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A clinical observation usually encountered after vestibuloplasty, or after interventions aiming to deepen the vestibule with or without simultaneous free epithelialized grafts in the posterior ridges, is that the vestibule can be subjected to major dimensional changes attributed to the buccinator fiber attachment. Therefore, this study aimed to assess the attachment of the buccinator muscles in relation to other anatomical landmarks. An ex vivo study was performed in cadaver heads to explore the association of fiber attachment in relation to the distance from the crestal aspect of the edentulous alveolar process (CAP) and the vestibular depth (VD), crestal band of keratinized mucosa (KM), and ridge height (RH). Interestingly, VD and KM were found to be strongly correlated. Likewise, VD/KM and CAP-BUC (CAP to the most coronal insertion of the buccinator muscle) were also correlated. CAP-BUC was negatively correlated with RH. Accordingly, the more atrophic the alveolar ridge (ie, more noticeable in the mandible), the shallower the vestibule, the smaller the crestal band of KM, and the greater crestal attachment of the buccinator muscular fibers. This may be the reason why the graft is subjected to major dimensional changes whenever a free epithelialized graft is performed in the posterior ridges to enhance the peri-implant soft tissue phenotype and deepen the vestibule. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusions Trial Registration To compare the 5‐year outcomes of collagen matrix (CM) and free gingival graft (FGG) used to augment the keratinized mucosa (KM) around posterior dental implants.Thirty patients (44 implants) with inadequate KM (< 2 mm) on posterior dental implants were randomized into two groups that received KM augmentation with CM or FGG. Clinical measurements comprising the KM width (KMW), buccal mucosal thickness (MT), and clinical parameters were examined in a 5‐year follow‐up. Marginal bone loss (MBL) was evaluated with standardized radiographs using the paralleling technique. Patient‐reported outcomes (PROs) during the first week post‐surgery and at the 5‐year follow‐up were evaluated.KMW increased significantly during the follow‐up period in both groups. The FGG group had a significantly greater KMW than the CM group at the 1, 2‐month follow‐up and after the 6‐month follow‐up. KM shrinkage was observed, and was greatest within the first 2 months post‐surgery in both groups. At the 5‐year follow‐up, the KM shrinkage was significantly different between the groups (FGG: 47%; CM: 70%) (p < 0.01). The MT increased significantly in the FGG group. The clinical parameters and MBL were similar between the groups. The bleeding score in the FGG group was higher than that in the CM group (p < 0.05) within the first 2 days post‐surgery, while other PROs scores were similar between groups in the first week post‐surgery. At 5‐year follow‐up, all patients were highly satisfied with the treatments.FGG was superior to CM in terms of the KM augmentation and MT increase. Except for a slight difference in self‐reported bleeding during the first two post‐operative days, CM didn't demonstrate other significant advantages in PROMs.ChiCTR1800018285 (date of registration: 9/9/2018, retrospectively registered. URL: https://www.chictr.org.cn/showproj.html?proj=24156) [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the gain in peri-implant keratinized mucosa (KM) using a combination of a free gingival graft (FGG) strip with a xenogeneic collagen matrix (XCM) and compare it to that of an FGG alone. Materials and Methods: This randomized controlled clinical study included a total of 30 patients with a minimal amount of peri-implant KM (= 1 mm) in the maxillary and mandibular anterior regions (including the premolars). The study population was divided into two groups using a randomization protocol; group A (n = 15) received a combination of FGG strip and XCM, and group B (n = 15) received FGG only to augment the KM. Clinical parameters included width of KM (WKM) measured at baseline, 1 month, and 6 months; a customized pink esthetic score (PES) measured at baseline and 6 months; and patient morbidity using visual analog scale (VAS) at days 1, 7, and 14 postoperatively. Results: After 1 month, both groups showed statistically significant gain in KM that reduced slightly by the 6-month follow-up but remained statistically significant when compared to baseline. When the gain was compared between the two groups, the difference was not statistically significant. Better esthetic outcomes and lower morbidity were reported in group A compared to group B, and this difference was statistically significant. Conclusions: Within the limitations of the study, it can be concluded that the combination of FGG strip with XCM is a viable alternative to the use of FGG in augmenting peri-implant KM. [ABSTRACT FROM AUTHOR]

Aim: To compare three-dimensional changes of aporcine derived collagen matrix (CM) and free gingival grafts (FGG) for increasing keratinized tissue (KT) at dental implants over a 24-month follow-up period. Materials and methods: This retrospective study enrolled 25 patients exhibiting 41 implants with deficient KT width (i.e., < 2 mm) who underwent soft tissue augmentation using either CM (11 patients/15 implants) or FGG (14 patients/26 implants). The primary outcome was tissue thickness change (mm) at treated implant sites between 1- (S0), 12- (S1), and 24-months (S2). Secondary outcome was the changes of KT width over a 24-month follow-up period. Results: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of -0.05 ± 0.35 mm and − 0.31 ± 0.41 mm in the CM group, and − 0.23 ± 0.38 mm and − 0.22 ± 0.81 mm in the FGG group, with no significant differences found between the groups (S0-S1: p = 0.14, S0-S2: p = 0.58). Within S1 and S2, the CM and FGG groups displayed comparable tissue thickness reduction (CM: -0.32 ± 0.53 mm, FGG: -0.02 ± 0.21 mm; p = 0.07). The FGG group exhibited a significantly greater KT gain 24-months compared to the CM group (CM: 1.50 ± 1.14 mm, FGG: 4.04 ± 1.65 mm; p < 0.001). Conclusions: CM and FGG were associated with comparable three-dimensional thickness changes over a period of 24 months. A significantly wider KT band could be established in the FGG group. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association, as well as to characterize the associated panel of pro‐ and anti‐inflammatory markers, between the different components of the peri‐implant phenotype and the presence of peri‐implantitis/peri‐implant soft‐tissue dehiscence (PISTD). Materials and Methods: A total of 324 implants in 112 patients were included. The following components of the peri‐implant phenotype were clinically measured through the use of a manual periodontal probe or a digital calliper: keratinized mucosa width (PIKM‐W), mucosal thickness (MT), attached mucosa (AM) and vestibulum depth (VD). The presence of peri‐implantitis and PISTD was assessed through clinical and radiographic examination. Mixed‐models logistic regression analyses were performed to analyse the association between peri‐implant phenotype and the presence of peri‐implantitis or PISTD, adjusting for relevant confounders. Multiplex immunoassays were employed to evaluate the peri‐implant crevicular fluid levels of a panel of pro‐ and anti‐inflammatory markers. Results: Peri‐implant health, peri‐implant mucositis and peri‐implantitis were diagnosed in 36.6%, 21.4% and 42% of the patients (classified according to their worst implant) and 35.2%, 34.3%, and 30.5% of the implants, respectively. In the multi‐level multiple regression model, the absence of PIKM‐W (odds ratio [OR] = 9.24; 95% CI: 2.73–31.28), the absence of attached mucosa (OR = 19.58; 95% CI: 6.12–62.56) and a reduced (<4 mm) vestibulum depth (OR = 2.61; 95% CI: 1.05–6.48) were associated with peri‐implantitis. Similarly, the absence of PIKM‐W (OR = 6.32; 95% CI: 1.67–23.83), a thin (<2 mm) mucosa (OR = 157.75; 95% CI: 14.06–1769.9) and a reduced vestibulum depth (OR = 3.32; 95% CI: 1.02–10.84) were associated with the presence of PISTD. Implants with PIKM‐W = 0 mm showed statistically significantly higher levels of interferon‐γ in both regular (≥2 maintenance/year) and irregular (<2 maintenance/year) compliers (p = 0.046 and p = 0.012). In irregular compliers, the absence of PIKM‐W was also associated with statistically significantly higher levels of interleukin (IL)‐1β and IL‐21 (p = 0.016, p = 0.046). These associations were independent of the effect of relevant confounders (e.g., plaque, compliance with maintenance, etc.). Conclusions: Within their limits, the present findings indicate that (a) peri‐implant soft‐tissue phenotype appears to be associated with the presence of peri‐implantitis and PISTD, and (b) in the absence of PIKM‐W, the inflammatory response seems to be dysregulated and the soft‐tissue remodelling up‐regulated. [ABSTRACT FROM AUTHOR]

Background/Aim: The stability of peri-implant tissues is crucial for the long-term success of dental implant treatments. A new cervical implant design has been developed to address the challenges associated with peri-implant tissue stability, featuring a concave cervical portion to increase tissue volume in this area. The present study aimed to clinically evaluate the effectiveness of the new cervical implant design in maintaining peri-implant tissue stability. Materials and Methods: Five clinical cases involving completely edentulous patients were selected, in which 25 implants were installed. The marginal bone level around each implant was assessed at three different time points—T0: immediately after the prosthesis installation, T1: 6 months post installation, and T2: at the last control visit, up to 38 months later. Measurements were taken to analyze changes in marginal bone levels (MBLs) and the keratinized mucosa (KM) over time. Furthermore, the keratinized mucosa (KM) around the implants was evaluated. Results: The mean and standard deviation values of the marginal bone levels at each time point were as follows—T0: 0.59 ± 0.55 mm; T1: 1.41 ± 0.59 mm; T2: 1.76 ± 0.69 mm. Statistical analysis showed significant differences across the time points (ANOVA p < 0.0001). The overall mean KM values were 3.85 mm for T1 and T2, showing the stability of the peri-implant soft tissues at ≥1-year controls. Conclusion: Within the limitations of the present study, the results showed that the Collo implants presented measured MBL values increasing within the time range analyzed in each case but within the normal values cited in the literature for these types of rehabilitation treatments. However, the measured KM values presented, in all cases, an average above the values referenced in the literature as a minimum for maintaining the health of the peri-implant tissues. [ABSTRACT FROM AUTHOR]

BACKGROUND: The substitution of missing teeth with implants is a dependable and anticipated therapeutic approach. Despite numerous studies affirming long-term success rates, there exists a spectrum of potential biological and aesthetic complications. OBJECTIVE: The primary objective of this study was to assess patient responses subsequent to surgical interventions, with a specific emphasis on the utilization of xenogenic collagen matrix (XCM), both with and without the application of a stent secured over healing abutments, in the context of keratinized gingival mucosa augmentation. The principal aim was to evaluate and draw comparisons between the clinical outcomes resulting from these two procedural approaches, with a particular focus on critical parameters encompassing post-operative complications, patient comfort, and the overall efficacy in achieving successful keratinized tissue augmentation. METHODS: Sixty patients were selected for this study. The patients were divided into three groups: A, B, and a control group, with each group comprising 20 participants. We used XCM in experimental group A, XCM covered with surgical stent in experimental group B, and free gingival graft (FGG) in the control group. After the surgical procedure, patients were required to complete a visual analogue scale (VAS) questionnaire for post-operative complications, and a quality of life (QOL) questionnaire on days 1, 3, and 7. RESULTS: Patients in the experimental groups A and B demonstrated markedly improved outcomes when compared with the control group. Assessments conducted on days 1, 3, and 7 demonstrated diminished levels of pain, bleeding, and swelling in both experimental groups, with experimental group B showing the least discomfort. The incorporation of XCM, either with or without stents, was associated with a reduction in analgesic consumption, underscoring its favorable influence on post-operative comfort, notwithstanding the exception of halitosis in experimental group B. CONCLUSION: Using XCM with or without a stent for keratinized tissue augmentation has better post-operative outcomes associated with reduced swelling, bleeding, and pain based on the QOL survey. This study provides data to support the clinical application of XCM and stents. [ABSTRACT FROM AUTHOR]

Background: Dental implants are susceptible to biological complications that affect the peri‑implant tissues. The role of the soft tissues compartment in promoting and maintaining peri‑implant health is still controversial in the literature, especially in terms of the amount/thickness of keratinized mucosa presence. Purpose: To discuss the complexities of surgical treatment of peri‑implantitis when it simultaneously presents with soft tissues deficiencies. Result: The available data supported that the presence of keratinized mucosa promotes peri‑implant health in the long term, as it favors soft tissues stability over time with less brushing discomfort reported. In the presence of peri‑implantitis associated with soft tissue deficiency, surgical peri‑implant therapy alone was not able to correct the soft tissues compartment, thus, a combined approach with peri‑implant plastic surgery is strongly advised. Conclusion: Peri-implant soft-tissue augmentation in peri‑implantitis treatment procedures may be helpful to guarantee long-term biological, aesthetic, and functional outcomes.

Deficiency of peri-implant tissue contours is commonly seen due to the process of alveolar ridge resorption after tooth loss. Minor deficiencies can be effectively managed by soft-tissue augmentation procedures to create a more biomimetic tissue contour. The minimally invasive roll technique is a modification of the palatal roll-flap technique and can be carried out at both stages of implant surgery. In this technique, the crestal keratinized tissue is marked and de-epithelialized using a circular partial-thickness incision. The crestal connective tissue is then reflected using a lingual full-thickness semi-circular incision, keeping the buccal attachment intact. This buccal attachment serves as the pedicle. The crestal connective tissue is then rolled into a pouch on the buccal aspect of the ridge to obtain soft-tissue augmentation. The present case study documents the clinical results of the minimally invasive roll flap technique (MIRT) in three clinical scenarios, namely single-stage implant surgery, second-stage implant surgery, and anterior esthetic soft-tissue contouring. In all the cases, excellent soft-tissue contour and thickness has been obtained around dental implants. The MIRT is a simple and efficient technique for areas that require minor soft-tissue augmentation. The technique can be used both in the maxilla and the mandible and facilitates a suture-free surgery.

Objectives: There is a growing evidence to suggest augmenting peri‐implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta‐analyses was to evaluate the clinical and patient‐reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. Material and Methods: Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri‐implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval −0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri‐implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. Conclusions: Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short‐term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether the lack of keratinized mucosa (KM) affects peri‐implant health after 10 years of loading. Materials and Methods: Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index, marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5‐year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri‐implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one‐piece or two‐piece) and compliance. Results: A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri‐implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri‐implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two‐piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two‐piece implants were associated with reduced MBL and MBL changes (p < 0.05). Conclusion: The lack of buccal KM appears to be linked with peri‐implant parameters such as BOP and MBL, but the association is weak. The design of one‐piece implants may account for their increased odds of exhibiting BOP. [ABSTRACT FROM AUTHOR]

Abstract Background The aim of this study was to assess the outcomes of the combination technique of strip free gingival grafts (SFGG) and xenogeneic collagen matrix (XCM) in augmenting the width of keratinized mucosa (KMW) around dental implants, and compare its efficacy with the historical control group (FGG). Methods Thirteen patients with at least one site with KMW ≤ 2 mm after implant surgery were included and received SFGG in combination with XCM. Another thirteen patients with the same inclusion and exclusion criteria from the previous trial received FGG alone. The same outcomes as the previous trial were evaluated. KMW, thickness of keratinized mucosa (KMT), gingival index (GI) and probing depth (PD) were measured at baseline, 2 and 6 months. Postoperative pain, patient satisfaction and aesthetic outcomes were also assessed. Results At 6 months after surgery, the combination technique could attain 3.3 ± 1.6 mm of KMW. No significant change could be detected in GI or PD at 6 months compared to those at 2 months (p > 0.05). The postoperative pain and patient satisfaction in VAS were 2.6 ± 1.2 and 9.5 ± 1.2. The total score of aesthetic outcomes was 3.8 ± 1.2. In the historical FGG group, 4.6 ± 1.6 mm of KMW was reported at 6 months, and the total score of aesthetic outcomes was higher than the combination technique (4.8 ± 0.7 vs. 3.8 ± 1.2, p

Is Insufficiently Keratinized Mucosa a Risk Factor for Periimplantitis? A Literature Review ABSTRACT In this study, a literature review was conducted including human studies assessing keratinized presence and extent in PubMed and Scopus whether insufficiently keratinized mucosa s risk factor for periimplantitis or not. The end of this review, we concluded that . The KM is important for masticatory stresses in the tooth margin or crown, and results in esthetics that are more favorable, overall comfort, and simplified brushing. Therefore, the presence of KM in the surrounding dental implant (DI) space is important for the prevention of inflammation, plaque buildup, gingival recession, and occurring periimplantitis. Keywords : Keratinized mucosa, Periimplantitis, Dental implants ÖZ Bu çalışmada, PubMed ve Scopus'ta keratinize varlığı ve yaygınlığını değerlendiren, yetersiz keratinize mukozanın periimplantitis için risk faktörü olup olmadığını değerlendiren insan çalışmalarını içeren bir literatür taraması yapılmıştır. Bu incelemenin sonunda şu sonuca vardık. KM, diş kenarındaki veya krondaki çiğneme stresleri için önemlidir ve daha olumlu estetik, genel konfor ve daha basit fırçalamayla sonuçlanır. Bu nedenle, çevredeki diş implantı (DI) boşluğunda KM'nin varlığı, iltihaplanmanın, plak oluşumunun, diş eti çekilmesinin ve ortaya çıkan periimplantitin önlenmesi için önemlidir.. Anahtar Kelimeler: Keratinize mukoza, Periimplantitis, Diş implantları

Background: The aim of this study was to assess the outcomes of the combination technique of strip free gingival grafts (SFGG) and xenogeneic collagen matrix (XCM) in augmenting the width of keratinized mucosa (KMW) around dental implants, and compare its efficacy with the historical control group (FGG). Methods: Thirteen patients with at least one site with KMW ≤ 2 mm after implant surgery were included and received SFGG in combination with XCM. Another thirteen patients with the same inclusion and exclusion criteria from the previous trial received FGG alone. The same outcomes as the previous trial were evaluated. KMW, thickness of keratinized mucosa (KMT), gingival index (GI) and probing depth (PD) were measured at baseline, 2 and 6 months. Postoperative pain, patient satisfaction and aesthetic outcomes were also assessed. Results: At 6 months after surgery, the combination technique could attain 3.3 ± 1.6 mm of KMW. No significant change could be detected in GI or PD at 6 months compared to those at 2 months (p > 0.05). The postoperative pain and patient satisfaction in VAS were 2.6 ± 1.2 and 9.5 ± 1.2. The total score of aesthetic outcomes was 3.8 ± 1.2. In the historical FGG group, 4.6 ± 1.6 mm of KMW was reported at 6 months, and the total score of aesthetic outcomes was higher than the combination technique (4.8 ± 0.7 vs. 3.8 ± 1.2, p < 0.05). Conclusions: The combination technique of SFGG and XCM could increase KMW and maintain peri-implant health. However, this combination technique was associated with inferior augmentation and aesthetic outcomes compared with FGG alone. Trial registration: This clinical trial was registered in the Chinese Clinical Trial Registry with registration number ChiCTR2200057670 on 15/03/2022. [ABSTRACT FROM AUTHOR]

The most challenging and time-consuming step in the free gingival graft (FGG) for keratinized mucosa augmentation is the compression suture anchoring the FGG to the periosteum. This article proposed a novel "microscrew with tie-down sutures" technique to anchor the FGG to the recipient site without the traditional trans-periosteum suture. This patient's keratinized mucosa width (KMW) around the healing abutments of teeth #29 and #30 was less than 1 mm. After an apically positioned flap (AFP) was prepared, 2 microscrews were placed at the buccal plate of the alveolar ridge bone, which is the coronal margin of the AFP. Then, the sutures winded between the microscrews and the healing abutments to anchor the FGG. In conclusion, the "microscrew with tie-down sutures" technique offers a feasible and straightforward alternative for the trans-periosteum compression suture, mainly when the periosteum is fragile, thin, or injured. [ABSTRACT FROM AUTHOR]

Copyright of Current Research in Dental Sciences is the property of Ataturk University Coordinatorship of Scientific Journals and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Deficiency of peri-implant tissue contours is commonly seen due to the process of alveolar ridge resorption after tooth loss. Minor deficiencies can be effectively managed by soft-tissue augmentation procedures to create a more biomimetic tissue contour. The minimally invasive roll technique is a modification of the palatal roll-flap technique and can be carried out at both stages of implant surgery. In this technique, the crestal keratinized tissue is marked and de-epithelialized using a circular partial-thickness incision. The crestal connective tissue is then reflected using a lingual full-thickness semi-circular incision, keeping the buccal attachment intact. This buccal attachment serves as the pedicle. The crestal connective tissue is then rolled into a pouch on the buccal aspect of the ridge to obtain soft-tissue augmentation. The present case study documents the clinical results of the minimally invasive roll flap technique (MIRT) in three clinical scenarios, namely single-stage implant surgery, second-stage implant surgery, and anterior esthetic soft-tissue contouring. In all the cases, excellent soft-tissue contour and thickness has been obtained around dental implants. The MIRT is a simple and efficient technique for areas that require minor soft-tissue augmentation. The technique can be used both in the maxilla and the mandible and facilitates a suture-free surgery. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to assess the relationship between keratinized mucosa width and peri-implant diseases, namely peri-implant mucositis and peri-implantitis. Materials and methods: Ninety-one dental implants in function for ≥ 6 months from 40 partially or completely edentulous non-smoker subjects (24 females and 16 males) were evaluated clinically and radiographically. The width of keratinized mucosa, probing depth, plaque index, bleeding on probing, and marginal bone levels were assessed. Keratinized mucosa width was categorized as ≥ 2 mm or < 2 mm. Results: There was no statistically significant association between keratinized buccal mucosa width and peri-implant mucositis or peri-implantitis (p ≥ 0.37). In the regression analysis, peri-implantitis was associated with longer implant function time (RR: 2.55, 95% CI: 1.25–11.81, p = 0.02) and implants in the maxilla (RR: 3.15, 95% CI: 1.61–14.93, p = 0.003). Mucositis was not associated with any of the factors analyzed. Conclusion: In conclusion, in the present sample, keratinized buccal mucosa width was not associated with peri-implant diseases, suggesting that a band of keratinized mucosa may not be necessary to maintain peri-implant health. Prospective studies are required to better understand its role in the maintenance of peri-implant health. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives There is a growing evidence to suggest augmenting peri‐implant keratinized mucosa in the presence of ≤ 2 mm of keratinized mucosa. However, the most appropriate surgical technique and augmentation materials have yet to be defined. The aim of this systematic review and meta‐analyses was to evaluate the clinical and patient‐reported outcomes of augmenting keratinized mucosa around implants using free gingival graft (FGG) versus xenogeneic collagen matrix (XCM) before commencing prosthetic implant treatment. Material and Methods Electronic databases were searched to identify observational studies comparing implant sites augmented with FGG to those augmented with XCM. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results Six studies with 174 participants were included in the present review. Of these, 87 participants had FGG, whereas the remaining participants had XCM. At 6 months, sites augmented with FGG were associated with less changes in the gained width of peri‐implant keratinized mucosa compared to those augmented with XCM (mean difference 1.06; 95% confidence interval −0.01 to 2.13; p = 0.05). The difference, however, was marginally significant. The difference between the two groups in changes in thickness of peri‐implant keratinized mucosa at 6 months was statistically significantly in favor of FGG. On the other hand, XCM had significantly shorter surgical time, lower postoperative pain score, and higher color match compared to FGG. Conclusions Within the limitation of this review, the augmentation of keratinized mucosa using FGG before the placement of the final prosthesis may have short‐term positive effects on soft tissue thickness. XCM might be considered in aesthetically demanding implant sites and where patient comfort or shorter surgical time is a priority. The evidence support, however, is of low to moderate certainty; therefore, further studies are needed to support the findings of the present review.

Background/Aim: The stability of peri-implant tissues is crucial for the long-term success of dental implant treatments. A new cervical implant design has been developed to address the challenges associated with peri-implant tissue stability, featuring a concave cervical portion to increase tissue volume in this area. The present study aimed to clinically evaluate the effectiveness of the new cervical implant design in maintaining peri-implant tissue stability. Materials and Methods: Five clinical cases involving completely edentulous patients were selected, in which 25 implants were installed. The marginal bone level around each implant was assessed at three different time points—T0: immediately after the prosthesis installation, T1: 6 months post installation, and T2: at the last control visit, up to 38 months later. Measurements were taken to analyze changes in marginal bone levels (MBLs) and the keratinized mucosa (KM) over time. Furthermore, the keratinized mucosa (KM) around the implants was evaluated. Results: The mean and standard deviation values of the marginal bone levels at each time point were as follows—T0: 0.59 ± 0.55 mm; T1: 1.41 ± 0.59 mm; T2: 1.76 ± 0.69 mm. Statistical analysis showed significant differences across the time points (ANOVA p < 0.0001). The overall mean KM values were 3.85 mm for T1 and T2, showing the stability of the peri-implant soft tissues at ≥1-year controls. Conclusion: Within the limitations of the present study, the results showed that the Collo implants presented measured MBL values increasing within the time range analyzed in each case but within the normal values cited in the literature for these types of rehabilitation treatments. However, the measured KM values presented, in all cases, an average above the values referenced in the literature as a minimum for maintaining the health of the peri-implant tissues.

Copyright of Journal of Prevention & Treatment For Stomatological Diseases is the property of Journal of Prevention & Treatment For Stomatological Diseases Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Peri-implant diseases, such as peri-implant mucositis and peri-implantitis, are induced by dysbiotic microbiota resulting in the inflammatory destruction of peri-implant tissue. Nonetheless, there has yet to be an established protocol for the treatment of these diseases in a predictable manner, although many clinicians and researchers have proposed various treatment modalities for their management. With the increase in the number of reports evaluating the efficacy of various treatment modalities and new materials, the use of multiple decontamination methods to clean infected implant surfaces is recommended; moreover, the use of hard tissue laser and/or air abrasion techniques may prove advantageous in the future. Limited evidence supports additional effects on clinical improvement in antimicrobial administration for treating peri-implantitis. Implantoplasty may be justified for decontaminating the implant surfaces in the supracrestal area. Surgical treatment is employed for advanced peri-implantitis, and appropriate surgical methods, such as resection therapy or combination therapy, should be selected based on bone defect configuration. This review presents recent clinical advances in debridement methods for contaminated implant surfaces and regenerative materials for treating peri-implant bone defects. It also proposes a new flowchart to guide the treatment decisions for peri-implant disease. [ABSTRACT FROM AUTHOR]

Abstract Background Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG. Aim The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period. Materials and Methods The study enrolled 32 patients exhibiting deficient KT width (i.e.,

Bone regenerative procedures have been widely proved to be a reliable treatment option to re‐create the ideal pre‐implant clinical conditions. Nevertheless, these techniques are not free from post‐operative complications which might result in implant failure. Consequently, as demonstrated by the increasing recently published evidence, a careful pre‐ and intra‐operative flap evaluation to ensure an ideal and hermetic tension‐free wound closure is of paramount importance to successfully treat bony defects. In this respect, several surgical interventions mainly aimed to increase the amount of keratinized mucosa either to allow an optimal healing after a reconstructive procedure or to establish an optimal peri‐implant soft tissue seal have been proposed. The present review summarizes the level of evidence on the surgical clinical aspects which have an impact on the soft tissue handling associated with bone reconstructive procedures and on the importance of soft tissue conditions to enhance and maintain peri‐implant health in the long‐term. [ABSTRACT FROM AUTHOR]

Copyright of Implantologie is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Purpose The aim of the present study was to evaluate the long-term effectiveness of a xenogeneic collagen matrix (CM) in pre-prosthetic augmentation of the keratinized mucosa width (KMW) at implant sites. Methods All of the patients with localized implant-supported rehabilitation previously treated with vestibuloplasty and KMW augmentation with a non-cross-linked porcine CM were recalled. KMW was measured clinically in an apico-coronal direction from the mucogingival junction to the mucosal margin at the prosthetic zenith of each crown. Measurements were performed clinically by means of a PCP-UNC15 periodontal probe and rounded to the nearest mm. KMW values recorded at 1 year, 5 and 10 years from the soft tissue augmentation procedure were compared using a one-way repeated-measures ANOVA with Bonferroni multiple comparison post-hoc analysis. The level of significance was set at 0.05. Results Measurements were conducted on 13 patients. All implants were in function with no signs of biological complications. All except one implant site showed KMW ≥ 2 mm. KMW decreased significantly from 1 year (3.33 ± 1.11 mm) to 5 years (2.77 ± 0.92 mm) (p = 0.001), and finally remained stable from 5 to 10 years (3.2 ± 0.99 mm) (p = 0.607). From a visual aspect, peri-implant soft tissues were characterized by a good texture and color blending compared to the adjacent teeth, highlighting good integration of the remodeled tissues and stability of the esthetic result. Conclusions The use of a CM in pre-prosthetic soft tissue augmentation at implant sites has proven to be effective in obtaining and maintaining at least 2 mm of KMW around dental implants over a follow-up of 10 years.

Abstract Background Assessment of the keratinized mucosa width (KMW) at edentulous sites is important for the subsequent implant treatment design. This pilot study aimed to evaluate the characteristics of the KMW at edentulous molar sites and explore the associated factors. Methods A total of 150 patients with 222 edentulous molar sites were included. The buccal KMW of the edentulous molar sites was measured during implant treatment planning. Potentially associated factors, including age, sex, smoking status, location, reasons for tooth loss/extraction, gingival phenotype (GP) and keratinized gingival width (KGW) of the adjacent teeth, were collected and analyzed. The Shapiro‒Wilk test, Student’s t test, one-way ANOVA, generalized estimation equations (GEEs) and linear regression analysis were used for data analysis at α = 0.05. Results The buccal KMW at edentulous molar sites was 3.97 ± 2.06 mm, and 41.9% of sites presented with KMW

Introduction: Analysis of the 3‐dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri‐implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri‐implant bone regeneration in presence of severe peri‐implant bone loss. Methods: A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri‐implant bone regeneration with a follow‐up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review. Results: Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri‐implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri‐implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5‐year follow‐up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri‐implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri‐implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full‐thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri‐implant bone regeneration without any clinical superiority of a certain technique. Conclusion: The available literature reveals that the success of peri‐implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri‐implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri‐implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri‐implant bone augmentation. [ABSTRACT FROM AUTHOR]

Aim: To investigate the spontaneous regeneration of the implanto‐mucosal and dento‐gingival unit after complete removal of keratinized tissue (KT). Materials and Methods: One hemi‐mandible per dog (n = 4) was allocated to receive three dental implants (test sites, premolar region), whereas three premolars on the contralateral side were controls. After osseointegration, the entire KT (buccal + lingual) was surgically excised on all test and control sites, leaving the bone exposed. Clinical measurements were performed before excision (T0) and after 12 weeks (T1). Following healing, the animals were euthanized, and the specimens were histologically processed. Descriptive statistical analyses were performed. Results: Clinical measurements revealed that at T1, on all teeth, a band of KT was spontaneously regenerated (mean width: 2.60 ± 0.66 mm), whereas on implants, KT was detected only occasionally at mesial or distal but not at buccal sites (mean total: 0.35 ± 0.53 mm; p <.0001). Histologically, spontaneous regeneration of the dento‐gingival unit was evident, displaying masticatory mucosa. At the implant sites, on the other hand, the implanto‐mucosal unit was characterized by a non‐keratinized epithelium and elastic fibres, indicating the characteristics encountered in alveolar mucosa. Conclusion: After excision of KT at implant sites, the spontaneous regeneration of the soft tissue is characterized by a non‐keratinized epithelium typical for alveolar mucosa, while at tooth sites the spontaneous regeneration was characterized by soft tissue resembling gingiva. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to describe the application of high‐frequency ultrasonography (HFUS) for assessing keratinized mucosa (KM) width at implant sites. Methods: KM width was measured at 28 implant sites exhibiting a peri‐implant soft tissue dehiscence at baseline and 12 months after soft tissue augmentation. KM width assessment was performed with a periodontal probe [clinical assessment (clKM)] and with HFUS, based on the echointensity of the keratinized epithelium compared to the adjacent structures. KM width measurements on ultrasound scans were performed linearly (lnKM) and along the soft tissue profile [surface distance (sdKM)]. Results: No statistically significant differences were observed between clKM, lnKM, and sdKM at baseline, while at 12 months, sdKM (5.313 ± 1.188 mm) was significantly higher than clKM (3.98 ± 1.25 mm) and lnKM (4.068 ± 1.197 mm) (P < 0.001 for both comparisons). A linear relationship between mucosal thickness (MT) and the difference between sdKM and lnKM was observed. In 95.2% of cases with MT > 2.51 mm, the discrepancy between sdKM and lnKM was at least 1 mm. Conclusions: HFUS is a noninvasive and valuable tool for measure KM width at implant site. Evaluating KM width along the soft tissue profile as a surface distance may improve the accuracy of the assessment. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to analyze the effect of keratinized mucosa (KM) on different peri-implant health-related parameters and on patient-reported outcome measures (PROMs). Material and methods: Randomized controlled trials, cohort, cross-sectional and case–control human studies with a follow-up period of at least 6 months comparing two groups of patients with presence or absence of KM, or with KM < 2 mm or ≥2 mm were included. Primary outcomes were implant failures, PROMs and BoP (BoP/mBI). Additional outcomes were PPD, plaque accumulation (mPI/PI), gingival inflammation (GI/mGI), marginal bone loss (MBL), soft tissue recession (REC) and biological complications. Results: Fifteen studies were included (one RCT, two cohort prospective and twelve cross-sectional). Meta-analysis was performed for cross-sectional studies. Implant failure and complications were not presented as outcome measures, and five studies analyzed PROMs. Results from the meta-analysis reported no evidence of any statistical significant difference between groups in PPD, BoP and MBL, while a statistical significant difference in GI/BI, PI and REC was present in favor of the group with KW ≥ 2 mm. More biological complications were present in the group with no KM/KM < 2 mm but few cases were present to draw any conclusions. Although a meta-analysis could not be performed, a consistent trend toward the worst pain/discomfort in KM < 2 mm was observed. Conclusions: No clear evidence was found supporting the role of KM in peri-implant health and PROMs, even if more plaque and marginal inflammation were present in the KM < 2 mm group. Clinical relevance: KM could have a role in patients with erratic maintenance and patient comfort. [ABSTRACT FROM AUTHOR]

The important role of adequate keratinized mucosa width (KMW) around implants has been studied, and although it is still a matter of debate due to inconsistent research results, recent systematic reviews have linked it to improved soft tissue health, esthetic patient satisfaction and biologic complications. To evaluate protective role of keratinized mucosa width around implant with brushing discomfort and peri-implant health tissue. This cross-sectional study evaluates 31 dental implants in 17 patients at Periodontic clinic, Dental Hospital Indonesia University. Patient were recruited during maintenance follow up from January to March 2021. The sample group were divided into two groups: adequate (KMW > 2mm) and inadequate group (KMW < 2mm). Peri-implant health parameters measured (Plaque Index (PI), Debris Index (DI) and Gingival Index (GI)), brushing discomfort (VAS) and periapical radiographic were evaluated. There was statistically different between the two groups accordingly to PI (P=0.00), DI (P=0.04) and GI (P=0.05), however brushing discomfort (P=0.15) and bone loss were not significantly correlated (P=0.23). There is a significant influence of keratinized mucosa width around implant on the health of the peri-implant tissues. Inadequate keratinized mucosa around implants associated with higher plaque index, debris index and gingival index. However there was no significant difference for brushing discomfort and bone level between the adequate and inadequate group. [ABSTRACT FROM AUTHOR]

Objectives: To assess the stability of soft tissues around implants by comparing mucosal recessions in patients with keratinized mucosa (test) with patients without keratinized mucosa (control) around osseointegrated dental implants. Method and materials: The PICO criteria used were as follows: Population, patients with osseointegrated dental implants; Intervention/exposure, presence of a keratinized mucosa; Comparison/control, absence of keratinized mucosa; Outcome, presence or absence of peri-implant mucosal recessions (mm). Data sources: An electronic search of Medline, Embase, and Cochrane Oral Health Group specialist trials supplemented by manual searching was conducted to identify studies reporting outcomes of at least 5 years on the presence of mucosal recessions at implants with or without attached mucosa. Mucosal recession (MR) was set as primary outcome. Prospective cohort studies published in English language up to October 2018, with a mean follow-up period of at least 5 years, reporting keratinized tissue height = 2 mm and < 2 mm or presence/absence of keratinized tissue, with fixed implant-supported prostheses. The homogeneity of studies was assessed by DerSimonian and Laird test (Q test). The differences in terms of gingival recession around implants reported between test groups (keratinized mucosa = 2 mm) and control (keratinized mucosa < 2 mm or no keratinized mucosa) were compared. Two studies reporting 201 patients with 514 tissue level implants were selected for the final analysis. Results: Due to the high heterogeneity between the selected studies, no statistical test could be performed. However, in both studies a deeper mucosal recession occurred when keratinized mucosa was < 2 mm: 0.61 ± 0.10 (-0.90; -0.32) and -1.92 ± 0.12 (-2.16; -1.68), respectively. Conclusion: Within their limitations, the findings indicate that after a mean observation period of at least 5 years, the presence of keratinized mucosa may lead to less mucosal recession at dental implants. [ABSTRACT FROM AUTHOR]

Objectives: To assess the clinical efficacy of xenogeneic collagen matrix (XCM) plus apically positioned flap (APF) in augmenting the keratinized mucosa (KM) width (KMW) and thickness (KMT) around posterior mandibular implants and compare it with free gingival graft (FGG) plus APF. Material and methods: Thirty patients with KMW ≤ 2 mm in the posterior mandibular implant site were randomly allocated to the FGG group (FGG plus APF) or the XCM group (XCM plus APF). Clinical assessments, including KMW and KMT, shrinkage rate of established KM, and peri-implant soft tissue health, were evaluated during a 6-month follow-up. Additionally, the esthetic outcomes and patient-reported postoperative morbidity were investigated. Results: At 6 months, the KMW measured 3.60 ± 0.79 mm in the FGG group and 3.28 ± 0.96 mm in the XCM group (p = 0.186). Both groups showed a tendency for graft contraction (FGG, 42.11%; XCM, 53.22%). The KMT measured 1.24 ± 0.34 mm in the FGG group and 0.95 ± 0.29 mm in the XCM group, with statistical difference (p = 0.002). No difference in the peri-implant soft tissue health was observed between the two groups (p > 0.05), but the esthetic outcomes were better in the XCM group (p < 0.05). Conclusions: XCM plus APF rendered a similar clinical efficacy in augmenting KMW as that with FGG plus APF, but with higher shrinkage. XCM plus APF was inferior with respect to FGG plus APF in augmenting KMT. The esthetic outcomes were better with XCM plus APF than FGG plus APF. Clinical relevance XCM plus APF graft was inferior with respect to FGG plus APF in augmenting KMT. Trial registration: Trial registration number: ChiCTR2200058027 and date: 03/27/2022. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the long-term effectiveness of a xenogeneic collagen matrix (CM) in pre-prosthetic augmentation of the keratinized mucosa width (KMW) at implant sites. Methods: All of the patients with localized implant-supported rehabilitation previously treated with vestibuloplasty and KMW augmentation with a non-cross-linked porcine CM were recalled. KMW was measured clinically in an apico-coronal direction from the mucogingival junction to the mucosal margin at the prosthetic zenith of each crown. Measurements were performed clinically by means of a PCP-UNC15 periodontal probe and rounded to the nearest mm. KMW values recorded at 1 year, 5 and 10 years from the soft tissue augmentation procedure were compared using a one-way repeated-measures ANOVA with Bonferroni multiple comparison post-hoc analysis. The level of significance was set at 0.05. Results: Measurements were conducted on 13 patients. All implants were in function with no signs of biological complications. All except one implant site showed KMW ≥ 2 mm. KMW decreased significantly from 1 year (3.33 ± 1.11 mm) to 5 years (2.77 ± 0.92 mm) (p = 0.001), and finally remained stable from 5 to 10 years (3.2 ± 0.99 mm) (p = 0.607). From a visual aspect, peri-implant soft tissues were characterized by a good texture and color blending compared to the adjacent teeth, highlighting good integration of the remodeled tissues and stability of the esthetic result. Conclusions: The use of a CM in pre-prosthetic soft tissue augmentation at implant sites has proven to be effective in obtaining and maintaining at least 2 mm of KMW around dental implants over a follow-up of 10 years. [ABSTRACT FROM AUTHOR]

Copyright of Implantologie is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This retrospective cohort study evaluates the regeneration of severe peri-implantitis deficiencies treated with the laser-assisted peri-implant defect regeneration (LAPIDER) approach within a 3-year follow-up. Methods: Twenty-four implants with severe peri-implantitis in 18 patients were treated according to the LAPIDER technique. In contrast to classic techniques for reconstructive peri-implantitis surgery with a marginal incision, a buccal split-flap preparation avoiding papillae separation was used. After a coronal flap elevation and a laser-assisted peri-implant defect cleaning, connective tissue and autogenous bone grafting was performed. Primary outcomes were the changes of the marginal bone levels (MBL) and the buccal bone thickness. Secondary outcomes included implant survival, peri-implant probing depths (PPD), bleeding on probing (BOP), recession, width of keratinized mucosa (KMW), thickness of keratinized mucosa (KMT), soft tissue esthetics (PES), and implant success. Results: MBL improved interproximal by 3.10 ± 2.02 mm (p < 0.001), buccal by 3.49 ± 2.89 mm (p < 0.001), and lingual by 1.46 ± 1.98 mm (p = 0.003); buccal bone thickness by 0.55 ± 0.60 mm (p = 0.005), and 1.01 ± 1.25 mm (p = 0.001) at 1 and 3 mm below reference level. Two implants were removed; 22 implants were still in function at a mean follow-up of 36 months. PPD changed from 5.05 ± 1.39 to 3.08 ± 0.71 mm (p < 0.001); recession was reduced from 2.07 ± 1.70 to 0.91 ± 1.13 mm (p = 0.001); KMW increased from 2.91 ± 1.81 to 4.18 ± 1.67 mm (p = 0.006); KMT improved from 1.73 ± 0.50 to 2.44 ± 0.43 mm (p < 0.001); PES changed from 7.7 ± 2.8 to 10.7 ± 1.9 (p < 0.001). 45.8% to 54.2% of the implants met the criteria of implant success. Conclusions: The favorable results document the proof of principle for the regeneration of severe peri-implant hard and soft tissue deficiencies by the LAPIDER treatment approach. [ABSTRACT FROM AUTHOR]

Background: Assessment of the keratinized mucosa width (KMW) at edentulous sites is important for the subsequent implant treatment design. This pilot study aimed to evaluate the characteristics of the KMW at edentulous molar sites and explore the associated factors. Methods: A total of 150 patients with 222 edentulous molar sites were included. The buccal KMW of the edentulous molar sites was measured during implant treatment planning. Potentially associated factors, including age, sex, smoking status, location, reasons for tooth loss/extraction, gingival phenotype (GP) and keratinized gingival width (KGW) of the adjacent teeth, were collected and analyzed. The Shapiro‒Wilk test, Student's t test, one-way ANOVA, generalized estimation equations (GEEs) and linear regression analysis were used for data analysis at α = 0.05. Results: The buccal KMW at edentulous molar sites was 3.97 ± 2.06 mm, and 41.9% of sites presented with KMW < 4 mm. The mean KMWs of the maxillary sites were significantly higher than that those of the mandibular sites (4.96 ± 2.05 mm vs. 3.41 ± 1.85 mm, respectively). In total, 54.7%, 46.5%, 29.8%, and 0.0% of mandibular first and second molar sites and maxillary first and second molar sites, respectively, displayed a KMW of < 4 mm. Statistically significant linear correlations were found between KMW and GP (r = 0.161, p = 0.025) and between KMW and KGW of the adjacent teeth (r = 0.161, p = 0.023), while other factors were found to have no significant association. Conclusion: Within the limitations of the present study, the KMW at edentulous molar site was related to the location of molar tooth loss/extraction. The GP and KGW of the adjacent teeth of edentulous molar sites were also associated with their KMW, which was probably attributed to the continuity of the adjacent soft tissue. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross‐sectional study was to evaluate the effect of brushing discomfort (BD) on peri‐implant health in sites exhibiting inadequate keratinized mucosa (KM) width. Material and Methods: Patients presenting with at least one implant exhibiting KM <2 mm and in function for ≥1 year were eligible for inclusion. BD was assessed with the visual analogue scale (VAS), and implants were classified into two groups: Absence (aBD; VAS = 0) or Presence (pBD; VAS > 0) of BD. Bleeding on probing (BoP), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), suppuration (Sup), and marginal bone level (MBL) were recorded. Mann–Whitney, chi‐square test, and a multilevel model were used for analysis. Results: Fifty‐nine patients with 155 dental implants were analyzed, of which 60 presented no BD, and 95 presented some level of BD. BoP, PD, CAL, and MBL were significantly higher in the pBD than in the aBD group (p <.05). The prevalence of peri‐implant diseases at implant level was also higher in the pBD group than in the aBD group. However, after controlling for confounding factors, only mPI showed an effect on BoP. In addition, difficulty to perform oral hygiene was statistically higher in the pBD group. Conclusions: The findings of the present study suggest that although BD around implants exhibiting KM <2 mm did not influence tissue inflammation, it could represent a symptom of peri‐implant diseases. Further clinical trials assessing the long‐term effect of BD must be considered to better ascertain its effects on peri‐implant health. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to provide the latest updates on the therapeutic effectiveness of keratinized mucosa (KM) augmentation using autogenous soft tissue grafts for dental implants retaining prostheses., Study Selection: A systematic search of electronic databases was conducted on autogenous soft tissue grafts to create and/or augment KM for functioning dental implants. Two investigators independently extracted data from the selected 11 clinical studies, including 290 participants, from the initially retrieved 573 publications., Results: A lack of KM surrounding dental implants was associated with greater mucosal inflammation. A free gingival graft (FGG) was used to increase the KM width, and a connective tissue graft (CTG) was used to manage peri-implant mucosal recession (MR). The weighted mean gain in KM was 2.6 mm from the selected FGG studies, with a significant reduction in mucosal inflammation and no changes in crestal bone levels for up to 4 years. The weighted mean reduction in MR was 2 mm in selected CTG studies., Conclusions: A lack of KM negatively affects soft tissue health around dental implants. FGG was effective in increasing KM and reducing mucosal inflammation, whereas CTG was effective in decreasing MR.

Purpose: To compare the effectiveness of keratinized mucosa (KM) augmentation with different techniques for the treatment of dental implants based on risk assessment., Methods: Thirty-nine patients who underwent KM augmentation at implant sites in the posterior mandible were included. Three techniques were used based on anatomy-guided risk assessment: an apically positioned flap (APF) alone, an APF plus a free gingival graft (APF plus FGG), and an APF plus a collagen matrix (APF plus CM). Clinically effective KM augmentation was defined as remaining KM ≥ 2 mm after the intervention. The effective rate, implant/prosthesis survival rates, and bone/soft tissue parameters were analyzed. The correlation between local anatomical characteristics and different techniques was also determined. The associations between the effectiveness of KM augmentation and related factors were analyzed using a linear model., Results: Overall, 74 sites received KM augmentation in the posterior mandible, for an effective rate of 94.6% at the 1-year follow-up and 93.2% at the 5-year follow-up. The KM width in the APF plus FGG group (3.85 ± 1.22 mm) was greater than that in the APF alone (3.05 ± 0.90 mm) (P = 0.016) and APF plus CM (3.21 ± 1.17 mm) groups (P = 0.038) at 5 years post-surgery. There was no significant difference in the effective/ineffective outcomes at the 1-year or 5-year follow-up among the three groups., Conclusions: Comparable effective outcomes were achieved with three KM augmentation techniques following the decision-making criterion based on risk assessment.

Objectives: The aim of this systematic review was to analyze the effect of keratinized mucosa (KM) on different peri-implant health-related parameters and on patient-reported outcome measures (PROMs). Material and methods: Randomized controlled trials, cohort, cross-sectional and case–control human studies with a follow-up period of at least 6 months comparing two groups of patients with presence or absence of KM, or with KM < 2 mm or ≥2 mm were included. Primary outcomes were implant failures, PROMs and BoP (BoP/mBI). Additional outcomes were PPD, plaque accumulation (mPI/PI), gingival inflammation (GI/mGI), marginal bone loss (MBL), soft tissue recession (REC) and biological complications. Results: Fifteen studies were included (one RCT, two cohort prospective and twelve cross-sectional). Meta-analysis was performed for cross-sectional studies. Implant failure and complications were not presented as outcome measures, and five studies analyzed PROMs. Results from the meta-analysis reported no evidence of any statistical significant difference between groups in PPD, BoP and MBL, while a statistical significant difference in GI/BI, PI and REC was present in favor of the group with KW ≥ 2 mm. More biological complications were present in the group with no KM/KM < 2 mm but few cases were present to draw any conclusions. Although a meta-analysis could not be performed, a consistent trend toward the worst pain/discomfort in KM < 2 mm was observed. Conclusions: No clear evidence was found supporting the role of KM in peri-implant health and PROMs, even if more plaque and marginal inflammation were present in the KM < 2 mm group. Clinical relevance: KM could have a role in patients with erratic maintenance and patient comfort.

Objective: The main objective of this study aimed to evaluate the response to treatment in implants with peri-implantitis regarding the presence or absence of keratinized mucosa. Materials and Methods: One hundred implants with peri-implantitis were treated non-surgically at the Prosthodontics and Occlusion Teaching Unit of the University of Valencia. Records were registered at day zero (recession, bleeding on probing, suppuration, probing depth, bone loss and plaque index), at 1, 3 and 6 months. Results: In both groups, a slight increase in recession and disappearance of suppuration took place, and no bone loss was observed during the following 6 months. However, after an initial reduction, probing depth, bleeding on probing and plaque index increased again in the group without keratinized mucosa (KM). Conclusions: Implants with KM presented better results after non-surgical treatment as well as in their medium-term evolution, although it would be advisable to increase the number of samples in order to achieve greater scientific evidence and standardization in the treatment protocol. Clinical relevance: The role of keratinized mucosa in the development of peri-implantitis has been mentioned in many publications, but less has been emphasized regarding its influence on the success of the treatment of this pathology. The presence of keratinized mucosa has been found to play a key role in the evolution of the non-surgical treatment of peri-implantitis. The amount of keratinized mucosa should be considered in the treatment of peri-implantitis, as well as when planning connective tissue grafts accompanying the decontamination of implants in the absence of keratinized mucosa. [ABSTRACT FROM AUTHOR]

1. Background: Peri-implantitis affects a high percentage of patients treated with dental implants. Among the risk factors that can cause this pathology, limited evidence exists regarding the absence of keratinized mucosa. The main objective of this study was to compare the amount of keratinized mucosa around healthy implants versus implants in patients with peri-implantitis, in order to analyze its influence on esthetics and the development of this pathology, and to study the possible influence of keratinized mucosa on various clinical parameters. 2. Methods: A retrospective case-control study was carried out in which 203 implants were evaluated, 103 of which presented a healthy peri-implant state, versus 100 which had peri-implantitis. The following elements were recorded: keratinized mucosa, recession, plaque index, bleeding, suppuration, probing depth, and bone level. 3. Results: Keratinized mucosa was present in 51% of the peri-implantitis group versus 97.1% of the healthy implants. In implants without keratinized mucosa, both recession and plaque index, bleeding on probing (96.2%), suppuration (57.7%), mean probing depth and bone level were higher. Implants without keratinized mucosa presented worse esthetics. 4. Conclusions: Absence of Keratinized mucosa around dental implants seems to be associated with the appearance of peri-implantitis modifying certain clinical parameters: there is a greater probability of recession, bleeding, suppuration, deficient hygiene, greater probing depth and greater bone loss in implants without keratinized mucosa. [ABSTRACT FROM AUTHOR]

Objectives: To assess the literature on (i) the relevance of the presence of a minimum dimension of keratinized peri‐implant mucosa (KPIM) to maintain the health and stability of peri‐implant tissues, and; (ii) the surgical interventions and grafting materials used for augmenting the dimensions of the KPIM when there is a minimal amount or absence of it. Material & Methods: Two systematic reviews complemented by expert opinion from workshop group participants served as the basis of the consensus statements, implications for clinical practice and future research, and were approved in plenary session by all workshop participants. Results: Thirty‐four consensus statements, eight implications for clinical practice, and 13 implications for future research were discussed and agreed upon. There is no consistent data on the incidence of peri‐implant mucositis relative to the presence or absence of KPIM. However, reduced KPIM width is associated with increased biofilm accumulation, soft‐tissue inflammation, greater patient discomfort, mucosal recession, marginal bone loss and an increased prevalence of peri‐implantitis. Free gingival autogenous grafts were considered the standard of care surgical intervention to effectively increase the width of KPIM. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues, since similar results when compared to connective tissue grafts were reported. Conclusion: Presence of a minimum width of KPIM should be assessed routinely in patients with implant supported restorations, and when associated with pathological changes in the peri‐implant mucosa, its dimensions may be surgically increased using autogenous grafts or soft‐tissue substitutes with evidence of proven efficacy. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the influence of the width of keratinized tissue (KT) on the prevalence of peri‐implant diseases, and soft‐ and hard‐tissue stability. Materials and methods: Clinical studies reporting on the prevalence of peri‐implant diseases (primary outcome), plaque index (PI), modified plaque index (mPI), bleeding index (mBI), bleeding on probing (BOP), probing pocket depths (PD), mucosal recession (MR), and marginal bone loss (MBL) and/or patient‐reported outcomes (PROMs; secondary outcomes) were searched. The weighted mean differences (WMD) were estimated for the assessed clinical and radiographic parameters by employing a random‐effect model that considered different KT widths (i.e., <2 and ≥2 mm). Results: Twenty‐two articles describing 21 studies (15 cross‐sectional, five longitudinal comparative studies, and one case series with pre–post design) with an overall high to low risk of bias were included. Peri‐implant mucositis and peri‐implantitis affected 20.8% to 42% and at 10.5% to 44% of the implants with reduced or absent KT (i.e., <2 mm or 0 mm). The corresponding values at the implant sites with KT width of ≥2 mm or >0 mm were 20.5% to 53% and 5.1% to 8%, respectively. Significant differences between implants with KT < 2 mm and those with KT ≥ 2 mm were revealed for WMD for BOP, mPI, PI, MBL, and MR all favoring implants with KT ≥ 2 mm. Conclusion: Reduced KT width is associated with an increased prevalence of peri‐implantitis, plaque accumulation, soft‐tissue inflammation, mucosal recession, marginal bone loss, and greater patient discomfort. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this systematic review was to evaluate the efficacy of soft tissue substitutes compared to autogenous gingival grafts in surgical procedures aimed at increasing the width of keratinized mucosa (KM) around dental implants. Materials and Methods: Two focused questions were developed: PICOS #1) "What is the efficacy of surgical procedures using soft tissue substitutes, as compared to autogenous grafts, to increase the amount of peri‐implant keratinized mucosa, in randomized clinical trials (RCTs) and controlled clinical trials (CCTs)?"; and PICOS #2) "What is the effectiveness of soft tissue substitutes to increase the amount of peri‐implant keratinized mucosa, in RCTs, CCTs, cohort studies or case series?". Besides KM augmentation, other relevant outcomes such as clinical and radiographic peri‐implant outcomes, incidence of biological complications, surgical time, or patient‐reported outcome measures (PROMs) were collected. Meta‐analyses were performed whenever possible. Results: Ten publications and an unpublished study were included. KM augmentation was significantly greater for autogenous grafts (n = 6; weighted mean difference (WMD) = −0.9 mm; 95% confidence interval (CI) [−1.4; −0.3]; p =.001). However, no significant differences between autogenous grafts and soft tissue substitutes were observed when exclusively xenografts were considered (n = 5; WMD=−0.8 mm; 95% CI [−1.6; 0.0]; p =.062). Surgical time and postsurgical pain seemed to be reduced by the use of soft tissue substitutes. Conclusions: Free gingival grafts (FGG) are more effective in the augmentation of KM mucosa around dental implants than soft tissue substitutes. However, substitutes of xenogeneic origin may be an alternative to autogenous tissues. [ABSTRACT FROM AUTHOR]

Aims: The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri‐implant mucosal phenotype modification therapy, referred to as "fibrin immobilization vestibular extension (FIVE)". Material and Methods: The protocol utilized entailed apical positioning and stabilization of peri‐implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet‐rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap. Results: A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri‐implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5–5.2 mm) of peri‐implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5–4.5 mm) at 3 years post‐FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8–6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6–5.6 mm). The mean of maxilla was significantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri‐implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri‐implantitis patients were removed due to advanced peri‐implantitis. Discussion The present case series provides proof‐of‐principle data for efficacy of FIVE for peri‐implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft. [ABSTRACT FROM AUTHOR]