Soft‑tissue first: five‑year lessons from a progressive‑thread implant and what baseline thickness tells you about graft choices

A 5‑year single‑center follow‑up shows predictable implant survival but clear links between keratinized mucosa/thickness and bleeding — and a randomized‑trial secondary analysis shows connective tissue grafts give larger absolute gains while thin sites gain proportionally more from any augmentation.

Two recent clinical reports should make you rethink routine “place-and-watch” after implant insertion. A five‑year single‑center follow‑up of a cylindrical‑conical implant with progressive threads examined 94 implants in 44 patients and found all recalled implants still in situ at five years, with acceptable prosthodontic scores and limited radiographic bone loss. Functional Implant Prosthodontic Scores averaged 7.6/10; bleeding on probing was absent at 37% of sites but was present at multiple sites (≥3/6) around about 31% of implants. Importantly, implants with less than 2 mm keratinized mucosa bled at nearly three times more sites than those with ≥2 mm. These data tell a familiar story: modern implant geometry can give excellent survival, but the peri‑implant soft tissue matters for inflammation and maintenance. ([pubmed.ncbi.nlm.nih.gov](