The authors highlighted the lack of research into soft-tissue alterations following tooth extraction, along with the drawbacks associated with the traditional autogenous connective tissue graft.
Geistlich Fibro-Gide®, which undergoes smart cross linking to enhance mechanical stability and blood clot stabilisation, was evaluated for the first time in conjunction with simultaneous implant placement and GBR utilising autogenous bone, Geistlich Bio-Oss® and Geistlich Bio-Gide®.
The authors found a significant increase in soft-tissue thickness was observed after a short-follow-up period and concluded that the results support that the use of Geistlich Fibro-Gide® in this indication is safe and showed an overall increase in soft-tissue thickness.
A summary of this paper can be found below;
Novel Collagen Matrix to Increase Tissue Thickness Simultaneous with Guided Bone Regeneration and Implant Placement in Esthetic Implant Sites: A Feasibility Study. Vivianne Chappuis, DMD/Kamal Shahim, PhD/Ramona Buser, DMD/Edi Koller, DMD/Tim Joda, DMD/Mauricio Reyes, PhD/Daniel Buser, DMD 2018.
Background
The impact of dimensional soft tissue alterations in post extraction sites has not been extensively researched, despite knowledge that soft-tissue morphology plays an important role in gaining positive aesthetic outcomes in the anterior maxilla. Despite this, a number of surgical techniques may indicate benefits for soft-tissue enhancement around implants to enhance colour and texture.
Connective tissue grafts (CTG's) remain the gold standard, but drawbacks include; volume shrinkage, patient morbidity and limited availability. Therefore research has focused on the development of soft-tissue substitutes.
A new resorbable collagen matrix has been developed; Geistlich Fibro-Gide®. It features smart cross-linking to improve mechanical stability, which improves blood clot stabilisation and provides space for the ingrowth of host cells during healing.
No clinical data currently exists for the use of this material in combination with simultaneous implant placement and GBR. This paper looks at the safety and feasibility of this product to enhance soft-tissue thickness in the aesthetic zone.
Methodology
Single centre, pilot study.
Single-tooth, central incisor implant placement - with sufficient bony wall as to allow for early placement protocol, with simultaneous GBR.
Soft-tissue thickness was measured prior to surgery and 4 and 8 weeks post-surgery.
Simultaneous GBR was performed with a 2-layer composite graft (autogenous bone, followed by Geistlich Bio-Oss®) and covered with a double layer of Geistlich Bio-Gide® membrane. This was followed by application of Geistlich Fibro-Gide®, trimmed to a thickness of 3mm and in a dry state and tension free wound closure.
Results & Conclusions
A significant increase of 1.56mm of soft-tissue thickness was observed after an 8 week follow-up period. No change in thickness was observed between 4-8 weeks. The overall increase was most significant at a distance of 5mm from the gingival margin.
No relationship was observed between the thickness of the applied matrix and the soft-tissue thickness after 8 weeks.
PROMS showed good patient acceptance of this treatment modality.
The results support that the use of Geistlich Fibro-Gide® in this indication is safe and showed an overall increase in soft-tissue thickness.
Longer term follow-up is required to validate the observed tissue stability beyond the 8 week period.