Crestal Soft Tissue Thickness before Implant Placement and Its Relationship with Crestal Cortical Bone Thickness: A CBCT Based Retrospective Study

International Journal of Dental Science and Innovative Research (IJDSIR) IJDSIR : Dental Publication Service Available Online at:www.ijdsir.com Volume – 8, Issue – 5, September – 2025, Page No. : 115 - 118 Corresponding Author: Dr. Madhumaitri Patra, ijdsir, Volume – 8 Issue - 5, Page No. : 115 - 118 Page115 ISSN: 2581-5989 PubMed - National Library of Medicine - ID: 101738774 Crestal Soft Tissue Thickness before Implant Placement and Its Relationship with Crestal Cortical Bone Thickness: A CBCT Based Retrospective Study 1Dr. Madhumaitri Patra Corresponding Author: Dr. Madhumaitri Patra Citation of this Article: Dr. Madhumaitri Patra, “Crestal Soft Tissue Thickness before Implant Placement and Its Relationship with Crestal Cortical Bone Thickness: A CBCT Based Retrospective Study”, IJDSIRSeptember – 2025, Volume – 8, Issue – 5, P. No. 115 – 118. Copyright: © 2025, Dr. Madhumaitri Patra, et al. This is an open access journal and article distributed under the terms of the creative common’s attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Type of Publication: Original Research Article Conflicts of Interest: Nil Abstract Background: Adequate peri‑implant mucosal thickness has been associated with improved marginal bone stability. This study quantified crestal soft tissue thickness at edentulous implant sites using CBCT and examined its relationship with crestal cortical bone and buccal/lingual cortical plates 5 mm apical to the crest. Methods: Retrospective analysis of CBCT scans from 10 adults (21 edentulous sites). Measurements (mm): (1) crestal soft tissue at the alveolar crest; (2) crestal cortical bone at the crest; (3) buccal and lingual cortical plates 5 mm apical. Descriptive statistics and Pearson correlation (α = 0.05) were used. Results: Mean crestal soft tissue thickness was 2.41 mm (median 2.2; range 1.41–4.87). Anterior sites were thicker than posterior (2.74 ± 0.28 vs 2.08 ± 0.19 mm). Mean crestal cortical bone was 1.42 mm (median 1.40). Buccal and lingual cortical plate means at 5 mm apical were 1.29 mm and 1.69 mm, respectively. Crestal soft tissue thickness positively correlated with crestal cortical bone (p < 0.001). Conclusions: More than half of implant sites exhibited thick crestal soft tissue (> 2 mm). Crestal soft tissue thickness was significantly associated with crestal cortical bone thickness but not with buccal/lingual plates 5 mm apical. Pre‑surgical CBCT assessment provides actionable, non‑invasive information for implant planning. Keywords: CBCT Scans, Crestal Soft Tissue, Implant Placement, Lingual Plates Introduction Peri‑implant tissue stability depends on both hard and soft tissue determinants, including implant design, platform switching, abutment height, occlusal loading, and the quantity/quality of peri‑implant mucosa. Animal and clinical data suggest that thicker initial mucosa (> 2 mm) reduces early crestal bone remodeling. Traditional measurement methods rely on intraoperative probing or punches and cannot guide pre‑surgical Dr. Madhumaitri Patra, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 Page116 planning. Cone‑beam computed tomography (CBCT) enables non‑invasive visualization of ridge anatomy, supporting both hard and soft tissue assessment prior to implant placement. Materials and Methods Design and Patients: Retrospective cross‑sectional analysis of adult patients (≥ 18 years) with edentulous sites planned for implants and a pre‑operative CBCT. Inclusion: generally healthy; measurable crestal soft tissue; no prior grafting at the site. Exclusion: systemic risks affecting healing (e.g., bisphosphonates, uncontrolled diabetes/osteoporosis). CBCT Acquisition: Sirona Orthophos SL (85 kV, 10 mA, 14 s), voxel 0.2 mm³, 16‑bit grayscale, FOV 60 × 80 mm². Images reviewed on HP Envy laptop. Cross‑sections perpendicular to the ridge were measured in Planmeca Romexis, Galileos Viewer, and MNT Viewer. Outcomes and Measurements: (1) crestal soft tissue thickness at the alveolar crest; (2) crestal cortical bone thickness at the crest; (3) buccal and lingual cortical plate thickness 5 mm apical to the crest. Statistics: descriptive metrics (mean, median, SE) and Pearson correlation (two‑sided α = 0.05; 95% CIs). Sites were analyzed as observational units. Results Cohort: 10 patients (5 female, 5 male; mean age 48.4 years, range 38–66) contributed 21 edentulous sites (maxillary anterior 6; mandibular anterior 5; maxillary posterior 4; mandibular posterior 6). No site received prior grafting; 6 patients wore provisional prostheses. Crestal soft tissue thickness: overall mean 2.41 mm (median 2.20; range 1.41–4.87). Females 2.64 mm; males 2.27 mm. Anterior sites were thicker than posterior (2.74 ± 0.28 vs 2.08 ± 0.19 mm). Four‑group means: maxillary anterior 2.83 ± 0.45; mandibular anterior 2.64 ± 0.36; mandibular posterior 2.20 ± 0.26; maxillary posterior 1.88 ± 0.23 mm. Crestal cortical bone thickness: mean 1.42 mm (median 1.40; range 0.50–4.97). Anterior 1.50 mm vs posterior 1.33 mm. Five‑millimeter apical plates: buccal 1.29 mm; lingual 1.69 mm. Correlations: crestal soft tissue thickness positively correlated with crestal cortical bone (p < 0.001). No positive correlation with buccal/lingual plates at 5 mm apical. Discussion CBCT‑based pre‑surgical evaluation revealed that most implant sites had thick crestal soft tissue (> 2 mm) and that anterior regions tended to be thicker than posterior. The significant association between crestal soft tissue and crestal cortical bone suggests a coordinated crest‑level soft‑hard tissue unit, whereas deeper buccal/lingual plates (5 mm apical) showed no such association. Clinically, knowing the crestal mucosal thickness aids decisions on abutment height, platform switching, and whether soft tissue augmentation is indicated to mitigate early marginal bone remodeling. Limitations include the small retrospective sample, unmodeled intra‑patient clustering, and the absence of longitudinal outcomes. Conclusions 1) A majority of sites exhibited thick crestal mucosa (> 2 mm). 2) Crestal soft tissue thickness correlated positively with crestal cortical bone thickness (p < 0.001) but not with buccal/lingual plates at 5 mm apical. 3) Anterior sites tended to present thicker crestal soft tissue than posterior sites. Dr. Madhumaitri Patra, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Page117 Figure 1: CBCT cross‑section showing linear measurements at the alveolar crest (soft tissue and crestal cortical bone). Figure 2: CBCT cross‑section 5 mm apical to the crest showing buccal and lingual cortical plate measurements. Table 1: Patient‑level measurements by site Table 2: Estimated means and SEs of hard and soft tissue measurements Dr. Madhumaitri Patra, et al. International Journal of Dental Science and Innovative Research (IJDSIR) ©2025 IJDSIR, All Rights Reserved Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Page118 Table 3: Estimated medians of hard and soft tissue measurements References 1. Albrektsson T, Buser D, Sennerby L. Crestal bone loss and oral implants. Clin Implant Dent Relat Res. 2012;14(6):783–791. 2. Thoma DS, Mühlemann S, Jung RE. Critical soft‑tissue dimensions with dental implants and treatment concepts. Periodontol 2000. 2014;66 (1): 106–118. 3. Berglundh T, Lindhe J. Dimension of the peri‑implant mucosa: biological width revisited. J Clin Periodontol. 1996;23(10):971–973. 4. Linkevicius T, Puisys A, Steigmann M, et al. Influence of vertical soft tissue thickness on crestal bone changes around implants with platform switching. Clin Implant Dent Relat Res. 2015;17 (6):1228–1236. 5. 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