Overview

Peri-implant soft tissue management strategies have evolved significantly, emphasizing preservation from tooth extraction through socket grafting and ovate pontics to maintain tissue volume and esthetics. Current evidence supports connective tissue grafts (CTG), such as free or pedicelled variants like the vascularized interpositional periosteal CTG (VIP-CT), along with different techniques which increase mucosal thickness, enhance pink aesthetic scores, and reduce recession when combined with coronally advanced flaps. Keratinized mucosa augmentation promotes peri-implant health, plaque control, and long-term stability, though inter-implant papilla reconstruction remains challenging due to vascular limitations. Systematic reviews confirm superior outcomes with soft tissue phenotype modification-increasing keratinized width, thickness, and supracrestal height-for preventing peri-implant diseases and improving patient satisfaction, despite it needs for more randomized controlled trials to further analyze the clinical conditions comprehensively.

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