Faculty of Medicine and Health Sciences, Oral Health Sciences, Department of Periodontology and Oral Implantology, Ghent University, Ghent, Belgium.
Faculty of Medicine and Pharmacy, Oral Health Research Group (ORHE), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
J Clin Periodontol. 2021 Dec;48(12):1502-1515. doi: 10.1111/jcpe.13560. Epub 2021 Oct 12.
To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of changes over time in buccal soft tissue profile (BSP) when applied at single implant sites.
Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi-centre randomized controlled trial. All sites had a bucco-palatal bone dimension of at least 6 mm and received a single implant and immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX: Geistlich Fibro-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) to increase buccal soft tissue thickness. Primary outcome was increase in BSP at T1 (immediately after operation) and T2 (3 months) based on superimposed digital surface models. Secondary parameters included patient-reported clinical and aesthetic outcomes.
Thirty patients were included per group (control: 50% females, mean age 50; test: 53% females, mean age 48). Even though surgeons applied thicker grafts when using CMX, sites treated with CMX demonstrated 0.78 mm (95% CI 0.41-1.14) more shrinkage between T1 and T2 than sites treated with CTG. The final increase in BSP was 1.15 mm (95% CI 0.88-1.43) for CTG and 0.85 mm (95% CI 0.58-1.13) for CMX. The mean difference of 0.30 mm (95% CI -0.01 to 0.61) at T2 in favour of CTG was of borderline significance (p = .054). There were no significant differences between the groups in terms of post-operative bleeding (p = .344), pain (p = .331), number of analgesics taken (p = .504), oedema (p = .227), and pink aesthetic score (p = .655). VAS for post-operative haematoma was 6.56 (95% CI 0.54-12.59) lower for CMX, and surgery time could be reduced by 9.03 min (95% CI 7.04-11.03) when applying CMX. However, CMX resulted in significantly more marginal bone loss (0.38 mm; 95% CI 0.15-0.60), deeper pockets (0.30 mm; 95% CI 0.06-0.54), and more mid-facial recession (0.75 mm; 95% CI 0.39-1.12) than CTG.
CTG remains the gold standard for increasing soft tissue thickness at the buccal aspect of implants.
比较在单个种植体部位应用时，结缔组织移植物（CTG）和胶原基质（CMX）在颊侧软组织轮廓（BSP）随时间变化方面的差异。
本多中心随机对照试验纳入了上颌前牙有单个牙间隙和水平黏膜缺损的患者。所有位点的颊腭向骨宽度均至少为 6mm，并采用全数字化工作流程接受单个种植体和即刻种植体修复。将所有位点随机分配到对照组（CTG）或试验组（CMX：Geistlich Fibro-Gide®，Geistlich Pharma AG，Wolhusen，瑞士）以增加颊侧软组织厚度。主要结局为根据叠加数字表面模型，在 T1（术后即刻）和 T2（3 个月）时 BSP 的增加量。次要参数包括患者报告的临床和美学结果。
每组纳入 30 名患者（对照组：50%为女性，平均年龄 50 岁；试验组：53%为女性，平均年龄 48 岁）。尽管外科医生在使用 CMX 时使用了更厚的移植物，但与 CTG 相比，CMX 治疗的位点在 T1 和 T2 之间收缩 0.78mm（95%CI 0.41-1.14）。CTG 的最终 BSP 增加量为 1.15mm（95%CI 0.88-1.43），CMX 为 0.85mm（95%CI 0.58-1.13）。T2 时 CTG 组平均差值为 0.30mm（95%CI -0.01 至 0.61），具有边缘显著意义（p=0.054）。两组间术后出血（p=0.344）、疼痛（p=0.331）、止痛药使用次数（p=0.504）、水肿（p=0.227）和粉红色美学评分（p=0.655）无显著差异。CMX 术后血肿的视觉模拟评分（VAS）低 6.56（95%CI 0.54-12.59），当使用 CMX 时，手术时间可缩短 9.03min（95%CI 7.04-11.03）。然而，CMX 导致的边缘骨丧失（0.38mm；95%CI 0.15-0.60）、更深的牙周袋（0.30mm；95%CI 0.06-0.54）和更多的中面部退缩（0.75mm；95%CI 0.39-1.12）显著多于 CTG。
CTG 仍然是增加种植体颊侧软组织厚度的金标准。
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