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. 2016 Sep;20(7):1369-87.
doi: 10.1007/s00784-016-1815-2. Epub 2016 Apr 4.

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

Renzo G Bassetti  1 , Alexandra Stähli  2 , Mario A Bassetti  2 , Anton Sculean  2
Affiliations
Free article

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

Renzo G Bassetti et al. Clin Oral Investig. 2016 Sep.
Free article

Abstract

Objectives: 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.

Results: 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.

Conclusions: 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.

Keywords: Peri-implant keratinized mucosa; Peri-implant soft tissue volume; Re-entry; Second-stage surgery.

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