Comparison of Envelope Coronally Advanced Flap and Modified Tunnel Technique in Soft Tissue Dehiscence Around Implants

The primary aim is to compare the test and control groups in terms of:

1. mean mid-facial recession coverage (mRC) measured as a percentage

2. the keratinized tissue (KT) gain measured in mm

3. the keratinized tissue thickness (KTT) gain measured in mm.

The secondary aims are to compare the two groups in terms of:

1. Esthetic score, using numeric values from 0 to 10

2. patient-reported esthetics, using numeric values from 1 to 5

3. patient-reported post-operative pain, based on VAS scale, measured as numbers from 0 to
10.

Inclusion Criteria:

- Age ≥ 18 years

- Periodontally and systemically healthy

- Full-mouth plaque score and full-mouth bleeding score ≤ 20% (measured at four sites
per tooth)

- Correct implant 3-dimensional position or buccal position ≤ 1 mm

- Buccal soft tissue dehiscence ≤ 4 mm

- Only osseointegrated implants

- The patient must be able to perform good oral hygiene

Exclusion Criteria:

- Contraindications for periodontal surgery

- Patients pregnant or attempting to get pregnant

- Malpositioned implant

- STD > 4 mm

- Multiple adjacent implants with STD

- Existing of peri-implantitis

- Severe bone loss (≥4mm)

- Moderate-severe interproximal bone loss (implant fixture level to the alveolar bone >
3 mm)

- Moderate-severe papilla height loss (Nordland and Tarnow implant papillae index >1)

- Previous mucogingival surgery around the implant within the past six months or implant
placement at the surgical site less than six months prior

- Smoking more than 10 cigarettes a day