Discussion
KTW, volume loss, PES, tooth
ANESTHETIC COMPLICATIONS
Esthetics is now considered a mandatory factor in assessing implant success and must be considered a priority and a goal side to side with osseointegration [Immediate temporization allows the shortening of the healing period and early optimization of the esthetics. It also has a pivotal effect on the shaping of the peri-implant soft tissues, papilla fill, and producing the proper emergence profile for single-tooth implant restorations [Patients with thin gingival phenotypes are at a higher risk of esthetic complications in the long term. The appearance of a greyish shadow of the implant, midfacial peri-implant mucosal recession, incomplete papilla fill, and decreased soft tissue stability are among those esthetic complications [The present study’s primary outcome was the pink esthetic score as it could objectively assess esthetics [There was no statistical difference between the IT and CTG groups after 1 year as they showed 11.88 ± 1.13 and 11.33 ± 1.25, respectively. The IT group did not result in better PES. Nevertheless, it allowed the patient to have a provisional crown at an earlier stage, therefore, saving the treatment time. The esthetics of single delayed implant placement in a thin phenotype represents a challenge to clinicians. The current study shows that subepithelial connective tissue grafting with or without temporization could produce excellent esthetics’ results.The detailed PES did not show a significant difference in the various comparison aspects. Furthermore, both groups showed excellent alveolar process readings, attributed to the connective tissue grafting. This compensates for the volume loss that occurs due to buccal bone resorption after extraction, which is a common defect in delayed implants. Occlusal photos could have given more insights into the alveolar process improvement. It appears that achieving excellent PES is related to soft tissue augmentation rather than the timing of temporization. The changes in peri-implant mucosal soft tissue thickness were evaluated at levels 2, 4, and 6 mm from the mucosal margin of the future restoration (Table Gingival thicknessIntragroup time points with the same letter indicate statistical significanceIntergroup: Mann–Whitney testIntra group: Friedman test, with post-hoc Wilcoxon*Statistically significantThe results of our CTG group are slightly inferior to those [In the literature, the studies that evaluated changes in mucosal thickness after concurrent application of C.T graft and immediate temporization were mainly related to immediate implant placement [Regarding the keratinized tissue width, there was no significant difference between the two groups, 4.88 ± 0.23 and 4.61 ± 0.42 at 12 months follow-up. Yet, there was a significant intragroup change through time from the baseline values of 4.13 ± 0.23 and 3.94 ± 0.58 for the test and the control groups, respectively (Table Keratinized tissueIntragroup time points with the same letter indicate statistical significanceIntergroup: Mann–Whitney testIntra group: Friedman test, with post-hoc Wilcoxon*Statistically significantIn the control group, there was a significant increase in KTW from 3.94 ± 0.58 to 4.56 ± 0.39 mm after 6 months. This agrees with [When interpreting the results of the current study, some limitations should be acknowledged. Although favorable results were achieved in this short-term follow-up, larger-scale clinical studies with longer follow-ups are needed to demonstrate good external validity and adequately evaluate the long-term efficacy of such treatment approaches. Furthermore, further research with radiographic tools should be explored to determine labial bone changes, with the peri-implant soft tissue thickness. Finally, all the patients were females, and the missing tooth was located in the premolar area, which could affect the outcomes.