Bone regeneration in the aesthetic area using a flap design adapted from mucogingival surgery. Background Systematic reviews showed that traditional flap design during GBR procedures in the esthetic area may lead to complications, such as scar tissues, alteration of the mucogingival line, dehiscence or absence of papillae.ù Aim this prospective cohort study was aimed to investigate, over 18 months, hard and soft tissue changes after GBR procedure to regenerate horizontal bone deficiencies in the anterior esthetic area using a flap design adapted from mucogingival surgery in association with resorbable membrane and β-TCP. Materials and Methods From April 2015 to June 2016, all patients with a hopeless tooth in the maxillary area between canines were enrolled. Three months after extraction and post-extraction site development, a midcrestal implant placement was carried out. The bone deficiency was restored with β-TCP and covered with a bioresorbable PLGA membrane. Submerged healing was obtained by a coronally advanced flap with papillae de-epithelization. Definitive metal-free restoration was seated 4 months thereafter. Clinical measurement, pictures and radiographs were acquired at the definitive restoration time point (T1) and after 18 months (T2). Digital impressions were taken at the time of extraction (T-1), implant insertion (T0) and at T2. Marginal bone level changes were assessed on radiographs and 3D soft tissue changes evaluated on digital impression using dedicated software. Non-parametric test was used to detect difference between the different time-points. Resultats 12 consecutive patients (7 men and 5 women with mean age of 63.7±14 years) with 15 implants have completed this study. No membrane exposure occurred. All implants resulted clinically osseointegrated, stable, and showed no sign of infection. Radiographic bone levels remained stable until the last follow-up (T0-T2 = 0.09±0.08mm). Statistically significant alveolar ridge width changes were observed after tooth extraction and after GBR (T-1 vs T0 = -1.72±0.30mm, p=0.00001; T0 vs T2 = +1.41±0.64mm, p=0.00001). Periodontal parameters never exceeded the physiological levels. Conclusions and Clinical Implications Within the limitations of this trial, it can be concluded that PLGA membrane and β-TCP in conjunction with a coronally-advanced flap is a predictable procedure to restore atrophic ridge with simultaneous implant placement in the esthetic area.
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