SUPRACRESTAL TISSUE ATTACHMENT: MORPHOLOGICAL BASIS AND CLINICAL SIGNIFICANCE IN MODERN DENTAL PRACTICE: NARRATIVE REVIEW

Background: The concept of “biological width,” now formally designated as supracrestal tissue attachment (STA) following the 2018 World Workshop on the Classification of Periodontal and Peri-Implant Diseases, defines a stable junctional complex of epithelial and connective tissue structures forming a physiological seal around natural teeth and dental implants. Despite its fundamental clinical importance, STA remains underappreciated in routine restorative and implant treatment planning. Materials and Methods: A narrative literature search was conducted in PubMed/MEDLINE, Scopus, and the Cochrane Library (January 2009 – December 2024) using the following terms: “supracrestal tissue attachment,” “biological width,” “peri-implant soft tissue seal,” “crestal bone remodeling,” and related keywords. Histological studies, experimental and clinical investigations, systematic reviews, and meta-analyses were included, alongside seminal historical contributions. Eighteen publications were selected for final inclusion. Conclusions: STA is a dynamic biological complex averaging 2.04 mm around natural teeth (range 1.77–2.43 mm) and 3–4 mm around two-piece implants. Its peri-implant architecture differs fundamentally from that of natural teeth due to the parallel orientation of supracrestal collagen fibers and the absence of cementum-mediated anchorage, rendering it inherently more susceptible to mechanical and microbial disruption. Implant macro-design, connection type, and soft tissue biotype are primary determinants of STA stability. Violation of STA dimensions initiates an irreversible cascade of junctional breakdown, marginal bone resorption, and soft tissue recession, underscoring the necessity of individualized STA assessment and preservation as a mandatory component of restorative and implant treatment planning.