JOMI ARTICLE SPOTLIGHT:

Single Implants in the Maxillary Esthetic Zone With or Without Connective Tissue Grafting: 4-Year Follow-up

Thiago Rodrigues Lazzari, DDS, MS, PhD/Victória Clara da Silva Lima, DDS, MS, PhD/Camilla Magnoni Moretto Nunes, DDS, MS, PhD/Nidia Castro dos Santos, DDS, MS, PhD/Felipe Lucas da Silva Neves, DDS, MS, PhD/Antonio Braulino de Melo Filho, DDS, MS, PhD/Mauro Pedrine Santamaria, DDS, MS, PhD/Maria Aparecida Neves Jardini, DDS, MS, PhD

Purpose: To assess the impact of a subepithelial connective tissue graft (CTG) on soft tissue volume and esthetics around implants placed in esthetically important areas over a 4-year period.

Materials and Methods: A total of 42 participants were divided into two groups: (1) implant and CTG (implant + CTG) (n = 20) and (2) implant only (n = 22). Both groups were evaluated after 48 months using various clinical and radiographic parameters, professional esthetic assessment, patient-centered esthetic evaluation, and quality of life improvement measured by the Oral Health Impact Profile questionnaire with 14 questions (OHIP-14) at 12 and 48 months.

Results: A total of 8 patients were lost to follow-up, leaving 34 patients for evaluation. Intragroup comparison was performed for the following variables: tissue thickness at the buccal aspect (TTb), keratinized tissue width (KTW), and buccal defect (BD). All intragroup comparisons showed no statistical difference (P > .05) in the evaluated periods. However, for proximal bone resorption (PBR), a statistical difference was observed (P < .05). In the intergroup comparison, statistical differences (P < .05) were observed in the variables TTb and BD in the two evaluated periods (12 and 48 months). In the analysis of Pink Esthetic Score/White Esthetic Score (PES/WES) and Jemt index, there were no differences between or within groups in the evaluated periods. Regarding patient-centered measures, there was no difference between the groups in terms of esthetics (visual analog scale), but for OHIP-14, there was an intragroup difference in both groups between 12 and 48 months.

Conclusions: The association of a CTG with dental implants in esthetic areas after a 48-month follow-up led to an increase in TTb; therefore, connective tissue grafting is indicated. However, there were no improvements in BD, PBR, or PES/WES over time. Esthetics and quality of life were similar between the two groups at 4 years posttreatment. Int J Oral Maxillofac Implants 2026;41:218–226. doi: 10.11607/ jomi.11269