# Influence of Crestal Mucosal Thickness on the Accuracy of Gingival Former Selection in Single-Tooth Implant Prosthodontics: An Observational Study

## TL;DR

This study shows that the thickness of the gum tissue around dental implants affects how well the implant shape is chosen, with thinner tissue leading to more complications.

## Contribution

The study identifies crestal mucosal thickness as a critical factor in selecting appropriate gingival formers for single-tooth implants.

## Key findings

- Thinner mucosal thickness (<2 mm) was significantly associated with inaccurate gingival former selection.
- Accurate selections were linked to thicker mucosa (mean 2.43 mm) and smaller former diameters (mean 4.45 mm).
- Logistic regression confirmed that thin mucosa and larger former diameter independently predict inaccurate outcomes.

## Abstract

Introduction

Accurate selection of gingival formers is critical for achieving optimal peri-implant soft tissue health and esthetics. Crestal mucosal thickness may play a significant role in the success of gingival former selection, particularly in single-tooth implant prosthodontics. The present study aimed to evaluate the impact of crestal mucosal thickness on the accuracy of gingival former selection using retrospective clinical data and cone-beam computed tomography (CBCT) analysis.

Materials and methods

This retrospective, cross-sectional, observational study was conducted in the Department of Prosthodontics after obtaining ethical approval. Patient records of 150 implant sites from August 2021 to December 2024 were reviewed. The inclusion criteria were adults (18-65 years) with single-tooth implants, adequate periodontal health, and complete clinical documentation, including CBCT scans. Patients with systemic conditions, tobacco use, or incomplete medical records were excluded. CBCT images were used to measure crestal mucosal thickness. The gingival former type, diameter, and clinical outcomes were documented. Accuracy of gingival former selection was defined as the absence of inflammation, ulceration, or recession, along with a good emergence profile at the final prosthetic placement. Statistical analyses included chi-square tests, independent t-tests, and multivariate logistic regression.

Results

Of the 150 implant sites, 108 (72%) had accurate gingival former selection, while 42 (28%) showed complications. No significant associations were found for sex (p = 0.894), jaw (p = 0.860), or site (p = 0.138). However, mucosal thickness significantly influenced selection accuracy (p = 0.001), with inaccurate outcomes more common in sites with <2 mm thickness. Accurate selections had significantly thicker mucosa (mean = 2.43 ± 0.3 mm) and smaller gingival formers (mean diameter = 4.45 ± 0.74 mm). Logistic regression revealed that thinner mucosa (odds ratio = 13.92) and larger former diameter (odds ratio = 4.15) were independent predictors of inaccurate selection.

Conclusion

Crestal mucosal thickness is a critical determinant for the accurate selection of gingival formers. Thin soft tissue biotypes and inaccurate formers significantly increase the risk of peri-implant soft tissue complications. Preoperative CBCT assessment and a tissue-informed approach are essential for optimizing outcomes in implant prosthodontics.