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Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review


Thoma, Daniel S; Buranawat, Borvornwut; Hämmerle, Christoph H F; Held, Ulrike; Jung, Ronald E (2014). Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review. Journal of Clinical Periodontology, 41(S15):S77-S91.

Abstract

AIM: To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites.
METHODS: A Medline search was performed for human studies augmenting keratinized mucosa (KM) and soft tissue volume around implants and in partially edentulous areas. Due to heterogeneity in between the studies, no meta-analyses could be performed.
RESULTS: Nine (KM) and eleven (volume) studies met the inclusion criteria. An apically positioned flap/vestibuloplasty (APF/V) plus a graft material [free gingival graft (FGG)/subepithelial connective tissue graft (SCTG)/collagen matrix (CM)] resulted in an increase of keratinized tissue (1.4-3.3 mm). Statistically significantly better outcomes were obtained for APF/V plus FGG/SCTG compared with controls (APF/V alone; no treatment) (p < 0.05). For surgery time and patient morbidity, statistically significantly more favourable outcomes were reported for CM compared to SCTGs (p < 0.05) in two randomized controlled clinical trials (RCTs), even though rendering less keratinized tissue. SCTGs were the best-documented method for gain of soft tissue volume at implant sites and partially edentulous sites. Aesthetically at immediate implant sites, better papilla fill and higher marginal mucosal levels were obtained using SCTGs compared to non-grafted sites.
CONCLUSIONS: An APF/V plus FGG/SCTG was the best-documented and most successful method to increase the width of KM. APF/V plus CM demonstrated less gain in KM, but also less patient morbidity and surgery time compared to APF/V plus SCTG based on two RCTs. Autogenous grafts (SCTG) rendered an increase in soft tissue thickness and better aesthetics compared to non-grafted sites.

Abstract

AIM: To review the dental literature in terms of efficacy of soft tissue augmentation procedures around dental implants and in partially edentulous sites.
METHODS: A Medline search was performed for human studies augmenting keratinized mucosa (KM) and soft tissue volume around implants and in partially edentulous areas. Due to heterogeneity in between the studies, no meta-analyses could be performed.
RESULTS: Nine (KM) and eleven (volume) studies met the inclusion criteria. An apically positioned flap/vestibuloplasty (APF/V) plus a graft material [free gingival graft (FGG)/subepithelial connective tissue graft (SCTG)/collagen matrix (CM)] resulted in an increase of keratinized tissue (1.4-3.3 mm). Statistically significantly better outcomes were obtained for APF/V plus FGG/SCTG compared with controls (APF/V alone; no treatment) (p < 0.05). For surgery time and patient morbidity, statistically significantly more favourable outcomes were reported for CM compared to SCTGs (p < 0.05) in two randomized controlled clinical trials (RCTs), even though rendering less keratinized tissue. SCTGs were the best-documented method for gain of soft tissue volume at implant sites and partially edentulous sites. Aesthetically at immediate implant sites, better papilla fill and higher marginal mucosal levels were obtained using SCTGs compared to non-grafted sites.
CONCLUSIONS: An APF/V plus FGG/SCTG was the best-documented and most successful method to increase the width of KM. APF/V plus CM demonstrated less gain in KM, but also less patient morbidity and surgery time compared to APF/V plus SCTG based on two RCTs. Autogenous grafts (SCTG) rendered an increase in soft tissue thickness and better aesthetics compared to non-grafted sites.

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21 citations in Web of Science®
17 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
04 Faculty of Medicine > Center for Dental Medicine > Clinic for Fixed and Removable Prosthodontics
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:26 May 2014 14:46
Last Modified:05 Apr 2016 17:53
Publisher:Wiley-Blackwell
ISSN:0303-6979
Additional Information:This is the accepted version of the following article: Journal of Clinical Periodontology (2014), 41(Sup15):S77-S91, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12220/abstract
Publisher DOI:https://doi.org/10.1111/jcpe.12220
PubMed ID:24641003

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