Treatment of Implant Labial Soft Tissue Dehiscence with Guided Bone Regeneration vs Subepithelial Connective Tissue Graft. A Randomized Clinical Trial

Background: Implant soft tissue dehiscence is a frequently reported esthetic complication, that more often than not affects the functional integrity of the dental implant with eventual loss of osteointegration. Many treatment modalities with different success rates have been proposed aiming to solve this complication or prolong the survival of the dental implant, of which are guided bone regeneration and soft tissue regeneration around the affected implants. Material and Methods: This prospective study was carried in the hospital of Future University. 11 Patients (1 Male – 10 Females) with 20 Maxillary implant sites demonstrating soft tissue dehiscence were randomly allocated to either a guided bone regeneration (GBR) group (Control) in which patients received a mixture of autogenous and xenogeneic bone graft substitute covered by a native collagen membrane fixated with titanium tacks over the affected implants or a connective tissue graft and coronal flap advancement (CTG + CAF) group (Intervention) in which patients received a de-epithelialized connective tissue graft harvest from the anterio-lateral hard palate combined with a coronally advanced flap. Recession levels were measured at baseline and at 1,3 and 6 months post operatively, while probing depths and bleeding indices were measured at baseline and 6 months post operatively and patient satisfaction levels were recorded through a visual analogue scale (VAS) questionnaire 6 months post operatively after completion of the follow up period. Results: Out of the 11 patients (1 Male – 10 Females) enrolled in this study, no major post-operative complications were encountered, the most common complication was post-operative swelling and edema that usually peaked 48 hours after surgery, which was more evident in the GBR group. Soft tissue recession levels measured from implant platform to gingival margin was significantly higher at baseline in GBR group compared to CTG+CAF group (P=0.042). While there was no significant difference in soft tissue levels between both groups at 1 month (P=0.362), 3 months (P=0.240) and 6 months (P=0.097). There was no statistically significant difference in VAS mean values between GBR and CTG+CAF groups (P=0.510). Conclusion: Based on the results of our study, we concluded that both treatment modalities provided satisfactory and stable results with major improvements in all clinical outcomes after 6 months compared to baseline measurements, however, GBR provided slightly superior clinical outcomes, compared to CTG + CAF