The use of commercially pure titanium endosseous implants has become state-of-the-art treatment for patients with craniofacial defects. This study defined criteria that can be used in assessing the peri-implant abutment epithelium. The criteria were then used to examine overall tissue reaction. In this investigation, seven patients with percutaneous craniofacial implants were evaluated. Two of these patients exhibited adverse skin reactions that were associated with heavy sebaceous crusting, skin cultures positive for Staphylococcus aureus, higher Periotest values, and thicker peri-abutment tissue with greater mobility. It was determined that these factors can predispose the patient to local infection, which, if ignored, can result in failure of the implant. This study indicates that adequate patient hygiene is crucial to maintaining healthy tissues in the peri-implant abutment site. Keywords: craniofacial prosthesis, peri-implant abutment epithelium