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

Abstract

Objective: The 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.

Data: All 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.

Source: A 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 Unpublished researches, the gray literature, nonprofit reports, government studies and other materials were reviewed electronically using an EASY search.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 selection: Of 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 significance: Previous 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.

Keywords: Collagen matrix; Connective tissue graft; Dental implant; Soft tissue; Soft tissue augmentation; Subepithelial connective tissue graft; Systematic review; Thickness increasing.

Fig. 1

PRISMA flow diagram of study search process

Fig. 2

Risk of Bias assessment

Fig. 3

Forest plot analysis of pooled mean of 3-month gain in soft tissue thickness of CTG (control) group, random effect model meta-analysis (subgroup by position), significance at p < 0.05

Fig. 4

Forest plot analysis of pooled mean of 3-month gain in soft tissue thickness of XCM (experimental) group, random effect model meta-analysis (subgroup by position), significance at p < 0.05

Fig. 5

Forest plot analysis of MD of 3-month gain in soft tissue thickness of CTG (control) and XCM (experimental) groups, random effect model meta-analysis (subgroup by position), significance at p <0.05

Fig. 6

Forest plot analysis of pooled mean of 3-month gain in soft tissue thickness of CTG (control) group, random effect model meta-analysis (subgroup by methodology), significance at p < 0.05

Fig. 7

Forest plot analysis of pooled mean of 3-month gain in soft tissue thickness of XCM (experimental) group, random effect model meta-analysis (subgroup by methodology), significance at p < 0.05

Fig. 8

Forest plot analysis of MD of 3-month gain in soft tissue thickness of CTG (control) and XCM (experimental) groups, random effect model meta-analysis (subgroup by methodology), significance at p < 0.05

Fig. 9

Funnel plot of SMD of 3-month gain in soft tissue thickness of CTG (control) and XCM (experimental) groups versus SE