Comparative Evaluation of Soft Tissue Augmentation Around Dental Implants Using Connective Tissue Grafts Versus Collagen Matrices

Abstract

Background:

Adequate peri-implant soft tissue volume and an adequate WKM are essential for maintaining peri-implant tissue health, enhancing esthetics, and ensuring the long-term success of dental implants. Although autogenous connective tissue grafts (CTGs) remain the gold standard for peri-implant soft tissue augmentation, collagen matrices (CMs) have emerged as a less invasive alternative that reduces patient morbidity by eliminating the need for a donor site.

Aim:

To compare the clinical effectiveness of CTGs and CMs for peri-implant soft tissue augmentation around dental implants

Materials and Methods:

A prospective randomized comparative clinical study was conducted on 40 patients requiring peri-implant soft tissue augmentation. Participants were randomly allocated into two groups: Group A received autogenous CTG (n = 20), while Group B received porcine-derived collagen matrices CM (n = 20). Clinical parameters, including peri-implant mucosal thickness, width of keratinized mucosa (WKM), plaque index (PI), gingival index (GI), probing pocket depth (PPD), and Pink Esthetic Score (PES), were recorded at baseline, 3 months, and 6 months. Postoperative pain was assessed using the Visual Analog Scale (VAS), and patient satisfaction was evaluated at the 6-month follow-up. Statistical analysis was performed using independent-samples t-tests, repeated-measures ANOVA, and the Chi-square test, with statistical significance set at p < 0.05.

Results:

Both treatment modalities produced significant improvements in peri-implant mucosal thickness and WKM from baseline to 6 months (p < 0.001). However, the CTG group demonstrated significantly greater mucosal thickness gain (2.40 ± 0.40 mm vs. 1.80 ± 0.30 mm; p = 0.002) and a significantly greater increase in WKM (2.25 ± 0.48 mm vs. 1.73 ± 0.44 mm; p < 0.001) than the CM group. At 6 months, the CTG group also achieved significantly higher PES (12.60 ± 1.20 vs. 11.40 ± 1.30; p = 0.004). No significant intergroup differences were observed for PI, GI, or PPD at any follow-up interval (p > 0.05). In contrast, patients treated with CM reported significantly lower postoperative pain throughout the first postoperative week (p < 0.001) and demonstrated higher treatment satisfaction at 6 months (70.0% vs. 45.0% very satisfied; p = 0.038).

Conclusion:

Both CTGs and CMs are effective treatment options for peri-implant soft tissue augmentation. CTGs provide superior gains in peri-implant mucosal thickness, WKW, and esthetic outcomes, whereas collagen matrices offer the advantages of reduced postoperative pain, greater patient satisfaction, and avoidance of donor-site surgery. Therefore, CTGs remain the preferred option when maximum soft tissue augmentation and esthetic enhancement are the primary treatment objectives, while CMs represent an effective minimally invasive alternative for patients in whom reduced surgical morbidity and improved postoperative comfort are prioritized.