The lack of keratinized mucosa as a risk factor for peri-implantitis: a systematic review and meta-analysis

Abstract

This study aimed to investigate the effect of the lack of keratinized mucosa on the risk of peri-implantitis, while also accounting for possible confounding factors. A literature search was conducted in PubMed and Scopus, including human studies that assessed the presence and width of keratinized mucosa in relation to the occurrence of peri-implantitis. Twenty-two articles were included, and 16 cross-sectional studies we meta-analyzed. The prevalence of peri-implantitis was 6.68–62.3% on patient-level and 4.5–58.1% on implant-level. The overall analysis indicated that the lack of keratinized mucosa was associated with a higher prevalence of peri-implantitis (OR = 2.78, 95% CI 2.07–3.74, p < 0.00001). Similar results were shown when subgroup analyses were performed, including studies with a similar case definition of peri-implantitis (Marginal Bone Loss, MBL ≥ 2 mm) (OR = 1.96, 95% CI 1.41–2.73, p < 0.0001), fixed prostheses only (OR = 2.82, 95% CI 1.85–4.28, p < 0.00001), patients under regular implant maintenance (OR = 2.08, 95% CI 1.41–3.08, p = 0.0002), and studies adjusting for other variables (OR = 3.68, 95% CI 2.32–5.82, p = 0.007). Thus, the lack of keratinized mucosa is a risk factor that increases the prevalence of peri-implantitis and should be accounted for when placing dental implants.

Evaluation of Behavior of Castable versus Machined Solid Abutments for Morse Tapper Implant Connection: A Clinical Retrospective Study

“…This fact agrees with the results of Ravidà et al (2022) [ 33 ], who showed that KMW < 2 mm might be a risk factor for developing peri-implant diseases, even though this fact is dependent on other site-specific characteristics, such as mucosa thickness, supracrestal tissue height, peri-implant bone thickness, pocket depth and superstructure crown design. The results of this study are consistent with previous research that has shown the importance of keratinized mucosa in maintaining implant stability and preventing mucositis [ 34 , 35 ]. The findings also suggest that castable UCLA abutments may be advantageous in reducing the risk of abutment fracture compared to machined solid abutments.…”

Augmentation of keratinized tissue using autogenous soft‐tissue grafts and collagen‐based soft‐tissue substitutes at teeth and dental implants: Histological findings in a pilot pre‐clinical study

“…While the 2017 World Workshop could not establish the necessity of KT for maintaining peri‐implant health (Araujo & Lindhe, 2018; Heitz‐Mayfield & Salvi, 2018; Schwarz et al, 2018), more recent systematic reviews indicated that a reduced width of KT is associated with soft‐tissue inflammation, increased biofilm accumulation, marginal bone loss and increased prevalence of peri‐implantitis (although with some heterogeneity among the studies) (Heydari et al, 2021; Longoni et al, 2019; Mahardawi et al, 2023; Ramanauskaite et al, 2022; Ravida et al, 2022). Soft‐tissue augmentation at implant sites has gained prominence for preventing these biological complications.…”

Technical Note on Simplified Free Gingival Graft Using Tack Fixation (sFGG)

“…At the 2017 World Workshop, jointly organized by the American Society of Periodontology and the European Society of Periodontology, the term "keratinized mucosa" was defined as the span extending from the peri-implant mucosal margin to the movable lining mucosa [1]. However, the necessity of a specific width of keratinized mucosa around dental implants is controversial due to conflicting research findings [2][3][4][5][6]. While some studies have suggested a positive correlation between an adequate width of keratinized mucosa and improved implant survival rates and soft tissue health [2][3][4], others have failed to establish such a connection [5,6].…”

“…However, the necessity of a specific width of keratinized mucosa around dental implants is controversial due to conflicting research findings [2][3][4][5][6]. While some studies have suggested a positive correlation between an adequate width of keratinized mucosa and improved implant survival rates and soft tissue health [2][3][4], others have failed to establish such a connection [5,6]. Notably, insufficient keratinized mucosa can lead to discomfort during toothbrushing [7,8], complicating oral hygiene management and potentially resulting in plaque accumulation [9].…”