What are the main factors associated with hard‐ and soft‐tissue deficiencies at potential implant sites?

The healing process following tooth loss leads to diminished dimensions of the alveolar process/ridge representing hard‐ and soft‐tissue deficiencies. Larger deficiencies may occur at sites exposed to the following factors: loss of periodontal support, endodontic infections, longitudinal root fractures, thin buccal bone plates, buccal/lingual tooth position in relation to the arch, extraction with additional trauma to the tissues, injury, pneumatization of the maxillary sinus, medications, and systemic diseases reducing the amount of naturally formed bone, agenesis of teeth, pressure from soft‐tissue supported removable prosthesis, and combinations.

What factors are associated with recession of the peri‐implant mucosa?

The principal factors for recession of the peri‐implant mucosa are malpositioning of implants, lack of buccal bone, thin soft tissue, lack of keratinized tissue, status of attachment of the adjacent teeth and surgical trauma.

Does the presence/absence of keratinized mucosa play a role in the long‐term maintenance of peri‐implant health?

The evidence is equivocal regarding the effect of keratinized mucosa on the long‐term health of the peri‐implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal.

What is the role of the peri‐implant bone in giving form to the peri‐implant soft tissues?

The papilla height between implants and teeth is affected by the level of the periodontal tissues on the teeth adjacent to the implants. The height of the papilla between implants is determined by the bone crest between the implants. Results are equivocal whether the buccal bone plate is necessary for supporting the buccal soft tissue of the implant in the long‐term.