BACKGROUND:This systematic review endeavored to investigate the effect of soft tissue phenotype modification therapy (PhMT-s) at sites with a tooth or an implant supported fixed dental prosthesis. METHODS:A comprehensive literature search was conducted by two independent examiners to identify relevant studies reporting differences in clinical, esthetic, or radiographic outcomes of interest between sites underwent PhMT-s and sites that remained untreated. Risk of bias assessment was calculated for all included studies. Meta-analyses involving endpoints of interest were performed when feasible. RESULTS:No controlled studies pertaining to tooth sites were identified. A total of six articles reporting on the outcomes of buccal soft tissue phenotype modification around implants were selected, of which, five were included in the meta-analyses. Quantitative analyses showed a weighted mean difference (WMD) of 0.98 mm (95% CI = 0.25 to 1.72 mm, P = 0.009) for change of tissue thickness; a WMD of -4.87% (95% CI = -34.27 to 24.53%, P = 0.75) for bleeding on probing (BOP); a WMD of 0.36 mm (95% CI = 0.12 to 0.59 mm, P = 0.003) for mucosal recession (MR); a WMD of 0.13 mm (95% CI = -0.11 to 0.36 mm, P = 0.30 for probing depth (PD); a WMD of 1.08 (95% CI = -0.39 to 2.55, P = 0.15) for pink esthetic score (PES), and a WMD of 0.40 mm (95% CI = -0.34 to 1.14 mm, P = 0.28) for marginal bone loss (MBL). CONCLUSIONS:Surgical modification of peri-implant soft tissue phenotype via PhMT-s may decrease the amount of MR. Future clinical trials are needed to warrant the clinical benefits of modifying soft tissue phenotype around tooth-supported restorations.

BACKGROUND:Advanced platelet-rich fibrin (A-PRF) is an autogenous blood product with applications in dento-alveolar surgery. However, there is minimal information regarding its optimal clinical application or efficacy. The aim of this multi-arm parallel randomized controlled clinical trial was to evaluate the efficacy of A-PRF alone or with freeze-dried bone allograft (FDBA) in improving vital bone formation and alveolar dimensional stability during ridge preservation. METHODS:Forty patients requiring extraction of non-molar teeth and replacement with dental implants were randomized into one of four ridge preservation approaches: A-PRF, A-PRF+FDBA, FDBA, or blood clot. A-PRF was prepared at 1,300 rpm for 8 minutes. Non-traumatic extractions and ridge preservation was performed. After an average of 15 weeks healing, bone core samples were harvested at the time of implant placement for micro-CT and histomorphometric analysis. Ridge dimensions were measured immediately after extraction and before implant placement. RESULTS:Significantly greater loss of ridge height was noted in the blood clot group (3.8 ± 2.0 mm) compared to A-PRF (1.8 ± 2.1 mm) and A-PRF+FDBA (1.0 ± 2.3 mm) groups (P < 0.05). No significant differences in ridge width reduction were noted between groups. Significantly more vital bone was present in the A-PRF group (46% ± 18%) compared to the FDBA group (29% ± 14%) (P < 0.05). Bone mineral density was significantly greater in the FDBA group (551 ± 58 mg/cm3 ) compared to blood clot (487 ± 64 mg/cm3 ) (P < 0.05). CONCLUSIONS:This study demonstrates A-PRF alone or augmented with FDBA is a suitable biomaterial for ridge preservation. This study represents the first randomized controlled clinical trial comparing A-PRF with and without FDBA to FDBA alone for ridge preservation.