This document summarizes a journal club presentation on a study examining the horizontal stability of connective tissue grafts at the buccal aspect of single implants over 1 year. The study aimed to clinically evaluate the horizontal stability of connective tissue grafts and compare gingival thickness between thin and thick biotypes. Results found an absolute mean tissue gain of 0.97mm 1 year after grafting, with no significant difference between biotypes. The study concluded that connective tissue grafts can substantially thicken peri-implant mucosa with acceptable stability over 1 year.

2. JOURNAL CLUB PRESENTATION
TOPIC: Horizontal stability of connective
tissue grafts at the buccal aspect of
single implants: a 1-year prospective case
series
JOURNAL: J Clin Periodontol 2015; 42:
876–882
AUTHORS: Thomas De et al

3. CONTENTS
• INTRODUCTION
• GINGIVAL BIOTYPE AND ITS
CLINICAL SIGNIFICANCE
• AIM
• MATERIALS AND METHOD
• RESULT
• DISCUSSION
• CONCLUSION
• REFERENCES

4. INTRODUCTION
• Aesthetics are more and more
becoming the key to success in oral
rehabilitation.

5. • Ample systematic reviews have been
published supporting the
effectiveness of ridge preservation in
limiting horizontal and vertical ridge
alterations in postextraction sites
(Darby et al. 2009, Vignoletti et
al.2012, Horvath et al. 2013,
Vittorini Orgeas et al. 2013)

6. GINGIVAL BIOTYPE AND ITS CLINICAL
SIGNIFICANCE
• The gingival morphology plays an
important role in determining the
final esthetic outcome.
• Therefore during treatment
planning, it is important to
recognize differences in gingival
tissue.

8. • In 1969, Ochsenbein & Ross
indicated that there were 2 main
types of gingival anatomy— flat
and highly scalloped.

9. • The term periodontal biotype was
used later by Seibert & Lindhe, who
classified the gingiva as either thin-
scalloped or thick-flat.

11. GINGIVAL BIOTYPE
ASSESSMENT
VISUAL EVALUATION

12. PROBE TRANSPARENCY

13. MODIFIED CALLIPER

14. TRANSGINGIVAL PROBING

15. ULTRASONIC DEVICE

16. CBCT

17. CLINICAL SIGNIFICANCE
1. Gingival biotype and labial plate
thickness.
• Fu et al 2010
• Cook et al 2011

18. 2. Gingival biotype and Schneiderian
membrane thickness.

19. 3. Tissue biotype in implant
treatment planning

20. • A 1996 animal study by Berglundh &
Lindhe concluded that thin gingival tissue
can lead to marginal bone loss during
formation of the peri-implant biologic
width.
• Huang et al reported that implant sites
with thin mucosa were prone to angular
bone defects, while stable crestal bone
was maintained in implants surrounded by
thick mucosa.

21. • According to Abrahamsson et al,
thick tissues (that is, ≥2.5 mm)
can avoid significant crestal bone
recession.
• According to Evans & Chen, gingival
recession increases in patients with
thin biotypes immediately after
single implant restorations.

22. 4.Gingival biotype and ridge
preservation

23. 5. Tissue biotype and root coverage

25. AIMS OF THE STUDY
1.To clinically evaluate the horizontal
stability of a connective tissue graft
(CTG) at the buccal aspect of
single implants.
2.To compare actual gingivaL
thickness between thin and thick
gingival biotype.

26. MATERIALS AND METHOD

27. 1. PATIENT SELECTION
• Patients with a single implant in
the anterior maxilla and a
horizontal alveolar defect at the
buccal aspect.

28. • MINIMUM AGE 18 YEARS
• GOOD ORAL HYGIENE
• SEIBERT CLASS I ALVEOLAR
DEFECT
• INFORMED SIGNED
CONSENT
INCLUSION
CRITERIA
• SYSTEMIC DISEASE
• PERIODONTAL DISEASE
• SMOKING
EXCLUSION
CRITERIA

29. 2. CONTOUR AUGMENTATION
• Patients were enrolled for this study
3 months after implant surgery.
• To compensate for tissue loss at the
buccal aspect a CTG,harvested
through a single-incision approach
from the palate, was used.

30. • A partial thickness envelope or
pouch with a depth of about 12
mm was prepared.
• An appropriately sized CTG,was
pulled into the envelope and
sutured .
• Sutures were removed after 2
weeks.

31. 3. ULTRASONIC EVALUATION OF
MUCOSAL STABILITY
• The device has a transducer probe
with a diameter of 4 mm that
was moistened with ultrasound gel

32. • t0 : before CTG
• t1 : immediately
• t2 : 2 weeks
• t3 : 3 months
• t4 : 1 year

33. 4. GINGIVAL THICKNESS AND BIOTYPE
5. MUCOSAL THICKNESS AND BIOTYPE
• Immediate tissue gain defined as MT
difference between t1 and t0•
• Absolute tissue loss at t4 defined as
MT difference between t1 and t4•
• Absolute tissue gain at t4 defined as
MT difference between t4 and t0•
• Relative tissue gain at t4 defined as
the proportion of absolute tissue gain
at t4 over immediate tissue gain.

39. DISCUSSION
• Contour augmentation by means of
CTG has been described around
natural teeth, pontics (Studer et
al.2000) and implants to increase
the soft tissue volume.

40. • One year following CTG, an absolute
MT gain of 0.97 mm was observed,
with no significant difference between
patients with a thin or thick biotype
(p≥0.290).
• It is interesting to note that this
mean gain was slightly higher when
compared with the results of Eghbali
et al. (2014) (0.83 mm), however,
lower when compared with the results
of the other available studies (1.75
mm; 1.20 mm) Speroni et al. 2010,
Wiesner et al.2010

41. CONCLUSION
• In conclusion, this study
demonstrated that contour
augmentation by means of CTG at
the buccal aspect of single implants
substantially thickens the peri-
implant mucosa with acceptable
stability over a 1-year period.

42. REFERENCES
• Araujo, M. G. & Lindhe, J. (2005) Dimensional ridge alterations following
tooth extraction. An experimental study in the dog. Journal of Clinical
Periodontology 32, 212–218.
• Chappuis, V., Buser, R., Bragger, U., Bornstein,M. M., Salvi, G. E. & Buser,
D. (2013) Long-term outcomes of dental implants with a tita-nium plasma-
sprayed surface: a 20-year prospective case series study in partially
edentulous patients.Clinical Implant Dentistry and Related Research 15, 780–
790.
• Cook, D. R., Mealey, B. L., Verrett, R. G., Mills, M. P., Noujeim, M. E.,
Lasho, D. J. & Cronin, R. J. Jr (2011) Relationship between clinical
periodontal biotype and labial plate thickness: an in vivo study.International
Journal of Periodontics and Restorative Dentistry 31, 345–354.
• Cosyn, J., Cleymaet, R. & De Bruyn, H. (2014) Predictors of alveolar
process remodeling following ridge preservation in high-risk patients. Clinical
Implant Dentistry and Related Research DOI: 10.1111/cid.12249 [Epub ahead
of print]. Cosyn, J., De Bruyn, H. & Cleymaet, R. (2013)
• Soft tissue preservation and pink aesthetics around single immediate implant
restorations:a 1-year prospective study.Clinical Implant Dentistry and Related
Research 15, 847–857.

43. • Cosyn, J., Eghbali, A., De Bruyn, H., Collys,
K.,Cleymaet, R. & De Rouck, T. (2011) Immediate
single-tooth implants in the anterior maxilla: 3-year
results of a case series on hard and soft tissue response
and aesthetics Journal of Clinical Periodontology 38,
746–753.
• Cosyn, J., Eghbali, A., De Bruyn, H., Dierens, M. & De
Rouck, T. (2012) Single implant treatment in healing
versus healed sites of the anterior maxilla: an aesthetic
evaluation. Clinical Implant Dentistry and Related
Research 14,517–526.
• Cosyn, J., Pollaris, L., Vander Linden, P. & De Bruyn,
H. (2015) Minimally-Invasive Single Implant Treatment
(M.I.S.I.T.) based on ridge preservation and contour
augmentation in patients with a high aesthetic risk
profile: one year results. Journal of Clinical
Periodontology 42, 398–405.
• Darby, I., Chen, S. T. & Buser, D. (2009) Ridge
preservation techniques for implant therapy.
International Journal of Oral and Maxillofacial Implants
24, 260–271.