Top

Clinical Oral Investigations

Published in:

01-01-2017 | Review

Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review

Authors: Renzo G. Bassetti, Alexandra Stähli, Mario A. Bassetti, Anton Sculean

Published in: Clinical Oral Investigations | Issue 1/2017

Abstract

Objectives

The aim was to compile the current knowledge about the efficacy of different soft tissue correction methods around osseointegrated, already uncovered and/or loaded (OU/L) implants with insufficient soft tissue conditions. Procedures to increase peri-implant keratinized mucosa (KM) width and/or soft tissue volume were considered.

Materials and methods

Screening of two databases: MEDLINE (PubMed) and EMBASE (OVID), and manual search of articles were performed. Human studies reporting on soft tissue augmentation/correction methods around OU/L implants up to June 30, 2016, were considered. Quality assessment of selected full-text articles to weight risk of bias was performed using the Cochrane collaboration’s tool.

Results

Overall, four randomized controlled trials (risk of bias = high/low) and five prospective studies (risk of bias = high) were included. Depending on the surgical techniques and graft materials, the enlargement of keratinized tissue (KT) ranged between 1.15 ± 0.81 and 2.57 ± 0.50 mm. The apically positioned partial thickness flap (APPTF), in combination with a free gingival graft (FGG), a subepithelial connective tissue graft (SCTG), or a xenogeneic graft material (XCM) were most effective. A coronally advanced flap (CAF) combined with SCTG in three, combined with allogenic graft materials (AMDA) in one, and a split thickness flap (STF) combined with SCTG in another study showed mean soft tissue recession coverage rates from 28 to 96.3 %. STF combined with XCM failed to improve peri-implant soft tissue coverage.

Conclusions

The three APPTF-techniques combined with FGG, SCTG, or XCM achieved comparable enlargements of peri-implant KT. Further, both STF and CAF, both in combination with SCTG, are equivalent regarding recession coverage rates. STF + XCM and CAF + AMDA did not reach significant coverage.

Clinical relevance

In case of soft tissue deficiency around OU/L dental implants, the selection of both an appropriate surgical technique and a suitable soft tissue graft material is of utmost clinical relevance.

Agudio G, Nieri M, Rotundo R et al (2008) Free gingival grafts to increase keratinized tissue: a retrospective long-term evaluation (10 to 25 years) of outcomes. J Periodontol 79:587–594CrossRefPubMed

Lang NP, Loe H (1972) The relationship between the width of keratinized gingiva and gingival health. J Periodontol 43:623–627CrossRefPubMed

Miyasato M, Crigger M, Egelberg J (1977) Gingival condition in areas of minimal and appreciable width of keratinized gingiva. J Clin Periodontol 4:200–209CrossRefPubMed

Kennedy JE, Bird WC, Palcanis KG et al (1985) A longitudinal evaluation of varying widths of attached gingiva. J Clin Periodontol 12:667–675CrossRefPubMed

Wennstrom J (1983) Regeneration of gingiva following surgical excision. A clinical study 10:287–297

Wennstrom JL (1987) Lack of association between width of attached gingiva and development of soft tissue recession. A 5-year longitudinal study. J Clin Periodontol 14:181–184CrossRefPubMed

Valderhaug J, Birkeland JM (1976) Periodontal conditions in patients 5 years following insertion of fixed prostheses. Pocket depth and loss of attachment. J Oral Rehabil 3:237–243CrossRefPubMed

Bassetti M, Kaufmann R, Salvi GE et al (2015) Soft tissue grafting to improve the attached mucosa at dental implants: a review of the literature and proposal of a decision tree. Quintessence Int 46:499–510PubMed

Berglundh T, Lindhe J, Jonsson K et al (1994) The topography of the vascular systems in the periodontal and peri-implant tissues in the dog. J Clin Periodontol 21:189–193CrossRefPubMed

10.

Berglundh T, Lindhe J, Ericsson I et al (1991) The soft tissue barrier at implants and teeth. Clin Oral Implants Res 2:81–90CrossRefPubMed

11.

Listgarten MA, Lang NP, Schroeder HE et al (1991) Periodontal tissues and their counterparts around endosseous implants [corrected and republished with original paging, article orginally printed in Clin Oral Implants Res 1991 Jan-mar;2(1):1-19]. Clin Oral Implants Res 2:1–19CrossRefPubMed

12.

Moon IS, Berglundh T, Abrahamsson I et al (1999) The barrier between the keratinized mucosa and the dental implant. An experimental study in the dog. J Clin Periodontol 26:658–663CrossRefPubMed

13.

Ikeda H, Shiraiwa M, Yamaza T et al (2002) Difference in penetration of horseradish peroxidase tracer as a foreign substance into the peri-implant or junctional epithelium of rat gingivae. Clin Oral Implants Res 13:243–251CrossRefPubMed

14.

Karring T, Ostergaard E, Loe H (1971) Conservation of tissue specificity after heterotopic transplantation of gingiva and alveolar mucosa. J Periodontal Res 6:282–293CrossRefPubMed

15.

Zuhr O, Hürzeler M, editors (2011) Plastisch-ästhetische Parodontal- und Implantatchirurgie. Berlin: Quintessenz Verlag

16.

Adell R, Lekholm U, Rockler B et al (1986) Marginal tissue reactions at osseointegrated titanium fixtures (I). A 3-year longitudinal prospective study. Int J Oral Maxillofac Surg 15:39–52CrossRefPubMed

17.

Bengazi F, Wennstrom JL, Lekholm U (1996) Recession of the soft tissue margin at oral implants. A 2-year longitudinal prospective study. Clin Oral Implants Res 7:303–310CrossRefPubMed

18.

Block MS, Gardiner D, Kent JN et al (1996) Hydroxyapatite-coated cylindrical implants in the posterior mandible: 10-year observations. Int J Oral Maxillofac Implants 11:626–633PubMed

19.

Esposito M, Grusovin MG, Maghaireh H et al. (2007) Interventions for replacing missing teeth: management of soft tissues for dental implants. Cochrane Database Syst Rev:CD006697

20.

Heitz-Mayfield LJ (2008) Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol 35:292–304CrossRefPubMed

21.

Lekholm U, Adell R, Lindhe J et al (1986) Marginal tissue reactions at osseointegrated titanium fixtures. (II) a cross-sectional retrospective study. Int J Oral Maxillofac Surg 15:53–61CrossRefPubMed

22.

Roos-Jansaker AM, Renvert H, Lindahl C et al (2006) Nine- to fourteen-year follow-up of implant treatment. Part III: factors associated with peri-implant lesions. J Clin Periodontol 33:296–301CrossRefPubMed

23.

Schou S, Holmstrup P, Hjorting-Hansen E et al (1992) Plaque-induced marginal tissue reactions of osseointegrated oral implants: a review of the literature. Clin Oral Implants Res 3:149–161CrossRefPubMed

24.

Strub JR, Gaberthuel TW, Grunder U (1991) The role of attached gingiva in the health of peri-implant tissue in dogs. 1. Clinical findings. Int J Periodontics Restorative Dent 11:317–333PubMed

25.

Warrer K, Buser D, Lang NP et al (1995) Plaque-induced peri-implantitis in the presence or absence of keratinized mucosa. An experimental study in monkeys. Clin Oral Implants Res 6:131–138CrossRefPubMed

26.

Wennström JL, Bengazi F, Lekholm U (1994) The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clin Oral Implants Res 5:1–8CrossRefPubMed

27.

Wennström JL, Derks J (2012) Is there a need for keratinized mucosa around implants to maintain health and tissue stability? Clin Oral Implants Res 23(Suppl 6):136–146CrossRefPubMed

28.

Zarb GA, Schmitt A (1990) The longitudinal clinical effectiveness of osseointegrated dental implants: the Toronto study. Part III: problems and complications encountered. J Prosthet Dent 64:185–194CrossRefPubMed

29.

Adibrad M, Shahabuei M, Sahabi M (2009) Significance of the width of keratinized mucosa on the health status of the supporting tissue around implants supporting overdentures. J Oral Implantol 35:232–237CrossRefPubMed

30.

Artzi Z, Carmeli G, Kozlovsky A (2006) A distinguishable observation between survival and success rate outcome of hydroxyapatite-coated implants in 5-10 years in function. Clin Oral Implants Res 17:85–93CrossRefPubMed

31.

Chung DM, Oh TJ, Shotwell JL et al (2006) Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 77:1410–1420CrossRefPubMed

32.

Crespi R, Cappare P, Gherlone E (2010) A 4-year evaluation of the peri-implant parameters of immediately loaded implants placed in fresh extraction sockets. J Periodontol 81:1629–1634CrossRefPubMed

33.

Schrott AR, Jimenez M, Hwang JW et al (2009) Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clin Oral Implants Res 20:1170–1177CrossRefPubMedPubMedCentral

34.

Bouri A Jr, Bissada N, Al-Zahrani MS et al (2008) Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 23:323–326PubMed

35.

Boynuegri D, Nemli SK, Kasko YA (2013) Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res 24:928–933CrossRefPubMed

36.

Malo P, Rigolizzo M, Nobre M et al (2013) Clinical outcomes in the presence and absence of keratinized mucosa in mandibular guided implant surgeries: a pilot study with a proposal for the modification of the technique. Quintessence Int 44:149–157PubMed

37.

Zigdon H, Machtei EE (2008) The dimensions of keratinized mucosa around implants affect clinical and immunological parameters. Clin Oral Implants Res 19:387–392CrossRefPubMed

38.

Brito C, Tenenbaum HC, Wong BK et al (2014) Is keratinized mucosa indispensable to maintain peri-implant health? A systematic review of the literature. J Biomed Mater Res B Appl Biomater 102:643–650CrossRefPubMed

39.

Gobbato L, Avila-Ortiz G, Sohrabi K et al (2013) The effect of keratinized mucosa width on peri-implant health: a systematic review. Int J Oral Maxillofac Implants 28:1536–1545CrossRefPubMed

40.

Lin GH, Chan HL, Wang HL (2013) The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 84(12):1755–1767CrossRefPubMed

41.

Zitzmann NU, Berglundh T, Marinello CP et al (2001) Experimental peri-implant mucositis in man. J Clin Periodontol 28:517–523CrossRefPubMed

42.

Hürzeler MB, Weng D (1996) Periimplant tissue management: optimal timing for an aesthetic result. Pract Periodontics Aesthet Dent 8:857–869 quiz 869PubMed

43.

Shibli JA, d’avila S, Marcantonio E Jr (2004) Connective tissue graft to correct peri-implant soft tissue margin: a clinical report. J Prosthet Dent 91:119–122CrossRefPubMed

44.

Yan JJ, Tsai AY, Wong MY et al (2006) Comparison of acellular dermal graft and palatal autograft in the reconstruction of keratinized gingiva around dental implants: a case report. Int J Periodontics Restorative Dent 26:287–292PubMed

45.

Bassetti RG, Stahli A, Bassetti MA et al (2016) Soft tissue augmentation procedures at second-stage surgery: a systematic review. Clin Oral Investig 20(7):1369–1387CrossRefPubMed

46.

Needleman IG (2002) A guide to systematic reviews. J Clin Periodontol 29(Suppl 3):6–9 discussion 37-38CrossRefPubMed

47.

Higgins JP, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J 343:d5928CrossRef

48.

Urban IA, Lozada JL, Nagy K et al (2015) Treatment of severe mucogingival defects with a combination of strip gingival grafts and a xenogeneic collagen matrix: a prospective case series study. Int J Periodontics Restorative Dent 35:345–353PubMed

49.

Happe A, Stimmelmayr M, Schlee M et al (2013) Surgical management of peri-implant soft tissue color mismatch caused by shine-through effects of restorative materials: one-year follow-up. Int J Periodontics Restorative Dent 33:81–88CrossRefPubMed

50.

Issarayangkul C, Schoenbaum TR, McLaren EA (2013) Prosthetic soft tissue management following two periimplant graft failures: a clinical report. J Prosthet Dent 110:155–160CrossRefPubMed

51.

Zucchelli G, Mazzotti C, Mounssif I et al (2013) Esthetic treatment of peri-implant soft tissue defects: a case report of a modified surgical-prosthetic approach. The International journal of periodontics & restorative dentistry 33:327–335CrossRef

52.

Ponzoni D, Jardim EC, de Carvalho PS (2013) Vestibuloplasty by modified Kazanjian technique in treatment with dental implants. J Craniofac Surg 24:1373–1375CrossRefPubMed

53.

Froum SJ, Froum SH, Rosen PS (2012) Successful management of peri-implantitis with a regenerative approach: a consecutive series of 51 treated implants with 3- to 7.5-year follow-up. The International journal of periodontics & restorative dentistry 32:11–20

54.

Mareque-Bueno S (2011) A novel surgical procedure for coronally repositioning of the buccal implant mucosa using acellular dermal matrix: a case report. J Periodontol 82:151–156CrossRefPubMed

55.

Lai YL, Chen HL, Chang LY et al (2010) Resubmergence technique for the management of soft tissue recession around an implant: case report. Int J Oral Maxillofac Implants 25:201–204PubMed

56.

Sanz M, Lorenzo R, Aranda JJ et al (2009) 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 36:868–876CrossRefPubMed

57.

Karl M, Fenner M, Amann K et al (2009) Interforaminal implant therapy using a split skin graft—treatment outcome after 13 years. Quintessence Int 40:191–194PubMed

58.

Shibli JA, d’Avila S (2006) Restoration of the soft-tissue margin in single-tooth implant in the anterior maxilla. J Oral Implantol 32:286–290CrossRefPubMed

59.

Deppe H, Horch HH, Kolk A (2004) Microstructured dental implants and palatal mucosal grafts in cleft patients: a retrospective analysis. J Craniomaxillofac Surg 32:211–215CrossRefPubMed

60.

Maksoud MA (2003) Manipulation of the peri-implant tissue for better maintenance: a periodontal perspective. J Oral Implantol 29:120–123CrossRefPubMed

61.

El-Askary AS (2002) Use of connective tissue grafts to enhance the esthetic outcome of implant treatment: a clinical report of 2 patients. J Prosthet Dent 87:129–132CrossRefPubMed

62.

Mathews DP (2002) The pediculated connective tissue graft: a technique for improving unaesthetic implant restorations. Pract Proced Aesthet Dent 14:719–724 quiz 726PubMed

63.

Deeb GR, Le BT, Ueeck BA et al (2001) Use of upper-lid blepharoplasty full-thickness skin for peri-implant keratinized tissue grafting: a report of 2 cases. J Oral Maxillofac Surg 59:1232–1235CrossRefPubMed

64.

Silverstein LH, Lefkove MD (1994b) The use of the subepithelial connective tissue graft to enhance both the aesthetics and periodontal contours surrounding dental implants. J Oral Implantol 20:135–138PubMed

65.

Yilmaz S, Efeoglu E, Biskin T et al (1994) Widening the zone of peri-implant attached gingiva. J Marmara Univ Dent Fac 2:383–388PubMed

66.

Campbell Z, Simons AM, Giordano JR (1993) Soft tissue grafting and vestibuloplasty technique in association with endosseous implants. J Mich Dent Assoc 75:26–29PubMed

67.

Simons AM, Darany DG, Giordano JR (1993) The use of free gingival grafts in the treatment of peri-implant soft tissue complications: clinical report. Implant Dent 2:27–30CrossRefPubMed

68.

Buser D (1987) Vestibuloplasty with free mucosal grafts in implants in the edentulous mandible. Surgical method and preliminary results. Schweiz Monatsschr Zahnmed 97:766–772PubMed

69.

Anderson LE, Inglehart MR, El-Kholy K et al (2014) Implant associated soft tissue defects in the anterior maxilla: a randomized control trial comparing subepithelial connective tissue graft and acellular dermal matrix allograft. Implant Dent 23:416–425PubMed

70.

Basegmez C, Karabuda ZC, Demirel K et al (2013) The comparison of acellular dermal matrix allografts with free gingival grafts in the augmentation of peri-implant attached mucosa: a randomised controlled trial. European journal of oral implantology 6:145–152PubMed

71.

Basegmez C, Ersanli S, Demirel K et al (2012) The comparison of two techniques to increase the amount of peri-implant attached mucosa: free gingival grafts versus vestibuloplasty. One-year results from a randomised controlled trial. Eur J Oral Implantol 5:139–145PubMed

72.

Lorenzo R, Garcia V, Orsini M et al (2012) Clinical efficacy of a xenogeneic collagen matrix in augmenting keratinized mucosa around implants: a randomized controlled prospective clinical trial. Clin Oral Implants Res 23:316–324CrossRefPubMed

73.

Schallhorn RA, McClain PK, Charles A et al (2015) Evaluation of a porcine collagen matrix used to augment keratinized tissue and increase soft tissue thickness around existing dental implants. The International journal of periodontics & restorative dentistry 35:99–103CrossRef

74.

Roccuzzo M, Gaudioso L, Bunino M et al (2014) Surgical treatment of buccal soft tissue recessions around single implants: 1-year results from a prospective pilot study. Clin Oral Implants Res 25:641–646CrossRefPubMed

75.

Zucchelli G, Mazzotti C, Mounssif I et al (2013) A novel surgical-prosthetic approach for soft tissue dehiscence coverage around single implant. Clin Oral Implants Res 24:957–962PubMed

76.

Burkhardt R, Joss A, Lang NP (2008) Soft tissue dehiscence coverage around endosseous implants: a prospective cohort study. Clin Oral Implants Res 19:451–457CrossRefPubMed

77.

Park JB (2006) Increasing the width of keratinized mucosa around endosseous implant using acellular dermal matrix allograft. Implant Dent 15:275–281CrossRefPubMed

78.

Karring T, Lang NP, Loe H (1975) The role of gingival connective tissue in determining epithelial differentiation. J Periodontal Res 10:1–11CrossRefPubMed

79.

Sculean A, Gruber R, Bosshardt DD (2014) Soft tissue wound healing around teeth and dental implants. J Clin Periodontol 41(Suppl 15):S6–22CrossRefPubMed

80.

Souza AB, Tormena M, Matarazzo F et al (2015) The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health. Clin Oral Implants Res 27(6):650–655CrossRefPubMed

81.

Puisys A, Linkevicius T (2015) The influence of mucosal tissue thickening on crestal bone stability around bone-level implants. A prospective controlled clinical trial. Clin Oral Implants Res 26:123–129CrossRefPubMed

82.

Linkevicius T, Puisys A, Linkeviciene L et al (2015) Crestal bone stability around implants with horizontally matching connection after soft tissue thickening: a prospective clinical trial. Clin Implant Dent Relat Res 17:497–508CrossRefPubMed

83.

Buyukozdemir Askin S, Berker E, Akincibay H et al (2015) Necessity of keratinized tissues for dental implants: a clinical, immunological, and radiographic study. Clin Implant Dent Relat Res 17:1–12CrossRefPubMed

84.

Costa FO, Takenaka-Martinez S, Cota LO et al (2012) Peri-implant disease in subjects with and without preventive maintenance: a 5-year follow-up. J Clin Periodontol 39:173–181CrossRefPubMed

85.

Linkevicius T, Apse P, Grybauskas S et al (2009) The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants 24:712–719PubMed

86.

Griffin TJ, Cheung WS, Zavras AI et al (2006) Postoperative complications following gingival augmentation procedures. J Periodontol 77:2070–2079CrossRefPubMed

87.

Schmitt CM, Moest T, Lutz R et al (2015) Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft) versus the free gingival graft: a comparative prospective clinical trial. Clin Oral Implants Res 27(11):e125–e133CrossRefPubMed

88.

Mombelli A, van Oosten MA, Schurch E Jr et al (1987) The microbiota associated with successful or failing osseointegrated titanium implants. Oral Microbiol Immunol 2:145–151CrossRefPubMed

89.

Schmitt CM, Tudor C, Kiener K et al (2013) Vestibuloplasty: porcine collagen matrix versus free gingival graft: a clinical and histologic study. J Periodontol 84:914–923CrossRefPubMed

90.

Hürzeler MB, Weng D (1999) A single-incision technique to harvest subepithelial connective tissue grafts from the palate. The International journal of periodontics & restorative dentistry 19:279–287

91.

Aroca S, Molnar B, Windisch P et al (2013) Treatment of multiple adjacent Miller class I and II gingival recessions with a modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: a randomized, controlled clinical trial. J Clin Periodontol 40:713–720CrossRefPubMed

92.

Jung RE, Sailer I, Hammerle CH et al (2007) In vitro color changes of soft tissues caused by restorative materials. The International journal of periodontics & restorative dentistry 27:251–257

93.

Jung RE, Holderegger C, Sailer I et al (2008) The effect of all-ceramic and porcelain-fused-to-metal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial. Int J Periodontics Restorative Dent 28:357–365PubMed

94.

Jung RE, Holderegger C, Sailer I et al (2008) The effect of all-ceramic and porcelain-fused-to-metal restorations on marginal peri-implant soft tissue color: a randomized controlled clinical trial. The International journal of periodontics & restorative dentistry 28:357–365

Title: Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review
Authors: Renzo G. Bassetti
Alexandra Stähli
Mario A. Bassetti
Anton Sculean
Publication date: 01-01-2017
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 1/2017
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-016-2007-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 1/2017

Evaluation of genetic factors involved in nocturnal electromyographic activity of masticatory muscles in twins

Magnetic resonance imaging of temporomandibular joint with anterior disk dislocation without reposition - long-term results

Incidence of microcracks in maxillary first premolars after instrumentation with three different mechanized file systems: a comparative ex vivo study

Clinical relevance for the use of ozone to enhance the remineralizing potential of n-HAP on initial enamel lesions

Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction—a double-blinded randomized clinical trial

Caries-preventive effect of anti-erosive and nano-hydroxyapatite-containing toothpastes in vitro