Top

Published in:

Open Access 01-12-2023 | Research

Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis

Authors: Igor Ashurko, Svetlana Tarasenko, Mary Magdalyanova, Svetlana Bokareva, Maxim Balyasin, Anna Galyas, Marina Khamidova, Mariia Zhornik, Alexey Unkovskiy

Published in: BMC Oral Health | Issue 1/2023

Abstract

Objective

The gold standard for a soft tissue augmentation around implants is a subepithelial connective tissue graft (CTG), but the xenogeneic collagen matrices (XCM) started to be used as an alternative. This systematic review aimed to assess the effectiveness XCM in comparison to CTG for the increasing the thickness of the soft tissue around implants.

Data

All studies included at least two parallel groups comparing the use of CTG and XCM with a minimum follow-up of 3 months. As the primary outcome, the amount of soft tissue thickness gain after soft tissue augmentation with XCM or CTG was assessed. Secondary outcomes were clinical and patient-related outcomes; evaluation of aesthetic outcomes, patient-reported outcomes measures (PROMs) and complications. Eligible studies were selected based on the inclusion criteria. Meta-analysis was applied whenever possible. The quality of the evidence of studies including in meta-analysis was assessed using the GRADE approach.

Source

A systematic literature search up to January 2022 was conducted using the following electronic databases: PubMed (MEDLINE), Scopus, Cochrane Library, LILACS, eLIBRARY.RU. Unpublished researches, the gray literature, nonprofit reports, government studies and other materials were reviewed electronically using an EASY search. An additional manual search was carried out in November 2022.

Study selection

Of the 1376 articles from the initial search, 8 randomized controlled trials (RCTs) (306 patients and 325 implants) were included in this systematic review, and 7 studies were part of the meta-analysis. Meta-analysis revealed that XCM is less effective than the CTG in increasing soft tissue thickness around dental implants. However, XCM also provides soft tissue thickness gain and can be recommended for use in various clinical situations.

Clinical significance

Previous systematic reviews and meta-analyses have shown that autologous grafts are more effective than collagen matrices in increasing soft tissue thickness, however, the latter can be used as an alternative. Studies included in previous systematic reviews varied in design, which could lead to limitations. The present systematic review and meta-analysis includes for the first time only randomized controlled clinical trials with collagen matrix of xenogeneic origin in the test group. Tight eligibility criteria were established, and the main parameter studied was soft tissue thickness. It was found that xenogeneic collagen matrix is effective for increasing soft tissue thickness around dental implants, however, the results obtained using an autogenous connective tissue graft are superior.

Moraschini V, Poubel LA, Ferreira VF, et al. Evaluation of survival and success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: A systematic review. Int J Oral Maxillofac Surg. 2015;44:377–88. https://doi.org/10.1016/j.ijom.2014.10.023.CrossRefPubMed

Thoma DS, Naenni N, Figuero E, et al. Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis. Clin Oral Implants Res. 2018;29:32–49. https://doi.org/10.1111/clr.13114.CrossRefPubMed

Steigenga JT, Al-Shammari KF, Nociti FH, et al. Dental implant design and its relationship to long-term implant success. Implant Dent. 2003;12:306–17. https://doi.org/10.1097/01.ID.0000091140.76130.A1.CrossRefPubMed

Moraschini V, Luz D, Velloso G, et al. Quality assessment of systematic reviews of the significance of keratinized mucosa on implant health. Int J Oral Maxillofac Surg. 2017;46:774–81. https://doi.org/10.1016/j.ijom.2017.02.1274.CrossRefPubMed

Tarasenko S, Ashurko I, Taschieri S, et al. Comparative analysis of methods to increase the amount of keratinized mucosa before stage-two surgery: a randomized controlled study. Quintessence Int. 2020;51:374–87. https://doi.org/10.3290/j.qi.a44216.CrossRefPubMed

Berglundh T, Lindhe J. Dimension of the periimplant mucosa Biological width revisited. J Clin Periodontol. 1996;23:971–3. https://doi.org/10.1111/j.1600-051X.1996.tb00520.x.CrossRefPubMed

Linkevicius T, Apse P, Grybauskas S, et al. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implant. 2009;24:712–9. https://doi.org/10.1111/cid.12222.CrossRef

Linkevicius T, Puisys A, Steigmann M, et al. Influence of vertical soft tissue thickness on crestal bone changes around implants with platform switching: a comparative clinical study. Clin Implant Dent Relat Res. 2015;17:1228–36.CrossRefPubMed

Jung RE, Sailer I, Hämmerle CHF, et al. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent. 2007;27:251–7. https://doi.org/10.11607/prd.00.0745.CrossRefPubMed

10.

Lissek M, Boeker M, Happe A. How thick is the oral mucosa around implants after augmentation with different materials: A systematic review of the effectiveness of substitute matrices in comparison to connective tissue grafts. Int J Mol Sci. 2020;21:1–19. https://doi.org/10.3390/ijms21145043.CrossRef

11.

Griffin TJ, Cheung WS, Zavras AI, et al. Postoperative Complications Following Gingival Augmentation Procedures. J Periodontol. 2006;77:2070–9. https://doi.org/10.1902/jop.2006.050296.CrossRefPubMed

12.

Vallecillo C, Toledano-Osorio M, Vallecillo-Rivas M, et al. Collagen matrix vs. autogenous connective tissue graft for soft tissue augmentation: a systematic review and meta-analysis. Polymers (Basel). 2021;13:1810. https://doi.org/10.3390/polym13111810.CrossRefPubMedPubMedCentral

13.

Fénelon M, Catros S, Fricain JC. What is the benefit of using amniotic membrane in oral surgery? A comprehensive review of clinical studies. Clin Oral Investig. 2018;22:1881–91. https://doi.org/10.1007/s00784-018-2457-3.CrossRefPubMed

14.

Tavelli L, McGuire MK, Zucchelli G, et al. Extracellular matrix-based scaffolding technologies for periodontal and peri-implant soft tissue regeneration. J Periodontol. 2020;91:17–25. https://doi.org/10.1002/JPER.19-0351.CrossRefPubMed

15.

Thoma DS, Zeltner M, Hilbe M, et al. Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous connective tissue grafts for soft tissue augmentation at implant sites. J Clin Periodontol. 2016;43:874–85. https://doi.org/10.1111/jcpe.12588.CrossRefPubMed

16.

Schmitt CM, Brückbauer P, Schlegel KA, et al. Volumetric soft tissue alterations in the early healing phase after peri- implant soft tissue contour augmentation with a porcine collagen matrix versus the autologous connective tissue graft: A controlled clinical trial. J Clin Periodontol. 2021;48:145–62. https://doi.org/10.1111/jcpe.13387.CrossRefPubMed

17.

Gargallo-Albiol J, Barootchi S, Tavelli L, et al. Efficacy of xenogeneic collagen matrix to augment peri-implant soft tissue thickness compared with autogenous connective tissue graft: A systematic review and meta-analysis. Int J Oral Maxillofac Implant. 2019;34:1059–69. https://doi.org/10.11607/jomi.7497.CrossRef

18.

De Angelis P, De Angelis S, Passarelli PC, et al. Clinical comparison of a xenogeneic collagen matrix versus subepithelial autogenous connective tissue graft for augmentation of soft tissue around implants. Int J Oral Maxillofac Surg. 2021;50:956–63. https://doi.org/10.1016/j.ijom.2020.11.014.CrossRefPubMed

19.

Ashurko I, Esayan A, Magdalyanova M, et al. Current concepts of surgical methods to increase mucosal thickness during dental implantation. J Adv Pharm Educ Res. 2021;11:37–41. https://doi.org/10.51847/bY9xiuZKJf.CrossRef

20.

Zuiderveld EG, Meijer HJA, Vissink A, et al. The influence of different soft-tissue grafting procedures at single implant placement on esthetics: A randomized controlled trial. J Periodontol. 2018;89:903–14. https://doi.org/10.1002/JPER.18-0061.CrossRefPubMed

21.

Moraschini V, Guimarães HB, Cavalcante IC, et al. Clinical efficacy of xenogeneic collagen matrix in augmenting keratinized mucosa round dental implants : a systematic review and meta-analysis. Clin Oral Investig. 2020;24:2163–74. https://doi.org/10.1007/s00784-020-03321-5.CrossRefPubMed

22.

Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343. https://doi.org/10.1136/bmj.d5928.

23.

Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–9. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.CrossRefPubMed

24.

Tavelli L, Barootchi S, Avila-Ortiz G, et al. Peri-implant soft tissue phenotype modification and its impact on peri-implant health: a systematic review and network meta-analysis. J Periodontol. 2021;92:21–44. https://doi.org/10.1002/JPER.19-0716.CrossRefPubMed

25.

Cairo R, Barbato L, Tonelli P, et al. Xenogeneic Collagen Matrix versus Connective Tissue Graft for buccal soft tissue augmentation at implant site. A randomized, controlled clinical trial. J Clin Periodontol. 2017;44:769–76. https://doi.org/10.1111/jcpe.12750.CrossRefPubMed

26.

Cosyn J, Eeckhout C, Christiaens V, et al. 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: 3-month results. J Clin Periodontol. 2021;48:1502–15. https://doi.org/10.1111/jcpe.13560.CrossRefPubMed

27.

Puzio M, Błaszczyszyn A, Hadzik J, et al. Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix – 1-year randomised follow-up. Ann Anat. 2018;217:129–41. https://doi.org/10.1016/j.aanat.2017.11.003.CrossRefPubMed

28.

Zeltner M, Jung RE, Hämmerle CHF, et al. Randomized controlled clinical study comparing a volume-stable collagen matrix to autogenous connective tissue grafts for soft tissue augmentation at implant sites: linear volumetric soft tissue changes up to 3 months. J Clin Periodontol. 2017;44:446–53. https://doi.org/10.1111/jcpe.12697.CrossRefPubMed

29.

Baldi N, Buti J, Mensi M, et al. Xenogeneic dermal matrix versus autologous connective tissue graft versus no graft at abutment connection for improving aesthetics: 6-month outcomes of a randomised controlled trial. Clin Trials Dent. 2020;2:49–62. https://doi.org/10.36130/CTD.03.2020.05.CrossRef

30.

Ashurko I, Tarasenko S, Esayan A, et al. Clinical Oral Investigations Connective tissue graft versus xenogeneic collagen matrix for soft tissue augmentation at implant sites : a randomized-controlled clinical trial. Clin Oral Investig. 2022;26:7191–208. https://doi.org/10.1007/s00784-022-04680-x.CrossRefPubMed

31.

Hélio M, Daiane P, Elizabeth M, et al. Peri-implant soft tissue augmentation with palate subepitelial connective tissue graft compared to porcine collagen matrix: A randomized controlled clinical study and histomorphometric analysis. Int J Appl Dent Sci. 2019;5:319–25.

32.

Higgins JPT, Thomas J, Chandler J, et al. Cochrane handbook for systematic reviews of interventions. Wiley. 2019.

33.

Zafiropoulos G-G, John G. Use of collagen matrix for augmentation of the peri-implant soft tissue at the time of immediate implant placement. J Contemp Dent Pract. 2017;18:386–91. https://doi.org/10.5005/jp-journals-10024-2052.CrossRefPubMed

34.

Schallhorn RA, McClain PK, Charles A, et al. Evaluation of a porcine collagen matrix used to augment keratinized tissue and increase soft tissue thickness around existing dental implants. Int J Periodontics Restorative Dent. 2015;35:99–103. https://doi.org/10.11607/prd.1888.CrossRefPubMed

35.

Eeckhout C, Bouckaert E, Verleyen D, et al. A 3-year prospective study on a porcine-derived acellular collagen matrix to re-establish convexity at the buccal aspect of single implants in the molar area: a volumetric analysis. J Clin Med. 2020;9:1568. https://doi.org/10.3390/jcm9051568.CrossRefPubMedPubMedCentral

36.

Verardi S, Orsini M, Lombardi T, et al. Comparison between two different techniques for peri-implant soft tissue augmentation: Porcine dermal matrix graft versus tenting screw. J Periodontol. 2020;91:1011–7. https://doi.org/10.1002/JPER.19-0447.CrossRefPubMed

37.

Liu X, Xu YY, Lai HC, et al. Comparison of acellular dermal matrix graft and palatal connective tissue graft in the augmentation of labial tissue around implants. Shanghai kou qiang yi xue [Shanghai J Stomatol]. 2007;16:484–8.PubMed

38.

Amin M. Comparison between acellular dermal matrix and connective tissue graft on vertical soft tissue thickness during submerged implant insertion, https://en.irct.ir/trial/59383 (2021).

39.

Lai HC, Xu YY, Zhang ZY, et al. Buccal soft tissue augmentation using acellular dermal matrix in implant therapy. Zhonghua Kou Qiang Yi Xue Za Zhi. 2006;41:395–6.PubMed

40.

Tavelli L, Barootchi S, Vera Rodriguez M, et al. Early soft tissue changes following implant placement with or without soft tissue augmentation using a xenogeneic cross-link collagen scaffold: A volumetric comparative study. J Esthet Restor Dent. 2022;34:181–7. https://doi.org/10.1111/jerd.12856.CrossRefPubMed

41.

Froum SJ, Khouly I, Tarnow DP, et al. The use of a xenogeneic collagen matrix at the time of implant placement to increase the volume of buccal soft tissue. Int J Periodontics Restor Dent. 2015;35:179–89. https://doi.org/10.11607/prd.2226.CrossRef

42.

Maiorana C, Beretta M, Pivetti L, et al. Use of a collagen matrix as a substitute for free mucosal grafts in pre-prosthetic surgery: 1 year results from a clinical prospective study on 15 patients. Open Dent J. 2016;10:395–410. https://doi.org/10.2174/1874210601610010395.CrossRefPubMedPubMedCentral

43.

Artzi Z, Renert U, Netanely E, et al. Histologic composition of marginal mucosal tissue augmented by a resorbable volume-stable collagen matrix in soft tissue thickening procedures in humans: a morphometric observational study. Clin Oral Investig. 2022;26:427–35. https://doi.org/10.1007/s00784-021-04016-1.CrossRefPubMed

44.

Zafiropoulos G-G, Deli G, Hoffmann O, et al. Changes of the peri-implant soft tissue thickness after grafting with a collagen matrix. J Indian Soc Periodontol. 2016;20:441–5. https://doi.org/10.4103/0972-124X.181245.CrossRefPubMedPubMedCentral

45.

Santagata M, Tartaro G, D’Amato S. Clinical and histologic comparative study of subepithelial connective tissue graft and extracellular matrix membrane. A preliminary split-mouth study in humans. Int J Periodontics Restor Dent. 2015;35:85–91. https://doi.org/10.11607/prd.1849.CrossRef

46.

Sanz M, Lorenzo R, Aranda JJ, et al. Clinical evaluation of a new collagen matrix (Mucograft® prototype) to enhance the width of keratinized tissue in patients with fixed prosthetic restorations: A randomized prospective clinical trial. J Clin Periodontol. 2009;36:868–76. https://doi.org/10.1111/j.1600-051X.2009.01460.x.CrossRefPubMed

47.

Thoma DS, Gasser TJW, Jung RE, et al. Randomized controlled clinical trial comparing implant sites augmented with a volume-stable collagen matrix or an autogenous connective tissue graft: 3-year data after insertion of reconstructions. J Clin Periodontol. 2020;47:630–9. https://doi.org/10.1111/jcpe.13271.CrossRefPubMed

48.

Huber S, Zeltner M, Hämmerle CHF, et al. Non-interventional 1-year follow-up study of peri-implant soft tissues following previous soft tissue augmentation and crown insertion in single tooth gaps. J Clin Periodontol. 2018;45:504–12. https://doi.org/10.1111/ijlh.12426.CrossRefPubMed

49.

Puzio M, Hadzik J, Błaszczyszyn A, et al. Soft tissue augmentation around dental implants with connective tissue graft (CTG) and xenogenic collagen matrix (XCM) 1-year randomized control trail. Ann Anat. 2020;230:151484. https://doi.org/10.1016/j.aanat.2020.151484.CrossRefPubMed

50.

Cosyn J, Eeckhout C, De Bruyckere T, et al. 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. J Clin Periodontol. 2022;49:911–21. https://doi.org/10.1111/jcpe.13691.CrossRefPubMed

51.

Studer SP, Lehner C, Bucher A, et al. Soft tissue correction of a single-tooth pontic space: A comparative quantitative volume assessment. J Prosthet Dent. 2000;83:402–11. https://doi.org/10.1016/S0022-3913(00)70034-5.CrossRefPubMed

52.

Thoma DS, Naenni N, Benic GI, et al. Soft tissue volume augmentation at dental implant sites using a volume stable three-dimensional collagen matrix – histological outcomes of a preclinical study. J Clin Periodontol. 2017;44:185–94. https://doi.org/10.1111/jcpe.12635.CrossRefPubMed

53.

Fickl S, Nannmark U, Schlagenhauf U, et al. Porcine dermal matrix in the treatment of dehiscence-type defects – an experimental split-mouth animal trial. Clin Oral Implants Res. 2015;26:799–805. https://doi.org/10.1111/clr.12355.CrossRefPubMed

54.

Chackartchi T, Romanos GE, Sculean A. Soft tissue-related complications and management around dental implants. Periodontol. 2019;2000(81):124–38. https://doi.org/10.1111/prd.12287.CrossRef

55.

Roccuzzo M, Grasso G, Dalmasso P. Keratinized mucosa around implants in partially edentulous posterior mandible: 10-year results of a prospective comparative study. Clin Oral Implants Res. 2016;27:491–6. https://doi.org/10.1111/clr.12563.CrossRefPubMed

56.

Lorenzo R, García V, Orsini M, et al. Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: A randomized controlled prospective clinical trial. Clin Oral Implants Res. 2012;23:316–24. https://doi.org/10.1111/j.1600-0501.2011.02260.x.CrossRefPubMed

57.

Sanz-Martín I, Rojo E, Maldonado E, et al. Structural and histological differences between connective tissue grafts harvested from the lateral palatal mucosa or from the tuberosity area. Clin Oral Investig. 2019;23:957–64. https://doi.org/10.1007/s00784-018-2516-9.CrossRefPubMed

58.

Bassetti RG, Stähli A, Bassetti MA, et al. Soft tissue augmentation procedures at second-stage surgery: a systematic review. Clin Oral Investig. 2016;20:1369–87. https://doi.org/10.1007/s00784-016-1815-2.CrossRefPubMed

59.

Valles C, Vilarrasa J, Barallat L, et al. Efficacy of soft tissue augmentation procedures on tissue thickening around dental implants: A systematic review and meta-analysis. Clin Oral Implants Res. 2022;33:72–99. https://doi.org/10.1111/clr.13920.CrossRefPubMed

60.

Cairo F, Barbato L, Selvaggi F, et al. Surgical procedures for soft tissue augmentation at implant sites. A systematic review and meta-analysis of randomized controlled trials. Clin Implant Dent Relat Res. 2019;21:1262–70. https://doi.org/10.1111/cid.12861.CrossRefPubMed

61.

Zeng L, Brignardello-Petersen R, Hultcrantz M, et al. GRADE guidelines 32: GRADE offers guidance on choosing targets of GRADE certainty of evidence ratings. J Clin Epidemiol. 2021;137:163–75. https://doi.org/10.1016/j.jclinepi.2021.03.026.CrossRefPubMed

Title: Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis
Authors: Igor Ashurko
Svetlana Tarasenko
Mary Magdalyanova
Svetlana Bokareva
Maxim Balyasin
Anna Galyas
Marina Khamidova
Mariia Zhornik
Alexey Unkovskiy
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: BMC Oral Health / Issue 1/2023
Electronic ISSN: 1472-6831
DOI: https://doi.org/10.1186/s12903-023-03475-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparative analysis of xenogeneic collagen matrix and autogenous subepithelial connective tissue graft to increase soft tissue volume around dental implants: a systematic review and meta-analysis

Abstract

Objective

Data

Source

Study selection

Clinical significance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Data

Source

Study selection

Clinical significance

Please log in to get access to this content

Other articles of this Issue 1/2023

Airway dimensional changes following bone anchored maxillary protraction: a systematic review

Pediatric sleep-disordered breathing in Shanghai: characteristics, independent risk factors and its association with malocclusion

Exploration of key factors in Gingival Crevicular fluids from patients undergoing Periodontally Accelerated Osteogenic Orthodontics (PAOO) using proteome analysis

Evaluation of implants in smoking and non-smoking patients with peri-implant disease risk analysis and esthetic scores: an observational study

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

The effectiveness of Carie-Care™, chemomechanical caries removal technique in primary teeth: randomized controlled clinical trial