{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T13:04:14Z","timestamp":1788786254938,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Camlog Foundation","award":["CF41106"],"award-info":[{"award-number":["CF41106"]}]},{"name":"Camlog Foundation","award":["400164"],"award-info":[{"award-number":["400164"]}]},{"name":"Geistlich Pharma AG","award":["CF41106"],"award-info":[{"award-number":["CF41106"]}]},{"name":"Geistlich Pharma AG","award":["400164"],"award-info":[{"award-number":["400164"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Proper horizontal and vertical thickness of the gingival connective tissue has been proven to be one of the success criteria in dental implant and reconstructive surgery. When thin tissue is found, gingiva augmentation methods can be used to increase the quality and volume of the tissue. Many methods have been described, among them pedicle soft-tissue flaps or autogenic tissue grafts. As an alternative to patients\u2019 own tissue, xenogenic materials can be used for grafting. The fundamental issue is to choose a material that will ensure the maximum therapeutic effect, while also minimizing the negative influence on the patient\u2019s health. The aim of this study was to compare gingival augmentation procedures using a palatal connective tissue graft (CTG) and an xenogenic soft-tissue substitute, Geistlich Mucograft (xenogeneic collagen matrix; CMX), and assess whether the timing of the graft surgery influences the clinical outcomes. The original study was a randomized control trial with a total of 75 implants placed. The patients received the soft-tissue thickening 3 months before the implant placement or 3 months after the implant placement (depending on the group). A connective tissue graft (CTG) or Geistlich Mucograft were used (depending on the group). For both the CTG and Geistlich Mucograft, better clinical outcomes were observed for maintaining the alveolar bone level and the thickness of the attached gingiva compared to the control group with no gingival augmentation. The Geistlich Mucograft showed good clinical performance in comparison to the control. Soft-tissue augmentation with the CTG before the implant placement was found to be most efficient method in terms of a stable increase of the tissue thickness since, throughout the entire observation period, the greatest increase of 1.035 mm (SD = 0.73 mm) in thickness was observed. Statistically important differences in the tissue thickness baseline compared after 5 years were observed for groups G1 vs. G2b (no augmentation vs. CTG before), G1 vs. G3b (no augmentation vs. CTG after) and for groups G2b vs. G3a (CTG before vs. CMX after).<\/jats:p>","DOI":"10.3390\/jcm12030924","type":"journal-article","created":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T04:22:16Z","timestamp":1674620536000},"page":"924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Soft-Tissue Augmentation around Dental Implants with a Connective Tissue Graft (CTG) and Xenogeneic Collagen Matrix (CMX)\u20145-Year Follow-Up"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2353-3198","authenticated-orcid":false,"given":"Jakub","family":"Hadzik","sequence":"first","affiliation":[{"name":"Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroc\u0142aw, 50-367 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"B\u0142aszczyszyn","sequence":"additional","affiliation":[{"name":"Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroc\u0142aw, 50-367 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Gedrange","sequence":"additional","affiliation":[{"name":"Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroc\u0142aw, 50-367 Wroc\u0142aw, Poland"},{"name":"Department of Orthodontics, TU Dresden, 01069 Dresden, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzena","family":"Dominiak","sequence":"additional","affiliation":[{"name":"Department of Dental Surgery, Faculty of Medicine and Dentistry, Medical University of Wroc\u0142aw, 50-367 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,24]]},"reference":[{"key":"ref_1","first-page":"712","article-title":"The influence of soft tissue thickness on crestal bone changes around implants: A 1-year prospective controlled clinical trial","volume":"24","author":"Linkevicius","year":"2009","journal-title":"Int. J. Oral Maxillofac. Implant."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"640","DOI":"10.4103\/0972-124X.168489","article-title":"The influence of soft tissue biotype on the marginal bone changes around dental implants: A 1-year prospective clinico-radiological study","volume":"19","author":"Bhat","year":"2015","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Lissek, M., Boeker, M., and Happe, A. (2020). How thick is the oral mucosa around implants after augmentation with different materials: A systematic review of the effectiveness of substitute matrices in comparison to connective tissue grafts. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21145043"},{"key":"ref_4","first-page":"415","article-title":"Modified roll technique for localized alveolar ridge augmentation","volume":"12","author":"Scharf","year":"1992","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/0022-3913(80)90090-6","article-title":"The subepithelial connective tissue graft","volume":"44","author":"Langer","year":"1980","journal-title":"J. Prosthet. Dent."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"151484","DOI":"10.1016\/j.aanat.2020.151484","article-title":"Soft tissue augmentation around dental implants with connective tissue graft (CTG) and xenogenic collagen matrix (XCM). 1-year randomized control trail","volume":"230","author":"Puzio","year":"2020","journal-title":"Ann. Anat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.aanat.2017.11.003","article-title":"Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix\u20141-year randomised follow-up","volume":"217","author":"Puzio","year":"2018","journal-title":"Ann. Anat."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1111\/jcpe.12535","article-title":"Peri-implantitis\u2014Onset and pattern of progression","volume":"43","author":"Derks","year":"2016","journal-title":"J. Clin. Periodontol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1002\/JPER.19-0032","article-title":"Effect of gingival augmentation procedure (free gingival graft) on reducing the risk of non-carious cervical lesions: A 25- to 30-year follow-up study","volume":"90","author":"Agudio","year":"2019","journal-title":"J. Periodontol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1002\/cre2.395","article-title":"Root coverage stability: A systematic overview of controlled clinical trials with at least 5 years of follow-up","volume":"7","author":"Bertl","year":"2021","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/j.1600-051X.2008.01275.x","article-title":"Peri-implant diseases: Diagnosis and risk indicators","volume":"35","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.aanat.2017.05.008","article-title":"Comparative evaluation of the effectiveness of the implantation in the lateral part of the mandible between short tissue level (TE) and bone level (BL) implant systems","volume":"213","author":"Hadzik","year":"2017","journal-title":"Ann. Anat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1007\/s00784-016-1815-2","article-title":"Soft tissue augmentation procedures at second-stage surgery: A systematic review","volume":"20","author":"Bassetti","year":"2016","journal-title":"Clin. Oral Investig."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1111\/j.1600-051X.2008.01283.x","article-title":"Peri-implant diseases: Consensus Report of the Sixth European Workshop on Periodontology","volume":"35","author":"Lindhe","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/clr.12703","article-title":"The influence of peri-implant keratinized mucosa on brushing discomfort and peri-implant tissue health","volume":"27","author":"Souza","year":"2016","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1016\/j.ijom.2017.02.1274","article-title":"Quality assessment of systematic reviews of the significance of keratinized mucosa on implant health","volume":"46","author":"Moraschini","year":"2017","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Hadzik, J., Kubasiewicz-Ross, P., Nawrot-Hadzik, I., Gedrange, T., Pitu\u0142aj, A., and Dominiak, M. (2021). Short (6 mm) and Regular Dental Implants in the Posterior Maxilla-7-Years Follow-up Study. J. Clin. Med., 10.","DOI":"10.3390\/jcm10050940"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1002\/JPER.21-0212","article-title":"Comparison of two types of xenogeneic matrices to treat single gingival recessions: A randomized clinical trial","volume":"93","author":"Santamaria","year":"2022","journal-title":"J. Periodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1111\/jcpe.13518","article-title":"Clinical evaluation of xenogeneic collagen matrix versus free gingival grafts for keratinized mucosa augmentation around dental implants: A randomized controlled clinical trial","volume":"48","author":"Huang","year":"2021","journal-title":"J. Clin. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1007\/s00784-020-03321-5","article-title":"Clinical efficacy of xenogeneic collagen matrix in augmenting keratinized mucosa round dental implants: A systematic review and meta-analysis","volume":"24","author":"Moraschini","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1111\/clr.12575","article-title":"Long-term outcomes after vestibuloplasty with a porcine collagen matrix (Mucograft\u00ae) versus the free gingival graft: A comparative prospective clinical trial","volume":"27","author":"Schmitt","year":"2016","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e28","DOI":"10.1111\/clr.12324","article-title":"Marginal bone loss as success criterion in implant dentistry: Beyond 2 mm","volume":"26","author":"Monje","year":"2015","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"209","DOI":"10.5051\/jpis.1904440222","article-title":"Influence of implant mucosal thickness on early bone loss: A systematic review with meta-analysis","volume":"50","author":"Valente","year":"2020","journal-title":"J. Periodontal Implant. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1111\/prd.12168","article-title":"Screw retained vs. cement retained implant-supported fixed dental prosthesis","volume":"73","author":"Wittneben","year":"2017","journal-title":"Periodontol. 2000"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1600-0501.2012.02538.x","article-title":"Cemented and screw-retained implant reconstructions: A systematic review of the survival and complication rates","volume":"23","author":"Sailer","year":"2012","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/prd.12335","article-title":"Breaking the wave of peri-implantitis","volume":"84","author":"Fu","year":"2020","journal-title":"Periodontol. 2000"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"475","DOI":"10.17219\/dmp\/150111","article-title":"Role of implant loading time in the prevention of marginal bone loss after implant-supported restorations: A targeted review","volume":"59","author":"Krawiec","year":"2022","journal-title":"Dent. Med. Probl."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/clr.13737","article-title":"Short communication: Cemented implant reconstructions are associated with less marginal bone loss than screw-retained reconstructions at 3 and 5 years of loading","volume":"32","author":"Strauss","year":"2021","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1902\/jop.2016.150571","article-title":"Influence of Soft Tissue Thickness on Peri-Implant Marginal Bone Loss: A Systematic Review and Meta-Analysis","volume":"87","author":"Lin","year":"2016","journal-title":"J. Periodontol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/clr.12301","article-title":"The influence of mucosal tissue thickening on crestal bone stability around bone-level implants. A prospective controlled clinical trial","volume":"26","author":"Puisys","year":"2015","journal-title":"Clin. Oral Implant. Res."},{"key":"ref_31","first-page":"27","article-title":"Connective tissue grafts for thickening peri-implant tissues at implant placement. One-year results from an explanatory split-mouth randomised controlled clinical trial","volume":"3","author":"Wiesner","year":"2010","journal-title":"Eur. J. Oral Implantol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.1111\/jcpe.12369","article-title":"Primary prevention of peri-implantitis: Managing peri-implant mucositis","volume":"42","author":"Jepsen","year":"2015","journal-title":"J. Clin. Periodontol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Hadzik, J., Kubasiewicz-Ross, P., G\u0119barowski, T., Waloszczyk, N., Maciej, A., Stolarczyk, A., Gedrange, T., Dominiak, M., Szajna, E., and Simka, W. (2023). An Experimental Anodized Titanium Surface for Transgingival Dental Implant Elements&mdash;Preliminary Report. J. Funct. Biomater., 14.","DOI":"10.3390\/jfb14010034"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Kulakov, A., Kogan, E., Brailovskaya, T., Vedyaeva, A., Zharkov, N., Krasilnikova, O., Krasheninnikov, M., Baranovskii, D., Rasulov, T., and Klabukov, I. (2021). Mesenchymal stromal cells enhance vascularization and epithelialization within 7 days after gingival augmentation with collagen matrices in rabbits. Dent. J., 9.","DOI":"10.3390\/dj9090101"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1186\/s40729-021-00356-5","article-title":"Patient-reported outcome measures and clinical outcomes following peri-implant vestibuloplasty with a free gingival graft versus xenogeneic collagen matrix: A comparative prospective clinical study","volume":"7","author":"Fu","year":"2021","journal-title":"Int. J. Implant Dent."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/924\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:15:03Z","timestamp":1760120103000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,24]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12030924"],"URL":"https:\/\/doi.org\/10.3390\/jcm12030924","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,24]]}}}