Comparison of Envelope Coronally Advanced Flap and Modified Tunnel Technique in Soft Tissue Dehiscence Around Implants

The primary aim is to compare the test and control groups in terms of:

• mean mid-facial recession coverage (mRC) measured as a percentage
• the keratinized tissue (KT) gain measured in mm
• the keratinized tissue thickness (KTT) gain measured in mm.

The secondary aims are to compare the two groups in terms of:

• Esthetic score, using numeric values from 0 to 10
• patient-reported esthetics, using numeric values from 1 to 5
• patient-reported post-operative pain, based on Visual Analog Scale (VAS) scale, measured as numbers from 0 to 10.

Inclusion criteria

• Age ≥ 18 years
• Periodontally and systemically healthy
• Full-mouth plaque score and full-mouth bleeding score ≤ 20% (measured at four sites per tooth)
• Correct implant 3-dimensional position or buccal position ≤ 1 mm
• Buccal soft tissue dehiscence ≤ 4 mm
• Only osseointegrated implants
• The patient must be able to perform good oral hygiene

Exclusion criteria

• Contraindications for periodontal surgery
• Patients pregnant or attempting to get pregnant
• Malpositioned implant
• Soft tissue dehiscence (STD) > 4 mm
• Multiple adjacent implants with STD
• Existing of peri-implantitis
• Severe bone loss (≥4mm)
• Moderate-severe interproximal bone loss (implant fixture level to the alveolar bone > 3 mm)
• Moderate-severe papilla height loss (Nordland and Tarnow implant papillae index >1)
• Previous mucogingival surgery around the implant within the past six months or implant placement at the surgical site less than six months prior
• Smoking more than 10 cigarettes a day