poured and subsequently digitally scanned, in order to measure the distance between the gingival outline and the free margin of the HCS. The recorded values were analyzed with the ANOVA test.
  
  
  
  The use of MTCP technique, in comparison to TFS, showed a significative better outcome, in terms of vertical increments, of gingiva, on the VS toward the HCSs, during the entire observation period (p = 0.000 for all).
  
  
  
  The Authors recommend the use of MCTP technique for a better vestibular soft tissue outcome in flapless implant surgery.
authors.affiliation: Private practice, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Andreasi Bassi
authors.affiliation: Private practice, Matera, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Andrisani
authors.affiliation: Private practice, Olevano Romano, (Rome), Italy.
authors.forename: S
authors.initials: S
authors.lastname: Lico
authors.affiliation: Departimento de Estomatologia, University of Valencia, Valencia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Silvestre
authors.affiliation: Department of Clinical Sciences and Translational Medicine, University of "Tor Vergata", Rome, Italy. Department of dentistry "Fra G.B. Orsenigo - Ospedale San Pietro F.B.F.", Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gargari
authors.affiliation: Department of Clinical Sciences and Translational Medicine, University of "Tor Vergata", Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Arcuri
keywords: creeping attachment; flapless surgery; gingival keratinized tissue; gingival thickness; soft-tissue profile