The etiology of hard‐ and soft‐tissue deficiencies at dental implants: A narrative review
Abstract
Objective: The objective of the present paper was to review factors and conditions that are associated with hard and soft‐tissue deficiencies at implant sites. Importance: Hard‐ and soft‐tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft‐tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft‐tissue deficiencies with the aim of improving clinical outcomes of implant therapy. Findings: A large number of etiological factors have been identified that may lead to hard and soft‐tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft‐tissue defects or may appear in conjunction with other factors. Conclusions: Hard‐ and soft‐tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri‐implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft‐tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.
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Other factors affecting the ridge can be associated with medications and systemic diseases reducing the amount of naturally formed bone, tooth agenesis, and pressure from prostheses.
“Other factors affecting the ridge can be associated with medications and systemic diseases reducing the amount of naturally formed bone, tooth agenesis, and pressure from prostheses.31”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [31]
Normal healing following tooth loss leads to diminished dimensions of the alveolar process/ridge that result in both hard and soft tissue deficiencies.
“Normal healing following tooth loss leads to diminished dimensions of the alveolar process/ridge that result in both hard and soft tissue deficiencies.”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [31]
Larger ridge deficiencies can occur at sites associated with severe loss of periodontal support, extraction trauma, endodontic infections, root fractures, thin buccal bone plates, poor tooth position, injury and pneumatization of the maxillary sinuses.
“Larger ridge deficiencies can occur at sites associated with severe loss of periodontal support, extraction trauma, endodontic infections, root fractures, thin buccal bone plates, poor tooth position, injury and pneumatization of the maxillary sinuses.”
From A new classification scheme for periodontal and peri‐implant diseases and conditions – Introduction and key changes from the 1999 classification (2018) · cites this paper as [31]
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Self-citationISP good clinical practice recommendations for gum care
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Prosthodontic Management of Implant Therapy
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- Authors
- Hämmerle, C. H. F., & Tarnow, D.
- Affiliations
- University of Zurich (CH)
- Columbia University Irving Medical Center (US)
- Corresponding author
- Hämmerle, Christoph H.F.
- Venue
- Journal of Periodontology
- Publisher
- Wiley
- Published
- 2018-06
- Volume
- 89
- Issue
- S1
- Pages
- S291-S303
- ISSN
- 0022-3492 (ISSN-L)
- 1943-3670
- OpenAlex
- W2809476695
- Semantic Scholar
- 3815a23e4a50ee60291520c6cc2124726c09b1c7
- Cited by
- 164
- References
- 129
- Citations by year
- 2026: 5 · 2025: 14 · 2024: 26 · 2023: 14 · 2022: 24 · 2021: 27 · 2020: 35 · 2019: 13 · 2018: 6
- FWCI
- 3.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Periodontology (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Topics
- Health Sciences › Dentistry › Oral Surgery › Dental Implant Techniques and Outcomes
- Health Sciences › Dentistry › Oral Surgery › Dental Radiography and Imaging
- Health Sciences › Dentistry › Periodontics › Scientific and Engineering Research Topics
- Keywords
- dental implants, soft tissue defects, etiology, alveolar ridge resorption, tooth extraction, periodontitis, peri-implantitis, root canal infection, keratinized mucosa, sinus floor, biomechanical overload, systemic disease, iatrogenic factors, tissue repair, implant survival
- MeSH terms
- Dental Implantation, Endosseous, Humans, Periodontium, Tooth Extraction, Dental Implants, Sinus Floor Augmentation
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