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Objectives <p>To evaluate the effects of autologous free gingival graft (FGG), xenogeneic collagen matrix (XCM), and acellular dermal matrix (ADM) combined with apically positioned flap (APF) on buccal soft-tissue volume change and keratinized mucosa augmentation around dental implants.</p> Materials and methods <p>Forty-four implants with buccal keratinized mucosa width (KMW) &lt; 2&#xa0;mm were randomly allocated to the FGG group, XCM group, or ADM group. The primary outcome was buccal soft-tissue volume change over a 12-month follow-up. Secondary outcomes included KMW, KMW shrinkage rate, mucosa thickness (MT), and peri-implant soft tissue health. Esthetic outcomes, postoperative pain, and patient satisfaction were further evaluated.</p> Results <p>Net buccal soft-tissue volume change decreased over time in all groups but remained significantly greater in the FGG group throughout follow-up. At 12 months, model-estimated net volume changes were 24.10&#xa0;mm³ (95% CI: 2.69, 45.51) for FGG, 3.34&#xa0;mm³ (− 19.77, 26.45) for XCM, and − 17.34&#xa0;mm³ (− 40.45, 5.77) for ADM (<i>P</i> = 0.041), with FGG significantly exceeding ADM after Bonferroni adjustment. KMW decreased progressively in all groups, with no significant between-group differences at any time point. At 12 months, observed KMW was 2.93 ± 1.29&#xa0;mm (FGG), 2.52 ± 0.51&#xa0;mm (XCM), and 1.86 ± 0.82&#xa0;mm (ADM). Using the immediately postoperative KMW as the reference, the 12-month KMW shrinkage rates were 56.25%, 61.44%, and 74.07%, respectively. FGG showed significantly greater mucosal thickness gain than ADM at 6 and 12 months (<i>P</i> &lt; 0.05), while XCM did not differ significantly from either group. Esthetic outcomes, peri-implant parameters, patient satisfaction, and postoperative pain were comparable among groups (<i>P</i> &gt; 0.05).</p> Conclusions <p>FGG plus APF provided the most favorable maintenance of peri-implant buccal soft-tissue volume and thickness over 12 months. XCM showed intermediate performance, whereas ADM showed the greatest dimensional reduction. All three grafts showed stable peri-implant clinical parameters over 12 months, achieved acceptable esthetic outcomes, and yielded high patient satisfaction.</p> Clinical relevance <p>For peri-implant soft-tissue augmentation with APF, FGG showed better maintenance of buccal soft-tissue volume and thickness than ADM over 12 months, while XCM showed intermediate performance. Graft selection should therefore consider the expected need for long-term dimensional stability.</p> Trial registration <p>This trial was registered in the Chinese Clinical Trial Registry with the registration number ChiCTR2100041688 (<a href="https://www.chictr.org.cn/showproj.html?proj=66722">https://www.chictr.org.cn/showproj.html?proj=66722</a>) on January 1, 2021.</p>

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Clinical outcomes of free gingival graft, xenogeneic collagen matrix, and acellular dermal matrix for peri-implant keratinized mucosa augmentation: a randomized controlled trial

  • 期刊论文

  • 发表日期：

    2026年7月16日

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  • Shaoqing Sun,
  • Wenxi Zhao,
  • Yunqiu Zhang,
  • Zikai Gong,
  • Xingfang Dai,
  • Shengjia Zhang,
  • Zhenghao Hao,
  • Yong Wen

摘要

Objectives

To evaluate the effects of autologous free gingival graft (FGG), xenogeneic collagen matrix (XCM), and acellular dermal matrix (ADM) combined with apically positioned flap (APF) on buccal soft-tissue volume change and keratinized mucosa augmentation around dental implants.

Materials and methods

Forty-four implants with buccal keratinized mucosa width (KMW) < 2 mm were randomly allocated to the FGG group, XCM group, or ADM group. The primary outcome was buccal soft-tissue volume change over a 12-month follow-up. Secondary outcomes included KMW, KMW shrinkage rate, mucosa thickness (MT), and peri-implant soft tissue health. Esthetic outcomes, postoperative pain, and patient satisfaction were further evaluated.

Results

Net buccal soft-tissue volume change decreased over time in all groups but remained significantly greater in the FGG group throughout follow-up. At 12 months, model-estimated net volume changes were 24.10 mm³ (95% CI: 2.69, 45.51) for FGG, 3.34 mm³ (− 19.77, 26.45) for XCM, and − 17.34 mm³ (− 40.45, 5.77) for ADM (P = 0.041), with FGG significantly exceeding ADM after Bonferroni adjustment. KMW decreased progressively in all groups, with no significant between-group differences at any time point. At 12 months, observed KMW was 2.93 ± 1.29 mm (FGG), 2.52 ± 0.51 mm (XCM), and 1.86 ± 0.82 mm (ADM). Using the immediately postoperative KMW as the reference, the 12-month KMW shrinkage rates were 56.25%, 61.44%, and 74.07%, respectively. FGG showed significantly greater mucosal thickness gain than ADM at 6 and 12 months (P < 0.05), while XCM did not differ significantly from either group. Esthetic outcomes, peri-implant parameters, patient satisfaction, and postoperative pain were comparable among groups (P > 0.05).

Conclusions

FGG plus APF provided the most favorable maintenance of peri-implant buccal soft-tissue volume and thickness over 12 months. XCM showed intermediate performance, whereas ADM showed the greatest dimensional reduction. All three grafts showed stable peri-implant clinical parameters over 12 months, achieved acceptable esthetic outcomes, and yielded high patient satisfaction.

Clinical relevance

For peri-implant soft-tissue augmentation with APF, FGG showed better maintenance of buccal soft-tissue volume and thickness than ADM over 12 months, while XCM showed intermediate performance. Graft selection should therefore consider the expected need for long-term dimensional stability.

Trial registration

This trial was registered in the Chinese Clinical Trial Registry with the registration number ChiCTR2100041688 (https://www.chictr.org.cn/showproj.html?proj=66722) on January 1, 2021.