Clinical and Radiographic Assessment of Buccal Bone Changes at Immediate Implants with simultaneous Vascularized Interpositional Periosteal Connective Tissue Grafting versus NO‐grafted Implants: A Randomized Controlled Clinical Trial

Background: Alveolar bone remodeling following extraction could not be prevented by immediate implant placement. Soft tissue augmentaion techniques have been suggested in order to overcome the alterations of buccal bone during remodeling. Nevertheless, it is still inconclusive whether soft tissue augmentation procedures actually have a protective role in preserving buccal bone thickness in immediate implants. Aim/Hypothesis: To clinically and radiographically assess the effect of soft tissue grafting on buccal bone resorption and pink esthetics around immediately placed implants in maxillary anterior teeth after 24 months from implant placement. Materials and Methods: 18 NO-restorable maxillary anterior teeth placed in 18 patients were randomly assigned into 2 groups: (test group) immediately placed implants with simultaneous vascular interpositional periosteal connective tissue (VIP-CT) grafting versus NO-augmented implant sites (control group). Buccal bone changes were assessed at implant placement (0) and at 4,9,12 and 24 months from baseline by specially manufactured device and at 24 months by cone beam computed tomography scans (CBCT). Pink esthetic score (PES) was evaluated at 6, 9, 12 and 24 months intervals. Pain and satisfaction were assessed through questionnaires to the patients Results: Buccal bone resorption as measured by cbct after 24 months at 2 mm from the bony crest showed mean bone loss of 1.55 ± 1.03 at the grafted group and 0.68 ± 0.49 at the NO-augmented group. While when measured with the device showed bone loss of 2.03 ± 1.57 mm for the test group and 1.09 ± 1.3 for the control group. PES was 11.93 ± 2.91 for the test group and 12.63 ± 1.19 for the control group at the final follow-up interval. PES changes over time also showed no significant statistical difference between the 2 groups presenting 0.83 mean difference at 6 months, 0.17 at 9 months, 0.15 at 12 months and 0.7 at the final 24-month follow-up. There was no significant difference in the severity of pain or the satisfaction between both groups. Interestingly, results generally favored no grafting. Conclusions and Clinical Implications: Simultaneous soft tissue grafting with immediate implant placement provided no additional curbing effect regarding buccal bone resorption nor enhancement regarding esthetics. Undisturbed healing with least interventions is encouraged. Keywords: Immediate Implants, Buccal bone, soft tissue augmentation, vascular interpositional periosteal connective tissue graft, esthetics.