Crestal total tissue thickness as a potential predictor of early gingival recession after anterior immediate implant placement and provisionalization: a retrospective study

Abstract

To preliminarily evaluate total tissue thickness at the level of the alveolar ridge crest (TT RC ) as a potential preoperative predictor of early gingival recession (GR) following immediate implant placement and provisionalization (IIPP) in the maxillary aesthetic zone. This retrospective cohort study enrolled patients who underwent IIPP for a single maxillary incisor. Pre-extraction hard and soft tissue dimensions, encompassing TT RC , gingival height (GH), subcrestal total tissue thickness (TT), bone thickness (BT), and gingival thickness (GT), were measured bilaterally (buccal and palatal) by superimposing intraoral scan digital models and cone-beam computed tomography (CBCT). GR was quantified at 6 months postoperatively through alignment of pre- and post-operative digital models. Pearson correlation analysis and linear regression were performed to explore the associations between preoperative parameters and the extent of 6-month GR. Forty-nine patients were enrolled in the study. TT RC demonstrated a consistent and strong negative correlation with 6-month GR on both the buccal ( r = -0.767, R 2 = 0.588, P < 0.001) and palatal ( r = - 0.786, R 2 = 0.513, P < 0.001) aspects. In contrast, the associations between 6-month GR and both subcrestal BT and GH were weak or negligible and statistically non-significant. Notably, on the buccal aspect, subcrestal GT and TT showed stronger negative correlations with 6-month GR than BT at corresponding levels. Within the limitations of this retrospective study, TT RC exhibits stronger statistical associations with early GR following IIPP in the anterior maxilla than conventional parameters, subcrestal BT and GH. These preliminary findings suggest the importance of total tissue evaluation for postoperative implant aesthetics; however, prospective validation is warranted before routine clinical adoption. chictr.org.cn, identifier ChiCTR2600122056 (April 8, 2026).