Effect of the Keratinized Mucosa Width on the Health Status of Periimplant and Contralateral Periodontal Tissues

Ueno, Daisuke; Nagano, Takatoshi; Watanabe, Tsuneaki; Shirakawa, Satoshi; Yashima, Akihiro; Gomi, Kazuhiro

doi:10.1097/id.0000000000000483

Cited by 37 publications

(67 citation statements)

References 32 publications

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“…This agrees with the findings of a recent cross‐sectional comparative study in which implant sites with a KM band width of <2 mm were found to be more prone to brushing discomfort, plaque accumulation and peri‐implant soft tissue inflammation . In contrast, two recent studies failed to support the association between the absence of KM and discomfort during brushing . This is certainly an area of controversy where the patient pain threshold, brushing strength, mucosal thickness and other anatomy‐related factors may play important roles.…”

Section: Discussionsupporting

confidence: 87%

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Significance of keratinized mucosa/gingiva on peri‐implant and adjacent periodontal conditions in erratic maintenance compliers

Monje

Blasi

2018

Journal of Periodontology

143

179

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Background Given the fact that most patients are not regular compliers in supportive peri‐implant maintenance programs, it is of interest to examine the significance of the peri‐implant soft tissue characteristics in relationship to the onset of peri‐implant diseases. Methods Based on an a priori statistical power calculation, a cross‐sectional study was conducted on erratic peri‐implant maintenance compliers (<2 times/year) to examine the significance of keratinized mucosa (KM) and gingival tissue (KT) on peri‐implant and adjacent periodontal conditions in implants restored ≥3 years. Seven clinical parameters were recorded around implants and the adjacent buccal sites. Radiographic assessment was performed using periapical X‐rays. In addition, a visual analog scale (VAS) was used to evaluate the impact of KM upon brushing comfort. The case definition used for peri‐implant diseases was in accordance with the 2017 World Workshop on the classification of periodontal and peri‐implant diseases and conditions. Results Overall, 37 patients with 45 edentulous gaps restored with 66 implants and 90 adjacent teeth were analyzed. On comparing a KM band of <2 mm versus ≥2 mm, with the exception of suppuration (P = 0.6), all the clinical and radiographic parameters were significantly increased when the KM band was <2 mm (P < 0.001). A significant correlation was observed between KM and KT (r = 0.55), though a lack of KM did not condition a lack of KT. In the presence of peri‐implantitis, only bleeding on probing at the adjacent dentate sites was identified to be increased. Conclusions The presence of <2 mm of KM around dental implants in erratic maintenance compliers seems to be associated with peri‐implant diseases. The lack of KM constitutes a site‐specific phenomenon independent of the keratinized tissue present in the adjacent dentition (NCT03501537).

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Section: Discussionsupporting

confidence: 87%

“…A priori statistical power analysis was performed assuming an intra‐class correlation coefficient (ICC) of 0.25, based on a previous study . The Kolmogorov‐Smirnov test was applied to assess normality between the parameters KM and KT.…”

Section: Methodsmentioning

confidence: 99%

Significance of keratinized mucosa/gingiva on peri‐implant and adjacent periodontal conditions in erratic maintenance compliers

Monje

Blasi

2018

Journal of Periodontology

143

179

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“…observed that implant sites with a KM of <2 mm had significantly higher plaque and BOP scores and were associated with an increased brushing discomfort than implant sites with a KM of ≥2 mm . This finding was also supported by data from another cross‐sectional analysis (n = 60 patients) indicating that implants with a KM of <2 mm revealed a significantly higher levels of plaque accumulation as well as increased BOP+ and PD values when compared with implant sites with a KM of ≥2 mm . Canullo et al.…”

Section: Observations and Discussionmentioning

confidence: 64%

Peri‐implantitis

Schwarz

Derks

Monje

et al. 2018

J Clinic Periodontology

600

585

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1)Peri-implantitis is a pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant connective tissue and progressive loss of supporting bone. 2)The histopathologic and clinical conditions leading to the conversion from peri-implant mucositis to peri-implantitis are not completely understood. 3)The onset of peri-implantitis may occur early during follow-up and the disease progresses in a non-linear and accelerating pattern. 4a)Peri-implantitis sites exhibit clinical signs of inflammation and increased probing depths compared to baseline measurements. 4b)At the histologic level, compared to periodontitis sites, peri-implantitis sites often have larger inflammatory lesions. 4c)Surgical entry at peri-implantitis sites often reveals a circumferential pattern of bone loss. 5a)There is strong evidence that there is an increased risk of developing peri-implantitis in patients who have a history of chronic periodontitis, poor plaque control skills, and no regular maintenance care after implant therapy. Data identifying "smoking" and "diabetes" as potential risk factors/indicators for peri-implantitis are inconclusive. 5b)There is some limited evidence linking peri-implantitis to other factors such as: post-restorative presence of submucosal cement, lack of peri-implant keratinized mucosa and positioning of implants that make it difficult to perform oral hygiene and maintenance. 6)Evidence suggests that progressive crestal bone loss around implants in the absence of clinical signs of soft tissue inflammation is a rare event.

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“…Although disagreement exists in the literature, the majority of studies agreed that the absence or lack (<2 mm) of KM was more likely to be associated with increased plaque accumulation, tissue inflammation, recession, attachment loss and reduced quality of self‐performed oral hygiene measures (Gobbato, Avila‐Ortiz, Sohrabi, Wang, & Karimbux, ; Lin et al, ; Ueno et al, ). These findings suggest that the presence of KM should be important not only for maintaining peri‐implant health, but also during surgical therapy of peri‐implantitis and long‐term maintenance.…”

Section: Introductionmentioning

confidence: 99%

Influence of keratinized mucosa on the surgical therapeutical outcomes of peri‐implantitis

Ravidà

Saleh

Siqueira

et al. 2020

J Clinic Periodontology

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Aim To assess the impact of keratinized mucosa (KM) width around dental implants on surgical therapeutic outcomes when treating peri‐implantitis. Material and Methods Surgically treated peri‐implantitis implants were divided into two groups (KM width < 2 mm and ≥2 mm). Retrospective data were obtained after implant placement (T0) and the day of peri‐implantitis surgical treatment (T1). Patients were later recruited (≥1 year after T1) for clinical and radiographic examination (T2). Outcomes were analysed using generalized estimating equation (GEE) models. Results A total of 40 patients (68 implants) (average follow‐up: 52.4 ± 30.5 months) were included in this study. From T0 to T1, no differences were found between KM groups in terms of peri‐implant probing depths (PPD) and bleeding on probing (BOP). However, sites with <2 mm KM exhibited significantly higher suppuration (SUP) and lower marginal bone level (MBL) (p > .01). Between T1 and T2, no major differences were noted on PPD reduction, BOP and MBL changes between the two groups. GEE modelling demonstrated that MBL severity prior to surgical therapy was a better predictor for implant survival than KM width. Conclusion Surgical outcome in treating peri‐implantitis was influenced by the severity of bone loss present at the time of treatment and not by the presence of KM at the time of treatment.

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Effect of the Keratinized Mucosa Width on the Health Status of Periimplant and Contralateral Periodontal Tissues

Abstract: Inadequate keratinized mucosa decreased cleansibility of implant sites and increased mucosal inflammation. There is a possibility that PA in implant sites caused more pronounced inflammatory response compared to contralateral tooth.

Cited by 37 publications

References 32 publications

Significance of keratinized mucosa/gingiva on peri‐implant and adjacent periodontal conditions in erratic maintenance compliers

Significance of keratinized mucosa/gingiva on peri‐implant and adjacent periodontal conditions in erratic maintenance compliers

Peri‐implantitis

Influence of keratinized mucosa on the surgical therapeutical outcomes of peri‐implantitis

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