Influence of soft tissue augmentation procedures around dental implants on marginal bone level changes—A systematic review

Abstract

Objectives This systematic review assessed the influence of soft tissue augmentation procedures on marginal bone level changes in partial or fully edentulous patients. Material and Methods We identified three relevant PICO questions related to soft tissue augmentation procedures and conducted a systematic search of four major electronic databases for clinical studies in systemically healthy patients receiving at least one dental implant and a minimum follow‐up of one year after implant placement. The primary outcome was mean difference in marginal bone levels, and secondary outcomes were clinical and patient‐related outcomes such as thickness of peri‐implant mucosa, bleeding indices, and Pink Esthetic Score. Results We identified 20 publications reporting on 16 relevant comparisons. Studies varied considerably and thus only two meta‐analyses could be performed. This systematic review showed that: Soft tissue augmentation either for augmentation of keratinized mucosa or soft tissue volume inconsistently had an effect on marginal bone level changes when compared to no soft tissue augmentation, but consistently improved secondary outcomes. The combination soft and hard tissue augmentation showed no statistically significant difference in terms of marginal bone level changes when compared to hard tissue augmentation alone, but resulted in less marginal soft tissue recession as shown by a meta‐analysis. Soft or hard tissue augmentation performed as contour augmentations resulted in comparable marginal bone level changes. Conclusions Peri‐implant soft and hard tissues seem to have a bidirectional relationship: “Bone stands hard, but soft tissue is the guard”.

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

“…Recently, Stefan, et al conducted a systematic review and they reported that soft tissue augmentation is beneficial regarding width of keratinized mucosa and midfacial recession and showed no influence regarding peri implant MBL [ 21 ]. Similarly, Angelis et al found that SCTG improve peri implant soft tissue thickness and alleviate soft tissue recession and marginal bone loss when placed simultaneously with IIP protocol [ 22 ].…”

Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping

“…For type 4 implant placement, STA could better preserve the mid‐facial soft tissue thickness (Raghoebar et al, 2021). However, STA had a limited effect on the interproximal bone level (Fickl et al, 2021) and patient‐reported outcome measures (Stefanini et al, 2021). In the future, studies investigating STA for implants in aesthetic areas should (1) develop validated and reliable sets of clinical outcome measures to comprehensively evaluate the clinical, aesthetic and patient‐reported outcomes of STA; (2) focus on the improvement of grafting materials and surgical techniques, to reduce or avoid the morbidity associated with harvesting autogenous connective tissue (Thoma et al, 2021) and (3) emphasize the diagnosis and prevention of the risk factors for aesthetic failures (Thoma et al, 2022).…”

“…For type 4 implant placement, STA could better preserve the mid-facial soft tissue thickness (Raghoebar et al, 2021). However, STA had a limited effect on the interproximal bone level (Fickl et al, 2021) and patientreported outcome measures (Stefanini et al, 2021) (Thoma et al, 2022).…”

A Case Report of Dental Implants and Site Augmentation in a Patient with Erosive Lichen Planus

“…Following a dental extraction, the alveolar ridge can undergo up to 50% dimensional changes within 12 months [ 6 ]. Even with ridge preservation techniques, the alveolar ridge cannot be preserved entirely [ 7 , 8 ]. Additional hard and soft tissue augmentations around the implant can aid in maintaining stable alveolar bone and provide healthier peri-implant tissues [ 9 ].…”