Long‐term stability of soft tissue augmentative procedures at implant sites

BACKGROUND: Peri-implant soft tissue phenotype plays a pivotal role in the long-term success of dental implants, influencing health, esthetic, and patient-reported outcomes. This review explores the long-term stability of soft tissue augmentation procedures at implant sites, focusing on keratinized mucosa (KM), mucosal thickness (MT), and supracrestal tissue height (STH), and investigating predictors for the stability of the soft tissue margin over time. MATERIALS AND METHODS: A narrative review aiming at identifying clinical studies reporting on the long-term outcomes of soft tissue augmentation procedures at implant sites was conducted. RESULTS: Robust evidence demonstrates that an inadequate soft tissue phenotype, particularly limited KM and thin MT, is associated with increased inflammation, soft tissue dehiscence, and marginal bone loss. Clinical trials and longitudinal studies show that augmentative procedures, including autogenous free gingival grafts, connective tissue grafts, and soft tissue substitutes, lead to stable outcomes in terms of soft tissue levels, volume, and esthetics. Techniques targeting MT and STH, especially through bilaminar approaches, further enhance long-term peri-implant tissue stability. Additionally, soft tissue augmentation has proven effective for managing peri-implant soft tissue dehiscences and improving papilla height, with the stability of the outcomes reported for up to 10 years. CONCLUSIONS: This review highlights the synergistic role of KM, MT, and STH in supporting peri-implant health, esthetics, and long-term tissue stability, and underscores the need for personalized treatment planning based on peri-implant phenotype. Clinical recommendations for when and how to intervene are provided based on the best available evidence. CLINICAL RELEVANCE: Long-term data support the importance of soft tissue augmentation in ensuring implant success, particularly in esthetically demanding zones and compromised sites.