title: Effects of soft tissue punch size on the healing of peri-implant tissue in flapless implant surgery.
abstract: OBJECTIVE
  In an attempt to help produce guidelines for the use of soft tissue punches, this animal study was undertaken to examine the effects of soft tissue punch size on the healing of peri-implant tissue in a canine mandible model.
  
  
  METHODS
  Bilateral, edentulous, flat alveolar ridges were created in the mandibles of 6 mongrel dogs. After a 3-month healing period, 3 fixtures (diameter 4.0 mm) were placed on each side of the mandible using 3-mm, 4-mm, or 5-mm soft tissue punches. After subsequent healing periods of 3 weeks and 3 months, the peri-implant mucosa was evaluated using clinical, radiologic, and histometric parameters, which included gingival index, bleeding on probing, probing pocket depth, marginal bone loss, and vertical dimension measurements of the peri-implant tissues.
  
  
  RESULTS
  The results obtained showed significant differences (P < .05) between the 3-mm, 4-mm, and 5-mm tissue punch groups for the length of the junctional epithelium, probing depth, and marginal bone loss at both 3 weeks and 3 months after implant placement. When the mucosa was punched with a 3-mm tissue punch, the length of the junctional epithelium was shorter, the probing depth was shallower, and less crestal bone loss occurred than when using a tissue punch with a diameter >or=4 mm.
  
  
  CONCLUSIONS
  The results show that the size of the soft tissue punch plays an important role in achieving optimal healing. The findings support the use of a tissue punch slightly narrower than the implant itself to obtain better peri-implant tissue healing around flapless implants.
authors.affiliation: Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea.
authors.forename: Du-Hyeong
authors.initials: DH
authors.lastname: Lee
authors.forename: Byung-Ho
authors.initials: BH
authors.lastname: Choi
authors.forename: Seung-Mi
authors.initials: SM
authors.lastname: Jeong
authors.forename: Feng
authors.initials: F
authors.lastname: Xuan
authors.forename: Ha-Rang
authors.initials: HR
authors.lastname: Kim
authors.forename: Dong-Yub
authors.initials: DY
authors.lastname: Mo
mesh_terms: D016301:Alveolar Bone Loss / Q000145:classification / Q000000981:diagnostic imaging; D000541:Alveolectomy / Q000379:methods; D000818:Animals; D003238:Connective Tissue / Q000473:pathology; D000044:Dental Abutments; D003758:Dental Implantation, Endosseous / Q000295:instrumentation* / Q000379:methods; D015921:Dental Implants; D004285:Dogs; D004846:Epithelial Attachment / Q000473:pathology; D005260:Female; D005884:Gingival Hemorrhage / Q000145:classification; D007576:Jaw, Edentulous, Partially / Q000601:surgery; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery*; D023421:Models, Animal; D016348:Osseointegration / Q000502:physiology; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification / Q000473:pathology; D010519:Periodontium / Q000601:surgery*; D011677:Punctures / Q000295:instrumentation*; D011859:Radiography; D011897:Random Allocation; D013524:Surgical Flaps; D013997:Time Factors; D014945:Wound Healing / Q000502:physiology
chemical_list: D015921:Dental Implants