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Journal of Peking University (Health Sciences) ›› 2020, Vol. 52 ›› Issue (2): 332-338. doi: 10.19723/j.issn.1671-167X.2020.02.022

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Effect of vertical soft tissue thickness on clinical manifestation of peri-implant tissue in patients with periodontitis

Zhong ZHANG,Huan-xin MENG(),Jie HAN(),Li ZHANG,Dong SHI   

  1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-10-07 Online:2020-04-18 Published:2020-04-18
  • Contact: Huan-xin MENG,Jie HAN E-mail:kqhxmeng@bjmu.edu.cn;han_jie17@sina.com

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Abstract:

Objective: To observe and investigate the effect of vertical soft tissue thickness on the peri-implant tissue condition and the prevalence of peri-implant disease in patients with history of periodontitis. Methods: Among 210 patients who showed initial interest of implant therapy, 92 patients were included in this study and received implant surgery during 2010 and 2015. Sixty-six patients with 66 implants finally came back for T2 evaluation. Prior to the implant therapy, all the patients had received periodontal treatment. During the implant placement surgery, the distance from palatal soft tissue edge to the alveolar crest, which was defined as vertical soft tissue thickness (VT), was measured after the buccal full thickness flap was elevated. According to the cut off point which was adopted from the operating characteristic curve, 66 implants within 66 patients were divided into two groups, which were called normal group (VT≤4.5 mm) and thick group (VT>4.5 mm), respectively. Information of the patient's general status, periodontal situation and implant information were recorded. After a follow-up period of 42.9 months, the parameters of peri-implant tissue and condition of peri-implant disease were recorded. Mann-Whitney U test as well as Chi-square test were used to compare the parameters between two groups. Moreover, Kaplan-Meier method was chosen to draw the event(peri-implantitis)-free survival curve. Results: The survival rate of the implants was 100%. At the end of the follow-up examination(T2), the parameters including max PDi, mean PDi, max BIi, mean BIi, mean MBL, MBL at distal side, MBL at mesial side, mean PLIi presented significantly higher values in thick group than in normal group (P ＜ 0.05). Moreover, the prevalence of peri-implantitis and peri-implant disease(peri-implant mucositis & peri-implantitis) in thick group was respectively 34.8% and 73.9%, which was significantly higher than 2.3% and 48.8% respectively in normal group (P＜0.05). The prevalence of peri-implant mucositis did not show significant difference in the two groups. In addition, Kaplan-Meier analysis showed that there was significant difference between the event-free survivals of the two groups. Conclusion: The vertical soft tissue thickness around implants in patients with periodontitis has a significant effect on the health of the peri-implant tissue. Excessive vertical soft tissue thickness may result in deeper peri-implant probing depth as well as more peri-implant marginal bone loss, and eventually increase the risk of peri-implant disease. The vertical remodeling of soft tissue may be a new direction to indicate the role of periodontitis in peri-implant tissue condition. Moreover, the biological mechanism of the association between soft tissue thickness and peri-implantitis risk as well as effective approaches to prevent the adverse effect of excessive soft tissue thickness on peri-implant tissue is necessary to be investigated.

Key words: Dental implants, Vertical soft tissue thickness, Peri-implant marginal bone loss, Peri-implant disease, Peri-implantitis

CLC Number: 

  • R783.3

Figure 1

ROC curve for determining the cut-off point of soft tissue thickness Cut off point of vertical soft tissue thickness with highest values of specificity and sensitivity (highest AUC=0.875) is 4.5 mm. AUC, area under the curve; ROC, receiver operating characteristic."

Table 1

Patients demographics"

Soft tissue
thickness		Number of
patients		Mean age/
years		Gender,
male/female		Periodontitis,
chronic/aggressive		Periodontitis,
grade Ⅰ-Ⅱ/Ⅲ-Ⅳ		Smoking,
yes/no		Follow-up
period/months		Maintenance
frequency,M1/M0
Normal4351.4±10.116/2739/45/387/3637(26-55)29/14
Thick2351.0±11.911/1218/51/224/1945(32-53)11/12

Table 2

The characteristics of implants"

Soft tissue
thickness		Number of
implants		Anterior
region		Posterior
region		MaxillaMandibleType of implantsBone grafting,
yes/no
Subcrestal implantsBone levelTissue level
Normal439(20.9%)34(70.1%)16(37.2%)27(62.8)12(27.9%)10(23.3%)21(48.8%)25/18
Thick2310(43.5%)13(56.5%)16(69.6%)*7(30.4%)*13(56.5%)*6(26.1%)4(17.4%)*14/9

Table 3

Peri-implant parameters at the follow up examination(T2) of ≤4.5 mm and >4.5 mm groups"

Soft tissue
thickness		Max PDi/
mm		Mean PDi/
mm		Max BIiMean BIiMean MBL/mmMean PLIi
Mesial sideDistal sideMean
Normal4(3-5)3(2.3-3.5)2(1-3)2(1-2.5)0.39(0.00-0.67)0.40(0.03-0.67)0.38(0.16-0.64)2(1-2)
Thick5(4-7)*4.8(3-5)*3(2-4)*2.5(2-4)*0.74(0.52-1.07)*0.81(0.45-1.06)*0.69(0.44-1.07)*2(2-3)*

Table 4

Prevalence of peri-implant mucositis at the follow up examination(T2) of ≤4.5 mm and >4.5 mm groups"

Soft tissue thicknessNumber of implantsPeri-implant mucositisPeri-implantitisPeri-implant disease
(Peri-implant mucositis & Peri-implantitis)
Normal4330(69.8%)1(2.3%)31(72.1%)
Thick2313(56.5%)8(34.8%)*21(91.3%)

Table 5

The characteristics of implants with peri-implantitis"

Soft tissue thicknessNumber of implantsPosition of implantsType of implantsBone grafting, yes/no
Normal126Subcrestal implantYes
Thick143Subcrestal implantNo
246Tissue levelYes
316Tissue levelYes
425Subcrestal implantYes
512Bone levelYes
611Subcrestal implantYes
711Subcrestal implantYes
815Bone levelYes

Figure 2

Event-free survival rate of implants Event: peri-implantitis."

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