The use of patient’s own blood plasma derivative and palatal tissue graft in dental implant surgery

INTERVENTION: Patients aged between 18 and 60 years with single or multiple non‐restorable teeth were selected according to inclusion and exclusion criteria. The patients were randomly assigned to two groups using the method of random numbers; Group I received delayed dental implantation with SCTG and PRF membrane during the second‐stage implant surgery while Group II received delayed dental implantation with SCTG during the second‐stage implant surgery. After implant placement during second‐stage implant surgery the SCTG that is de‐epithelialized extraorally was harvested from the lateral part of the hard palate. Two horizontal and two vertical incisions are performed perpendicular to the mucosal surface, 1.0–1.5 mm deep. The mucosal defect on the donor part is closed with a collagen membrane and sutured. The graft is positioned on sterile gauze, moistened with a saline solution and de‐epithelialized with a scalpel blade. The SCTG was put inside the vestibular pouch by mattress suture. In Group I the PRF membrane was prepared, where 10 ml of blood was obtained from the vein and transferred to the free anticoagulant tube. The blood sample was centrifuged at 700 g for 8 min and then the resultant fibrin clot was compressed in the PRF bo Xto obtain the PRF membrane which was then applied over the SCTG. The feature of the surgical procedure was the formation of the flap and the shift of the initial keratinized tissues to the lingual side. The graft and PRF were stabilized with an absorbable suture (Vicryl 5‐0). CONDITION: Improvement of gingival thickness in patients with thin gingiva biotype who undergoing dental implantation ; Oral Health PRIMARY OUTCOME: 1. Width of the keratinized tissue determined by measuring the distance between the mucogingival junction (MGJ) and free gingiva using a graduated periodontal probe at baseline, 3 and 6 months after the surgical procedure; 2. Thickness measured by the cone‐beam computed tomography (CBCT) with Ez3D‐1 software (Vatech, Korea) before and 3, 6 months after the surgical procedure. The measurement of the thickness of mucous for determination of biotype was provided according to the following steps: before the examination in the vestibule site of the oral cavity dental cotton swabs were put, measurements are carried out in the frontal and sagittal dimensions in areas corresponding to the vestibular cortical plates of the root of the examined tooth, in the projection of the central axis of the tooth, from the top of the cortical plate to the mucogingival junction. SECONDARY OUTCOME: 1. Wound healing (epithelialization) measured using a cytological analysis at baseline, 3, 5, 7, and 10 days; 2. Local immunity measured using a sandwich enzyme‐linked immunosorbent assay (ELISA) for determination of the concentration of pro‐ and anti‐inflammatory cytokines (IL‐1ß, TNFa and IL‐4) in the peri‐implant cervicular fluid at baseline, 1, 7 and 30 days; 3. Gingival blood flow measured using a laser Doppler flowmetry (LDF) at baseline,1, 7 and 14 days; 4. Esthetic result (mesial and distal papilla, soft tissue level, soft tissue contour, alveolar process deficiencies, soft tissue color, and texture) measured using a Pink esthetic score (PES) at 6 months after the prosthetic phase INCLUSION CRITERIA: 1. Aged 18‐60 years 2. Patients with single or multiple non‐restorable teeth 3. Thin biotype of gingiva 4. Sufficient bone of alveolar ridge 5. Absence of untreated periodontal disease