A Randomized Controlled Trial on the Timing of Soft Tissue Augmentation in Immediate Implant Placement: Correspondence

We comment on this article "A Randomized Controlled Trial on the Timing of Soft Tissue Augmentation in Immediate Implant Placement: Soft Tissue Changes and Esthetic Outcome [1]." The purpose of this study was to assess the impact of soft tissue augmentation at different dates on soft tissue alterations and esthetic outcomes following rapid implant implantation in maxillary anterior teeth. Both soft tissue augmentation procedures (ISTA and DSTA) are required during the treatment phase to keep the soft tissue–implant contact stable. The use of STL files for dimensional change evaluation with image overlay is an effective method for measuring changes, but it has limits in terms of accuracy and explaining long-term differences between groups. Nevertheless, while this criticism is valid, it is important to note that, as of now, no ideal method exists for assessing such change. Therefore, this limitation should not detract from the value of the method used in this context. In terms of study design, this investigation employed a randomized controlled trial (RCT), which is an excellent approach for avoiding bias and increasing the reliability of the findings. However, just 40 samples were studied, which may be insufficient to detect a significant statistical difference. The 95% confidence level (CI) of the comparison in soft tissue changes shows uncertainty, and the p value obtained was still greater than 0.05; thus, it is impossible to infer that there is a statistically significant effect. This is a reasonable point, though the authors of the original study did acknowledge the potential lack of statistical power in the discussion of the study's limitations. Additionally, it is important to highlight that the authors did not claim a significance reference but instead concluded that no significant difference was found. Another intriguing feature is the evaluation of satisfaction and esthetic (Pink Esthetic Score: PES), which revealed no significant difference between the groups, both from the patient's and assessor's perspectives. This is a pertinent observation, as certain aspects of the PES, such as color and texture, may not be solely influenced by soft tissue augmentation, with factors like inflammation potentially impacting these parameters. Furthermore, the use of a Likert scale to assess patient satisfaction may not adequately capture potential confounding variables, particularly those related to the prosthesis, which may influence patient satisfaction outcomes. Such an evaluation may not accurately reflect the genuine effect of soft tissue augmentation over time. A more in-depth examination of the relationship between function and esthetics could help to increase the data. Future research should consider increasing the sample size in order to detect a significant difference, as well as conducting additional studies using a variety of assessment tools, such as the use of new soft tissue implants, innovative materials, or tissue augmentation that may enhance the long-term stability and appearance of soft tissues around dental implants, thus improving overall prosthetic outcomes, or techniques that improve long-term esthetic efficacy in the case of immediate dental implant placement. H.D. contributed 50% ideas, writing, analyzing, and approval. V.W. contributed 50% ideas, supervision, and approval. The authors used a computational tool for language editing/checking in preparation of the article. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.