[Clinical decision-making for soft-tissue augmentation in implant therapy in the anterior esthetic zone: selection of connective tissue grafts and soft-tissue substitutes].

The long-term success of implant therapy in the anterior esthetic zone depends not only on osseointegration and implant survival, but also, and more critically, on the sustained stability of peri-implant soft-tissue architecture and esthetic outcomes. Autogenous connective tissue grafting (CTG) currently has the strongest evidence base and offers a high degree of predictability for soft-tissue augmentation. It can effectively increase peri-implant mucosal thickness, improve soft-tissue conditions at sites with a thin gingival phenotype, preserve buccal contour volume, and stabilize the peri-implant mucosal margin. However, its clinical benefits are primarily confined to soft-tissue dimensions and should not be indiscriminately interpreted as providing universal protection against peri-implant marginal bone loss. Moreover, improvements in all esthetic outcome measures cannot be assumed to occur concurrently. Soft-tissue substitutes, particularly collagen matrices, avoid donor-site morbidity and therefore represent clinically valuable alternatives for cases with low-to-moderate esthetic risk and limited soft-tissue deficiencies. Nevertheless, at high-risk sites characterized by a thin gingival phenotype, a high smile line, pronounced buccal contour collapse, or planned immediate implant placement, CTG remains difficult to replace because of its superior augmentation capacity and long-term stability. Clinical decision-making should be guided by a systematic risk assessment that integrates local hard-and soft-tissue conditions, the three-dimensional position of the implant, the transmucosal contour of the prosthetic restoration, and the patient's esthetic expectations. Precise selection of the timing of augmentation, together with the appropriate surgical technique and grafting material, is essential for developing an individualized treatment strategy that balances clinical effectiveness with minimal invasiveness.