Porcine Derma for Soft Tissue Augmentation Around Implants

Description of the study methodology (including the expected completion date) This is a prospective, controlled, post-marketing clinical follow-up study (Phase IV), to be conducted at the Faculty of Dental Medicine of the University of Porto. The aim is to evaluate the effectiveness of the resorbable porcine-derived collagen matrix Derma OsteoBiol® for soft tissue augmentation around dental implants.

Fifteen adult participants, aged 18 years or older, will be included, presenting a need for augmentation of the keratinized mucosa at the buccal aspect of an implant previously placed in the posterior region of the maxilla or mandible. Participants must be able to understand the nature of the study, provide free and informed consent, comply with the procedures and visits defined in the protocol, and maintain good oral hygiene. The dental implant must have been placed at least six weeks prior to the start of the study, and the width of the buccal keratinized mucosa must be great than one millimeters.

Individuals with general contraindications to dental surgery, such as uncontrolled use of anticoagulants, or presenting vertical bone defects greater than three millimeters at the implant site, will be excluded. Additional exclusion criteria include: heavy smoking (more than ten cigarettes per day), presence of active periodontal or peri-implant disease, insulin-dependent diabetes mellitus, history of malignant neoplasia with treatment within the last five years, pregnancy or breastfeeding, lack of effective contraception in women of childbearing age, use of medications that affect soft tissue healing, systemic diseases interfering with connective tissue metabolism (such as autoimmune or arterial diseases), alcohol abuse, collagen allergy, participation in other clinical studies within the previous six months, inadequate oral hygiene (plaque index greater than 25%), or occurrence of any adverse event preventing continuation of treatment.

After inclusion, participants will undergo mucogingival surgery using the VISTA (Vestibular Incision Submucosal Tunnel Access) surgical technique. The Derma OsteoBiol® membrane will be pre-hydrated in sterile saline solution, trimmed, and positioned at the surgical site, and stabilized with monofilament sutures. The incision will be completely closed, avoiding membrane exposure.

Tissue thickness will be assessed through intraoral digital impressions and three-dimensional tissue volume analysis, with measurements performed before surgery and at 1, 3, 6, and 12 months after the intervention. These images will be superimposed using stable anatomical reference points to ensure accuracy and will be analyzed by a calibrated and independent examiner. Clinical data will also be collected throughout the study, including measurements of keratinized mucosa width, probing depth, clinical attachment level, presence of bleeding on probing, plaque index, and gingival recession. Standardized clinical photographs will be obtained at each visit for documentation of soft tissue status and aesthetic evaluation.

Patient perspective will be assessed using the Oral Health Impact Profile questionnaire (OHIP-14) and a numerical pain rating scale, applied at specific follow-up time points. The occurrence of adverse events will be continuously monitored and recorded in accordance with applicable legal and regulatory standards.

This study will be conducted in accordance with the Declaration of Helsinki, Good Clinical Practice.

• Patient-Reported Outcomes (PROs) [Time frame: 10 days, 1, 3, 6, and 12 months]
• General Clinical Measurements [Time frame: screening (-30 to -1), baseline (day 0), Visit 3 - 10 days, Visit 4 - 1 month, Visit 5 - 3 months, Visit 6 - 6 months, Visit 7 - 12 months]
• Safety Monitoring [Time frame: baseline (day 0), Visit 3 - 10 days, Visit 4 - 1 month, Visit 5 - 3 months, Visit 6 - 6 months, Visit 7 - 12 months]
• Aesthetic Outcomes [Time frame: screening (-30 to -1), baseline (day 0), Visit 3 - 10 days, Visit 4 - 1 month, Visit 5 - 3 months, Visit 6 - 6 months, Visit 7 - 12 months]
• Clinical Photographs [Time frame: screening (-30 to -1), baseline (day 0), Visit 3 - 10 days, Visit 4 - 1 month, Visit 5 - 3 months, Visit 6 - 6 months, Visit 7 - 12 months]
• Pain Assessment (NRS) [Time frame: 10 days, 1 month, and any time the patient reports increased discomfort (through study completion, an average of 1 year).]