To evaluate the efficacy of coronally advanced flap (CAF) vs tunnel technique (TUN) in covering isolated midfacial peri-implant soft tissue dehiscences (PSTDs).
Twenty-eight participants presenting with isolated non-molar implants exhibiting PSTDs were enrolled and randomized to receive either CAF or TUN, both with a connective tissue graft (CTG). The primary outcome of the study was the percentage of mean PSTD coverage at 12 months. Secondary endpoints included the frequency of complete PSTD coverage, changes in keratinized mucosa width (KMW) and horizontal mucosal thickness (MT), as assessed with transgingival probing, 3D optical scanning, and ultrasonography, professional esthetic evaluation, and patient-reported outcome measures (PROMs).
At 12 months, the mean PSTD coverage of the CAF and TUN groups was 90.23 and 59.76%, respectively (p=0.03). CAF-treated sites showed a substantially higher frequency of complete PSTD coverage (p=0.07), together with significantly greater gain of KMW (p=0.01), increase in MT (p=0.02), volumetric gain (p<0.01) and professional esthetic outcomes (p=0.01). Both interventions demonstrated an improvement in patient-reported esthetics and a reduction of the anxiety related to the appearance of the implant compared to baseline, with the CAF group obtaining significantly higher scores (p=0.03 for both PROMs).
CAF + CTG resulted in superior PSTD coverage outcomes, greater KMW and MT, and better PROMs than TUN + CTG for the treatment of isolated PSTDs ( NCT03498911).

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