Soft tissue grafting for the prevention and management of peri-implantitis

To critically summarize the current evidence on the role of the peri-implant soft tissue phenotype [specifically the width of keratinized peri-implant mucosa (KPIM) and the soft tissue thickness (STT)] and of the soft tissue grafting procedures used for the prevention and management of peri-implant diseases.

A narrative review of the literature was conducted, using PubMed for articles published up to December 2025, complemented by manual searching of reference lists. All different study designs were considered, prioritizing the highest available level of evidence.

Peri-implant diseases are multifactorial biofilm-induced chronic inflammatory conditions. Their onset, progression, and response to treatment are influenced by the characteristics of the peri-implant soft tissues, which, unlike periodontal tissues, form a weaker biological seal, rendering them more susceptible to inflammation-driven tissue breakdown. A reduced width of KPIM is consistently associated with higher plaque accumulation, mucosal inflammation, discomfort during oral hygiene, and a greater prevalence of peri-implant diseases. It should be emphasized, however, that most of this evidence derives from cross-sectional and observational studies. KPIM augmentation procedures improve peri-implant soft tissue health and patient-reported outcomes, and STT augmentation by increasing mucosal thickness (MT) may enhance soft-tissue margin stability and reduce marginal bone loss. These benefits are best supported for surrogate outcomes, whereas the independent effect of soft tissue augmentation (STA) on the prevention of peri-implantitis remains less certain. In the treatment of peri-implantitis, there is some evidence that simultaneous or staged STA (particularly KPIM reconstruction) may improve clinical stability; however, its effect on disease resolution remains unclear, as most available studies lack a negative control group.

Soft tissue grafting is a clinically relevant, phenotype-modifying strategy for preventing and managing peri-implant diseases. Risk-based, phenotype-driven decision-making (distinguishing KPIM augmentation from targeted STT augmentation) is essential for optimizing treatment outcomes.