On the other hand, the sulcus around implants
is mainly determined by the height of the soft tissues,
the local anatomy and the depth of placement of the implant.
Therefore, especially in anterior implants
where the placement is often deep in the tissues
for aesthetic reasons,
a sulcus of 3, 4,or even 5 mm is not uncommon.
Looking closer at this implant
placed in the position of a central incisor,
we can see that the first couple of millimetres
on top of the implant, is the only zone of attachment.
This is the connective tissue and junctional epithelium.
The remaining tissue all the way to the margin
of the soft tissues, is epithelialized sulcus,
and as you see in the mesial and distal sides,
it can be several millimetres deep.
The same can happen in other locations,
such as for example in the posterior maxilla,
as we approach areas where the soft tissues are thicker.
As we can see with the dental floss,
the sulcus around the central incisor
does not extend deeper than a millimetre,
yet, around the neighbouring implant,
the sulcus is several millimetres deep.
The clinical significance of the deep sulcus around implants
is critical, as we need to ensure
that it remains free of plaque and biofilm.
The bacterial biofilm will be created
in the coronal part of the sulcus,
so we need to ensure that the first millimetre or two
of the peri-implant sulcus is accessible to oral hygiene,
and our patient can keep this critical junction clean.