Impact of peri‐implant soft tissue characteristics on health and esthetics

Abstract

Objective: To review the impact of key peri-implant soft tissue characteristics on health and esthetics.Main Considerations: The keratinized mucosa width (KMW), the mucosal thickness (MT), and the supracrestal tissue height (STH) are essential components of the peri-implant soft tissue phenotype. An inadequate KMW (<2 mm) has been associated with local discomfort upon oral hygiene performance and increased risk for the onset of peri-implant diseases. A minimum buccal MT (≥2 mm) is generally required to prevent esthetic issues related to the effect of transmucosal prosthetic elements on the color of the mucosa and can also contribute to long-term mucosal stability. STH is directly related to marginal bone remodeling patterns during the early healing process that follows the connection of transmucosal prosthetic components. Short STH, generally defined as <3 mm, has been consistently associated with marginal bone loss resulting from the physiologic establishment of the mucosal seal. Insufficient STH may also derive into the fabrication of unfavorable transmucosal prosthetic contours, which frequently results in unpleasing esthetic outcomes and predisposes to submarginal biofilm accumulation. Peri-implant soft tissue dehiscences (PISTDs) are a type of peri-implant deformity that are associated with esthetic issues and often occur in sites presenting KMW, MT, and/or STH deficiencies. PISTDs should be correctly diagnosed and treated accordingly, usually by means of multidisciplinary therapy. Conclusion:Understanding the impact of different dimensional and morphologic features of the peri-implant mucosa on health and esthetic outcomes is fundamental to make appropriate clinical decisions in the context of tooth replacement therapy with implant-supported prostheses.

How do the dimensions of peri‐implant mucosa affect marginal bone loss in equicrestal and subcrestal position of implants? A 1‐year clinical trial

“…Recent publications have determined peri-implant soft-tissue phenotype to be one of the factors that contribute to the maintenance of peri-implant health and stability of peri-implant marginal bone over time. 7,[15][16][17] There are three components of peri-implant soft-tissue phenotype: keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). 7 According to the current literature, lacking a keratinized mucosa band or a KMW of <2 mm are predisposing factors for peri-implant diseases and apical migration of the mucosal margin in patients with poor plaque control (having <2 mm of keratinized mucosa causes the patient more discomfort when practicing oral hygiene).…”

“…7 According to the current literature, lacking a keratinized mucosa band or a KMW of <2 mm are predisposing factors for peri-implant diseases and apical migration of the mucosal margin in patients with poor plaque control (having <2 mm of keratinized mucosa causes the patient more discomfort when practicing oral hygiene). 17,18 MT is particularly important, especially in the coronal region close to the mucosal margin. A minimum of 2 mm is needed to achieve positive esthetic results, as >2 mm of mucosa prevents discoloration by the restorative material.…”

“…7,19 However, while the presence of thick mucosa seems to have a benefit on peri-implant health, its role in maintaining marginal bone, preventing the accumulation of biofilm and other parameters is not yet clear. 17 Finally, STH appears to be related to marginal bone loss: the literature has shown that implants placed in a site with short STH (<2 mm) exhibit more marginal bone loss due to physiologic STH establishment. 20,21 At present, the most widely accepted threshold for defining STH as thin is <3 mm.…”

Effects of socket‐shield therapy on inter‐implant papilla preservation between upper central and lateral incisors: A case series with 3–5 year follow‐up

“…4,5 Various factors, including the bone level of the adjacent tooth, the vertical distance from the contact point to the ridge crest, soft tissue phenotype, keratinized gingiva, surgical procedure, provisionalization protocol, and abutment crown shape influence the dimensions of peri-implant papillae. [6][7][8][9][10][11][12][13][14] In cases involving early and immediate implants, it is common for the distal papilla to exhibit greater insufficiency and lower PES compared to the mesial papilla. 2,15,16 Thus, despite favorable soft tissue cosmetic outcomes around single central incisor implants, papillary insufficiency on the distal aspect can result in detectable esthetic imperfection.…”

“…The lack of complete papilla filling in the embrasure space in the esthetic zone can raise concerns, potentially jeopardizing cosmetic results 4,5 . Various factors, including the bone level of the adjacent tooth, the vertical distance from the contact point to the ridge crest, soft tissue phenotype, keratinized gingiva, surgical procedure, provisionalization protocol, and abutment crown shape influence the dimensions of peri‐implant papillae 6–14 …”