Soft‐tissue volume augmentation during early, delayed, and late dental implant therapy: A systematic review and meta‐analysis on professionally determined esthetics and self‐reported patient satisfaction on esthetics
Authors: Ausra Ramanauskaite, Sofya Sadilina, Frank Schwarz, Emilio A. Cafferata, Franz J. Strauss, Daniel S. Thoma
Journal: Periodontology 2000 (2025)

Abstract The objective of the study was to assess the effect of soft‐tissue volume augmentation during early, delayed, and late dental implant therapy in terms of professionally determined esthetics and self‐reported patient satisfaction on esthetics. For this, a comprehensive electronic literature search was performed to identify randomized clinical trials (RCTs) and controlled clinical trials (CCTs) reporting professionally determined esthetic outcomes and self‐reported patient satisfaction on esthetics (primary outcomes) during early, delayed, and late dental implant placement comparing soft‐tissue volume augmentation to the absence of soft‐tissue grafting (control) (PICO 1) or comparing various soft‐tissue augmentation techniques, procedures, and materials (PICO 2). Secondary outcomes were mucosal thickness (MT), intra‐ and postoperative complications, marginal soft‐tissue‐level changes, keratinized tissue width, radiographic marginal bone levels, and clinical parameters for the diagnosis of peri‐implant tissue health. The standard mean differences (SMD)/weighted mean differences (WMD) were estimated for the Pink Esthetic Score (PES), self‐reported patient satisfaction assessed by Visual Analog Scale (VAS) and MT gain for PICO 1 and PICO 2 by employing a random effect model. Five RCTs were included for PICO 1, whereas 7 RCTs and 1 CCT addressed PICO 2. PICO 1: The SMD for the PES between autogenous soft‐tissue grafting ( SCTG ) and the absence of grafting (control group) was 0.47; 95% CI [−0.15, 1.09; p = 0.14] based on 5 RCTs . The SMD for the VAS values for patient‐reported satisfaction on esthetics in the SCTG and control group was 0.46; 95% CI [−0.12, 1.03; p = 0.12] (2 RCTs ). The WMD for gain of MT amounted to 1.06 mm; 95% CI [0.81, 1.31; p = 0.00] in favor of the SCTG group (3 RCTs ). PICO 2: The SMD for the PES comparing collagen‐based matrices ( CM group) to the SCTG group was −0.32; 95% CI : (−0.57, −0.07; p = 0.01), in favor of the SCTG group (5 RCTs and 1 CCT ). The SMD for the VAS for patient‐reported satisfaction on soft‐tissue esthetics was 0.24; 95% CI : (−0.31, 0.78; p = 0.40) (2 RCTs comparing CM vs. SCTG ). The WMD for gain of MT was −0.27 mm; 95% CI : (−0.36, −0.17; p = 0.00), significantly favoring the SCTG group (4 RCTs ). Professionally and patient‐assessed outcomes showed no substantial differences between autogenous soft‐tissue grafting and the absence of grafting for early, delayed, and late implant placement. However, autogenous soft‐tissue grafts led to significantly improved esthetic outcomes as assessed by professionals compared to soft‐tissue substitutes. Patient‐assessed outcomes, nevertheless, were similar regardless of the grafting material (i.e., SCTG or soft‐tissue substitute). Therefore, autogenous soft‐tissue grafting, though, resulted in a considerably higher gain in mucosal thickness compared to both the absence of soft‐tissue grafting and the use of soft‐tissue substitutes. Complications and adverse events were rarely reported by the included studies, thus suggesting that many trials underreport harms (e.g., complications).