Aim: The aim of the present review was to systematically assess the dental literature in terms of soft tissue grafting techniques. The focused question was: is there superiority of one method over others for augmentation and stability of the augmented soft tissue in terms of increasing the width of keratinized tissue (part 1), and gain in soft tissue volume (part 2).
Methods: A Medline search was performed for human studies focusing on augmentation of keratinized tissue and/or soft tissue volume, and complimented by additional hand searching. Relevant studies were identified and statistical results reported for meta-analyses including the test minus control weighted mean differences (WMD) with 95% confidence intervals (CI), the I-squared statistic for tests of heterogeneity, and the number of significant studies.
Results: Twenty-five (part 1) and three (part 2) studies met the inclusion criteria; 14 studies (part 1) were eligible for comparison using meta-analyses. An apically positioned flap/vestibuloplasty (APF/V) procedure resulted in a statistically significantly greater gain in keratinized tissue than untreated controls. APF/V plus autogenous tissue revealed statistically significant more attached gingiva compared to untreated controls and a borderline statistical significance compared to APF/V plus allogenic tissue. Statistically significantly more shrinkage was observed for APF/V plus allogenic graft compared to APF/V plus autogenous tissue. Patient-centered outcomes did not reveal a superiority of any of the treatment methods regarding post-operative complications. The 3 studies reporting on soft tissue volume augmentation could not be compared due to lack of homogeneity. The use of subepithelial connective tissue grafts (SCTGs) resulted in statistically significantly more soft tissue volume gain compared to free gingival grafts (FGGs).
Conclusions: APF/V is a successful treatment concept to increase the width of keratinized tissue or attached gingiva around teeth. The addition of autogenous tissue statistically significantly increases the width of attached gingiva. For soft tissue volume augmentation only limited data are available favoring SCTGs over FGG.