An interventional study of Soft tissue augmentation at the buccal aspect of single implants in Buccal Soft Tissue Profile (BSP), sponsored by University Ghent. Active, not recruiting at 1 site in Belgium. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2025-03-06.
Sponsored by University Ghent · Not applicable, Interventional, and Treatment
Patients in need of a single implant in the premaxilla and presenting with a horizontal buccal soft tissue defect at the single tooth gap will be invited to participate in a multicenter RCT. Prior to surgery, a small-field low-dose CBCT is taken since a buccopalatal bone dimension of at least 6 mm at the central and crestal aspect of the single tooth gap is required to ensure complete embedding of an implant by bone. Sixty patients will be randomly allocated to the test group or control group in 6 centers. Each center receives 10 sealed envelopes (5 are internally labelled with 'test group' and 5 with 'control group').
For each patient a digital planning is performed in implant planning software and a tooth-supported surgical guide is fabricated. In the control group, a single implant is placed following flap elevation and surgical guide installation. Then, a CTG from the palate is positioned under the buccal mucosa to thicken the tissues. A provisional restoration is placed at the day of surgery, which is replaced by a permanent one 3m later. Patients in the test group are treated in the same way, yet a CM (Fibro-Gide®) is used instead of a CTG.
Changes in the buccal soft tissue profile are registered over time by superimposing intra-oral scans in SMOP® software.
Secondary outcomes included clinical, aesthetic and patient-reported outcomes.
Patients will be included in a multicenter RCT following screening and after having received written consent.
A sample size calculation using the Satterthwaite t-test was performed in SAS Power and Sample Size based on a comparison of mean change in BSP (primary outcome variable) from baseline to 1 year between the control group and test group. The calculation was based on finding a mean difference of at least 0.5 mm between these groups with a standard deviation of 0.5 mm for CTG and 0.7 mm for CM (as adopted from Zeltner et al. 2017). With alpha set at 0.05 and a power of 0.80, the sample size calculation indicated 25 patients to be included per group. To compensate for drop-outs, 30 patients would be treated with CTG and 30 would be treated with CM.
Clinicians and centers, randomization, allocation concealment and blinding Six experienced clinicians will treat 10 patients each. All clinicians are staff members of the Department of Periodontology and Oral Implantology at UGent - UZ Gent, who also work part-time in different private practices. The digital workflow, the implant placement protocol, the application of CTG and CM and the restorative protocol will be thoroughly discussed among the 6 clinicians in a training session before the start of the trial.
During the training session each clinician will receive 5 sealed envelopes internally coded as 'CTG' and another 5 as 'CM'. Just prior to surgery, a sealed envelope will be randomly selected and opened to reveal the treatment to be conducted. The measuring investigator will not be involved in the treatment of any of the patients and will be blinded to allow unbiased registrations.
Pre-operative digital planning A full digital workflow will be adopted for every patient. This implies the fabrication of a stereolythographic surgical guide on the basis of a 3D digital implant planning in designated software (NobelClinician, Nobel Biocare, Zürich, Switserland). A low-dose small-field Cone-Beam CT and intra-oral scan are required for this purpose. The same software will also be used to design a provisional acrylic crown, which will be adapted chairside immediately following surgery (Tempshell, Nobel Biocare, Zürich, Switserland).
Surgery Control group: soft tissue augmentation with CTG Patients start to take systemic antibiotics (Amoxicilline 1g) and anti-inflammatory medication (ibuprofen 600 mg) 1h pre-operatively. Following local anesthesia (Septanest special, Septodont, Saint Maur des Fossés, France) and oral disinfection (Corsodyl mouth rinse, GSK, Wavre, Belgium), a conventional mucoperiosteal flap will be raised. Thereupon, the surgical guide is positioned and a dental implant (NobelReplace CC PMC, Nobel Biocare, Zürich, Switserland) is installed. A CTG is harvested from the palatal mucosa in the premolar area by means of the single-incision technique as described by De Bruyckere et al. (2015) (fig. 1). The CTG is pulled into the envelope and fixed with two sutures (Seralon 6/0, Serag Weissner, Naila, Germany). Tension-free primary wound closure with the same suture material is pursued around a provisional acrylic crown. Post-op instructions include the intake of systemic antibiotics during 4 days (Amoxicilline 1g, two times a day), anti-inflammatory medication as deemed necessary by the patient and oral disinfection twice a day during 1 week. Then, sutures are removed. After 3 months, the provisional crown will be replaced by a permanent crown by the general dentist.
Test group: soft tissue augmentation with CM In the test group, no CTG is harvested as it will be replaced by CM (Fibro-Gide, Geistlich Biomaterials, Wolhusen, Switserland). Apart from that, all pre-op, surgical and post-op procedures are identical in the control group and test group.
Prior to surgery (baseline = t0), at 3 months (t1), 1 year (t2) and 5 years (t3) an intra-oral optical scan of the implant site and neighboring teeth will be taken (Trios, 3shape, Copenhagen, Denmark). The region of interest (ROI) will be defined on STL files with a trapezoid shape encompassing the following borders: 1 mm apical to the midbuccal soft tissue level (coronal), the mucogingival junction (apical) and 1 mm distance from the neighbouring tooth at both sides (mesial, distal). This ROI may vary between patients due to anatomical variation but will be kept constant in each patient and site over time. The STL images of baseline and follow-up will be superimposed and matched using the best-fit algorithm at the adjacent tooth surfaces. The linear changes in BSP will be measured in the middle of the ROI, calculated by the software and expressed in mm corresponding to the mean distance between the surfaces representing the evaluated time points (t0, t1, t2, t3).
All patients are scheduled for suture removal and oral hygiene instructions after 1 week with registration of:
Postoperative bleeding, Pain and amount of anti-inflammatory medication taken, Oedema and Hematoma.
After 3 months, 1 year and 2 years, all patients are scheduled for a clinical and radiographic follow-up visit, including registration of mesial and distal marginal bone level. Intra-oral radiographs will be taken using the long-cone parallel technique. Bone levels will be assessed and defined as the distance from the implant-abutment interface to the first bone-to-implant contact to the nearest 0.1 mm. Clinical parameters ,such as probing pockets depths (mm), plaque (presence or absence) and bleeding on probing (presence or absence) are registered as well as vertical soft tissue levels at the midbuccal aspect to the nearest 0.5 mm. White and Pink esthetics are assessed according to Furhauser.
University Ghent is the lead sponsor of 345 studies on the registry; 85 are open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Connective tissue graft harvested from the palate
Procedure: Soft tissue augmentation at the buccal aspect of single implants
Pig-derived collagen matrix (Fibro-Gide, Geistlich Biomaterials, Wolhusen, Switserland)
Procedure: Soft tissue augmentation at the buccal aspect of single implants
Soft tissue augmentation is performed following mucoperiosteal flap elevation at the buccal aspect of single implants. The connective tissue graft (control) or collagen matrix (test) is inserted in the buccal pouch and attached with monofilament sutures.
Changes in buccal soft tissue profile (BSP)
Volumetric analysis with designated software on the basis of intra-oral scans at fixed time points (absolute changes in mm, relative changes in %)
Time frame: Pre-op, 3 months, 1 year, 2 years
Changes in Probing pocket depth
Probing pocket depth (mm)
Time frame: 3 months, 1 year, 2 years
Changes in Bleeding on probing
Bleeding on probing (score 0-4)
Time frame: 3 months, 1 year, 2 years
Changes in Plaque Index
Plaque index (score 0-4)
Time frame: 3 months, 1 year, 2 years
Changes in radiographic outcomes
marginal peri-implant bone loss (mm)
Time frame: 3 months, 1 year, 2 years
Patient-reported outcome measures
Assessment of pain (VAS)
Time frame: 1 week
Patient-reported outcome measures
oedema (VAS)
Time frame: 1week
Patient-reported outcome measures
bleeding (VAS)
Time frame: 1 week
Patient-reported outcome measures
hematoma (VAS)
Time frame: 1 week
Patient-reported outcome measures
aesthetic evaluation by patients (VAS)
Time frame: 1 week
Patient-reported outcome measures
aesthetic evaluation by patients (VAS)
Time frame: 3 months
Patient-reported outcome measures
aesthetic evaluation by patients (VAS)
Time frame: 1 year
Patient-reported outcome measures
aesthetic evaluation by patients (VAS)
Time frame: 2 years
Patient-reported outcome measures
willingness to undergo again (VAS)
Time frame: 1 week
Patient-reported outcome measures
willingness to undergo again (VAS)
Time frame: 3 months
Patient-reported outcome measures
willingness to undergo again (VAS)
Time frame: 1 year
Patient-reported outcome measures
willingness to undergo again (VAS)
Time frame: 2 years
Aesthetic outcome as assessed by care providers
Pink Esthetic Score (0-14)
Time frame: 1 year
Aesthetic outcome as assessed by care providers
Pink Esthetic Score (0-14)
Time frame: 2 year
Aesthetic outcome as assessed by care providers
WhiteEsthetic Score (0-10)
Time frame: 1 year
Aesthetic outcome as assessed by care providers
White Esthetic Score (0-10)
Time frame: 2 years
Surgery time
Time needed to complete the contour augmentation procedure
Time frame: At Surgery
Primary stability
Primary stability after implant placement (Ncm)
Time frame: At Surgery
Incremental cost-effectiveness ratio
Difference in cost divided by the effect of the different procedures
Time frame: baseline - 2 years
Plan to share: Undecided — If the data can be included in a meta-analysis upon request by the authors, they can be transferred
This study is active, not recruiting, as verified in Mar 2025. You cannot join it, but the record below documents what was studied.
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