Background: Implants can be placed at the time of tooth extraction (immediate), after several weeks (delayed), or after complete healing (late). The purpose of this study was to evaluate clinical bone healing of buccal dehiscence‐type defects around maxillary implants placed together with bioabsorbable collagen barrier membranes and bone graft at the 3 time points.Methods: Three implant placement protocols were compared: immediate procedures primarily closed by a rotated split palatal flap (19 patients, 23 implants; group 1); delayed sites closed by a rotated (full‐thickness) palatal flap at the time of tooth extraction (25 patients, 39 implants; group 2); and late implantation (22 patients, 40 implants; group 3). One to 3 proximal implants were simultaneously placed. Defect height and width were measured at the time of implant placement and at second‐stage surgery. Surface area was calculated as half ellipses.Results: The best results were obtained with delayed implantation. The mean percentage of the reduced defect height for groups 1, 2, and 3 was 77.4% ± 16.92%, 88.8% ± 15.29%. and 75.2% ± 17.99%, respectively, and the mean percentage area of the reduced defect was 90.2% ± 9.1 5%, 95.6% ± 8.73%, and 87.6% ± 11.48%, respectively. Differences between groups were statistically significant. The mean percentage of the reduced defect height and area was significantly smaller when there was spontaneous implant cover screw exposure. Single rather than multiple implant placement led to significantly better results.Conclusions: Timing of placement, number of simultaneously placed implants, and spontaneous implant exposure significantly influence clinical bone healing around maxillary implants placed together with augmentation procedures. J Periodontol 2002;73:754‐761.

Background: Free grafts, pedicle flaps, and barrier membranes have been used to cover exposed root surfaces. The aim of the present study was to evaluate the clinical efficacy of a coronally advanced flap procedure with the additional use of enamel matrix protein derivative (EMD) to treat gingival recession and to compare it to the subpedicle connective tissue graft procedure (CTG).Methods: The study was conducted in six different periodontal clinics. Miller Class I or II buccal recession type defects in the anterior or premolar teeth were treated in 70 consecutive patients, 30 with EMD and 40 with CTG. At baseline and 6 and 12 months post‐surgical treatment, vertical recession defect, defined as the distance from cemento‐enamel junction to gingival margin; width of keratinized tissue; and probing depth were recorded and the percentage of coverage of the original defect was calculated. Statistical analyses consisted of t‐test, analysis of variance, and analysis of covarianceResults: At 6 months, percent of root coverage was 77.4% ± 11.92% in EMD and 84.1% ± 11.97% in CTG (statistically significant at P = 0.024). At 12 months, percent of root coverage in EMD was 71.7% ± 16.14% and 87.0% ± 12.22% in CTG; again, differences between groups were statistically significant (P <0.001). Differences between the 6‐ and 12‐month vertical recession defect and percent of root coverage recordings within each group were also statistically significant.Conclusions: The connective tissue graft procedure was superior to the coronally positioned flap with the addition of enamel matrix proteins derivative in percentage of coverage and increase in width of keratinized tissue. The EMD procedure is a predictable treatment for root coverage that is relatively easy to perform and presents low patient morbidity, and is appropriate especially where a substantial increase in the width of keratinized tissue is not of prime importance. J Periodontol 2004;75:600‐607.