Currently, private practice, Racine, WI; previously, University of Iowa College of Dentistry, Department of Periodomtics, Iowa City, IA.
University of Iowa College of Dentistry, Department of Periodontics.
J Periodontol. 2018 Jul;89(7):807-814. doi: 10.1002/JPER.17-0597. Epub 2018 Jul 20.
Current evidence supports the positive effect of adequate peri-implant mucosal thickness (PMT) on both marginal bone level stability and esthetic outcomes. While the subepithelial connective tissue graft (sCTG) has been traditionally considered as the gold standard for peri-implant mucosal augmentation, acellular dermal matrix (ADM) may be a valid alternative. The primary aim of this randomized clinical trial was to determine the clinical efficacy of ADM in the augmentation of PMT as compared to an autologous sCTG.
Patients who could benefit from peri-implant mucosal augmentation at the time of implant placement were recruited. Participants were randomized to the control (simultaneous sCTG) or test (simultaneous ADM) group. The primary outcome in this study was changes in PMT between baseline and 16 weeks later. Keratinized mucosal width (KMW) changes, modified wound healing index (MWHI) variations and patient-reported outcome measures (PROMs) were recorded, as well.
A total of 20 participants were recruited per an a priori power analysis. There were no statistically significant differences between groups at baseline for any of the parameters analyzed. The gain in PMT at 1 mm, 3 mm, and 5 mm from the expected mucosal margin was 0.44 ± 2.04 mm, 1.20 ± 1.48 mm, and 1.20 ± 0.89 mm in the sCTG group, and 0.05 ± 1.57 mm, 0.85 ± 1.29 mm, and 1.45 ± 1.17 mm in the ADM group. No statistically significant differences in terms of PMT, KMW, and MWHI changes were observed between groups. The perceived discomfort was higher at 2 and 4 weeks for patients in the sCTG group.
ADM produces similar outcomes to sCTG in terms of mucosal augmentation at the time of implant placement.
现有证据支持足够的种植体周围黏膜厚度（PMT）对边缘骨水平稳定性和美学效果均有积极影响。虽然黏膜下结缔组织移植（sCTG）一直被认为是种植体周围黏膜增量的金标准，但去细胞真皮基质（ADM）可能是一种有效的替代方法。本随机临床试验的主要目的是确定 ADM 在增加 PMT 方面与自体 sCTG 相比的临床疗效。
招募了在种植体放置时受益于种植体周围黏膜增量的患者。参与者被随机分配到对照组（同期 sCTG）或试验组（同期 ADM）。本研究的主要结局是在基线和 16 周后 PMT 的变化。还记录了角化黏膜宽度（KMW）的变化、改良愈合指数（MWHI）的变化和患者报告的结果测量（PROMs）。
根据预先进行的功效分析，每个组均招募了 20 名参与者。在任何分析的参数方面，两组在基线时均无统计学差异。sCTG 组在距预期黏膜边缘 1mm、3mm 和 5mm 处 PMT 的增加量分别为 0.44±2.04mm、1.20±1.48mm 和 1.20±0.89mm，ADM 组分别为 0.05±1.57mm、0.85±1.29mm 和 1.45±1.17mm。两组间 PMT、KMW 和 MWHI 的变化无统计学差异。sCTG 组患者在第 2 周和第 4 周时的不适感更高。
ADM 在种植体放置时进行黏膜增量的效果与 sCTG 相似。
