Morimoto, Taichiro

Facial gingival tissue thickness (FGTT) is important for an esthetically pleasing anterior restoration since it determines the soft tissue's ability to conceal the underlying restorative material. The purpose of this study was to investigate the change in FGTT after immediate implant placement and provisionalization with and without a connective tissue graft. Patients with a failing maxillary anterior tooth planned for immediate implant placement and provisionalization with (CT group) or without (NCT group) a subepithelial connective tissue graft were included in this study. After tooth extraction, direct measurement of the FGTT was performed; subsequent measurements were performed at the time of definitive prosthesis placement. Data were analyzed using independent and paired t tests at a significance level of α = .05. There was no statistically significant difference in the mean FGTT at tooth extraction between the CT and NCT groups. At prosthesis delivery, the mean FGTT for the CT group was significantly greater than that of the NCT group. The mean FGTT of both groups at prosthesis delivery was significantly higher than that at tooth extraction. The mean change in FGTT in the CT group was also significantly greater than that in the NCT group. Immediate implant placement and provisionalization in conjunction with a connective tissue graft is more likely to result in sufficient peri-implant tissue thickness to conceal underlying implant restorative materials than when performed without a connective tissue graft.

This study evaluated the reliability of assessing visually the facial gingival biotype of maxillary anterior teeth with and without the use of a periodontal probe in comparison with direct measurements. Forty-eight patients (20 men, 28 women) with a single failing maxillary anterior tooth participated in this study. Three methods were used to evaluate the thickness of the gingival biotype of the failing tooth: visual, periodontal probing, and direct measurement. Prior to extraction, the gingival biotype was identified as either thick or thin via visual assessment and assessment with a periodontal probe. After tooth extraction, direct measurement of the gingival thickness was performed to the nearest 0.1 mm using a tension-free caliper. The gingival biotype was considered thin if the measurement was = 1.0 mm and thick if it measured > 1.0 mm. The assessment methods were compared using the McNemar test at a significance level of α = .05. The mean gingival thickness obtained from direct measurements was 1.06 ± 0.27 mm, with an equal distribution (50%) of sites with gingival thicknesses of = 1 mm and > 1 mm. The McNemar test showed a statistically significant difference when comparing the visual assessment with assessment using a periodontal probe (P = .0117) and direct measurement (P = .0001). However, there was no statistically significant difference when comparing assessment with a periodontal probe and direct measurement (P = .146). Assessment with a periodontal probe is an adequately reliable and objective method in evaluating gingival biotype, whereas visual assessment of the gingival biotype by itself is not sufficiently reliable compared to direct measurement.