The Influence of Soft Tissue Thickness on Crestal Bone Changes Around Implants: A 1-Year Prospective Controlled Clinical Trial

Purpose: The aim of this clinical trial was to evaluate the influence of gingival tissue thickness on crestal bone loss around dental implants after a 1-year follow-up. Materials and Methods: Forty-six implants (23 test and 23 control) were placed in 19 patients. The test implants were placed about 2 mm supracrestally, whereas the control implants were positioned at the bone level. Before implant placement, the tissue thickness at implant sites was measured with a periodontal probe. After healing, metal-ceramic cement-retained prostheses were constructed. According to tissue thickness, the test implants were divided into A (thin) and B (thick) groups. Intraoral radiographs were performed and crestal bone changes were measured at implant placement and after 1 year. Results: Mean bone loss around the test implants in group A (thin mucosa) was 1.61 ± 0.24 mm (SE; range, 0.9 to 3.3 mm) on the mesial and 1.28 ± 0.167 mm (range, 0.8 to 2.1 mm) on the distal. Mean bone loss in test group B (thick mucosa) implants was 0.26 ± 0.08 mm (range, 0.2 to 0.9 mm) on the mesial aspect and 0.09 ± 0.05 mm (range, 0.2 to 0.6 mm) on the distal aspect. Mean bone loss around control implants was 1.8 ± 0.164 mm (range, 0.6 to 4.0 mm) and 1.87 ± 0.166 mm (range, 0.0 to 4.1 mm) on the mesial and distal aspects, respectively. Analysis of variance revealed a significant difference in terms of bone loss between test A (thin) and B (thick) groups on both the mesial and the distal. Conclusion: Initial gingival tissue thickness at the crest may be considered as a significant influence on marginal bone stability around implants. If the tissue thickness is 2.0 mm or less, crestal bone loss up to 1.45 mm may occur, despite a supracrestal position of the implant-abutment interface. Keywords: biologic width, crestal bone loss, dental implants, microgap, mucosal thickness