Applicability of buccal fat pad grafting for oral reconstruction

This study evaluated the applicability of pedicled buccal fat pad grafting for the reconstruction of defects surgically created during oral surgery. A buccal fat pad graft was applied in 23 patients (5 males, 18 females; mean age 68.3 years) between 2003 and 2011. The graft was used to cover surgical defects of the palate, maxilla, upper gingiva, buccal mucosa, lower gingiva, oral floor, and temporomandibular joint region. Size of the surgical defects ranged from 15 mm × 12 mm to 30 mm × 40 mm; size of the buccal fat pad ranged from 15 mm × 12 mm to 43 mm × 38 mm. A pedicled buccal fat pad was prepared by incising the maxillary vestibule following primary surgery, and the surrounding connective tissue was preserved to supply nutrition to the pedicle during surgery. The buccal fat pad was placed on the raw surface of soft tissue or bone surface and sutured to the surrounding tissue of the defect. Complete epithelialization was observed within 4 weeks postoperatively. There were no complications or functional disorders during follow-up. Buccal fat pad grafting appears to be feasible for the reconstruction of surgically induced defects, and can be extended to the palate, mandible, mouth angle, and temporomandibular joint region.     

Is dermis fat arthroplasty better than plain gap arthroplasty? A prospective randomised controlled trial

The aim of the study was to compare interpositional arthroplasty using a dermis fat graft with gap arthroplasty in the management of ankylosis of the temporomandibular joint (TMJ). We organised a prospective randomised study of 22 patients who presented with ankylosis of the TMJ. They were randomised to be treated with either plain gap arthroplasty or dermis fat arthroplasty, and the predictor variable was the method of treatment. The primary outcome variables were mouth opening and pain on jaw exercises. Pain and interincisal opening were measured on day 5, day 14, at the end of one month, and at six months, one year, two years, and three years. There was a significant difference between the two groups on two occasions: postoperative day 5 (p = 0.013) and at one year (p = 0.018). The mean (SD) scores for mouth-opening were higher in the dermis fat group at all times (41.20 (4.69) mm compared with 39.50 (2.46) mm in gap arthroplasty at two years, and 41.40 (3.60) mm compared with 38.9 (2.02) mm at three years). The visual analogue pain scores were also lower in the dermis fat graft group. The groups showed similar results at the end of three years follow up, with no significant difference in mouth opening. We conclude therefore that the two techniques have similar outcomes in the management of ankylosis of the TMJ.     

Treatment modalities of TMJ ankylosis: experience in Delta Nile,Egypt

The study reports the authors’ experience in managing TMJ ankylosis in Delta Nile, Egypt (1995–2006) and compares the surgical modalities used. 101 patients (109 joints) were reviewed in this retrospective study. Pre- and postoperative assessment included history, radiological and physical examination, and mouth opening. Age, sex, aetiology, joint(s) affected, surgical modality, complications and follow up periods were evaluated. Various types (fibrous, fibro-osseous and bony) of TMJ ankylosis were diagnosed; trauma was the commonest aetiology. The patients’ age range was 2–41 years, 62% were female, and the follow up period ranged from 14 to 96 months. Average mouth opening was significantly increased from 5.3 mm pre-operatively to 32.9 mm 12 months postoperatively (P = 0.0001). Marked improvement in mouth opening was documented when the ramus-joint complex was reconstructed using distraction osteogenesis (34.7 mm), costochondral graft (34.4 mm) and Surgibone (34.6 mm). Gap arthroplasty showed least satisfactory mouth opening compared with other techniques (P = 0.001). Minor and major complications were encountered in 33% of cases, including 5% recurrence rate. Early release of TMJ ankylosis; reconstruction of the ramus height with distraction osteogenesis or bone grafting combined with interpositional arthroplasty, followed by vigorous physiotherapy is successful for managing TMJ ankylosis.     

Efficacy of buccal fat pad in the surgical management of oral submucous fibrosis: a prospective study

Purpose

Various surgical treatment modalities have been advocated in the surgical management of oral submucous fibrosis with variable results. This prospective study evaluates the efficacy of buccal fat pad in the surgical treatment of oral submucous fibrosis.

Patients and Method

In the present study, 20 patients were treated for oral submucous fibrosis with interincisal mouth opening less than 16 mm. Surgical procedure included fibrotomy, all third molar extractions, and coronoidotomy or coronoidectomy followed by reconstruction of fibrotomy defect with buccal pad of fat. Postoperatively, patients were prescribed nutritional and antioxidant supplements along with vigorous mouth opening exercise for 6 months. Regular follow-up was carried out for 2 years.

Results

Excellent increase in the interincisal mouth opening was noticed relieving trismus. Patient’s ability of masticate and tolerance to regular food was increased significantly. Buccal fat pad underwent rapid epithelization within a period of 5–7 weeks.

Conclusion

Buccal fat pad can be used effectively in the surgical management of oral submucous fibrosis with good functional and esthetic outcome, with only drawback of supple lobulated fat, which requires delicate handling and its limitation to reach anteriorly beyond the canine region.

     

Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study: A protocol for the management of oral submucous fibrosis

PurposeThe aim this study was to compare the buccal fat pad (BFP) and nasolabial flap for reconstruction of intraoral defects after release of fibrous bands in patients with oral submucous fibrosis (OSF).Materials and methodsThis is a comparative study. The study sample was derived from the population of patients who presented, with restricted mouth opening of less than 20 mm, to the Department of Oral and Maxillofacial Surgery, Swargiya Dada Saheb Kalmegh Dental College and Hospital Hingna Nagpur. The patients were divided into two groups. In Group I (n = 10) reconstruction was performed with a nasolabial flap and in Group II (n = 10) with BFP. Both groups were analysed separately for mouth opening (interincisal distance in millimetres) preoperatively and 20 months postoperatively, time taken for epithelialization of BFP and nasolabial flaps. Statistical analysis was performed with SPSS statistical software for Windows, version 8.0 (SPSS, Inc, Chicago, IL) using the _2 test and Student's t test.ResultsIn all 20 patients the interincisal mouth opening was (mean) 11 mm (3–19 mm) preoperatively which improved to a mean of 42 mm (23–52 mm). In Group I there were more complications as compared to Group II such as partial flap necrosis particularly at the tips, temporary widening of oral commissure and subluxation of TMJ. The unsightly extraoral scar and intraoral growth of hairs were not seen in Group II.ConclusionBFP is the better choice for reconstruction in comparison to nasolabial flap.     

Analysis of outcomes after revision replacement of failed total temporomandibular joint prostheses

End-stage disease of the temporomandibular joint (TMJ) can be managed successfully with alloplastic total replacements, but these can fail because of allergy, infection, wear, fracture, and heterotopic development of bone. We prospectively reviewed the outcome data of all patients who required revision of previously placed replacement joints between 2004 and 2016. Data included pain and diet scores using 100 mm visual analogue scales (VAS), and interincisal distance recorded before, and at six weeks, six months and 12 months after operation. The reasons for failure and the number of previous procedures were also noted.Twenty patients (26 joints) had revisions. The reasons included infection (n = 9), reankylosis (n = 5), wear of the existing prosthesis (n = 2), fracture of the prosthesis (n = 2), foreign body reaction (n = 1), and allergy to the prosthesis (n = 1). The mean (range) age of the patients was 53.3 (47-68) years, and 15 were female and five male. Preoperatively, the mean (SD) pain score was 73.1 (22.4), mouth opening was 20.9 (10.2) mm, and diet score 41.7 (23.6). At 12-month follow up, all the measurements had improved significantly (p ≤ 0.05), with the pain score improving to a mean (SD) of 18.4 (25.2), mouth opening to 32.2 (9.3) mm, and diet score to 89.4 (18.5). Revision replacements done by an experienced team result in considerably improved outcomes with limited complications, but the improvements in function and pain are not as marked as they are after primary replacement.     

Strategies to reduce re-ankylosis in temporomandibular joint ankylosis patients

The purpose of the study was to define a protocol for the prevention of re-ankylosis after surgical management of temporomandibular joint ankylosis (TMJA). The investigators designed a retrospective study on all TMJA patients treated with different treatment modalities from 2013 to 2019. The investigators observed that complete removal of the ankylotic mass particularly on the medial side; use of a piezoelectric scalpel for a clean and smooth osteotomy with copious irrigation to remove bone chips and slurry; less trauma to the local tissue; osteotomy design parallel and inferior osteotomy at the narrowest part, which mostly corresponds to the condylar neck; performance of a coronoidectomy (if mouth opening is <30 mm), fat interposition; no intraoperative correction of any pre-existing chin deviation when treated with costochondral graft; patient motivation; and aggressive physiotherapy, and use of a vacuum drain are all important to prevent re-ankylosis, irrespective of the treatment modality. A total of 114 patients (n = 152 joints), [bilateral (n = 38), unilateral (n = 76)] were evaluated retrospectively. Interpositional arthroplasty with fat was performed in n = 43, CCG was used for reconstruction in n = 30 and total joint replacement (TJR) was done in n = 41 patients. Re-ankylosis was seen in n = 3 (2.6%) patients (2 in CCG and 1 patient in interpositional arthroplasty). The follow-up ranged from 12-80 months. The results conclude that following the suggested best practice protocol is effective in reducing re-ankylosis.     

Assessment of the contralateral facial artery pedicle nasolabial island flap for buccal defect repair

The facial artery pedicle nasolabial island flap (FAPNIF) is widely used for oral and maxillofacial reconstruction. However, its use in reconstruction after malignant tumour resection is limited by the possibility of ipsilateral cervical lymph node metastasis along the facial artery. Through fine dissection, it was found that the contralateral FAPNIF can be used to repair the defect after buccal carcinoma resection. The aim of this study was to evaluate the clinical outcomes of the contralateral FAPNIF for buccal defect repair. From 2013 to 2016, 30 patients underwent the repair of a buccal defect with a contralateral FAPNIF after tumour resection. Clinical outcomes and complications were recorded and quality of life was evaluated preoperatively and at 3, 6, and 12 months postoperative. The flaps survived in all 30 cases. Mean mouth opening was 2.50 ± 0.14 cm at 1 month, 3.22 ± 0.25 cm at 6 months, and 3.35 ± 0.23 cm at 12 months postoperative. With regard to patient quality of life, adverse effects included impaired aesthetics, pain, and difficulty eating; these usually subsided within 1 year after surgery. The contralateral FAPNIF is easily harvested and is a safe and effective option for the repair of medium-sized buccal defects after the resection of carcinoma.     

The surgical management of extra-articular ankylosis in noma patients

Extraarticular ankylosis occurs frequently in children suffering from noma sequelae. Over 20 years of operating on these patients, we observed high recurrence of mouth opening limitation. We therefore progressively changed our surgical strategy. This retrospective study compares the impact of different parameters (types of surgery, noma type, physiotherapy compliance, age and sex) on immediate and long-term mouth opening. It includes a series of 121 patients with extraarticular ankylosis operated on between 1990 and 2015. Soft tissue reconstruction evolved from local and pedicled flaps to large free flaps. Mouth opening was performed by bone-bridge excision, sometimes associated to contralateral coronoidectomy. Mouth opening technique including bilateral coronoidectomy with free flap reconstruction was the only independent factor for significantly better immediate mouth opening with a mean increase of 8.7 mm [95% confidence interval (CI) 4.3–13.1, P < 0.001) and this effect was maintained in the 3 years of follow-up. Another positive factor related to long-term results was excellent physiotherapy, while noma type 4 was a negative factor. Recurrence remains problematic in the management of noma sequelae. If physiotherapy and long-term follow-up cannot be offered, patients should not be operated on, because if limitation of mouth opening recurs, oral feeding may become impossible when a facial defect has been reconstructed.     

Functional outcome of two different grafting techniques in the surgical management of oral submucous fibrosis: a comparative evaluation

Objective

To evaluate the functional efficacy of two different grafting techniques following the fibrotomy among subjects with oral submucous fibrosis (OSMF).

Design

Forty consecutively treated OSMF subjects between 20 and 40 years who had grades 3 and 4a OSMF and mouth opening?<?15 mm were included in the present study. All the subjects were randomly divided into two groups. In Group I, all the subjects received a buccal pad of fat sandwiched with a nasolabial flap following fibrotomy. In contrast, Group II subjects received a buccal pad of fat combined with a collagen graft. The effect of two different surgical protocols on mouth opening was evaluated clinically before the surgery (T₀) and 1 month (T₁), 6 months (T₂), and 12 months (T₃) after the surgery.

Results

In Group I subjects, the mouth opening increased significantly (P?<?0.001) from 10.90?±?1.971 mm at T₀ to 34.25?±?3.127 mm at T₁, but reduced marginally to 32.15?±?3.422 mm at T₂, and 31.30?±?3.358 mm at T₃. In Group II, the mouth opening increased significantly (P?<?0.001) from 10.85?±?1.725 mm at T₀ to 28.90?±?3.059 mm, 29.10?±?2.808 mm, and 28.20?±?2.285 mm at T₁, T₂, and T_3, respectively. At the end of 12 months of follow-up, the mean value improvement in the mouth opening (T₀–T₃) was 20.4?±?3.5 mm and 17.3?±?2.9 mm in Groups I and II, respectively, and the difference was statistically significant (P?=?0.006).

Conclusion

The buccal pad of fat sandwiched with a nasolabial flap for the reconstruction following fibrotomy had a slightly better beneficial effect on the postoperative mouth opening among OSMF subjects.

     

Immediate dental implant placement with a horizontal gap more than two millimetres: a randomized clinical trial

The purpose of this study was to evaluate the horizontal dimensional changes in buccal alveolar bone immediately after dental implant placement in the upper premolar area with horizontal gaps >2 mm. A total of 48 patients were enrolled in this randomized clinical trial and were randomly assigned to one of three groups. Group I (flap with graft; n = 16) patients received an immediate implant with bone graft, membrane, and primary flap closure. Group II (flap without graft; n = 16) patients received an immediate implant with primary flap closure only. Group III (flapless without graft; n = 16) patients received an immediate implant without graft, membrane, or primary closure. Cone beam computed tomography (CBCT) scans were obtained preoperatively, immediately after implant placement, and at 6 months postoperative to evaluate horizontal dimensional changes in the buccal alveolar bone. Pain intensity was measured using a numerical rating scale. CBCT examinations revealed that bone had filled the horizontal gap in all three groups. Group II showed the greatest horizontal dimensional changes in the buccal alveolar bone, followed by group I. The least amount of change was recorded for group III. Furthermore, significantly less postoperative pain was recorded in group III when compared to the other groups. Short-term results suggest that the ‘flapless without graft’ technique shows similar results to the ‘flap with graft technique’ for immediate implant placement in the maxillary premolar extraction site with a horizontal gap >2 mm, when the bone plate is intact.     

Surgical management of oral submucous fibrosis using buccal fat pad: a retrospective study of 30 cases

The aim of our study was to evaluate the effectiveness of buccal fat pad (BFP) in the management of oral submucous fibrosis (OSMF). Retrospective records of 30 patients of OSMF treated with BFP with atleast a year of follow-up were analyzed. Patients were divided into groups based on the stages of OSMF. Surgical management consisted of resection of fibrous bands, bilateral temporalis myotomy, and coronoidectomy followed by grafting with BFP. There were 17 patients of stage III (mouth opening 16–25 mm) and 13 patients of stage IV OSMF (mouth opening less than 16 mm). The mean mouth opening of stage III group pre-operatively was 19.94?±?2.19 mm which increased to a mean of 35.12?±?5.69 mm (p?<?0.0001). For patients with stage IV OSMF, the mouth opening increased from a pre-operative of 10.23?±?4.07 mm to a post-operative of 31.46?±?6.78 mm (p?<?0.0001). No intra-operative complications were noted in any patient. Relapse was seen in 1 patient (5.8%) of stage III while 3 patients (23.07%) had relapse in stage IV group. Our results indicate that BFP is a good flap owing to its benefits which are easy to harvest and entails minimal morbidity for management of OSMF.     

Treatment of chronic mandibular dislocations using miniplates: follow-up of 8 cases and literature review

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study reports 8 cases using miniplates for chronic mandibular dislocations, evaluates the results and critically reviews the literature. The sample was obtained from the records of the Oswaldo Cruz University Hospital and comprises patients undergoing chronic mandibular dislocation treatment using 2.0 mm titanium miniplates between August 2002 and March 2004. Pre- and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxations, recurrence rate and presence of facial nerve paralysis. The mean maximal mouth opening preoperatively was 42.75 ± 11.53 mm and was 45.62 ± 8.52 mm postoperatively. There was no facial nerve paralysis. Miniplate fracture was observed in 2 cases and there was one recurrence. Treating chronic mandibular dislocation using miniplates was shown to be efficient in relation to postoperative maximal mouth opening, recurrence and articular function, however, the possibility of the miniplate fracturing must be considered.     

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P < 0.05). No statistically significant difference in pink aesthetic score (P = 0.379, 6 months postoperative) or marginal bone loss (P = 0.449 at 3 months postoperative, P = 0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P < 0.0001) and the time to complete the surgical procedure (P = 0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.     

Extended nasolabial flap compared with the platysma myocutaneous muscle flap for reconstruction of intraoral defects after release of oral submucous fibrosis: a comparative study

We compared extended nasolabial flaps and coronoidectomy with platysma myocutaneous muscle flaps in the management of 20 randomly selected patients with histologically confirmed oral submucous fibrosis. Ten patients were treated by release of fibrous bands, bilateral coronoidectomy, and reconstruction with an extended nasolabial flap (nasolabial group), and the other 10 by bilateral release of fibrous bands, coronoidectomy, and reconstruction with a platysma myocutaneous muscle flap (platysma group). In the nasolabial group the mean preoperative interincisal mouth opening was 12 (range 3–14) mm, and in the platysma group it was 11 (3–13). All 20 patients were given vigorous postoperative physiotherapy, and were followed up for 3 years. The interincisal mouth opening improved to 47 (35–45) mm in the nasolabial group and 48 (41–52) mm in the platysma group. The procedures were equally effective in the management of the oral submucous fibrosis, except that the extraoral scar was not aesthetically acceptable in the nasolabial group.     

A two-year follow-up of surgical and non-surgical treatments in patients with masticatory muscle tendon-aponeurosis hyperplasia

This study re-examined the usefulness of surgery for the management of masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) through a comparison of the outcomes between patients who underwent surgery and those who did not. The duration of follow-up was 2 years. Twenty-eight patients who attended the study hospital and were given a diagnosis of MMTAH were included. Nineteen patients underwent surgery (surgical group) and nine patients were instructed to open their mouths wide once a day and did not undergo surgery (non-surgical group). Maximum mouth opening, impairment of daily activities, satisfaction, and the status of mouth opening training were evaluated after surgery. The mean increase in mouth opening after 2 years was 20.2 mm in the surgical group and 2.4 mm in the non-surgical group. Adequate mouth opening training led to satisfactory results 2 years postoperative, and sustained mouth opening training for 6 months after surgery was a key factor for obtaining good outcomes. The general condition and personality of individual patients should be evaluated carefully before surgery to estimate whether or not they can endure the pain associated with postoperative mouth opening training. The results of this study suggest that the surgical procedure is useful for the management of MMTAH.     

Inlay–onlay grafting for three-dimensional reconstruction of the posterior atrophic maxilla with mandibular bone

This prospective study describes and evaluates a surgical approach for 3D reconstruction of the posterior maxilla with autogenous mandibular bone in 16 patients (mean age 51 years). Bone blocks were harvested from the mandible and used as lateral or vertical block grafts (onlay); they were also partially milled and used for sinus elevation (inlay). In 4 cases, anorganic bovine bone was added at the periphery of the blocks. 4 months after grafting, implants were placed in a second operation and loaded after 12 weeks. Lateral and vertical augmentations were measured immediately after grafting and at re-entry for implant placement. Mean lateral augmentation performed was 5.5 mm, reduced to 4.3 mm (p < 0.01) after 4 months’ healing. Mean vertical augmentation was 3.2 mm, reduced to 2.1 mm (p < 0.01) after healing. The amounts of lateral and vertical graft resorption were similar (1.2 mm vs. 1.1 mm) but were different when compared with the original graft (22% vs. 34%). 49 implants were placed 4 months after grafting. Implant parameters were evaluated after 32–48 months follow up and demonstrated 100% survival rates. The use of mandibular bone grafts for 3D augmentation of the posterior maxilla has shown good results and minor complications.     

Histologic examination of pedicled buccal fat pad graft in oral submucous fibrosis.

PURPOSE: This report evaluates the wound healing process of buccal fat pad (BFP) grafted on a defect of the buccal mucosa for oral submucous fibrosis (OSF). PATIENTS AND METHODS: Sixteen patients with limitation of mouth opening under the diagnosis of OSF were surgically treated by cutting the fibrotic bands on the buccal mucosa (10 bilateral and 6 unilateral). The defects created were then covered by a BFP graft. The bulging BFP was trimmed postoperatively on a weekly basis until it was fully epithelialized. The specimens were stained and examined microscopically. RESULTS: Inflammatory cell infiltrate, blood vessel congestion, and fibrinous exudates covering the BFP were obvious by week 2. At week 3, blood vessel congestion and fat cell number decreased markedly. Evidence of stratified squamous epithelium with parakeratosis was seen in the margin of the BFP graft. At week 4, the number of fat cells decreased significantly and the original BFP was almost completely replaced by granulation tissue. The original BFP was fully covered by stratified squamous epithelium by week 5. CONCLUSIONS: The BFP graft has been widely used for covering exposed defects created by fibrotic band excision for the improvement of mouth opening limitation. The healing process was documented microscopically by weekly observation.     

Evaluation of the screw tent-pole technique for the repair of anterior maxilla width defects: a prospective,randomized, split-mouth study

The aim of this prospective study was to compare horizontal bone augmentation in the anterior maxilla associated with two types of tenting screw used in the screw tent-pole technique. Ten patients with a premaxilla width deficiency underwent grafting with protein-free xenograft bone. A split-mouth design was used, with sides allocated randomly to receive standard and wide-head tenting screws. Implants were installed after 9 months. Patients underwent clinical, cone beam computed tomography (CBCT), and histomorphometric evaluations. The buccal aspect of the ridge was classified as flat or concave in shape. Clinical measurements showed width augmentation of 1.05 mm, 2.45 mm, and 2.70 mm for standard screws and 1.50 mm, 3.10 mm, and 3.45 mm for wide-head screws, at the ridge, 5 mm, and 10 mm, respectively. CBCT showed width augmentation of 0.74 mm, 3.88 mm, and 4.72 mm for standard screws and 0.91 mm, 4.05 mm, and 4.37 mm for wide-head screws, at the crest, 5 mm, and 10 mm, respectively. Histomorphometric analysis showed 30.99% ± 26.43% vital bone tissue, 11.32% ± 9.68% graft residue, and 57.66% ± 21.85% connective tissue for standard screws and 32.64% ± 20.28%, 9.73% ± 5.82%, and 57.61% ± 20.15%, respectively, for wide-head screws. Flat alveolar ridges showed the lowest percentage of vital bone. New bone formation seems to be optimized on concave ridges. There was no statistically significant difference in bone gain results between standard and wide-head tenting screws.     

Comparison of procedures for immediate reconstruction of large osseous defects resulting from removal of a single tooth to prepare for insertion of an endosseous implant after healing

This study evaluated the treatment outcome of immediate reconstruction of 45 large osseous defects resulting from removal of a single tooth with a 1:2 mixture of Bio-Oss^® and autologous tuberosity bone, and three different procedures for soft tissue closing (Bio-Gide^® membrane, connective tissue graft, full-thickness palatal mucosa graft; n = 15 per group). All defects had an unfavourable osseous–gingival relationship and vertical bone loss of >5 mm. The hard and soft tissues were immediately reconstructed after removal of the tooth. Implants were inserted after 3 months. Patients’ acceptance, complications and postoperative morbidity were prospectively evaluated by standardized clinical and radiographic examinations up to 12 months after the augmentation procedure. The patients completed a questionnaire on subjective complaints related to the procedure. All hard–soft tissue procedures resulted in sufficient bone volume for the insertion of implants and a favourable aesthetic outcome. The gingival mid-buccal aesthetics before, and 1 year after, treatment significantly favoured the full-thickness palatal mucosa graft, showing a gain in gingival contour of 0.5 ± 0.8 mm; the other procedures resulted in a 1.2 ± 1.6 mm decrease. Of the procedures evaluated, a full-thickness palatal mucosa graft was the most predictable for immediate reconstruction of the socket after tooth removal.