Autogenous Connective Tissue Graft Research Articles

Advancing Periodontal Care: Development of a Novel Collagen-Chitosan-Bioglass Scaffold as a Substitute for Autologous Soft Tissue Grafts.

Introduction Modern dentistry prioritizes aesthetic outcomes, making root coverage for gingival recession a key focus. Various approaches, including autologous grafts, address this issue, yet no substitute matches the properties of autogenous connective tissue grafts. The innovative collagen-chitosan-bioglass scaffold presents a promising solution, surpassing the limitations of the traditional methods. This scaffold blends the advantages of collagen with chitosan's antibacterial and regenerative properties, enhanced by bioglass, which promotes tissue healing through angiogenesis. It was evaluated for its physicochemical characteristics, as well as antioxidativeand anti-inflammatory properties, making it a promising solution for soft tissue management in dentistry. Materials and methods Chitosan, collagen, and bioglass were combined into a scaffold through the lyophilization process (freeze-drying). Chitosan was sourced from shrimp, collagen from bovine, and the bioglass 1% comprised 58% tetra-ethyl ortho silicate, 33% calcium silicate, and phosphorous pentoxide. After the scaffold was created, it was subjected to physicochemical characterization via scanning electron microscopic and infrared spectroscopic analysis. Its anti-inflammatory and antioxidantproperties were evaluated using DPPH (2,2-diphenyl -1-picrylhydrazyl) assay and by measuring the scaffold's radical scavenging activity. Results This study employed infrared spectroscopy and scanning electron microscopy techniques to analyze the sample components and their morphology. The infrared (attenuated total reflection) analysis revealed various elements confirming the presence of all the biomaterials required to fabricate the scaffold. Scanning electron microscope imaging displayed a folded-like morphology with a porous structure. The protein denaturation inhibition increased from 25% at 50 μg of scaffold weight to 45% at 200 μg of scaffold weight. Similarly, the antioxidant activity increased, with values rising from 23% at 50μg to 35% at 200μg of scaffold weight. Conclusion The fabricatedcollagen-chitosan-bioglass scaffolddemonstrates promising antioxidant andanti-inflammatory properties. These findings suggest that this scaffold holds significant potential as a viable substitute for soft tissue augmentation.

A preliminary investigation into the impact of soft tissue augmentation-based periodontal phenotype modification therapy for patients exhibiting class III decompensation

BackgroundPatients with skeletal angle Class III malocclusion usually have inadequate hard and soft tissue volume at the mandibular anterior teeth. The labial proclination at the teeth may lead to gingival recession. The purpose of this study was to explore whether periodontal phenotype modification therapy with soft tissue augmentation (PhMT-s) can prevent gingival recession in these patients.MethodsFour patients with skeletal Class III malocclusion and a thin periodontal phenotype underwent surgical-orthodontic treatment. Prior to tooth movement, they underwent a minimally invasive vestibular incision with subperiosteal tunnel access combined with autogenous connective tissue grafts for periodontal phenotype modification with soft tissue augmentation (PhMT-s). The labial gingival thickness of the anterior mandibular teeth was measured at three distinct levels: at the cementoenamel junction (GT0), 3 mm apical to the CEJ (GT3), and 6 mm apical to the CEJ (GT6). These measurements were taken at baseline, three months following PhMT-s, and after tooth decompensation. Additionally, a biopsy sample was obtained from the PhMT-s site of one patient. All sections were subsequently stained using hematoxylin and eosin, Masson trichrome, Sirius Red, and immunohistochemistry.ResultsThe thickness of the labial gingiva was increased about 0.42 to 2.00 mm after PhMT-s. At the end of pre-orthognathic surgical orthodontic treatment, the thickness of the labial gingiva was increased about − 0.14 to 1.32 mm compared to the baseline and no gingival recession occurred after the pre-orthognathic surgical orthodontic treatment. The histologic results demonstrated that the grafts obtained from the PhMT-s site exhibited increased deposition of collagen fibers. Moreover, the proportion of type III collagen increased and the grafts displayed significantly reduced positive expression of CD31 and OCN.ConclusionsPhMT-s increased the thickness of the soft tissue, stabilizing the gingival margin for teeth exhibiting a thin periodontal phenotype and undergoing labial movement. This is attributed to the increased deposition of collagen fibers.

The distally anchored connective tissue graft platform for papilla enhancement: A case report

AbstractBackgroundAs the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal papillae fill in single‐tooth implant restorations remains a challenge. The distally anchored connective tissue platform is a novel soft tissue augmentation technique that consists of harvesting an autogenous connective tissue graft from the palate, folding it, and positioning it at the level of the distal occlusal and buccal surfaces with the help of a distal sling suture to the adjacent distal tooth.MethodsThis case report describes how a maxillary central incisor with compromised hard and soft tissues were replaced using a comprehensive treatment plan.ResultsThe clinical outcomes showed stable mucosal margin levels and complete papillae fill. The patient expressed satisfaction with the achieved results.ConclusionsThe distally anchored connective tissue graft platform performed at the time of implant placement emerges as a viable and effective soft tissue augmentation technique that yields highly esthetic results.Key pointsWhy is this case new information? To the best of our knowledge, this is the first case report in the literature using the distally anchored connective tissue platform. What are the keys to successful management of this case? Adequate diagnosis and decision‐making, resulting in a treatment plan focused on reconstructing both soft and hard tissues in a single‐tooth implant within the esthetic area, yield favorable clinical, radiological, and patient‐reported outcomes. What are the primary limitations to success in this case? The primary limitation of this study is its reliance on a single case report.

Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis

ObjectiveThe gold standard for a soft tissue augmentation around implants is a subepithelial connective tissue graft (CTG), but the xenogeneic collagen matrices (XCM) started to be used as an alternative. This systematic review aimed to assess the effectiveness XCM in comparison to CTG for the increasing the thickness of the soft tissue around implants.DataAll studies included at least two parallel groups comparing the use of CTG and XCM with a minimum follow-up of 3 months. As the primary outcome, the amount of soft tissue thickness gain after soft tissue augmentation with XCM or CTG was assessed. Secondary outcomes were clinical and patient-related outcomes; evaluation of aesthetic outcomes, patient-reported outcomes measures (PROMs) and complications. Eligible studies were selected based on the inclusion criteria. Meta-analysis was applied whenever possible. The quality of the evidence of studies including in meta-analysis was assessed using the GRADE approach.SourceA systematic literature search up to January 2022 was conducted using the following electronic databases: PubMed (MEDLINE), Scopus, Cochrane Library, LILACS, eLIBRARY.RU. Unpublished researches, the gray literature, nonprofit reports, government studies and other materials were reviewed electronically using an EASY search. An additional manual search was carried out in November 2022.Study selectionOf the 1376 articles from the initial search, 8 randomized controlled trials (RCTs) (306 patients and 325 implants) were included in this systematic review, and 7 studies were part of the meta-analysis. Meta-analysis revealed that XCM is less effective than the CTG in increasing soft tissue thickness around dental implants. However, XCM also provides soft tissue thickness gain and can be recommended for use in various clinical situations.Clinical significancePrevious systematic reviews and meta-analyses have shown that autologous grafts are more effective than collagen matrices in increasing soft tissue thickness, however, the latter can be used as an alternative. Studies included in previous systematic reviews varied in design, which could lead to limitations. The present systematic review and meta-analysis includes for the first time only randomized controlled clinical trials with collagen matrix of xenogeneic origin in the test group. Tight eligibility criteria were established, and the main parameter studied was soft tissue thickness. It was found that xenogeneic collagen matrix is effective for increasing soft tissue thickness around dental implants, however, the results obtained using an autogenous connective tissue graft are superior.

Clinical Evaluation of Bilateral Multiple Gingival Recession Treatment with Autogenous Connective Tissue Graft Associated with Low-Level Laser Therapy

Gingival recession (GR) is described as an apical displacement of the gingival margin in relation to the cementoenamel junction, exposing the root surface to the oral cavity environment. This study aimed to evaluate the clinical results of a bilateral root coverage (RC) of GR associated with an autogenous connective tissue graft (aCTG) alone or combined with low-level laser therapy (aCTG + LLLT). This cross-sectional, split-mouth, double-blind, clinical pilot study featured three individuals who attended a periodontics post-graduate program with the main complaint of GR and dental hypersensitivity (DHS). Of these, only one patient met the inclusion criteria and the parameters evaluated were: DHS, the keratinized tissue's thickness and width clinical attachment level (CAL), probing on depth (PD), and bilateral GR based on Cairo RT I. The patient was evaluated by a first clinical evaluator and the treatment was randomly divided into two groups, G1: aCTG only (control group, n = 3 teeth per side) and G2: aCTG + LLLT (test group, n = 3 teeth per side). LLLT used a diode laser (660 nm) with a dose of 3 J/cm2 per point and 4 s per point was applied in four different periods, preoperatively; transoperatively and immediately postoperatively, the application was performed in three points (eight applications) on alternate days for 7 days and a 90-day follow-up was performed for clinical evaluations of the periodontal parameters and the collected data were analyzed by Kruskal-Wallis and Dunn tests. the RC mean percentage was <95% in both groups after 90 days. Comparing treatment sides, G1 (n = 3/3, 100%) had a higher prevalence of RC than G2 had (n = 3/3, 95%). DHS significantly decreased after 90 days in both groups. Both groups showed an improvement in the other periodontal parameters evaluated during the short-term follow-up; mainly, PD had a statistically significant (p ˂ 0.05) increase after 90 days and a CAL decrease during this period; KTW and KTT also had a significant increase in both groups (p ˂ 0.05). the results indicated that aCTG + LLLT might have an additional benefit to GR root coverage within the evaluated time and this section also includes the within-study limitations.

Effect of polydeoxyribonucleotide with xenogeneic collagen matrix on gingival phenotype modification: a pilot preclinical study.

To investigate the effect of xenogeneic collagen matrix (XCM) with polydeoxyribonucleotide (PDRN) for gingival phenotype modification compared to autogenous connective tissue graft. Five mongrel dogs were used in this study. Box-type gingival defects were surgically created bilaterally on the maxillary canines 8 weeks before gingival augmentation. A coronally positioned flap was performed with either a subepithelial connective tissue graft (SCTG) or XCM with PDRN (2.0 mg/mL). The animals were sacrificed after 12 weeks. Intraoral scanning was performed for soft tissue analysis, and histologic and histomorphometric analyses were performed. One animal exhibited wound dehiscence, leaving 4 for analysis. Superimposition of STL files revealed no significant difference in the amount of gingival thickness increase (ranging from 0.69±0.25 mm to 0.80±0.31 mm in group SCTG and from 0.48±0.25 mm to 0.85±0.44 mm in group PDRN; P>0.05). Histomorphometric analysis showed no significant differences between the groups in supracrestal gingival tissue height, keratinized tissue height, tissue thickness, and rete peg density (P>0.05). XCM soaked with PDRN yielded comparable gingival augmentation to SCTG.

Soft tissue augmentation with a volume-stable collagen matrix or an autogenous connective tissue graft at implant sites: Five-year results of a randomized controlled trial post implant loading.

Interventions to augment the mucosal thickness around dental implants are indicated to optimize esthetics and maintain peri-implant health. However, there is a lack of clinical data on the long-term performance of soft tissue substitutes, such as volume-stable collagen matrix (VCMX), compared to autogenous grafts, such as subepithelial connective tissue grafts (SCTGs). This randomized controlled trial aimed to assess 5-year data on clinical and radiographic outcomes at implant sites previously augmented with VCMX or SCTG. Twenty patients were randomly assigned for soft tissue augmentation with VCMX or SCTG at single implant sites. Following abutment connection, final restorations were inserted (baseline; BL) and patients were reexamined up to 5 years (FU-5). Measurements included clinical data, marginal bone levels, mucosal thickness, and ridge contour changes. Nonparametric tests and estimates were applied for the statistical analysis. The median buccal mucosal thickness increased by 0.3mm (Q1: -0.8; Q3: 1.0) in the VCMX group (P=0.656) and 0.3mm (Q1: 0.0; Q3: 1.0) in the SCTG group (P=0.188) between BL and FU-5 (intergroup P=0.752), while the ridge contour decreased by a median of -0.3mm (-0.9; -0.1) (P=0.078) for VCMX and -0.3mm (-0.4; -0.2) (P=0.039) for SCTG (intergroup P=0.817). Peri-implant health was maintained in both groups with stable clinical and radiographic outcomes and without significant differences between the treatments. Despite the limited power and considerable dropout rate in the present study, soft tissue augmentation at implant sites with either VCMX or SCTG resulted in similar stable peri-implant tissues, favorable esthetics, and clinically negligible contour changes at 5 years post loading.

DIAGNOSIS AND TREATMENT OF MILLER CLASS I GINGIVAL RECESSION USING FREE CONNECTIVE TISSUE AUTOGRAFT FROM THE HARD PALATE. CLINICAL OBSERVATION.

The article presents the study of diagnostic methods and the use of autogenous connective tissue grafts in surgical methods of treating Miller class I gingival recession. As the results, in the period from 2020-2021, 33 Miller class I gingival recession zones were treated. The height of gingival recessions before treatment averaged 3.5 ± 1.13 mm. Assessment of the level of attached keratinized gingiva up to the cement-enamel junction of the tooth showed a significant (p &lt;0.001) increase after surgical treatment. The average percentage efficacy of recession coverage in the study group was - 84%. Pain, fibrinous plaque and soft tissue edema were insignificant. The use of free connective tissue autograft taken from the hard palate is an effective method of treating Miller class I gingival recession.

The use of the connective tissue graft from the palate for vertical soft tissue augmentation during submerged dental implant placement: A case series.

ObjectivesTo evaluate the efficacy of the soft tissue augmentation vertically, using connective tissue graft from the palate, during submerged dental implant placement.Material and MethodsVertical soft tissue augmentation, using connective tissue graft from the palate, combining with submerged dental implant placement was performed for 50 patients (10 males and 40 females, mean age 57.22 years). Soft tissue thickness vertically was measured in the middle of the alveolar crest with the periodontal probe. After 3 months, healing abutments or multiunits were connected to the dental implants, augmented soft tissue thickness was measured vertically in the middle of the alveolar crest. The vertical soft tissue volume gain was calculated using analysis of variance descriptive analysis, significance set to p = .05.ResultsAll 50 autogenous connective tissue grafts from the palate healed successfully. The average thickness of the soft tissue grafts from the palate was 1.8 ± 0.41 mm. After 3 months, soft tissue thickness vertically increased from 2.27 ± 0.64 mm to 4.35 ± 0.64 mm. This difference between mean figures, between the groups, before and after soft tissue augmentation was found to be statistically significant F (263;477). The mean increase in soft tissue thickness was 2.08 ± 0.71 mm.ConclusionIt can be concluded that soft tissue augmentation vertically, using connective tissue graft from the palate can be successfully used for vertical soft tissue augmentation.

Treatment of Multiple Gingival Recessions Using Modified Tunnel Technique with V-reverse Sutures: A Report of Three Cases

The clinical case series presents a minimally invasive modified tunnel procedure with autogenous connective tissue graft (CTG) using a V-reverse sutures to treat multiple gingival recessions. In periodontal and peri-implant plastic procedures, proper graft and flap stabilization are crucial in the outcomes. The coronally advanced flap allows for better access with the possibility of suturing the graft to the de-epithelialized papillae of the periosteum; there is little evidence with using the V-reverse sutures technique in stabilizing the graft and the flap when performing tunnel techniques (TUN). The following case series presents a minimally invasive modified tunnel procedure with autogenous CTG using V-reverse sutures to treat gingival recessions. Three patients with Miller Class I maxillary buccal gingival recessions defects were selected for this study. All subjects were treated with the minimally invasive modified tunnel technique with autogenous subepithelial CTG. V-reverse sutures technique was performed to further improve the stability of the graft at the recipient site. Clinical parameters, including mean recession depth and root coverage esthetic score (RES), were recorded at baseline, 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1-year postoperative follow-up visits. At the 1-year follow-up, complete root coverage was achieved in multiple gingival recessions defect sites. In conclusion, this technique represents an alternative treatment for Miller Class I gingival recessions defects with clinical and esthetically satisfactory outcomes. Combining the advantages of V-reverse sutures and CTG in the treatment of gingival recessions is feasible and noninvasive.

Immediate Implant Placement in Conjunction with Acellular Dermal Matrix or Connective Tissue Graft: A Randomized Controlled Clinical Volumetric Study.

Connective tissue grafts have become a standard for compensating horizontal volume loss in immediate implant placement. The use of new biomaterials like acellular matrices may avoid the need to harvest autogenous grafts, yielding less postoperative morbidity. This randomized comparative study evaluated the clinical outcomes following extraction and immediate implant placement in conjunction with anorganic bovine bone mineral (ABBM) and the use of a porcine acellular dermal matrix (ADM) vs an autogenous connective tissue graft (CTG) in the anterior maxilla. Twenty patients (11 men, 9 women) with a mean age of 48.9 years (range: 21 to 72 years) were included in the study and randomly assigned to either the test (ADM) or control (CTG) group. They underwent tooth extraction and immediate implant placement together with ABBM for socket grafting and either ADM or CTG for soft tissue augmentation. Twelve months after implant placement, the cases were evaluated clinically and volumetrically. All implants achieved osseointegration and were restored. The average horizontal change of the ridge dimension at 1 year postsurgery was -0.55 ± 0.32 mm for the ADM group and -0.60 ± 0.49 mm for the CTG group. Patients of the ADM group reported significantly less postoperative pain. Using xenografts for hard and soft tissue augmentation in conjunction with immediate implant placement showed no difference in the volume change in comparison to an autogenous soft tissue graft, and showed significantly less postoperative morbidity.

A Minimally Invasive Approach for the Treatment of Multiple Adjacent Gingival Recessions with a Volume-Stable Collagen Matrix: A Case Series

Several soft tissue graft materials have been utilized over the years as alternatives to the autogenous connective tissue graft for reducing patient morbidity. In particular, a novel volume-stable xenogeneic collagen matrix (VXCM) has recently been introduced for soft tissue augmentation at implant sites. The VXCM is porous in nature, and its mechanical properties suggest utilizing a specific flap approach when treating multiple adjacent gingival recessions (MAGRs). Herewith, a minimally invasive surgical technique is described in combination with VXCM for treatment of MAGRs. Five patients with 16 MAGRs were treated with this approach. All sites healed uneventfully, and patients reported minimal discomfort. At 6 months, the technique resulted in a mean root coverage of 94.73%, and complete root coverage was achieved in 13 sites (81.25%). The proposed minimally invasive approach may have potential to enhance flap blood supply and graft vascularization, promoting rapid healing with minimal postoperative discomfort. In addition, this approach can result in satisfactory clinical, esthetic, and patient-reported outcomes. Future adequately powered clinical trials are needed to validate the findings of this preliminary report.

Peri-implant soft-tissue esthetic outcome after immediate implant placement in conjunction with xenogeneic acellular dermal matrix or connective tissue graft: A randomized controlled clinical study.

This randomized comparative study evaluated the clinical esthetic outcome of the peri-implant mucosa following extraction and immediate implant placement in conjunction with anorganic bovine bone mineral (ABBM) and the use of a porcine acellular dermal matrix (pADM) versus an autogenous connective tissue graft (CTG) in the anterior maxilla. Twenty patients (11 men, 9 women) with a mean age of 48,9 years (range 21-72) were included in the study and randomly assigned to either the test (pADM) or control group (CTG). They underwent extraction and immediate implant placement together with ABBM for socket grafting and either pADM or CTG for soft tissue augmentation. Twelve months after implant placement color measurements of the peri-implant mucosa and a reference tooth were performed using a spectophotometer and the color difference (ΔE) was calculated. The overall esthetic appearance of the peri-implant soft tissue was evaluated using the Pink Esthetic Score (PES). Statistical analysis was performed using Student's T-Test, the alpha was set to 0.05. All implants received osseointegration and were restored. The mean color difference of the peri-implant mucosa 1year after surgery amounted ΔE 4.06 ± 1.6 for the test group (pADM) and ΔE 3.58 ± 1.36 mm for the control group (CTG), showing no statistically significant difference (p=0.47). The mean PES of the pADM group was 11.4 ± 1.4 and for the CTG group 10.7 ± 1.5, showing no statistically significant difference (p=0.29). Twelve months after surgery, a porcine acellular dermal matrix for soft tissue augmentation in conjunction with immediate implant placement showed no difference in the overall esthetic appearance regarding color match and Pink Esthetic Score in comparison to autogenous soft tissue graft. Connective tissue grafts have become a standard in order to enhance the soft tissue quality and esthetic appearance in immediate implant placement. The use of new biomaterials like porcine acellular dermal matrices may avoid the need to harvest autogenous grafts resulting in simplified treatment and less postoperative morbidity.

Efficacy of a harvest graft substitute for recession coverage and soft tissue volume augmentation: A randomized controlled trial.

The autogenous connective tissue graft (CTG) with coronally advanced flap (CTG+CAF) is the "gold standard" for recession defect coverage; however, researchers continue to pursue lower morbidity, more convenient and unlimited supply harvest graft substitutes, including those that could provide soft tissue volume augmentation. A randomized, controlled, double-masked comparison of a volume-stable collagen matrix (VCMX) versus CTG was conducted at four clinical investigation sites. Single, contralateral, within patient matched-pair, RT1 recession defects were treated with VCMX+CAF (test) and CTG+CAF (control). The primary efficacy end point was percent root coverage at 6 months. Secondary efficacy end points included clinical measures such as soft tissue volume, attachment level, and keratinized tissue width. Patient-reported outcomes included measures such as discomfort, esthetics, and overall satisfaction; 6-month end point results were followed for 1 year. Thirty patients received control and test therapies, and all patients were available for follow-up measures. Average percent root coverage for CTG+CAF was 90.5% ± 14.87%versus 70.7% ± 28.26% for VCMX+CAF, P<0.0001. Both therapies produced significant soft tissue volume increases (84.8 ± 47.43 mm3 control versus 48.90 ± 35.58 mm3 test, P=0.0006). The test, harvest graft substitute produced less postoperative pain and was preferred by patients at the 6-month end point. All other end point measures were not significantly different. VCMX+CAF root coverage was inferior to CTG+CAF but produced less morbidity and was preferred by patients. Case/patient selection and surgical technique appear key to achieving successful results with the harvest graft alternative.

Immediate implant placement in fresh alveolar sockets with a minimal split-thickness envelope flap: A randomised controlled clinical trial.

Comparing PES/WES scores, modified success rate, survival, success, buccal bone thickness and patient-reported outcomes of immediate dental implants placed in fresh alveolar sockets using a flap or a minimal split-thickness envelope flap (MSTEF). Implants following random assignment into a flap or MSTEF group were placed immediately in anterior and premolar areas. Guided bone regeneration and autogenous connective tissue graft were used in all cases. A temporary prosthesis was provided followed by the final prosthesis at 16-18weeks. Success and survival rates together with radiographic buccal bone thickness and patient satisfaction were evaluated at 12-month post-loading. The aesthetic outcome was evaluated through the Pink (PES) and White (WES) Aesthetic Score by 8 blind clinicians of different training background and incorporated in modified success criteria. 28 implants were placed on 28 patients. No statistically significant differences were noted in PES (10.54 control versus 10.80 test), WES scores (6.97 control versus 6.95 test) or success criteria including aesthetic parameters (modified success criteria) for the different specialty groups (Range 69%-92%). In addition, no statistically significant differences were noted in survival (100%), success (100%), buccal wall thickness between control (0.72±0.22) and test group (0.92±0.31) and patients' reported outcomes. Immediate dental implant treatment with flap/ MSTEF provided similar mean PES/WES scores, modified success rate, survival, mean buccal bone levels and patients' satisfaction. However, aesthetic failures were common in both groups.

The Ball Technique for Peri-implant Soft Tissue Augmentation Using a Xenogeneic Collagen Matrix: A Technical Report.

In the maxillary anterior region, augmentation to correct a soft tissue deficiency is often required for an esthetic outcome and long-term implant therapy success. This case series of three patients presents a novel approach for soft tissue augmentation using xenogeneic collagen matrix balls in the esthetic zone around the implants. This technique avoids a secondary donor site compared to autogenous connective tissue graft. With this technique, a horizontal soft tissue volume increase (range: 3 to 5 mm) was observed postsurgically and maintained at later follow-ups. The described ball technique offers a viable method for peri-implant mucosal augmentation in the maxillary anterior region.

Collagen Matrix vs. Autogenous Connective Tissue Graft for Soft Tissue Augmentation: A Systematic Review and Meta-Analysis.

Soft tissues have been shown to be critical for the maintenance of both teeth and implants. Currently, regenerative soft tissue techniques propose the use of collagen matrices, which can avoid the drawbacks derived from the obtainment of autogenous tissue graft. A systematic review and meta-analysis were conducted to ascertain the efficacy of collagen matrices (CM) compared to autogenous connective tissue graft (CTG) to improve soft tissue dimensions. An electronic and manual literature searches were performed to identify randomized clinical trials (RCT) or controlled clinical trials (CCT) that compared CTG and CM. Pooled data of width of keratinized tissue (KT) and mucosal thickness (MT) were collected and weighted means were calculated. Heterogeneity was determined using Higgins (I2). If I2 > 50% a random-effects model was applied. Nineteen studies were included based on the eligibility criteria. When using CTG a higher MT gain (0.32 mm, ranging from 0.49 to 0.16 mm) was obtained than when employing CM. Similar result was obtained for the width of KT gain, that was 0.46 mm higher (ranging from 0.89 to 0.02 mm) when employing CTG. However, it can be stated that, although autogenous CTG achieves higher values, CM are an effective alternative in terms of total width of KT and MT gain.

The influence of soft-tissue volume grafting on the maintenance of peri-implant tissue health and stability

BackgroundTo investigate the influence of soft-tissue volume grafting employing autogenous connective tissue graft (CTG) simultaneous to implant placement on peri-implant tissue health and stability.Material and methodsThis cross-sectional observational study enrolled 19 patients (n = 29 implants) having dental implants placed with simultaneous soft-tissue volume grafting using CTG (test), and 36 selected controls (n = 55 implants) matched for age and years in function, who underwent conventional implant therapy (i.e., without soft-tissue volume grafting). Clinical outcomes (i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mucosal recession (MR)) and frequency of peri-implant diseases were evaluated in both groups after a mean follow-up period of 6.15 ± 4.63 years.ResultsSignificant differences between test and control groups at the patient level were noted for median BOP (0.0 vs. 25.0%; p = 0.023) and PD scores (2.33 vs. 2.83 mm; p = 0.001), respectively. The prevalence of peri-implant mucositis and peri-implantitis amounted to 42.1% and 5.3% in the test and to 52.8% and 13.9% in the control group, respectively.ConclusionSimultaneous soft-tissue grafting using CTG had a beneficial effect on the maintenance of peri-implant health.

Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants

Dental implant placement is a predictable therapy for replacing teeth. Nevertheless, mechanical, biological, and aesthetic complications frequently occur. The aim of this study was to compare the clinical outcomes of a xenogeneic collagen matrix (XCM) used at the time of implant placement as an alternative to a subepithelial connective tissue graft (SCTG), for soft tissue augmentation. This was a prospective clinical trial with 12 months of follow-up. In the control group, soft tissue augmentation at the time of implant placement was performed with a SCTG, while in the test group, a XCM was employed. At 12 months postoperative, all xenografts showed no postoperative complications. In both groups, a significantly greater thickness was observed on the buccal and occlusal sides from preoperative to 3 months postoperative (P<0.05). No statistically significant difference in pink aesthetic score (P=0.379, 6 months postoperative) or marginal bone loss (P=0.449 at 3 months postoperative, P=0.778 at 6 months postoperative) was observed between the groups. Statistically significant differences in pain perceived by the patients (P<0.0001) and the time to complete the surgical procedure (P=0.0008) were detected. At 12 months after surgery, XCM provided similar clinical results in terms of soft tissue augmentation on the buccal and occlusal sides as compared with the SCTG.

Clinical and volumetric analysis of peri-implant soft tissue augmentation using an acellular dermal matrix: A prospective cohort study.

The role of keratinized mucosa in promoting peri-implant health is controversial, however recent evidence support the use of soft tissue augmentation procedures around dental implants. Soft tissue substitutes have been proposed to replace autogenous connective tissue grafts, therefore the aims of this study are to report clinical and volumetric three-dimensional changes in mucosal thickness (MT) 1 year after treatment with an acellular dermal matrix (ADM). Soft tissue augmentation was performed at second-stage surgery in the premolar maxillary area with an ADM. MT was assessed prior to implant placement and 1, 6, and 12 months after treatment. Digital linear and volumetric measurements were recorded at baseline and after 1 and 12 months. Furthermore, clinical parameters (Probing Pocket Depths, Bleeding On Probing, Plaque Index) and marginal bone loss were also recorded. Esthetic outcomes of treatment were evaluated objectively using the Pink Esthetic Score and through patient reported outcomes. Twelve patients were enrolled in this prospective study. Post-hoc analysis of the assessments with Tukey's honestly significant difference adjustment revealed that the MT had increased significantly from baseline to 1 month (P < 0.001), 6 months (P < 0.001) and 12 months (P < 0.001), and remained stable between 6 months and 12 months (P > 0.05). Based on the volumetric evaluation, a shrinkage of 23.31% occurred from 1 month to 12 months (P > 0.05). A significant increase in MT was reported after 1 year, with a mean gain of 1.25 mm. Soft tissues were stable, with no statistically significant differences between 6 months and 1 year.