The gingiva surrounding the tooth has a band of about 2–3 mm of bright pink, strong, strongly attached mucous membrane, and then a darker, larger area of unattached mucosa that folds into the cheeks. When replacing a tooth with an implant, a strip of strong gum is needed to maintain the health of the implant over the long term. This is particularly important for the continuity of blood supply to the gums, which are theoretically more susceptible to infection due to their longer attachment to the implant than to the tooth.[36] When an adequate band of attached tissue is absent, it can be recreated by soft tissue grafting. There are four methods that can be used for soft tissue transplantation. A roll of tissue adjacent to the implant (referred to as a palatal roll) can be taken and placed towards the lip. Gum can be transplanted from palatal tissue. Deep connective tissue can be transplanted from the palate. When a larger piece of palate is transplanted, larger tissue is needed. A finger can be repositioned from Tissue with blood vessels surrounding the palate.[37]
In addition, in order for the implant to look aesthetically pleasing, a strip of plump gum is needed to fill the space on either side of the implant. The most common soft tissue complication is known as the black triangle, in which the papilla (a small triangular piece of tissue between two teeth) shrinks back and leaves a three-way space between the implant and adjacent teeth. Dentists can only expect 2-4 mm of papilla height over the underlying bone. The black triangle can be expected if the distance between the place where the teeth touch the bone is greater than that.[38]
