Coronally advanced flap versus tunnel technique for the treatment of peri‐implant soft tissue dehiscences with the connective tissue graft: A randomized, controlled clinical trial

• Published in: Journal of clinical periodontology Vol. 50; no. 7; pp. 980 - 995
• Main Authors: Tavelli, Lorenzo, Majzoub, Jad, Kauffmann, Frederic, Rodriguez, Maria Vera, Mancini, Leonardo, Chan, Hsun‐Liang, Kripfgans, Oliver D., Giannobile, William V., Wang, Hom‐Lay, Barootchi, Shayan
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-07-2023
• Subjects: Aesthetics; complication; Connective tissue; Connective Tissue - transplantation; Connective tissues; dental implant; Dental implants; Esthetics, Dental; Gingiva - surgery; Gingival Recession - surgery; Humans; Patients; recession; Skin & tissue grafts; soft tissue augmentation; Tooth Root - surgery; Transplants & implants; Treatment Outcome; ultrasonography; soft tissue augmentation; complication; ultrasonography; dental implant; recession
• ISSN: 0303-6979; 1600-051X
• DOI: 10.1111/jcpe.13806

Aim
To evaluate the efficacy of coronally advanced flap (CAF) versus tunnel technique (TUN) in covering isolated mid‐facial peri‐implant soft tissue dehiscences (PSTDs).
Materials and Methods
Twenty‐eight participants presenting with isolated non‐molar implants exhibiting PSTDs were enrolled and randomized to receive either CAF or TUN, both with a connective tissue graft (CTG). The primary outcome of the study was the percentage of mean PSTD coverage at 12 months. Secondary endpoints included the frequency of complete PSTD coverage, changes in keratinized mucosa width (KMW) and horizontal mucosal thickness (MT), as assessed with transgingival probing, 3D optical scanning and ultrasonography, professional aesthetic evaluation and patient‐reported outcome measures (PROMs).
Results
At 12 months, the mean PSTD coverage of the CAF and TUN groups was 90.23% and 59.76%, respectively (p = .03). CAF‐treated sites showed a substantially higher frequency of complete PSTD coverage (p = .07), together with significantly greater gain of KMW (p = .01), increase in MT (p = .02), volumetric gain (p < .01) and professional aesthetic outcomes (p = .01). Both interventions showed an improvement in patient‐reported aesthetics and a reduction of the anxiety related to the appearance of the implant compared to baseline, with the CAF group obtaining significantly higher scores (p = .03 for both PROMs).
Conclusions
CAF + CTG resulted in superior PSTD coverage outcomes, greater gain in KMW and MT, and better PROMs than TUN + CTG for the treatment of isolated PSTDs (ClinicalTrials.gov NCT03498911).