Effects of soft tissue punch size on the healing of peri-implant tissue in flapless implant surgery

Objective. In an attempt to help produce guidelines for the use of soft tissue punches, this animal study was undertaken to examine the effects of soft tissue punch size on the healing of peri-implant tissue in a canine mandible model. Study design. Bilateral, edentulous, flat alveolar ridges were created in the mandibles of 6 mongrel dogs. After a 3-month healing period, 3 fixtures (diameter 4.0 mm) were placed on each side of the mandible using 3-mm, 4-mm, or 5-mm soft tissue punches. After subsequent healing periods of 3 weeks and 3 months, the peri-implant mucosa was evaluated using clinical, radiologic, and histometric parameters, which included gingival index, bleeding on probing, probing pocket depth, marginal bone loss, and vertical dimension measurements of the peri-implant tissues. Results. The results obtained showed significant differences (P < .05) between the 3-mm, 4-mm, and 5-mm tissue punch groups for the length of the junctional epithelium, probing depth, and marginal bone loss at both 3 weeks and 3 months after implant placement. When the mucosa was punched with a 3-mm tissue punch, the length of the junctional epithelium was shorter, the probing depth was shallower, and less crestal bone loss occurred than when using a tissue punch with a diameter >= 4 mm. Conclusions. The results show that the size of the soft tissue punch plays an important role in achieving optimal healing. The findings support the use of a tissue punch slightly narrower than the implant itself to obtain better peri-implant tissue healing around flapless implants. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 525-530)