Connective Tissue Graft Under Pontics: Early Gain, Uncertain Long-Term Edge

A connective tissue graft (CTG) under a pontic builds back ridge contour and makes the bridge look like it grows from gum rather than rests on it. The aesthetic gain is rarely disputed; what stays unclear is whether it lasts. This systematic review pooled clinical studies measuring three-dimensional volumetric and linear soft-tissue change at CTG-treated pontic sites, with at least six months of follow-up, drawing on seven databases and assessing bias with RoB 2 and ROBINS-I.

Seven studies met criteria, only two of them randomized. The pattern was consistent: CTG produced clear early improvements in ridge contour and soft-tissue volume. But over time minor dimensional reductions set in, and the gap between grafted and non-grafted sites tended to narrow after the initial remodeling phase. Long-term data, stretching to fifteen years, suggested the outcomes that remained were broadly stable.

The honest conclusion is deflating in a useful way. CTG reliably augments soft tissue at pontic sites early on, but its long-term advantage over simply letting the site heal ungrafted looks limited, and the certainty of evidence is very low — seven studies, mostly non-randomized, methodologically heterogeneous. For the clinician this argues for tempered expectations and informed consent about the durability of the result, not against grafting as such, while better randomized work is awaited.