Five‐year evaluation of the influence of keratinized mucosa on peri‐implant soft‐tissue health and stability around implants supporting full‐arch mandibular fixed prostheses

Abstract

Background The question of the importance of keratinized mucosa around dental implants for the prevention of peri-implant disease could not be answered in the relevant literature so far. Objective To investigate the influence of peri-implant keratinized mucosa on long-term peri-implant soft-tissue health and stability over a period of 5 years. Material and methods A total of 386 mandibular dental implants were placed in 73 completely edentulous patients, and subsequently restored with fixed full-arch prostheses. At prosthesis delivery (baseline) and after 3, 6, 12, 18, 24, 36, 48 and 60 months, modified plaque index (mPlI), modified sulcus bleeding index (mBI), distance between implant shoulder and mucosal margin (DIM) and width of peri-implant keratinized mucosa (KM) were recorded. Statistical analysis included multivariate logistic regression, multivariate ordinal logistic regression, generalized estimating equations and Bonferroni’s correction. Results Fifty-eight patients with 307 implants completed the 5-year study. Statistically significantly higher plaque accumulation on lingual sites (mean mPlI 0.67, SD 0.85), bleeding tendencies on lingual sites (mean mBI 0.22, SD 0.53) and larger soft-tissue recession on buccal sites (mean DIM − 0.69 mm, SD 1.11 mm) were found when the width of KM was <2 mm, compared to sites with ≥2 mm of KM (mean mPlI 0.40, SD 0.68, P = 0.001; mean mBI 0.13, SD 0.41, P < 0.01; mean DIM − 0.08 mm, SD 0.86 mm, P < 0.001). The width of keratinized mucosa had no effect on bleeding tendency or plaque accumulation on buccal sites (P > 0.05). Conclusion In patients exercising good oral hygiene and receiving regular implant maintenance therapy, implants with a reduced width of < 2 mm of peri-implant keratinized mucosa were more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue recession over a period of 5 years.

Soft Tissue Biology and Management in Implant Dentistry

“…The consensus of opinions expressed by the authors participating in this debate was in general, supportive of the clinical practice of providing a keratinized gingival band around implant restorations where possible and practical. Another recent study reported a 5-year observation provided further data to support that keratinized gingival band of > 2 mm promotes better gingival health around dental implant/restorations (Schrott, Jimenez et al 2009). In a systemic review, Cairo and others concluded that in some clinical situations soft tissue augmentation is warranted (Cairo, Pagliaro et al 2008).…”

Prevalence and Possible Risk Factors of Peri-implantitis: A Concept Review

“…Schrott et al 30 observed that in patients with good hygiene records the presence of at least 2 mm of keratinized mucosa was significant to minimize bleeding and plaque accumulation on the lingual surface and soft tissue recession on the buccal surface of functioning dental implants. Therefore, the authors suggested that, in sites with insufficient keratinized mucosa, special attention should be driven in the maintenance of lingual surfaces and that a higher soft tissue recession should be expected on the buccal surface of dental implants.…”

Taller 4 - Desafíos de la rehabilitación implanto-soportada en la zona estética

“…Delaying implant placement (10) or performing soft tissue grafts and the placement simultaneously is recommended. It is currently believed that an adequate amount of soft tissue helps prevent marginal recession, hide the margins of the restoration and disguise the shadow in the implant platform (11,12) (Figs. 1, 2).…”

“…Se recomienda o diferir la colocación del implante 10 o realizar injertos de tejido blando simultáneamente a su colocación. Actualmente se considera que una cantidad adecuada de tejido blando es útil en la prevención de la recesión marginal, ocultar los márgenes de restauración, y camuflar de la sombra de la plataforma del implante (11,12) (Figs. 1, 2).…”