Comparative Randomized Clinical Study of Acellular Dermal Matrix Allograft and Subepithelial Connective Tissue Graft Around Immediate Dental Implants: 12-Months Clinical and Esthetic Outcomes

Objectives: The aim of the present study was to compare the clinical outcomes of immediate implant placement in the anterior maxilla with subepithelial connective tissue graft (SCGT) and acellular dermal matrix allograft (ADMA), during a 12-month postsurgical evaluation.
The primary outcome of the study was to assess keratinized mucosa (KM) width changes following the two different clinical protocols. Secondary outcomes were to assess enhancement of the soft tissue using pink esthetic score (PES), changes in bleeding index score and probing depth.
Material and methods: Adult patients were eligible for the study if they needed one immediate implant placement (IIP) replacing a tooth to be extracted with thin gingival biotype within the maxillary anterior region. The patients included in the study were divided into two groups; the first group received IIP simultaneously with subepithelial connective tissue graft while patients in the second group received IIP simultaneously with acellular dermal matrix allograft. Clinical assessments including width of keratinized mucosa (KM), pink esthetic score (PES) bleeding Index (BI) and probing depth (PD) were performed before IIP (baseline) and scheduled 4, 8 and 12 months after implant placement.
Results: The means of BI and PD values at the 12 months follow up indicated healthy peri-implant soft tissues for both groups. There was no statistically significant difference in KM and PES between both groups through 12 months follow up period.
Conclusions: Using acellular dermal matrix allograft can predictably maintain keratinized mucosa and esthetic outcomes as those achieved using subepithelial connective tissue when performed with immediate dental implants. Acellular dermal matrix allograft can be an alternative to subepithelial connective tissue to maintain soft tissue contour around immediate implant placement in esthetic zone with inherited thin soft tissue biotype.