Impact of soft tissue augmentation procedures on esthetics and patient satisfaction in the treatment of peri‐implant buccal soft tissue dehiscences: A systematic review and meta‐analysis

The aim of this systematic review was to assess the performance of soft tissue augmentation (STA) procedures, with or without a modification of the prosthetic rehabilitation, for the treatment of buccal peri-implant soft tissue dehiscence (PSTD) in terms of esthetics and patient-reported outcomes. A systematic review protocol was developed following the PRISMA checklist. Electronic and hand searches were conducted to identify randomized clinical trials (RCTs) and prospective studies on the treatment of buccal PSTD in implants without peri-implantitis, with a follow-up of at least 6 months. Professional assessment of esthetics and self-reported patient satisfaction were considered the primary outcomes, while clinical variables were considered secondary outcomes. Meta-analysis was carried out when possible using a fixed- or random-effect model. Eight publications reporting on five studies (two RCTs and three prospective studies), published from 2013 to 2024 and including a total of 87 patients, were included in this systematic review. All studies evaluated a coronally advanced flap (CAF) with connective tissue graft (CTG) or substitutes, whereas one arm of an RCT employed a tunnel procedure. Two studies included changing of the prosthetic component. Three studies were rated at low risk of bias. A total of 10 meta-analyses were performed. STA using CAF achieved a final professional esthetic score of 7.7 on a 0-10 scale (95% CI: 6.63; 8.83) and showed improvements in terms of patient-reported esthetics on a 0-100 visual analogue scale (60.8; 95% CI: 46.56; 75.01), with moderate-to-high heterogeneity. The estimated reduction in PSTD depth was 2.2 mm (95% CI: 1.76; 2.69), with an estimated rate of complete PSTD coverage of 71% (95% CI: 59; 82). Based on limited evidence, it can be concluded that STA procedures around implants affected by buccal PSTD appear to positively influence both professional and patient-reported esthetics outcomes.