Timing of soft tissue augmentation around implants: A clinical review and decision tree

The goal of soft tissue augmentation is to improve the volume around implants and thus achieve better aesthetic and functional properties. The present review aims to make recommendations and guide clinicians in performing soft tissue augmentation procedures, focusing on the importance of timing.

Soft tissue augmentation can be performed at different time points: before or after implant placement, at implant placement (immediate/delayed), at healing abutment connection or after final restoration. Before/after implant placement or at healing abutment connection are considered the gold standard time points at which to perform soft tissue augmentation due to the possibility of achieving complete coverage of the soft tissue graft or its substitute through simple flap elevation and the easy handling of tissue. On the other hand, performing soft tissue augmentation at implant placement or after crown delivery seems to be less predictable due to the different healing approaches and the unexpected shrinkage that occurs.

Timing needs to be considered when performing soft tissue augmentation, taking into account the advantages and disadvantages related to operator experience, implant position and patient expectations. Employing a reliable approach at the appropriate time of intervention could limit complications.