Impact of Hyaluronic Acid and Bone Graft on Peri-Implant Tissue

• Dental Implants with Hyaluronic Acid (Procedure): Surgical placement of dental implants, followed by the application of hyaluronic acid gel at the implant site, was performed to evaluate its impact on peri-implant tissue phenotype.
• Dental Implants with Hyaluronic Acid and Particulate Bone Graft (Procedure): Surgical placement of dental implants, combined with the application of hyaluronic acid gel and particulate bone graft at the implant site, was performed to evaluate its impact on peri-implant tissue phenotype.
• Standard Dental Implants Placement only (Procedure): Standard surgical placement of dental implants following conventional clinical protocols without the application of any adjunctive materials.

Primary outcomes

• Ridge Width Changes (RW) [Baseline (preoperative), immediate postoperative, 8 weeks, and 16 weeks.]: The changes in Ridge Width is measured at the reference points using a digital vernier caliper.
• Bone Width (BW) [Baseline (preoperative), and 16 weeks postoperatively]: Measured in millimeters by subtracting the buccal and lingual mucosal thickness from the ridge width.
• Change in width of keratinized tissue (KTW) [Baseline (preoperative), 8 weeks, and 16 weeks]: Measured in millimeters at the mid-buccal aspect of the implant site using an endodontic rotary file and digital vernier caliper.
• Keratinized Tissue Thickness (KTT) [Baseline (preoperative), and 16 weeks postoperatively]: Measured in millimeters at the buccal, crestal and lingual reference points using a periodontal probe and a digital vernier caliper.
• Radiographic Mucosal Thickness (RT) [Baseline (preoperative), immediate postoperative, 8 weeks, and 16 weeks]: Measured in millimeters on periapical radiographs using digital software from the crestal bone level to the crest of crestal oral mucosa 5 mm away from the height distal surface of the adjacent tooth on the mesial side of the implant.
• Crestal Bone Height (BH) [Immediate postoperative, 8 weeks, and 16 weeks]: Measured in millimeters on periapical radiographs using digital software from the second serration on the mesial side of the implant to the crest of the bone.

Secondary outcomes

• Postoperative Pain Scores [Three times daily (morning, afternoon, and evening) for the first 7 days postoperatively]: Patients received a standardized pain assessment chart for self-evaluation over seven consecutive postoperative days. This chart featured an 11-point (0-10) Numerical Rating Scale (NRS) integrated with the Wong-Baker Faces Pain Rating Scale and supplemented with descriptive pain expressions ranging from a minimum value of 0 (representing no pain) to a maximum value of 10 (representing the worst possible pain), where higher scores indicate a worse outcome (greater pain severity).
• Plaque Index (PI) [Baseline (preoperative), 8 weeks, and 16 weeks]: O'Leary plaque index
• Gingival Index (GI) [Baseline (preoperative), 8 weeks, and 16 weeks]: Gingival Bleeding Index

Sex: All, ages: 18 Years to 75 Years, accepts healthy volunteers

Inclusion Criteria:

* Adults ≥ 18 years old.
* Partially edentulous patients requiring dental implant placement.
* Good oral hygiene (Calibrated Gingival Bleeding Index (GBI) < 10%, O'Leary ---Plaque Index (PI) < 10%).
* Sufficient bone volume for implant placement.

Exclusion Criteria:

* Systemic conditions affecting bone healing (e.g., uncontrolled diabetes).
* Smoking > 10 cigarettes/day.
* Medications affecting bone metabolism (e.g., bisphosphonates).
* Active periodontal disease.
* Pregnant or lactating women.