Do Soft Tissue Augmentation Techniques Provide Stable and Favorable Peri-Implant Conditions in the Medium and Long Term?

Consensus Statement 1: Single implant sites may display stable peri-implant interproximal bone levels in the medium and long-term, whether or not soft tissue augmentation is performed. This statement is supported by 12 studies (3 RCTs and 9 prospective clinical studies).

Consensus Statement 2: At healthy single implant sites, probing depths, bleeding, and plaque scores evaluated at 1 year, remain stable for up to 5 years, with or without soft tissue augmentation. This statement is supported by 11 studies (2 RCTs and 9 prospective clinical studies).

Consensus Statement 3: Single implant sites augmented with connective tissue grafts, either for soft tissue phenotype modification or buccal soft tissue dehiscence, display a stable level of the soft tissue margin up to 5 years. This statement is supported by 10 studies (2 RCTs and 8 prospective clinical studies). Non-augmented sites may show apical migration of the soft tissue margin in the long-term. This statement is supported by five studies (1 RCT and 4 prospective clinical studies).

Consensus Statement 4: Single implant sites receiving connective tissue grafts, display stable, or even increased soft tissue thickness and/or width of keratinized mucosa, from 1 to 5 years. This statement is supported by five studies (1 RCT and 4 prospective clinical studies) for soft tissue thickness and three studies (1 RCT and 2 prospective clinical studies) for the width of keratinized mucosa.

Consensus Statement 5: Single implant sites after augmentation with connective tissue grafts or substitutes with favorable aesthetic outcomes (i.e., pink aesthetic score, visual analog scale) are maintained or even improved, from 1 to 5 years. This statement is supported by four studies (1 RCT and 3 prospective clinical studies) for connective tissue grafts and 1 RCT for substitutes (15 patients in total, 8 vs. 7 implants). Single implant sites without soft tissue augmentation may display a higher discoloration (ie. mucosal discoloration score) compared to sites with connective tissue grafts. This statement is supported by 1 prospective clinical study (17 patients in total, 28 implants, 20 vs. 8).

Consensus Statement 6: Single implant sites receiving soft tissue augmentation maintain stable patient-reported aesthetic outcomes, from 1 to 5 years. This statement is based on three studies (1 RCT and 2 prospective clinical 48 | JENSEN et al. studies). Patient-reported brushing discomfort is reduced at implant sites where keratinized mucosa width was augmented with a free gingival graft. This statement is based on 1 prospective clinical study, including 98 patients and 98 implants followed up to 10 years.

1) Are soft tissue augmentation procedures recommended in the presence of inadequate keratinized mucosa at healthy implant sites?

In patients with difficulty in plaque control and/or reporting brushing discomfort, a free gingival graft is recommended in nonaesthetic implant sites, whereas a connective tissue graft is recommended in aesthetic implant sites.

2) Are soft tissue augmentation procedures recommended in the presence of a thin soft tissue phenotype at healthy implant sites?

Soft tissue augmentation procedures are recommended only when there is a patient aesthetic request. A connective tissue graft should be used when there is no keratinized mucosa, while soft tissue substitutes may also be selected as an alternative in the presence of keratinized mucosa.

3) Are soft tissue augmentation procedures recommended in the presence of a mid-facial soft tissue dehiscence at a restored implant with healthy peri-implant conditions?

In case of acceptable 3-dimensional implant position: Soft tissue augmentation with a connective tissue graft is recommended to improve aesthetic outcomes and promote long-term stability of the soft tissue margin. In case of facial implant malposition: In the presence of patient aesthetic complaints and based on the severity of implant malposition, two treatment options should be considered: connective tissue graft with a new implant crown/abutment, or removal of the implant.

4) In the presence of a concave soft tissue profile and thin buccal bone, can soft tissue augmentation be performed alone?

In the presence of patient aesthetic complaint or difficulty in plaque control due to a concave soft tissue profile, a connective tissue graft is recommended.

1) How long will I have to be without a tooth?

Ideally, we will try to avoid leaving you without a tooth. We can offer both fixed and removable solutions and design them so there is no pressure on the surgical site. If you already have a tooth replacement, we can adjust it (usually by cutting it back by 2 mm) to avoid any pressure.

2) Will I need to have a soft tissue graft?

It depends on the shape and volume of your jaw bone and gum where the implant is to be placed.

3) Will you use part of my palate to increase the thickness of gum around the implant?

Most likely we will need to use soft tissue from your palate, either from behind the teeth or from the back of the upper jaw. In some specific cases, we may be able to use a soft tissue substitute.

4) How long after implant placement and soft tissue grafting will I get the crown?

In some favorable cases it is possible to have a screwretained temporary crown fitted immediately. If this is not possible, 3 months is usually the longest you will have to wait.

5) Can bone and soft tissue grafting be performed in the same surgical procedure?

Yes, this can be done if the conditions are favorable and feasible.