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If the thickness of the mucosa in which the implants are
placed is less than 3mm, resorption of the marginal bone will occur in order to
create space for the mucosal seal. This can be a concern in posterior
mandibular zones, where it can be advisable to have a slightly subcrestal
location of the implant neck, since bone loss will be difficult to avoid. The
thickness of the mucosa is also concerning in aesthetic cases where a thin
biotype is found. In these situations, any marginal bone remodeling will cause
gingival recession. In thick biotypes, the soft tissue level can remain stable
even with more severe bone loss. In thin biotypes, connective tissue grafts may
be able to modify the local conditions, which may explain their clinical
efficacy especially in “pouch” techniques where no flap needs to be raised.
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