Is there a need for keratinized mucosa around implants to maintain health and tissue stability?
OBJECTIVE
The objective of the present review was to analyze the literature with regard to the need for keratinized mucosa around implants to maintain health and tissue stability.


METHODS
Human and animal studies were identified through electronic and hand searches. Predetermined outcome measures were (i) implant loss, (ii) peri-implant health, (iii) oral hygiene, (iv) soft-tissue recession, (v) change in marginal bone level, and (vi) patient-centered outcomes. With respect to outcome variables, change in "attachment level", soft-tissue recession and change in peri-implant bone level were only retrieved from longitudinal studies. For remaining parameters, cross-sectional studies were also considered.


RESULTS
Nineteen relevant publications were identified (17 human and 2 animal studies). Due to marked heterogeneity in study design and reported data, no statistical analysis of retrieved data was feasible. Twelve human studies reported plaque scores for sites with "adequate" (≥2 mm) and "inadequate" (<2 mm) width of keratinized mucosa, and in five studies, an "inadequate" width was associated with a significant higher plaque score. Half of the studies showed significantly higher bleeding scores at implants with < 2 mm of keratinized mucosa, while the majority of publications (8 of 10) found no differences for probing depths. Two of three longitudinal studies reporting on recessions described no long-term differences with regard to the amount of keratinized mucosa. Evidence on the effect of keratinized mucosa on bone-level changes or implant loss was scarce, and no conclusions could be drawn. No article reporting patient-centered outcomes could be identified.


CONCLUSIONS
Collectively, the findings of this review show that evidence in support of the need for keratinized tissues around implants to maintain health and tissue stability is limited.
Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. jan.wennstrom@odontologi.gu.se
Jan L
JL
Wennström
Jan
J
Derks
D016301:Alveolar Bone Loss / Q000517:prevention & control*; D000818:Animals; D015921:Dental Implants; D003774:Dental Plaque Index; D019232:Dental Restoration Failure; D005881:Gingiva / Q000033:anatomy & histology; D005889:Gingival Recession / Q000517:prevention & control*; D006801:Humans; D007633:Keratins; D009061:Mouth Mucosa / Q000502:physiology*; D009910:Oral Hygiene; D017622:Periodontal Attachment Loss / Q000517:prevention & control*; D010514:Periodontal Pocket / Q000517:prevention & control; D014945:Wound Healing
D015921:Dental Implants; D007633:Keratins