Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years

Abstract

AIM The aim of the study was to identify and report outcome measures and methods of assessment on soft-tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years. MATERIAL AND METHODS The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and the frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes. RESULTS Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft-tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. CONCLUSION Clinical research on peri-implant soft-tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies.

Influence of healing time on the outcomes of alveolar ridge preservation using a collagenated bovine bone xenograft: A randomized clinical trial

“…Our findings could bring a valuable perspective on the soft tissue dimensional changes that take place after ARP procedures, which seem to differ from those that are typically observed in extraction sites that were left to heal with no further intervention. Also, while other advanced imaging techniques such as ultrasonography, optical coherence tomography, and laser speckle interferometry hold great promise, linear assessments using the superimposition of DICOM‐STL files should be considered a reliable method to evaluate the periodontal/peri‐implant soft tissue phenotype and soft tissue changes over time in different phenotype modification therapies (Avila‐Ortiz et al, 2022 ), due to precision, non‐tissue invasiveness, high reproducibility, and relatively low cost compared with other options (Couso‐Queiruga, Tattan, et al, 2021 ).…”

Comparative histological evaluation of intra‐ and extraorally de‐epithelialized connective tissue graft samples harvested from the posterior palate region

“…Third, no additional local phenotypic (e.g., total palatal tissue thickness) or histomorphometric characteristics (proportion of lamina propria and submucosa) were assessed, mainly because this was outside of the primary scope of this study. Future investigations should further evaluate the efficacy of different and novel intra‐ and extraoral methods, such as Er,Cr:YSG, 48 ER:YAG, 49 or CO2 50 lasers, for de‐epithelization of CTG harvested from different intraoral donor regions, and evaluate the differential effect that these methods have on patient reported outcomes (e.g., level of self‐reported discomfort during the healing period) to identify reliable while minimally invasive CTG harvesting strategies 51 …”

“…Future investigations should further evaluate the efficacy of different and novel intraand extraoral methods, such as Er,Cr:YSG, 48 ER:YAG, 49 or CO2 50 lasers, for de-epithelization of CTG harvested from different intraoral donor regions, and evaluate the differential effect that these methods have on patient reported outcomes (e.g., level of self-reported discomfort during the healing period) to identify reliable while minimally invasive CTG harvesting strategies. 51…”

Relevant domains, core outcome sets and measurements for implant dentistry clinical trials: The Implant Dentistry Core Outcome Set and Measurement (ID‐COSM) international consensus report

“…Five systematic reviews covering the main areas of clinical research in implant dentistry were commissioned to identify the outcomes used in publications from the 10‐year period between 2011 and 2020. The five systematic reviews covered the following topics: (i) single and partial tooth replacement (Sailer et al, 2022), (ii) rehabilitation of full‐arch edentulism (Messias et al, 2022), (iii) prevention and treatment of peri‐implant mucositis and peri‐implantitis (Derks et al, 2022), (iv) soft‐tissue augmentation (STA; Avila‐Ortiz et al, 2022) and (v) bone augmentation (BA) trials (Shi, Montero, et al, 2022). All protocols were registered in PROSPERO.…”