Soft-tissue augmentation for increasing keratinized tissue around dental implants: A systematic review

Area of Science:

• Periodontology
• Dental Implantology
• Oral Surgery

Background:

• Compromised soft-tissue status around dental implants necessitates effective augmentation strategies.
• Keratinized mucosa (KM) width is crucial for long-term implant health and esthetics.
• Limited data exists on optimal soft-tissue grafting techniques for KM enhancement.

Purpose of the Study:

• To systematically review and assess the efficacy of soft-tissue augmentation procedures for increasing keratinized mucosa (KM) width.
• To evaluate techniques for patients with compromised soft-tissue status around dental implants.

Main Methods:

• Comprehensive literature search of MEDLINE, PubMed, and EMBASE up to July 2023.
• Inclusion of human studies in English within the last decade focusing on soft-tissue grafting for KM width.
• Risk of bias assessment using Joanna Briggs Institute critical appraisal tools.

Main Results:

• The review analyzed 27 studies (9 prospective, 13 RCTs, 5 case series).
• Interventions resulted in augmented KM width ranging from 0.89 mm to 7.7 mm.
• Apically positioned partial-thickness flaps and vestibuloplasty (VP) with xenogeneic collagen matrix (XCM) or free gingival graft (FGG) yielded optimal outcomes.

Conclusions:

• Apically positioned partial-thickness flaps and VP techniques using XCM or FGG show potential for augmenting KM width.
• Further randomized controlled trials (RCTs) with longer follow-up are needed.
• Future research should address graft integration and shrinkage minimization strategies.