Clinical Evaluation of Soft Tissue Augmentation Techniques around Early Implant Placement in the Maxillary Aesthetic Zone

Background: Peri-implant soft tissue volume is critical for esthetic success in the anterior maxilla. Subepithelial connective tissue grafts (SCTG) are the gold standard but cause palatal donor-site morbidity, whereas xenogeneic collagen matrices (XCM) provide a less invasive alternative. Objective: To clinically compare soft tissue augmentation using SCTG or XCM performed simultaneously with early implant placement in the esthetic zone. Methods: Twenty patients with a thin gingival biotype requiring single anterior maxillary implant were enrolled in a randomized trial and allocated to SCTG or XCM groups (n=10). In SCTG sites, palatal subepithelial connective tissue grafts were used; in XCM sites, a porcine-derived collagen matrix (Mucoderm®) was applied. Early implant placement and soft tissue augmentation were performed 8 weeks after extraction. Gingival thickness (GT), keratinized tissue width (KTW), plaque and gingival indices, probing depth, and peri-implant crestal bone levels were recorded at baseline and at 3, 6, 9, and 12 months. Results: Both groups showed significant increases in GT and KTW compared with baseline. SCTG produced greater early gains, whereas XCM showed gradual improvement. At 12 months, no significant differences were found between groups in GT, KTW, or peri-implant clinical/radiographic parameters, while XCM patients avoided palatal harvesting and reported less discomfort. Conclusion: Peri-implant soft tissue augmentation performed at early implant placement in the maxillary esthetic zone can be predictably and safely achieved with either SCTG or XCM, and XCM offers an acceptable, less invasive alternative when minimizing patient morbidity is prioritized.