Manipulation of the peri-implant tissue for better maintenance: a periodontal perspective.

Enhancement of peri-implant soft tissue is an essential factor in implant survival. As in periodontal tissue, the integrity of the attached gingiva, plus gingival contour, color, shape, size, consistency, and bleeding upon probing, is an indicator of bacterial activity that will eventually lead to gingivitis and periodontitis. The trajectory of peri-implant tissue is different from that of periodontal tissue because of periodontal ligament fibers, the absence of which makes the implant-bone interface weaker than that of natural dentition. The destruction of peri-implant tissue can be a faster and more devastating process, so maintenance of the peri-implant tissue is a must in implant therapy to avoid a potentially massive destruction of the understructure. The treatment of inadequately attached gingiva, gingiva hyperplasia, and peri-implant gingivitis is discussed with techniques that can alleviate these problems.