Dr Fazeela Khan-Osborne
In many complex dental implant cases, the anatomy of a patient may, at first, appear unfavourable. After all, the dental implant has to comply with the surrounding hard and soft tissues to be viable – osseointegration is paramount for success, and poor gingival adaption can lead to the implant exposure and potential infection risks.
In cases where patients have lost bone or soft tissue around the implant site, clinicians need to remedy the situation to have confidence in a predictable result. Enter tissue augmentation, a key factor when treating complex cases that opens the door to new treatment opportunities.
Clinicians who already place dental implants but want to expand their skillset must understand how tissue augmentation can be utilised for a positive prognosis. They must also recognise favourable indications, and be knowledgeable about various augmentation approaches that are used in modern implant dental care.
Soft tissue indications
The role of peri-implant soft tissue is varied; adequate levels of keratinised tissue around an implant site lead to improved oral health, aesthetics and plaque control, as bushing discomfort is reduced compared to patients with insufficient keratinised tissue.[i]
Its ability to contribute to long-term stability is debated, with some literature finding no correlation between implant success and the presence of keratinised mucosa – others have found that implant sites without adequate keratinised mucosa exhibit an increased inflammation susceptibility and adverse peri-implant hard and soft tissue reactions.[ii] The potential risks of higher plaque accumulation, inflammatory responses, soft tissue recession and attachment loss are cited, and signal that, where appropriate, a surgical intervention for soft tissue augmentation could be useful.ii
Of course, it is helpful to understand what the adequate level of keratinised mucosa is, as this will influence treatment planning. It is typically understood to be ≥2mm of keratinised mucosa width; this is the amount required to prevent soft-tissue recession, bone resorption, and to support oral hygiene routines.[iii] Note that keratinised mucosa width at peri-implant sites is typically around 1mm less than the keratinised tissue around contralateral natural teeth,iii supporting the need for soft tissue augmentation in many cases, especially where patients have previous issues with periodontal health.
Augmenting the bone
Bone augmentation plays a key role in the placement of implants where there is insufficient hard tissue or defects in the maxilla and mandible.[iv] It is needed frequently in implant dentistry – findings in the literature state 25% of implant treatments require a bone graft,iv others say it could be as many as 50% of all implants and 75% of those in the anterior maxilla[v] – which means hard tissue augmentation has become a near essential skill for the modern implant dentist.
Bone resorption can occur before and after the placement of a dental implant. After a tooth extraction, the bone at the treatment site resorbs at different rates. As one example, the literature notes that extraction in the anterior maxilla prompts resorption mostly in the labial bone wall, accompanied by soft tissue recession.v Incidences of traumatic dental injuries often inflict further horizontal and vertical bone atrophy, creating a greater need for bone augmentation in some of these cases.v
On the link between atrophy and disease, marginal bone loss around the implant site does not lead to peri-implantitis – but patients cannot have the presence of peri-implantitis without this marginal bone loss.[vi] Some level of resorption around the neck of an implant can be explained as physiological remodelling after surgery or prosthetic loading, but this could become pathological and lead to an instance of peri-implantitis; the literature recommends that a 0.5mm of marginal bone loss post-loading is the criteria that differentiates a physiological stabilisation and the presence of pathological issues.vi
Hard tissue augmentation can facilitate the placement of a dental implant and create the greatest opportunity for long-term stability. Understanding why bone is resorbed is a key part of treatment diagnoses, which forms larger augmentation workflows.
High-quality education
After identifying when tissue augmentation should be utilised for the greatest opportunity for success, it is down to the clinician to safely and effectively implement it. However, clinicians can only do this if they are trained, competent and, ultimately, confident.[vii]
One to One Implant Education delivers the PG Diploma in Advanced Techniques in Implant Dentistry, a leading course for dental professionals looking to build on their established skills. The renowned course delves into soft and hard tissue augmentation, equipping clinicians with the skills to recognise clinical indications and implement successful restorations. Delegates also develop skills for full arch reconstruction, socket therapies, and much more.
Soft and hard tissue augmentation is imperative in modern implant dental care. Recognising when each may be implemented, and why, is important to ensuring patients are treated appropriately for a successful outcome.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000
Author bio:
Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.
Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20th year. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.
[i] Thoma, D. S., Strauss, F. J., Mancini, L., Gasser, T. J., & Jung, R. E. (2023). Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta‐analysis of patient‐reported outcome measures. Periodontology 2000, 91(1), 182-198.
[ii] Bassetti, R. G., Stähli, A., Bassetti, M. A., & Sculean, A. (2017). Soft tissue augmentation around osseointegrated and uncovered dental implants: a systematic review. Clinical oral investigations, 21, 53-70.
[iii] Ravidà, A., Arena, C., Tattan, M., Caponio, V. C. A., Saleh, M. H., Wang, H. L., & Troiano, G. (2022). The role of keratinized mucosa width as a risk factor for peri‐implant disease: A systematic review, meta‐analysis, and trial sequential analysis. Clinical implant dentistry and related research, 24(3), 287-300.
[iv] Dam, V. V., Trinh, H. A., Rokaya, D., & Trinh, D. H. (2022). Bone augmentation for implant placement: recent advances. International journal of dentistry, 2022(1), 8900940.
[v] Nørgaard Petersen, F., Jensen, S. S., & Dahl, M. (2022). Implant treatment after traumatic tooth loss: A systematic review. Dental Traumatology, 38(2), 105-116.
[vi] Galindo‐Moreno, P., Catena, A., Pérez‐Sayáns, M., Fernández‐Barbero, J. E., O’Valle, F., & Padial‐Molina, M. (2022). Early marginal bone loss around dental implants to define success in implant dentistry: A retrospective study. Clinical implant dentistry and related research, 24(5), 630-642.
[vii] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed April 2025]
