Peri-implant soft tissue augmentation. Proper timing and surgical procedure for predictable surgical outcomes. A bibliographic review

Resumen

The role that the width of keratinized mucosa (KM) surrounding dental implants plays in the long-term stability of periimplant tissues remains a topic for debate. The aim of this review is to evaluate and describe the outcomes of available surgical procedures and the proper timing for augmenting peri-implant soft tissue. A bibliographic search was conducted on the online PubMed and Medline databases, as well as a manual search for relevant articles comprising the period between 2012 and 2017, selecting for articles dealing with the various surgical procedures performed starting at time B (implant placement). A total of 10 articles was selected, contrasting them in terms of the moment in time at which the surgical procedure was performed while analyzing the following study variables: keratinized mucosa width, keratinized mucosa thickness, postoperative contraction, surgical timing, and aesthetic outcome and postoperative discomfort. The conclusion may be drawn that free gingival grafting has been shown to result in the greatest widths of keratinized mucosa. However, there are other materials available that reduce patient morbidity and eliminate the need for a second surgical site, such as a xenogeneic collagen matrix, which can be equally effective and predictable in outcome. Both a xenogeneic collagen matrix and connective tissue grafting offer superior aesthetic results to those achieved with free gingival grafting.