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Treatment Algorithm · Module
Peri-implant soft tissue: widen, thicken, or leave it
Matching the soft-tissue deficiency to the right graft. A keratinized mucosa width < 2 mm and a mucosal thickness < 2 mm are the working thresholds that distinguish free gingival grafting from connective-tissue augmentation.
Use: Peri-implant phenotype planning
Thresholds: KT & thickness < 2 mm
Framework: EFP / ITI consensus
01 — Phenotype Assessment
The three soft-tissue dimensions
Assess keratinized mucosa width, mucosal thickness, and vestibular depth. A minimum of ~2 mm of keratinized tissue and ~2 mm of thickness supports the biological seal, hygiene access, and esthetics.
Dimension
Keratinized mucosa width
- < 2 mm = deficient (working threshold)
- Narrow KT linked to more plaque, inflammation, discomfort
- Addressed primarily by FGG
- Most relevant in posterior mandible
Dimension
Mucosal thickness / biotype
- < 2 mm = thin phenotype
- Risk of grey "shine-through" & recession
- Thin tissue may also track more early bone loss
- Addressed by CTG / subepithelial graft
Dimension
Vestibular depth
- Shallow vestibule traps plaque & limits hygiene
- Often co-exists with narrow KT
- FGG / vestibuloplasty deepens the vestibule
- Improves brushing access & comfort
02 — Decision Pathway
Interactive grafting selector
Identify the dominant deficiency, then match it to the graft that addresses it. Some sites need both width and thickness — sequence or combine accordingly.
Tap the deficiency that best describes the site.
Step 1 — What is the dominant deficiency?
WIDTH
KT width < 2 mm
Inadequate band of keratinized mucosa; hygiene/comfort issues.
THICKNESS
Thin tissue / recession / shine-through
Adequate KT but thin phenotype or soft-tissue dehiscence.
ADEQUATE
KT ≥ 2 mm and thick, stable tissue
No esthetic or hygiene concern; healthy peri-implant phenotype.
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03 — Quick Reference
Indication → graft type → timing
Augmentation can be performed before, at, or after implant placement; second-stage surgery and pre-prosthetic phases are common windows.
| Indication | Graft type | Timing |
|---|
| Increase KT width (< 2 mm) | Free gingival graft (FGG); xenogeneic collagen matrix as alternative | 2nd stage or pre-prosthetic |
| Increase thickness (thin phenotype) | Connective-tissue / subepithelial graft (CTG); collagen matrix as alternative | At placement or 2nd stage |
| Cover recession / dehiscence | CTG (+/- coronally advanced flap) | After diagnosis; phenotype-dependent |
| Deepen vestibule | FGG / apically positioned flap + vestibuloplasty | Pre-prosthetic |
| Adequate phenotype | No graft — maintenance & monitoring | Routine recall |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published consensus and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. The 2 mm thresholds are pragmatic working values, not absolute cut-offs — graft selection and timing remain case-specific.
- Thoma DS, Naenni N, Figuero E, et al. Effects of soft tissue augmentation procedures on peri-implant health or disease: a systematic review and meta-analysis. Clin Oral Implants Res. 2018;29(Suppl 15):32–49.
- Giannobile WV, Jung RE, Schwarz F; on behalf of Group 1 of the 2017 EFP/IT/Osteology workshop. Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues. Clin Oral Implants Res. 2018;29(Suppl 15):7–10.
- Lin GH, Chan HL, Wang HL. The significance of keratinized mucosa on implant health: a systematic review. J Periodontol. 2013;84(12):1755–1767.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0