title: Soft tissue substitutes in non-root coverage procedures: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The present systematic review compared the effectiveness of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) in non-root-coverage procedures to increase keratinized tissue (KT) width around teeth.
  
  
  METHODS
  Included studies fulfilled the following main eligibility criteria: (a) preclinical in vivo or human controlled trials using FGG as control, (b) non-root-coverage procedures, and (c) assessment of KT width. Meta-analysis was performed on the gain in KT width (primary outcome variable) and several secondary variables.
  
  
  RESULTS
  Eight human trials with short observation time evaluating five different STSs were identified. FGG yielded consistently significantly (p < 0.001) larger increase in KT width irrespective whether the comparison regarded an acellular matrix or a tissue-engineered STS. Further, FGG yielded consistently ≥2 mm KT width postoperatively, while use of STS did not, in the few studies reporting on this outcome. On the other hand, STSs resulted in significantly better aesthetic outcomes and received greater patient preference (p < 0.001).
  
  
  CONCLUSIONS
  Based on relatively limited evidence, in non-root-coverage procedures, FGG (1) resulted consistently in significantly larger increase in KT width compared to STS and (2) yielded consistently ≥2 mm KT width postoperatively, while STSs did not. STSs yielded significantly better aesthetic outcomes, received greater patient preference, and appeared safe.
  
  
  CONCLUSIONS
  Larger and more predictable increase in KT width is achieved with FGG, but STSs may be considered when aesthetics is important. Clinical studies reporting relevant posttreatment outcomes, e.g., postop KT width ≥2 mm, on the long-term (>6 months) are warranted.
authors.affiliation: Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden.|Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bertl
authors.affiliation: Division of Oral Surgery, School of Dentistry, Medical University of Vienna, Vienna, Austria.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Melchard
authors.affiliation: Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Pandis
authors.affiliation: Division of Conservative Dentistry and Periodontology, School of Dentistry, Medical University of Vienna, Vienna, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Müller-Kern
authors.affiliation: Department of Periodontology, Faculty of Odontology, University of Malmö, Carl Gustafs väg 34, 20506, Malmö, Sweden. andreas.stavropoulos@mah.se.
authors.forename: Andreas
authors.identifier: http://orcid.org/0000-0001-8161-3754
authors.initials: A
authors.lastname: Stavropoulos
mesh_terms: D003238:Connective Tissue / Q000637:transplantation*; D004955:Esthetics, Dental; D005881:Gingiva / Q000637:transplantation*; D005889:Gingival Recession / Q000601:surgery*; D005893:Gingivoplasty / Q000379:methods*; D006801:Humans; D013524:Surgical Flaps
keywords: Attached gingiva; Keratinized tissue; Meta-analysis; Randomized controlled trials; Soft tissue augmentation; Systematic review