Prospective study of the impact of peri-implant soft tissue properties on patient-reported and clinically assessed outcomes.

Bonino F1, Steffensen B1, Natto Z2, Hur Y1, Holtzman LP3, Weber HP4.

J Periodontol. 2018 Sep;89(9):1025-1032. doi: 10.1002/JPER.18-0031. Epub 2018 Aug 14.



It has been proposed that the presence of a zone of keratinized mucosa (KM) around implants is associated with less discomfort during brushing and improved esthetic outcomes. Therefore, mucogingival procedures have been recommended for patients with discomfort during brushing, and to enhance esthetic results around implants without KM. However, no study has systematically assessed and compared discomfort during brushing, patient soft tissue esthetic satisfaction, and other clinical parameters between implants with and without KM.


Group 1 included patients with implants surrounded by KM, whereas patients in Group 2 had no KM around implants. Patient discomfort during brushing and esthetic satisfaction were measured with a visual analog scale and compared between the 2 groups using a mixed model. Clinical width of KM, probing depth, peri-implant recession, plaque index, and bleeding on probing were compared within and between groups 3 and 6 months following implant restoration.


Twenty-four patients (12 in each group) were evaluated at the 3- and 6-month follow-up visits. Patients without peri-implant KM were less satisfied with the esthetics of the soft tissue around their implants (P < 0.01). However, lack of KM was not associated with discomfort during brushing. In Group 1, width of KM was significantly increased after 6 months (P < 0.01). There was greater recession around implants without KM after 3 months (P < 0.01), but not after 6 months.


Patients reported that presence or absence of keratinized mucosa did not affect discomfort associated with brushing. Yet, esthetically, patients preferred implants with a zone of keratinized mucosa.

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