Soft tissue grafting at immediate implants: does it protect the buccal plate?

Abstract A Commentary on Jung M, Tran D, Chang CC, Kim SK, Tsukiboshi Y, Min S, Ayilavarapu S, Lee CT . Volumetric buccal bone alterations at immediate implant sites with or without soft tissue augmentation: A 6-month assessment. J Periodontol. 2026;97:220–33. https://doi.org/10.1002/jper.11381 . Design This was a secondary analysis of cone-beam computed tomography (CBCT) and scanned model data from a registered randomised controlled trial evaluating immediate implant placement with or without soft tissue augmentation 1 . The study compared immediate implant placement with subepithelial connective tissue grafting, immediate implant placement with acellular dermal matrix, and immediate implant placement without soft tissue augmentation (control). Case selection Forty-five patients requiring extraction of a single maxillary anterior or premolar tooth followed by immediate implant placement were included. Participants were allocated to one of three groups: immediate implant with subepithelial connective tissue graft, immediate implant with acellular dermal matrix, or immediate implant alone. In all groups, the gap between the implant and the alveolar bone was filled with bovine bone material and a collagen dressing was placed. Data analysis CBCT scans were taken before extraction and 6 months after immediate implant placement. The scans were superimposed to assess three-dimensional volumetric and two-dimensional linear buccal bone dimensional changes. The buccal region was divided into coronal, middle and apical thirds. Volumetric bone loss was calculated in absolute and relative terms. Linear horizontal and vertical bone changes were also assessed. Measurements were carried out by a calibrated blinded examiner. Statistical analysis included ANOVA or Kruskal–Wallis tests, linear regression analysis to explore associations between clinical factors and volumetric bone change, and Pearson correlation coefficients to compare 3D and 2D measurements. Results There was no statistically significant difference in volumetric buccal bone loss between the three groups at 6 months. The greatest loss occurred in the coronal third, with mean volumetric reductions of −14.99 ± 4.29 mm³ in the connective tissue graft group, −13.60 ± 3.97 mm³ in the acellular dermal matrix group, and −12.58 ± 4.09 mm³ in the control group (p = 0.286). Thick bone morphotype was associated with greater absolute volumetric bone loss. Correlations between 3D and 2D measurements varied between anatomical segments. Conclusion Soft tissue augmentation using either a subepithelial connective tissue graft or acellular dermal matrix did not significantly reduce buccal bone dimensional loss at immediate implant sites after 6 months. Linear measurements may not represent fully volumetric buccal bone changes.