الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Immediate implant placement is progressively gaining insight among dental practitioners, as it allows for early restoration of function and esthetics of hopeless teeth. This is particularly important when dealing with the esthetic zone. However, it doesn’t fully counteract ridge remodeling and reduction of hard and soft tissue contours resulting from tooth extraction.
Flapless surgery preserves local blood supply to hard and soft tissue. Therefore, its recommended at time of immediate implant placement to minimized postoperative loss labial bone and soft tissue. However, primary wound coverage over the implant is difficult to achieve. Many approaches have been proposed for this purpose including free soft tissue grafts and pedicled flaps.
Soft tissue augmentation at time of immediate implantation is recommended to improve the stability of soft tissue volume and accordingly, esthetic outcomes. Connective tissue graft is considered the gold standard for such procedure and has been widely used for augmentation of peri-implant soft tissues.
PRF is considered an autogenous biomaterial that has been proved to stimulate hard and soft tissue healing and regeneration. It has a wide range of clinical application in the field of periodontal implant dentistry. It has been used in conjunction with connective tissue graft and coronally advanced flaps for increasing gingival thickness and recession coverage. Moreover, it has been used for coverage of extraction sockets over immediately placed implants.
The present study was designed to investigate the efficacy of the adjunctive use of PRF with connective tissue graft as a tool for primary coverage and augmentation of soft tissue volume around immediate implants placed in the maxillary esthetic region, and to evaluate the esthetic outcome of this procedure. It was compared to a positive control group where connective tissue graft was solely used and to negative control group where no soft tissue augmentation was done.
After atraumatic extraction and flapless IIP, the test group received PRF membrane and connective tissue graft over the implant and extending into labial and palatal pouches. Positive control group received connective tissue graft placed in the same manner, while in negative control group the implant was covered by healing abutment.
Volumetric analysis was done to determine tissue contour changes after 9 months of implant placement. This was performed by superimposition of digitized images of preoperative and postoperative stone casts. Esthetic outcomes were evaluated using PES and WES. Clinical parameters (PD, BOP, KTW) and patient’s satisfaction were also recorded.
Results of the present study showed that group I&II showed that demonstrated significant increase in tissue contours, while group III showed significant tissue collapse. There was a significant difference between the degree of contour changes of the three groups. group I showed significantly higher gain in tissue volume than the other groups. Regarding Esthetic outcomes, group I showed the highest PES, followed by group II, and the lowest score was for group III. No significant difference was found between the three groups regrading WES or Combined PES&WES.
Regarding clinical parameters, differences between study groups didn’t reach the level of significance. Patient’s satisfaction didn’t show significant differences between study groups.