Esthetics and bone changes of immediate implants with or without vascularized interpositional periosteal connective tissue grafting: A 2‐year randomized controlled trial

Objectives To compare esthetics at single immediately placed implants with and without soft tissue augmentation. Materials and Methods Patients with non‐restorable maxillary teeth in the esthetic zone were assigned into 2 groups: immediately placed implants with simultaneous vascularized interpositional periosteal connective tissue grafting (VIP‐CTG) or non‐grafted immediately placed implants (NG). The outcomes included: pink esthetic score (PES), gingival thickness, keratinized tissue width, buccal bone changes, marginal bone loss, pain, and satisfaction. Results Eighteen implants were included. At 2 years the mean value for PES was 12 ± 3.2 for the VIP‐CTG and 12.9 ± 1.3 for the NG (p = .855). Mucosal thickness and keratinized tissue width showed no statistically significant difference between the two groups (p = .253) and (p = .931) respectively. Clinically buccal bone showed mean bone loss of 2.03 ± 1.57 mm for VIP‐CTG and 1.09 ± 1.3 mm for NG (p = .247) and radiographically showed 1.67 ± 0.84 mm at the VIP‐CTG and 1.16 ± 0.47 mm at the NG (p = .118). No statistically significant difference between both groups was demonstrated regarding marginal bone level changes (p = .142), pain (p = .622), or satisfaction (p = .562) at any time point. Conclusion Simultaneous soft tissue grafting with immediate implant placement did not provide a more favorable outcome regarding esthetics or alveolar bone preservation effect. Undisturbed healing with the least surgical intervention seems to provide more favorable outcomes.