Patient-reported outcome measures and clinical outcomes following peri-implant vestibuloplasty with a free gingival graft versus xenogeneic collagen matrix: a comparative prospective clinical study

Abstract

Background The objective of this study was to compare patient-reported outcome measures (PROMs) and clinical outcomes after augmentation with xenogeneic collagen matrix (XCM) or free gingival graft (FGG) during different postoperative phases. Methods Forty-two patients (21 per group) with keratinized mucosa width (KMW) of < 2 mm at buccal implant sites in the posterior mandible were enrolled. All underwent vestibuloplasty and were allocated to either FGG (control) or XCM (test) group. Intraoperative morbidity of pain, stress, nausea, tolerance to time, and acceptance of surgery were evaluated immediately after surgery. The severity and duration of subjective pain, swelling, and bleeding were compared within a 2-week postoperative period. The willingness to retreat and satisfaction were assessed at 6 months. All PROMs were obtained using questionnaires and visual analog scales. The buccal KMW and other peri-implant parameters were also evaluated. Results No significant between-group differences were observed in PROMs immediately after surgery, except acceptance of surgery (0, 0–30.0 vs. 30, 0–50.0, p = 0.025). At 2 weeks, pain severity (46.7 ± 25.9 vs 61.9 ± 20.2, p = 0.040) and duration (5.52 ± 3.57 vs 8.48 ± 2.80, p = 0.005) were significantly lower in the test group, and pain perception during speaking and chewing was significantly higher for FGG, with no significant between-group differences in swelling and bleeding. At 6 months, the test group showed a higher willingness to retreat (76% vs 43%, p = 0.021); however, satisfaction with treatment outcomes was similar in both groups. At 6 months, the gain of KMW was significantly higher in FGG than in XCM (XCM: 1.57 ± 1.69 mm, FGG: 2.68 ± 1.80 mm, p = 0.003). Other peri-implant parameters did not show significant differences. Conclusions Within the limitation of the present nonrandomized study, XCM demonstrated more positive PROMs than FGG during different postoperative phases, mainly for less pain perception during the early healing stage, but was inferior to FGG in terms of gain of KMW. For KMW augmentation in the posterior mandible, XCM may be indicated when patients can bear little pain. Clinical trial registration ChiCTR1900022575, date of registration: 17/4/2019, retrospectively registered,

Bone regeneration as treatment of peri‐implant disease: A narrative review

“…From the patient's point of view, the burden (pain and duration) of an APF in combination with a CM was significantly lower compared to a FGG at 2‐weeks postoperatively 90 . At 6 months the increase in KMW was significantly higher in the FGG group, but CM group showed a higher willingness for another retreatment.…”

Effectiveness of keratinized mucosa augmentation procedures around dental implants based on risk assessment: a 5-year retrospective cohort study

“…Lee et al determined surgical techniques based on the KMW baseline (>3 mm APF alone; 2-3 mm APF plus CM; APF plus FGG) [47]. Zhang et al also suggested surgical techniques selection according to the residual KMW (<=0.5mm APF plus FGG; >0.5 mm APF plus FGG or CM) [42]. Schmitt et al reported in their study the decision on joining the CM or FGG group was left to the patient after a detailed explanation about upcoming surgery, autologous soft tissue grafting, and the used collagen matrix [25].…”

“…Huang et al showed that FGG (gain 4.1 mm) could result in greater increase of KMW than CM (gain 1.7 mm), though both could increase KMW, maintain peri-implant health, and attain comparable aesthetic outcomes [41]. Fu et al reported at 6 months, the KMW was signi cantly higher with FGG (3.74 mm at 6 months) than with CM (2.82 mm at 6 months) in the posterior mandible [42]. Shrinkage of KM was reported on KM augmentation techniques.…”

Patient‐reported outcomes for bone regenerative procedures

“…A characteristic of comparative GBR studies including PROMs is a low prevalence of post‐surgical complications, and therefore the studies do not have enough power to find differences in treatment modalities 27 . On the other hand, several studies find improvements in PROMs over time for the patients 28–31 . One reason for that may be recall bias or acquiescence bias, which is the tendency to give positive responses to questions to satisfy the “nice” dentist, and a challenge of recalling the memory of the situation before treatment 8,32 …”

“…27 On the other hand, several studies find improvements in PROMs over time for the patients. [28][29][30][31] One reason for that may be recall bias or acquiescence bias, which is the tendency to give positive responses to questions to satisfy the "nice" dentist, and a challenge of recalling the memory of the situation before treatment. 8,32 In GBR studies, the alveolar bone ridge is frequently too narrow for having complete marginal bone surrounding the dental implants.…”