الفهرس 
Title : Clinical Comparison of the volumetric changes in single Pontic Site Development through connective tissue grafting using Modified Pouch Technique versus Pouch Technique in the maxillary esthetic zone: A Randomized Controlled Clinical Trial
AbstractOnly 14 pages are availabe for public view
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Abstract
Immediately following tooth extraction, biological processes are initiated, which can lead to substantial resorptive processes of the alveolar ridge and leading to localized alveolar ridge defects, which result in the need for surgical reconstruction. The replacement of missing teeth is mandatory for proper chewing of food, esthetic, jaw support and stability of the remaining teeth. Missing teeth disrupt proper function and the teeth next and opposite to the missing tooth/teeth will shift, move, and tip into the space by time. It is better to restore soon a missing tooth than ending by the consequences of long-term post extraction complications.
The size and shape of the pontic were also documented to contribute to some problems that occur on the natural teeth abutments. These problems are mainly related to the hindrance of sanitization by classic or special oral hygiene methods and may cause accumulation of plaque under the bridge in the immediate vicinity of the abutments.
Surgical periodontal procedures are considered an integral component of the recent approach to the treatment of periodontal diseases. Soft tissue grafting has been increasingly used in clinical practice for augmenting tissue thickness, re-establishing an adequate width of keratinized tissue, correcting mucogingival deformities, and improving esthetics, at teeth and dental implant sites.
The use of soft tissue grafts in augmentation of ridge defects is a well-documented approach. Additionally, soft tissue volume augmentation procedures have been also proposed to surgically correct localized alveolar defects as pre-prosthetic site development and soft tissue contouring around implants. Subepithelial connective tissue grafts (SCTG) are superior in terms of volume gain, esthetics, and long-term stability compared with full-thickness free gingival grafts and are currently the gold standard of care for soft tissue volume augmentation procedures.
The present clinical trial aims to compare the effects of soft tissue augmentation with connective tissue graft using the traditional pouch technique versus the modified pouch technique in pontic site development in seibert class I ridge defect in the maxillary esthetic zone. The study population in this randomized, controlled, double-blinded, parallel-grouped clinical trial included twenty patients with single tooth gaps (pontic sites) in the maxillary esthetic area presenting Seibert Class I ridge defects. Patients were randomly assigned into two equal groups; Test group (n:11): having single pontic site (missing single tooth in the esthetic zone from the maxillary right second premolar to the maxillary left second premolar) received soft tissue augmentation with connective tissue graft using modified pouch technique, and Control group (n:11): having single pontic site received soft tissue augmentation with connective tissue graft using pouch technique. Only sixteen patients completed their follow up period (8 cases in each group).
The assessment of the soft tissue volume is receiving increasing attention in the evaluation of treatment outcomes. Although traditional methods such as photographs, direct visual assessment, and transgingival probing have limitations due to reduced accuracy, practicability, and clinical indications, digital optical scanning has been lately applied with the aim of measuring volumetric changes of oral soft tissues over time in a non-invasive way following therapy. Allowing for a quantitative three-dimensional (3D) assessment of soft tissue changes. Accordingly, the volumetric evaluation performed in this study was carried out by taking impressions at baseline, 3- and 6-months post surgically then scanning the casts to produce .stl files which is then analyzed using a three-