Soft tissue is the issue: new concepts for peri-implant stability

Peri-implant diseases represent a major biological complication associated with implant therapy. Although biofilm is the principal aetiological factor, the peri-implant soft-tissue phenotype modulates susceptibility, inflammatory progression and long-term tissue stability. Key parameters include keratinized mucosa width, mucosal thickness, supracrestal tissue height and tissue quality (elasticity). This review summarizes the biological rationale for soft tissue phenotype modification (STPM), appraises contemporary surgical techniques and soft tissue substitutes, and proposes a practical decision tree to guide phenotype-based prevention and adjunctive peri-implant therapy. CPD/Clinical Relevance: Soft tissue grafting is a critical procedure for long term peri-implant stability, and it can be performed either preventively or in addition to non-surgical and surgical peri-implant therapy.