Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study

Leonardo Mancini; Franz J Strauss; Hyun-Chang Lim; Lorenzo Tavelli; Ronald E Jung; Nadja Naenni; Daniel S Thoma

doi:10.1111/cid.13314

Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study

Clin Implant Dent Relat Res. 2024 Feb 28. doi: 10.1111/cid.13314. Online ahead of print.

Authors

Leonardo Mancini^{1

2

3}, Franz J Strauss^{1

4

5}, Hyun-Chang Lim^{1

6}, Lorenzo Tavelli^{3

7}, Ronald E Jung¹, Nadja Naenni¹, Daniel S Thoma^{1

8}

Affiliations

¹ Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
² Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
³ Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA.
⁴ Faculty of Dentistry, Universidad Finis Terrae, Santiago, Chile.
⁵ Department of Conservative Dentistry, Faculty of Dentistry, University of Chile, Santiago, Chile.
⁶ Department of Periodontology, Periodontal-Implant Clinical Research Institute, Kyung Hee University School of Dentistry, Seoul, Korea.
⁷ Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
⁸ Department of Periodontology, Research Institute for Periodontal Regeneration, Yonsei University College of Dentistry, Seoul, Korea.

PMID: 38419210
DOI: 10.1111/cid.13314

Abstract

Aim: To investigate whether the lack of keratinized mucosa (KM) affects peri-implant health after 10 years of loading.

Materials and methods: Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index, marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5-year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri-implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one-piece or two-piece) and compliance.

Results: A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri-implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri-implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two-piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two-piece implants were associated with reduced MBL and MBL changes (p < 0.05).

Conclusion: The lack of buccal KM appears to be linked with peri-implant parameters such as BOP and MBL, but the association is weak. The design of one-piece implants may account for their increased odds of exhibiting BOP.

Keywords: bone loss; dental implant; keratinized mucosa; peri-implantitis.