Surgical treatment of soft tissue dehiscence in dental implants: a systematic review
DOI:
https://doi.org/10.62741/ahrj.v3iSuppl.%202.158Keywords:
soft tissue dehiscences, peri-implant dehiscences, Dental implants, peri-implant recessionAbstract
Introduction: Replacing missing teeth with dental implants is currently an accepted and effective approach for restoring both function and aesthetics. Peri-implant soft tissue dehiscence is characterized by recession of the gingival margin around implant-supported crowns, with or without exposure of the implant’s metal components. This systematic review aims to evaluate the effectiveness of different surgical techniques used in the treatment of peri-implant soft tissue dehiscence. Several surgical approaches, including coronally advanced flap procedures, connective tissue grafts and tunnel techniques, have been proposed for the management of these defects, although their relative effectiveness remains unclear.
Objectives: This systematic review aims to evaluate the effectiveness of different surgical techniques used in the treatment of peri-implant soft tissue dehiscence.
Methodology: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251002309). The research question was structured using the PICO framework. A bibliographic search was performed in the PubMed, ScienceDirect, EBSCO, and B-on databases using the keywords “soft-tissue dehiscence”, “peri-implant dehiscence”, “soft-tissue recession”, “peri-implant recession”, “dental implants” and “treatment”. After duplicate removal, titles, abstracts and full texts were screened according to predefined inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal tool for randomized clinical trials and case studies was used to assess the risk of bias. Eleven studies were included, comprising two randomized clinical trials and nine case series
Results: From an initial 459 records, 11 studies involving 130 implants in 123 patients were included. The results indicate that, among the various surgical approaches analyzed, the coronally advanced flap technique combined with connective tissue grafting remains the most widely adopted. Mean defect coverage ranged from 28% to 99.2%, while complete defect coverage ranged from 0% to 90.9% of treated implants. Overall, this approach demonstrated superior outcomes in terms of tissue coverage and aesthetic improvement, with consistent improvements in peri-implant soft tissue thickness, keratinized mucosa width, and aesthetic outcomes. The randomized clinical trial comparing techniques demonstrated superior outcomes for coronally advanced flap associated with connective tissue graft compared with the tunnel technique
Conclusion: Current evidence suggests that coronally advanced flap procedures combined with connective tissue grafts may provide the most predictable clinical and aesthetic outcomes for the treatment of peri-implant soft tissue dehiscence.It is concluded that further studies, particularly randomized clinical trials, are needed to more rigorously determine the most effective technique for correcting peri-implant soft tissue dehiscence.
References
Anderson, L. E., Inglehart, M. R., El-Kholy, K., Eber, R., & Wang, H. L. (2014). Implant
associated soft tissue defects in the anterior maxilla: A randomized control trial
comparing subepithelial connective tissue graft and acellular dermal matrix
allograft. Implant Dentistry, 23(4), 416–425.
https://doi.org/10.1097/ID.0000000000000122
Burkhardt, R., Joss, A., & Lang, N. P. (2008). Soft tissue dehiscence coverage around
endosseous implants: A prospective cohort study. Clinical Oral Implants Research,
(5), 451–457. https://doi.org/10.1111/j.1600-0501.2007.01497.x
Clem, D. S., McClain, P. K., McGuire, M. K., Richardson, C. R., Santarelli, G. A.,
Schallhorn, R. A., Scheyer, E. T., Gunsolley, J. C., & Morelli, T. (2024). Harvest
graft substitute for soft tissue volume augmentation around existing implants: A
randomized, controlled and blinded multicenter trial. Journal of Periodontology,
(8), 740–748. https://doi.org/10.1002/JPER.23-0305
Cosyn, J., Thoma, D. S., Hämmerle, C. H., & De Bruyn, H. (2017). Esthetic assessments
in implant dentistry: objective and subjective criteria for clinicians and
patients. Periodontology 2000, 73(1), 193–202. https://doi.org/10.1111/prd.12163
Frisch, E., & Ratka-Krüger, P. (2020). A new technique for peri-implant recession
treatment: Partially epithelialized connective tissue grafts. Description of the
technique and preliminary results of a case series. Clinical Implant Dentistry and
Related Research, 22(3), 403–408. https://doi.org/10.1111/cid.12897
Harris, R. J. (1992). The Connective Tissue and Partial Thickness Double Pedicle Graft:
A Predictable Method of Obtaining Root Coverage. Journal of Periodontology,
(5), 477–486. https://doi.org/10.1902/jop.1992.63.5.477
Kotsailidi, E. A., Tatakis, D. N., Chen, Y., Caton, J. G., Ercoli, C., Barmak, A. B., &
Tsigarida, A. (2022). Comparison of Maxillary Tuberosity and Palatal Donor Sites
for Soft Tissue Augmentation at Implant Placement.
https://doi.org/10.21203/rs.3.rs-1633566/v1
Mazzotti, C., Stefanini, M., Felice, P., Bentivogli, V., Mounssif, I., & Zucchelli, G.
(2018). Soft-tissue dehiscence coverage at peri-implant sites. Periodontology
, 77(1), 256–272. https://doi.org/10.1111/prd.12220
Monje, A., González-Martín, O., & Ávila-Ortiz, G. (2023). Impact of peri-implant soft
tissue characteristics on health and esthetics. Journal of esthetic and restorative
dentistry: official publication of the American Academy of Esthetic Dentistry ... [et
al.], 35(1), 183–196. https://doi.org/10.1111/jerd.13003
Roccuzzo, A., Mancini, L., Marruganti, C., Ramieri, G., Salvi, G. E., Sculean, A., &
Roccuzzo, M. (2024). Long-term treatment outcomes of single maxillary buccal
peri-implant soft tissue dehiscences: A 10-year prospective study. Clinical Implant
Dentistry and Related Research, 26(1), 150–157. https://doi.org/10.1111/cid.13273
Roccuzzo, M., Dalmasso, P., Pittoni, D., & Roccuzzo, A. (2019). Treatment of buccal
soft tissue dehiscence around single implant: 5-year results from a prospective
study. Clinical Oral Investigations, 23(4), 1977–1983.
https://doi.org/10.1007/s00784-018-2634-4
Roccuzzo, M., Gaudioso, L., Bunino, M., & Dalmasso, P. (2014). Surgical treatment of
buccal soft tissue recessions around single implants: 1-year results from a
prospective pilot study. Clinical Oral Implants Research, 25(6), 641–646.
https://doi.org/10.1111/clr.12149
Rojo, E., Stroppa, G., Sanz-Martin, I., Gonzalez-Martín, O., Alemany, A. S., & Nart, J.
(2018). Soft tissue volume gain around dental implants using autogenous
subepithelial connective tissue grafts harvested from the lateral palate or tuberosity
area. A randomized controlled clinical study. Journal of Clinical Periodontology,
(4), 495–503. https://doi.org/10.1111/jcpe.12869
Romandini, M., Pedrinaci, I., Lima, C., Soldini, M. C., Araoz, A., & Sanz, M. (2021a).
Prevalence and risk/protective indicators of buccal soft tissue dehiscence around
dental implants. Journal of Clinical Periodontology, 48(3), 455–463.
https://doi.org/10.1111/jcpe.13417
Sculean, A., Chappuis, V., & Cosgarea, R. (2017). Coverage of mucosal recessions at
dental implants. Periodontology 2000, 73(1), 134–140.
https://doi.org/10.1111/prd.12178
Sculean, A., Nikou, G., Deppe, H., Allen, E. P., & Cosgarea, R. (2025). The Modified
Coronally Advanced Tunnel Technique for Coverage of Mucosal Recessions at
Dental Implants. Journal of Esthetic and Restorative Dentistry.
https://doi.org/10.1111/jerd.13423
Tavelli, L., Barootchi, S., Majzoub, J., Chan, H. L., Stefanini, M., Zucchelli, G.,
Kripfgans, O. D., Wang, H. L., & Urban, I. A. (2022). Prevalence and risk
indicators of midfacial peri-implant soft tissue dehiscence at single site in the
esthetic zone: A cross-sectional clinical and ultrasonographic study. Journal of
Periodontology, 93(6), 857–866. https://doi.org/10.1002/JPER.21-0402
Tavelli, L., Majzoub, J., Kauffmann, F., Rodriguez, M. V., Mancini, L., Chan, H. L.,
Kripfgans, O. D., Giannobile, W. V., Wang, H. L., & Barootchi, S. (2023).
Coronally advanced flap versus tunnel technique for the treatment of peri-implant
soft tissue dehiscences with the connective tissue graft: A randomized, controlled
clinical trial. Journal of Clinical Periodontology, 50(7), 980–995.
https://doi.org/10.1111/jcpe.13806
Tavelli, L., Zucchelli, G., Stefanini, M., Rasperini, G., Wang, H. L., & Barootchi, S.
(2023). Vertical soft tissue augmentation to treat implant esthetic complications: A
prospective clinical and volumetric case series. Clinical Implant Dentistry and
Related Research, 25(2), 204–214. https://doi.org/10.1111/cid.13188
Thoma, D. S., Gil, A., Hämmerle, C. H. F., & Jung, R. E. (2022). Management and
prevention of soft tissue complications in implant dentistry. Periodontology
, 88(1), 116–129. https://doi.org/10.1111/prd.12415
Zucchelli, G., Felice, P., Mazzotti, C., Marzadori, M., Mounssif, I., Monaco, C., &
Stefanini, M. (2018). 5-year outcomes after coverage of soft tissue dehiscence
around single implants: A prospective cohort study. European journal of oral
implantology, 11(2), 215–224.
Zucchelli, G., Mazzotti, C., Mounssif, I., Mele, M., Stefanini, M., & Montebugnoli, L.
(2013). A novel surgical-prosthetic approach for soft tissue dehiscence coverage
around single implant. Clinical Oral Implants Research, 24(9), 957–962.
https://doi.org/10.1111/clr.12003
Zucchelli, G., Tavelli, L., Stefanini, M., Barootchi, S., Mazzotti, C., Gori, G., & Wang,
H. L. (2019). Classification of facial peri-implant soft tissue
dehiscence/deficiencies at single implant sites in the esthetic zone. Journal of
Periodontology, 90(10), 1116–1124. https://doi.org/10.1002/JPER.18-0616
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Athena Health & Research Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of published papers is assigned to the Journal, but all content is licensed under the terms of Creative Commons Non-comercial 4.0 International License. Thus users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
