Brushing discomfort around dental implants with inadequate keratinized mucosa width

Abstract

Background: The impact of inadequate keratinized mucosa (KM) width on peri-implant health has been a matter of ongoing discussions. Lately, the influence of KM on patient-reported outcomes (PROs), i.e., pain/discomfort during brushing, has also been brought to attention. Objectives: The objective of the present study was to provide a broad overview of the impact of inadequate KM width on PROs and peri-implant health and stability. Materials and methods: A search of the literature was systematically conducted in the main electronic databases (MEDLINE-PubMed, Web of Science and Cochrane Library). Data on PROs (primary outcome), plaque accumulation, tissue inflammation (primary outcome), probing depth (PD), clinical attachment level (CAL), mucosal recession (MR) and marginal bone level/loss (MBL) were collected. Titles and abstracts were reviewed according to the eligibility criteria, and the findings structured into themes. Results: Of 2324 studies retrieved, 28 were included in this review. The analysis of the included studies suggested that inadequate KM width is associated with higher levels of BD during daily oral hygiene and lower esthetic self-perception scores. Moreover, more plaque accumulation, signs of inflammation, and mucosal recession have been observed at implants sites with inadequate KM width than at sites with adequate KM width. However, whether the lack of KM might represent a risk factor for peri-implants diseases remains inconclusive. Conclusions: The data on PROs around implants with inadequate KM is still limited. The potential benefits of KM width on PROs, such as comfort upon brushing and esthetics, need to be further evaluated. Although KM width seems to have an impact on the inflammatory status and stability of peri-implant soft tissues, it remains unclear whether it might represent a risk factor for the onset and progression of bone loss and the severity of peri-implant diseases.