[Facial contour alterations following immediate implant placement and provisionallization with definite abutment with...

Objective: To evaluate the effects of combining a connective tissue graft (CTG) with immediate implant placement and provisionalization (IIPP) on facial soft tissue contour and alveolar bone remodeling using 3-dimensional quantitative analysis, aiming to provide a clinical reference for decision-making. Methods: This prospective, randomized controlled clinical trial enrolled 31 patients requiring a single immediate implant in the anterior maxilla based on strict inclusion and exclusion criteria. The patients were assigned to the experimental group (n=19, receiving IIPP combined with a CTG harvested from the palate) or the control group (n=12, receiving IIPP alone) and followed up for 12 months. Cone-beam CT and intraoral scanning data were collected and standardized. Evaluation indicators included implant survival rate, complications, horizontal facial bone thickness, vertical facial bone height, vertical changes for gingival margin, vertical changes for mesial and distal papilla height, horizontal changes for facial contour, and pink esthetic score. Statistical analysis was performed. Results: No implant failure occurred in either group during the 12-month follow-up. Regarding bone parameters, at the implant shoulder level (0 mm), the loss of horizontal bone thickness [(1.90±1.19) mm vs. (0.95±0.89) mm] and the reduction in vertical bone height [(1.57±1.08) mm vs. (0.76±0.25) mm] were significantly higher in the experimental group than in the control group (P>0.05). However, no significant differences in bone remodeling were observed between the two groups in the region 1-10 mm apical to the implant platform (all P>0.05). Regarding soft tissue parameters, the facial contour collapse at 0, 1, and 2 mm from the implant shoulder [(0.11±0.43), (0.05±0.44), (0.06±0.59) mm, respectively] and the gingival margin recession [(0.15±0.85) mm] in the experimental group were significantly lower than those in the control group [(0.49±0.17), (0.38±0.16), (0.54±0.43), (0.92±0.84) mm, respectively] (all P>0.05). No significant differences were found between the two groups regarding facial contour changes at -1 and -2 mm from the implant shoulder, or in mesial/distal papilla recession (all P>0.05). Conclusions: Alterations in facial contour and bone tissue were observed in both groups during the 12-month follow-up. The combined use of CTG, IIPP, and customized definitive abutments compensated for facial soft tissue collapse and stabilized gingival height, but failed to maintain the facial alveolar ridge crest bone within 12 months.