Is there any biomaterial substitute for peri-implant soft tissue phenotype modification? A network meta-analysis of the appraisal literature.

Evidence shows that an increased width and thickness of the keratinized mucosa favours peri-implant health. The aim of this network meta-analysis was to compare the clinical effects of alternative biomaterials for peri-implant soft tissue phenotype modification (PSPM) in patients with dental implants when compared to autologous tissue grafts. An electronic search without language or date limitations was performed in four databases and the grey literature for articles published until November 2020. The eligibility criteria included randomized clinical trials (RCTs) evaluating the clinical outcomes of biomaterials for PSPM. A pairwise and network meta-analysis was conducted for each parameter to assess and compare the outcomes between the different treatment arms for the primary and secondary outcomes. A total of 11 RCTs were included in this review. The free gingival graft (FGG) showed the best clinical effect for increasing keratinized mucosa width (KMW). When compared in a network, the FGG demonstrated the best treatment ranking of probability results, followed by connective tissue graft (CTG), acellular dermal matrix (ADM), and xenogeneic collagen matrix (XCM). For the parameters 'mucosa thickness' and 'participant satisfaction with aesthetics', the results were CTG > ADM > XCM and XCM > ADM > CTG, respectively. Autogenous tissue grafts (FGG/CTG) demonstrate the best results in increasing KMW and mucosa thickness when compared to the other biomaterials.

Maxillary sinus floor elevation with simultaneous implant placement without grafting materials: a systematic review and meta-analysis.

The present study aimed to conduct a systematic review and meta-analysis on the effectiveness of maxillary sinus floor elevation and immediate implant installation without the use of grafting material. An electronic search without date or language restriction ​​was performed in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Embase, and the grey literature, to May 2016. Eligibility criteria encompassed prospective and retrospective cohort studies, controlled clinical trials, and randomized clinical trials. The search and selection process yielded 18 studies, published between 2005 and 2016. A meta-analysis was conducted only for experimental studies comparing sinus floor elevation with and without grafting material; results were expressed as the standardized mean difference (SMD) or risk ratio (RR) with the 95% confidence interval (CI). An average gain in bone height of 4.7mm over an average 39.4 month period was observed in the sinus elevated without grafting material. Regarding implants, there was a cumulative average survival rate of 97%. On meta-analysis, bone gain (P=0.98) and implant survival (P=0.13) did not differ significantly between sinuses lifted with or without grafting material, with a SMD of 0.01 (95% CI -0.42 to 0.44) and with a RR of 0.55 (95% CI 0.26 to 1.19), respectively.