Rationale

Peri-implant soft tissues differ from periodontal tissues in terms of structure (more collagen fibers in a parallel arrangement) and defense capacity (fewer cells) (see Chapter 2). The role of soft tissue in implant success is still questionable.

Although the presence of keratinized tissue is not essential for peri-implant tissue health and implant survival (Wennstrom et al., 1994), it can certainly facilitate plaque control, which is a crucial prerequisite to long-term implant success. Moreover, soft tissue quality and quantity around implants can have implications for esthetic results and soft tissue margin stability.

Soft tissue augmentation techniques aim to create an optimum soft tissue environment around implants, to improve implant prognosis and/or prosthetic cosmetic integration.

However, it should be noted that the recommendations that follow are essentially based on clinicians’ opinions, as scientific data regarding indications or technique selection (Klinge & Flemmig, 2009) are very limited in the literature.

Indications

The indications for soft tissue augmentation procedures can be divided into two groups.

• Keratinized tissue augmentation is required when:
  • a reduced keratinized tissue height (less than 2 mm) or width (less than 1 mm) is associated with insufficient plaque control
  • a shallow vestibule prevents access to oral hygiene originally or after tissue displacement (bone regenerative procedures)
  • soft tissue quantity is too small to assure covering of augmented bone areas.
• Soft tissue volume augmentation is performed in the following situations:
  • thin biotype when long-term soft tissue margin stability is required (esthetic)
  • ridge defects correction to improve pontic design for esthetic or plaque control (Seibert & Salama, 1996)
  • primary soft tissue closure on fresh extraction socket for ridge preservation (see Chapter 32, Fig. 32.1) or covering of GBR material (Jung et al., 2004).

The decision to perform a soft tissue augmentation is based on risk assessment (implant survival or esthetic) and the