Flapless Immediate Implants: Soft Tissue Alterations Following a Trimodal Approach with or Without Modifying Osseous and Mucosal Compartments in the Esthetic Zone: A Non-Randomized Clinical Trial with Historical Control Group

<b>Objective</b>: This study aimed to compare two protocols for immediate implants with fixed provisional restoration, no grafting (trimodal approach = TA) versus grafting in both the osseous gap and peri-implant mucosa (a trimodal approach with modification of the bony and mucosal compartments = TAOM), by measuring soft tissue changes over time. The periodontal phenotype was noted to investigate the relationship between its thickness and the clinical outcomes. <b>Methods</b>: Thirty-one patients met the inclusion criteria (15 in the TA group and 16 in the TAOM group). The TA group was a historical control group. Measurements were taken using a digital caliper at T0 and 3, 6, and 12 months following the procedure (T3), (T6), and (T12), respectively, from reference points marked in a dental-supported stent. The periodontal phenotype was determined using an analogical caliper. <b>Results</b>: T12: Vertical midfacial change was -0.17 ± 0.37 in the TAOM group and 0.54 ± 0.33 in the TA group, respectively. Statistical significance (<i>p</i> = 0.0001) was found. Papilla vertical change in the TAOM group was -0.16 ± 0.45 mesially and 0.00 ± 0.44 distally. In the TA group, it was 0.55 ± 0.82 mesially and 0.86 ± 0.95 distally. Statistical significance (<i>p</i> = 0.0001) was also found. <b>Conclusions</b>: There were differences in soft tissue change between the two groups, and changes were related to the periodontal phenotype. Studies with more extended follow-up periods are needed to assess the long-term evolution of both protocols.