This is in preposition of a treatment planning of an appropriate surgical technique for increasing the width of the attached mucosa in order to maintain Peri-implant health.
The soft tissue around gingival being divided into gingival and mobile alveolar mucosa, the gingival width varies individually as 2-9 mm.There is a time-point to distinguish the peri-implant mucosa from the gingival around the teeth: The peri-implant connective tissue has less number of fibroblasts & more collagen fibers’ as compared to gingiva. The junctional epithelium is more permeable with scarce number of blood vessels than that of around the tooth.
The peri-implant connective tissue fibers’ run in a parallel direction to the implant or abutment surface without being attached rather being perpendicular to the root cementum.
It has been concluded that presence of non-elastic collagen fibers’ in the connective tissue is responsible for keratinization. Based on findings, >2 mm of keratinized tissue is required for maintenance of healthy gingival tissues.However,around the dental implants, the crucial role of an adequate width of keratinized /attached mucosa for the clinical success is still controversial.
Recent studies have shown that lack of adequate width of Keratinized alveolar mucosa around dental implants is associated with more plaque accumulation, inflammation, soft tissue recession, attachment loss.
Since implant surgery includes one or two stage bone augmentation procedures, displacement of the mucogingival Junction does occur.hence, in order to regulate the width of keratinized attached mucosa, two different peri-implant soft tissue augmentation procedures can be concluded: Increase in soft tissue volume using a sub epithelial connective tissue graft or soft tissue replacement graft Enlargement of keratinized mucosa width by means of an apically repositioned flap/vestibuloplasty.