Peri‐implant marginal mucosa defects: Classification and clinical management

Abstract

Peri-implant marginal mucosa defects (PMMDs) are alterations of the periimplant soft tissue architecture characterized by an apical discrepancy of the mucosal margin respective to its ideal position with or without exposure of transmucosal prosthetic components or the implant fixture surface. PMMDs may not only represent an esthetic concern but also predispose to biofilm accumulation and subsequent initiation and progression of peri-implant inflammatory diseases. A treatment-driven classification for tooth-bound, facial PMMDs in nonmolar sites, consisting of three different levels of complexity, is proposed. Clinical recommendations pertaining to the prosthetic and surgical management of each type of PMMD, illustrated with practical examples, are provided with the purpose of facilitating decision-making processes in daily practice. K E Y W O R D Sclinical decision-making, dental implant, oral mucosa, plastic surgery PERI-IMPLANT SOFT TISSUE DEFORMITIESDeformity is a congenital or acquired alteration of the normal shape, size or alignment of a biological structure. Deficiencies and defects are specific types of deformities. Deficiency is an insufficient or inadequate amount of a necessary constituent. Defects are dysmorphic abnormalities associated with structural alterations.Thus, peri-implant soft tissue deficiencies and defects can be categorized into three distinct groups: A. Keratinized mucosa width deficienciesPeri-implant keratinized mucosa width

Knowledge, awareness, and perception of dental students, interns, and freshly graduated dentists regarding dental implant complications in Saudi Arabia: a web-based anonymous survey

“…In our study, participants responded similarly that loss of the interdental papilla, gingival recession, exposure of the implant margin and a poor emergence profile are the most common aesthetic complications associated with dental implants. Recent studies in the literature have reported aesthetic complications, revealing that between 4 and 16% of single implant crowns in the anterior maxilla fail for aesthetic reasons [48][49][50]. The most common aesthetic complication is gingival recession exposing the implant/abutment junction, with one study reporting up to 61% of cases with at least 1 mm of gingival recession on the facial aspect.…”

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

“…These deformities have been defined as alterations of the peri-implant soft tissue morphology characterized by an apical discrepancy of the mucosal margin respective to its ideal position with or without exposure of transmucosal prosthetic components or the implant fixture surface. 73 On the other hand, gingival recession defects (GRDs) are defined periodontal deformities characterized by an apical migration of the gingival margin respective to the cementoenamel junction (CEJ) resulting in partial exposure of the root surface to the oral cavity, which may have important esthetic, functional, and periodontal health implications. 74 In the natural dentition, GRDs are assessed by determining the relative position of the gingival margin respective to the cementoenamel junction (CEJ).…”

“…Proper management of these defects can be very challenging and may require a purely surgical 77,78 or, in most situations, a combined multidisciplinary approach, including surgical, prosthetic, and even orthodontic therapy. 73,79 7 | FINAL REMARKS…”

“…Peri‐implant soft tissues dehiscences (PISTDs), also known as peri‐implant marginal mucosa defects, are a type of clinical entity that deserves special attention given its correlation with the peri‐implant soft tissue phenotype. These deformities have been defined as alterations of the peri‐implant soft tissue morphology characterized by an apical discrepancy of the mucosal margin respective to its ideal position with or without exposure of transmucosal prosthetic components or the implant fixture surface 73 …”

“…Treatment of PISTDs primarily aims at recreating an adequate peri‐implant mucosa architecture considering all the phenotypical components previously addressed in this review (i.e., KMW, MT, and STH). Proper management of these defects can be very challenging and may require a purely surgical 77,78 or, in most situations, a combined multidisciplinary approach, including surgical, prosthetic, and even orthodontic therapy 73,79 …”