J Periodontal Implant Sci.  2020 Aug;50(4):209-225. 10.5051/jpis.1904440222.

Influence of implant mucosal thickness on early bone loss: a systematic review with meta-analysis

  • 1Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
  • 2Department of Stomatology, University of Seville Faculty of Dentistry, Seville, Spain
  • 3Formerly - Unit of Oral Surgery and Implantology, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
  • 4Department of Multidisciplinary Regenerative Research, Guglielmo Marconi University, Rome, Italy
  • 5Unit of Oral Surgery, Department of Surgical, Medical, Molecular and Critical Needs Pathologies, University of Pisa, Pisa, Italy


Marginal bone loss (MBL) is an important clinical issue in implant therapy. One feature that has been cited as a contributing factor to this bone loss is peri-implant mucosal thickness. Therefore, in this report, we conducted a systematic review of the literature comparing bone remodeling around implants placed in areas with thick (≥2-mm) vs. thin (<2-mm) mucosa.
A PICO question was defined. Manual and electronic searches were performed of the MEDLINE/PubMed and Cochrane Oral Health Group databases. The inclusion criteria were prospective studies that documented soft tissue thickness with direct intraoperative measurements and that included at least 1 year of follow-up. When possible, a meta-analysis was performed for both the overall and subgroup analyses.
Thirteen papers fulfilled the inclusion criteria. A meta-analysis of 7 randomized clinical trials was conducted. Significantly less bone loss was found around implants with thick mucosa than around those with thin mucosa (difference, −0.53 mm; P<0.0001). Subgroups were analyzed regarding the apico-coronal positioning, the use of platformmatched vs. platform-switched (PS) connections, and the use of cement-retained vs. screw-retained prostheses. In these analyses, thick mucosa was found to be associated with significantly less MBL than thin mucosa (P<0.0001). Among non-matching (PS) connections and screw-retained prostheses, bone levels were not affected by mucosal thickness.
Soft tissue thickness was found to be correlated with MBL except in cases of PS connections used on implants with thin tissues and screw-retained prostheses. Mucosal thickness did not affect implant survival or the occurrence of biological or aesthetic complications. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42018084598


Alveolar bone loss; Dental implant-abutment design; Dental implants; Meta-analysis; Systematic review; Wound healing
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