Single Implants in the Maxillary Esthetic Zone With or Without Connective Tissue Grafting: 4-Year Follow-up

To assess the impact of a subepithelial connective tissue graft (CTG) on soft tissue volume and esthetics around implants placed in esthetically important areas over a 4-year period.

A total of 42 participants were divided into two groups: (1) implant and CTG (implant + CTG) (n = 20) and (2) implant only (n = 22). Both groups were evaluated after 48 months using various clinical and radiographic parameters, professional esthetic assessment, patientcentered esthetic evaluation, and quality of life improvement measured by the Oral Health Impact Profile questionnaire with 14 questions (OHIP-14) at 12 and 48 months.

A total of 8 patients were lost to follow-up, leaving 34 patients for evaluation. Intragroup comparison was performed for the following variables: tissue thickness at the buccal aspect (TTb), keratinized tissue width (KTW), and buccal defect (BD). All intragroup comparisons showed no statistical difference (P > .05) in the evaluated periods. However, for proximal bone resorption (PBR), a statistical difference was observed (P < .05). In the intergroup comparison, statistical differences (P < .05) were observed in the variables TTb and BD in the two evaluated periods (12 and 48 months). In the analysis of Pink Esthetic Score/White Esthetic Score (PES/WES) and Jemt index, there were no differences between or within groups in the evaluated periods. Regarding patient-centered measures, there was no difference between the groups in terms of esthetics (visual analog scale), but for OHIP-14, there was an intragroup difference in both groups between 12 and 48 months.

The association of a CTG with dental implants in esthetic areas after a 48-month follow-up led to an increase in TTb; therefore, connective tissue grafting is indicated. However, there were no improvements in BD, PBR, or PES/WES over time. Esthetics and quality of life were similar between the two groups at 4 years posttreatment.