1. Role of keratinized mucosa in peri-implant tissue health.
Topic: Tissue augmentation and engineering
Role of keratinized mucosa in peri-implant tissue health.
Review of the literature and case series.
Zempila M., Iskas A., Tsachouridou I., Doufexi A.E., Makris G.
Dept. of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Greece.
PBI532
Background
Connective tissue graft at 2nd stage surgery of implant #12
CASE 1
In implant therapy, the adequate state of peri-implant tissue health and soft tissue aesthetics, is the essential criterion of restorative success. The need for keratinized mucosa for the maintenance of peri-implant health and soft tissue integration remains a debated issue. This is the reason why many clinicians apply several surgical approaches in order to increase the peri-implant keratinized mucosa width.
Aim
To provide a review of the literature evidence concerning the significance of keratinized mucosa on implant health and thus help the clinician to decide if any further surgical approaches aiming at increasing the keratinized mucosa width are necessary. Three clinical implant cases with inadequate width of keratinized mucosa, treated with different approaches, are being presented.
1 year after prosthetic rehabilitation
Free gingival graft before 2nd stage surgery of implants #14,16
CASE 2
Material and Methods
An electronic search of five databases and a hand search of peer-reviewed journals for relevant articles were performed up to January The keywords used were the following: gingiva, peri-implantitis, review, dental implants, gingival recession. Screening titles, abstracts and more importantly full texts included only English-language publications. Three clinical implant cases with inadequate width (<2mm) of keratinized mucosa are being presented. Depending on the periodontal history, the medical history and the patients’ expectations, different surgical approaches were performed in each case.
2ND stage:2 months after FGG
2 weeks healing
2 weeks healing
2 weeks healing
Results
Inadequate width of keratinized mucosa<2 mm at 2nd stage at implants #45,46- no surgical intervention
CASE 3
Evidence in support of the need for keratinized tissues around implants to maintain health and tissue stability is limited. Reduced keratinized mucosa width around implants appears to be associated with clinical parameters indicative of inflammation and poor oral hygiene. However, based on the selected evidence, the predictive value of keratinized mucosa width is limited. The presence of an adequate zone of keratinized tissue may be necessary, because it was shown to be related to peri-implant tissue health. Based on current available evidence, a lack of adequate keratinized mucosa around dental implants is associated with more plaque accumulation, tissue inflammation, mucosal recession and attachment loss.
2 weeks healing
1 year after prosthetic rehabilitation
Conclusions
Implants that are not surrounded by keratinized tissues are more prone to plaque accumulation and gingival recession, even in patients applying sufficient oral hygiene and receiving adequate supporting periodontal therapy. That is the reason why in selected cases, additional surgical soft tissue manipulations may be necessary. The clinician should pay individual consideration in each implant case, since the variety of clinical features in patients pursuing implant therapy is wide.
References
Implants that are not surrounded by keratinized tissues are more prone to plaque accumulation and gingival recession, even in patients exercising sufficient oral hygiene and receiving adequate supporting periodontal therapy. That is the reason why in selected cases, additional surgical soft tissue manipulations may be neccesary. The clinician is highly recommended to pay individual consideration in each implant case, since the variety of clinical features in patients pursuing implant therapy is wide.
Presented at the 25nd Annual Scientific Meeting of the European Association of Osseointegration
2016, PARIS, France