PERIO - Periodontal Practice Today 5 (2008), No. 4 4. June 2009
As with natural teeth, controversy exists with regards to the need for keratinized mucosa around dental implants. Most clinicians find that a healthy zone of keratinized mucosa circumventing dental implants facilitates restorative procedures and improves patient comfort relative to plaque control and professional maintenance. It has been found that the quantity of keratinized mucosa in a planned implant site may vary significantly, due to local anatomy and/or local procedures. This is especially true in edentulous posterior regions where significant bone resorption has occurred. Keratinized mucosa may also be reduced or eliminated during the surgical phase of implant dentistry due to the incisions needed for flap elevation during first or second stage procedures. Concerns related to the absence of keratinized mucosa around dental implants are most often observed during the maintenance phase of treatment. These considerations include mucosal pouching, gingival hyperplasia, gingival fistulas and gingivitis. Schroeder et al (1981) postulated that the establishment of a circumferential sealing effect by a dense connective tissue collar at the site of implant penetration into the contaminated environment of the oral cavity was a prerequisite for long-term implant success. It is critical that the implant surgeon remain knowledgeable regarding the treatment of peri-implant tissues as it relates to the development of keratinized mucosa. By reconstructing keratinized mucosa at the time of implant placement the surgeon can reduce treatment time and patient expense, minimize marginal tissue recession and improve esthetics. Part I of this series focused on the development of keratinized mucosa around non-submerged dental implants with vascularized flaps. This installment focuses on techniques involving non-vascularized soft tissue grafts, specifically the sub-epithelial connective tissue graft and the free gingival graft.
Keywords: dental implants, peri-implant keratinized mucosa, connective tissue graft, free gingival graft