Patient‐reported outcome measures following soft‐tissue grafting at implant sites: A systematic review

Abstract

Objectives To review the available literature on patient‐reported outcome measures (PROMs) following soft tissue augmentation at implant sites. Materials and Methods A comprehensive electronic and manual search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported PROMs, including post‐operative morbidity, painkillers intake, quality of life, aesthetics and satisfactions. Results Nineteen articles were included in the qualitative analysis. Autogenous grafts (free gingival graft and connective tissue graft), acellular dermal matrix and xenogeneic collagen matrix were utilized, either with a bilaminar‐ or an apically positioned flap approach. PROMs reported in the literature included perceived hardship of the procedure and pain during the surgery, post‐operative morbidity, painkillers intake, number of days with discomfort, satisfaction, aesthetic evaluation, quality of life and willingness to undergo the treatment again. Most of the included studies showed similar PROMs between autogenous grafts and substitutes, in terms of post‐operative morbidity, painkillers intake, quality of life, aesthetic assessment and satisfaction. Nevertheless, a trend towards lower post‐operative discomfort was observed for graft substitutes. High scores for patient satisfaction and aesthetic evaluation were observed in all the interventions compared to non‐grafted sites. Conclusions PROMs represent a crucial endpoint of clinical studies evaluating the outcomes of soft tissue grafts at implant sites. Most of the studies did not find significant differences in terms of patient morbidity and painkillers between autogenous grafts and substitutes. Soft tissue grafting can enhance patient satisfaction and aesthetic evaluation compared to non‐grafted sites.

A multi‐centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buccal aspect of single implants: 1‐year results

“…Minor buccal bone defects result in soft tissue concavities, which can be effectively treated by means of soft tissue augmentation (Cairo et al, 2019; Raghoebar et al, 2021; Tavelli et al, 2021; Thoma et al, 2021). The outcome of soft tissue augmentation is clinically relevant because thicker tissues support peri‐implant health (Thoma et al, 2018; Tavelli et al, 2021) and result in higher patient satisfaction and superior aesthetics (Stefanini et al, 2021). Soft tissue augmentation also seems to favour soft tissue stability in the vertical dimension, regardless of the timing of implant placement (Raghoebar et al, 2021; Seyssens et al, 2021).…”

“…In order to overcome these limitations, xenogeneic collagen matrices have been developed (Thoma et al, 2012(Thoma et al, , 2014Rothamel et al, 2014). However, most of the studies included in a recent systematic review showed similar patient-reported outcomes between autogenous grafts and substitutes (Stefanini et al, 2021;Thoma et al, 2021).…”

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).…”

Clinical applications of mucogingival therapies utilizing adjunctive autologous blood products

“…22 Use of autologous graft materials has been associated with increased patientreported pain when compared to the use of allografts and/or xenografts. 22,23 Additionally, the method of harvest of autologous grafts has been associated with changes in postoperative patient pain perception. 24 The perception of postoperative discomfort may have a significant impact on future treatment acceptance, with willingness to retreat gingival grafting sites negatively associated with intraoral treatment areas, size of treated sites, and patientreported postoperative pain.…”

“…In addition to clinical outcomes, it is important to assess patient satisfaction and patient‐reported outcomes measures, such as postoperative pain, swelling, bleeding, and overall assessment of healing 22 . Use of autologous graft materials has been associated with increased patient‐reported pain when compared to the use of allografts and/or xenografts 22,23 . Additionally, the method of harvest of autologous grafts has been associated with changes in postoperative patient pain perception 24 .…”