Evaluation of Peri-implant Soft Tissue Thickness Following Augmentation Using Subepithelial Connective Tissue Graft Versus Submerged Tenting Abutment Versus Sub-crestal Implant Placement: A Randomized Controlled Clinical Trial
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Change in Peri-implant Soft Tissue Thickness
研究概览
简要总结
Peri-implant soft tissue thickness is an important determinant of the long-term stability and success of dental implants. Patients with a thin peri-implant soft tissue phenotype are at increased risk of soft tissue recession, marginal bone loss, and compromised esthetic and functional outcomes. Subepithelial connective tissue graft (SCTG) is considered the gold standard for soft tissue augmentation; however, it requires harvesting tissue from the palate, increasing surgical complexity, operative time, and postoperative morbidity. Less invasive approaches, including submerged tenting abutments and subcrestal implant placement, have been proposed as alternatives to improve peri-implant soft tissue dimensions while reducing patient morbidity, but direct comparative clinical evidence remains limited.
This investigator-initiated, single-center, randomized, parallel-group clinical trial will compare three approaches for peri-implant soft tissue augmentation in patients with a thin peri-implant soft tissue phenotype requiring a single dental implant in the posterior mandible. Eligible implant sites will be randomly assigned in a 1:1:1 allocation ratio to receive either subepithelial connective tissue grafting, submerged tenting abutment placement, or subcrestal implant placement during implant surgery.
The primary objective is to compare changes in peri-implant soft tissue thickness using three-dimensional digital intraoral scanning over a 12-month follow-up period. Secondary objectives include evaluation of keratinized tissue width, clinical soft tissue thickness, histological characteristics of peri-implant soft tissue, peri-implant crestal bone level changes, postoperative pain, operative time, patient-reported satisfaction, and postoperative complications. The results of this study are expected to provide evidence regarding whether minimally invasive treatment approaches can achieve clinical outcomes comparable to connective tissue grafting while reducing surgical morbidity and improving patient-centered outcomes.
详细描述
Peri-implant soft tissue thickness is a critical factor influencing the biological stability, function, and long-term success of dental implant therapy. A thin peri-implant soft tissue phenotype has been associated with increased marginal bone remodeling, soft tissue recession, and compromised peri-implant tissue stability. Consequently, augmentation of peri-implant soft tissues has become an important component of implant treatment planning, particularly in patients with thin soft tissue phenotypes.
Subepithelial connective tissue grafting (SCTG) is widely regarded as the reference standard for peri-implant soft tissue augmentation because of its predictable ability to increase tissue volume and improve peri-implant tissue stability. Nevertheless, harvesting autogenous connective tissue from the palate increases operative time, donor-site morbidity, postoperative discomfort, and surgical complexity. These limitations have encouraged the development of less invasive techniques capable of enhancing peri-implant soft tissue dimensions while minimizing patient morbidity.
Submerged tenting abutments have recently been introduced as a minimally invasive method for maintaining soft tissue space during submerged healing following implant placement. By supporting the overlying soft tissues throughout the healing phase, these abutments may promote increased soft tissue thickness without the need for connective tissue harvesting. Although preliminary clinical reports have shown encouraging outcomes, direct comparisons with connective tissue grafting remain limited.
Subcrestal implant placement has also been proposed as an alternative method for improving peri-implant soft tissue dimensions. Positioning the implant platform approximately 2 mm below the alveolar crest may increase the vertical dimension of peri-implant soft tissues without requiring grafting procedures or additional prosthetic components. While this technique has demonstrated favorable biological behavior in previous studies, evidence directly comparing it with connective tissue grafting and submerged tenting abutments remains scarce.
Advances in digital intraoral scanning have enabled accurate, reproducible, and non-invasive three-dimensional assessment of peri-implant soft tissue changes over time. Digital volumetric analysis provides objective measurements while reducing operator-dependent variability associated with conventional clinical measurements. Combining digital assessment with clinical, radiographic, histological, and patient-reported outcomes provides a comprehensive evaluation of treatment effectiveness.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
盲法说明
Blinding of participants and the operating surgeon is not feasible because of the nature of the surgical interventions. Outcome assessors responsible for clinical, digital, radiographic, and histological measurements will remain blinded to treatment allocation. Statistical analysis will also be performed by a blinded biostatistician.
入排标准
- 年龄范围
- 20 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adults aged 20 years or older.
- •Partially edentulous patients requiring a single dental implant in the posterior mandible.
- •Thin peri-implant soft tissue phenotype (<2 mm).
- •Horizontal alveolar ridge width of at least 6 mm.
- •Vertical bone height of at least 10-12 mm, confirmed radiographically.
- •Adequate interarch restorative space for implant-supported restoration.
- •Medically healthy (American Society of Anesthesiologists [ASA] Physical Status I or II).
- •Good oral hygiene.
- •Able and willing to provide written informed consent.
排除标准
- •Local pathological lesions affecting the surgical site.
- •Pregnancy or breastfeeding.
- •Alcohol abuse or parafunctional habits that may compromise implant survival or wound healing.
- •Medical or local conditions that could interfere with osseointegration, soft tissue healing, or study participation
研究组 & 干预措施
Subepithelial Connective Tissue Graft (SCTG)
Participants assigned to this arm will receive equi-crestal dental implant placement followed by augmentation of the peri-implant soft tissue using an autogenous subepithelial connective tissue graft harvested from the palate. The graft will be positioned over the implant site to increase peri-implant soft tissue thickness before primary flap closure.
干预措施: subepithelial connective tissue graft (Procedure)
Submerged Tenting Abutment
Participants assigned to this arm will receive equicrestal dental implant placement followed by placement of a submerged low-profile tenting healing abutment beneath the flap to support peri-implant soft tissue contour during healing without connective tissue grafting.
干预措施: Submerged Tenting Abutment (Device)
Subcrestal Implant Placement
Participants assigned to this arm will receive dental implant placement approximately 2 mm below the alveolar crest without connective tissue grafting or placement of a submerged tenting abutment.
干预措施: Sub-crestal Implant Placement (Procedure)
结局指标
主要结局
Change in Peri-implant Soft Tissue Thickness
时间窗: Baseline, 3 months, 6 months, and 12 months after implant placement.
Change in peri-implant soft tissue thickness from baseline measured using three-dimensional digital intraoral scanning (Medit Intraoral Scanner) and digital volumetric analysis (Medit Design software). Measurements will be performed by blinded outcome assessors and expressed in millimeters (mm).
次要结局
- Histological Characteristics of Peri-implant Soft Tissue(3 months)
- Clinical Peri-implant Soft Tissue Thickness(Baseline, 3 months, 6 months, and 12 months)
- Peri-implant Crestal Bone Level Changes(Baseline, 3 months, 6 months, and 12 months)
- Width of Keratinized Tissue(Baseline, 3 months, 6 months, and 12 months)
- Postoperative Pain(Daily during the first 10 postoperative days)