Clinical Evaluation of Soft Tissue Augmentation Using Connective Tissue Graft and Platelet Rich Fibrin Around Immediately Placed Dental Implants Versus Immediate Implant Alone in Esthetic Zone

• The primary objective Evaluation of connective tissue graft and platelet rich fibrin combined with immediate implant placement as an innovative option for more pink esthetic score, versus immediate implant alone.
• The secondary objective Evaluation of patient satisfaction, width of keratinized mucosa, crestal bone level after the use of platelet rich fibrin and connective tissue graft combined with immediate implant versus immediate implant alone.

8. Trial design:

• A Randomized clinical trial.
• Uni center: A trial will be carried out in one hospital.
• Equal randomization: participants with equal probabilities for intervention.
• Positive controlled: Both groups receiving treatment.
• Parallel group study: Each group of patients receives a single treatment simultaneously.
• Two assessors will assess the result (1st Assessor Perryhan.M.) & (2nd Assessor Nada Farouk)

Methods: Participants, interventions, and outcomes 9. Study setting: This study will be carried out on patients attending outpatient clinics in Oral Medicine, Diagnosis and Periodontology Department- Faculty of Dentistry Cairo University-Egypt. Post graduate Periodontology clinic 1st floor old section. Sirona dental units with LED light.

Preoperative measures (for both groups):

• Phase I therapy (Supragingival scaling, subgingival debridement and oral hygiene instructions) should apply for the two groups before any surgical procedures.
• 4 weeks later both groups will be examined to determine patient compliance with oral hygiene procedures (tooth brushing twice daily and chlorhexidine HCL 1.25% mouthwash* twice daily).
• Radiographic measurements for marginal bone changes will be performed at baseline ( time of implant placement), three months and six months after implant placement or crown construction. Intra oral periapical radiographs performed with paralleling technique will facilitate bone level measurement on distal and mesial aspects of the implant . The highest coronal area of healing abutment will be recorded as a static reference line.
• Width of keratinized mucosa measured at the line of mucogingival junction to the groove of free gingiva by Williams graduated periodontal probe 1 using the roll technique.
• Ttissue biotype measured after anasthesia application and percing the keratinized gingiva perpendicular to the tooth against the alveolar bone. using Williams graduated periodontal probe .
• Crestal bone level at the mesial and distal side of each implant was measured with using Kodak D speed films with a reference point before and after the surgical procedure.
• Study casts for case study will be fabricated.