volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year...

Volume gain and stability ofperi-implant tissue following bone andsoft tissue augmentation: 1-year resultsfrom a prospective cohort study

David SchneiderUeli GrunderAndreas EnderChristoph H. F. HammerleRonald E. Jung

Authors’ affiliations:David Schneider, Christoph H. F. Hammerle,Ronald E. Jung, Clinic for Fixed and RemovableProsthodontics and Dental Material Science,University of Zurich, Zurich, SwitzerlandUeli Grunder, Private practice, Zollikon,SwitzerlandAndreas Ender, Division of Aesthetic andComputer Restorations, Clinic of PreventiveDentistry, Periodontology and Cariology,University of Zurich, Zurich, Switzerland

Corresponding author:Dr med., Dr med. dent. David SchneiderClinic for Fixed and Removable Prosthodontics andDental Material ScienceUniversity of ZurichPlattenstrasse 118032 ZurichSwitzerlandTel.: þ 41 44 634 32 51Fax: þ 41 44 634 43 05e-mail: [email protected]

Key words: dental implants, GBR, guided bone regeneration, volumetry

Abstract

Objectives: The aim of the present study was to evaluate the dimensional changes of peri-

implant tissues obtained by implant placement, bone and soft tissue augmentation,

prosthetic reconstruction and 1 year of function using a new, non-invasive method for

volumetric measurements.

Materials and Methods: In 16 patients, the missing central or lateral maxillary incisor was

reconstructed with an implant-supported single crown. Impressions were taken before (t1),

after implant placement with guided bone regeneration using DBBM and a PTFE

membrane (t2), after soft tissue augmentation (t3), immediately after crown placement (t4)

and 1 year later (t5). The cast models were optically scanned and digitally superimposed

allowing qualitative and quantitative analysis of alterations of the labial peri-implant tissue

contour. In addition, the crown length and papilla height were measured at crown

placement (t4) and after 1 year (t5).

Results: Fifteen patients were available for recall after 1 year. During therapy, a mean gain

in distance in the labial direction of 1.27 � 0.67 mm was observed after the surgical

procedures. One year after crown insertion, a mean loss of 0.04 � 0.31 mm in the labial

direction was recorded. During the same period, the crown length increased by a mean of

0.22 � 0.57 mm and the papilla height by 0.07 � 0.61 mm. The degree and pattern of

tissue change following crown insertion were highly variable between individuals,

irrespective of the amount and quality of previously augmented tissues.

Conclusions: The clinical procedures were effective in augmenting peri-implant tissue

volume that remained stable to a high degree within 1 year after crown insertion. Large

inter-individual variations regarding the tissue alterations were observed.

Dental implants and implant-supported

reconstructions are well established and

widely accepted in reconstructive dentistry

(Noack et al. 1999; Weng et al. 2003;

Bragger et al. 2005; Pjetursson et al. 2007;

Jung et al. 2008). Because of bone resorp-

tion and loss of buccal volume after tooth

extraction (Schropp et al. 2003; Araujo &

Lindhe 2005), bone and soft tissue aug-

mentations are often performed in connec-

tion with implant treatment. The aim of

these procedures is to restore the missing

volume and to allow a prosthetically correct

implant position (Garber & Belser 1995;

Evans & Chen 2008). The position of the

implant and the quality and quantity of the

surrounding tissues are considered to be of

great importance for the achievement of a

biologically and esthetically acceptable and

stable result (Hermann et al. 2000; Tarnow

et al. 2000, 2003; Grunder et al. 2005;

Chen et al. 2007; Evans & Chen 2008).

Although bone and soft tissue augmenta-

tions are frequent procedures associated

Date:Accepted 4 May 2010

To cite this article:Schneider D, Grunder U, Ender A, Hammerle CHF,Jung RE. Volume gain and stability of peri-implant tissuefollowing bone and soft tissue augmentation: 1-yearresults from a prospective cohort studyClin. Oral Impl. Res. 22, 2011; 28–37.doi: 10.1111/j.1600-0501.2010.01987.x

28 c� 2010 John Wiley & Sons A/S

mailto:[email protected]

with implant treatment (Hammerle et al.

2002; Esposito et al. 2006; Bornstein et al.

2008), there is limited knowledge about the

long-term behavior of the augmented tis-

sues and the resulting esthetic changes.

Unfortunately, in many studies the suc-

cess of a treatment is reported as implant

survival rate only, while in others the

amount of crestal bone resorption on radio-

graphs is reported or patient satisfaction is

described (Belser et al. 2004; Donos et al.

2008). Clinical success, however, regarding

the ‘‘pink esthetics’’ depends on many

other rarely investigated factors. Recently,

efforts have been made to classify peri-

implant soft tissue from an esthetic point

of view (Jemt 1997; Furhauser et al. 2005;

Meijer et al. 2005).

Vertical loss of buccal peri-implant tissue

volume may lead to recession, to a crown

length differing from the contralateral tooth

and to a visible abutment or implant

shoulder. Missing volume in the horizontal

direction at the buccal aspect causes a

shadow in the respective region. Therefore,

a sufficient amount of tissue is of great

interest regarding the esthetic outcome

(Chang et al. 1999a, 1999b; Tarnow et al.

2000; Grunder et al. 2005).

The aim of the present study was to

evaluate the alterations and the stability

of peri-implant tissues during and after

implant treatment.

Material and methods

Surgical and prosthetic procedures

Sixteen patients with missing or hopeless

central or lateral maxillary incisors were

planned to be restored by an implant and a

single crown according to a standardized

protocol (Grunder et al. 1996) (Fig. 1).

Patients with general contraindications

against surgical procedures were excluded.

Without any other case selection criteria

(smokers were also included), 16 consecu-

tive patients were treated and included in

the study.

In three cases the tooth was already

missing at the time of the first consulta-

tion; in all other patients, the hopeless

tooth was extracted. After a healing period

of 8 weeks, an alginate impression was

taken before the surgical procedure (t1)

(Figs 2 and 3).

Fig. 1. Treatment sequence and time points of evaluation (t1–t5).

Fig. 2. Preoperative situation (t1), before implant placement and guided bone regeneration procedure. Facial view.

Fig. 3. Preoperative situation (t1), before implant placement and guided bone regeneration procedure. Incisal view.

Fig. 4. Intraoperative situation after implant placement, before guided bone regeneration procedure.

Schneider et al �Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation

c� 2010 John Wiley & Sons A/S 29 | Clin. Oral Impl. Res. 22, 2011 / 28–37

Before surgery, the patient rinsed with a

chlorhexidine 0.12% solution for 1 min.

After local anesthesia, an intrasulcular in-

cision and a vertical releasing incision were

placed and a mucoperiosteal flap was

raised. Drilling of the prospective implant

bed was then performed according to the

manufacturer’s protocol and a screw-type

rough surface implant (Biomet3i Implant

Innovations, Palm Beach Gardens, FL,

USA or SPI, Thommen Medical, Walden-

burg, Switzerland) was placed (Fig. 4). The

buccal border of all implant shoulders was

in a position palatal to a line connecting the

facial emergence points of the two adjacent

crowns. An augmentation procedure buc-

cally to the implant was performed with

deproteinized bovine bone mineral

(Bio-Oss Collagens

, Geistlich Pharma

AG, Wolhusen, Switzerland). This bone

substitute material was covered with a

non-resorbable titanium-reinforced ePTFE-

membrane (Gore-Texs

, W.L. Gore &

Assoc., Flagstaff, AZ, USA), which was

secured with the cover screw and/or suture

and with one or two non-resorbable pins

(Frioss

, Friadent GmbH, Mannheim,

Germany) (Fig. 5). For a tension-free adap-

tation, the buccal flap was mobilized after a

periosteal-releasing incision. Wound clo-

sure was achieved with mattress and single

interrupted sutures. If no contraindications

were present, each patient received an

analgetic (Mefenamine-acid, Ponstans

, Pfi-

zer AG, Zurich, Switzerland, 250 mg up to

qid) and an antibiotic (Amoxicillin, Cla-

moxyls

, GlaxoSmithKline AG, Munchen-

buchsee, Switzerland, 375 mg, tid for 5

days). The patient was instructed to cool

the operation site with a cold pack during

the first 6 h after surgery and to rinse with a

chlorhexidine 0.12% solution (Plak outs

,

KerrHawe SA, Bioggio, Switzerland) twice

a day for 10 days. The pontic of the partial

removable prosthesis was shortened to

avoid pressure on the tissue. Seven to 10

days after surgery, the sutures were re-

moved.

After a 6-month healing period, a second

alginate impression was taken (t2). The

surgical site was reopened under local an-

esthesia, a full-thickness flap was raised

and the non-resorbable membrane and the

pins removed (Fig. 6). A subepithelial con-

nective tissue graft from the palate was

placed under the flap and stabilized with

non-resorbable sutures (Fig. 7). The buccal

flap was mobilized and wound closure was

achieved with a non-resorbable suture. The

postoperative regimen and medication were

the same as after the implantation but no

antibiotics were administered. Seven to 10

days later, the sutures were removed.

Four weeks later, another alginate im-

pression was taken (t3). Under local an-

esthesia, the abutment connection

procedure was performed by a semilunar

mucosal incision over the coverscrew and

the placement of a healing abutment.

One month after the abutment connec-

tion, an impression was taken and a crown

was fabricated. Two months after the

second-stage procedure, a porcelain-fused-

Fig. 5. Intraoperative situation after implant placement and guided bone regeneration procedure.

Fig. 6. Intraoperative situation after membrane removal (t2), before soft tissue grafting procedure.

Fig. 7. Intraoperative situation after membrane removal (t2) and soft tissue grafting procedure.


30 | Clin. Oral Impl. Res. 22, 2011 / 28–37 c� 2010 John Wiley & Sons A/S

to-metal crown or an all-ceramic crown

was cemented using a composite cement

(Panavia F, Kuraray, Frankfurt am Main,

Germany). Another alginate impression

was taken 1 week later (t4) (Figs 8 and 9).

The patient was included in a structured

maintenance care program. One year after

crown insertion, another alginate impres-

sion was taken (t5) (Figs 10–12).

Measurements

Cast models (CAM-Bases

, Dentona AG,

Dortmund, Germany) based on the alginate

impressions were used to compare tissue

dimensions at different time points. Casts of

the implant site with the surrounding soft

tissues and the adjacent teeth were optically

scanned with a 3D camera (Cerec 3D,

Sirona Dental Systems GmbH, Bensheim,

Germany). These scans represented the fol-

lowing time points: immediately before (t1)

and 6 months after implantation and simul-

taneous bone augmentation (t2), 1 month

after soft tissue augmentation (t3), 1 week

after crown insertion (t4) and 1 year after

crown insertion (t5). The acquired data were

visualized with a CAD/CAM software

(Cerec 3, Sirona Dental Systems GmbH).

The digital images obtained were then

transferred into another digital imaging soft-

ware (Match3D, University of Munich,

Munich, Germany). During the next step,

this software was used to superimpose and

match the images in one coordinate system.

The buccal surfaces of the adjacent teeth

were used as a reference for the superposi-

tion of the different images.

In order to assess the amount of bone and

soft tissue augmentation, an area of interest

at the labial aspect of each extraction site

was defined and measured and the volume

difference between the time points was

calculated (Figs 13 and 14). Because of the

individually variable anatomic situation in

each patient, the measured area varied from

patient to patient but was the same in one

patient site over time (t1, t2 and t3).

For the assessment of the buccal tissue

alterations between crown insertion 1 year

thereafter (t4 and t5), a new baseline mea-

surement of the same region and a follow-

up at 1 year were obtained as described

above (Fig. 15).

In order to compare the volume altera-

tions between the different sites, the mean

volume change per area was calculated as a

distance (Dd [mm]¼Dvol [mm3]/area

[mm2]). This distance (Dd) represents the

mean change in the bucco-oral direction of

all measured points perpendicular to the

labial surface (Fig. 16).

The height of the mesial and distal

papilla and the level of the labial gingival

margin after crown insertion (t4) and after

1 year (t5) were measured on the cast

models using a caliper with 0.1 mm inter-

vals. The incisal edges of the crown and of

the adjacent teeth were used as references;

the direction of the measurement was par-

allel to the long axis of the reconstructed

tooth.

Fig. 8. Facial view, 1 week after placement of permanent crown at site 11 (t4).

Fig. 9. Incisal view, 1 week after placement of permanent crown at site 11 (t4).

Fig. 10. Facial view, 1 year after placement of permanent crown at site 11 (t5).



In summary, the following measure-

ments were performed:

1. Tissue volume difference immediately

before and 6 months after implantation

and simultaneous bone augmentation

(t1–t2).

2. Tissue volume difference immediately

before and 1 month after membrane

removal and soft tissue augmentation

(t2–t3).

3. Tissue volume difference from 1 week

after crown insertion to 1 year later

(t4–t5).

4. Change in papilla height from 1 week

after crown insertion to 1 year there-

after (t4–t5).

5. Change of the level of the gingival

margin from 1 week after crown inser-

tion to 1 year thereafter (t4–t5).

Statistics

Descriptive statistics including the mean,

median, standard deviation, maximum and

minimum values were applied (SPSS 17,

SPSS Inc., Chicago, IL, USA). Linear re-

gression with the Pearson coefficient was

used to analyze the possible influence of

various factors on the volume alterations

after crown insertion. A correlation analy-

sis was performed to test if larger overall

tissue augmentations lead to a higher abso-

lute volume decrease than small volume

gains over the observation period.

Results

No intraoperative or postoperative compli-

cations occurred. All patients showed un-

eventful healing and no membrane

exposures were observed. After 1 year, 15

of the 16 patients were available for the

follow-up examination. Five patients were

males, 10 females. The mean age was 47.5

years, ranging from 22 to 70 years. In 12

cases, a central incisor was replaced, in

three cases the lateral incisor.

Volume changes resulting from peri-implantguided bone regeneration (GBR) (t1–t2) andconnective tissue graft (CTG) (t2–t3)

Qualitative assessment

In all cases, an increase in volume in the

labial area of the tooth gap and a loss of

volume in areas around the adjacent teeth

were observed from t1 to t2 and t2 to t3.

The pattern of volume alteration varied

between individuals.

Quantitative assessment

The mean area of measurement for the

evaluation of volume changes from t1 to t2

and t2 to t3, respectively, was 18.97� 6.59

mm2 (range: 9.22–29.49mm2) (Table 1).

Between t1 and t2, the labial prominence

increased by þ0.72� 0.47mm (range:

þ0.14 to þ 1.45 mm) on average. The

mean increase between t2 and t3 was

þ 0.55� 0.53 mm (range: �0.09 to

þ 1.74mm). The overall resulting increase

in labial prominence from t1 to t3 amounted

to þ1.27� 0.67mm (range: þ0.26 to

þ 3.18mm) on average.

Volume changes within the first year aftercrown insertion (t4–t5)

Qualitative assessment

Generally speaking, the pattern of gain or

loss was not homogenous within the area

Fig. 11. Incisal view, 1 year after placement of permanent crown at site 11 (t5).

Fig. 12. Radiograph, 1 year after placement of permanent crown at site 11 (t5).



of measurement. In detail, a decrease in

volume was observed close to the peri-

implant mucosal margin and an increase

in volume in the more apical part of the

area measured (Fig. 13). Furthermore, the

pattern of volume change showed a high

variability between patients.

Quantitative assessment

The mean measured area for the evaluation

of the volume changes between t4 and t5

was 21.05� 12.53 mm2 (range: 11.63–

54.56 mm2) (Table 1). The mean loss of

the facial prominence within the first year

after insertion was � 0.04� 0.31 mm

(range: � 0.57 to þ 0.56 mm).

When analyzing the amount of volume

change over time in relation to the volume

gain obtained by the therapeutical inter-

ventions, a weak correlation was found

demonstrating a more pronounced loss of

volume with the increasing volume of the

augmentation (r¼0.142). Statistical analy-

sis, however, did not reveal a relevant level

of significance (P¼ 0.166) (Fig. 17).

Changes in marginal tissue height within 1year after crown insertion (t4–t5; Table 2)

The mean change of the level of the

gingival margin at the labial aspect of the

implant-supported crown measured �0.22

� 0.57 mm (range: � 1.2 to þ1 mm). In

nine out of 15 patients, a recession of the

marginal tissue of 0.1 to 1.2 mm was ob-

served, whereas in five patients a gain in

tissue height leading to a reduction of the

clinical crown length of 0.1–1 mm was

recorded. In one patient, no difference

was observed after 1 year.

Changes of papilla height within 1 yearafter crown insertion (t4–t5; Table 3)

The mean change in papilla height amoun-

ted to þ0.07� 0.61 mm (range: � 1 to

þ 1.1 mm). The mean difference between

t4 and t5 was þ 0.01 mm (SD 0.5, range

� 0.8 to þ0.8 mm) for the mesial

and þ0.14 mm (SD 0.72, range �1 to

þ 1.1 mm) for the distal papilla. In nine

out of 15 patients, a loss of the mesial

papilla height and in six out of 15 a loss

of the distal papilla height were observed.

Four patients showed a loss of height at

both papillae.

Discussion

The results of this prospective clinical

study demonstrated that labial volume

could successfully be augmented using

GBR and the subsequent connective tissue

grafting. Implant placement with simulta-

neous GBR resulted in a gain of labial

volume in all cases. In the majority of the

treated patients, the gain in the labial

direction ranged from about 1 to 1.5 mm.

The GBR procedure contributed more to

volume gain than soft tissue grafting.

Furthermore, the connective tissue grafting

failed to increase the volume in almost a

third of the patients.

Within 1 year following crown insertion,

the augmented volume remained stable on

average. The pattern of remodeling, how-

ever, was highly variable between indivi-

duals. The commonly observed pattern

was a migration of the soft tissue promi-

nence from a marginal to a more apical

region. The amount or pattern of tissue

alteration was independent on whether the

bulk of the volume was gained by the GBR

or the CTG procedure.

To date, no clinical studies analyzing

labial tissue contours long-term after

peri-implant GBR are available in the lit-

erature. Clinical studies performed with

autogenous bone block grafts reported a

mean decrease of the initially built-up

Fig. 13. Measured area of tissue volume changes at site 21 (patient 3) after implantation and bone augmenta-

tion. Superimposition of images at t1 and at t2. Red areas, loss of volume; black areas, no change; white areas,

gain in volume.

Fig. 14. Measured area of tissue volume changes at site 21 (patient 3) after soft tissue augmentation.

Superimposition of images at t2 and at t3. Red areas, loss of volume, black areas, no change, white areas,

gain in volume.



buccal countour of 22% (Jemt & Lekholm

2005) or 1 mm (55%), respectively,

after prosthetic reconstruction (Henriksson

& Jemt 2004). In the present study,

the amount of loss was much less than

in the studies mentioned above. In

addition, during the first year after

crown insertion, even a volume gain was

observed in six patients. This gain is diffi-

cult to explain and warrants further inves-

tigation.

When analyzing labial recession during 1

year in function by measuring the crown

length, a slight mean gingival recession of

0.2 mm was observed. Except for one pa-

tient with a recession of 1.2 mm, all pa-

tients showed variations of the crown

length within 1 mm. In nine out of 15

patients, the clinical crown length in-

creased, and in five patients a decrease of

the crown length was recorded. The mean

value and the variation are in agreement

with other clinical studies measuring the

crown length alterations after insertion of

implant-supported crowns (Grunder 2000;

Small & Tarnow 2000; Priest 2003; Jemt

& Lekholm 2005; Cardaropoli et al. 2006).

Comparing the results of these studies, the

amount of mucosal recession did not ap-

pear to be influenced by the presence or

absence of augmentation procedures. The

crown length increased slightly (0.4–

0.6 mm) over a long-term period of up to

17 years (Jemt et al. 2006).

In the present study, no statistically

relevant correlation was found between

the change in crown height and either the

amount of tissue augmentation or the di-

mensional change in the bucco-oral direc-

tion. Hence, large augmentations did not

lead to a more stable mucosal margin

than smaller augmentations. Further stu-

dies, however, are needed to elucidate this

topic.

Even though the augmentation proce-

dure was aimed at gaining volume in the

horizontal direction, the effect on the inter-

dental papilla was also assessed. The mea-

surements taken immediately after crown

insertion and the 1-year time-point re-

vealed no change in mean papilla height.

These results confirm previous studies in-

vestigating papilla height over time at im-

plant-supported single crowns. Whether or

not a bone augmentation procedure was

performed at the implant site did not in-

fluence the papilla height (Grunder 2000;

Fig. 16. Principle of measurement. The green grid represents the surface with volume gain and the red grid

represents the surface with loss of volume. The volume changes over the measured area are averaged and

indicated as a distance Dd [mm].

Fig. 15. Measured area of tissue volume changes at site 21 (patient 3) during 1 year after crown insertion.

Superimposition of images at t4 and at t5. Note the inhomogenous pattern of volume alteration within the

selected area. Red areas, loss of volume, black areas, no change, white areas, gain in volume.

Table 1. Volume changes during different treatment sequences, indicated as mean changeof distance in millimeters in labial direction

Patient Change after boneaugmentation (t1–t2)

Change afterCTG (t2–t3)

Total change afterGBRþCTG (t1–t3)

Change within1 year (t4–t5)

1 0.7 � 0.09 0.61 0.262 0.23 0.55 0.78 0.563 1.21 0.59 1.8 � 0.074 0.15 0.78 0.93 � 0.075 0.19 0.06 0.26 0.286 1.34 � 0.03 1.31 0.257 0.56 0.46 1.02 � 0.578 0.56 0.91 1.47 0.149 0.53 0.45 0.97 � 0.1210 0.98 0.78 1.76 � 0.1811 0.88 0.11 1 � 0.4212 1.45 � 0.09 1.35 � 0.3113 0.14 1.34 1.48 � 0.2914 0.48 0.6 1.08 0.2315 1.44 1.74 3.18 � 0.28Mean 0.72 0.55 1.27 � 0.04SD 0.47 0.53 0.67 0.32

GBR, Guided bone regeneration; CTG, connective tissue graft.



Priest 2003; Jemt & Lekholm 2005; Car-

daropoli et al. 2006).

Methodological studies performed pre-

viously demonstrated the measurement

technique used in this study to be highly

precise and reproducible with a measure-

ment error below 10 mm (Mehl et al. 1997;

Windisch et al. 2007). Nevertheless, a

certain inaccuracy resulting from various

procedural steps cannot be ruled out.

These steps mainly encompass the impres-

sion, cast fabrication and digital superim-

position.

Based on the high accuracy and ease of

applicability, this technique has success-

fully been used for the measurement of

occlusal wear (Mehl et al. 1997) and re-

cently also for the volumetric evaluation of

tissue changes (Fickl et al. 2009). Further

advantages of this technique include its

non-invasive character, absence of radia-

tion and the fact that it can easily be

applied either chairside or on the lab bench.

The equipment consists of an optical

scanner, a software program and a personal

computer. Hence, this method has the

potential to be applied successfully in a

variety of indications assessing intraoral

volume changes.

Conclusions

Based on the results of the present study, it

can be concluded that:

� The used surgical techniques were ef-

fective in augmenting tissue volume.

Fig. 17. Linear regression analysis of augmented volume per area and volume change per area within 1 year

(r¼ 0.142, P¼ 0.166).

Table 2. Crown length in millimeters at time of crown insertion (t4) and 1 year later (t5),measured from the margo gingivae to the incisal edge

Patient Crown length at t4 Crown length at t5 Change of the level of themucosal margin within 1 year

1 9.8 9.7 0.12 9.7 9.7 03 8.1 9.3 � 1.24 9.5 10.4 � 0.95 9.6 9.2 0.46 9.5 10.2 � 0.77 9.9 10.4 � 0.58 11.9 10.9 19 10.3 10.6 � 0.310 11.2 11.5 � 0.311 12.5 13.4 � 0.912 8.7 8.6 0.113 9.3 9.4 � 0.114 11.9 12.1 � 0.215 10.3 10.1 0.2Mean � 0.22SD 0.57

A negative value means mucosal recession.

Table 3. Papilla height mesially and distally in millimeters at time of crown insertion (t4) and after 1 year (t5), measured along theperpendicular to the incisal edge of implant crown

Patient Height of mesialpapilla (t4)

Height of distalpapilla (t4)

Height of mesialpapilla (t5)

Height of distalpapilla (t5)

Change within1 year, mesial papilla

Change within1 year, distal papilla

1 5 5.1 5.2 5.9 � 0.2 � 0.82 8.8 7.6 9.6 8 � 0.8 � 0.43 6.2 5.5 5.4 5.6 0.8 � 0.14 7.8 6.9 8.1 7.4 � 0.3 � 0.55 7.5 7.8 7.1 6.8 0.4 16 6.5 7.1 7 6.4 � 0.5 0.77 7.2 6 7.6 5.7 � 0.4 0.38 8 4.7 8.1 5.7 � 0.1 � 19 7.8 7.5 7.2 6.6 0.6 0.910 7.8 8.4 7.2 7.9 0.6 0.511 8.9 9.6 9.1 10.5 � 0.2 � 0.912 5.2 6.4 5.3 5.8 � 0.1 0.613 8.3 7 7.9 7 0.4 014 9 9.6 9.6 8.9 � 0.6 0.715 8.3 8.2 7.8 7.1 0.5 1.1Mean 0.01 0.14SD 0.5 0.72

A negative value means loss of papillar tissue.



They resulted in a mean gain in tissue

volume of 1.3 mm at the labial peri-

implant region.

� The augmented tissue volume remai-

ned stable to a high degree within 1

year after crown insertion. A mean loss

of 0.04 mm was measured.

� A mean gingival recession of 0.2 mm

was recorded over the observation

period.

� The mean papilla height remained un-

altered over the observation period.

� The selected method for analysis of

volume changes proved to be easily

applicable.

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