Background: Tooth loss results in hard- and soft-tissue volume loss over time. We compared the handling of three different soft tissue substitutes (STS) to the subepithelial connective tissue graft (SCTG) for soft tissue volume augmentation in a pig ex vivo model.

Methods: Five dentists simultaneously shaped, placed and sutured randomized four graft types in single-tooth soft tissue defects created in pig mandibles. The STS, produced from slightly crosslinked collagen fibres (VCMX), were either 3 mm or 6 mm thick blocks or a newly developed pre-customized saddle-shape. Each graft type was handled 20 times. The time required for shaping, placement, and suturing was recorded. Dentists reported outcomes on the grafts’ handling were evaluated with a visual-analogue-scale (VAS). Statistical analysis included calculating means and medians and testing significance.

Results: The mean time of 0.72 min for shaping the pre-customized saddle-shape STS was significantly lower than 1.31 min for SCTG, 1.73 min for 3 mm STS and 2.17 min for 6 mm STS. Placement/suturing time was similar for all grafts. The dentists mainly preferred the saddle-shape STS and the SCTG.

Conclusions: The saddle-shape STS required less time for graft-shaping and, therefore, reduced the overall treatment time, suggesting a more efficient and less invasive workflow for soft tissue augmentation.