Clinical Oral Investigations

, Volume 20, Issue 7, pp 1369–1387 | Cite as

Soft tissue augmentation procedures at second-stage surgery: a systematic review

  • Renzo G. BassettiEmail author
  • Alexandra Stähli
  • Mario A. Bassetti
  • Anton Sculean



The aim of this systematic review was to evaluate the efficacy of different soft tissue augmentation/correction methods in terms of increasing the peri-implant width of keratinized mucosa (KM) and/or gain of soft tissue volume during second-stage surgery.

Materials and methods

Screening of two databases, MEDLINE (PubMed) and EMBASE (OVID), and hand search of related articles, were performed. Human studies reporting on soft tissue augmentation/correction methods around submucosally osseointegrated implants during second-stage surgery up to July 31, 2015 were considered. Quality assessment of the selected full-text articles was performed according to the Cochrane collaboration’s tool to assess the risk of bias.


Overall, eight prospective studies (risk of bias: high) and two case series (risk of bias: high) were included. Depending on the surgical technique and graft material used, the enlargement of keratinized tissue (KT) ranged between −0.20 and 9.35 mm. An apically positioned partial-thickness flap/vestibuloplasty (APPTF/VP) in combination with a free gingival graft (FGG) or a xenogeneic graft material (XCM) was most effective. Applying a roll envelope flap (REF) or an APPTF in combination with a subepithelial connective tissue graft (SCTG), mean increases in soft tissue volumes of 2.41 and 3.10 mm, respectively, were achieved. Due to the heterogeneity of study designs, no meta-analysis could be performed.


Within the limitations of this review, regarding the enlargement of peri-implant KT, the APPTF in the maxilla and the APPTF/VP in combination with FGG or XCM in the lower and upper jaw seem to provide acceptable outcomes. To augment peri-implant soft tissue volume REF in the maxilla or APPTF + SCTG in the lower and upper jaw appear to be reliable treatment options.

Clinical relevance

The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.


Second-stage surgery Re-entry Peri-implant keratinized mucosa Peri-implant soft tissue volume 


Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.


This review article was supported by the authors’ own institutions (Department of Oral & Maxillofacial Surgery of the Lucerne Cantonal Hospital and Department of Periodontology of the University of Bern, Switzerland).

Informed consent

For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Renzo G. Bassetti
    • 1
    Email author
  • Alexandra Stähli
    • 2
  • Mario A. Bassetti
    • 2
  • Anton Sculean
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryLucerne Cantonal HospitalLucerneSwitzerland
  2. 2.Department of PeriodontologyUniversity of BernBernSwitzerland

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