Systematic Review
Evaluation of the efficacy of keratinized mucosa augmentation techniques around dental implants: A systematic review

https://doi.org/10.1016/j.prosdent.2014.10.001Get rights and content

Abstract

Statement of problem

The absence of periimplant keratinized mucosa is considered risky in patients with a predisposition to periodontitis or recession. Although various soft tissue augmentation techniques exist, dentists are seeking for more efficient approaches to augment periimplant keratinized mucosa.

Purpose

The purpose of this systematic review was to evaluate the efficacy of the various techniques and biomaterials adopted in periimplant keratinized mucosa augmentation and whether one technique or biomaterial is superior.

Material and methods

A search in Medline-PubMed and the Cochrane Central Register of controlled trials was conducted. Randomized clinical trials, prospective cohort studies, clinical control studies, and case series from January 1, 1980, to December 31, 2013, with a follow-up of at least 6 months reporting changes on keratinized mucosa width were included. Several journals were hand-searched for related articles. The bibliographies of all publications selected for inclusion were also scanned.

Results

The screening of titles and abstracts resulted in 60 relevant publications. Six of them were finally included. Free gingival graft, connective tissue graft, acellular dermal matrix, and collagen matrix were used for keratinized mucosa augmentation. Because of heterogeneity of the studies, only descriptive analysis was performed. Improvements in keratinized mucosa width were reported in all studies.

Conclusions

A definitive conclusion could not be achieved owing to the lack of well-designed studies and appropriate methods of studying soft tissue. The establishment of universal surgical guidelines and measurement systems is imperative in the future.

Section snippets

Material and Methods

The focused question was, “What are the effects of various techniques and biomaterials on periimplant KM augmentation in terms of KMW and periimplant tissue health?”

The National Library of Medicine (Medline via PubMed) and the Cochrane Central Register of Controlled Trials were searched for relevant articles published between January 1, 1980, and December 31, 2013. The search, limited to human subjects, was designed to include any evidence associated with soft tissue manipulations around dental

Results

The search strategy resulted in 737 articles. After initial screening, 60 potentially relevant articles were identified. After going through the full texts, only 6 studies were selected. Hand-searching or cross-referencing did not result in any additional articles. Therefore, 6 studies were finally included (Fig. 1).

The details of included studies are shown in Table 2. Only 2 were RCTs, both presenting parallel design, one with 4 study groups and a 1- to 9-year follow-up (Study 1) and the other

Discussion

Various techniques and materials have been proposed to augment periimplant KM. The lack of clinical studies impeded the evaluation of these procedures and materials. In the present review, a comprehensive search was conducted. The results of the combined procedure (immediate implant+CTG) showed improved KMW. Immediate implant placement offered many advantages over conventional treatment.65 However, esthetic risks existed in this treatment option because of postextraction dimensional tissue

Conclusions

Although all included studies reported satisfactory results regarding KMW increase by using CTG, ADM, or CM, definitive answers could not be provided to the questions posed initially because of the scarcity of eligible articles, especially well-designed RCTs. Investigators should perfect their study designs and choose valid parameters and unified methods of measurement.

Acknowledgments

The authors are thankful for the valuable suggestions from Hans Peter Weber and Hamasat Gheddaf Dam during the initiation of the study; and we appreciate the critical review provided by Shrestha Rachana, West China School of Stomatology.

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    Supported by National Key Clinical Speciality on Oral Implantology, National Science Foundation (81101347) and an ITI small grant (2009660).

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