An interventional study of subepithelial connective tissue graft and Submerged Tenting Abutment in Peri-implant Soft Tissue Deficiency, Partial Edentulism and Tooth Loss, sponsored by Misr International University. Recruiting at 1 site in Egypt. Open to participants aged 20 Years and older. Per ClinicalTrials.gov, last updated 2026-07-21.
Sponsored by Misr International University · Not applicable, Interventional, and Treatment
Peri-implant soft tissue thickness is an important determinant of the long-term stability and success of dental implants. Patients with a thin peri-implant soft tissue phenotype are at increased risk of soft tissue recession, marginal bone loss, and compromised esthetic and functional outcomes. Subepithelial connective tissue graft (SCTG) is considered the gold standard for soft tissue augmentation; however, it requires harvesting tissue from the palate, increasing surgical complexity, operative time, and postoperative morbidity. Less invasive approaches, including submerged tenting abutments and subcrestal implant placement, have been proposed as alternatives to improve peri-implant soft tissue dimensions while reducing patient morbidity, but direct comparative clinical evidence remains limited.
This investigator-initiated, single-center, randomized, parallel-group clinical trial will compare three approaches for peri-implant soft tissue augmentation in patients with a thin peri-implant soft tissue phenotype requiring a single dental implant in the posterior mandible. Eligible implant sites will be randomly assigned in a 1:1:1 allocation ratio to receive either subepithelial connective tissue grafting, submerged tenting abutment placement, or subcrestal implant placement during implant surgery.
The primary objective is to compare changes in peri-implant soft tissue thickness using three-dimensional digital intraoral scanning over a 12-month follow-up period. Secondary objectives include evaluation of keratinized tissue width, clinical soft tissue thickness, histological characteristics of peri-implant soft tissue, peri-implant crestal bone level changes, postoperative pain, operative time, patient-reported satisfaction, and postoperative complications. The results of this study are expected to provide evidence regarding whether minimally invasive treatment approaches can achieve clinical outcomes comparable to connective tissue grafting while reducing surgical morbidity and improving patient-centered outcomes.
Peri-implant soft tissue thickness is a critical factor influencing the biological stability, function, and long-term success of dental implant therapy. A thin peri-implant soft tissue phenotype has been associated with increased marginal bone remodeling, soft tissue recession, and compromised peri-implant tissue stability. Consequently, augmentation of peri-implant soft tissues has become an important component of implant treatment planning, particularly in patients with thin soft tissue phenotypes.
Subepithelial connective tissue grafting (SCTG) is widely regarded as the reference standard for peri-implant soft tissue augmentation because of its predictable ability to increase tissue volume and improve peri-implant tissue stability. Nevertheless, harvesting autogenous connective tissue from the palate increases operative time, donor-site morbidity, postoperative discomfort, and surgical complexity. These limitations have encouraged the development of less invasive techniques capable of enhancing peri-implant soft tissue dimensions while minimizing patient morbidity.
Submerged tenting abutments have recently been introduced as a minimally invasive method for maintaining soft tissue space during submerged healing following implant placement. By supporting the overlying soft tissues throughout the healing phase, these abutments may promote increased soft tissue thickness without the need for connective tissue harvesting. Although preliminary clinical reports have shown encouraging outcomes, direct comparisons with connective tissue grafting remain limited.
Subcrestal implant placement has also been proposed as an alternative method for improving peri-implant soft tissue dimensions. Positioning the implant platform approximately 2 mm below the alveolar crest may increase the vertical dimension of peri-implant soft tissues without requiring grafting procedures or additional prosthetic components. While this technique has demonstrated favorable biological behavior in previous studies, evidence directly comparing it with connective tissue grafting and submerged tenting abutments remains scarce.
Advances in digital intraoral scanning have enabled accurate, reproducible, and non-invasive three-dimensional assessment of peri-implant soft tissue changes over time. Digital volumetric analysis provides objective measurements while reducing operator-dependent variability associated with conventional clinical measurements. Combining digital assessment with clinical, radiographic, histological, and patient-reported outcomes provides a comprehensive evaluation of treatment effectiveness.
This investigator-initiated, single-center, randomized, parallel-group interventional clinical trial will enroll 33 implant sites in medically healthy adults requiring single implant placement in the posterior mandible and presenting with a thin peri-implant soft tissue phenotype (\<2 mm). Implant sites will be randomly allocated in a 1:1:1 ratio to one of three intervention groups: (1) equicrestal implant placement with subepithelial connective tissue grafting, (2) equicrestal implant placement with a submerged tenting abutment, or (3) subcrestal implant placement without grafting or tenting abutment. Randomization will be performed using a computer-generated sequence with allocation concealment through opaque sealed envelopes. Outcome assessors and the biostatistician will remain blinded throughout data collection and analysis, whereas blinding of participants and the operating surgeon is not feasible because of the nature of the surgical interventions.
The primary outcome will be the change in peri-implant soft tissue thickness measured by standardized three-dimensional intraoral scanning and digital volumetric analysis. Secondary outcomes include histological characteristics of peri-implant soft tissues, clinical soft tissue thickness, width of keratinized mucosa, peri-implant crestal bone level changes assessed using standardized radiographs, postoperative pain measured using a visual analog scale (VAS), operative time, patient satisfaction measured using the Oral Health Impact Profile-14 (OHIP-14), and postoperative complications. Participants will be followed according to the predefined study schedule for 12 months after implant placement using standardized clinical, digital, radiographic, and patient-reported assessments.
The results of this study will provide high-quality comparative evidence regarding three contemporary approaches for peri-implant soft tissue augmentation. By evaluating volumetric, clinical, histological, radiographic, and patient-centered outcomes within the same randomized clinical trial, the study aims to identify treatment strategies that maximize peri-implant soft tissue stability while minimizing surgical morbidity. The findings may contribute to evidence-based decision-making for clinicians managing patients with thin peri-implant soft tissue phenotypes and support the development of less invasive treatment protocols for implant therapy.
165 studies on the registry are indexed under Tooth Loss; 44 are open to participants now.
This study's planned enrollment of 30 is close to the median of 30 across 120 interventional studies indexed under Tooth Loss.
Browse Tooth Loss studies →Misr International University is the lead sponsor of 46 studies on the registry; 15 are open to participants now.
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The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
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You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
ASA physical status
The anaesthetists’ scale of health before surgery: I is healthy, II has a mild illness that is under control, III a severe one, IV a severe illness that is a constant threat to life. V and VI are used for the critically ill and for organ donors.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants assigned to this arm will receive equi-crestal dental implant placement followed by augmentation of the peri-implant soft tissue using an autogenous subepithelial connective tissue graft harvested from the palate. The graft will be positioned over the implant site to increase peri-implant soft tissue thickness before primary flap closure.
Procedure: subepithelial connective tissue graft
Participants assigned to this arm will receive equicrestal dental implant placement followed by placement of a submerged low-profile tenting healing abutment beneath the flap to support peri-implant soft tissue contour during healing without connective tissue grafting.
Device: Submerged Tenting Abutment
Participants assigned to this arm will receive dental implant placement approximately 2 mm below the alveolar crest without connective tissue grafting or placement of a submerged tenting abutment.
Procedure: Sub-crestal Implant Placement
Harvesting of an autogenous connective tissue graft from the palate and placement over an equicrestally positioned dental implant to augment peri-implant soft tissue thickness.
Also known as: SCTG
Placement of a submerged low-profile tenting healing abutment over an equicrestally positioned dental implant to support peri-implant soft tissue during healing.
Placement of a dental implant approximately 2 mm apical to the alveolar crest without soft tissue grafting or tenting abutment placement.
Also known as: Subcrestal Implant Placement
Change in Peri-implant Soft Tissue Thickness
Change in peri-implant soft tissue thickness from baseline measured using three-dimensional digital intraoral scanning (Medit Intraoral Scanner) and digital volumetric analysis (Medit Design software). Measurements will be performed by blinded outcome assessors and expressed in millimeters (mm).
Time frame: Baseline, 3 months, 6 months, and 12 months after implant placement.
Histological Characteristics of Peri-implant Soft Tissue
Histological evaluation of peri-implant soft tissue biopsy specimens obtained during second-stage implant surgery. Tissue sections will be stained with hematoxylin and eosin and Masson's trichrome to assess epithelial thickness and collagen density.
Time frame: 3 months
Clinical Peri-implant Soft Tissue Thickness
Clinical measurement of peri-implant soft tissue thickness using standardized transgingival probing.
Time frame: Baseline, 3 months, 6 months, and 12 months
Postoperative Pain
Participant-reported postoperative pain measured using a 10-point Visual Analog Scale (VAS). The scale ranges from 0 to 10, where 0 = no pain, 1-3 = mild pain, 4-6 = moderate pain, 7-9 = severe pain, and 10 = worst pain imaginable (very severe pain). Higher scores indicate greater postoperative pain.
Time frame: Daily during the first 10 postoperative days
Peri-implant Crestal Bone Level Changes
Changes in peri-implant crestal bone level assessed using standardized periapical radiographs analyzed with ImageJ software.
Time frame: Baseline, 3 months, 6 months, and 12 months
Width of Keratinized Tissue
Clinical measurement of peri-implant keratinized tissue width using a standardized periodontal probe.
Time frame: Baseline, 3 months, 6 months, and 12 months
Plan to share: Undecided — At the time of registration, a decision regarding sharing de-identified individual participant data has not yet been finalized. Any future data sharing will be considered in accordance with institutional policies, participant informed consent, applicable regulations, and journal requirements.
Start is estimated for Jul 2026; primary completion for Jul 2027, 11 months later.
Of 71 non-industry interventional studies with no phase under Tooth Loss, half reached primary completion within 28 months of starting (the median), counting those still running; a quarter within 12 and three quarters within 48. This study's planned 11 months is below that.
Counting every sponsor, half of 77 studies reached it within 28 months; a quarter within 12 and three quarters within 48.
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Misr International University