Comprehensive Alveolar and Tooth Esthetic Replacement

Recent studies suggest a positive association between the volume of the peri-implant mucosa surrounding a dental implant. A soft allograft (e.g., PerioDerm®) has been advocated to increase mucosa volume avoiding autogenous soft tissue grafting morbidity. However, the evidence supporting this is limited and inadequately controlled, and prospective trials are lacking. This study evaluates whether including an allograft during implant therapy improves the implant's health and appearance. Thirty-nine patients needing a single implant placement were recruited and enrolled in the study. Patients were randomized into test and control groups to receive or not a Perioderm when the implant was placed. This was done following a fully digital and completely guided protocol by Immediate smile by Dentsply Sirona implants. In the test group, patients (19) received the Perioderm at the implant placement appointment, while the control group (20) was left free of graft at implant placement. OHIP-14 questionnaire was asked to be answered before implant placement and then re-done one year after treatment. Intraoral scans of the complete arch were taken with a Trios 3 intraoral scanner before implant placement, at definitive crown delivery, and a year after implant placement. Then, STL files were used and merged to compare horizontal and vertical longitudinal changes in buccal tissue contours at the implant site at the gingival margin, and 1 mm, 2 mm, and 3 mm away from the G.M. Comparisons were made using Geomagic Control X 2020, 3D systems software. Graft dimensional measurements were taken by comparing the pre-treatment STL with implant crown delivery STL, as well as the comparison between delivery date STL and one-year post-surgery STL. Horizontal longitudinal measurements between groups when comparing STL before implant placement and STL after delivery of definitive crown were calculated, and independent t-test resulted in a P=0.34 at G.M, 0.20 at 1 mm from G.M, 0.13 at 2 mm from G.M. and 0.56 at 3 mm from G.M . Horizontal longitudinal measurements between post-treatment and one-year follow-up post-treatment, Independent t-test resulted in p values: 0.23 at the Gingival margin, 0.79 at 1 mm from the G.M, 0.32 at 2 mm from the G.M, and 0.56 at 3 mm from the G.M. Results describe nonsignificant differences between groups. Vertical measurements assessed the vertical changes within STL at the time of delivery and one-year follow-up. The mean result for the test group was 0.18 mm, and for the control group was 0.16 gain in vertical height of the G.M. An Independent t-test was performed, and the p-value was 0.77. The results are not statistically significant. However, both groups seem to have vertical gain over a one-year follow-up. OHIP-14 Results in patients demonstrate a positive impact on their OHQoL regardless of the use of graft, with an average total score of the test group of 2.47 after the 1-year follow-up after treatment. However, these low scores indicate that all patients have an excellent OHQo, and the differences were not statistically significant ( p = 0.11). The findings suggest that there is a similar longitudinal dimensional change when performing allograft at the time of implant placement. However, allograft uses at implant placement are still a promising option to ensure favorable gingival contours around dental implant.