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BACKGROUND Interventions to augment the mucosal thickness around dental implants are indicated to optimize aesthetics and maintain peri-implant health. However, there is a lack of clinical data on the long-term performance of soft tissue substitutes (VCMX) compared to autogenous grafts (SCTGs). The aim of the present randomized controlled trial was to assess 5-year data on clinical and radiographic outcomes at implant sites, previously augmented with VCMX or SCTG. METHODS In 20 patients, VCMX or SCTG were randomly assigned for soft tissue augmentation at single implant sites. Following abutment connection, final restorations were inserted (baseline; BL). Patients were re-examined up to 5 years (FU-5). Measurements included: clinical data, marginal bone levels, mucosal thickness and ridge contour changes. Nonparametric tests and estimates were applied for the statistical analysis. RESULTS The median buccal mucosal thickness increased by 0.3mm (Q1:-0.8;Q3:1.0) in group VCMX (p = 0.656) and by 0.3mm (Q1:0.0;Q3:1.0) in group SCTG (p = 0.188) between BL and FU-5 (intergroup p = 0.752). The ridge contour decreased by a median of -0.3mm (-0.9;-0.1)(p = 0.078) for VCMX and of -0.3mm (-0.4;-0.2)(p = 0.039) for SCTG (intergroup p = 0.817) between BL and FU-5. Peri-implant health was maintained in both groups with stable clinical and radiographic outcomes and without significant differences between the treatments. CONCLUSION Despite the limited power and the considerable drop-out rate of the present study, soft tissue augmentation at implant sites either with VCMX or SCTG results in similar stable peri-implant tissues, favorable esthetics and clinically negligible contour changes at 5 years post loading. This article is protected by copyright. All rights reserved.