Skip to main content

Advertisement

Log in

Volumetric and linear changes at dental implants following grafting with volume-stable three-dimensional collagen matrices or autogenous connective tissue grafts: 6-month data

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The objective of this study was to test whether or not soft tissue augmentation with a volume-stable collagen matrix (VCMX) leads to similar volume gain around dental implants compared to autogenous subepithelial connective tissue graft (SCTG).

Materials and methods

In 12 adult beagle dogs, immediate implants were placed with simultaneous guided bone regeneration. After 25–45 weeks, soft tissue augmentation was randomly performed using VCMX, SCTG, or a sham-operated control. Impressions were taken pre-op and post-op (tissue augmentation) and again at sacrifice after healing periods of 4, 8, and 24 weeks. They were then digitized to allow for superimposition. Values of linear and volumetric changes were calculated.

Results

The median increase (pre-op to post-op) in buccal volume measured 0.92 mm for VCMX, 1.47 mm for SCTG, and 0.24 mm for SH. The values (pre-op to sacrifice) were − 0.25 mm for VCMX, 0.52 mm for SCTG, and − 0.06 mm for group SH. The median ridge width 2 mm below the crest measured − 0.26 mm for VCMX, 0.53 mm for SCTG, and − 0.15 mm for SH (pre-op to sacrifice).

Conclusions

Volume augmentation using VCMX and SCTG resulted in an increase in ridge dimension (pre- to post-op). During the follow-up, the volume decreased in all three groups to a level close to the situation prior to surgery.

Clinical relevance

Soft tissue volume augmentation around dental implants is usually performed using the patient’s own tissue. This therapy is associated with an increased morbidity due to a second surgical site. Soft tissue volume at implant sites can be augmented using VCMX and SCTG. The gain on top of the ridge appears not to be stable during the follow-up in both groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Cardaropoli G, Araujo M, Lindhe J (2003) Dynamics of bone tissue formation in tooth extraction sites. An experimental study in dogs. J Clin Periodontol 30:809–818

    Article  PubMed  Google Scholar 

  2. Araujo MG, Sukekava F, Wennstrom JL, Lindhe J (2005) Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. J Clin Periodontol 32:645–652. https://doi.org/10.1111/j.1600-051X.2005.00726.x

    Article  PubMed  Google Scholar 

  3. Schropp L, Wenzel A, Kostopoulos L, Karring T (2003) Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restorative Dent 23:313–323

    PubMed  Google Scholar 

  4. Christensen DK, Karoussis IK, Joss A, Hammerle CH, Lang NP (2003) Simultaneous or staged installation with guided bone augmentation of transmucosal titanium implants. A 3-year prospective cohort study. Clin Oral Implants Res 14:680–686

    Article  PubMed  Google Scholar 

  5. Veltri M, Ekestubbe A, Abrahamsson I, Wennstrom JL (2016) Three-dimensional buccal bone anatomy and aesthetic outcome of single dental implants replacing maxillary incisors. Clin Oral Implants Res 27:956–963. https://doi.org/10.1111/clr.12664

    Article  PubMed  Google Scholar 

  6. Thoma DS, Buranawat B, Hammerle CH, Held U, Jung RE (2014) Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. J Clin Periodontol 41(Suppl 15):S77–S91. https://doi.org/10.1111/jcpe.12220

    Article  PubMed  Google Scholar 

  7. Schneider D, Grunder U, Ender A, Hammerle CH, Jung RE (2011) Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study. Clin Oral Implants Res 22:28–37. https://doi.org/10.1111/j.1600-0501.2010.01987.x

    Article  PubMed  Google Scholar 

  8. Langer B, Calagna L (1980) The subepithelial connective tissue graft. J Prosthet Dent 44:363–367

    Article  PubMed  Google Scholar 

  9. Langer B, Calagna LJ (1982) The subepithelial connective tissue graft. A new approach to the enhancement of anterior cosmetics. Int J Periodontics Restorative Dent 2:22–33

    PubMed  Google Scholar 

  10. Pizzo D (2002) The connective tissue graft: a comparative clinical evaluation of wound healing at the palatal donor site. A preliminary study. J Clin Periodontol 29:848–854

    Article  PubMed  Google Scholar 

  11. Jepsen K, Jepsen S, Zucchelli G, Stefanini M, de Sanctis M, Baldini N, Greven B, Heinz B, Wennstrom J, Cassel B, Vignoletti F, Sanz M (2013) Treatment of gingival recession defects with a coronally advanced flap and a xenogeneic collagen matrix: a multicenter randomized clinical trial. J Clin Periodontol 40:82–89. https://doi.org/10.1111/jcpe.12019

    Article  PubMed  Google Scholar 

  12. Schmitt CM, Moest T, Lutz R, Wehrhan F, Neukam FW, Schlegel KA (2016) Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft(R) ) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res 27:e125–e133. https://doi.org/10.1111/clr.12575

    Article  PubMed  Google Scholar 

  13. Pabst AM, Happe A, Callaway A, Ziebart T, Stratul SI, Ackermann M, Konerding MA, Willershausen B, Kasaj A (2014) In vitro and in vivo characterization of porcine acellular dermal matrix for gingival augmentation procedures. J Periodontal Res 49:371–381. https://doi.org/10.1111/jre.12115

    Article  PubMed  Google Scholar 

  14. Wei PC, Laurell L, Geivelis M, Lingen MW, Maddalozzo D (2000) Acellular dermal matrix allografts to achieve increased attached gingiva. Part 1. A clinical study. J Periodontol 71:1297–1305. https://doi.org/10.1902/jop.2000.71.8.1297

    Article  PubMed  Google Scholar 

  15. Rebele SF, Zuhr O, Schneider D, Jung RE, Hurzeler MB (2014) Tunnel technique with connective tissue graft versus coronally advanced flap with enamel matrix derivative for root coverage: a RCT using 3D digital measuring methods. Part II Volumetric studies on healing dynamics and gingival dimensions. J Clin Periodontol 41:593–603. https://doi.org/10.1111/jcpe.12254

    Article  PubMed  Google Scholar 

  16. Thoma DS, Naenni N, Benic GI, Hammerle CH, Jung RE (2017) Soft tissue volume augmentation at dental implant sites using a volume stable three-dimensional collagen matrix—histological outcomes of a preclinical study. J Clin Periodontol 44:185–194. https://doi.org/10.1111/jcpe.12635

    Article  PubMed  Google Scholar 

  17. Thoma DS, Hammerle CHF, Cochran DL, Jones AA, Gorlach C, Uebersax L, Mathes S, Graf-Hausner U, Jung RE (2011) Soft tissue volume augmentation by the use of collagen-based matrices in the dog mandible—a histological analysis. J Clin Periodontol 38:1063–1070. https://doi.org/10.1111/j.1600-051X.2011.01786.x

    Article  PubMed  Google Scholar 

  18. Thoma DS, Jung RE, Schneider D, Cochran DL, Ender A, Jones AA, Gorlach C, Uebersax L, Graf-Hausner U, Hammerle CHF (2010) Soft tissue volume augmentation by the use of collagen-based matrices: a volumetric analysis. J Clin Periodontol 37:659–666. https://doi.org/10.1111/j.1600-051X.2010.01581.x

    Article  PubMed  Google Scholar 

  19. Mathes SH, Wohlwend L, Uebersax L, von Mentlen R, Thoma DS, Jung RE, Gorlach C, Graf-Hausner U (2010) A bioreactor test system to mimic the biological and mechanical environment of oral soft tissues and to evaluate substitutes for connective tissue grafts. Biotechnol Bioeng 107:1029–1039. https://doi.org/10.1002/bit.22893

    Article  PubMed  Google Scholar 

  20. Thoma DS, Zeltner M, Hilbe M, Hammerle CH, Husler J, Jung RE (2016) Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites. J Clin Periodontol 43:874–885. https://doi.org/10.1111/jcpe.12588

    Article  PubMed  Google Scholar 

  21. Boardman N, Darby I, Chen S (2016) A retrospective evaluation of aesthetic outcomes for single-tooth implants in the anterior maxilla. Clin Oral Implants Res 27:443–451. https://doi.org/10.1111/clr.12593

    Article  PubMed  Google Scholar 

  22. Akcalı A, Trullenque-Eriksson A, Sun C, Petrie A, Nibali L and Donos N (2016) What is the effect of soft tissue thickness on crestal bone loss around dental implants? A systematic review. Clin Oral Implants Res

  23. Jung RE, Sailer I, Hammerle C, Attin T, Schmidlin P (2007) In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent 27:251

    PubMed  Google Scholar 

  24. Mir-Mari J, Benic GI, Valmaseda-Castellon E, Hammerle CH and Jung RE (2016) Influence of wound closure on the volume stability of particulate and non-particulate GBR materials: an in vitro cone-beam computed tomographic examination. Part II. Clin Oral Implants Res doi: https://doi.org/10.1111/clr.12845

  25. Mir-Mari J, Wui H, Jung RE, Hammerle CH, Benic GI (2016) Influence of blinded wound closure on the volume stability of different GBR materials: an in vitro cone-beam computed tomographic examination. Clin Oral Implants Res 27:258–265. https://doi.org/10.1111/clr.12590

    Article  PubMed  Google Scholar 

  26. Harris RJ (2003) Histologic evaluation of connective tissue grafts in humans. Int J Periodontics Restorative Dent 23:575–583

    PubMed  Google Scholar 

  27. Studer SP, Lehner C, Bucher A, Scharer P (2000) Soft tissue correction of a single-tooth pontic space: a comparative quantitative volume assessment. J Prosthet Dent 83:402–411

    Article  PubMed  Google Scholar 

  28. Rotenberg SA, Tatakis DN (2014) Dimensional changes during early healing after a subepithelial connective tissue graft procedure. J Periodontol 85:884–889. https://doi.org/10.1902/jop.2013.130478

    Article  PubMed  Google Scholar 

  29. Kolerman R, Nissan J, Rahmanov A, Zenziper E, Slutzkey S, Tal H (2016) Radiological and biological assessment of immediately restored anterior maxillary implants combined with GBR and free connective tissue graft. Clin Implant Dent Relat Res 18:1142–1152. https://doi.org/10.1111/cid.12417

    Article  PubMed  Google Scholar 

  30. Clementini M, Tiravia L, De Risi V, Vittorini Orgeas G, Mannocci A, de Sanctis M (2015) Dimensional changes after immediate implant placement with or without simultaneous regenerative procedures: a systematic review and meta-analysis. J Clin Periodontol 42:666–677. https://doi.org/10.1111/jcpe.12423

    Article  PubMed  Google Scholar 

  31. Chen ST, Buser D (2014) Esthetic outcomes following immediate and early implant placement in the anterior maxilla—a systematic review. Int J Oral Maxillofac Implants 29:186–215. 10.11607/jomi.2014suppl.g3.3

    Article  PubMed  Google Scholar 

  32. Benic GI, Mokti M, Chen CJ, Weber HP, Hämmerle CH, Gallucci GO (2012) Dimensions of buccal bone and mucosa at immediately placed implants after 7 years: a clinical and cone beam computed tomography study. Clin Oral Implants Res 23:560–566

    Article  PubMed  Google Scholar 

  33. Kuchler U, Chappuis V, Gruber R, Lang NP, Salvi GE (2016) Immediate implant placement with simultaneous guided bone regeneration in the esthetic zone: 10-year clinical and radiographic outcomes. Clin Oral Implants Res 27:253–257

    Article  PubMed  Google Scholar 

  34. Fickl S, Kebschull M, Schupbach P, Zuhr O, Schlagenhauf U, Hürzeler MB (2011) Bone loss after full-thickness and partial-thickness flap elevation. J Clin Periodontol 38:157–162

    Article  PubMed  Google Scholar 

  35. Rubin CT, Lanyon LE (1985) Regulation of bone mass by mechanical strain magnitude. Calcif Tissue Int 37:411–417

    Article  PubMed  Google Scholar 

  36. Rubin CT, Lanyon L (1984) Regulation of bone formation by applied dynamic loads. J Bone Joint Surg Am 66:397–402

    Article  PubMed  Google Scholar 

  37. Schmitt CM, Matta RE, Moest T, Humann J, Gammel L, Neukam FW, Schlegel KA (2016) Soft tissue volume alterations after connective tissue grafting at teeth: the subepithelial autologous connective tissue graft versus a porcine collagen matrix—a pre-clinical volumetric analysis. J Clin Periodontol 43:609–617. https://doi.org/10.1111/jcpe.12547

    Article  PubMed  Google Scholar 

  38. Schwarz F, Sahm N, Becker J (2014) Combined surgical therapy of advanced peri-implantitis lesions with concomitant soft tissue volume augmentation. A case series. Clin Oral Implants Res 25:132–136. https://doi.org/10.1111/clr.12103

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to express thanks to the team of Biomatech Namsa, Lyon, France, for excellent support in animal care and housing. The support and expertise of Sibylle Huber, Geistlich Pharma AG, Wolhusen, Switzerland, is highly acknowledged. The help of Gisela Müller, study monitor at the Clinic for Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, is highly appreciated.

Funding

The study was supported by a research grant of Geistlich Pharma AG, Wolhusen, Switzerland.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Daniel S. Thoma.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

Informed consent

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naenni, N., Bienz, S.P., Benic, G.I. et al. Volumetric and linear changes at dental implants following grafting with volume-stable three-dimensional collagen matrices or autogenous connective tissue grafts: 6-month data. Clin Oral Invest 22, 1185–1195 (2018). https://doi.org/10.1007/s00784-017-2210-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-017-2210-3

Keywords

Navigation