Abstract
BACKGROUND: Immediate implant placement in the esthetic zone presents challenges in achieving optimal peri-implant soft tissue outcomes. Enhancing keratinized tissue thickness is critical to achieving long-term esthetic stability. The modified vascularized interpositional periosteal connective tissue graft (mVIP-CTG) has been proposed as an autogenous pedicled technique for improving keratinized tissue thickness. Xenogeneic collagen matrix (XCM) represents a less invasive alternative with reduced patient morbidity. This study aimed to evaluate and compare the clinical effectiveness of mVIP-CTG versus XCM in augmenting peri-implant soft tissue in the esthetic zone. OBJECTIVES: The primary objective was to assess and compare the effect of mVIP-CTG versus XCM on keratinized tissue thickness (KTT). Secondary objectives included evaluating changes in keratinized tissue width (KTW), pink esthetic score (PES), and radiographic buccal cortex thickness (BCT) around immediate implants over a 6-month follow-up period. METHODS: This parallel-arm, assessor-blinded, randomized controlled trial included twenty patients requiring the extraction of a hopeless single anterior tooth. Patients were randomly allocated into two equal groups. One group received immediate implant placement, xenogeneic bone grafting, and mVIP-CTG, while the other groupreceived immediate implant placement, xenogeneic bone grafting, and XCM.Cone-beam computed tomography (CBCT) scans were obtained at baseline (prior to extraction) and at 6 months postoperatively. Clinical parameters, including KTT, KTW, and PES, were assessed at baseline, 3 months, and 6 months. BCT was measured radiographically at baseline and 6 months using CBCT. Statistical analysis was performed using IBM SPSS® version 26. Data normality was evaluated using the Shapiro–Wilk test. Independent and paired t-tests were used for intra- and intergroup comparisons—repeated measures ANOVA was employed to assess changes over time. A p-value < 0.05 was considered statistically significant. Ethical approval was obtained from the Faculty Research Ethics Committee, Minia University (543/84/2021). The trial was retrospectively registered on ClinicalTrials.gov (NCT06808243) on February 5, 2025. RESULTS: All patients completed the 6-month follow-up without dropout. There were no statistically significant differences between groups regarding KTW, PES, or BCT. However, the mVIP-CTG group demonstrated a significantly greater increase in KTT compared to the XCM group (p < 0.05). CONCLUSION: The pedicled mVIP-CTG technique resulted in a superior increase in keratinized tissue thickness around immediate implants compared to XCM. Despite this, XCM offered advantages in terms of reduced morbidity and shorter surgical time, suggesting it remains a viable alternative in cases where patient preference or clinical limitations preclude autogenous grafting.