Şahin BMC Oral Health (2023) 23:925 BMC Oral Health

https://doi.org/10.1186/s12903-023-03696-3

RESEARCH Open Access

Evaluation of implants in smoking and non-

smoking patients with peri-implant disease
risk analysis and esthetic scores: an
observational study
Tuğba Şahin1*

Abstract
Background This study examined how smoking affects esthetics, peri-implant health, gingiva around the implant,
and implant disease risk assessment in patients with implants.
Methods The study included two hundred ninety-eight implants of systemically healthy patients aged between 38
and 62 who applied to the Periodontology Clinic and whose functionally prosthesis-loaded implants had been at
least six months and at most five years old. Implants of patients with bruxism were not included in the study. Implants
are divided into two according to the patient’s smoking. Vestibule depth around the implant, keratinized gingival
thickness and width, gingival recession, bleeding on probing, pocket depth, and gingival index by a sole clinician. The
pink esthetic score, peri-implant disease risk assessment, and implant health scale were also examined to measure
implant esthetics and success.
Results There was a statistically significant difference in the implant disease risk assesment scores for the examined
implants of smokers and nonsmokers (p < 0.05). People who had peri-implantitis had higher implant disease risk
assesment score levels. The dental implant health scale revealed a statistically significant difference (p < 0.05) in the
likelihood of implant disease. According to the dental implant health scale, dental implants were 100% successful for
non-smokers. There was a significant difference in the keratinized gingiva width between smokers and nonsmokers
(p < 0.05). The results of the study showed that nonsmokers had a wider keratinized gingiva.
Conclusions Research has demonstrated that the act of smoking has the potential to jeopardize the long-term
survival of dental implants and the surrounding peri-implant tissues. The results of this study indicate that it would be
advisable for dentists to provide guidance to their patients on smoking cessation and to monitor any alterations in
behavior closely. Furthermore, it would be advantageous for dental professionals to elucidate the impact of smoking
on the susceptibility of smokers to peri-implant disease.
Keywords Dental implant, Implant Disease risk assessment, Keratinized tissue, Pink esthetic score

*Correspondence:
Tuğba Şahin
[email protected]
1
Dentistry Faculty, Division of Periodontology, Bolu Abant İzzet Baysal
University, Bolu, Türkiye

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The
Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available
in this article, unless otherwise stated in a credit line to the data.
Şahin BMC Oral Health (2023) 23:925 Page 2 of 6

Background evaluates the soft tissue around individual implant resto-

The oral environment and its ecology, gingival tissues, rations [16].
vasculature, inflammatory and immunological responses, The demand for a risk assessment tool that can forecast
and the homeostasis and capacity for healing of peri- the development of peri-implantitis and is comparable
odontal connective tissues are all impacted by cigarette to the one created for periodontal diseases has grown
smoking [1]. Dental implant therapy is one of the best along with interest in the etiology and pathophysiol-
options for restoring lost teeth [2]. Implant care over the ogy of peri-implant infections. The peri-Implant disease
long term may be threatened by pathological disorders, risk assessment (IDRA) graphic was designed to reduce
including peri-implant mucositis and peri-implantitis the consequences of peri-implant tissue damage [17].
[3]. Potential risk factors can increase the susceptibil- The IDRA algorithm is a valuable tool for determining
ity to peri-implant diseases at both the implant and the whether a patient is at moderate or high risk for devel-
patient levels [4]. The evidence linking diabetes mellitus oping peri-implantitis [18]. Based on the data collected
and cigarette smoking to peri-implantitis is still unclear, for this study, this risk assessment tool can be used to
and these moderating variables are considered poten- diagnose peri-implant disease early on. Determining par-
tial risk indicators or emerging risk factors [5]. There is ticular risk variables may increase the likelihood of an
substantial evidence that poor oral hygiene, history of implant surviving [19]. This study aimed to examine the
periodontitis, and cigarette smoking are associated with effects of smoking on esthetics, peri-implant health sta-
peri-implant diseases [6]. Smoking significantly reduces tus, and the condition of the gingiva around the implant,
neutrophil transmigration across the periodontal micro- along with the peri-implant disease risk assessment dia-
vasculature and causes systemic neutrophilia. It has been gram in patients with implants.
shown that smoking inhibits chemokinesis, chemotaxis,
phagocytosis, and neutrophil cell spreading. Neutrophils’ Methods
protease release may be crucial in tissue deterioration Study design and participants
[1]. Nicotine causes an increase in alveolar bone loss by This research complied with the World Medical Asso-
promoting the formation and proliferation of osteoclasts ciation Declaration of Helsinki on medical research
[7]. In addition, different protocols have been developed [20]. The Ethical Review Board approved the study of
against traditional methods to improve oral hygiene hab- the Bolu Abant İzzet Baysal University, Bolu (2022/160).
its, which is another crucial risk factor for peri-implant This clinical study was registered at ClinicalTrials.gov
diseases [8]. (NCT05823038).
The success or failure of an implant is not just deter- This study was conducted at a single center (Bolu
mined by periodontal indicators [9]. These clinical indi- Abant İzzet Baysal University, Dentistry Faculty, Divi-
ces must be connected to additional elements, such as sion of Periodontology, Bolu, Turkey). A clinician docu-
exudate or prosthesis overloading [10]. Compared with mented the medical histories of individuals receiving
implant success or survival, implant failure is more implants (T.Ş.). Individuals with uncontrolled diabetes
straightforward to explain and can be caused by several and bruxism were excluded from the trial, leaving 298
variables. Implant removal is warranted in cases of pain, implants whose functional prosthetic loading had not
vertical movement, or uncontrollably progressing bone occurred for at least six months and at most five years
loss [11]. Plaque assessment, mucosal conditions, peri- old. The patients who came to have their implants exam-
implant probing depth, peri-implant sulcus fluid analysis, ined and did not undergo guided bone regeneration were
suppuration, implant mobility, discomfort, resonance fre- included in the study. Patients mainly were split into two
quency analysis, and radiographic evaluation are among groups: nonsmokers and smokers. Those who smoked
the parameters that may be used to evaluate peri-implant 100 cigarettes or more in their life and still smoked were
health and the severity of peri-implant disease [12]. The grouped as smokers, and those who smoked less than 100
thickness of the tissue around the dental implant is cru- cigarettes in their life and did not currently smoke were
cial, along with the other factors [13]. It is suggested that grouped as non-smokers [21]. The concept of the sug-
2 mm of keratinized gingiva (corresponding to 1 mm gested treatment, in addition to its advantages and dis-
attached gingiva in the material used in this study) is ade- advantages, was explained to the participants, who then
quate for maintaining gingival health [14]. signed consent forms. It turned out that the patients did
The pink esthetics score (PES) makes it possible to not utilize dental hygiene products explicitly designed for
evaluate the esthetic outcomes of different surgical and implants, nor did they have regular implant checkups.
prosthetic implant techniques more objectively, both Plaque, gingival index, bleeding on probing, pocket
in the short and long term [15]. Furthermore, it gener- depth, gingival recession, clinical attachment loss, kera-
ates robust intraexaminer agreement and consistently tinized thickness, keratinized width, vestibule depth,
PES, dental implant health scale, and IDRA were all
Şahin BMC Oral Health (2023) 23:925 Page 3 of 6

systematically assessed in each implant in patient. The Table 1 Demographics of the study participants
pink aesthetic score examined papilla, soft tissue mar- Smokers Nonsmokers P
gin level, soft tissue contour, alveolar process, soft tis- Age 51.79 ± 10.41 49.39 ± 11.17 0.331
sue color, and texture. The pink esthetic score is assessed Gender Male 22 (64.7%) 23 (50.0%) 0.139
on a scale ranging from 0 to 10 [16]. Four groups on the Female 12 (35.3%) 23 (50.0%)
implant health scale define the clinical conditions of
success, satisfactory survival, compromised survival, or mean and standard deviation are used to represent open-
failure. While making these evaluations, pain, mobil- ended data. Two hundred ninety-eight dental implants
ity, radiographic bone loss, pocket depth, and exudate in 80 patients were assessed within the study’s param-
were examined [9]. The eight vectors of the diagram in eters. In the two groups who participated in the study,
the IDRA include an assessment of a history of peri- each group had 149 implants examined. To look into
odontitis, the percentage of sites with bleeding on any discrepancies between the two groups investigated
probing, the number of teeth or implants with probing open-ended values, an independent sample t-test was
depths ≥ 5 mm, the ratio of periodontal bone loss (evalu- employed. Categorical variables were compared using
ated from a radiograph) divided by the patient’s age, peri- chi-square analysis. In this investigation, p < 0.05 was
odontitis susceptibility as described from the 2017 World used as the statistical significance threshold.
Workshop on the Classification of Periodontal and Peri-
implant Diseases [22] the frequency/compliance with Results
supportive periodontal therapy, the distance from the Regarding age, sex, or implant duration, there were no
restorative margin of the implant-supported prosthesis to statistically significant differences between smokers and
the marginal bone crest, and prosthesis-related factors, nonsmokers (p > 0.05) (Table 1).
including cleanability and fit of the implant-supported There is a statistically significant difference in the dis-
prosthesis [17]. A single clinician (T.Ş.) conducted the ease/health status evaluation of the examined implants of
measurements in one session. smoker and non-smoker participants (p < 0.05) (Table 2).
There was a statistically significant difference in the
Inclusion and exclusion criteria IDRA scores for the examined implants of smokers and
Inclusion Criteria: nonsmokers (p < 0.05) (Table 3). The peri-implantitis
–  38 to 62 years of age. group contained most patients with high IDRA scores;
– Systemically healthy or with a controlled medical patient distributions for the other two disease categories
condition. differed. High IDRA scores were linked to failed implants
– At least six months and at most five years passed in both groups (Table 4).
after a dental implant’s functional prosthetic loading There was no statistically significant difference between
and received one or more dental implants with a smokers and non-smokers regarding the pink esthetic
fixed prosthesis. scores of the implants under examination (p > 0.05)
Exclusion Criteria: (Table 3). Whereas 69.8% of the individuals who did not
–  Presence of uncontrolled systemic disease. smoke had pink esthetic ratings of 8 or higher, 30.2% of
– Bruxism. the participants who smoked had implants that were
inspected, and 27.5% of the people who did not smoke
Statistical analysis had implants that were examined and had pink esthetic
Within the parameters of the investigation, statistical scores of less than 8. By contrast, the nonsmoking indi-
analyses were conducted using Statistics*. Numbers and viduals’ implants had a pink esthetic score of 8 or above
percentages are used to convey categorical data. The in 72.5% of the examined cases.

Table 2 Peri-implant health and occurrence of disease in patients

Group Total p
Smokers Nonsmokers
Disease/Health Peri-implant Mucositis n 37 59 96 0.001*
% 24.8% 39.6% 32.2%
Peri-implant Health n 100 64 164
% 67.1% 43.0% 55.0%
Peri-implantitis n 12 26 38
% 8.1% 17.4% 12.8%
Total n 149 149 298
% 100.0% 100.0% 100.0%
Şahin BMC Oral Health (2023) 23:925 Page 4 of 6

Table 3 Dental implant assessment tools and scales

Smokers Nonsmokers p
Dental Implant Health Scale 1 141 (94.6%) 149 (100.0%) 0.042*
2 3 (2.0%) 0 (0.0%)
3 3 (2.0%) 0 (0.0%)
4 2 (1.3%) 0 (0.0%)
Pink Esthetic Score 0–9 79 (53.0%) 65 (43.6%) 0.114
10 18 (12.1%) 25 (16.8%)
11–12 42 (28.2%) 39 (26.2%)
13–14 10 (6.7%) 20 (13.4%)
Keratinized Tissue Thickness 1 mm and below 80 (53.7%) 66 (44.3%) 0.077
2 mm 50 (33.6%) 69 (46.3%)
2 mm and above 19 (12.8%) 14 (9.4%)
Keratinized Tissue Width 2 mm below 67 (45.0%) 55 (36.9%) 0.195
2 mm and above 82 (55.0%) 94 (63.1%)
Vestibule Depth 4 mm below 36 (24.2%) 36 (24.2%) 0.999
4 mm and above 113 (75.8%) 113 (75.8%)
IDRA Low 10 (6.7%) 25 (16.8%)
Moderate 49 (32.9%) 21 (14.1%) 0.001*
High 90 (60.4%) 103 (69.1%)

Table 4 Dental implant health scale and distribution of IDRA scores in disease and health
Peri-implant Mucositis Peri-implant Health Peri-implantitis p
Dental Implant Health Scale Success 95 (100.0%) 162 (98.8%) 33 (84.6%) 0.001*
Survival - 2 (1.2%) 4 (10.3%)
Failure - - 2 (5.1%)
IDRA Low 15 (15.6%) 18 (11.0%) 2 (5.3%) 0.003*
Moderate 16 (16.7%) 46 (28.0%) 8 (21.1%)
High 65 (67.7%) 100 (61.0%) 28 (73.7%)

The implants’ keratinized gingival thickness and ves- was found in 4 patients (12%) at moderate risk and 12
tibule depth under examination showed no statistically patients (27%) at high risk. Peri-implantitis is a common
significant differences between smokers and nonsmok- condition in patients with a high IDRA risk. [18]. De Ry
ers (p > 0.05). 53.7% of the examined implants of smok- et al. reported that increased IDRA was present in 28% of
ers were 2 mm and below, and 44.3% of the examined individuals with peri-implantitis. Fifteen implants at low
implants of non-smoking participants were 1 mm and risk had peri-implant mucositis (25%), and six implants at
down (Table 3). moderate risk had peri-implantitis (75%) [19]. Individuals
There was a statistically significant difference in the with high-risk IDRA profiles seem to be more vulnerable
dental implant health scale score for the examined to developing biological problems and implant loss [23].
implants of smokers and nonsmokers (p < 0.05). The In the present study, the two failing implants had high
non-smoking group had a complete implant health scale IDRA levels. Smokers had a greater frequency of high
1 (Table 3). The peri-implantitis group had fewer people values. In the group with peri-implantitis, most implants
with successful dental implants than the other groups showed high IDRA levels.
(Table 4). Peri-implant soft tissue position, texture, color, con-
The peri-implantitis group had fewer people with suc- tour, and alveolar process deficiency were also measured
cessful dental implants than the other groups (p < 0.05) and compared with a natural tooth reference (adjacent
(Table 3). or contralateral to the study site) [24]. The thresholds
for clinical acceptance are currently set at values of 8 to
Discussion 14 for the PES [25]. It has been proposed that PES levels
IDRA is a risk assessment approach considering several between 10 and 12 indicate good esthetic outcomes and
characteristics that may help identify individuals at risk that PES values between 13 and 14 indicate ideal implant
of getting peri-implantitis. According to the IDRA data, esthetics [24]. In one study, all 45 anterior maxillary
56.3% of the 79 patients had a high risk, and 42.5% had single-tooth implants examined fulfilled strict criteria
a moderate risk. According to IDRA, peri-implantitis for the success of implants concerning osseointegration;
Şahin BMC Oral Health (2023) 23:925 Page 5 of 6

these criteria included the absence of peri-implant radio- The study confirmed that shallow vestibule depth is
lucency, implant mobility, suppuration, and pain. The associated with higher mucosal recession, a higher rate of
mean total PES of 7.8 ± 0.88 indicated favorable over- relative attachment loss, radiographic bone level, greater
all peri-implant soft tissue conditions [26]. PES values bleeding on probing, gingival index, and peri-implant
varied from 3.17 to 7.46 in a study evaluating 41 ante- failure compared with sites at which there is adequate
rior implants [27]. After a year, the PES score for all 39 vestibule depth ( > 4 mm). Moreover, sites with shallow
patients was 7.07 [28]. The average was 9.09 for smokers vestibule depth presented a lower keratinized mucosa
and 9.07 for nonsmokers in this research. In thirty single width than sites with adequate vestibule depth [38]. The
implants, the implant-related mean PES varied from 2.28 average implant circumference vestibule depth measure-
to 13.8 for single-tooth implants [15]. The pink esthetic ment in patients who smoke was 5.93 ± 2.95, while that in
score in the study ranged from 3 to 14. patients who do not smoke was 5.94 ± 2.70. While 55.0%
The “success” category describes optimum conditions, of the implants of the smoking participants had mucosal
the “survival” category describes implants that are func- tissue that was 2 mm or greater in width, 63.2% of the
tional but not associated with ideal conditions, and the nonsmoking participants did.
“failure” of an implant indicates that the implant should
be removed or has already been removed [9]. Based on Conclusions
a study’s measure for evaluating dental implant health, Smoking, with other risk factors, has a considerable
98.4% were effective and in excellent condition [11]. In impact on the success or failure of implant surgery,
another study, the cumulative implant survival rate was the individual’s risk status, and the width of keratini-
90.9% [23]. The dental implant health scale was higher in zation. The results of this study suggest that there is a
smokers than in nonsmokers. The success and survival need to increase patient awareness regarding the ben-
rates on the implant health scale were reported to be efits of smoking cessation or reduction and to promote
98.6% in smokers compared to 100% in nonsmokers. such efforts actively. Additionally, it is essential to pro-
Adequate peri-implant gingival height, a thick tissue vide support to patients in their endeavors, considering
phenotype, and a wide area of immobile keratinized gin- the detrimental effects of smoking on individuals with
giva may all help lower the risk of tissue inflammation implants.
and subsequent problems [29]. Compared to implant
Abbreviations
sites with ≥ 2 mm of keratinized gingiva, implant sites *IBM SPSS Version 26.0 IBM Corp., Armonk, NY, USA
with a band of keratinized gingiva that was less than IDRA Implant Disease Risk Assesment
2 mm in width were found to be more likely to experi- PES Pink Esthetic Score

ence pain when brushing, plaque accumulation, peri- Acknowledgements

implant soft tissue inflammation, greater probing depth, English editing was done by Wiley’s editing service.
gingival recession, bleeding on probing, and peri-implan-
Authors’ contributions
titis [30–32]. According to the findings of one study, T.Ş. found study idea / hypothesis. T.Ş. made study design. T.Ş collected data.
smoking did not affect keratinized gingival width [33]. T.Ş. made analysis and/or interpretation of results. T.Ş. wrote article. T.Ş. made
In another research, smokers’ keratinized gingival width critical review.

was much more significant than that of nonsmokers [34]. Funding

The keratinized gingival width was significantly wider in No funding has been received from any organization.
nonsmokers in the current study.
Data Availability
The gingival biotype was considered thin if the mea- The datasets analyzed during the current study are available from the
surement was ≤ 1.0 mm and thick if it was > 1.0 mm [10]. corresponding author upon reasonable request.
Soft tissues at the level of the supracrestal portion require
a thickness of at least 2 mm to prevent the occurrence of Declarations
mucosal recession and unesthetic tissue discoloration
Ethics approval and consent to participate
[35]. When the mucosal tissue is 2 mm or less in width, The study was conducted according to the guidelines of the Declaration of
significant crestal bone loss might be expected. The ini- Helsinki and approved by the Ethics Committee of Bolu Abant İzzet Baysal
tial gingival tissue thickness at the crest may significantly University. All involved subjects gave their written informed consent before
study inclusion.
influence marginal bone stability around implants [36]. If
the tissue thickness is 2.0 mm or less, crestal bone loss Consent for publication
of up to 1.45 mm may occur [37]. In the current study, All involved participants gave their written informed consent for the
publication.
46.3% of the examined implants of the smoking partici-
pants were 2 mm or thicker, whereas 55.7% of the exam- Competing interests
ined implants of the nonsmoker participants were. The authors declare no competing interests.
Şahin BMC Oral Health (2023) 23:925 Page 6 of 6

Received: 15 July 2023 / Accepted: 22 November 2023 21. Newman MG, Takei H, Klokkevold PR, Carranza FA. (2018). Newman and Car-
ranza’s Clinical Periodontology. Philedelphia: 219. p. 182.
22. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH, et al. Peri-
odontitis: Consensus report of workgroup 2 of the 2017 World workshop on
the classification of Periodontal and Peri-implant Diseases and conditions. J
References Periodontol. 2018;89(Suppl 1):173–s82.
1. Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of 23. Mo JJ, Lai YR, Qian SJ, Shi JY, Lai HC, Tang GY. Long-term clinical outcomes of
environmental factors–Tobacco Smoking. J Clin Periodontol. 2005;32(Suppl short implant (6mm) in relation to Implant Disease Risk Assessment (IDRA).
6):180–95. Clin Oral Implants Res. 2022;33(7):713–22.
2. Ra’ed Omar AH, Mahmoud Khalid AO, Ahed Mahmoud AW. Psychologi- 24. Chen ST, Buser D. Clinical and esthetic outcomes of implants placed in
cal impact on implant patients’ oral health-related quality of life. Clin Oral postextraction sites. Int J Oral Maxillofac Implants. 2009;24:186–217.
Implants Res. 2006;17(2):116–23. 25. Chen J, Chiang C, Zhang Y. Esthetic evaluation of natural teeth in anterior
3. Mattheos N, Collier S, Walmsley A. Specialists’ management decisions and maxilla using the pink and white esthetic scores. Clin Implant Dent Relat Res.
attitudes towards mucositis and peri-implantitis. Br Dent J. 2012;212(1). 2018;20(5):770–7.
4. Sun TC, Chen CJ, Gallucci GO. Prevention and management of peri-implant 26. Belser UC, Grütter L, Vailati F, Bornstein MM, Weber HP, Buser D. Outcome
Disease. Clin Implant Dent Relat Res. 2023;25(4):752–66. evaluation of early placed maxillary anterior single-tooth implants using
5. Schwarz F, Derks J, Monje A, Wang HL. Peri-implantitis. J Periodontol. objective esthetic criteria: a cross-sectional, retrospective study in 45 patients
2018;89(Suppl 1):267–s90. with a 2- to 4-year follow-up using pink and white esthetic scores. J Periodon-
6. Heitz-Mayfield LJ. Peri-implant Diseases: diagnosis and risk indicators. J Clin tol. 2009;80(1):140–51.
Periodontol. 2008;35(8 Suppl):292–304. 27. Cho HL, Lee JK, Um HS, Chang BS. Esthetic evaluation of maxillary
7. Kubota M, Yanagita M, Mori K, Hasegawa S, Yamashita M, Yamada S, et al. The single-tooth implants in the esthetic zone. J Periodontal Implant Sci.
effects of cigarette smoke condensate and nicotine on Periodontal tissue in a 2010;40(4):188–93.
Periodontitis Model mouse. PLoS ONE. 2016;11(5):0155594. 28. Bonnet F, Karouni M, Antoun H. Esthetic evaluation of periimplant soft tissue
8. Cosola S, Oldoini G, Giammarinaro E, Covani U, Genovesi A, Marconcini S. The of immediate single-implant placement and provisionalization in the anterior
effectiveness of the information-motivation model and domestic brushing maxilla. Int J Esthet Dent. 2018;13(3):378–92.
with a hypochlorite-based formula on peri-implant mucositis: a randomized 29. Lin GH, Madi IM. Soft-tissue conditions around Dental implants: a Literature
clinical study. Clin Exp Dent Res. 2022;8(1):350–8. Review. Implant Dent. 2019;28(2):138–43.
9. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P 30. Souza AB, Tormena M, Matarazzo F, Araújo MG. The influence of peri-implant
et al. Implant success, survival, and failure: the International Congress of keratinized mucosa on brushing discomfort and peri-implant tissue health.
Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent. Clin Oral Implants Res. 2016;27(6):650–5.
2008;17(1):5–15. 31. Ueno D, Nagano T, Watanabe T, Shirakawa S, Yashima A, Gomi K. Effect of
10. Van Steenberghe D, Lekholm U, Bolender C, Folmer T, Henry P, Herrmann I, the Keratinized Mucosa Width on the Health Status of Periimplant and
Higuchi K, Laney W, Linden U, Astrand P. Applicability of osseointegrated oral Contralateral Periodontal tissues: a cross-sectional study. Implant Dent.
implants in the rehabilitation of partial edentulism: a prospective multicenter 2016;25(6):796–801.
study on 558 fixtures. Int J Oral Maxillofac Implants. 1990;5(3):272–81. 32. Schrott AR, Jimenez M, Hwang JW, Fiorellini J, Weber HP. Five-year evaluation
11. Misch CE. The implant quality scale: a clinical assessment of the health–Dis- of the influence of keratinized mucosa on peri-implant soft-tissue health and
ease continuum. Oral Health. 1998;88(7):15–20. stability around implants supporting full-arch mandibular fixed prostheses.
12. Salvi GE, Lang NP. Diagnostic parameters for monitoring peri-implant condi- Clin Oral Implants Res. 2009;20(10):1170–7.
tions. Int J Oral Maxillofac Implants. 2004;19 Suppl:116 – 27. 33. Wang Q, Tang Z, Han J, Meng H. The width of keratinized mucosa around
13. Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on dental implants and its influencing factors. Clin Implant Dent Relat Res.
implant health: a systematic review. J Periodontol. 2013;84(12):1755–67. 2020;22(3):359–65.
14. Lang NP, Löe H. The relationship between the width of keratinized gingiva 34. Esfahanizadeh N, Daneshparvar N, Motallebi S, Akhondi N, Askarpour F,
and gingival health. J Periodontol. 1972;43(10):623–7. Davaie S. Do we need keratinized mucosa for a healthy peri-implant soft
15. Fürhauser R, Florescu D, Benesch T, Haas R, Mailath G, Watzek G. Evaluation of tissue? Gen Dent. 2016;64(4):51–5.
soft tissue around single-tooth implant crowns: the pink esthetic score. Clin 35. Giovanni Zucchelli CM. Mucogingival esthetic Surgery around implants. Italy:
Oral Implants Res. 2005;16(6):639–44. Quintessence Publishing; 2022. p. 10.
16. Gehrke P, Lobert M, Dhom G. Reproducibility of the pink esthetic score–rat- 36. Puisys A, Linkevicius T. The influence of mucosal tissue thickening on crestal
ing soft tissue esthetics around single-implant restorations with regard to bone stability around bone-level implants. A prospective controlled clinical
dental observer specialization. J Esthet Restor Dent. 2008;20(6):375–84. trial. Clin Oral Implants Res. 2015;26(2):123–9.
17. Heitz-Mayfield LJ, Heitz F, Lang NP. Implant Disease Risk Assessment 37. Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue
IDRA–a tool for preventing peri‐implant Disease. Clin Oral Implants Res. thickness on crestal bone changes around implants: a 1-year prospective
2020;31(4):397–403. controlled clinical trial. Int J Oral Maxillofac Implants. 2009;24(4):712–9.
18. De Ry SP, Roccuzzo A, Lang NP, Heitz-Mayfield LJ, Ramseier CA, Sculean A, et 38. Halperin-Sternfeld M, Zigdon-Giladi H, Machtei EE. The association between
al. Evaluation of the implant Disease risk assessment (IDRA) tool: a retrospec- shallow vestibular depth and peri-implant parameters: a retrospective 6 years
tive study in patients with treated periodontitis and implant-supported fixed longitudinal study. J Clin Periodontol. 2016;43(3):305–10.
dental prostheses (FDPs). Clin Oral Implants Res. 2021;32(11):1299–307.
19. Jain M, Shaffa’ee B, Uppoor MS, Pralhad A, Nayak S, Saldanha SU. Evaluation
of risk factors of Peri-implant Disease using a New Manual Risk Assessment Publisher’s Note
Model: a clinical study. Int J Dent. 2022;2022:1347569. Springer Nature remains neutral with regard to jurisdictional claims in
20. Emanuel EJ. Reconsidering the declaration of Helsinki. Lancet. published maps and institutional affiliations.
2013;381(9877):1532–3.