Thick soft tissues around implant-supported restoration; stable crestal bone levels?

Abstract

The peri-implant tissue remodeling just after implant surgery forms a coagulum that occupies the space between mucosa and implant. This is invaded by neutrophils and a barrier forms around implant consisting of dense fibrin network. In another 2 weeks post surgery, it is replaced by connective tissue and vascular structures. In the crestal area, the proliferation of epithelium takes place and forms a junctional epithelium. The barrier epithelium around the implant matures in 6–8 weeks. Formation of biological width begins when the implant gets exposed to the oral environment. This could be through healing screw or prosthetic abutment depending on connection to the implant. It is said that thin or thick tissues have different approaches to healing as the blood supply is varied. Flap is raised during the second stage of implant surgery damaging the blood supply of surrounding tissues. Thin mucosa present around the implant crestal area might lead to more bone loss but not thick tissues as more blood vessels are present here. Bone turnover can lead to crestal bone loss up to 3.2 mm apical to soft-tissue margin. The thickness of the tissues may be a recognized biological factor that might lead to crestal bone stability. In this report, we describe three cases where bone remodeling was camouflaged by thick soft tissues around implant-supported restorations.