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Peri-implant keratinized mucosa (PI-KM) may support implant survival. Acellular collagen matrices (aCMs) have been widely used to facilitate soft tissue regeneration. The aim of this study was to investigate clinical outcomes obtained with the use of an aCM (mucoderm®) to enhance PI-KM. In this retrospective non-randomized case series, 27 restored implants in 14 patients (eight males and six females, mean age = 56 years) with a PI-KM width ≤ 1 mm were followed for 6 months. It was demonstrated that aCM grafts augmented PI-KM effectively (mean increase of 5.4 mm, &gt, 533%) without a significant change in bleeding on probing (BOP) from baseline. The mean aCM shrinkage was 3.9 mm (42%). Gender, area, arch, and BOP did not influence PI-KM augmentation or aCM shrinkage significantly. The present results demonstrated that the examined aCM was effective and predictable for attaining a band of keratinized tissue, while avoiding graft donor site harversting.

O objetivo deste estudo foi realizar uma revisão sistemática integrativa sobre a eficácia do enxerto gengival livre para o aumento de mucosa queratinizada peri-implantar. Foi realizada uma pesquisa bibliográfica na plataforma PubMed (via National Library of Medicine) usando a combinação dos seguintes termos científicos: dental implants, increasing keratinized mucosa, free gingival graft, keratinized mucosa e peri-implant health. A pesquisa identificou 265 artigos, dos quais 16 foram considerados relevantes para este estudo. Esses estudos forneceram dados importantes sobre os resultados obtidos com enxerto gengival livre para o aumento da mucosa quertinizada peri-implantar. A implantologia tem evoluído bastante nos últimos anos, tornando-se cada vez mais uma opção de tratamento popular na reabilitação de espaços edêntulos, devido à sua estabilidade biológica, permitindo restaurar a estética e a função. Atualmente, sabe-se que a mucosa queratinizada peri-implantar, indispensável do ponto de vista estético, desempenha um papel fulcral na defesa a agressões biológicas e mecânicas, e é preponderante para a manutenção da saúde peri-implantar. Desta forma, técnicas cirúrgicas que possibilitam o aumento das dimensões de mucosa queratinizada peri-implantar, tem sido um tópico amplamente discutido na literatura atua. Este estudo sugere que pelos resultados obtidos, o enxerto gengival livre deve ser considerado o gold standard para o aumento de mucosa queratinizada peri-implantar.

In maxillofacial reconstruction implant treatment, unsatisfactory soft tissue treatment of the area around the implant may lead to inflammation. As a result, appropriate soft tissue treatment is critical. To the best of our knowledge, there are no studies that compare the different tissue treatment methods available. Hence, in this study, we compare three soft tissue treatment methods around implants after mandibular reconstruction is achieved with a fibula-free flap. Out of 33 patients who underwent mandible reconstruction using fibula-free flaps between 2006 and 2015, 5 were selected for this study. A total of 17 implants were used for treatment by the final prosthetics of the five patients. Three soft tissue treatment methods with free gingival graft (FGG) were evaluated, namely, installing a splint in a modified abutment to protect the wounded area during a palatal mucosa transplant (method 1), installing a splint or dentures to a locator abutment (method 2), and the use of screw-in fixed dentures (method 3). The method that could guarantee the widest keratinized mucosa was the screw-in fixed denture method. The results of our study indicated that employing screw-in fixed dentures for FGG may be a useful soft tissue treatment for mandible reconstruction implants.

The aim of this case report was to describe a modified free gingival graft technique for gaining vertical and horizontal soft-tissue growth in the posterior region of the mandible before installation of dental implants. Patient A.A., a 38-year-old female, received a modified free gingival graft in the posterior region of the mandible. After 90 days, an increase, both horizontally and vertically, of the gingival tissue was observed, and the patient was satisfied with the result. The dental implant was installed, and a 3-mm of the vertical gain of keratinized gingiva was observed. Further research is needed to evaluate the effectiveness of this technique before prosthetic dental implantation.

This study presents statistically processed morphometric data on maxillary and mandibular keratinised mucosa height and some clinical considerations. Measurements were performed at incisive, premolar and molar levels, in the maxillary and the mandibular jaws, in 31 patients (21 women and 10 men). The results obtained were centralised and the mean values of the keratinised mucosa height were determined, which were graphically presented. These results were then discussed by comparing with the findings in other studies.

BACKGROUND: This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS: Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS: A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P

Background The aim of this cross-sectional study was (1) to determine the prevalence of peri-implant mucositis and peri-implantitis and (2) to reveal the risk indicators associated with peri-implant diseases. The second point was to investigate the role of keratinized mucosa on peri-implant health. Materials and methods Three hundred and eighty-two subjects who were treated with 1415 dental implants between 2011–2017 were clinically evaluated. Patients’ medical and dental history, as well as implant details, were recorded. Peri-implant examination included probing pocket depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and keratinized tissue width. Furthermore, the patient (sex, age, and smoking) and implant/prosthesis-related factors (surface characteristic, time in function, design of prosthesis etc.) were evaluated. Implants were classified into three groups: healthy, peri-implant mucositis, and peri-implantitis. Uni- and multi-variate regression analyses were utilized for statistics. Results 41.1% (n = 157) and 36.9% (n = 84) of patients had mucositis and peri-implantitis, respectively. 53.6% (n = 758) of implants (95%CI 80.2–90.4) had mucositis, and 21.7% (n = 307) had peri-implantitis. Patients with a maintenance < 2/year (OR = 2.576), having periodontitis (OR = 3.342) and higher PI (OR = 3.046) had significant associations with the development of peri-implant mucositis. Significant ORs were determined for peri-implantitis with patients having maintenance < 2/year (OR = 2.048), having number of implants ≥ 4 (OR = 2.103), diagnosed with periodontitis (OR = 3.295), and higher PI (OR = 7.055). Keratinized tissue width < 2 mm (ORs = 5389/8.013), PPD (ORs = 1.570/8.338), PI (ORs = 6.726/5.205), and BoP (ORs = 3.645/4.353) independent variables were significantly associated with both peri-implant mucositis and peri-implantitis at implant level, respectively. Conclusions Within the limits of this study, the prevalence of mucositis and peri-implantitis was shown to be high in Turkish population. Furthermore, increased risk for peri-implantitis was identified in patients having maintenance < 2/year, presence of periodontitis, poor plaque control, and having number of implants ≥ 4. Less keratinized tissue (< 2 mm), PPD, and BoP were also risk indicators for peri-implantitis development.

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4–6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.

Atualmente há cada vez mais pacientes que querem substituir os dentes perdidos com implantes. O sucesso destes depende de muitos fatores: um deles é a mucosa queratinizada (MQ). Durante os primeiros anos das cirurgias implantares, era automático pensar que uma quantidade de MQ ≥ 2mm era essencial para manter a saúde dos implantes, mas hoje existe controvérsia neste argumento. O objetivo deste trabalho será realizar uma revisão na literatura atual sobre a saúde dos implantes que tem MQ ≥ 2mm e avaliar se realmente é uma condição necessária para a saúde deles em relação ao índice de placa (IP) e ao sangramento à sondagem (BoP). Uma pesquisa bibliográfica foi realizada no final de 2019 na plataforma de busca (bases de dados) PUBMED, COCHRANE, JOURNAL OF PERIODONTOLOGY, JOURNAL OF CLINICAL PERIODONTOLOGY, PERIODONTOLOGY 2000, utilizando as seguintes palavra-chave: “keratinized mucosa; implants; posterior; molar; width” que levou à seleção de 24 artigos que obedeciam aos critérios de inclusão determinadas. O estudo dos artigos indicou que não há evidências absolutas sobre a necessidade de uma banda de MQ adequada ao redor dos implantes para manter a saúde e a estabilidade dos tecidos peri-implantares. A presença de MQ não é fundamental para o bom controlo da placa, mas uma banda suficiente de MQ favorece uma higiene implantar correta, um melhor conforto pelo paciente e consequentemente um melhor controlo de BoP. Nenhum artigo apresentou uma espessura ideal de MQ, confirmando, no entanto, uma melhor situação peri-implantar em presencia desta.

Objective: The aim of this study was to evaluate the infl uence of periodontal clinical parameters on the treatment of gingival recession by means of a coronally positioned fl ap (CPF). Materials and methods: In this clinical study, the coronally positioned fl ap technique was used in a sample of 14 individuals with Miller’s Class I or II gingival recession of the canines and/or maxillary premolars, totaling 39 recessions. The clinical periodontal parameters evaluated were: probing depth (PD), gingival recession height (GRH), gingival recession width (GRW), clinical attachment level (CAL), keratinized mucosa (KM), attached keratinized mucosa (AKM), gingival thickness (GT) and free gingival margin thickness (GMT). The degree of root coverage was evaluated 3 months after the surgical procedures were performed. The data were analyzed using Student’s-t, Mann-Whitney and Pearson’s correlation tests, as well as the Cohen’s d. Results: After root coverage, there was no signifi cant change in PD. Signifi cant reductions in GRH and GRW were observed. In addition, a signifi cant reduction in KM and AKM, and an increase in GMT were also observed. A signifi cant negative correlation was found between initial GMT and gingival recession at 3 months, and a signifi cant negative correlation between GT and periodontal recession at 3 months. There was large effect size for GRH, GRW, CAL, KM, AKM and GMT parameters. Conclusions: The initial gingival recession height, keratinized mucosa and free gingival margin thickness were the parameters that had the most infl uence on root coverage by the coronal sliding fl ap technique

Peri-implant dokuların sağlığının korunmasında keratinize mukozanın gerekliliği ve miktarı uzun süredir tartışılan ve henüz netlik kazanmayan bir konudur. Peri-implant keratinize mukoza yetersizliğinin plak akümülasyonunu, mukozal inflamasyonu, klinik ataşman kaybını, yumuşak doku çekilmesi ve peri-implant alveoler kemik kaybı riskini artırdığı destekleyen araştırmacılar olmasına rağmen bazı araştırmacılar implant sağ kalım oranının keratinize mukozaya bağlı olmadığını ve peri-implant keratinize mukoza yokluğunda peri-implant mukoza sağlığının korunabildiğini savunmaktadır. Bu derlemenin amacı, peri-implant keratinize mukoza genişliğinin peri-implant klinik ve immunolojik parametrelere etkisini güncel çalışmalar ışığında değerlendirmektir. Peri-implant keratinize mukoza yetersizliğinin peri-implantitis için risk faktörü olduğunu destekleyen kanıtlar sınırlı olmakla birlikte peri-implant keratinize mukozanın hasta konforunu artırması ve ağız hijyen prosedürlerinin yapılmasını kolaylaştırması yönünde avantajları mevcuttur., The need and amount of keratinized mucosa for maintenance of peri-implant tissue health has been discussed for a long time and remain a contraversial subject as well. Although authors support that the insufficient width of peri-implant keratinized mucosa may increase plaque accumulation, mucosal inflammation, clinical attachment loss, soft tissue recession and risk of periimplant alveolar bone loss, some authors suggest that the survival rate of the implant is not associated with peri-implant keratinized mucosa and peri-implant health could be maintained irrespective of the lack of peri-implant keratinized mucosa. The aim of this review is to evaluate the effect of peri-implant keratinized mucosa width on peri-implant clinical and immunological parameters in consideration of current studies. While there is limited evidence to support that lack of peri-implant keratinized mucosa is a risk factor for peri-implantitis, peri-implant keratinized mucosa has advantages to improve patient comfort and maintenance oral hygiene procedures.

In maxillofacial reconstruction implant treatment, unsatisfactory soft tissue treatment of the area around the implant may lead to inflammation. As a result, appropriate soft tissue treatment is critical. To the best of our knowledge, there are no studies that compare the different tissue treatment methods available. Hence, in this study, we compare three soft tissue treatment methods around implants after mandibular reconstruction is achieved with a fibula-free flap. Out of 33 patients who underwent mandible reconstruction using fibula-free flaps between 2006 and 2015, 5 were selected for this study. A total of 17 implants were used for treatment by the final prosthetics of the five patients. Three soft tissue treatment methods with free gingival graft (FGG) were evaluated, namely, installing a splint in a modified abutment to protect the wounded area during a palatal mucosa transplant (method 1), installing a splint or dentures to a locator abutment (method 2), and the use of screw-in fixed dentures (method 3). The method that could guarantee the widest keratinized mucosa was the screw-in fixed denture method. The results of our study indicated that employing screw-in fixed dentures for FGG may be a useful soft tissue treatment for mandible reconstruction implants., 博士（医学）・乙第1491号・令和2年12月24日, Copyright © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Trabalho Final do Mestrado Integrado em Medicina Dentária apresentado à Faculdade de Medicina Introduction: In implant therapy, the success and survival rates are dependent on the capacity and efficiency of the mucosa on providing a protective and resistant barrier in order to keep an adequate state of periimplant tissue health. The need for keratinized mucosa (KM) around dental implants is not defined in the literature being a controversial topic. Aim: The main aim of this systematic review is to evaluate the effect of a cuff comprised with at least 2 mm of keratinized mucosa on the survival rates of dental implants. The secondary goal is to determine the influence of keratinized mucosa on clinical parameters, which indicate the health status of the periimplant tissues.Materials and Method: An electronic search was performed on the following platforms: MEDLINE; EMBASE and Cochrane library. A manual search was also performed in order to include potential relevant studies. A 20-year time limit was established and prospective, longitudinal and cohort studies realized in humans with a minimum follow-up of 6 months were included. The studies had to compare different widths of keratinized mucosa in order to be included.Results: 11 trials were included in this systematic review: 7 resulted from the electronic search while 4 were included from the manual search. The following clinical parameters were recorded: Plaque Index (PI); Gingival Index (GI); Bleeding on Probing (BoP); Probing Depth; Mucosal Recession (MR); Average Bone Loss (ABL) and implant survival rate.Conclusion: Based on the results obtained from the clinical trial included in this review, we can conclude that an inadequate width of keratinized mucosa is related with higher plaque accumulation, bleeding on probing, mucosal recession and periimplant tissue inflammation. No conclusions were taken related to the impact of keratinized mucosa on implant survival rate due to limited results. Further randomized prospective trials are required in order to establish de relationship between the width of keratinized mucosa and the survival rate of dental implants. Introdução: O sucesso e a taxa de sobrevivência dos implantes dentários estão dependentes da capacidade e eficiência da mucosa em formar uma barreira protetora e resistente, de modo a manter os tecidos peri-implantares num estado de saúde saudável. A necessidade de uma banda de mucosa queratinizada (KM) em redor dos implantes ainda não está explícita na literatura sendo ainda um tópico controverso. Objetivos: A elaboração desta revisão sistemática tem como objectivo principal investigar o efeito de uma banda de no mínimo 2 mm de mucosa queratinizada na taxa de sucesso dos implantes. Como objectivo secundário é avaliar a influência da banda de mucosa queratinizada nos parâmetros relacionados com a saúde dos tecidos periimplantares.Materiais e Métodos: Foi efetuada uma pesquisa nas bases de dados da MEDLINE, EMBASE e da Cochrane library com um limite temporal de nos últimos 20 anos. Foi também realizada uma pesquisa manual às referências de modo a incluir artigos relevantes. Foram incluídos estudos prospectivos, transversais e coorte realizados em humanos, com um seguimento mínimo de 6 meses. Os artigos incluídos comparavam diferentes larguras da banda de KM presente.Resultados: A pesquisa resultou num total de 11 estudos, onde 7 originaram da pesquisa electrónica e 4 da pesquisa manual. Estes estudos apresentavam resultados para os seguintes parâmetros: Índice de Placa (PI); Índice Gengival (GI); Hemorragia à Sondagem (BoP); Profundidade de Sondagem (PD); Recessão da Mucosa (MR); Perda Óssea Média (ABL) e taxa de sobrevivência dos implantes.Conclusão: Com base nos resultados dos artigos incluídos nesta revisão sistemática, podemos concluir que o défice de KM em torno dos implantes, está associado com um aumento da acumulação de placa, do índice hemorrágico, da recessão da mucosa e da inflamação dos tecidos periimplantares. Não foi possível tirar conclusões acerca do impacto da banda de KM na taxa de sobrevivência devido à falta de resultados dos estudos para este parâmetro. São necessários estudos clínicos prospectivos randomizados, de modo a obtermos mais evidência em relação ao impacto da KM na taxa de sobrevivência dos implantes.

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. The aim of this paper is to provide a narrative review of the current literature concerning the significance of keratinized mucosa with respect to the clinical parameters of monitoring oral hygiene practice and tissue status. The published studies revealed that there were conflicting results with regard to the influence of keratinized mucosa on plaque score and soft-tissue inflammation. Most studies showed that the amount of soft-tissue recession was significantly increased at implant sites with narrow keratinized mucosa, but the amount of keratinized mucosa had little effect on deepening of peri-implant pockets. The evidence related to the effect of keratinized mucosa on the changes of attachment or bone levels is limited, and conclusions could not be drawn at present. Further, this review found that a band of keratinized mucosa was not absolutely necessary for the maintenance of peri-implant tissue, whereas lack of adequate keratinized mucosa around the implant might impede proper oral hygiene performance and compromise the aesthetic results. In conclusion, because there is a wide variety of clinical features in patients pursuing implant therapy, individual consideration of treatment strategies for the patient with minimal keratinized mucosa is recommended.

FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior Objective: This study aimed to evaluate the effect of initial periodontal clinical parameters on the final outcome of the treatment of periodontal recessions by means of a coronally positioned flap (CPF). Materials and methods: The CPF technique was used in a total of 39 Miller Class I/ II gingival recessions of the upper canines and/or premolars. The clinical periodontal parameters evaluated were: probing depth, gingival recession height, gingival recession width, keratinized mucosa, attached keratinized mucosa, flap thickness and free gingival margin thickness. The degree of root coverage was evaluated 6 months and 1 year after the surgery. The data were analyzed by Student’s t-test, Mann-Whitney and Pearson’s correlation tests, as well as linear regression. Results: A significant reduction in gingival recession height, gingival recession width, keratinized mucosa, and attached keratinized mucosa were observed. A significant negative correlation was found between gingival recession and root coverage percentage at 1 year, and a significant negative correlation between gingival margin thickness and coverage percentage at 1 year. The gingival recession and flap thickness significantly predicted the amount of root coverage. Conclusions: The initial dimensions of gingival recession and the mucosa thickness were correlated to the percentage of root coverage. The gingival recession width was the major predictor of root coverage

Rationale: With respect to improving the quality of oral rehabilitation, the management of keratinized mucosa is as important as bone condition for implant success. To enhance this management, a natural teeth-retained splint based on a patient-specific 3-dimensional (3D) printed mandible was used in vestibuloplasty to provide sufficient keratinized mucosa around dental implants to support long-term implant maintenance. Patient concerns: A 28-year-old male patient had a fracture of the anterior andible 1 year ago, and the fracture was treated with titanium. Diagnoses: The patient had lost mandibular incisors on both the sides and had a shallow vestibule and little keratinized mucosa. Interventions: In the first-stage implant surgery, 2 implants were inserted and the titanium fracture fixation plates and screws were removed at the same time. During second-stage implant surgery, vestibuloplasty was performed, and the natural teeth-retained splint was applied. The splint was made based upon a patient-specific 3D-printed mandible. At 30-day follow-up, the splint was modified and reset. The modified splint was removed after an additional 60 days, and the patient received prosthetic treatment. Outcomes: After prosthetic treatment, successful oral rehabilitation was achieved. Within 1 year and 3 years after implant prosthesis finished, the patient exhibited a good quantity of keratinized gingiva. Lessons subsections: The proposed splint is a simple and time-effective technique for correcting soft tissue defects in implant dentistry that ensures a good quantity of keratinized mucosa.

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Objetivo: Avaliar a importância do fenótipo gengival e da presença de mucosa queratinizada na manutenção da saúde e da estética nas regiões peri-implantares. Materiais e métodos: Realizou-se a pesquisa, sem restrição de data ou de idioma, nas bases de dados MEDLINE/PUBMED, Bireme e Scielo. Utilizaram-se como palavras-chaves “Keratinized mucosa”, “peri-implantitis”, “gingival biotypes”, “implants”, “keratinized gingiva” e “gingival phenotype”. 90 artigos foram identificados. Após leitura dos títulos e respetivos resumos, selecionaram-se 27. Pela análise dos textos completos, 22 artigos foram incluídos. Resultados: A presença de mucosa queratinizada parece ser importante para o estabelecimento e a manutenção da saúde e estética periimplantar, ainda que não interfira com a osteointegração. Relativamente ao fenótipo, um fenótipo gengival fino parece ser um fator de risco para o desenvolvimento de peri-implantite. Discussão/Conclusão: Mais estudos clínicos randomizados e controlados são necessários para confirmar e clarificar as informações apresentadas. Objective: To evaluate the importance of gingival phenotype and the influence of keratinized mucosa in maintaining health and aesthetics in the peri-implant regions. Materials and methods: A search was carried out in the MEDLINE / PUBMED, Bireme and Scielo databases, without restriction of date or language. "Keratinized mucosa", "peri-implantitis", "gingival biotypes", "implants", "keratinized gingiva" and "gingival phenotype" were used as keywords. 90 articles were identified. After reading the titles and respective summaries, 27 were selected. After the analysis of the complete texts, 22 articles were included. Results: The presence of keratinized mucosa appears to be important for the establishment and maintenance of peri-implant health and aesthetics, although it does not interfere with osseointegration. Regarding the phenotype, a fine gingival phenotype appears to be a risk factor for the development of peri-implantitis. Discussion / Conclusion: More randomized and controlled clinical trials are needed to confirm and clarify the information presented.

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4-6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.

Background This retrospective study evaluated soft-tissue grafting as a surgical treatment option for peri-implantitis in case of unsuitable basic skeletal morphology of the alveolar bone and lack of keratinized mucosa. Methods Twenty-eight patients (21 females, 7 males, at a mean age 59.4 years) were included with a total of 54 implants. All implants showed peri-implantitis and attached keratinized buccal mucosa of ≤2 mm. A surgical procedure of soft-tissue grafting (STG) was made by inserting an inlay and inlay-onlay transplant. Clinical investigations were made prior to the STG (baseline) and after 9–180 months (Ø 43 months) including the following parameters: soft-tissue biotype, skeletal basic morphology of the alveolar bone, width of the peri-implant keratinized mucosa (KM), mobility of the KM, pocket probing depth (PPD), and bleeding on probing (BOP). Results Nearly all patients showed a thin soft-tissue biotype. The analysis of the skeletal basic morphology of the alveolar bone revealed a narrow apical base in 18 patients, middle base in 7 patients, and broad base in 3 patients. Width of the KM increased significantly (p

The aim of thisstudy was to compare the degree of brushing discomfort (BD) and peri-implant soft tissues health in patients presenting implant sites with ≥ 2 mm or < 2 mm of keratinized mucosa (KM). The patients were recruited during their return for maintenance therapy from January to October, 2013. Based on the presence of KM, the patients were divided into 2 groups: presence of implant sites with ≥ 2 mm of KM (Group A) and presence of implant sites with < 2 mm of KM (Group B). At the beginning of the experiment, clinical measurements of plaque index (PI), probing pocket depth (PPD), clinical atachment level (CAL) and bleeding on probing (BoP) were performed in 3 sites/implant (buccal aspect). Immediately after oral hygiene instructions, the patients were asked to perform brushing of the experimental implant sites. Subsequently, the patients reported on the corresponding brushing discomfort using the Visual Analog Scale (VAS). Non-paired student-t test and Mann-Whitney test were performed to analyze the outcome variables. Level of significance was established in 5%. Seventy-nine patients with a total of 269 implant sites were included. The results showed that the implant sites in Group B exhibited more BD (p

Aim The aim of this study was to evaluate the outcome of a soft tissue dehiscence coverage technique, at single non-submerged implant sites, presenting shallow isolated buccal mucosal recession. Material and Methods Sixteen patients were included in this prospective study. A connective tissue graft (CTG) was harvested from the maxillary tuberosity. The donor soft tissue was de-epithelialized and trimmed with a mucotome for an optimal adaptation to the collar of the implant. Results Surgery and healing proceeded with no complications and minimal post-operative discomfort. One-year follow-up demonstrated clinical and esthetic improvements. Treatment resulted in 89.6 ± 13.1% mean coverage, and complete implant soft tissue coverage was achieved in nine of 16 cases, corresponding to a 56.3%. The VAS esthetic analysis showed a significant improvement from 3.6 ± 0.2 to 8.5 ± 0.3. Conclusions These positive preliminary results suggest that, by means of the surgical technique presented, buccal soft tissue dehiscences around single implants can be successfully treated. Additional Randomized controlled trials (RCTs) should be encouraged to assess the most effective variation to the technique in the various clinical situations and around implants of different designs.