Soft tissue features of peri‐implant diseases and related treatment

Abstract

Background The need for soft tissue grafting at implant sites for preventing and treating peri‐implant diseases is a currently investigated and debated topic. Purpose The aim of this manuscript is to explore the inflammatory mechanisms at the peri‐implant soft tissue compartment, to distinguish the structural components of the peri‐implant soft tissue phenotype and their role on peri‐implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri‐implant diseased sites. Materials and Methods This narrative review depicts the inflammatory biomarkers and mediators in the peri‐implant crevicular fluid utilized to diagnose peri‐implant disease and that have been shown to be associated with peri‐implant soft tissue phenotype modification and disease resolution. The impact of the peri‐implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri‐implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri‐implant health/disease and the evaluation of the treatment outcomes following surgical therapies. Results Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri‐implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri‐implant mucositis or peri‐implantitis are presented and discussed in detail. Conclusions Soft tissue grafting can be beneficial in preventing and treating peri‐implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard‐ and soft‐tissue‐oriented treatment of peri‐implant disease.

Coronally advanced flap versus tunnel technique for the treatment of peri‐implant soft tissue dehiscences with the connective tissue graft: A randomized, controlled clinical trial

“…The intra‐examiner reproducibility was 0.89 for PSTD depth and 0.92 KMW. The clinical measurements of interest included the following: PSTD depth: corono‐apical distance between the peri‐implant soft tissue margin and the cemento‐enamel junction (CEJ) of the homologous contralateral tooth (Zucchelli et al, 2019; Zucchelli, Mazzotti, Mounssif, Mele, et al, 2013); PD: measured from the soft tissue margin to the base of the peri‐implant sulcus; Clinical attachment level (CAL): obtained by adding PD to PSTD depth; KMW: corono‐apical width/height measured from the soft tissue margin to the muco‐gingival junction (Zucchelli, Mazzotti, Mounssif, Mele, et al, 2013); AMW: obtained by calculating the difference between KMW and PD (Galarraga‐Vinueza & Tavelli, 2022; Grischke et al, 2019; McGuire et al, 2011). Readers should be aware that the term “attached” refers to the clinical presentation of the soft tissue only (movable vs. not movable) rather than its histological feature; MT: measured 1.5 mm apical to the soft tissue margin using a short injection needle for anaesthesia and a silicon disk stop, which was then fixed with a few drops of cyanoacrylate as described by Zucchelli and coworkers (Zucchelli et al, 2010; Zucchelli, Mazzotti, Mounssif, Marzadori, & Stefanini, 2013).…”

“…• AMW: obtained by calculating the difference between KMW and PD (Galarraga-Vinueza & Tavelli, 2022;Grischke et al, 2019;McGuire et al, 2011). Readers should be aware that the term "attached" refers to the clinical presentation of the soft tissue only (movable vs. not movable) rather than its histological feature;…”

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,[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). 17,18 MT is particularly important, especially in the coronal region close to the mucosal margin.…”

Morpho-Functional Effect of a New Collagen-Based Medical Device on Human Gingival Fibroblasts: An In Vitro Study

“…As a matter of fact, in concomitance with the presence of a diseased periodontal tissue or with the insertion of dental implants, the connective tissue undergoes significant alterations, provoking the lowering of such defense mechanism that, in association with an increase in inflammation and bacterial infiltration, promotes the onset of periodontitis and peri-implantitis [ 3 , 4 ].…”