Non-Cochrane · intervention · PM41332230
Comparative outcomes of xenogeneic collagen matrices and autogenous graft-based techniques to increase mucosal thickness and keratinised mucosa width at implant sites: are autologous grafts still the gold standard? A systematic review and meta-analysis of randomised clinical trials.
Ríos-Osorio Néstor, Orozco-Agudelo Mangriveth, Cespedes-Moreno Iván, et al. · Journal of periodontal & implant science · 2026 · PubMed · doi:10.5051/jpis.2500260013
Findings
4 findings
| Population | ||||
|---|---|---|---|---|
| Systemically healthy patients with peri-implant mucosal thickness deficiency (MT <2 mm) undergoing soft tissue augmentation | Xenogeneic collagen matrices (XCM*, non-crosslinked, and VCMX, crosslinked) with bilaminar technique | Subepithelial connective tissue graft (CTG) with bilaminar technique | Increase in buccal mucosal thickness (MT), mm 3 months · Dental implant sites, peri-implant soft tissue augmentation · Overall (XCM* and VCMX pooled) | MD 0.27 [0.12, 0.42] GRADE not reported 9 studies · 294 participants |
| Systemically healthy patients with peri-implant mucosal thickness deficiency (MT <2 mm) undergoing soft tissue augmentation | Crosslinked xenogeneic collagen matrix (VCMX, Fibro-Gide) with bilaminar technique | Subepithelial connective tissue graft (CTG) with bilaminar technique | Increase in buccal mucosal thickness (MT), mm 3 months · Dental implant sites, peri-implant soft tissue augmentation · Subgroup: VCMX vs CTG | MD 0.02 [-0.17, 0.22] GRADE not reported 4 studies · 142 participants |
| Systemically healthy patients with peri-implant mucosal thickness deficiency (MT <2 mm) undergoing soft tissue augmentation | Non-crosslinked xenogeneic collagen matrix (XCM*) with bilaminar technique | Subepithelial connective tissue graft (CTG) with bilaminar technique | Increase in buccal mucosal thickness (MT), mm 3 months · Dental implant sites, peri-implant soft tissue augmentation · Subgroup: XCM* vs CTG | MD 0.27 [0.05, 0.49] GRADE not reported 5 studies · 152 participants |
| Systemically healthy patients with peri-implant keratinized mucosa width deficiency (KMW <2 mm) undergoing soft tissue augmentation | Non-crosslinked xenogeneic collagen matrix (XCM*) with apically repositioned flap | Free gingival graft (FGG) with apically repositioned flap | Increase in buccal keratinized mucosa width (KMW), mm 6 months · Dental implant sites, peri-implant soft tissue augmentation · Overall (XCM* vs FGG) | MD 1.47 [0.63, 2.3] GRADE not reported 5 studies · 179 participants |
Included primary studies 33
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Cairo 2017 Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled… DOI:10.1111/jcpe.12750 | 2017 | 2 other reviews | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Clem 2024 Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter… DOI:10.1002/jper.23-0305 | 2023 | 2 other reviews | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Hamdy 2024 Volumetric assessment of volume stable collagen matrix in maxillary single implant site development: A randomized controlled clinical trial DOI:10.1111/cid.13353 | 2024 | 2 other reviews | not stated | not extracted yet |
| Cairo 2017 Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue augmentation at implant site. A randomized, controlled… PMID:28548210 | 2017 | 1 other review | not stated | not extracted yet |
| Clem 2024 Harvest graft substitute for soft tissue volume augmentation around existing implants: A randomized, controlled and blinded multicenter… PMID:38071454 | 2024 | 1 other review | not stated | not extracted yet |
| Hamdy 2024 Volumetric assessment of volume stable collagen matrix in maxillary single implant site development: A randomized controlled clinical trial. PMID:38938060 | 2024 | 1 other review | not stated | not extracted yet |
| Huang 2021 Clinical evaluation of xenogeneic collagen matrix versus free gingival grafts for keratinized mucosa augmentation around dental implants:… DOI:10.1111/jcpe.13518 | 2021 | 1 other review | Increase in buccal keratinized mucosa width (KMW), mm | not extracted yet |
| Puzio 2018 Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic… DOI:10.1016/j.aanat.2017.11.003 | 2018 | 1 other review | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Puzio 2018 Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic… PMID:29248711 | 2018 | 1 other review | not stated | not extracted yet |
| Qiu 2023 Xenogeneic collagen matrix versus free gingival graft for augmenting keratinized mucosa around posterior mandibular implants: a randomized… DOI:10.1007/s00784-022-04853-8 | 2023 | 1 other review | Increase in buccal keratinized mucosa width (KMW), mm | not extracted yet |
| Ramanauskaite 2023 Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of… DOI:10.1186/s40729-023-00482-2 | 2023 | 1 other review | Increase in buccal keratinized mucosa width (KMW), mm | not extracted yet |
| Tarasenko 2020 DOI:10.3290/j.qi.a44216 | NR | 1 other review | Increase in buccal keratinized mucosa width (KMW), mm | not extracted yet |
| Ashurko 2022 Connective tissue graft versus xenogeneic collagen matrix for soft tissue augmentation at implant sites: a randomized-controlled clinical… DOI:10.1007/s00784-022-04680-x | 2022 | this review only | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Ashurko 2022 Connective tissue graft versus xenogeneic collagen matrix for soft tissue augmentation at implant sites: a randomized-controlled clinical… PMID:36029335 | 2022 | this review only | not stated | not extracted yet |
| Cosyn 2021 A multi‐centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the… DOI:10.1111/jcpe.13560 | 2021 | this review only | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Cosyn 2021 A multi-centre randomized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the… PMID:34605057 | 2021 | this review only | not stated | not extracted yet |
| Hadzik 2023 Soft-Tissue Augmentation around Dental Implants with a Connective Tissue Graft (CTG) and Xenogeneic Collagen Matrix (CMX)—5-Year Follow-Up DOI:10.3390/jcm12030924 | 2023 | this review only | not stated | not extracted yet |
| Hadzik 2023 Soft-Tissue Augmentation around Dental Implants with a Connective Tissue Graft (CTG) and Xenogeneic Collagen Matrix (CMX)-5-Year Follow-Up. PMID:36769572 | 2023 | this review only | not stated | not extracted yet |
| Hammerle 2023 Efficacy of a collagen matrix for soft tissue augmentation after implant placement compared to connective tissue grafts: A multicenter,… DOI:10.1111/clr.14127 | 2023 | this review only | not stated | not extracted yet |
| Hammerle 2023 Efficacy of a collagen matrix for soft tissue augmentation after implant placement compared to connective tissue grafts: A multicenter,… PMID:37403575 | 2023 | this review only | not stated | not extracted yet |
| Helio 2019 (Monteiro) matched by author and year (probable) | NR | this review only | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Huang 2021 Clinical evaluation of xenogeneic collagen matrix versus free gingival grafts for keratinized mucosa augmentation around dental implants:… PMID:34219259 | 2021 | this review only | not stated | not extracted yet |
| Monteiro 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Qiu 2023 Xenogeneic collagen matrix versus free gingival graft for augmenting keratinized mucosa around posterior mandibular implants: a randomized… PMID:36637519 | 2023 | this review only | not stated | not extracted yet |
| Schmitt 2021 Volumetric soft tissue alterations in the early healing phase after peri‐ implant soft tissue contour augmentation with a porcine collagen… DOI:10.1111/jcpe.13387 | 2020 | this review only | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Schmitt 2021 Volumetric soft tissue alterations in the early healing phase after peri- implant soft tissue contour augmentation with a porcine collagen… PMID:33047372 | 2021 | this review only | not stated | not extracted yet |
| Solonko 2022 Efficacy of keratinized mucosal augmentation with a collagen matrix concomitant to the surgical treatment of peri‐implantitis: A… DOI:10.1111/clr.13870 | 2021 | this review only | Increase in buccal keratinized mucosa width (KMW), mm | not extracted yet |
| Solonko 2022 Efficacy of keratinized mucosal augmentation with a collagen matrix concomitant to the surgical treatment of peri-implantitis: A… PMID:34651349 | 2022 | this review only | not stated | not extracted yet |
| Tarasenko 2020 Comparative analysis of methods to increase the amount of keratinized mucosa before stage-two surgery: a randomized controlled study. PMID:32159530 | 2020 | this review only | not stated | not extracted yet |
| Thoma 2016 Randomized controlled clinical study evaluating effectiveness and safety of a volume‐stable collagen matrix compared to autogenous… DOI:10.1111/jcpe.12588 | 2016 | this review only | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Thoma 2016 Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to autogenous… PMID:27310522 | 2016 | this review only | not stated | not extracted yet |
| Zeltner 2017 Randomized controlled clinical study comparing a volume‐stable collagen matrix to autogenous connective tissue grafts for soft tissue… DOI:10.1111/jcpe.12697 | 2017 | this review only | Increase in buccal mucosal thickness (MT), mm | not extracted yet |
| Zeltner 2017 Randomized controlled clinical study comparing a volume-stable collagen matrix to autogenous connective tissue grafts for soft tissue… PMID:28107560 | 2017 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Systemically healthy patients with peri-implant mucosal deficiencies (MT <2 mm and/or KMW <2 mm) undergoing soft tissue grafting | 496 patients and 534 implants (XCMs vs CTG, 12 RCTs); 195 patients and 251 implants (XCM* vs FGG, 5 RCTs) |
| Intervention | Xenogeneic collagen matrix (non-crosslinked XCM* or crosslinked VCMX) with bilaminar technique or apically repositioned flap | XCM* (Mucograft, Mucoderm, FibroMATRIX) and VCMX (Fibro-Gide) |
| Comparison | Subepithelial connective tissue graft (CTG) for MT; free gingival graft (FGG) with apically repositioned flap for KMW | Subepithelial CTG (12 RCTs); FGG with apically repositioned flap (5 RCTs) |
| Outcomes | Primary: increase in peri-implant MT and KMW; secondary: plaque index, bleeding index, probing depth, marginal bone levels, surgical time, aesthetics, patient-reported outcomes | MT increase at 3 months (9 RCTs in meta-analysis); KMW increase at 6 months (5 RCTs in meta-analysis); secondary outcomes narratively |
| Study designs | RCTs with 2 parallel arms (XCMs vs CTG and/or XCM* vs FGG) | 17 RCTs in qualitative synthesis (n=17); 14 in meta-analysis (n=14) |
| Timing | Minimum follow-up 3 months | 3 to 60 months follow-up; meta-analyses at 3 months (MT) and 6 months (KMW) |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Yes | Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Low | Low | yes |