Application Effect Of Acellular Dermal Matrix Combined With Platelet Rich Fibrin Solution In Soft Tissue Increment Of Upper Anterior Teeth

Objective:In this study,we observed the changes of gingival contour to evaluate the application effect of different materials in the soft tissue increment of anterior teeth.Accurate measurement of gingival thickness can provide a basis for the changing trend of labial gingival fullness and long-term stability evaluation,so as to find a more effective and easily accepted soft tissue increment method.Methods:In this study,a total of 25 patients(10 males and 15 females,the age range is 20 to52)who had lost a single tooth in the aesthetic area of the anterior teeth and had undergone temporary coronectomy for three months were enrolled.Patients were included according to the following criteria: no prostheses in adjacent teeth;during the second operation,CBCT showed complete labial bone plate and poor labial fullness(mild to moderate);no additional teeth,jaw bone lesions and other causes of oral soft and hard tissue changes;peri-implant tissues were basically healthy,and gingival tissues had no obvious swelling,hyperplasia or atrophy;did not take any drugs that might cause gingiva to grow and did not have any operation on the gums or upper palate.All operations were performed using tunneling technique,which was divided into three groups according to different graft materials:The oral scanning was performed on the Subepithelial Connective Tissue Graft(SCTG)group,Acellular Dermal Matrix(ADM)+0.9% sodium chloride injection group and ADM+platelet-rich fibrin solution(PRFs)group,respectively,before surgery,immediately after surgery,10 days,3 months and 6months after surgery.The unified output is in STL format.Geomagic Control 2014 was used to quantitatively analyze the contour volume of soft tissue and gingival thickness around the implant.The final aesthetic effect was evaluated using the Visual Analogue Scale(VAS),and postoperative pain was evaluated using the Numerical Rating Scale(NRS).Results:In all the three groups,swelling followed by contraction occurred after surgery.However,compared with preoperation,the soft tissue thickness of the lip of the implant was still compensated to increase.Swelling occurred in the three groups at day 10,the SCTG group was the smallest,and the ADM+ PRFS group was the largest.At day 10,the average thickening amount of gingival was 1.0550±0.1007 mm,and the swelling rate was +3.31%±1.61%.In the ADM+PRFS group,the thickening amount was1.1428±0.0195 mm,and the swelling rate was +14.49%±1.77%.A further contraction occurred at 3 and 6 months.In the ADM+0.9% sodium chloride injection group,the shrinkage rate was the highest(-39.38%±3.81%).ADM+ PRFs group was the next(-37.38%±2.73%).SCTG group was the smallest(-27.58%±3.85%).The SCTG group had the largest amount of gingival thickening,with an average of0.7135±0.0702 mm.Postoperative pain index of ADM group and SCTG group was much lower than that of ADM group.Conclusion:This study showed that the application of ADM and SCTG in the soft tissue increment of anterior teeth could increase the preoperative gingival thickness.Within the observation range of this experiment,the grafts all expanded first and then contracted,among which,the average shrinkage rate of SCTG group was the lowest,followed by ADM+ PRFs group and the highest in ADM+0.9% sodium chloride injection group.ADM+ PRFs could improve the shrinkage of ADM,but not significantly,and the thickening effect of SCTG group was the best.The pain of the ADM group was much lower than that of the SCTG group.