{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T02:04:25Z","timestamp":1791425065366,"version":"4.3.3"},"reference-count":44,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Periodontal Research"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the 20\u2010year outcomes of tissue\u2010level implants placed in the posterior mandible, comparing implants surrounded by keratinized tissue (KT) or alveolar mucosa (AM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>At baseline, 128 patients (128 implants) were rehabilitated with implant\u2010supported fixed dental prostheses in the posterior mandible and enrolled in a supportive periodontal\/peri\u2010implant care (SPC) program. Patients were categorized based on the presence (KT) or absence (AM) of keratinized mucosa. During the first 10\u2009years of SPC, 11\u2009AM patients underwent free gingival grafting (FGG), identifying a third group (AM + FGG). At the 20\u2010year follow\u2010up, peri\u2010implant health status and soft\u2010tissue dehiscence were assessed according to the 2018 Case Definitions. The need for additional treatment between the 10\u2010 and 20\u2010year examinations was also recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 98 patients evaluated at the 10\u2010year follow\u2010up, 64 (KT\u2009=\u200942; AM\u2009=\u200916; AM + FGG\u2009=\u20096; drop\u2010out rate: 35%) attended the 20\u2010year examination. Additional treatment was required in 11\u2009AM patients (50%) versus 2 KT patients (5%) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). AM implants exhibited significantly greater marginal bone loss, bleeding on probing, and soft tissue recession compared to KT implants (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). The application of an FGG (AM + FGG\u2009=\u20096) had a protective effect on peri\u2010implant health status at 20\u2009years. Peri\u2010implantitis was diagnosed in 4.2% of implants surrounded by keratinized mucosa (KT or AM + FGG) versus 25% in the AM group (OR\u2009=\u20096.67; 95% CI: 1.09\u201340.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Tissue level implants placed in the posterior mandible without KT showed greater marginal bone loss, bleeding on probing, soft tissue recession, and peri\u2010implant diseases compared to implants with KT at 20\u2009years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jre.70018","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T13:29:11Z","timestamp":1753104551000},"page":"1212-1221","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Role of Keratinized Mucosa on the Risk of Peri\u2010Implant Diseases and Soft Tissue Dehiscence in the Posterior Mandible\u2014A 20\u2010Year Prospective Cohort Study"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8079-0860","authenticated-orcid":false,"given":"Andrea","family":"Roccuzzo","sequence":"first","affiliation":[{"name":"Shanghai Perio\u2010Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology  Shanghai China"},{"name":"Department of Periodontology School of Dental Medicine, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6690-5249","authenticated-orcid":false,"given":"Jean\u2010Claude","family":"Imber","sequence":"additional","affiliation":[{"name":"Department of Periodontology School of Dental Medicine, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"St\u00e4hli","sequence":"additional","affiliation":[{"name":"Department of Periodontology School of Dental Medicine, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5646-083X","authenticated-orcid":false,"given":"Mario","family":"Romandini","sequence":"additional","affiliation":[{"name":"Shanghai Perio\u2010Implant Innovation Center, Institute of Integrated Oral, Craniofacial and Sensory Research, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine  Shanghai China"},{"name":"College of Stomatology, Shanghai Jiao Tong University, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2836-5477","authenticated-orcid":false,"given":"Anton","family":"Sculean","sequence":"additional","affiliation":[{"name":"Department of Periodontology School of Dental Medicine, University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni E.","family":"Salvi","sequence":"additional","affiliation":[{"name":"Department of Periodontology School of Dental Medicine, University of Bern  Bern 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