Efficacy of Microneedling-Assisted Gingival Augmentation: A Systematic Review of Six-Month Clinical Outcomes

Background: Microneedling has been investigated as a minimally invasive approach to soft-tissue augmentation, either alone or combined with adjunctive materials or surgical techniques. This systematic review evaluated its clinical benefits in gingival phenotype modification over a minimum follow-up of six months. Materials and Methods: The protocol was registered in PROSPERO (CRD420251124291). PubMed, Web of Science, the Cochrane Library (Trials) and Google Scholar were searched without language restrictions, with the final search completed in July 2026, supplemented by forward and backward citation searching. Two reviewers independently selected studies, extracted data and assessed risk of bias using the Cochrane RoB 2 tool. Primary outcomes were gingival thickness and keratinized tissue width; secondary outcomes were clinical attachment level and plaque index. Findings were synthesized narratively without meta-analysis. Results: Four randomized controlled trials comprising 137 participants were included. Combining microneedling with injectable platelet-rich fibrin (i-PRF) produced greater gingival thickness than either component alone in the respective comparisons. Keratinized tissue width findings were inconsistent, with benefits favoring microneedling combined with a coronally advanced flap or with hyaluronic acid. Three trials were judged to be at low overall risk of bias and one as having some concerns. No pooled effect estimate was calculated. Conclusion: Microneedling-based approaches appear promising for improving soft-tissue thickness over six months, particularly when combined with adjunctive materials. However, small samples and differences in interventions, comparators and tissue types limit firm conclusions about superiority over conventional augmentation. Larger randomized trials with standardized outcomes and longer follow-up are needed.