The aim of this study was to compare patient-reported outcome measures (PROMs) of soft tissue substitutes versus autogenous grafts for soft tissue augmentation procedures at implant sites. Comprehensive and systematic literature searches were performed until December 2021. A focused question was formulated based on the Population, Intervention, Comparison and Outcome criteria (PICO): In patients with dental implants undergoing soft tissue augmentation (P), do soft tissue substitutes (I) compared to autogenous soft tissue graft (SCTG [subepithelial connective tissue graft]) (C) limit the post-operative morbidity and other patient reported-outcomes measures (O). Randomized controlled clinical trials, prospective-, retrospective- and case-series studies were included. Meta-analyses were performed whenever possible and the results were expressed as weighted mean differences (WMD). A total of 29 clinical studies were included. For mucosal thickness gain, soft tissue substitutes significantly reduced the pain perception compared to SCTG (n = 4; WMD = 14.91 Visual Analog Scale [VAS] units; 95% confidence interval [CI] 6.42-23.40; P < .0006) based on a 0-100 VAS scale. Based on a 0-10 VAS scale, a borderline significance of pain reduction was found when soft tissue substitutes were applied (n = 4; WMD = 1.62 VAS units; 95% CI 0.01-3.23; P = .05). For keratinized tissue gain, soft tissue substitutes significantly reduced the pain perception after keratinized tissue augmentation compared to SCTG based on a 0-100 VAS scale (n = 2; WMD = 21.43 VAS units; 95% CI 12.58-30.28; P < .0001). Based on the 0-10 VAS scale, soft tissue substitutes significantly reduced the pain as compared to SCTG (n = 4; WMD = 1.65 VAS units; 95% CI 0.66-2.64; P = .001). Regarding pain medication, soft tissue substitutes required less painkillers (n = 6; WMD = 1.56 tablets; 95% CI 1.22-1.91; P < .00001) after soft tissue augmentation. The surgery time was significantly reduced when soft tissue substitutes were used (n = 5; WMD = 10.9 minutes; 95% CI 4.60-17.19; P < .00001). There were no significant differences in satisfaction, aesthetics, and quality of life (OHIP-14) between soft tissue substitutes and autogenous grafts following soft tissue augmentation at implants sites. Soft tissue substitutes, compared to autogenous grafts, significantly improve PROMs following soft tissue augmentation at implant sites. Soft tissue substitutes can reduce pain perception, amounts of painkillers and surgery time while achieving similar levels of patient´s satisfaction as autogenous grafts without impairing the clinical outcomes. The current evidence indicates that they constitute a valid and reliable alternative to minimize the invasiveness in soft tissue augmentation procedures at implant sites.

中文翻译：

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牙种植体软组织增量的微创性：对患者报告的结果测量的系统评价和荟萃分析

本研究的目的是比较软组织替代物与自体移植物在植入部位软组织增强手术中的患者报告结果测量 (PROM)。进行了全面系统的文献检索，直至 2021 年 12 月。根据人口、干预、比较和结果标准 (PICO) 制定了一个重点问题：在接受软组织增强 (P) 的种植牙患者中，做软组织替代物 (I) ) 与自体软组织移植物 (SCTG [上皮下结缔组织移植物]) 相比 (C) 限制术后发病率和其他患者报告的结果措施 (O)。包括随机对照临床试验、前瞻性、回顾性和病例系列研究。尽可能进行荟萃分析，结果表示为加权平均差（WMD）。共纳入 29 项临床研究。对于粘膜厚度增加，与 SCTG 相比，软组织替代品显着降低了疼痛感（n = 4；WMD = 14.91 视觉模拟量表 [VAS] 单位；95% 置信区间 [CI] 6.42-23.40；P  < .0006) 基于 0-100 VAS 等级。基于 0-10 VAS 量表，当应用软组织替代品时，发现疼痛减轻具有临界意义（n = 4；WMD = 1.62 VAS 单位；95% CI 0.01-3.23；P = .05 ）  。对于角化组织增益，与基于 0-100 VAS 量表的 SCTG 相比，软组织替代物显着降低了角化组织增强后的疼痛感（n = 2；WMD = 21.43 VAS 单位；95% CI 12.58-30.28；P <  .0001 ). 基于 0-10 VAS 量表，与 SCTG 相比，软组织替代物显着减轻了疼痛（n = 4；WMD = 1.65 VAS 单位；95% CI 0.66-2.64；P = .001 ）  。关于止痛药，软组织替代品需要较少的止痛药（n = 6；WMD = 1.56 片；95% CI 1.22-1.91；P  < .00001) 软组织增强后。使用软组织替代物时，手术时间显着缩短（n = 5；WMD = 10.9 分钟；95% CI 4.60-17.19；P <.00001）。在植入部位软组织增强后，软组织替代物和自体移植物在满意度、美学和生活质量 (OHIP-14) 方面没有显着差异。与自体移植物相比，软组织替代物显着改善植入部位软组织增强后的 PROM。软组织替代物可以减少痛觉、止痛药的用量和手术时间，同时在不损害临床结果的情况下实现与自体移植物相似的患者满意度。目前的证据表明，它们构成了一种有效且可靠的替代方案，可以最大限度地减少植入部位软组织增强手术的侵入性。