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Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis*

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Abstract

Objective

The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft – CTG and free gingival graft—FGG) with different type of matrices (acellular dermal matrix—ADM, xenograft collagen matrix—XCM, volume-stable collagen matrix—VCMX) used to increase peri-implant soft tissues.

Materials and methods

A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements.

Results

A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days.

Conclusions

While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients’ morbidity.

Limitations

The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups).

Clinical Relevance

Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.

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Data availability

The authors confirm that the data supporting the findings of this study are available within the article [and/or] its supplementary materials.

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Funding

This study was self-funded by the authors and their institutions, and no external funding was received.

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Authors and Affiliations

  1. Department of Biomedical, Surgical and Dental Sciences, Università Degli Studi Di Milano, Milan, Italy

    Grazia Tommasato, Massimo Del Fabbro & Nadim Oliva

  2. Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Policlinico of Milan (Policlinico Di Milano Ospedale Maggiore | Fondazione IRCCS Ca’ Granda), Milan, Italy

    Shahnawaz Khijmatgar

  3. University Vita Salute S Raffaele, Milan, Gorizia, Italy

    Maria Gabriella Grusovin

  4. Department of Periodontology, University of Bern, Bern, Switzerland

    Anton Sculean

  5. Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, Rome, Italy

    Luigi Canullo

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  1. Grazia Tommasato
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  2. Massimo Del Fabbro
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  3. Nadim Oliva
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  4. Shahnawaz Khijmatgar
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  5. Maria Gabriella Grusovin
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  6. Anton Sculean
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Contributions

Grazia Tommasato, Concept/Design, Data collection, Data analysis/interpretation, Drafting manuscript, Critical revision of manuscript, Approval of manuscript.

Massimo Del Fabbro, Data analysis/interpretation, Statistics, Approval of manuscript.

Nadim Oliva Data collection, Data analysis/interpretation, Drafting manuscript.

Shahnawaz Khijmatgar NMA methods, Data collection, Data analysis/interpretation, results, discussion, Statistics, critical revision of manuscript.

Maria Gabriella Grusovin, Data analysis/interpretation, Critical revision of manuscript, Approval of manuscript

Anton Sculean, Data analysis/interpretation, Critical revision of manuscript, Approval of manuscript

Luigi Canullo, Data analysis/interpretation, Critical revision of manuscript, Approval of manuscript.

Corresponding authors

Correspondence to Grazia Tommasato or Shahnawaz Khijmatgar.

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Tommasato, G., Del Fabbro, M., Oliva, N. et al. Autogenous graft versus collagen matrices for peri-implant soft tissue augmentation. A systematic review and network meta-analysis*. Clin Oral Invest 28, 300 (2024). https://doi.org/10.1007/s00784-024-05684-5

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