Clinical Outcomes of Comparing Soft Tissue Alternatives to Free Gingival Graft: A Systematic Review and Meta-Analysis

Irina F Dragan; Lucrezia Paterno Hotlzman; Nadeem Y Karimbux; Rebecca A Morin; Seyed Hossein Bassir

doi:10.1016/j.jebdp.2017.05.008

Clinical Outcomes of Comparing Soft Tissue Alternatives to Free Gingival Graft: A Systematic Review and Meta-Analysis

J Evid Based Dent Pract. 2017 Dec;17(4):370-380.e3. doi: 10.1016/j.jebdp.2017.05.008. Epub 2017 May 26.

Authors

Irina F Dragan¹, Lucrezia Paterno Hotlzman², Nadeem Y Karimbux³, Rebecca A Morin⁴, Seyed Hossein Bassir⁵

Affiliations

¹ Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA, USA. Electronic address: irina.dragan@tufts.edu.
² Department of Periodontology, University of Maryland, Baltimore, MD, USA.
³ Department of Periodontology, Tufts University School of Dental Medicine, Boston, MA, USA.
⁴ Tufts University Hirsh Health Sciences Library, Boston, MA, USA.
⁵ Division of Periodontology, Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.

PMID: 29197438
DOI: 10.1016/j.jebdp.2017.05.008

Abstract

Objectives: This systematic review and meta-analysis aimed to compare clinical outcomes and width of keratinized tissue (KT) around teeth, following the soft tissue alter- natives and free gingival graft (FGG) procedures. The specific graft materials that were explored were extracellular matrix membrane, bilayer collagen membrane, living cellular construct, and acellular dermal matrix.

Methods: Four different databases were queried to identify human controlled clinical trials and randomized controlled clinical trials that fulfilled the eligibility criteria. Relevant studies were identified by 3 independent reviewers, compiling the results of the electronic and handsearches. Studies identified through electronic and handsearches were reviewed by title, abstract, and full text using Covidence Software. Primary outcome in the present study was change in the width of KT. Results of the included studies were pooled to estimate the effect size, expressed as weighted mean differences and 95% confidence interval. A random-effects model was used to perform the meta-analyses.

Results: Six hundred thirty-eight articles were screened by title, 55 articles were screened by abstracts, and 34 full-text articles were reviewed. Data on quantitative changes in width of KT were provided in 7 studies. Quantitative analyses revealed a significant difference in changes in width of KT between patients treated with soft tissue alternatives and patients treated with FGGs (P < .001). The weighted mean difference of changes in the width of KT was 21.39 (95% confidence interval: 21.82 to 20.96; heterogeneity I 5 70.89%), indicating patients who were treated with soft tissue alternatives gained 1.39 mm less KT width compared with the patients who received free gingival graft.

Conclusions: Based on the clinical outcomes, the results of this systematic review and meta-analysis showed that soft tissue alternatives result in an increased width of KT. Patients in the soft tissue alternatives group obtained 1.39 mm less KT compared with those in the FGGs group.

Keywords: Clinical outcomes; Guided tissue regeneration; Meta-analysis; Periodontal tissues/periodontium; Systematic reviews and evidence-based medicine.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Connective Tissue
Gingiva*
Gingivoplasty*
Guided Tissue Regeneration, Periodontal
Humans
Surgical Flaps