Gingival creep is a well-known and highly desirable effect of gingival augmentation procedures. Matter and Bell as early as the late seventies demonstrated this concept in what could be described as case series. At present, we do not definitely know what the predictive variables for this phenomenon are. It is strongly associated with:
- Tooth position in the arch
- Thickness of the soft tissues
- Level of plaque control
The remaining question in the 21st century is whether this phenomenon is exclusive to teeth or does it affect implants as well.  The answer is a surprising yes!! The oral epithelium has unique adhesive properties that allow it to adhere to dentine, cementum but also plaque free titanium. This is irrespective of the smooth or roughened nature of the titanium.
The case demonstrated is of a severe peri-implantitis lesion with a 2 walled defect in a palatally positioned implant. Therefore, the position of the implant favours guided bone regeneration as well as gingival creep. There is a distinction between gingival creep and relapse of pocketing (ie oedema). The pictures demonstrate consistent pocketing with decreasing recession which basically means gain in attachment.
