Soft Tissue Grafting Around Implants: Why, When, and How?

Abstract

This paper discusses the role of soft tissue grafting around dental implants. The aim of this review is to present pertinent literature on peri-implant soft tissue including its role, indications for augmentation, techniques used to enhance the quality and/or quantity of the soft tissue, and corresponding timing of those procedures. Most reviewed soft tissue grafting studies in this paper were published in the last 5 years. However, the review also included older articles to mitigate the lack of recent randomized controlled trials or even case series on the reviewed soft tissue graft types. Soft tissue management with custom healing abutments or temporary restorations should be considered whenever possible. Soft tissue grafting to increase the width of keratinized mucosa (KM) seems to result in greater reduction of inflammation signs and a greater maintenance of crestal bone levels. The use of soft tissue grafts to increase soft tissue thickness tends to have a positive effect on maintaining crestal bone levels, especially when used to increase vertical thickness. Apically positioned flaps (APFs) in combination with free gingival grafts (FGGs), subepithelial connective tissue grafts (SCTGs), or xenogenic collagen matrix (XCM) can significantly increase the KM width. Grafts to enhance facial tissue thickness lack evidence to support their long-term impact on mucosal marginal levels. Nonetheless, soft tissue manipulation is frequently performed at second-stage surgery to improve the facial thickness and esthetics. No clear advantages for the timing of soft tissue grafting with regard to clinical outcomes can be delineated when grafting is performed to increase KM or tissue thickness in simultaneous or staged approaches. The decision and timing to treat soft tissue defects should be based on risk assessment at the site and patient levels.