Soft Tissue Phenotype Modification Impacts on Peri-Implant Stability: A Comparative cohort study

Objectives: Soft tissue phenotype modification could be performed to maintain peri-implant health. Therefore, the aim of the study was to analyze tissue alteration around implants following soft tissue phenotype modification during implant uncovering surgery. Materials and methods Patients had soft tissue phenotype modification (either pouch roll or modified roll technique) during implant second-stage surgery with at least 12-month follow-up were included. Clinical and radiographic parameters including mucosal tissue thickness, recession (REC), keratinized mucosa width (KMW), probing pocket depth (PPD), marginal bone loss (MBL), emergence profile, and emergence angle were extracted from 2-week, 2-month, and 12-month visits after 2nd stage surgery. Results Twenty-eight patients with 33 implants fulfilled the inclusion criteria were included. After soft tissue phenotype modification, at 2-week, REC was negatively correlated to mean MTT at mid-buccal site (r=-0.41, p = 0.018) and borderline correlated at mid-lingual site (r=-0.343, p = 0.051). Stable KMW was maintained from 2-week to 12-month with minimal shrinkage rate (3 ~ 14%). MBL change was limited (0.24 ~ 0.47 mm) after STPM. All implants had shallow PPD (≤ 3 mm) with the absence of bleeding on probing. Emergence angle at the mesial side, however, was significantly correlated to surgical techniques, which indicated pouch roll technique would have 6.96 degrees more than modified roll technique (p = 0.024) Conclusions Soft tissue phenotype modification, either pouch roll or modified roll technique, during uncovering surgery resulted in favorable clinical outcomes. Thin mucosal tissue thickness and pouch roll technique are the factors related to more recession at 2 weeks. Pouch roll technique could influence the restorative design by having a wide emergence angle at the mesial side. Clinical relevance: Modified and pouch roll techniques during uncovering surgery were viable methods to yield favorable peri-implant health, while the preciseness of pouch roll technique was required to avoid mucosal recession and inadequate restorative design.