Evaluation of the effect of keratinized mucosa on peri-implant tissue health using a multivariate analysis

Abstract

Maintaining peri-implant tissue health is necessary for the longterm success of implant treatment. Poor oral hygiene, smoking, and a history of periodontal disease have been reported as risk factors for peri-implantitis [1].Previous research has discussed whether the presence of keratinized mucosa (KM) is required to keep peri-implant tissue healthy [2].Peri-implant tissue health requires no clinical signs of inflammation, no bleeding and suppuration on gentle probing, no increase in probing depth compared with previous examinations, and no bone loss beyond crestal bone level changes resulting from initial bone remodeling [3]. Some evidence suggests implants with less than 2 mm of KM exhibit more bleeding on probing and supporting bone loss than those with more than 2 mm of KM [4]. Conversely, Roccuzzo et al. found that peri-implant tissue health could be maintained with good oral hygiene in spite of the width of KM [5]. It is important, therefore, to confirm the influence of KM on peri-implant tissue health. If the presence of KM is important for peri-implant tissue health, soft tissue grafting may be considered in cases with insufficient KM. Although many studies have investigated the influence of KM, a clear conclusion has not yet been reached.One of the difficulties in reaching a consensus is the presence of confounders such as poor oral hygiene, smoking, and a history of periodontal disease in previous studies. Most previous studies did not consider factors affecting peri-implant tissue health that prevent accurate assessment of the effect of KM.The purpose of our cross-sectional study was to confirm the association between peri-implant tissue health and the presence of KM using multivariate analysis to control for the confounding effects. We hypothesize that the presence of ≥ 2 mm of KM is related to improved peri-implant tissue health when compared with KM that is < 2 mm wide.We built up the null hypothesis that the presence of ≥ 2 mm of KM is not related to improved peri-implant tissue health when compared with KM that is < 2 mm wide.

Multivariate analysis of the effect of keratinized mucosa on peri‐implant tissues with platform switching: A retrospective study

“…For ΔBLm, ΔBLd, and ΔBLb, KMW <1.5 mm was a significant factor for bone loss over time (Tables 3 and 4A). This result is consistent with the longitudinal study by Perussolo and colleagues 3 and the cross‐sectional studies by Shimomoto and colleagues 11 & Mameno and colleagues, 37 which mainly used multivariate analyses to evaluate PM implants. The studies suggested that KMW ≥2 mm was an important factor in bone loss.…”

“…A history of periodontitis 11,12 was recorded when medical records or patient inquiries indicated that the implant was placed at a site where tooth extraction occurred because of chronic periodontitis. The definition of periodontitis conformed to that reported by Papapanou and colleagues 13 …”

Farklı mukozal kalınlıkların implant çevresi krestal kemik kaybına etkisi

“…22 The results of a more recent clinical trial published by Shimomoto et al in 2021 also suggest that the width of keratinized tissue increases periimplant bone stability. 23 On the other hand, Roccuza et al, in their retrospective study published in 2015 with 10 years of follow-up, concluded that even if the width of the keratinized tissue is inadequate, this condition can be tolerated with good oral care. 24 According to the study of Kim et al in 2009, inadequate keratinized tissue width around the implant does not have a definite negative effect on poor oral hygiene and soft tissue health.…”