The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis
OBJECTIVES: In systematically healthy patients with an implant‐supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri‐implant soft tissues on aesthetic outcomes (O)? METHODS: Following an a priori protocol, a literature search of six databases was conducted...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543651/ https://www.ncbi.nlm.nih.gov/pubmed/35763024 http://dx.doi.org/10.1111/clr.13789 |
_version_ | 1784804424939470848 |
---|---|
author | Bienz, Stefan P. Pirc, Miha Papageorgiou, Spyridon N. Jung, Ronald E. Thoma, Daniel S. |
author_facet | Bienz, Stefan P. Pirc, Miha Papageorgiou, Spyridon N. Jung, Ronald E. Thoma, Daniel S. |
author_sort | Bienz, Stefan P. |
collection | PubMed |
description | OBJECTIVES: In systematically healthy patients with an implant‐supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri‐implant soft tissues on aesthetic outcomes (O)? METHODS: Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant‐supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random‐effects meta‐analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence. RESULTS: Thirty‐four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross‐sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow‐up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = −0.24, 0.53]; p = .46). PES changes during the follow‐up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, −0.62 mm (4 studies; [95% CI = −1.06, −0.18]; p = .006). Patient‐reported outcome measures (patient satisfaction) were in favour of thick soft tissues −2.33 (6 studies; [95% CI = −4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non‐randomized studies, high risk of bias and residual confounding. CONCLUSION: Within the limitations of the present study (weak study designs and various soft tissue measurements or time‐points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes. |
format | Online Article Text |
id | pubmed-9543651 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-95436512022-10-14 The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis Bienz, Stefan P. Pirc, Miha Papageorgiou, Spyridon N. Jung, Ronald E. Thoma, Daniel S. Clin Oral Implants Res DGI/SEPA/Osteology Consensus Meeting Peri‐implant Soft Tissues OBJECTIVES: In systematically healthy patients with an implant‐supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri‐implant soft tissues on aesthetic outcomes (O)? METHODS: Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant‐supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random‐effects meta‐analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence. RESULTS: Thirty‐four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross‐sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow‐up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = −0.24, 0.53]; p = .46). PES changes during the follow‐up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, −0.62 mm (4 studies; [95% CI = −1.06, −0.18]; p = .006). Patient‐reported outcome measures (patient satisfaction) were in favour of thick soft tissues −2.33 (6 studies; [95% CI = −4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non‐randomized studies, high risk of bias and residual confounding. CONCLUSION: Within the limitations of the present study (weak study designs and various soft tissue measurements or time‐points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes. John Wiley and Sons Inc. 2022-06-28 2022-06 /pmc/articles/PMC9543651/ /pubmed/35763024 http://dx.doi.org/10.1111/clr.13789 Text en © 2022 The Authors. Clinical Oral Implants Research published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | DGI/SEPA/Osteology Consensus Meeting Peri‐implant Soft Tissues Bienz, Stefan P. Pirc, Miha Papageorgiou, Spyridon N. Jung, Ronald E. Thoma, Daniel S. The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis |
title | The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis |
title_full | The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis |
title_fullStr | The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis |
title_full_unstemmed | The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis |
title_short | The influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: A systematic review and meta‐analysis |
title_sort | influence of thin as compared to thick peri‐implant soft tissues on aesthetic outcomes: a systematic review and meta‐analysis |
topic | DGI/SEPA/Osteology Consensus Meeting Peri‐implant Soft Tissues |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543651/ https://www.ncbi.nlm.nih.gov/pubmed/35763024 http://dx.doi.org/10.1111/clr.13789 |
work_keys_str_mv | AT bienzstefanp theinfluenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT pircmiha theinfluenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT papageorgiouspyridonn theinfluenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT jungronalde theinfluenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT thomadaniels theinfluenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT bienzstefanp influenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT pircmiha influenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT papageorgiouspyridonn influenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT jungronalde influenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis AT thomadaniels influenceofthinascomparedtothickperiimplantsofttissuesonaestheticoutcomesasystematicreviewandmetaanalysis |