Dimension of the periimplant mucosa. Biological width revisited

The objective of the present study was to determine the dimension of the mucosal-implant attachment at sites with insufficient width of the ridge mucosa. 5 beagle dogs were used. Extractions of all mandibular premolars were performed and 3 months later, 3 fixtures of the Branemark System were installed in each side. Following 3 months of healing, abutment connection was carried out. On the right or left side of the mandible, abutment connection was performed according to the Branemark System manual (control side). On the contralateral side (test side), an incision not extending through the periosteum was made at the crest of the ridge. The soft tissue was dissected and a critical amount of connective tissue on the inside of the flap was excised. The periosteum was subsequently incised, abutment connection performed, and the trimmed flaps sutured. The sutures were removed after 10 days. After a 6-month period of plaque control, the animals were sacrificed, biopsies sampled and processed for light microscopy. The length of the junctional epithelium varied within a rather narrow range; 2.1 mm (control side) and 2.0 mm (test side). The height of the suprabony connective tissue in this model varied between 1.3+/-0.3 mm (test side) and 1.8+/-0.4 mm (control side). At sites where the ridge mucosa prior to abutment connection was made thin (< or = 2 mm), wound healing consistently included bone resorption. This implies that a certain minimum width of the periimplant mucosa may be required, and that bone resorption may take place to allow a stable soft tissue attachment to form.