Doppler ultrasonographic evaluation of tissue revascularization following connective tissue graft at implant sites

Abstract Aim To assess the Doppler ultrasonographic tissue perfusion at dental implant sites augmented with connective tissue graft (CTG) using coronally advanced flap (CAF) or tunnel technique (TUN). Materials and Methods Twenty‐eight patients presenting with isolated healthy peri‐implant soft‐tissue dehiscence (PSTD) were included in this randomized clinical trial. PSTDs were treated with either CAF + CTG or TUN + CTG. Ultrasound scans were taken at baseline, 1 week, 1 month, 6 months and 12 months. Tissue perfusion at the mid‐facial, mesial and distal aspects of the implant sites was assessed by colour Doppler velocity (CDV) and power Doppler imaging (PDI). Early vascularization of the graft and the flap at 1 week and at 1 month were evaluated via dynamic tissue perfusion measurements (DTPMs), including flow intensity (FI), mean perfusion relief intensity (pRI) and mean perfused area (pA). Results Regression analysis did not reveal significant differences in terms of mid‐facial CDV and PDI changes between CAF and TUN over 12 months ( p > .05), while significant differences between the two groups were observed at the interproximal areas ( p < .001 for both CDV and PDI changes). Higher early DTPMs were observed at the TUN‐treated sites in terms of mean FI of the graft ( p = .027) and mean FI ( p = .024) and pRI of the flap ( p = .031) compared with CAF‐treated sites at 1 week. Assessment of the FI direction showed that CTG perfusion at 1 week and at 1 month mainly occurred from the flap towards the implant/bone. Early tissue perfusion outcomes were found to be associated with the 12‐month mean PSTD coverage and mucosal thickness gain. Conclusions Doppler ultrasonography shows tissue perfusion changes occurring at implant sites augmented with CTG. The main differences in tissue perfusion between CAF and TUN were observed at the interproximal sites, with early perfusion associated with clinical and volumetric outcomes at 12 months.