Evidence-based alternatives for autogenous grafts around teeth: outcomes, attachment, and stability

Although the use of autogenous harvested tissues has proven to be the gold standard for soft tissue augmentation procedures involving root coverage or generation of keratinized tissue, harvest site morbidity and limited supply have prompted clinicians to seek graft alternatives. Using a hierarchy of evidence, the author reviews both clinical and patient-reported results for harvest graft substitutes and, considering his own research experience, reviews autogenous graft substitute outcomes, attachment, and stability over time. Overall, when the goal is keratinized-tissue generation, living cellular constructs and xenogeneic collagen matrices have provided acceptable clinical results, but with better esthetics and patient preference than autogenous free gingival grafts. For root coverage therapy, enamel matrix derivatives, platelet-derived growth factors, and xenogeneic collagen matrices have provided acceptable results with equivalent esthetics to autogenous connective tissue grafts, while also being preferred by patients. Longterm results for enamel matrix derivatives, platelet-derived growth factors, and xenogeneic collagen matrices indicate root coverage can be maintained over time. In the author's hands, xenogeneic collagen matrices have been the only harvest graft alternatives that can be used either covered or uncovered by soft tissue.