Volumetric Changes at Pontic Sites After Connective Tissue Grafting: A Systematic Review

Background/Objectives: Connective tissue grafting (CTG) has been proposed to enhance ridge contour at pontic sites; however, its long-term volumetric stability remains unclear. This systematic review evaluated three-dimensional (3D) volumetric and linear soft-tissue changes over time following CTG at pontic sites. Methods: A systematic search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, LILACS, Scopus, Web of Science, and Google Scholar. Clinical studies assessing linear and/or volumetric soft-tissue outcomes at pontic sites treated with CTG, with a minimum follow-up of six months, were included. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers using RoB 2 and ROBINS-I tools. Results were synthesized descriptively. Results: Seven studies (two randomized and five non-randomized) were included. CTG was associated with consistent early improvements in ridge contour and soft-tissue volume. Over time, minor dimensional reductions were observed, and differences between grafted and nongrafted sites tended to decrease after the initial remodeling phase. Long-term follow-up (up to 15 years) suggested overall stability of both volumetric and linear outcomes. However, the evidence is limited by a small number of studies, methodological heterogeneity, and predominance of non-randomized designs. Conclusions: CTG provides early soft-tissue augmentation at pontic sites, but its long-term advantage over non-grafted healing appears limited. Given the very low certainty of evidence, these findings of such studies should be interpreted with caution in clinical decision-making.