Immediate prosthetic rehabilitation in patients with periodontitis under quantitative seating control: clinical outcomes and zonal analysis of compression

Background. Immediate prosthetic rehabilitation in patients with periodontitis is challenged by reduced soft-tissue tolerance to pressure and variable gingival vascular response, which together increase the risk of early ischemic compression (blanching), discomfort, and unplanned adjustments. A protocol that combines targeted FDM modification of the pontic profile with a thin-layer silicone film test and a prespecified target thickness of 60–150 μm aims to shift seating from empirical chairside adjustment to a reproducible, quantitatively controlled procedure. Aim: to improve the quality of immediate prosthetic treatment in patients with periodontal disease through the implementation of a protocol for quantitative control of seating. Material and methods. A single-center prospective controlled study was conducted. Two parallel groups (n = 10 each) were formed to compare subjective and operator outcomes (clinician VAS, patient VAS). An independent cohort of 48 patients was analyzed for zonal silicone-film thickness across five standardized zones (mesial, distal, buccal, oral, central). Distributional assumptions were assessed with the Shapiro–Wilk test. Between-group VAS differences were analyzed by the Mann–Whitney test with Hodges–Lehmann median differences and 95% confidence intervals. Inter-zonal differences were tested by the Kruskal–Wallis test with Dunn’s post-hoc comparisons and false-discovery control by the Benjamini–Hochberg method. Associations between thickness and VAS were evaluated by Spearman’s rank correlation. The proportion within the 60–150 μm target range was reported with exact binomial 95% confidence intervals. Two-sided p 0.05 was considered statistically significant. Descriptive statistics are reported as medians with interquartile ranges; means with standard deviations are additionally provided where informative. Results. Under quantitative control, both clinician- and patient-reported VAS values were lower than with conventional adjustment: clinician VAS median 6.8 [6.6; 7.1] vs. 9.2 [8.9; 9.3]; patient VAS median 7.3 [5.3; 7.9] vs. 8.8 [8.6; 9.0]. Across 240 zonal measurements, median silicone-film thickness was 80 [60; 100] μm, with 67.5% of observations within the 60–150 μm target. The highest conformity to target values was observed in the buccal zone (95.8%), whereas the distal zone showed the lowest proportion within target (41.7%). Conclusion. Quantitatively controlled soft-tissue compression during immediate prosthetic treatment in periodontitis patients is associated with improved subjective outcomes and a high proportion of seating zones within the predefined thickness target. Integrating FDM modification with a thin-layer silicone test standardizes the procedure, reduces seating variability, and provides conditions for gentle soft-tissue contouring. The protocol is statistically substantiated and operationally reproducible, and it can serve as a practice guideline and as a foundation for multicenter randomized studies.