Horizontal stability of connective tissue grafts at the buccal aspect of single implants: a 1‐year prospective case series

Aim To clinically evaluate the horizontal stability of a connective tissue graft ( CTG ) at the buccal aspect of single implants (1); to compare actual gingival thickness between thin and thick gingival biotype (2). Materials and Methods Periodontally healthy non‐smoking patients with a single implant in the anterior maxilla (15–25) were selected for a prospective case series. All demonstrated a horizontal alveolar defect and were in need of contour augmentation by means of CTG for aesthetic reasons. Patients were enrolled 3 months after implant surgery and had been provided with a provisional screw‐retained crown. CTG was inserted in the buccal mucosa via the envelope technique using one intrasulcular incision. An ultrasonic device was used to evaluate mucosal thickness ( MT ) at the buccal aspect. MT was assessed at t0 (before CTG ), t1 (immediately after CTG ), t2 (2 weeks after CTG  = suture removal), t3 (3 months after CTG  = permanent crown installation) and t4 (1 year after implant placement). The gingival biotype was categorized as thin or thick based on the transparency of a periodontal probe through the soft tissues while probing the buccal sulcus of the contra‐lateral tooth. Gingival thickness ( GT ) was measured at the contra‐lateral tooth using the same ultrasonic device. Results Thirty‐seven patients (19 men, 18 women; mean age 38) met the selection criteria and consented to the treatment. Mean soft tissue gain immediately after CTG was on average 1.07 mm ( SD 0.49). What remained of this tissue gain after 1 year was on average 0.97 mm ( SD 0.48; 90.5%). Hence, mean soft tissue loss amounted to 0.10 mm ( SD 0.23; 9.5%; p  = 0.015) with no significant difference between patients with a thin or thick biotype ( p  ≥ 0.290). Patients with a thin biotype had a mean GT of 1.02 mm ( SD 0.21), whereas GT was on average 1.32 mm ( SD 0.31) in subjects with a thick biotype ( p  = 0.004). Conclusion Connective tissue graft substantially thickens the peri‐implant mucosa with acceptable stability over a 1‐year period.