Significantly less bone loss can occur around bone-level implants placed in naturally thick mucosal tissues, in comparison with thin biotype. Augmentation of thin soft tissues with allogenic membrane during implant placement could be way to reduce crestal bone loss.

Implants with cement remnants in patients with history of periodontitis may be more likely to develop peri-implantitis, compared with patients without history of periodontal infection.

It can be concluded that platform switching does not prevent crestal bone loss if, at the time of implant placement, mucosal tissue is thin. In thick soft tissue, use of platform-switched implants maintained crestal bone level with minimal remodeling.

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The amount of residual cement after cleaning increased as the restoration margins were located more subgingivally.

The deeper the position of the margin, the greater amount of undetected cement was discovered. Dental radiographs should not be considered as a reliable method for cement excess evaluation.

It can be concluded that thin mucosal tissues may cause early crestal bone loss, but their thickening with allogenic membrane may significantly reduce bone resorption. Implants in naturally thick soft tissues experienced minor bone remodeling.

PurposeAims of the study were: (a) to register crestal bone loss around 1.5 mm subcrestally placed implants and epicrestally placed implants with soft tissue tenting technique, (b) to record bone remodeling in subcrestal group, and (c) to determine the increase of vertical soft tissues after tenting.Materials and methodsThirty‐two patients with vertically thin tissues of 2 mm or less received 40 submerged bone level platform‐switched implants, divided into two groups—(a) 1.5 mm subcrestally placed implants and (b) epicrestally placed implants with soft tissue tenting over 2 mm healing abutments. At the second stage surgery, implants received 4 mm healing abutments, soft tissue thickness was measured in epicrestal group, and later implants were restored with zirconia‐based screw‐retained single restorations. Radiological images were taken at the second stage surgery, restoration delivery and after 2 years of follow‐up. Bone loss was calculated as a distance between implant neck and first radiographically visible bone‐to‐implant contact. Bone remodeling was calculated as a distance between the bone crest and implant neck. Mann‐Whitney U test was used for statistical analysis, significance set to 0.05.ResultsAfter 2 years of follow‐up, Group 1 (subcrestal) had 0.18 ± 0.32 mm of bone loss, Group 2 (epicrestal with 2 mm healing abutment) had 0.51 ± 0.4 mm of bone loss, with statistically significant difference (P = .001). Bone remodeling in Group 1 (subcrestal) was 1.17 ± 0.51 mm. Vertical tissue thickness in epicrestal group before the intervention was 1.85 ± 0.26 and 3.65 ± 0.41 mm after the use of 2 mm healing abutment, with a statistical difference (P = .005).ConclusionSubcrestal implant placement can significantly reduce crestal bone loss, compared to vertical soft tissue thickening by tenting of epicrestally placed implants, although soft tissue tenting can significantly increase soft tissue thickness.