title: Soft tissue grafting to improve the attached mucosa at dental implants: A review of the literature and proposal of a decision tree.
abstract: BACKGROUND
  Scientific data and clinical observations appear to indicate that an adequate width of attached mucosa may facilitate oral hygiene procedures thus preventing peri-implant inflammation and tissue breakdown (eg, biologic complications). Consequently, in order to avoid biologic complications and improve long-term prognosis, soft tissue conditions should be carefully evaluated when implant therapy is planned. At present the necessity and time-point for soft tissue grafting (eg, prior to or during implant placement or after healing) is still controversially discussed while clinical recommendations are vague.
  
  
  OBJECTIVE
  To provide a review of the literature on the role of attached mucosa to maintain periimplant health, and to propose a decision tree which may help the clinician to select the appropriate surgical technique for increasing the width of attached mucosa.
  
  
  RESULTS
  The available data indicate that ideally, soft tissue conditions should be optimized by various grafting procedures either before or during implant placement or as part of stage-two surgery. In cases, where, despite insufficient peri-implant soft tissue condition (ie, lack of attached mucosa or movements caused by buccal frena), implants have been uncovered and/or loaded, or in cases where biologic complications are already present (eg, mucositis, peri-implantitis), the treatment appears to be more difficult and less predictable.
  
  
  CONCLUSIONS
  Soft tissue grafting may be important to prevent peri-implant tissue breakdown and should be considered when dental implants are placed. The presented decision tree may help the clinician to select the appropriate grafting technique.
authors.forename: Mario
authors.initials: M
authors.lastname: Bassetti
authors.forename: Regula
authors.initials: R
authors.lastname: Kaufmann
authors.forename: Giovanni E
authors.initials: GE
authors.lastname: Salvi
authors.forename: Anton
authors.initials: A
authors.lastname: Sculean
authors.forename: Renzo
authors.initials: R
authors.lastname: Bassetti
mesh_terms: D003238:Connective Tissue / Q000637:transplantation; D003663:Decision Trees; D003758:Dental Implantation, Endosseous; D015921:Dental Implants; D005881:Gingiva / Q000637:transplantation*; D005893:Gingivoplasty / Q000379:methods; D006801:Humans; D009061:Mouth Mucosa / Q000637:transplantation*; D013524:Surgical Flaps; D014727:Vestibuloplasty / Q000379:methods
chemical_list: D015921:Dental Implants