Long-term success through peri-implant soft tissue management: when, why and how

In the first part of his lecture at the FOR Greater China Symposium 2024, Dr. Giorgio Tabanella discusses the critical importance of healthy, well‐managed soft tissue around dental implants—often called the peri‐implant mucosa or pre‐implant mucosa. He emphasizes that although implants can integrate well in bone, it is actually the soft‐tissue seal (the “collar”) that serves as the first line of defense against bacterial infiltration and subsequent complications such as mucositis and peri‐implantitis.

He begins by describing how peri‐implant mucosa differs from natural gingiva around a tooth. Unlike gingiva, which has perpendicular collagen fibers inserting into the tooth, peri‐implant mucosa typically exhibits parallel collagen fibers running along the implant or abutment. Blood supply is also more limited around an implant because it lacks a periodontal ligament. Together, these differences make the tissue seal on implants more fragile and easily disrupted.

A key point is the role of the “soft‐tissue collar” in preventing bacteria from penetrating along the implant–abutment junction. When that seal is disrupted—for example, by repeated abutment removals—epithelial cells can be torn away, moving the biologic width apically and exposing more of the implant surface to bacterial colonization. Such breaches can precipitate mucositis and, ultimately, peri‐implantitis.

Dr. Tabanella cites multiple studies indicating:

• Thin tissue (<2 mm) around an implant is more prone to bone loss—sometimes more than 1 mm in the first year—while thicker tissue (>2 mm) greatly reduces this risk.

• Adequate keratinized tissue band (≥2 mm) correlates with lower plaque scores, lower bleeding scores, and fewer inflammatory complications over time.

• Keeping a one‐abutment–one‐time approach (or using prosthetic components like a “tissue‐level” extension or an On1 concept) helps preserve that original seal by limiting disconnections.

He then examines implant material and surface considerations, noting that rough surfaces are more conducive to fibroblast attachment, whereas epithelium migrates faster over smooth or polished surfaces. Innovations such as anodized abutments or hybrid surfaces (e.g., “Xeal” for transmucosal components and “TiUltra” for the implant body) can speed keratinocyte migration and improve soft‐tissue thickness, all while minimizing plaque adhesion.

Finally, Dr. Tabanella points out five main reasons for “soft‐tissue boosting” around implants:

1. A more robust seal at the collar to thwart bacterial contamination

2. Less peri‐implant bone loss when tissue is ≥2 mm thick

3. Improved plaque control (lower plaque and bleeding scores)

4. Better maintenance, even in partially compliant patients

5. Enhanced pink esthetics by preventing visible graying of implants

He closes the first part of his lecture by reminding clinicians that preventing complications starts with sound planning, preserving soft tissue during surgery, and using carefully chosen prosthetic connections that avoid repeated disruption of the tissue seal.