Soft Tissues, Strong Outcomes

The long-term stability of the periodontium is closely tied to the integrity and management of soft tissues. During the American Academy of Periodontology's 109th Annual Meeting in 2023, I had the opportunity to share clinical insights and current evidence regarding soft tissue considerations that are essential for maintaining periodontal health. This article presents key takeaways from that presentation-particularly those that are relevant to dental hygienists who play an essential role in both prevention and maintenance of soft tissue health.

The Role of Soft Tissues in Periodontal Defense

A foundational understanding of soft tissue anatomy is critical in daily practice. The gingiva serves not just as a passive barrier but as an active defense mechanism against bacterial invasion. Keratinized tissue plays a structural and functional role, resisting mechanical stress and supporting plaque control.

When we assess the quantity and quality of keratinized gingiva, we're evaluating more than tissue thickness-we're evaluating comfort, cleanability, and the patient's long-term prognosis. Studies have shown that patients with inadequate keratinized gingiva are more prone to discomfort during brushing and have greater difficulty maintaining oral hygiene, which may lead to inflammation and an increased risk of recession. For hygienists, recognizing the early signs of soft tissue compromise allows for timely intervention and appropriate referral when needed.

Identifying Soft Tissue Deficiencies Early

Effective periodontal care begins with comprehensive assessment. This includes not only probing depths and attachment levels but also the visual and tactile evaluation of soft tissue integrity. Common soft tissue defects-such as marginal tissue recession, insufficient attached gingiva, aberrant frenal attachments, and gingival overgrowth-must be identified early to guide clinical decisions.

Particularly in patients with thin gingival phenotypes, early detection is key. These biotypes are more prone to recession, especially when exposed to mechanical or inflammatory trauma. Identifying these features early supports patient education and allows for the development of tailored maintenance protocols. Tracking soft tissue changes over time is essential, especially in high-risk individuals. Incorporating digital tools such as intraoral scanning and clinical photography not only enhances clinical decision-making but also improves communication with patients, helping them better understand their condition and the importance of treatment.

Overview of Grafting Techniques

When soft tissue intervention is indicated, grafting procedures become an important part of the treatment discussion. In clinical practice, both autogenous and non-autogenous grafts are used depending on the patient's needs and preferences.

Autogenous grafts, such as connective tissue grafts and free gingival grafts, offer predictability, integration, and long-term stability. These are highly effective for increasing tissue thickness, achieving root coverage, and improving esthetic outcomes. However, in cases where reducing surgical morbidity is a priority, non-autogenous options like acellular dermal matrices or allografts can be valuable alternatives.

Dental hygienists are key partners in supporting these patients before and after surgery. Pre-surgical hygiene optimization, reinforcement of postoperative care instructions, and careful monitoring during healing phases all contribute to successful outcomes. A strong understanding of these procedures allows hygienists to answer patient questions confidently and provide continuity of care throughout the treatment process.

Advanced Considerations in Soft Tissue Management

Certain clinical scenarios require a more nuanced approach to soft tissue management. This includes patients with lingual defects, those undergoing complex restorative treatment, or individuals with systemic conditions such as diabetes or cardiovascular disease that may complicate periodontal care.

Systemic health plays a substantial role in the healing process and the long-term success of periodontal interventions. In these cases, interdisciplinary collaboration is essential. Coordination between medical providers, restorative dentists, and specialists allows for the development of comprehensive treatment plans that reflect the full scope of a patient's health needs. For high-risk patients or those with advanced soft tissue concerns, more frequent monitoring and personalized hygiene strategies can help minimize complications and improve clinical outcomes.

Addressing Mucogingival Deformities Around Implants

Maintaining soft tissue health around dental implants presents unique challenges. Unlike natural teeth, implants lack a connective tissue fiber insertion, which makes the surrounding soft tissue more vulnerable to breakdown. Thin or inadequate peri-implant soft tissue can lead to complications such as recession, implant exposure, or even peri-implantitis.

Early identification of soft tissue deficiencies and proactive management are critical. Augmentation procedures using connective tissue grafts or collagen matrices are commonly used to enhance both functional and esthetic outcomes, especially in the anterior region where appearance is often a significant concern for patients. During maintenance visits, hygienists play a critical role in evaluating peri-implant mucosa, identifying early signs of inflammation, and providing tailored home care instructions to support long-term implant success.

Integration of Genetic Research and Emerging Technologies

Recent advances in genetic research are beginning to shape the way we approach periodontal risk assessment. While still an emerging field, the identification of genetic predispositions to periodontal disease holds the potential to create more individualized treatment and prevention strategies. In the future, genetic testing may help us identify patients who require closer monitoring and more proactive intervention.

In the present, tools such as salivary diagnostics and biomarker testing are already being incorporated into periodontal practice. These tools offer new ways to assess inflammation, detect disease early, and monitor treatment response-particularly in patients with elevated risk profiles. Combined with advances in digital dentistry, including three-dimensional imaging and intraoral scanning, these innovations are enhancing the accuracy of our diagnostics and the precision of our treatment planning.

For dental hygienists, staying informed about these developments strengthens the ability to communicate with patients about emerging technologies and supports a more collaborative, evidence-based approach to care.

Conclusion

Soft tissue health is not a secondary consideration in periodontal therapy-it is foundational to successful outcomes. From comprehensive assessments and grafting procedures to the integration of emerging technologies, effective soft tissue management relies on a proactive and personalized approach.

Dental hygienists are vital to this process. You are not only responsible for the ongoing maintenance of periodontal health but also for patient education, early detection, and reinforcement of treatment goals. As our tools and understanding of soft tissue management continue to evolve, so too does your ability to impact patient outcomes in meaningful and lasting ways. By working together across roles, we can ensure that every patient receives care that is both scientifically grounded and individually tailored.

About the Author

Rachel Schallhorn, DDS, MS
Rachel Schallhorn, DDS, MS, is a board-certified periodontist based in Aurora, Colorado. She is actively involved in clinical research, education, and interdisciplinary care. She has received multiple awards for her contributions to periodontology and is passionate about working collaboratively with hygienists to advance patient outcomes.