: This clinical trial aimed to evaluate changes at the marginal bone level by analysing the influence of the peri‑implant mucosal phenotype on implants restored with direct screw-retained prostheses after a 3-year follow-up.

Fifty-one patients received 56 implants in the posterior part of the maxilla or mandible. The implants were placed equicrestally, 1 mm subcrestally (SC), or > 1 mm SC, depending on the initial supracrestal tissue height (STH). After 3 months of non-submerged healing, screw-retained single-unit crowns were placed in direct connection with the implant shoulder. Clinical (STH, mucosal thickness, and keratinised mucosa width, KMW) and radiographic (marginal bone remodelling and marginal bone loss, MBR and MBL, respectively) data were recorded during the implant placement surgery (T0) and at the 3, 6, 12, and 36-month follow-ups (T1–T4). MBL was considered the main variable in this work.

There was a significant reduction in the mean KMW (by 0.3 ± 0.7 mm) between the 12 and 36-month follow-up (p = .001). After 36 months, significant MBR had occurred between the T3 and T4 periods (0.15 ± 0.29 mm; p = .001), however there had also been some non-significant MBL. Implants with SC positioning > 1 mm showed the highest MBR levels, while equicrestal implants showed the highest MBL. Multiple linear regression analysis indicated that MBR is driven chiefly by implant length, implant diameter and the implant’s apico-coronal position, whereas MBL depends mainly on KMW and implant diameter.

Implant crestal position, implant diameter, and keratinised mucosal width were the most important factors in marginal peri‑implant bone loss.

The peri‑implant soft-tissue phenotype, specifically the KMW, seems to be the main protective factor against peri‑implant bone loss.

Dental implants

Direct prosthesis to implant

Marginal bone loss

Interproximal bone changes

Subcrestal implant placement

phenotype Clinical trial registration: Identification number: NCT05670340

© 2025 The Author(s). Published by Elsevier Ltd.