The soft tissue response to osseointegrated dental implants

The use of dental implants in the treatment of fully edentulous patients has become an important addition in oral/dental rehabilitation. The fact that these implants penetrate the oral mucosa can lead to the assumption that peri-implant tissues, similar to the periodontal tissues, are fulfilling an important function as a barrier to protect the bony anchorage underneath. It has been shown that insufficient plaque removal may lead to peri-implant tissue disease with bone loss similar to teeth. However, it is unclear how important this cause is as a source of implant failure compared with other factors, such as inadequate bone healing, unfavorable quantity and quality of bone, or (bio)mechanical and functional problems. It is also not understood if peri-implant epithelium and connective tissue are equally needed and/or qualified to slow down or prevent tissue breakdown as their periodontal counterparts. The scientific work focusing on peri-implant soft tissues has dramatically increased in the past few years. Most studies to date have examined and described their structure but little data exist on their true biologic function. This review analyzes the current understanding of morphologic and clinical features of the peri implant soft tissues. Furthermore, evidence shall be provided that peri-implant soft tissues do not interfere with the current favorable results obtained when treating the edentulous patient with osseointegrated implants.