Tissue integration and vascularization of volume collagen matrices and connective tissue grafts following peri-implant soft tissue augmentation
a secondary histological analysis
DOI:
https://doi.org/10.61872/sdj-2025-02-04PMID:
40329895Keywords:
collagen-based matrix, dental implant, soft tissue augmentation, subepithelial connective tissue graftAbstract
This study aimed to histologically reanalyze tissue integration and vascularization of volume collagen matrices (VCMX) and subepithelial connective tissue grafts (SCTG) at 3 and 4 months following peri-implant soft tissue augmentation. Peri-implant soft tissue augmentation was performed with VCMX or SCTG and biopsies were harvested at 3 and 4 months. Secondary analyses included descriptive histology, blood vessel count and tissue composition [remaining matrix, peri-implant connective tissue containing 3 different components (collagen bundles, elastic connective tissue and loose connective tissue), elastic fibers and background]. A total of 21 samples were analyzed (VCMX: 6/9 biopsies at 3/4 months; SCTG: 6 biopsies at 3 months). Compared to SCTG, VCMX sites displayed fewer and smaller blood vessels within denser tissue. Collagen bundles in VCMX were thicker, whereas SCTG sites displayed a looser tissue structure. The proportion of elastic connective tissue were 22.5% (VCMX/3 months), 32,7% (VCMX/4 months) and 17.4% (SCTG/3 months). Additionally, VCMX samples at 3 months also showed the highest proportion of elastic fibers (10,7%). Peri-implant soft tissue augmentation with VCMX resulted in reduced vascularization but increased tissue density compared to sites augmented with SCTG.
References
1. Giannobile WV, Jung RE, Schwarz F, the Groups of the 2nd Osteology Foundation Consensus Meeting. Evidence-based knowledge on the aes-thetics and maintenance of peri-implant soft tis-sues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation proce-dures on the maintenance of peri-implant soft tissue health. Clin Oral Impl Res. 2018 Mar;29:7–10.
2. Thoma DS, Naenni N, Figuero E, Hämmerle CHF, Schwarz F, Jung RE, et al. Effects of soft tissue augmen-tation procedures on peri-implant health or disease: A systematic review and me-ta-analysis. Clin Oral Implants Res. 2018 Mar;29 Suppl 15:32–49.
3. Burkhardt R, Joss A, Lang NP. Soft tissue dehis-cence coverage around endosseous implants: a prospec-tive cohort study. Clin Oral Implants Res. 2008 May;19(5):451–7.
4. Zucchelli G, Tavelli L, McGuire MK, Rasperini G, Feinberg SE, Wang H, et al. Autogenous soft tis-sue graft-ing for periodontal and peri‐implant plastic surgical reconstruction. Journal of Perio-dontology. 2020 Jan;91(1):9–16.
5. Hämmerle CHF, Jepsen K, Sailer I, Strasding M, Zeltner M, Cordaro L, et al. Efficacy of a collagen matrix for soft tissue augmentation after implant placement compared to connective tissue grafts: A multicenter, nonin-feriority, randomized con-trolled trial. Clinical Oral Implants Res. 2023 Sep;34(9):999–1013.
6. Thoma DS, Strauss FJ, Mancini L, Gasser TJW, Jung RE. Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta‐analysis of patient‐reported outcome measures. Periodontolo-gy 2000. 2023 Feb;91(1):182–98.
7. Cosyn J, Eeckhout C, De Bruyckere T, Eghbali A, Vervaeke S, Younes F, et al. A multi‐centre ran-domized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buc-cal aspect of single implants: 1‐year results. J Clinic Periodontology. 2022 Sep;49(9):911–21.
8. Thoma DS, Zeltner M, Hilbe M, Hämmerle CHF, Hüsler J, Jung RE. Randomized controlled clinical study evaluating effectiveness and safety of a volume-stable collagen matrix compared to au-togenous connective tissue grafts for soft tissue augmentation at implant sites. J Clin Periodontol. 2016;43(10):874–85.
9. Bienz SP, Vaquette C, Ioannidis A, Hämmerle CHF, Jung RE, Ivanovski S, et al. Tissue integra-tion and biodegradation of soft tissue substitutes with and without compression: an experimental study in the rat. Clin Oral Investig. 2023 Jan;27(1):313–28.
10. Bienz SP, Kuonen J, Hüsler J, Gadzo N, Hitz S, Jung RE, et al. Comparison of the Histological Structure of an Anterior as well as a Posterior Biopsy From the Human Palate: A Comparative Study. J Clin Periodontol. 2025 Jan 29;
11. Caballé-Serrano J, Zhang S, Ferrantino L, Simion M, Chappuis V, Bosshardt DD. Tissue Response to a Porous Collagen Matrix Used for Soft Tissue Augmentation. Materials. 2019 Nov 11;12(22):3721.
12. Husseini B, Friedmann A, Wak R, Ghosn N, Senni K, Changotade S, et al. The ‘HAT-TRICK’ tech-nique: A modification of soft tissue grafting using volume stable collagen matrix and cross-linked hyaluronic acid. Part A: The pontic site. Journal of Stomatology, Oral and Maxillofacial Surgery. 2024 Oct;125(5):101754.
13. Cosyn J, Eeckhout C, Christiaens V, Eghbali A, Vervaeke S, Younes F, et al. A multi‐centre ran-domized controlled trial comparing connective tissue graft with collagen matrix to increase soft tissue thickness at the buc-cal aspect of single implants: 3‐month results. J Clinic Periodontolo-gy. 2021 Dec;48(12):1502–15.
14. Reis INR, Sant’Anna LOC, Hayashi M, Galdeano N, Peruzzo D, Strauss FJ, et al. Collagen Matrix for In-creasing Peri-implant Mucosal Thickness in Smokers: A Prospective Case Series. Int J Per-iodontics Restorative Dent. 2024 Jul;1–25.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Rawen Smirani, Franz J. Strauss, Sonja Hitz, Ronald E. Jung, Riccardo Kraus, Daniel S. Thoma
This work is licensed under a Creative Commons Attribution 4.0 International License.
