title: Efficacy of soft tissue augmentation around dental implants and in partially edentulous areas: a systematic review.
abstract: OBJECTIVE
  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.
authors.affiliation: Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Thoma
authors.forename: Borvornwut
authors.initials: B
authors.lastname: Buranawat
authors.forename: Christoph H F
authors.initials: CH
authors.lastname: Hämmerle
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Jung
mesh_terms: D003094:Collagen / Q000627:therapeutic use; D003238:Connective Tissue / Q000637:transplantation; D015921:Dental Implants; D005881:Gingiva / Q000637:transplantation; D005893:Gingivoplasty / Q000379:methods; D006801:Humans; D007576:Jaw, Edentulous, Partially / Q000601:surgery*; D010510:Periodontal Diseases / Q000601:surgery; D010519:Periodontium / Q000601:surgery*; D013524:Surgical Flaps / Q000601:surgery; D016896:Treatment Outcome; D014727:Vestibuloplasty / Q000379:methods
chemical_list: D015921:Dental Implants; D003094:Collagen
keywords: allogenic dermal matrix graft; collagen matrix; dental implant; free gingival graft; keratinized tissue; soft tissue augmentation; soft tissue volume; subepithelial connective tissue graft; vestibuloplasty