Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Mar 6;17(5):1221.
doi: 10.3390/ma17051221.

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review

Roberto Rotundo  1 , Gian Luca Pancrazi  2 , Alessia Grassi  2 , Lara Ceresoli  2 , Giovanna Laura Di Domenico  2 , Vanessa Bonafede  1
Affiliations
Review

Soft Tissue Substitutes in Periodontal and Peri-Implant Soft Tissue Augmentation: A Systematic Review

Roberto Rotundo et al. Materials (Basel). .

Abstract

Background: Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants.

Methods: Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included.

Results: Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width.

Conclusions: Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Keywords: biomaterials; connective tissue graft; dental implants; free gingival graft; gingival recession; keratinized tissue; soft tissue substitutes.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart diagram of selected studies. For each soft tissue substitute (STS), the related number of systematic reviews (SR) and randomized controlled trials (RCT) are reported. ADM: allogeneic dermal matrix; CAF: coronally advanced flap; CTG: connective tissue graft; FGG: free gingival graft; TUN: tunnel technique; XDM: xenogeneic dermal matrix; CMX: xenogeneic collagen matrix; VCMX: volume-stable collagen matrix.
See this image and copyright information in PMC

References

    1. Björn H. Coverage of denuded root surfaces with a lateral sliding flap. Use of free gingival grafts. Odontol. Revy. 1971;22:37–44. - PubMed
    1. Sullivan H.C., Atkins J.H. Free autogenous gingival grafts. I. Principles of successful grafting. Periodontics. 1968;6:121–129. - PubMed
    1. Miller P.D., Jr. Root coverage using the free soft tissue autograft following citric acid application. III. A successful and predictable procedure in areas of deep-wide recession. Int. J. Periodontics Restor. Dent. 1985;5:14–37. - PubMed
    1. Chambrone L., Salinas Ortega M.A., Sukekava F., Rotundo R., Kalemaj Z., Buti J., Pini Prato G.P. Root coverage procedures for treating localised and multiple recession-type defects. Cochrane Database Syst. Rev. 2018;10:CD007161. doi: 10.1002/14651858.CD007161.pub3. - DOI - PMC - PubMed
    1. Stefanini M., Barootchi S., Sangiorgi M., Pispero A., Grusovin M.G., Mancini L., Zucchelli G., Tavelli L. Do soft tissue augmentation techniques provide stable and favorable peri-implant conditions in the medium and long term? A systematic review. Clin. Oral. Implants Res. 2023;34((Suppl. S26)):28–42. doi: 10.1111/clr.14150. - DOI - PubMed

LinkOut - more resources