Peri-implant Tissue Changes Research Articles

Volumetric Analysis of Peri-implant Tissue Change Over Time: Validating an Innovative 3D Method.

To validate an innovative 3D volumetric method of evaluating tissue changes proposed by Lee et al in 2020 by comparing the results of this method-in which the scanned peri-implant surfaces were transformed, visualized, and analyzed as 3D objects-to the results reported by an existing method based on calculation of the mean distance between measured surfaces. The null hypothesis was that there was no statistically significant difference between the two methods. Additionally, the present study evaluated peri-implant tissue changes 5 years after single implant placement in the esthetic zone. Both methods were applied to 11 oral implant site casts (6 maxillary central incisor sites, 5 maxillary lateral incisor sites) taken from 11 patients at crown placement and at follow-up examinations 5 years later. The methods are based on digital workflows in which the reference and 5-year casts are scanned and the resulting STL files are superimposed and analyzed for three regions of interest (mesial papilla, central area, and distal papilla). The volumetric changes reported by the Lee et al method and the mean distance method were calculated and compared using the Spearman rank correlation coefficient (P < .01) and the Wilcoxon signed-rank test (P < .05). The correlation between the two sets of measurements was very high (Spearman rank correlation coefficient = 0.885). The new volumetric method indicated a mean volume loss of 2.82 mm3 (SD: 5.06), while the method based on the measurement of mean distance showed a mean volume loss of 2.92 mm3 (SD: 4.43; Wilcoxon signed-rank test result: P = .77). No statistically significant difference was found. The two methods gave equivalent results, and the null hypothesis was accepted. The new volumetric method was validated and can be considered a trustworthy tool.

In Vivo Safety of New Coating for Biodegradable Magnesium Implants.

Biodegradable Magnesium (Mg) implants are promising alternatives to permanent metallic prosthesis. To improve the biocompatibility and with the aim of degradation control, we provided Plasma Electrolytic Oxidation (PEO) of pure Mg implant in silicate-based solution with NaOH (S1 250 V) and Ca(OH)2 (S2 300 V). Despite the well-structured surface, S1 250 V implants induced enormous innate immunity reaction with the prevalence of neutrophils (MPO+) and M1-macrophages (CD68+), causing secondary alteration and massive necrosis in the peri-implant area in a week. This reaction was also accompanied by systemic changes in visceral organs affecting animals' survival after seven days of the experiment. In contrast, S2 300 V implantation was associated with focal lymphohistiocytic infiltration and granulation tissue formation, defining a more favorable outcome. This reaction was associated with the prevalence of M2-macrophages (CD163+) and high density of αSMA+ myofibroblasts, implying a resolution of inflammation and effective tissue repair at the site of the implantation. At 30 days, no remnants of S2 300 V implants were found, suggesting complete resorption with minor histological changes in peri-implant tissues. In conclusion, Ca(OH)2-contained silicate-based solution allows generating biocompatible coating reducing toxicity and immunogenicity with appropriate degradation properties that make it a promising candidate for medical applications.

Three-Dimensional Peri-Implant Tissue Changes in Immediately vs. Early Placed Tapered Implants Restored with Two Different Ceramic Materials-1 Year Results.

A prospective multi-center randomized controlled clinical trial was performed to digitally analyze tissue volume changes in immediately and early placed implants with simultaneous bone augmentation restored with two different all-ceramic materials. A total of 60 patients received 60 bone-level tapered implants (BLT, Straumann AG) immediately (n = 30) or early placed, 8-10 weeks after tooth extraction, (n = 30). Implants were restored with all-ceramic single crowns fabricated out of zirconia (Lava Plus, 3M), or lithium disilicate (E.max CAD, Ivoclar Vivadent AG) bonded to titanium base abutments (Variobase for Cerec, Straumann AG). Impressions were taken at baseline (BL), 6 and 12 months, and STL data were used to define an area of interest (AOI) to analyze peri-implant volume changes and midfacial recessions. For immediate placement, a mean volume loss of -5.56 mm3 (±5.83 mm3) was found at 6 months, and of -6.62 mm3 (±6.56 mm3) at 12 months. For early placement, a mean volume loss of -1.99 mm3 (±5.82 mm3) at 6 months, and of -3.7 mm3 (±5.62 mm3) at 12 months was found. The differences in volume loss at 12 months between the two implant placement protocols were significant (p = 0.005). In both groups, mean midfacial recessions of 0.48 mm (±0.52) occurred. A more pronounced peri-implant volume loss can be expected 12 months after immediate implant placement compared with early placement.

Clinical and radiographic evaluation of peri-implant tissue changes associated with use of standard versus customized healing abutments

Clinical and radiographic evaluation of peri-implant tissue changes associated with use of standard versus customized healing abutments

Effect of Anti-Diabetic Medications on Dental Implants: A Scoping Review of Animal Studies and Their Relevance to Humans.

Animal studies have ascertained that hyperglycemia adversely affects bone metabolism and dental implant osseointegration. However, diabetic patients show low occurrence of unfavorable hard or soft peri-implant tissue changes, differences that are possibly due to treatment with anti-diabetic medications. This scoping review aimed to systematically examine the effects of these drugs on implant outcomes and explore the predictive modality of animal studies for clinical practice according to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Three electronic databases (MEDLINE, EBSCOHost, and Cochrane) were searched according to the PRISMA-ScR standards for studies on diabetic animals that received titanium implants and anti-diabetic treatments. Risk assessment was performed using the SYRCLE Risk-of-Bias (RoB) tool. Twenty-one papers were included, encompassing six types of medications. Fifteen studies were on T1DM animals, and only six involved T2DM models. T1DM animals were treated with non-insulin drugs in four investigations, while insulin was utilized in 11 other studies. In T2DM experiments, five administered non-insulin drugs, and only one applied locally delivered insulin. Only insulin in T1DM studies produced a positive influence on bone-implant contact (BIC), bone mineral content, and removal torque values. Inappropriate drug selection, inadequate glycemic control, and high RoB depict a mismatch between the research focus and the translational rationale to clinical practice. There remains a knowledge gap regarding T2DM investigations due to the lack of studies. More data are needed concerning intraoral implants and the performance of osseointegrated implants in patients with a later onset of diabetes. Future research should reflect the pathophysiology and treatment of each type of diabetes to ensure clinical applicability.

Clinical and radiographic assessment of peri-implant tissue changes using two different implant connections with immediate implant placement and loading.

Aim: Radiographic assessment of dimensional changes of peri implant tissues in immediately placed implants with non-functional loading in maxillary esthetic zone with Internal Hex (IH) and Conical Tapered (CT) connections&#x0D; Materials and Methods: 20 immediately placed implant with immediate loading were inserted in the maxillary esthetic zone, patients meeting the inclusion criteria were allocated into one of the two groups: Internal Hex or Conical tapered connection.&#x0D; Results: Pink Esthetic Scores(PES) of the CT connection showed significantly higher values than IH. It was shown that the IH group showed statistically significant higher mean value than the CT connection in the values of crestal bone loss using CBCT.&#x0D; Conclusion: CT connection has proved to result in better clinical, radiographic and volumetric outcomes than IH.

Prospective evaluation of socket shield technique for immediate implant placement in anterior maxilla

Purpose: The purpose of the study was to report the four year implant survival rate for immediate implant placement using socket shield technique. Objectives included evaluation of the esthetic outcomes and to report any complications associated with this technique. Material and methods: This study is a prospective cohort of 10 consecutive patients with Implant placement between the maxillary first premolars using socket shield technique. Data were collected (PPD, BOP, PES, buccal width of keratinized mucosa, peri-apical radiographs and photographs) to assess and compare the changes in peri-implant tissues in pre-operative and follow up visits. Results: All the implants osseointegrated successfully without any adverse events. Peri-implant probing revealed healthy conditions in terms of pocket depth and bleeding on probing. Mean buccal width of keratinized mucosa of 4.1 was achieved. A mean pink aesthetic score of 12.3 was recorded. Conclusion: Within the limitations of this study, the results were suggesting that socket shield technique is effective in maintaining the hard and soft tissue architecture of anterior maxillary region and delivers high esthetic outcomes with shorter duration of treatment period. However, a prospective randomized study to compare socket shield with other techniques is needed to draw any definitive conclusion.

Peri-implant and esthetic outcomes of cemented and screw-retained crowns using zirconia abutments in single implant-supported restorations-A systematic review and meta-analysis.

To evaluate the peri-implant tissue changes and esthetic outcomes of cemented and screw-retained crowns of single-tooth implants in the esthetic zone using zirconia abutments. An electronic search was performed on nine databases. The risk-of-bias was assessed by the revised Cochrane risk-of-bias tool for randomized (RoB 2) and non-randomized (ROBINS-I) clinical trials. Marginal bone level change, soft tissue thickness, bleeding on probing, probing depth, survival rates of implants and crowns, complications, plaque and papilla indexes, and pink esthetic score data were extracted and analyzed. The certainty of evidence was accessed through the GRADE approach. Nine records were included and 7 were used in the meta-analyses. Screw-retained crowns presented greater marginal bone level change (MD -0.04 [-0.08, -0.00] p=0.04, I2 =0%) compared to cemented crowns up to 1-year. At 3 and 4years no significant differences (p>0.05) were observed. Soft tissue thickness did not differ between groups (p>0.05). The bleeding on probing was higher in cemented group than in screw-retained crowns at 1-year (MD 0.17 [0.08, 0.27] p=0.0005, I2 =0%), at medium-term periods (3 and 4years) no statistically significant differences (p>0.05) were observed for this outcome. Probing depth, survival rates of implants and crowns, complications, and plaque index, as well as esthetic analysis using the papilla index and pink esthetic score did not differ statistically (p>0.05) between both retention systems at short and medium-term periods. The connection system considering zirconia abutments presented no influence on peri-implant parameters and esthetics evaluation for medium-term periods (3 and 4years).

Mandibular implant-supported overdenture: A systematic review and meta-analysis for optimum selection of attachment system.

Aim:This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system.Settings and Design:This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines.Materials and Methods:A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies.Statistical Analysis Used:The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020.Results:Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10).Conclusion:It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.

Three-Year Prospective Randomized Comparative Assessment of Anterior Maxillary Single Implants with Different Abutment Interfaces

The goal of this investigation was to define time-dependent peri-implant tissue changes at implants with different abutment interface designs. Participants requiring replacement of single maxillary anterior and first premolar teeth were recruited and treated under an institutional review board (IRB)-approved protocol. Implants, titanium abutments, and provisional crowns were placed in healed ridges 5 months following preservation after tooth extraction with recombinant human bone morphogenetic protein-2 (rhBMP-2). Twelve weeks later, permanent crowns were placed on patient-specific abutments and evaluated at 6, 12, and 36 months following implant placement. Clinical and radiographic assessments of abutments and crowns, peri-implant mucosa, and marginal bone levels were recorded. The 3-year assessment included 45 conical interface (CI), 34 flat-to-flat interface (FI), and 32 platform-switched interface (PS) implants in 111 participants. At 3 years, the mean marginal bone level (MBL) change at CI, FI, and PS implants was -0.12, -1.02, and -1.04 mm, respectively (P = .014). "Zero" MBL loss or gain was measured over the 3-year period at 72.1% CI, 3.0% FI, and 16.6% PS implants. There was a minor change (0.0 to 0.3 mm) in peri-implant mucosal zenith positions over time and between groups. Eighty percent of CI implants, 61% of FI implants, and 84% of PS implants were observed to have a clinically stable peri-implant mucosal zenith position with less than 0.5 mm of measured recession. Over the 36-month period, there were no significant changes in the location of mesial or distal papilla in any group. Significant differences in MBLs were observed at different implant interfaces. Conical implant interfaces, but not flat-to-flat or platform-switched implant interfaces, were associated with no MBL changes over 3 years. Peri-implant mucosal stability was generally observed. The relationship of marginal bone responses and peri-implant mucosal stability requires further evaluation.

Periodic Assessment of Peri-implant Tissue Changes: Imperative for Implant Success

The aim of this study was to evaluate the changes in the peri-implant hard and soft tissues and implant stability and to assess the correlation of bone loss and peri-implant probing depth with implant stability. Twenty-one patients with implants were included in this study and implants were assessed by resonance frequency analysis (RFA). Bone levels of the implants were assessed by measuring mesial and distal bone levels from the periapical radiograph, and soft tissue was assessed from probing depth using a periodontal probe. Implants were assessed for stability and probing depth at pre-loading, at 3 months and 6 months post-loading. RFA and probing depth were statistically compared from different time points. Correlation of probing depth and marginal bone loss with implant stability was also determined. The average change in implant stability quotient (ISQ) measurements from pre-loading to 6 months post-loading was found to be statistically significant (p <0.005). The average probing depth reduced from 1.767 mm at pre-loading to 1.671 mm at post-loading 3 months, and 1.600 mm at post-loading 6 months. At 6 months of function, radiographic examination yielded 0.786 mm mesial bone loss and 0.8 mm distal bone loss. It was found to be statistically significant (p <0.005) but within an acceptable range. No significant correlation was found between implant stability and bone loss; and implant stability and probing depth. The study revealed an increasing trend in implant stability values with the time that indicates successful osseointegration. Increasing mean values for mesial and distal bone loss were also found. The success of dental implants is highly dependent on the quality of bone and implant-bone interface, i.e., osseointegration. The most important factors that influence the survival rate of an implant is initial stability. The present study found the changes in the peri-implant hard and soft tissues and implant stability. This article, while being a prospective study, may show the evidence of successful osseointegration by increasing trend in implant stability (RFA) values with time which can help to the clinician in the long-term management of implants.

Effect of Different Implant Number and Distribution Used to Retain Mandibular Overdenture; A Study of Peri-implant Tissue Changes

Effect of Different Implant Number and Distribution Used to Retain Mandibular Overdenture; A Study of Peri-implant Tissue Changes

Evaluation of peri-implant tissues around nanopore surface implants with or without platelet rich fibrin: a clinico-radiographic study

Objective: To comparatively evaluate peri-implant tissue changes around the nano-pore implant surface with or without platelet rich fibrin (PRF). Material and methods: For the present study, a total of 17 patients was initially enrolled (6 females, 11 males), and 38 sites (19 control and 19 experimental sites) were randomly assigned to either group 1 (control), i.e. extraction site received immediate implants without any PRF, and group 2 (experimental), i.e. extraction sites received immediate implants with PRF. Clinical and radiographic parameters were recorded for 9 months after the implant-loading phase. Results: Clinically, there was a significant (p < 0.001) increase in the peri-implant probing depth from the prosthetic phase up to 9 months in both the groups, and the increase was greater in the control group. However, the mean difference in the changes between the two groups was non-significant. The modified gingiva index for group 2 was significantly lower than that for group 1 in the prosthetic phase. Radiographically, in the control group and experimental group, there was a significant increase (<0.01) in bone loss (BL) in the mesial and distal aspect of the implant from the surgical to prosthetic phase, surgical up to 9 months and from the prosthetic phase up to 9 months. There was greater BL in the control group than in the experimental group in both the mesial and distal aspect of the implant; however the difference in BL was non-significant (<0.01). There was greater BL in the distal aspect than in the mesial aspect in both groups; however, the difference in BL was non-significant. Conclusion: PRF treatment may provide a way to prevent BL during the surgical-to-prosthetic phase. These results were based on a short-term, low sample randomized clinical study, therefore a long-term study with more sites and homogenous sampling is recommended.

One-time versus repeated abutment connection for platform-switched implant: A systematic review and meta-analysis.

ObjectiveThis review aims to compare peri-implant tissue changes in terms of clinical and radiographic aspects of implant restoration protocol using one-time abutment to repeated abutment connection in platform switched implant.MethodA structured search strategy was applied to three electronic databases, namely, Pubmed, Embase and Web of Science. Eight eligible studies, including seven randomised controlled studies and one controlled clinical study, were identified in accordance with inclusion/exclusion criteria. Outcome measures included peri-implant bone changes (mm), peri-implant soft tissue changes (mm), probing depth (mm) and postsurgical complications.ResultSix studies were pooled for meta-analysis on bone tissue, three for soft tissue, two for probing depth and four for postsurgical complications. A total of 197 implants were placed in one-time abutment group, whereas 214 implants were included in repeated abutment group. The implant systems included Global implants, Ankylos, JDEvolution (JdentalCare), Straumann Bone level and Conelog-Screwline. One-time abutment group showed significantly better outcomes than repeated abutment group, as measured in the standardised differences in mean values (fixed- and random-effect model): vertical bone change (0.41, 3.23) in 6 months, (1.51, 14.81) in 12 months and (2.47, 2.47) in 3 years and soft tissue change (0.21, 0.23). No significant difference was observed in terms of probing depth and complications.ConclusionOur meta-analysis revealed that implant restoration protocol using one-time abutment is superior to repeated abutment for platform switched implant because of less bone resorption and soft tissue shifts in former. However, future randomised clinical trials should be conducted to further confirm these findings because of the small samples and the limited quality of the original research.

Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis

Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri-implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single-tooth implants in the esthetic zone. MEDLINE, EMBASE, and CENTRAL databases were searched for publications up to June 2013. Studies reporting on implant survival, changes in hard and soft peri-implant tissues, esthetic outcome, and patient satisfaction were considered. A pooled analysis was performed to identify factors associated with survival and peri-implant tissue changes after immediate implant placement. Thirty-four studies were considered eligible. Immediate placement of single-tooth implants in the esthetic zone was accompanied by excellent 1-year implant survival (97.1%, 95% confidence interval [CI]: 0.958 to 0.980). Mean marginal peri-implant bone loss was 0.81 ± 0.48 mm, mean loss of interproximal peri-implant mucosa level was 0.38 ± 0.23 mm, and mean loss of peri-implant midfacial mucosa level was 0.54 ± 0.39 mm. Regression analysis revealed that delayed provisionalization (odds ratio [OR] 58.03, 95% CI: 8.05 to 418.41, P <0.000), use of a flap (OR 19.87, 95% CI: 10.21 to 38.66, P <0.000), and use of a connective tissue graft (OR 4.56, 95% CI: 1.72 to 12.08, P <0.002) were associated with marginal peri-implant bone-level change >0.50 mm. Because of underreporting, esthetic results and patient outcome did not allow for reliable analysis. Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short-term treatment outcome in terms of implant survival and minimal change of peri-implant soft and hard tissue dimensions.

Implant-supported overdenture therapy: a 3- to 8-year prospective study.

Inflammatory changes in periimplant soft tissues and loss of alveolar bone can develop as in periodontal diseases. This clinical phenomena has been described as periimplantitis. Microorganisms such as Gram-negative anaerobic rods, spirochetes, and bacteroides that are seen in subgingival flora in periodontitis have also been found in sulcular microflora in periimplantitis. The purpose of this study was to evaluate periimplant tissue changes in totally edentulous patients who had implant-supported overdentures for 3 to 8 years (5-5.5 years) clinically from both a subjective and an objective point of view. The clinical parameters used in this study can be helpful in the evaluation of periimplant tissue health.

Digital image processing. II. In vitro quantitative evaluation of soft and hard peri-implant tissue changes.

The aim of this study was to evaluate the ability of computer-assisted densitometric image analysis (CADIA) to detect small changes in mineralized and nonmineralized tissues adjacent to dental implants and to correlate these changes with CADIA values. A section of a pig mandible including all soft tissues and in which a hollow cylinder ITI Bonefit implant with an artificial mesial and a buccal infrabony defect was placed was used to obtain pairs of standardized radiographs. Series of radiographs were obtained with exposure times of 0.13, 0.20, 0.44, and 0.53 s. Specimens of mineralized or nonmineralized tissues were placed arbitrarily in the defects before each radiographic exposure. The radiographs were captured through a video camera, digitized and stored in a personal computer. Every radiographic image was then subtracted from a baseline one without any change. The result of the subtraction was evaluated with CADIA. A linear correlation (r2 = 0.99) was found between the bone chips (1-5 mg of dry weight) placed in the mesial defect and the CADIA values. Bone chips in the buccal defect (behind the implant), however, were not detected unless their weight reached 14 mg or more. For conventionally exposed radiographs, it was not possible to recognize soft tissue specimens (1-6 mg), either in the buccal or the mesial defect. However, when "underexposed" radiographs (exposure time: 0.13 s) were obtained, a linear correlation (r2 = 0.80) was calculated for soft tissue specimens in the mesial defect and CADIA values. In normally exposed radiographs, the CADIA system could detect even the smallest change in bone density (bone chip of 1 mg of dry bone weight) and correlated almost linearly with these changes. Provided that the radiographic images are obtained with standardized geometry and normal exposure time, the tissue density changes detected by this system within bone defects represent only mineralized tissue changes. By underexposing radiographs, CADIA may even reveal soft tissue changes around dental implants.