Autogenous grafts versus substitute scaffolds for soft tissue augmentation in implant therapy: A systematic review.

BACKGROUND: To analyze the effect of autogenous soft tissue grafts or substitute scaffolds on the outcomes of soft tissue augmentation (STA) performed in the context of implant therapy. METHODS: The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42024611477). Articles reporting the findings of randomized controlled trials (RCTs) that met the eligibility criteria were identified through a literature search. Following final article selection, data were extracted, including relevant clinician- and patient-reported outcomes and experiences (CROs and PROs/PREs). Risk of bias assessment was performed using the RoB2 tool. Network meta-analyses (NMA) were performed when feasible to compare the performance of different techniques. RESULTS: Forty RCTs were selected. Risk of bias assessment revealed that the methodological quality of the selected studies was generally high. Although CROs and PROs/PREs were inconsistently reported, it was possible to conduct five sets of NMA regarding mucosal thickness (MT) and keratinized mucosa width (KMW) changes. These analyses revealed that the use of an autogenous connective tissue graft in a bilaminar approach is the best treatment for MT augmentation regardless of the timing, while the application of a free mucosal graft over a partial-thickness vascular bed is generally the best to obtain KMW gains. Alternatively, other treatment options involving the use of specific types of substitute scaffolds were considered as viable alternatives given their similar performance, particularly in terms of MT gain. Additionally, it was found that, compared with autogenous soft tissue grafts, the use of substitute scaffolds is consistently associated with lower postoperative discomfort. CONCLUSIONS: Autogenous soft tissue grafts should be considered as the primary choice to achieve predictable MT and KMW gains in the context of implant therapy. The use of specific substitute scaffolds may render similar STA outcomes with lower postoperative morbidity.