Keratinized Tissue: terminology and best time to correct?
One of the factors in maintaining the health of implants is insuring that there is an adequate zone of keratinized tissue around the implant. Failure to have or establish an adequate zone of keratinized tissue may compromise the health and longevity of the implant and may increase the chances of peri-implantitis. Regarding terminology, are the terms keratinized mucosa and attached gingiva synonymous? I thought keratinized mucosa includes marginal gingiva and free gingiva while attached gingiva is area apical to that. Is that right? What is the most appropriate terminology to describe the zone of keratinized tissue around the implant? When is the best time to augment the zone of keratinized tissue, before or after implant installation?
2 Comments on Keratinized Tissue: terminology and best time to correct?
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Niels
2/14/2017
Keratinized tissue is not the same as attached gingiva from a terminology standpoint. You are correct in the fact that attached tissue is apical to the free gingival margin. It is the keratinized tissue that has fibers inserting from the root surface. There is no attached gingiva around an implant because the gingival fibers do not attach to the implant surface (despite what some implant companies claim). The gingival fibers around an implant originate from the bone and run parallel to the implant surface. Keratinized mucosa is much more sturdy, however, and is still recommended around implants.
In regard to what to call this tissue around an implant, I simply call it "zone of keratinized tissue" or simply "keratinized tissue". There may be more descriptive terms, but I believe this to be simplest.
When to augment the zone of keratinized tissue around an implant depends on the case. If it is a 2 stage implant, the most logical time is at the time of implant uncovery. If there is bone augmentation needed prior to implant, it sometimes is done before even the bone augmentation, as it is much better from a soft tissue handling standpoint to have keratinized tissue to work with and suture for the ridge graft. It is always possible after the implant has been restored, but subjects the implant to some risk if the implant is restored with little to no keratinized tissue. How much risk is open for debate.
William
2/14/2017
Nice review was done in the Compendium. Available here.
