Treatment of Labial Soft Tissue Recession Around Dental Implants in the Esthetic Zone Using Guided Bone Regeneration With Mineralized Allograft: A Retrospective Clinical Case Series

Purpose: Soft tissue augmentation procedures are often performed to correct gingival recession on the facial aspects of implants in the esthetic zone. This retrospective clinical case series reports on the use of guided bone regeneration (GBR) and a coronal advancement flap with a resorbable membrane and allograft. Materials and Methods: We analyzed the records of 14 patients (7 men and 7 women) with a mean age of 36.78 years (SD, 13.9 years) who were treated for soft tissue recessions around implant-supported restorations in the maxillary central or lateral incisor location. Implant diameters ranged from 3.3 to 4.7 mm. All patients had bone loss confined to the labial surface of the implant. A solvent-dehydrated particulate mineralized allograft (Puros Cancellous Bone Allograft; Zimmer Biomet Dental, Palm Beach Gardens, FL) and a resorbable membrane (CopiOs Pericardium; Zimmer Biomet Dental) were used in a GBR surgical procedure in combination with a roughened titanium tenting screw placed 3 to 4 mm below the implant platform to restore unesthetic defects in the anterior maxilla. Results: All postoperative tissue changes from their preoperative states were statistically significant (P < .05, Wilcoxon signed rank test). Mean preoperative crestal bone thickness (measured 2 mm from crest) and mid-implant buccal bone thickness increased by 1.84 mm(SD, 0.89 mm; 95% confidence interval [CI], 1.32 to 2.35 mm) and 2.07 mm(SD, 0.81 mm; 95% CI, 1.60 to 2.53 mm), respectively, approximately 1 year after treatment (P < .001). Significant mean increases of 1.28 mm (SD, 0.53 mm; 95% CI, 0.97 to 1.58 mm), 1.29 mm(SD, 0.81 mm; 95% CI, 0.82 to 1.75 mm) and 1.23 mm (SD, 0.53 mm; 95% CI, 0.92 to 1.53 mm) also were noted in soft tissue thickness, keratinized tissue width, and gingival height, respectively (P < .001). Conclusions: Use of the allograft and xenogeneic membrane effectively increased alveolar hard and soft tissue dimensions in the esthetic zone of the anteriormaxilla. Future prospective clinical trialswith a control group are needed to compare this technique with conventional methods such as connective tissue graft. (C) 2016 American Association of Oral and Maxillofacial Surgeons