Soft-Tissue Integration of Dental Implants: Formation, Maintenance, and Relevance for Peri-Implant Health

Implant dentistry has historically centered on osseointegration, yet it is now evident that soft-tissue integration is equally critical for long-term success. The stability of bone-anchored dental implants hinges on the establishment and maintenance of a stable attachment that mirrors, at least functionally, the supracrestal attachment around teeth. This review synthesizes current understanding of how the soft tissue-implant interface forms and how it is maintained over time. This interface comprises (i) a rapidly developing peri-implant epithelium and (ii) a connective-tissue component that gradually rebuilds its collagen architecture after implant placement. Although current knowledge is surprisingly limited, evidence indicates that neither the epithelium nor the connective tissues form a true attachment to the implant surface or prosthetic components. Soft-tissue dimensions, the role of keratinization of the peri-implant epithelium, the characteristic presence of inflammation within peri-implant connective tissue, and the biological and clinical determinants shaping the formation and maintenance of this interface are discussed, highlighting major knowledge gaps for future research. Finally, we examine the contribution of soft-tissue phenotype to peri-implant diseases and soft-tissue dehiscence. A better understanding of the principles governing the development and homeostasis of soft tissue-implant interfaces may inform strategies to improve the barrier function of peri-implant soft tissues around all bone-anchored implants, ultimately guiding future translational research to enhance implant longevity.