ETEP (Etiology and Therapy of Periodontal and Peri-implant Diseases), Research Group, University Complutense of Madrid, Madrid, Spain.
Department of Periodontology, Universidad Internacional de Catalunya, Barcelona, Spain.
Clin Oral Implants Res. 2022 Jun;33 Suppl 23:32-46. doi: 10.1111/clr.13751.
The aim of this systematic review was to evaluate the efficacy of soft tissue substitutes compared to autogenous gingival grafts in surgical procedures aimed at increasing the width of keratinized mucosa (KM) around dental implants.
Two focused questions were developed: PICOS #1) "What is the efficacy of surgical procedures using soft tissue substitutes, as compared to autogenous grafts, to increase the amount of peri-implant keratinized mucosa, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; and PICOS #2) "What is the effectiveness of soft tissue substitutes to increase the amount of peri-implant keratinized mucosa, in RCTs, CCTs, cohort studies or case series?". Besides KM augmentation, other relevant outcomes such as clinical and radiographic peri-implant outcomes, incidence of biological complications, surgical time, or patient-reported outcome measures (PROMs) were collected. Meta-analyses were performed whenever possible.
Ten publications and an unpublished study were included. KM augmentation was significantly greater for autogenous grafts (n = 6; weighted mean difference (WMD) = -0.9 mm; 95% confidence interval (CI) [-1.4; -0.3]; p = .001). However, no significant differences between autogenous grafts and soft tissue substitutes were observed when exclusively xenografts were considered (n = 5; WMD=-0.8 mm; 95% CI [-1.6; 0.0]; p = .062). Surgical time and postsurgical pain seemed to be reduced by the use of soft tissue substitutes.
Free gingival grafts (FGG) are more effective in the augmentation of KM mucosa around dental implants than soft tissue substitutes. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues.
本系统评价旨在评估软组织替代物在旨在增加牙种植体周围角化黏膜（KM）宽度的手术中的疗效，与自体牙龈移植物相比。
制定了两个重点问题：PICOS#1）“在随机临床试验（RCT）和对照临床试验（CCT）中，使用软组织替代物进行的手术与自体移植物相比，增加种植体周围角化黏膜的效果如何？”；和 PICOS#2）“在 RCT、CCT、队列研究或病例系列研究中，软组织替代物增加种植体周围角化黏膜的效果如何？”。除了 KM 增加外，还收集了其他相关结果，如临床和影像学种植体周围结果、生物并发症发生率、手术时间或患者报告的结果测量（PROMs）。只要有可能，就进行了荟萃分析。
纳入了 10 篇出版物和一项未发表的研究。自体移植物的 KM 增加明显更大（n=6；加权均数差（WMD）=-0.9mm；95%置信区间（CI）[-1.4；-0.3]；p=0.001）。然而，当仅考虑异种移植物时，自体移植物和软组织替代物之间没有观察到显著差异（n=5；WMD=-0.8mm；95%CI[-1.6；0.0]；p=0.062）。使用软组织替代物似乎可以减少手术时间和术后疼痛。
游离龈移植（FGG）在增加牙种植体周围 KM 黏膜方面比软组织替代物更有效。然而，异种来源的替代品可能是自体组织的替代物。
