The initial bone modeling around implants within the first year after insertion presents a challenging topic in current research. Previous studies have shown that this process is characterized by a remodeling of the horizontal and vertical bone dimension with a range of 0.7 to 3 mm within the first year [1].

First attempts to reduce this loss of tissue focused on changes of implant shapes, implant surfaces, implant position, and abutment design. The concept of “platform switching” seemed to be the most promising step in this process. Hürzeler et al. and Vela-Nebot et al. reported a reduced loss of bone substance with platform-switched abutments when compared to regular abutments after a 6-month loading. Cochran et al. and Canullo et al. support this thesis, whereas Becker et al. could not report any histological differences between platform-switched and regular abutments [2–6]. However, initial bone modeling could not be fully avoided in the abovementioned studies.

A second approach to reduce bone loss is the altering of peri-implant soft tissue. Berglundh et al. showed that the peri-implant mucosa has many features in common with the gingiva around natural teeth [7]. Around implants, a biological constant is formed comparable to the biological width, characterized by a thick epithelial layer of 2 mm and a suprabony connective tissue layer of 1 mm. Abrahamsson published similar results, showing that the dentogingival complex around implants ranges from 3.5 mm to 4 mm [8]. Lindhe et al. reported that thinning or destruction of this tissue thickness leads inevitably to peri-implant bone resorption [9]. This implies that the existence of a minimum of peri-implant mucosa thickness is crucial for the long-term stability of the bone level.

Linkevicius et al. showed that the initial tissue thickness influences crestal bone changes around implants [10, 11]. After 6 months, the group of patients with thin tissue (up to 2 mm) had a mean bone loss of 1.35 mm+/−0.33 SD, whereas patients with normal tissue or thick tissue (3.1 mm and more) showed significantly less bone loss (0.32 mm+/−0.44 SD and 0.12 mm+/−0.52 SD, respectively) [10].