Significance of keratinized mucosa/gingiva on peri‐implant and adjacent periodontal conditions in erratic maintenance compliers

Abstract

Background Given the fact that most patients are not regular compliers in supportive peri‐implant maintenance programs, it is of interest to examine the significance of the peri‐implant soft tissue characteristics in relationship to the onset of peri‐implant diseases. Methods Based on an a priori statistical power calculation, a cross‐sectional study was conducted on erratic peri‐implant maintenance compliers (<2 times/year) to examine the significance of keratinized mucosa (KM) and gingival tissue (KT) on peri‐implant and adjacent periodontal conditions in implants restored ≥3 years. Seven clinical parameters were recorded around implants and the adjacent buccal sites. Radiographic assessment was performed using periapical X‐rays. In addition, a visual analog scale (VAS) was used to evaluate the impact of KM upon brushing comfort. The case definition used for peri‐implant diseases was in accordance with the 2017 World Workshop on the classification of periodontal and peri‐implant diseases and conditions. Results Overall, 37 patients with 45 edentulous gaps restored with 66 implants and 90 adjacent teeth were analyzed. On comparing a KM band of <2 mm versus ≥2 mm, with the exception of suppuration (P = 0.6), all the clinical and radiographic parameters were significantly increased when the KM band was <2 mm (P < 0.001). A significant correlation was observed between KM and KT (r = 0.55), though a lack of KM did not condition a lack of KT. In the presence of peri‐implantitis, only bleeding on probing at the adjacent dentate sites was identified to be increased. Conclusions The presence of <2 mm of KM around dental implants in erratic maintenance compliers seems to be associated with peri‐implant diseases. The lack of KM constitutes a site‐specific phenomenon independent of the keratinized tissue present in the adjacent dentition (NCT03501537).

Influence of keratinized mucosa on the surgical therapeutical outcomes of peri‐implantitis

“…Current evidence underlines the importance of frequent periodontal and peri‐implant maintenance, suggesting that in highly compliant patients, KM plays a null role in the prevention of biological complications (Lim et al, ). Conversely, in poorly compliant patients, the presence of ≥2 mm of KM has been demonstrated to be beneficial for long‐term outcomes (Monje & Blasi, ; Romanos, Grizas, & Nentwig, ). Generally, the influence of peri‐implant KM on peri‐implantitis therapeutic outcomes is poorly understood.…”

Ridge preservation in molar extraction sites with an open‐healing approach: A randomized controlled clinical trial

“…That study compared the shift of MGJ between the groups with/without primary flap closure, demonstrating 3.83 ± 2.68 and 1.21 ± 0.94 mm of shift, respectively. Despite controversy regarding keratinized mucosa around implants (Lim, Wiedemeier, Hammerle, & Thoma, ; Monje & Blasi, ; Schwarz, Derks, Monje, & Wang, ), a recent systematic review favoured the soft tissue grafting procedure for gaining keratinized mucosa in order to establish peri‐implant health (Thoma et al, ). Less change in the MGJ following ARP with the open‐healing approach may contribute to the stable mucosal situation around the implants without an additional soft tissue grafting procedure.…”

Morphology and severity of peri‐implantitis bone defects

“…However, it was further exhibited that~25% displayed a circumferential defect combined with a buccal dehiscence-type defect. [26][27][28] However, breaking down this data, it was found that, in the mandibular anterior peri-implantitis implants, 67.7% lacked KM, while periimplantitis in the maxillary anterior and posterior sites occurred 75% and 46.2%, in areas ≥2 mm KM, respectively. Nevertheless, the rate of peri-implantitis defects displaying in a 2-3-walls infraosseous morphology was slightly greater than the aforementioned studies.…”