Comparison of Sub-epithelial Connective Tissue Graft and Platelet Rich Fibrin in Peri-implant Soft Tissue Augmentation: A Randomized Clinical Split-mouth Study

Ayman Abdel-Rahim Elkashty1, Wael Mohamed Aboelmaaty1, 2, 3, Samah Elmeadawy1
, Mohammed Elsaed Elewa1, Alaa Mansour4, Islam Mohammed Ateia1, *
1 Faculty of Dentistry, Mansoura University, Mansoura, Egypt
2 College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
3 King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
4 Periodontology Unit, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates

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Creative Commons License
© 2022 Elkashty et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Faculty of Dentistry, Mansoura University, Mansoura, Egypt; E-mail:


Aims and Background:

Gingival phenotype has a crucial impact on the peri-implant marginal bone stability. The aim of this clinical trial is to assess and compare the efficacy of the sub-epithelial connective tissue graft (SCTG) and platelet-rich fibrin (PRF) in improving the peri-implant soft tissue phenotype and enhancing esthetic outcomes.

Materials and Methods:

The present study was a split-mouth randomized controlled clinical trial. A total of ten patients who had bilateral missing teeth in the maxillary esthetic zone with a thin gingival phenotype were included in this study. For each study participant, one randomly selected site was treated with SCTG, while the other was treated with PRF membrane during dental implant placement. Treatment outcomes included the assessment of the facial gingival thickness using cone-beam computed tomography (CBCT) at the baseline (T0) and 6 months postoperatively (T1), and the Pink esthetic score (PES) at T1 and 3 months later after prosthesis placement (T2).

Results and Discussion:

Both treatment options resulted in a significant increase in gingival tissue thickness at T1 compared with T0, and in PES at T2 compared with T1 (p ˂ 0.05).


PRF is an effective alternative to SCTG in augmenting peri-implant soft tissue phenotype and improving esthetic outcomes. This would help overcome the complications associated with harvesting the SCTG and increasing patients’ satisfaction.

Clinical Trial Registration ID: ISRCTN11961919.

Keywords: Dental implants, Platelet-rich fibrin, Sub-epithelial connective tissue graft, Thin gingival phenotype, Pink esthetic score, Treatment.