Modified roll flap a handy technique to augment the peri-implant soft tissue in the esthetic zone: A randomized controlled clinical trial

The esthetic outcome of single-tooth implants in the esthetic zone has become increasingly important concern in the current literature. Deficient or thin per-implant labial soft tissue thickness seriously and adversely affects the esthetic outcome of such situations. Themodified roll flap (MRF) is a pedicle flap designed to make use of the gingival tissue overlying the covering screwto expand the thickness of the labial soft tissue instead of discarding it as in flapless technique. The current randomized control trial assesses the efficiency of the MRF technique for augmenting the labial peri-implant soft tissue during stage-two implant surgery. The outcome measures include the measurement of the labial soft tissue thickness and the implant esthetic score system (IES). Methods: 12 out of 14 patients (8 males and 4 females) aged from 20 to 50 years old were included. All patients were suffering a missing tooth in the esthetic zone and surrounded by a thin gingival biotype classified according to TRAN technique and direct method. At stage II surgery, patients were randomly split to: Control group using a standard crestal incision and MRF study group. All surgical procedures were performed by a single operator the principal author*. Thickness was measured by the direct method using periodontal probe with endodontic stopper via a special stent with a fixed hole to ensure reproducible measurements. A modified form of the IES system composed of the summation of four parameters individually measured was used to assess esthetics. All assessments were performed by a single Co-author who was blinded to the group under evaluation. Results: The MRF group showed a statistically significant difference over the control group regarding thickness at baseline, 3 month (P = 0.01) and 6 month postoperatively (P = 0.03). The IES score showed a statistically significant difference in favor of MRF at 3 and 6 month (P 0.05), while, the baseline measurement was not significant (P 0.05). Conclusion: MRF is a cost effective convenient technique that can effectively augment the thickness of the labial peri-implant soft tissue and help to achieve better appearance in the esthetic zone.