Assessment of the Hard and Soft Tissues

Prior to the placement of an implant, it is important to evaluate the existing hard and soft tissues associated with the proposed implant site (Figure 3).¹³ It is reported that at least 2mm of keratinized tissue should be present to maintain the long-term health of the implant.¹⁴ Likenvicius et al., have reported that the peri-implant crestal mucosal thickness of 2.0 mm or less may predispose to crestal bone loss regardless of supracrestal position of the implant-abutment interface or platform switching.^15,16 In addition to the thickness of peri-implant mucosal tissues, history of periodontal disease which affects the presence/absence of a buccal plate and the interproximal bone should also be reviewed.¹⁴

When the bone volume is adequate but there is a buccal plate deficiency, implant placement may be more palatal compared to the optimal position thereby resulting in a ridge lap restoration which may be difficult to clean and maintain.¹⁷ Also, interproximal bone loss is associated with the loss of papilla thereby resulting in compromised esthetics and cleansibility of the restoration.¹³ When the patient has hard and/or soft tissue deficiencies they need to be informed regarding the challenges and augmentation procedures that are necessitated to help improve the overall outcome.¹³

Figure 3. Deficient Hard and Soft Tissues

Figure 3. Deficient Hard and Soft Tissues