OBJECTIVE The etiology and progression of periimplant mucogingival defects are multifactorial. As such, the aim of this study was to discern and discuss the key long-term prognostic factors that change the balance of homeostasis/regeneration in periimplant mucogingival and recession defects. METHODS This report provides cases and a discussion of anatomical factors that affect the long-term maintenance of periimplant soft tissue. RESULTS The factors guiding long-term maintenance of the periimplant soft tissue apparatus are increasingly complex due to the additive combination of patient-related factors, anatomical variations, and unique material-host interactions. CONCLUSIONS Severity and number of these contributing factors should be considered before implant placement and/or in the treatment of periimplant defects to achieve the best esthetic and functional outcome. In addition, assessment of prognostic factors should be used to provide the patient a realistic, long-term assessment of the esthetic and functional stability of both implant and the surrounding periimplant tissues.