A Novel Approach for Implant Rehabilitation Combined with Immediate Bone and Soft-Tissue Augmentation in a Compromised Socket-A B2S Approach: Case Report with a 2-Year Follow-Up.

In this case report, we aimed to describe a novel approach for aesthetic rehabilitation of the anterior maxilla that combined immediate implant installation with the "Bone2Soft Tissue Reconstruction" (B2S technique), which involves the use of a triple graft harvested from the maxillary tuberosity. The regeneration potential of a tuberosity graft appeared to surpass that of corticocancellous bone grafts harvested from other intraoral donor sites and allowed for quicker regeneration of both bone and soft tissue. The B2S technique extended the indications for immediate implant placement and ridge augmentation to cases involving severe bone resorption and other complex clinical scenarios. Owing to the good visualization facilitated by open-flap access, the surgical procedures can be completed in a single intervention, which will be beneficial for both doctors and patients.

Contour angle and peri-implant tissue height: Two interrelated features of the implant supracrestal complex.

OBJECTIVES: Recent research has suggested the contour of the prosthesis and the vertical height of the peri-implant mucosa as important parameters that can influence the long term health and stability of the peri-implant tissue. In particular, overcontouring of the prosthesis has been correlated with an increased risk for peri-implantitis, while reduced soft tissue height has been associated with marginal bone loss, recession, and other soft tissue complications. Although these two parameters have been investigated as independent in the current literature, clinical experience points toward a close interrelation between transmucosal tissue height and prosthesis contour angle. It is often found that a reduced vertical height of the implant supracrestal complex is the main reason for overcontouring of the prosthesis. At the same time, achieving a favorable contour of 30o or less is not possible unless the clinician has ensured an adequate vertical height of the soft tissue. The purpose of this short communication is to establish the relation between tissue vertical height and prosthesis contour by utilizing a theoretical geometry equation based on the Pythagorean theorem. In doing so, one can use the dimensions of the implant as well as those of the prosthesis at the mucosal margin to calculate the essential vertical height for achieving a favorable prosthesis contour. CONCLUSIONS: As the treatment plan of the implant supracrestal complex is "top-down," in case of deficient vertical height, subcrestal placement of the implant should be considered to achieve a proper prosthesis contour.

Influence of Cement Type on its Quality of Removal from Zirconium Oxide Implant-Supported Restorations

PURPOSE: To assess excess cement removal after cementation of implant-supported cementretained restorations using different cements. MATERIALS AND METHODS: A dental model with soft tissue imitation, 20 individual zirconium oxide abutments, and 20 zirconium oxide crowns were fabricated. Half of the restorations were cemented using resin cement (RX) and the other half with resin-modified glass-ionomer cement (GC). After cement cleaning, each crown-abutment unit was removed from the model, photographed, and analyzed from 4 surfaces, resulting in a final sample size of 80 measurements. Radiographic examination and the computerized planimetric method in Adobe Photoshop were used to determine the amount of the cement left and to evaluate the ratio between the area of cement residue and the whole crown-abutment surface. The significance was set to .05. RESULTS: GC resulted in 7.4% more cement residue on all surfaces (P < .05) than RX. The P value on three of the surfaces (all except mesial) was < .05, meaning that the data were statistically significantly different between groups and surfaces. Absolute removal of the cement was impossible in all cases (100%), and in 95% of the cases, cement remnants could not be detected radiographically. CONCLUSION: More undetected cement remains when using resin-modified glass-ionomer cement. It was impossible to remove excess of both types of cements completely. Most of the cement remains on the distal surface. Radiographic examination could not be considered as a reliable method to identify excess cement.

Connective tissue graft vs porcine collagen matrix after immediate implant placement in esthetic area: A randomized clinical trial.

BACKGROUND: The use of connective tissue graft (CTG) with immediate implant placement and provisionalisation have shown promising results. It is not clear if the same outcome could be achieved using porcine-derived collagen matrix (PDCM) as grafting material. OBJECTIVES: This study aimed to assess the esthetic and functional outcomes of immediate temporization of immediately placed fully tapered implants combined with bone and soft tissue augmentation, using either a CTG or a PDCM, in fresh extraction sockets of the anterior sites. MATERIALS AND METHODS: Patients with a failing anterior tooth were included in this study. After extraction, they received an immediate implant with simultaneous hard and soft tissue augmentation and immediate provisional restoration. Patients were randomly assigned to one of the group. Soft tissue augmentation in the control group (CTG) consisted of a CTG, whereas PDCM was used in the test group. After 4 months, definitive restorations were delivered, and pink esthetic score (PES) was evaluated at T1, prosthetic delivery, and at 12-month follow-up (T2). In addition, crestal bone change, probing depth, bleeding on probing, plaque index, bleeding on provisional removal, and implant stability quotient were also recorded. RESULTS: A total of 45 patients received the intended treatment (22 controls and 23 tests) 45 implants totally, with no implant failures at T2. PES mean ± SD after 1 year was noted to be 12.9 ± 1.2 for the CTG group and 12.1 ± 1.3 for the PDCM group (p = 0.507). CONCLUSION: Within the limits of this trial, both treatment protocols resulted in comparable esthetic outcomes, with results showing PES >12 and stable clinical parameters after 1 year of follow-up.

Immediate implant placement vs. early implant treatment in the esthetic area. A 1-year randomized clinical trial.

OBJECTIVES: To assess the impact of implant placement and temporization timing on esthetic outcomes of single maxillary anterior implants with intact bone walls and interproximal bone. MATERIALS AND METHODS: Test group patients received an immediate implant with immediate provisional restoration and socket preservation, while patients in the control group received an early implant placement with guided bone regeneration and delayed loading. Patients were followed for 1 year after final prosthetic and pink esthetic score (PES), mid-buccal mucosal level (MBML), crestal bone changes (CBC), and peri-implant soft tissue parameters, and patient chair time was recorded. RESULTS: Fifty patients received the intended treatment (25 test and 25 control). No implants failed. PES after 1 year was 12.8 ± 1.19 for the test group and 12.5 ± 1.36 for the control group (p = .362). MBML difference between baseline (after final crown delivery) and the 1-year follow-up was gain of 0.2 ± 1.02 mm for the test group (p = .047) and no change in the control group. CBC after 1 year were 0.1 mm ± 0.21 mm (mesial) and 0.2 mm ± 0.22 mm (distal) for the test group and 0.2 mm ± 0.25 mm (mesial) and 0.3 mm ± 0.19 mm (distal) for the control group, p = .540 (mesial) and p = .462 (distal). Test group required half the chair time (127 ± 13 min) when compared to the control group (259 ± 15 min, p < .001). CONCLUSIONS: Within the limits of this trial, both treatment protocols resulted in excellent esthetic outcomes with PES >12 after 1-year follow-up.

Full versus partial thickness flap to determine differentiation and over keratinization of non-keratinized mucosa. A 3-year split mouth randomized pilot study.

OBJECTIVES: It was shown, that Connective Tissue Grafts (CTG) retrieved from the tuberosity tends to determine hyperplastic responses and may induce a beneficial over-keratinization of non-keratinized mucosa. Clinically evaluate and compare CTG from tuberosity ability to increase soft tissue thickness and the keratinization potential after recipient area is either prepared using split or full thickness flap in edentulous mandible. MATERIALS AND METHODS: Fourty implants were placed in 10 edentulous patients with atrophied mandible (Class IV of Misch) presenting less than 1.0 mm of keratinized tissue using a flapless approach and immediately restored with acrylic temporary bridge on multi-unit abutments. The surgical sites were split-mouth randomized and prepared as CTG recipients by a tunneling procedure. Twenty benefited of a partial thickness approach and 20 of a full thickness one. The CTG was placed buccally using partial thickness or full thickness flap according to the randomization schedule. The width of keratinized tissue (KT), the horizontal soft tissue thickness (STT), the marginal hard and soft tissue levels as well as the implant success parameters were collected and analyzed. RESULTS: After a 3 year follow-up period the increase of KT was statistically significantly (p < 0.001) larger in the partial thickness group from 0.6(0.6) to 5.1(0.72) mm, while full thickness group showed very little improvement from 0.5(0.51) to 1(0.57) mm (p < 0.001). STT was significantly increased in both groups over time: from 2.4(0.88) to 5.4(0.68) mm in full thickness group and from 2.5(0.51) to 5.8(0.41) mm in partial thickness group without any significant difference between the groups. CONCLUSION: The increase of soft tissue thickness by using CTG from tuberosity was found in both groups, while keratinization of non-keratinized mucosa appeared more in the partial thickness group.

Assessment of the Bone Healing Process Mediated by Periosteum-Derived Mesenchymal Stem Cells' Secretome and a Xenogenic Bioceramic-An In Vivo Study in the Rabbit Critical Size Calvarial Defect Model.

The mesenchymal stem cell (MSC) secretome has been considered an innovative therapeutic biological approach, able to modulate cellular crosstalk and functionality for enhanced tissue repair and regeneration. This study aims to evaluate the functionality of the secretome isolated from periosteum-derived MSCs, from either basal or osteogenic-induced conditions, in the healing of a critical size calvarial bone defect in the rabbit model. A bioceramic xenograft was used as the vehicle for secretome delivery, and the biological response to the established biocomposite system was assessed by clinical, histological, histomorphometric, and microtomographic analysis. A comparative analysis revealed that the osteogenic-induced secretome presented an increased diversity of proteins, with emphasis on those related to osteogenesis. Microtomographic and histological morphometric analysis revealed that bioceramic xenografts implanted with secretomes enhanced the new bone formation process, with the osteogenic-induced secretome inducing the highest bone tissue formation. The application of the MSC secretome, particularly from osteogenic-induced populations, may be regarded as an effective therapeutic approach to enhance bone tissue healing and regeneration.

Influence of Implant Placement Depth and Soft Tissue Thickness on Crestal Bone Stability Around Implants With and Without Platform Switching: A Comparative Clinical Trial.

This case control study measured early crestal bone changes around subcrestally placed platform-switched implants surrounded by thin soft tissue and compared them with regular, matching-platform implants placed in a supracrestal position and surrounded by thick soft tissue. Sixty-six patients received two-piece internal hex dental implants. Control group patients (n = 33) received implants that had a horizontally matching implant-abutment connection and were placed approximately 0.5 to 1 mm supracrestally. Test group patients (n = 33) received platform-switched implants that were placed about 1.5 mm subcrestally. Clinical examinations were conducted, intraoral radiographs were taken, and statistical analysis was performed. After 2 months, the mean bone loss was 0.2 mm (SD: 0.22 mm; range: 0.1 to 1.2 mm) in the control group and -0.69 mm (SD: 0.65 mm; range: 0 to 2.6 mm) in the test group; this difference was found to be statistically significant (P < .05). After 1 year, mean bone loss was 0.28 mm (SD: 0.36 mm; range: 0.1 to 1.63 mm) in the control group and -0.6 mm (SD: 0.55 mm; range: 0.05 to 1.8 mm) in the test group. Platform-switched implants placed in a subcrestal position in vertically thin soft tissues showed statistically significantly more bone loss than non-platform-switched implants placed supracrestally with vertically thick tissues.

A novel fully tapered, self-cutting tissue-level implant: non-inferiority study in minipigs.

OBJECTIVES: To assess the osseointegration and crestal bone level maintenance of a novel fully tapered self-cutting tissue-level implant for immediate placement (test) compared to a clinically established tissue-level implant (control) in moderate bone quality. MATERIALS AND METHODS: Test and control implants were compared in 3 groups, i.e., small-, medium-, and large-diameter implants in an edentulous mandibular minipig model with moderate bone quality after 12 weeks of healing. Histometrically derived bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC) were subjected to statistical non-inferiority testing. Maximum insertion torque values in artificial bone were assessed for comparison. RESULTS: BIC values for the tests and control implants for all 3 diameters were comparable and non-inferior: small diameter (61.30 ± 10.63% vs. 54.46 ± 18.31%) (p=0.99), medium diameter (60.91 ± 14.42 vs. 54.68 ± 9.16) (p=0.55), and large diameter (45.60 ± 14.67 vs. 52.52 ± 14.76) (p=0.31). fBIC values for test implants were higher and non-inferior compared to control implants in all three groups. Test implants further showed distinctly higher maximum insertion torque values compared to control implants. CONCLUSION: The investigated novel tissue-level implant is able to achieve high levels of primary and secondary implant stability under simultaneous preservation of crestal bone levels. This qualifies the studied implant as an attractive candidate for immediate placement in bone of limited quality. CLINICAL RELEVANCE: This pilot pre-clinical study investigated a novel tissue-level implant for immediate placement. With the aim of translating the studied prototype into clinical application pre-clinical models, procedures and controls have been chosen with the aim of reflecting its future clinical indication and use.

Decompression technique - A modified approach for lateral alveolar ridge augmentation: A case report.

A particular technique can increase the mucosal and peri-implant bone thickness, prevent compression around implant neck, and obtain proper space for the following prosthetic treatment with an adequate emergence profile.

Crestal bone stability after flapless placement of sloped implants with immediate temporization in edentulous mandible. A prospective comparative clinical trial.

OBJECTIVES: The purpose of this study was to evaluate crestal bone stability around sloped implants using the flapless procedure and compare it with conventional implants placed axially. MATERIALS AND METHODS: A total of 40 bone-level implants with platform switching were used for this study for 10 patients (4 males and 6 females) in edentulous mandible. Twenty mesial conventional implants were placed in upright position and 20 distal 30° sloped implants tilted 30°. Bone loss was estimated using radiographic imaging after a 6- and a 12-month follow-up period. Comparison of the bone loss in the distal and mesial region at both implantation angles were conducted to understand the nature and progression of crestal bone loss. RESULTS: Crestal bone loss around the sloped implants was 0.29 mm (SD = 0.292) on average, while around conventional implants it was 0.22 mm (SD = 0.202) after one-year follow-up. However, there was no significant difference in the average of crestal bone loss between two trial groups after 6 months (p < 0.243) and one-year (p < 0.614) follow-up. The results indicated a 100% implant survival rate after one-year follow-up. Additionally, three fixed prostheses needed realignment after fracturing during the follow-up time. CONCLUSION: Considering the limitations of this study, it can be presumed that sloped and conventional implants with platform switching and conical connection have the same potential for minimal crestal bone loss.

Comparison of Selected Anatomical and Treatment-related Diagnostic Parameters Estimated by Cone-Beam Computed Tomography and Digital Periapical Radiography in Teeth with Apical Periodontitis.

OBJECTIVES: To compare selected anatomical and treatment-related diagnostic parameters estimated by cone-beam computed tomography and by digital periapical radiography in teeth with apical periodontitis, and to evaluate reliability of different examiners in interpretation of images obtained by both methods. MATERIAL AND METHODS: Teeth with apical periodontitis were evaluated independently by 2 endodontists and 1 radiologist based on 128 cone-beam computed tomography (CBCT) and 162 digital periapical radiography (DPR) images. Anatomical (size, relation with root, location of periapical radiolucency) and treatment-related (canal obturation length, homogeneity, coronal seal) parameters were assessed. Fleiss kappa reflected inter-observer agreement while intra-examiner agreement was estimated by Cohen's kappa. McNemar and McNemar-Bowker tests served for evaluation of differences between CBCT- and DPR-based estimates. RESULTS: Cohen's kappa ranged from 0.62 to 1 for all examiners. Fleiss kappa values were nearly perfect for majority of parameters. Diagnostic discrepancy between methods was found for size of radiolucency that in 15 - 17% cases was larger, and in 25 - 28% smaller in DPR than in CBCT images. DPR revealed 20% of root canals scored as non-obturated while in CBCT - obturation present. Canal obturation was rated as homogenous by CBCT, while absent or non-homogenous by DPR, in 17 - 23%, and 11 - 14% of cases, respectively. Radiologist detected more root perforations in CBCT than in DPR images. CONCLUSIONS: Good intra- and inter-examiner agreement for anatomical and treatment-related diagnostic parameters was achieved using cone-beam computed tomography and digital periapical radiography methods and demonstrated similar diagnostic capability, although variation regarding root perforations and canal obturation quality was observed.

The influence of submerged healing abutment or subcrestal implant placement on soft tissue thickness and crestal bone stability. A 2-year randomized clinical trial.

PURPOSE: Aims of the study were: (a) to register crestal bone loss around 1.5 mm subcrestally placed implants and epicrestally placed implants with soft tissue tenting technique, (b) to record bone remodeling in subcrestal group, and (c) to determine the increase of vertical soft tissues after tenting. MATERIALS AND METHODS: Thirty-two patients with vertically thin tissues of 2 mm or less received 40 submerged bone level platform-switched implants, divided into two groups-(a) 1.5 mm subcrestally placed implants and (b) epicrestally placed implants with soft tissue tenting over 2 mm healing abutments. At the second stage surgery, implants received 4 mm healing abutments, soft tissue thickness was measured in epicrestal group, and later implants were restored with zirconia-based screw-retained single restorations. Radiological images were taken at the second stage surgery, restoration delivery and after 2 years of follow-up. Bone loss was calculated as a distance between implant neck and first radiographically visible bone-to-implant contact. Bone remodeling was calculated as a distance between the bone crest and implant neck. Mann-Whitney U test was used for statistical analysis, significance set to 0.05. RESULTS: After 2 years of follow-up, Group 1 (subcrestal) had 0.18 ± 0.32 mm of bone loss, Group 2 (epicrestal with 2 mm healing abutment) had 0.51 ± 0.4 mm of bone loss, with statistically significant difference (P = .001). Bone remodeling in Group 1 (subcrestal) was 1.17 ± 0.51 mm. Vertical tissue thickness in epicrestal group before the intervention was 1.85 ± 0.26 and 3.65 ± 0.41 mm after the use of 2 mm healing abutment, with a statistical difference (P = .005). CONCLUSION: Subcrestal implant placement can significantly reduce crestal bone loss, compared to vertical soft tissue thickening by tenting of epicrestally placed implants, although soft tissue tenting can significantly increase soft tissue thickness.

Photo-activated implants: a triple-blinded, split-mouth, randomized controlled clinical trial on the resistance to removal torque at various healing intervals.

OBJECTIVES: Hydrophilic implant surfaces promote faster osseointegration of dental implants with a higher bone-implant contact (BIC) rate. Animal and in vitro studies proved that ultraviolet (UV) irradiation of titanium implants regains hydrophilicity. Clinical impact is still unclear. The objective of this RCT was to assess the removal torque (RT) required to unfix a surface-treated implant (test group) versus the original surface implant (control group) performed at various points in time. The null hypothesis stated that test and control implants will show the same deliberation force at specific time points. MATERIAL AND METHODS: One hundred eighty partially edentulous patients were randomly assigned to six groups. In single-stage surgery, each patient received one test and one control implant. In total, 180 test and 180 control implants were placed epicrestally. Test implants received a surface treatment with UV irradiation prior to insertion, in order to reduce carbon and enhance hydrophilicity and thus wettability. Maximum RT values for test and control implants were recorded with a torque measuring device at implant placement (T1), after 1 (group 1), 2 (group 2), 3 (group 3), 4 (group 4), 6 (group 5) (T2), and 8 weeks (group 6) of healing. Subsequently, implants were returned to their original position for the continuation of the healing process. RESULTS: No implant was lost. Age, gender, smoking, implant position, and bone quality could be excluded as confounding factors because of the lack of statistical significance. At T2, RT values were higher for test implants compared with those for control implants, being statistically significant in groups 2, 3, 4, and 6 (p < 0.05). CONCLUSIONS: Our data support rejection of the null hypothesis. CLINICAL RELEVANCE: Photo-activation of the surface of titanium implants leads to higher resistance to RT forces compared with that of non-treated implants, indicating improved healing and implant stability especially in the early healing phase.

Extraction Socket Preservation with or without Membranes, Soft Tissue Influence on Post Extraction Alveolar Ridge Preservation: a Systematic Review.

OBJECTIVES: The purpose of this systematic review was to assess quantitatively and qualitatively the influence of two different factors: membranes and soft tissue graft influence for the extraction socket preservation. MATERIAL AND METHODS: A wide-ranging electronic search was performed in six databases up to 30 of November 2018 in order to identify all the clinical and randomized clinical trials performed in humans published with no data restriction. The inclusion criteria were extraction socket preservation with and without membranes or a soft tissue graft in a intact socket with at least six months of follow-up, have more than 12 patients or treat more than 12 sites per group and evaluated at least one of the primary outcomes measures (radiographic measures histological assessment, clinical measures). RESULTS: From an initial search of 1524 studies only 6 papers fulfil the inclusion and exclusion criterions. All the six selected papers, presented a wide heterogeneity of treatments used, evaluated variables and observation period that made impossible to recommend any specific techniques and/or material to achieve better results. The limited data found suggest that the used of membrane reveals to achieve better results. It wasn't possible to observe in any clinical trial that compares the used of soft tissue graft. CONCLUSIONS: New trials need to be performed in order to identify what specific techniques and/or materials are better to decrease the reabsorption of the socket after tooth extraction. Clinical trials designed to understand when/how the soft tissues grafts influence at the socket preservation is needed.

The 2nd Baltic Osseointegration Academy and Lithuanian University of Health Sciences Consensus Conference 2019. Summary and Consensus Statements: Group II - Extraction Socket Preservation Methods and Dental Implant Placement Outcomes within Grafted Sockets.

INTRODUCTION: The task of Group II was to review and update the existing data concerning extraction socket preservation with or without membranes and soft tissue influence on post-extraction alveolar ridge preservation; extraction socket preservation using different biomaterials as bone grafts, growth factors, and stem cells. Special interest was paid to the dental implant placement outcomes within grafted sockets. MATERIAL AND METHODS: The main areas evaluated by this group were as follows: quantitative and qualitative assessment of the effect of different alveolar preservation techniques performed immediately after tooth extraction, with or without membranes and/or soft tissue grafting, and the use of different bone substitutes, stem cells or growth factors in the postextraction socket. Evaluation of the treatment outcomes of dental implants placed in the grafted sockets in terms of primary and secondary outcomes were assessed. The systematic reviews and/or meta-analyses were registered in PROSPERO, an international prospective register of systematic reviews: http://www.crd.york.ac.uk/PROSPERO/. TThe literature in the corresponding areas of interest was screened and reported following the PRISMA guidelines (Preferred Reporting Item for Systematic Review and Meta-Analysis) Statement: http://www.prisma-statement.org/. Method of preparation of the systematic reviews, based on comprehensive search strategies, was discussed and standardized. The summary of the materials and methods employed by the authors in preparing the systematic reviews and/or meta-analyses is presented in the Preface chapter. RESULTS: The results and conclusions of the review process are presented in the respective papers. Three systematic reviews and one systematic review and meta-analysis were performed. The group's general commentaries, consensus statements, clinical recommendations and implications for research are presented in this article.

Bone Remineralization around Dental Implants following Conservative Treatment after Peri-Implantitis.

The aim of this case report is to show that bone remineralization around dental implants with a history of peri-implantitis is possible after irritant factors are removed and only conservative treatment is performed. Patient came to the clinic after three years of dental implant placement complaining about swelling, sensitivity and gingiva color changes at the posterior part of the maxilla. During radiographic and intraoral examinations peri-implantitis of the #24 implant site was diagnosed. The surgical treatment method was rejected and performed conservative treatment instead. The outcome is promising; periapical radiographs three months later showed bone remineralization as well as stable bone after 10 years. A key clinical message: Bone remineralization around dental implants with a history of peri-implantitis is possible after irritant factors are removed and conservative treatment performed.

Early crestal bone loss: Is it really loss?

Bone remineralization around dental implants might be possible after early crestal bone loss.

Clinical and Histologic Evaluations of Porcine-Derived Collagen Matrix Membrane Used for Vertical Soft Tissue Augmentation: A Case Series.

This case series aimed to clinically and histologically evaluate porcine-derived membrane used for vertical thickening of thin soft tissues. Twenty porcine-derived collagen membranes and bone-level implants were placed in 20 patients. After 2 months, thickened soft tissues were measured and biopsy samples were harvested. All xenografts healed successfully. The average thickness of thin soft tissue before vertical thickening was 1.65 ± 0.36 mm, while tissue thickness increased to 3.45 ± 0.52 mm after the procedure (P < .001); the mean thickness increase was 1.8 ± 0.13 mm. Histologic analysis showed complete integration of the graft and no differences (P = .4578) in vascularization between the host (39.74 ± 17.15 vessels/mm2) and graft (30.43 ± 11.26 vessels/mm2). It can be concluded that porcine-derived membrane can be used for vertical soft tissue thickening with substantial gain in tissue height.

The use of a porcine-derived collagen matrix for vertical soft tissue augmentation. A case report.

Soft tissue augmentation is a well-established procedure employed in a diverse range of applications such as soft tissue thickening, keratinized tissue augmentation, improvement of the esthetics of existing dental implants and teeth, and crestal bone preservation around implants. This case report describes a technique for the augmentation of vertically thin soft tissue in the lower jaw posterior area. At the time of the implant placement, after measuring the soft tissue thickness, soft tissues were augmented with a porcine accellular dermal matrix (Mucoderm, Botiss Biomaterials, Germany). After 2 months, during the second stage surgery, the implant was exposed and the soft tissue thickness was measured.