Soft tissue augmentation procedures at second-stage surgery: a systematic review
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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.
The localization in the jaw and the clinical situation are crucial for the decision which second-stage procedure should be applied.
KeywordsSecond-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).
For this type of study, formal consent is not required.
- 10.Stimmelmayr M, Allen EP, Reichert TE, et al. (2010) Use of a combination epithelized-subepithelial connective tissue graft for closure and soft tissue augmentation of an extraction site following ridge preservation or implant placement: description of a technique. Int J Periodontics Restorative Dent 30:375–381PubMedGoogle Scholar
- 13.Listgarten MA, Lang NP, Schroeder HE et al (1991) Periodontal tissues and their counterparts around endosseous implants [corrected and republished with original paging, article orginally printed in Clin Oral Implants Res 1991 Jan-Mar; 2(1):1–19]. 2:1–19Google Scholar
- 14.Berglundh T, Lindhe J (1994) Jonsson K et al. The topography of the vascular systems in the periodontal and peri-implant tissues in the dog 21:189–193Google Scholar
- 18.Zuhr O, Hürzeler M (eds) (2011) Plastisch-ästhetische Parodontal- und Implantatchirurgie. Quintessenz Verlag, BerlinGoogle Scholar
- 24.Esposito M, Grusovin MG, Maghaireh H et al (2007) Interventions for replacing missing teeth: management of soft tissues for dental implants. Cochrane Database Syst Rev:CD006697Google Scholar
- 43.Frisch E, Ziebolz D, Vach K et al (2013) The effect of keratinized mucosa width on peri-implant outcome under supportive postimplant therapy. Clin Implant Dent Relat ResGoogle Scholar
- 46.Lin GH, Chan HL, Wang HL (2013) The significance of keratinized mucosa on implant health: a systematic review. J PeriodontolGoogle Scholar
- 61.Schmitt CM, Moest T, Lutz R et al (2015) Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants ResGoogle Scholar
- 65.Souza AB, Tormena M, Matarazzo F et al (2015) The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health. Clinical oral implants researchGoogle Scholar
- 72.Sanz M, Lorenzo R, Aranda JJ, et al. (2009) Clinical evaluation of a new collagen matrix (Mucograft prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: a randomized prospective clinical trial. J Clin Periodontol 36:868–876CrossRefPubMedGoogle Scholar
- 83.Linkevicius T, Puisys A, Steigmann M et al (2014) Influence of vertical soft tissue thickness on crestal bone changes around implants with platform switching: a comparative clinical study. Clinical implant dentistry and related researchGoogle Scholar
- 85.Sieira Gil R, Pages CM, Diez EG, et al. (2015) Tissue-engineered oral mucosa grafts for intraoral lining reconstruction of the maxilla and mandible with a fibula flap. J Oral Maxillofac Surg 73(195):e191–e116Google Scholar