Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
Section of Graduate Periodontology, University Complutense, Madrid, Spain.
Clin Oral Implants Res. 2018 Mar;29 Suppl 15:32-49. doi: 10.1111/clr.13114.
To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri-implant health or disease in partially and fully edentulous patients.
A MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri-implant mucosa. Studies reporting on the peri-implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full-text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta-analyses were applied whenever possible.
Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) [n = 2; WMD = 0.863; 95% CI (0.658; 1.067); p < .001]. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention [with or without residual keratinized tissue]) [n = 4; WMD = -0.175 mm; 95% CI: (-0.313; -0.037); p = .013]. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time [WMD = 0.110; 95% CI: 0.067; 0.154; p < .001] and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting.
Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri-implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss.
回顾有关软组织增量手术的牙科文献，并评估其对部分和完全缺牙患者种植体周围健康或疾病的影响。
从 1966 年至 2016 年进行了 MEDLINE 检索，以确定比较种植体部位软组织移植与无软组织移植（维持）或两种软组织移植方法的对照临床试验。软组织移植术包括增加角化组织或增加种植体周围黏膜厚度。本综述纳入了评估种植体周围组织健康的研究，如通过出血或牙龈指数进行评估。此外，还对 2011 年至 2016 年期间发表的所有选定全文文章和综述进行了额外的手工检索。初始检索共获得 2823 项研究。根据纳入标准（最终纳入：四项关于增加角化组织的研究；六项关于增加黏膜厚度的研究）和进行的质量评估选择合格研究。只要有可能，就进行了荟萃分析。
与维持组（有或无角化组织）相比，用于增加角化组织的软组织移植术可显著改善牙龈指数值[n=2；加权均数差（WMD）=0.863；95%置信区间（0.658；1.067）；p<0.001]。对于最终的边缘骨水平，与所有对照治疗（单独使用 APF；APF 加胶原基质；不干预的维持治疗[有或无残留角化组织]）相比，计算出统计学上有利于根尖定位瓣（APF）加自体移植物的差异[n=4；WMD=-0.175mm；95%置信区间：（-0.313；-0.037）；p=0.013]。用于增加黏膜厚度的软组织移植术并未随着时间的推移显著改善出血指数，但随着时间的推移，边缘骨损失明显减少[WMD=0.110；95%置信区间：0.067；0.154；p<0.001]，与未移植部位相比，在研究终点时边缘骨水平具有边缘显著性。
在本综述的限制范围内，得出的结论是软组织移植术可改善种植体周围的健康状况：（i）对于使用自体移植物增加角化黏膜，可改善出血指数并提高边缘骨水平；（ii）对于使用自体移植物增加黏膜厚度，可显著减少边缘骨丢失。
