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Background: Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. Methods: Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. Results: Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. Conclusions: Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants.

Background: The aim of this study was to construct crosslinked polylysine‐hyaluronic acid microspheres (pl‐HAM) ladened with gingival mesenchymal stem cells (GMSCs) and explore its biologic behavior in soft tissue regeneration. Methods: The effects of the crosslinked pl‐HAM on the biocompatibility and the recruitment of L‐929 cells and GMSCs were detected in vitro. Moreover, the regeneration of subcutaneous collagen tissue, angiogenesis and the endogenous stem cells recruitment were investigated in vivo. We also detected the cell developing capability of pl‐HAMs. Results: The crosslinked pl‐HAMs appeared to be completely spherical‐shaped particles and had good biocompatibility. L‐929 cells and GMSCs grew around the pl‐HAMs and increased gradually. Cell migration experiments showed that pl‐HAMs combined with GMSCs could promote the migration of vascular endothelial cells significantly. Meanwhile, the green fluorescent protein‐GMSCs in the pl‐HAM group still remain in the soft tissue regeneration area 2 weeks after surgery. The results of in vivo studies showed that denser collagen deposition and more angiogenesis‐related indicator CD31 expression in the pl‐HAMs+ GMSCs + GeL group compared with the pl‐HAMs + GeL group. Immunofluorescence showed that CD44, CD90, CD73 co‐staining positive cells surrounded the microspheres in both pl‐HAMs + GeL group and pl‐HAM + GMSCs + GeL group. Conclusions: The crosslinked pl‐HAM ladened with GMSCs system could provide a suitable microenvironment for collagen tissue regeneration, angiogenesis and endogenous stem cells recruitment, which may be an alternative to autogenous soft tissue grafts for minimally invasive treatments for periodontal soft tissue defects in the future. [ABSTRACT FROM AUTHOR]

Background: Different extracellular matrix (ECM)-based technologies in periodontal and peri-implant soft tissue augmentation have been proposed in the market. The present review compared the efficacy of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) or connective tissue grafts (CTGs) in mucogingival procedures to increase keratinized tissue (KT) width around teeth and implants. Methods: Two independent examiners performed an electronic search on MEDLINE and the Cochrane Library based on the following PICOS format: (P) adult patients; (I) soft tissue substitutes and FGGs/CTGs; (C) STSs vs. CTGs; STSs vs. FGGs; STSs vs control; (O) KT width gain; (S) systematic reviews, randomized controlled trials. Studies published before November 2023 were included. Results: Around teeth, all biomaterials showed superior performance compared to a coronally advanced flap (CAF) alone for treating gingival recessions. However, when compared to CTGs, acellular dermal matrices (ADMs) yield the most similar outcomes to the gold standard (CTGs), even though in multiple recessions, CTGs continue to be considered the most favorable approach. The use of STSs (acellular matrix or tissue-engineered) in combination with apically positioned flaps (APF) resulted in significantly less gain in KT width compared to that achieved with FGGs and APFs. Around dental implants, free gingival grafts were deemed more effective than soft tissue substitutes in enhancing keratinized mucosa width. Conclusions: Based on the available evidence, questions remain about the alternative use of soft tissue substitutes for conventional grafting procedures using free gingival grafts or connective tissue grafts around teeth and implants. [ABSTRACT FROM AUTHOR]

Aim: To histomorphometrically assess three treatment modalities for gaining keratinized tissue (KT) at teeth and at dental implants., Materials and Methods: In five dogs, the distal roots of the mandibular second, third and fourth premolars were extracted. Dental implants were placed at the distal root areas 2 months later. After another 2 months, KT augmentation was performed at both distal (implants) and at mesial root (teeth) areas in the presence (wKT groups) or absence (w/oKT groups) of a KT band at the mucosal/gingival level. Three treatment modalities were applied randomly: apically positioned flap only (APF), free gingival grafts (FGGs) and xenogeneic collagen matrices (XCMs). A combination of the above produced six groups. Two months later, tissue sections were harvested and analysed histomorphometrically., Results: The median KT height and length were greatest at implants with FGG in both wKT (3.7 and 5.1 mm, respectively) and w/oKT groups (3.7 and 4.6 mm), and at teeth with FGG in wKT groups (3.7 and 6.1 mm) and with APF in the w/oKT groups (3.9 and 4.4 mm). The XCM and APF produced more favourable results at teeth than at implants., Conclusions: FGG was advantageous in gaining KT, especially at implants., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols.

BACKGROUND: Subepithelial connective tissue grafts are generally considered as the gold standard for soft tissue augmentation. However, it needs a second surgical site, which will prolong the surgical time and increase patients’ pain. OBJECTIVE: To compare the histological and thickness changes of attached gingiva following grafting with different soft tissue substitutes in the labial region of the cuspids. METHODS: In three Beagle dogs, attached gingival augmentation was performed with double-layer allogeneic acellular dermal matrix membrane (AADM), bovine-derived acellular dermal matrices (BADM) combined with concentrated growth factor membrane or BADM combined with collagen sponge. Thickness of attached gingiva was measured before augmentation, and 1, 2, 3, and 4 months after augmentation. Histological analyses were performed after 4 months. RESULTS AND CONCLUSION: The mean values of attached gingival thickness and attached gingival thickness augmentation were higher in the double-layer AADM group than in the other two groups (all P < 0.05) from the 1st to 4th month after surgery. At 1 month after surgery, the attached gingival thickness of the three groups increased significantly and then decreased. At 3 months after surgery, the BADM combined with collagen sponge group and the BADM combined with concentrated growth factor membrane group showed no significant difference in the attached gingival thickness of the graft area compared with that before surgery (P > 0.05). At 4 months after surgery, the mean value of attached gingival thickness in the double-layer AADM group was still significantly increased compared with that before surgery (P < 0.05). The value of attached gingival thickness was highest in the double-layer AADM group, followed by the BADM combined with collagen sponge group, and the lowest in the BADM combined with concentrated growth factor membrane group at 1-4 months after surgery. Histological analyses revealed that AADM was well integrated with the host gingival tissue, and new fibrous connective tissue and fibroblasts grew into the AADM. But the grafts in the other two groups were absorbed and the augmentation area was remodeled into a structure consistent with the surrounding host tissue. To conclude, AADM is superior to BADM combined with concentrated growth factor and BADM combined with collagen sponge with regard to gingival augmentation. [ABSTRACT FROM AUTHOR]

About half of the cases of gingival recession are associated with the noncarious cervical lesion (NCCL), resulting in combined defects (CDs). NCCL negatively affects the root coverage outcomes. In addition, considering the morbidity associated with graft harvesting, soft-tissue substitutes (STSs) appeared as a suitable option for connective tissue grafts for surgical root coverage. Currently, the literature addressing the therapy of CDs employing STSs is scarce. Thus, the present review aimed to update the literature and outline the future perspectives about root coverage of CDs using STSs. A detailed literature search was conducted on MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Google Scholar databases using keywords and Boolean operators. Randomized clinical trials (2) and case reports (6) were included. None of the selected studies reported any adverse effect using STSs. Based on the limited evidence available, we cannot state that STSs may benefit the periodontal clinical and patient-centered outcomes. Randomized controlled trials are needed to assess the long-term outcomes, surgical approaches, and restorative protocols., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Society of Periodontology.)

Objective: This study aims to validate the standardized procedure for designing soft tissue substitutes (STS) adapted to optimally fit single-tooth defects in the anterior jaws and double-tooth defects in the posterior jaw and to compare mathematically modeled average shapes., Materials and Methods: Casts from 35 patients with 17 single-tooth defects in anterior region and 21 double-tooth defects in posterior region were scanned. STS were designed and sectioned in 3D slices meshes. Thickness values were documented respecting mesial-distal and buccal-lingual orientations. Graphs were embedded into images, and hierarchical clustering was applied to group STS according to shape and thickness., Results: STS clustered into two groups per defect type. For anterior single defects, STS (n = 4) were either a small and thin oval: 7 mm buccal-lingual, 4-5 mm mesial-distal direction and 1.1-1.5 mm thick or a larger oval (n = 13): 9 mm buccal-lingual, 5-7 mm mesial-distal and 1.6 m thick. For posterior double tooth defects, STS (n = 10) were either narrow, long and thick: 6-7 mm buccal-lingual, 16-20 mm mesial-distal and 2.2 thick or a wide, thinner rectangle (n = 11): 9-11 mm buccal-lingual, 12-14 mm mesial-distal and 1.1-1.5 mm thick., Conclusions: The study validated the standardized digital method to design grafts for soft tissue volume augmentation and identified four average shapes for anterior single-tooth and posterior double-tooth soft tissue defects., Clinical Significance: We developed and validated a standardized digital method to design an optimal geometrical shape of a soft tissue substitute for oral volume augmentation and combined it with mathematical modeling to identify average shapes for single-interior, and double-posterior tooth defects. The identified average shapes offer the possibility to produce better-fitted xenografts or synthetic STS blocks requiring minimal chair-side adaptation leading to reduced clinical time and patient discomfort and potentially improving soft tissue volume augmentation outcomes., (© 2022 The Authors. Journal of Esthetic and Restorative Dentistry published by Wiley Periodicals LLC.)

Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Re-osseointegration of an infected/contaminated dental implant poses major clinical challenges. We tested the hypothesis that the application of an antibiotic-releasing construct, combined with hard/soft tissue replacement, increases the efficacy of reconstructive therapy. We initially fabricated semi-flexible hybrid constructs of β-TCP/PHBHHx, with tetracycline (TC) (TC amounts: 5%, 10%, and 15%). Thereafter, using in vitro assays, TC release profile, attachment to rat bone marrow-derived stem cells (rBMSCs) and their viability as well as anti-bacterial activity were determined. Thereafter, regenerative efficacies of the three hybrid constructs were assessed in a rat model of peri-implantitis induced by Aggregatibacter actinomycetemcomitans biofilm; control animals received β-TCP/Bio-Gide and TC injection. Eight weeks later, maxillae were obtained for radiological, histological, and histomorphometric analyses of peri-implant tissues. Sulcus bleeding index was chronologically recorded. Serum cytokines levels of IL-6 and IL-1β were also evaluated by enzyme-linked immunosorbent assay. Substantial amounts of tetracycline, from hybrid constructs, were released for 2 weeks. The medium containing the released tetracycline did not affect the adhesion or viability of rBMSCs; however, it inhibited the proliferation of A. actinomycetemcomitans. Osteogenesis and osseointegration were more marked for the 15% hybrid construct group than the other two groups. The height of attachment and infiltration of inflammatory cells within fibrous tissue was significantly reduced in the experimental groups than the control group. Our protocol resulted in re-osseointegration on a biofilm-contaminated implant. Thus, an antibiotic releasing inorganic/organic construct may offer a therapeutic option to suppress infection and promote guided tissue regeneration thereby serving as an integrated multi-layer substitute for both hard/soft tissues., (© 2022 Wiley Periodicals LLC.)

Objectives: Soft-tissue volume augmentation treatments do not provide the satisfactory long-term functional and esthetic outcomes. The aim of the study was to develop a standardized digital procedure to design individual soft-tissue substitutes (STS) and apply mathematical modeling to obtain average shape STS for single posterior tooth defects., Material and Methods: Thirty-three casts from 30 patients were scanned. STS were designed with a computer-aided design software and a systematic procedure standardized the measurements across all STS using 3D-analysis software. The occlusal, mesial-distal, and buccal-lingual planes were defined to partition, each STS and produce a mesh. The thickness values of each 3D slice were documented in a coordinate system chart to generate a scatter graph. Graphs were embedded into images (Orange software) and images were analyzed via hierarchical clustering., Results: Three STS groups were identified according to shape. Two shapes corresponded to the maxilla defects: a square (n = 13) with dimensions of 10 mm in a lingual-buccal (length) and 7-10 mm in a mesial-distal (width) direction; a rectangle (n = 11) of 11 mm in length and 4-7 mm in width. The average shape for mandible defects (n = 9) was smaller (6-8 mm in length, 5-10 mm in width). The highest thickness in all STS was in the buccal portion, above the alveolar ridge, with median values of 2 mm. The lowest thickness of 0.2 mm was at the edges., Conclusions: The study developed novel methodology to design customized, as well as average shape STS for volume augmentation. Future STS harboring adapted geometry might increase volume augmentation efficiency and accuracy, while reducing surgical time., (© 2021 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd.)