Controlled soft tissue compression during immediate prosthetic rehabilitation in patients with periodontitis: a clinical and quantitative study

Relevance. During immediate prosthetic rehabilitation in patients with periodontitis, the early prosthodontic stage– specifically the placement of a provisional restoration—is frequently associated with mucosal ischemic blanching, pain, and unplanned adjustments. These complications largely result from the absence of quantitative criteria defining acceptable levels of soft tissue compression. A silicone-based fit-checking technique with a predefined film thickness range allows standardized seating of provisional restorations and enhances procedural reproducibility.

Objective. To improve the quality of immediate prosthetic rehabilitation in patients with periodontitis by using a silicone-based fit-checking technique with quantitative control of film thickness combined with site-specific FDM-based modification of the pontic.

Materials and methods. A single-center prospective controlled study was conducted. Two independent groups of 10 patients each were formed to assess patientand clinician-reported outcomes. In the study group, provisional restorations were seated with quantitative assessment of soft tissue compression using a thin-layer condensation silicone fit-checking material with a predefined film thickness range of 60–150 μm, followed by site-specific FDM-based modification of the pontic. In the control group, restorations were adjusted using standard chairside fitting procedures without quantitative reference values. An additional cohort of 48 patients was included for zonal assessment of silicone film thickness (five zones per patient; 240 measurements in total). Data normality was evaluated using the Shapiro–Wilk test. Intergroup differences in VAS scores were analyzed using the Mann–Whitney U test. Associations between silicone film thickness and VAS scores were examined using Spearman’s rank correlation coefficient.

Results. The study group demonstrated more favorable patientand clinician-reported outcomes. Median clinician VAS scores were 6.8 [6.6; 7.1] compared with 9.2 [8.9; 9.3] in the control group, while median patient VAS scores were 7.3 [5.3; 7.9] versus 8.8 [8.6; 9.0], respectively (n = 10 per group). Across all assessed zones (n = 240), the median silicone film thickness was 80 [60; 100] μm, with a mean value of 84.6 ± 50.3 μm and a range of 20–300 μm. The proportion of measurements within the predefined target range of 60–150 μm was 67.5%. Zonal analysis demonstrated the highest degree of controllability in the vestibular region (95.8% of measurements within the target range) and the lowest in the distal region (41.7%), indicating the need for targeted correction primarily in this area.

Conclusion. Quantitative control of provisional restoration seating using a thin-layer silicone-based fit-checking technique combined with targeted FDM-based modification is clinically feasible, reduces perceived soft tissue trauma, and improves the reproducibility of the early prosthodontic phase of immediate rehabilitation in patients with periodontitis. The proposed numerical thresholds and zonal reference values may serve as formalized quality endpoints and provide a foundation for protocol standardization in clinical practice. Multicenter randomized controlled trials are required to evaluate mediumand long-term outcomes.

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