Keratinised soft tissue crucial for implants

PD Dr. Kristina Bertl, PhD MSc MBA

The recently published EFP treatment guidelines for the treatment of peri-implant diseases have led to extensive discussion of the treatment options based on the available scientific evidence.
However, almost more important than the treatment itself is the prevention of peri-implant conditions. The initial focus here is on peri-implant mucositis, as treating this can prevent the occurrence of peri-implantitis in the first place.

Keratinised soft tissue crucial for implants

What factors can contribute to the occurrence of peri-implant diseases? One very important but often somewhat neglected point is the peri-implant soft tissue. A recent consensus report provided a comprehensive summary of the data on the importance of keratinised mucosa (Ramanauskaite et al. 2022).

Keratinised mucosa around implants corresponds to the keratinised gingiva around teeth. Unfortunately, however, the amount of keratinised mucosa can be dramatically reduced following tooth loss and, above all, following bone construction prior to an implant treatment. This, in turn, can lead to implants having very little (i.e. < 2 mm of keratinised mucosa) or no keratinised mucosa at all after prosthetic treatment has been completed. But does this play a role?

Thanks to the consensus report mentioned above, it is very easy to answer this question: YES, it plays a role! If patients have very little or no mucosa, these patients have, among other things, a significantly higher risk of accumulating plaque, increased bleeding indices, greater pain sensitivity when performing oral hygiene at home and, ultimately, a higher risk of peri-implantitis. For example, the prevalence of peri-implantitis with a lack of keratinised mucosa is 11–44%, while it stands at just 5–8% if there is a sufficient amount of keratinised mucosa.

In light of this, it is necessary to examine all patients’ peri-implant soft tissue more closely, but especially those showing the initial signs of peri-implant mucositis. Furthermore, the team should discuss if there is a need for treatment in patients with a lack of keratinised mucosa (i.e. < 2 mm of keratinised mucosa). The width of the keratinised mucosa can be significantly improved by a surgical intervention.

References

1. Ramanauskaite A, Schwarz F, Sader R. Influence of width of keratinized tissue on the prevalence of peri-implant diseases: A systematic review and meta-analysis. Clin Oral Impl Res. 2022;33(Suppl. 23):8–31. https://doi.org/10.1111/clr.13766