Soft Tissue Augmentation Around Dental Implants: Techniques, Timing, and Comparative Efficacy-A Systematic Review and...

Area of Science:

• Dental Implantology
• Periodontology
• Regenerative Medicine

Background:

• Peri-implant soft tissue phenotype, including keratinized tissue width (KTW) and mucosal thickness (MT), is crucial for dental implant health and stability.
• Various soft tissue augmentation (STA) procedures exist, utilizing different techniques and materials to enhance these parameters.

Purpose of the Study:

• To systematically compare the effectiveness of different STA techniques and surgical timings for improving KTW and MT.
• To establish the relative efficacy of various STA approaches through a Bayesian network meta-analysis.

Main Methods:

• Systematic review and Bayesian network meta-analysis (NMA) of randomized controlled trials (RCTs) evaluating STA around dental implants.
• Primary outcomes: KTW and MT gain. Secondary analysis included subgroup comparisons (APF-based vs. bilaminar) and meta-regression for surgical timing.
• Hierarchical Bayesian model with Markov chain Monte Carlo simulations for pairwise and indirect comparisons.

Main Results:

• APF + free gingival graft (FGG) demonstrated the most significant KTW gain (MD: 0.22-4.11 mm). APF alone showed limited efficacy; bilaminar techniques did not yield significant KTW gain.
• Bilaminar techniques, particularly connective tissue graft (CTG), were most effective for MT gain (MD: 0.02-0.94 mm), followed by xenogeneic collagen matrix and buccally displaced flap.
• Surgical timing did not significantly impact MT gain, but delayed timing may benefit KTW gain. APF+FGG and CTG showed better long-term stability.

Conclusions:

• APF+FGG is the most reliable technique for increasing KTW, while CTG is the gold standard for MT enhancement in STA procedures.
• The selection of STA technique and graft material is more critical for outcomes than surgical timing.
• Further research with standardized reporting is needed to optimize clinical decision-making for long-term stability of augmented tissues.