Evaluation of the effect of connective tissue graft (CTG) and T-PRF (titanium prepared platelet-rich fibrin) inserted with a double layer technique on peri-implant soft tissue thickening – A randomized prospective clinical study

Background

In recent years studies have concluded that peri-implant soft tissue thickness and keratinized tissue have been associated with health of periodontal tissues and clinical parameters. Initial tissue thickness influences crestal bone changes around implants. It is generally accepted that a thin tissue biotype is associated with an increased risk for unfavorable treatment outcomes following surgical interventions

Aim/Hypothesis

The aim of this study is to decrease the crestal bone resorption around the implant site by increasing the thickness of the gingiva with T-PRF (titanium prepared platelet-rich fibrin) or CTG (connective tissue graft), and to compare the efficacy of the two techniques.

Material and Methods

A total of 30 implants were placed in 30 patients (12 males and 18 females, with mean age of 38.4 years) with simultaneous augmentation of the soft tissue by the use of a T-PRF or CTG. The patients were randomly divided into two groups; I. Test group: implants placed in thin tissues and thickened with T-PRF membrane simultaneously with implant placement, II. Control group: implants placed in thin tissues and thickened with connective tissue graft simultaneously with implant placement. Soft tissue thickness was measured with endodontic spreader and digital caliber from three points; 1) occlusal part of crest (CREST), 2) midbuccal of mucosa (MBM), 3) over 1 mm of mucogingival junction (OMGJ). Keratinized tissue height (KTH), as the distance between the healing abutment and the mucogingival junction was also recorded at the time of surgery (T0) and 3 months postoperatively (T1).

Results

In the CTG and T-PRF group, there was a significant increase in KTH (P < 0.001) and in the thickness of gingiva at the level of CREST (P < 0.001), MBM (P < 0.001) and OMGJ (P = 0.026, P < 0.001) between T0 and T1. When the change in time-related soft tissue thickness was compared between the groups, there was no significant difference in KTH between the T-PRF and BDG group (P = 0.189). In the CTG group, significantly more soft tissue thickness increased in CREST (P = 0.040), MBM (P = 0.025), OMGJ (P = 0.041) levels compared to the T-PRF group.

Conclusion and Clinical Implications

Within the limitations of this study, it could be concluded that the T-PRF used in conjunction with simultaneously implant placement leads to an increased thickness of peri-implant soft tissue and could be an alternative to connective tissue graft.