Does simultaneous soft tissue augmentation around immediate or delayed dental implant placement using sub-epithelial connective tissue graft provide better outcomes compared to other treatment options? A systematic review and meta-analysis

Abstract

Objective The clinical benefits of simultaneous implant placement and soft tissue augmentation using different treatment modalities are unclear. The current meta-analysis aimed to compare the effect of simultaneous soft tissue augmentation using subepithelial connective tissue graft (SCTG) around immediate or delayed dental implant placement with other treatment modalities on the peri-implant tissue health and esthetic. Methods Up to May 2021, four databases (PubMed, EMBASE, Cochrane Central, and Google Scholar) were searched. Randomized control trials with follow-up >3 months, evaluating simultaneous implant placement (immediate or delayed) and soft tissue augmentation using SCTG compared with other treatment modalities were included. The predictor variables were SCTG versus no augmentation with/without guided bone regeneration (GBR) or other augmentation techniques (Acellular dermal matrix (ADM), Xenogeneic collagen matrix (XCM). The outcome variables were buccal tissue thickness (BTT), mid-buccal gingival level (MGL), marginal bone loss (MBL), and pink esthetic scores (PES). Cumulative mean differences (MD) and 95% confidence interval (CI) were estimated. Results Twelve studies were included. SCTG along with immediate implant placement (IIP) or delayed implant placement (DIP) showed a statistically significant improvement in BTT (Fixed; MD, 0.74; 95% CI, 0.51; 0.97), MGL (Fixed; MD, 0.5; 95% CI, 0.21; 0.80), PES (Fixed; MD, 0.79; 95% CI, 0.29; 1.29), and less MBL (Fixed; MD, -0.11; 95% CI, -0.14; -0.08) compared to no graft (P<0.05). A statistically insignificant differences in BTT (Random; MD, 0.62; 95% CI, -0.41; 1.65), MGL (Fixed; MD, -0.06; 95% CI, -0.23; 0.11), MBL (Fixed; MD, 0.36; 95% CI, -0.05; 0.77) and PES (Fixed; MD, 0.28; 95% CI, -0.10; 0.67) was observed when SCTG along with DIP was compared with no augmentation plus GBR. Similarly, no statistically significant difference was observed when comparing SCTG along with DIP with acellular dermal matrix (ADM) concerning BTT (MD:0.71, P = 0.18) and KMW (MD: 0.6, P = 0.19). Conclusion There is a very low quality of evidence to provide recommendations on whether simultaneous dental implant placement (IIP or DIP) and soft tissue augmentation using SCTG is superior to no augmentation or is comparable to the other tissue augmentation materials in improving the quality and quantity of peri-implant tissues. Therefore, further, well-designed RCTs with larger sample sizes and long follow-up times are still needed.

Soft tissue esthetics around immediately provisionalized delayed implants with and without connective tissue graft: A randomized clinical trial pilot study

“…36,37 Regarding the change in mucosal thickness from baseline after 12 months, the SCTGG showed a statistically significant increase of 1.5 (0.4) mm. This is in line with the findings reported by Aldhohrah and colleagues 15 who observed an average gain in BTT, over 12 months, of 1.3 mm with SCTG in delayed implant placement. More interestingly, the NGG from baseline showed a 0.4 (0.2) mm gain in BTT which could be attributed to the design of the immediate provisional restoration that led to the formation of a space between the implant restoration and the peri-implant mucosal tissues that was filled with a clot in the subcritical contour contributing to soft tissue thickening.…”

“…23,24 Nevertheless, there is a paucity of studies on immediate provisionalization and its effect on the esthetics around delayed implants. 14 Moreover, in a recent systematic review, 15 T A B L E 4 Buccal peri-implant soft tissue thickness (mm) in both groups at baseline (TP), after 6 (T1), and 12 months (T2) concluded that there is still a lack of clear evidence regarding the benefits of SCTG around delayed implants from a clinical and esthetic point of view. Hence, the aim of the current study was to assess whether immediate provisionalization without soft tissue augmentation could lead to a comparable peri-implant soft tissue esthetic score when compared to soft tissue augmentation combined with immediate provisionalization.…”

“…13 However, the extent of the effect of a provisional temporary crown on the stability and the esthetics of the peri-implant tissues remains poorly understood. 14 In a recently published systematic review by Aldhohrah and colleagues, 15 it was concluded that the evidence available on whether implant placement with concomitant soft tissue augmentation using SCTG is superior to no augmentation in improving the quality and quantity of peri-implant tissues is of very low quality to provide recommendations. Therefore, there is a need for clinical studies on soft tissue augmentation around dental implants that aim to establish periimplant health and optimum esthetics.…”

Clinical efficacy of soft‐tissue augmentation on tissue preservation at immediate implant sites: A randomized controlled trial

“…Bone grafting has compensated for soft‐ and hard‐tissue collapse (Mao et al, 2021; Tarnow et al, 2014). However, the benefits of using autologous tissue grafts or alternative materials, such as a collagen matrix or acellular dermal matrix (ADM), combined with immediate implantation are equivocal (Aldhohrah et al, 2022; Jung et al, 2022). A thick mucosal phenotype is associated with more stable peri‐implant bone levels and dimensions than a thin mucosal phenotype, as demonstrated in several preclinical (Berglundh & Lindhe, 1996) and clinical studies (Linkevicius et al, 2009; Vervaeke et al, 2016).…”

Immediate versus Delayed Implantation for Single-Tooth Restoration of Maxillary Anterior Teeth: A Comparative Analysis on Efficacy

“…In the past, delayed implantation (DI) was mostly used; that is, implantation was accomplished 3 to 6 months after tooth extraction when the tooth extraction site was completely healed and the bone reconstruction was basically stable, so that the implant could form bony union after implantation with favorable safety [ 2 ]. However, this implant procedure will result in a protracted period of tooth loss, as well as keratinization of the gums and insufficient bone mass in the edentulous area due to alveolar bone absorption following tooth extraction, which will impact the aesthetic effect of implant repair [ 3 , 4 ]. With the advances in stomatology, immediate implantation (II) technology has attracted the attention of stomatologists at home and abroad, as it not only shortens the number of surgical interventions and simplifies the treatment procedures but also preserves the soft tissue capsule to achieve the best soft tissue aesthetics [ 5 , 6 ].…”