Buccally displaced flap versus sub-epithelial connective tissue graft for peri-implant soft tissue augmentation: a pilot double-blind randomized controlled trial

Background: This article describes a novel surgical technique, the buccally displaced flap, for keratinized mucosa (KM) augmentation during implant uncovering. Furthermore, it clinically compares this technique with sub-epithelial connective tissue graft (SCTG) for peri-implant KM augmentation. Twelve weeks following implant placement, subjects were randomly divided for KM augmentation into group A (buccally displaced flap) and group B (SCTG). The width (WKM) and thickness (TKM) of the KM were assessed prior to the implant uncovering, 4 weeks and 1 year after implant loading. Post-operative pain assessment was performed using the Numeric Rating Scale. Results: The study comprised of 20 implants that were uncovered in 20 subjects. For group A, the mean WKM increased from 0.98 (+/- 0.23 mm) to 3.01 mm (+/- 0.18 mm), and the mean TKM increased from 1.45 (+/- 0.13 mm) to 2.21 mm (+/- 0.16 mm) at 1 year. For group B, the mean WKM increased from 0.93 (+/- 0.18 mm) to 3.28 mm (+/- 0.13 mm), and the mean TKM increased from 1.41 (+/- 0.15 mm) to 2.25 mm (+/- 0.11 mm) at 1 year. Post-operative pain was significantly higher for group B 4.15 (+/- 1.35) as compared to group A 2.6 (+/- 1.22) (p< 0.001). Conclusion: The buccally displaced flap increased the WKM and TKM during implant uncovering, with results comparable to SCTG. The main advantages of the technique were lack of sutures, maintenance of blood supply, reducing number of surgical sites, and it was relatively atraumatic with lesser post-operative pain.