Distal Papilla Research Articles

Dynamic monitoring and esthetic evaluation of dimensional changes in the peri-implant soft tissue contour after the immediate implant placement and provisionalization with the modified socket-shield technique in the esthetic zone

Objective: To accurately measure the dynamic changes of peri-implant soft tissue within one year after the immediate implant placement and provisionalization with the modified socket-shield technique (MSST) in the esthetic zone, and to provide a basis for evaluating the effect of the modified socket-shield technique on the maintenance of peri-implant soft tissue. Methods: A total of 22 patients (22 implants) were prospectively included 1 year after completion of immediate implant placement and provisionalization (IIPP) within MSST in the esthetic zone from January 2022 to January 2024 at the Department of Oral Implantology in the Stomatological Hospital of Chongqing Medical University. The intraoral optical models of patients were obtained by an intraoral scanner system preoperatively and at 3, 6, and 12 months postoperatively, respectively. The standard tessellation language files of intraoral optical models at multiple time points were imported to Geomagic Studio 2013 to be superimposed and aligned for analyzing the peri-implant soft tissue contour on the labial side of the implant site at multiple levels. The amount of gingival margin recession, gingival papilla change, and thickness change of the labial side of the soft tissues at each postoperative point in time were measured at each postoperative time point, as well as evaluating the esthetic effect by the pink esthetic score (PES). Results: The patients were (40±13) years old (21-75 years), including 9 males and 13 females. No adverse events occurred in all the implants during the 12-month follow-up period. The recession level of the gingival margin of the implant site (GL) was 0.08 (0.07) mm, the recession level of the mesial papilla (ML) was 0.19 (0.25) mm, and the recession level of the distal papilla (DL) was 0.19 (0.10) mm. The average collapse thickness of the soft tissue contour on the labial side of the implant (ΔD) was (0.39±0.09) mm, mainly occurring within 2 mm of the root of the gingival margin. The height of the alveolar bone was reduced by (0.17±0.08) mm. The thickness of the labial alveolar bone at 1, 3, and 5 mm root side of the implant shoulder was reduced by (0.13±0.08), (0.12±0.10) and 0.04 (0.17) mm, respectively. The postoperative pink esthetic score was 13.00 (2.25) points at 12 months, which suggested that all implant sites achieved ideal esthetic results. Conclusions: The labial soft tissue contour at implant sites shows minimal change following immediate implant placement and provisionalization using the modified socket-shield technique for 1 year in the esthetic zone.

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.

The Use of Tissue Grafts Associated with Immediate Implant Placement to Achieve Better Peri-Implant Stability and Efficacy: A Systematic Review and Meta-Analysis

Background: The goal of this systematic study and meta-analysis was to evaluate the efficacy of hard and/or soft tissue grafts associated with type-1 implants on healing and treatment outcomes. The primary outcomes studied were implant survival rate, pocket depth, marginal peri-implant recession, bone loss, bone thickness (volumetric change), interproximal bone level, mesial and distal papilla migration, and radiographic evaluation; and the secondary parameters were Pink Esthetic Score (PES), vertical distance from implant shoulder and bone, Visual Analogue Score (VAS), Implant Stability Quotient (ISQ), and biological complications (fistulas, pain, mucositis, and peri-implantitis). Methods: The PICO strategy was used to formulate the hypothesis under study: “For patients who underwent extraction and immediate implant placement, what is the efficacy of using any type of graft (bone or soft tissue) compared to non-grafting regarding the peri-implant parameters?” The electronic search process was performed on the MedLine/PubMed and Cochrane databases. It included randomized controlled trials (RCTs) from the last 11 years (from 2012 to November 2023), which were identified and analyzed. Results: Nine RCTs (κ = 0.98) were selected (403 patients and 425 implants); they were divided into three groups: bone graft (75 patients and 75 implants inserted), bone graft and membrane (213 patients and 235 implants inserted), and without bone graft (115 patients and 115 implants inserted). Three studies calculated the mid-facial mucosa level and two reported better results when a connective tissue graft was combined with the xenograft, whereas another study found better results in the combination of a dual-zone technique with a xenograft. Three studies evaluated the total Pink Esthetic Score (PES) at 12 months, where the authors found no significant difference in using a xenogeneic graft with or without a membrane. In the same period, the facial bone thickness was assessed in two articles; the authors reported better results in graft-treated and flapless groups. The risk-of-bias assessment found four studies with low risk, four with moderate risk, and one with a high risk of bias. The meta-analysis showed a medium level of heterogeneity for the mid-facial mucosa level analysis (I2 = 46%) and an overall effect size of 0.79 (95% CI [0.18; 1.40]), a statistically significant results (p = 0.01), with a tendency to favor the experimental group. Also, there was a medium level of heterogeneity among studies regarding total PES (I2 = 45%), with no significant differences between studies (p = 0.91). Homogeneous results (I2 = 0%) were found among studies analyzing facial bone thickness, favoring the experimental group; the forest plot showed an effect of 0.37 (95% CI [0.25; 0.50]), which was statistically significant (p &lt; 0.00001) for this parameter. Conclusions: Then, it was possible to conclude that using bone and soft tissue grafting techniques associated with immediate implant placement (IIP), even though they are not fundamental, was a valuable resource to prevent significant tissue reduction, reaching greater bone stability and higher levels in the Pink Esthetic Score (PES) and Visual Analogue Score (VAS).

Immediate Implant Placement Using the Socket Shield Technique: Clinical, Radiographic, and Volumetric Results Using 3D Digital Techniques-A Case Series.

Extraction-site alveolar remodeling is a major concern due to negative volumetric hard and soft tissue changes that inevitably limit rehabilitation options and diminish esthetic outcomes. Surgical techniques employed to minimize alveolar dimensional changes are not always predictable. Utilizing a socket shield with an immediate surgical implant procedure helps maintain a thin portion of the root in the vestibular area and thus minimizes bone resorption, especially at the coronal cortical aspect. This case series assesses the dimensional changes in peri-alveolar structures via superimposition of the preoperative and 6-month postoperative 3D digital quantification of soft tissue. Fifty patients with 50 sites fulfilled the inclusion criteria. Implant survival was 100%, with no incidence of complications. Tissue changes were as follows: -0.85 mm at the mesial papilla, -0.95 mm at the distal papilla, -0.7 mm at both the vertical and horizontal central margins, -0.21 mm at a distance 4 mm from the margin, and -0.64 mm at the palatal central margin. The buccal contour was clinically convex in all cases. The site with highest frequency of > 1 mm of dimensional loss was the distal papilla (42% of sites), and the site with the lowest frequency was the point 4 mm from the midfacial margin (0% of sites).

The bone shielding versus dual-zone concept in treating thin-walled fresh extraction sockets with immediate implant placement: Soft and hard tissue changes. A randomized clinical trial.

To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual-zone (DZ) technique versus the bone shielding concept in patients with intact thin-walled sockets in the esthetic zone. This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco-palatal ridge dimensional changes were measured and assessed using intra-oral digital scans at baseline and 1 year post-procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year. The bone shielding group provided bucco-palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco-palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco-palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively. The bone shielding concept might offer a reliable alternative for restoring thin-walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization." NCT05381467.

Star-shaped incision technique for gingiva patients treated with implant-supported fixed prosthesis.

To evaluate the modified star-shaped incision on gingival sulcus for reducing horizontal food impaction around implant-supported restoration. Total 24 patients receiving bone-level implant placement were enrolled, a star-shaped incision was made on the gingiva sulcus before the placement of zirconia crown. Follow-up examination was carried out 3 and 6 months after final restoration, respectively. Assessment of soft tissue includes papilla height, modified plaque index, modified sulcus bleeding index, periodontal depth, gingival biotype and gingival margin level. Marginal bone level was measured on periapical radiographs. Only 1 patient complained about the horizontal food impaction. Both the mesial and distal papilla almost filled the entire proximal space, in good harmony with the adjacent papillae. No recession of the gingival margin was found around the crown even in the patients with thin gingival biotype. Other parameters of soft tissue including modified plaque index, modified sulcus bleeding index and periodontal depth remained low during the whole follow-up visit. The resorption of marginal crestal bone was less than 0.6 mm during the first 6 month, and there was no significant difference among baseline, 3-month and 6-month visit. The modified star-shaped incision on the gingiva sulcus maintained the gingival papilla height and reduced the occurrence of horizontal food impaction, and no recession of the gingiva margin was found around implant-supported restoration.

PERIPHERAL ODONTOGENIC FIBROMA IN THE GINGIVA

A 22-year-old Caucasian male was referred to evaluate an isolated lesion in the region of tooth 23. During anamnesis, a slow, progressive, and painless growth was perceived, not bleeding upon palpation and with no color change, with a one-year evolution. On clinical examination, a well-defined exophytic enlargement was noticed, with no color change in the distal papilla of tooth 23. Some gingival hyperplastic process was suspected. Imaging exams were requested, in which a possible fibro-osseous lesion was detected in the apical region of the same tooth. A biopsy was performed, targeting the intrasulcular region between teeth 22 and 25, from which a bone fragment and the entire soft tissue lesion were collected. The material was sent for histopathological analysis, and the report was conclusive for peripheral odontogenic fibroma over vital bone tissue. The patient is currently under follow-up, with no clinical signs of recurrence. A 22-year-old Caucasian male was referred to evaluate an isolated lesion in the region of tooth 23. During anamnesis, a slow, progressive, and painless growth was perceived, not bleeding upon palpation and with no color change, with a one-year evolution. On clinical examination, a well-defined exophytic enlargement was noticed, with no color change in the distal papilla of tooth 23. Some gingival hyperplastic process was suspected. Imaging exams were requested, in which a possible fibro-osseous lesion was detected in the apical region of the same tooth. A biopsy was performed, targeting the intrasulcular region between teeth 22 and 25, from which a bone fragment and the entire soft tissue lesion were collected. The material was sent for histopathological analysis, and the report was conclusive for peripheral odontogenic fibroma over vital bone tissue. The patient is currently under follow-up, with no clinical signs of recurrence.

Hard and Soft Tissue Alterations After Immediate Implant Placement and Provisionalization with Customized Definite Abutment in Esthetic Zone: A Retrospective Study.

To evaluate the hard and soft tissue alterations of immediate implant placement and provisionalization with customized definitive abutments in the esthetic zone. Single unsalvageable maxillary anterior teeth were replaced with immediate implant placement and provisionalization with definitive abutments in 22 participants. Digital impressions and CBCT images were obtained presurgery, immediately after surgery, and 6 months after surgery. Horizontal and vertical buccal bone changes in thickness and height (HBBT, VBBH), vertical changes for the gingiva margin, mesial and distal papilla height, and horizontal changes for soft tissue (HCST) were analyzed using a 3D superimposition method. Twenty-two participants completed the study. No implant failed, and there were no mechanical or biologic complications for any patients. At 6 months after surgery, the mean HBBT changes at 0, 1, 2, 3, 5, 7, 10, 11.5, and 13 mm were -0.92 ± 0.73, -0.83 ± 0.53, -0.82 ± 0.49, -0.70 ± 0.64, -0.65 ± 0.47, -0.50 ± 0.51, -0.15 ± 0.45, -0.10 ± 0.57, and -0.00 ± 0.64 mm, respectively. The mean VBBH change was -0.61 ± 0.76 mm. The mean HCSTs at -3, -2, -1, 0, 1, 2, and 3 mm sub- and supra-implant shoulder were -0.65 ± 0.54, -0.70 ± 0.56, -0.65 ± 0.51, -0.61 ± 0.56, -0.47 ± 0.54, -0.47 ± 0.59, and -0.46 ± 0.59 mm, respectively. The mean gingiva margin recession was -0.38 ± 0.67 mm. The mean mesial papilla height recession was -0.03 ± 0.50 mm. The mean distal papilla height recession was -0.12 ± 0.56 mm. The definitive abutment used with immediate implant placement and provisionalization could potentially maintain the buccal bone thickness and height. For the facial soft tissue, it also benefited the maintenance of the midfacial gingival margin position and papilla height during the 6-month follow-up. Int J Oral Maxillofac Implants 2023;38:479-488. doi: 10.11607/jomi.9914.

Correlation of ectopic distal location of papilla of Vater and clinical characteristics in pediatric choledochal cysts.

Ectopic distal location of papilla of Vater (EDLPV) is an obvious pathological feature of choledochal cyst (CDC). This study aimed to investigate the correlation between EDLPV and clinical characteristics of CDCs. Three groups were studied: Group 1 (G1), papilla in the middle third of second part of duodenum (n = 38); Group 2 (G2), papilla from the distal third of second part to the beginning of third part of duodenum (n = 168); Group 3 (G3), papilla from the middle of third part to fourth part of duodenum (n = 121). Relative variables among three groups were compared. Compared with G1 and G2, G3 patients had the largest cysts (relative diameter: 1.18 vs. 1.60 vs. 2.62, p < 0.001), the youngest age (20.52 vs. 19.47 vs. -3.40months, p < 0.001), the highest rate of prenatal diagnosis (26.32% vs. 36.31% vs. 62.81%, p < 0.001), the lowest occurrence of protein plugs in common channel (44.74% vs. 38.69% vs. 16.53%, p < 0.001), and the most elevated total bilirubin level (7.35 vs. 9.95 vs. 28.70μmol/L, p < 0.001). Prenatally diagnosed G3 patients had heavier liver fibrosis than G2 (13.16% vs. 1.67%, p = 0.015). The more distal papilla location, the more severe clinical characteristics of CDCs, suggesting a crucial role in its pathogenesis.

Influence of supracrestal tissue height on peri-implant hard and soft tissues of single implants placed in the esthetic areas using one abutment-one time approach: A pilot, prospective interventional study.

This pilot, prospective interventional study aimed to analyze the influence of supracrestal tissue height (STH) when using the one abutment-one time concept (OAOT) at the time of implant placement, on peri-implant hard and soft tissue remodeling in esthetic areas. The definitive crown was placed seven days later. Facial mucosal margin position (FMMP), mesial and distal papilla levels (MPL and DPL, respectively), and mesial and distal marginal bone loss (M-MBL and D-MBL, respectively) were assessed after seven days (placement of the definitive crown), and 1, 2, 3, 6 and 12 months after implant placement. Patients were classified according to the STH in thin (STH < 3 mm) and thick (STH ≥ 3 mm). Fifteen patients fulfilled the eligibility criteria and were included in the study. Eight presented a thick STH and seven a thin STH. After 12 months, the implant success rate was 100%. The mean recession at FMMP was -0.47 ± 0.57 mm and -0.19 ± 0.41 mm in thin and thick groups, respectively (p = 0.29). The mean MPL recession was -0.19 ± 0.06 mm in the thin group and -0.01 ± 0.07 mm in the thick group (p < 0.01), and the mean DPL recession was -0.15 ± 0.09 mm in the thin group and 0.00 ± 0.15 mm in the thick group (p < 0.05). The mean bone loss was -0.21 ± 0.18 mm and -0.04 ± 0.14 mm in the thin and thick groups, respectively (p < 0.05). Single maxillary anterior implants with thin supracrestal tissue height (< 3 mm) at the time of implant placement had greater bone loss and papillary recession than implants with a thick soft tissue height (≥ 3 mm), even when using the one abutment one time concept.

Single-Tooth Replacement in the Maxillary Esthetic Zone with Immediate Implant Insertion and Definitive Abutment Placement and Provisionalization: 1-Year Results of a Prospective Case Series.

This prospective longitudinal study evaluated the peri-implant soft tissue remodeling, marginal bone levels, and implant success rate of immediately placed single implants-which received a definitive zirconia abutment and provisional restoration at implant placement-in the maxillary esthetic zone. The final crown was delivered 7 days later. Patients (n = 26) presenting a single extraction-indicated lateral or central incisor with adequate bone volume were eligible for this study. Mesial and distal papilla levels (MPL and DPL, respectively), facial gingival level (FGL), and mesial and distal marginal bone levels (MMBL and DMBL, respectively) were assessed after 7 days and at 1, 2, 3, 6, and 12 months. Patients were classified according to gingival phenotype: thin (≤ 2 mm) or thick (> 2 mm). After 1 year, the implant success rate was 100%. Mean soft tissue recession was -0.04 ± 0.15 mm (MPL), -0.09 ± 0.02 mm (DPL), and -0.13 ± 0.18 mm (FGL). Mean bone remodeling at 1 year was 0.12 ± 0.17 mm (MMBL) and 0.13 ± 0.18 mm (DMBL). The marginal interproximal bone was above the implant platform in 100% of sites. Patients with thick phenotype showed significantly less papillary recession than thin-phenotype patients. Minimal peri-implant hard and soft tissue changes were observed at the 1-year follow-up.

Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial.

The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year. Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n= 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n= 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap. All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p< 0.001). Similarly, changes in mesial papilla (test=-0.64 ± 0.95 mm, control=-1.20 ± 0.81 mm), distal papilla (test=-0.56 ± 1.17 mm, control=-1.26 ± 0.63 mm), horizontal soft-tissue (test=-0.82 ± 0.95 mm, control=-1.84 ± 0.88 mm; p< 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes. The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.

A Novel Approach to Immediate Implants: The CastleWall Surgical Technique.

Objective: The purpose of this study was to investigate the volumetric stability around immediate implants, in which a 360-degree socket-shield was retained using the CastleWall Surgical Technique (CWST). Material and methods: This retrospective study examined the results of the CWST used for 25 consecutive patients, involving 31 immediate implants. Silicone impressions taken prior to extraction, and at a review appointment were converted to STL files and compared. The median follow-up time was 14.2 ± 5.5 months. Volumetric changes and gingival recession on both buccal and lingual sites were measured. Papillary height changes were also evaluated from available photographs taken before and after treatment. Patients in the study completed a Visual Analogue Scale (VAS) for evaluation of post-operative discomfort and overall satisfaction with this procedure. Results: All implants integrated successfully without complications. Mean loss of buccal and lingual tissue was 0.30 ± 0.32 mm and 0.17 ± 0.27 mm, respectively. Mean recession at the mid-buccal and mid-lingual gingival margin was 0.66 ± 0.64 mm and 0.87 ± 0.84 mm, respectively. Mean recession of the mesial and distal papilla was 0.26 ± 0.55 mm and 0.29 ± 0.52 mm, respectively. Patients reported 97.74 ± 5.60% satisfaction with this procedure using the Visual Analogue Scale (VAS), with minimal post-operative discomfort. Conclusions: The results of this study showed excellent soft tissue stability and aesthetics were achieved using the CWST, with minimal postoperative pain. The other main advantage of retaining a 360-degree socket-shield, is there is more available surface area to lock the implant to the shield to prevent shield migration over time.

Clinical Evaluation of Pink Esthetic Score of Immediately Impressed Posterior Dental Implants.

While comparative outcome results for peri-implant crestal bone levels, mucosal margin position, and peri-implant indices have been reported, no studies are available that evaluate and compare the esthetic result of impressions performed immediately at implant placement with that of impressions performed on healed implants. The purpose of this cross-sectional study was to evaluate the pink esthetic score of posterior implants restored with an immediate impression workflow compared to implants restored with a delayed impression workflow. Twenty-eight eligible participants who had received a single implant crown either in the premolar or molar regions at least 4 months before the study, were identified by an electronic health record review and scheduled for a single-visit study appointment. Esthetic outcomes were measured using the pink esthetic score. Several local- and prosthesis-related factors were recorded and their association with the selected outcome was assessed. Two-sample t-test was used for comparisons between the groups. Pink esthetic score ranged between 4 and 12 (mean: 8). No significant difference between immediate (8.36 ±1.12) and delayed (7.76 ±2.14) impression workflow groups were seen for the total PES (p = 0.25). In addition, individual comparisons between immediately and delayed impressed implants for mesial papilla (1.27 ±0.47; 0.88 ±0.78), distal papilla (0.73 ±0.65; 0.76 ±0.83), tissue margin (1.73 ±0.47; 1.47 ±0.51), tissue contour (1.27 ±0.65; 0.82 ±0.64), alveolar process (0.82 ±0.60; 1.00 ±0.87), color (1.27 ±0.65; 1.29 ±0.69), and texture (1.36 ±0.50; 1.53 ±0.62) did not show significant differences. The current study suggests that the pink esthetic score is not significantly different between single posterior implants impressed with immediate and delayed implant workflows.

Radiographic evaluation of a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis

BackgroundTo evaluate a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis.MethodsTotal 55 patients receiving cross-shaped incision were assigned into thick-gingiva group (29 cases) and thin-gingiva group (26 cases). Follow-up was performed at 3 and 12-month after final restoration.ResultsMesial and distal papilla height was significantly greater in thick-gingiva group than thin-gingiva group at 3 and 12 months, while periodontal depth and crestal marginal bone level around implant had no significant difference between the two groups during follow-up. No case of recession of buccal marginal gingiva was observed in thick-gingiva group. However, the recession of marginal gingiva of buccal aspect of the crown was found in 5 patients (19.2%) with thin-gingiva.ConclusionsThe cross-shaped incision may be applied to reconstruct gingival papillae and avoid the gingival recession in patients with thick-gingiva phenotype.Trial registration This study was registered at ClinicalTrials.gov (registration number NCT04706078, date 12 January 2021, Retrospectively registered).

Clinical evaluation of gingival margin stability following conventional versus microsurgical techniques of esthetic crown lengthening: a randomized controlled clinical trial.

Aim: To assess the gingival margin stability following conventional versus microsurgical approach of esthetic crown lengthening in management of patients with anterior short clinical crowns. Methodology: Twenty-four patients indicated for esthetic crown lengthening were selected and divided into either test or control groups where microsurgical approach or conventional technique were performed respectively. All patients were assessed at different intervals (baseline, 3, and 6 months) for the outcomes: gingival margin (GM), Pink esthetic score (PES), soft tissue level (STL), mesial (MP) and distal papilla (DP) levels, postoperative swelling (POS), postoperative pain (POP) and patient satisfaction and were subjected to statistical analysis. Results: there was a statistically significant reduction in the gingival margin level after 3 and 6 months in both groups with statistically significant more mm and percentage reduction within the control group. The microsurgical approach showed a statistically significant improvement in the PES at 3 and 6 months, while the conventional approach showed a statistically significant improvement only at 6 months with no statistically significant percentage gain between both groups at 3 and 6 months. Less pain was experienced with the test group through less intake of analgesics. Also, less swelling was observed in the test group at day 2 and day 5 with statistically significant difference with more patient satisfaction. Conclusions: Both groups significantly improved all clinical outcomes after 6 months, but the microsurgical approach showed less postoperative pain, swelling and gained more patient satisfaction.

A study to evaluate age and gender as determinants of papillary proportions in the esthetic region

Aim An interdisciplinary team approach to multidisciplinary therapies in esthetic restorative treatment has become common in the dental profession. The existence of interdental papillae and healthy gingiva harmonizing with the natural dentition is one of the important esthetic aspects that need to be considered for dental treatment and diagnosis. The purpose of this study is to quantify the interdental papilla location mathematically as a percentage ratio of clinical crown length for males and females in different age groups and establish a useful parameter for treatment. Materials and Methods Papilla heights of maxillary anterior teeth were evaluated on dental casts of 40 volunteers using digital vernier calipers. Crown height and width were measured and gingival zenith was used as the reference points. Papilla proportions were calculated for males and females in age groups 20-35 years and 36-50 years. Result The mesial papilla proportion for canine, lateral incisor and central incisor were 42.6%, 39.8% and 39.7% respectively. The distal papilla proportion for canine, lateral incisor and central incisor were 47.5%, 39.6% and 38.6% respectively. The papilla proportions were found to be higher in males and in individuals in age group of 36-50 years. Conclusion Gender variations exist in papilla proportions with the values being higher for males. Age appears to have an influence on papilla proportion.

A Pilot Study of Small-Diameter One-Piece Ceramic Implants Placed in Anterior Regions: Clinical and Esthetic Outcomes at 1-Year Follow-up.

The aim of this study was to evaluate the clinical, esthetic, and patient-reported outcomes of one-piece zirconia implants placed in incisal areas using digital surgical templates after 1 year of follow-up. Patients who had lost an anterior tooth received a 3.3-mm-diameter zirconia implant placed by computer-guided surgery. Implant survival and soft tissue conditions were assessed periodically 1 week, 3 months, 6 months, and 1 year after loading. Standardized radiographs were taken at definitive prosthesis insertion and 1 year postloading to evaluate peri-implant bone loss. Additionally, the esthetic outcomes and patient-reported outcomes were also investigated. Twenty zirconia implants were placed in 20 patients with no implants lost, resulting in 100% survival rates. A minor change in the mean marginal bone level (0.14 ± 0.87 mm) was found between definitive prosthetic loading and 12 months later. Peri-implant soft tissue remained stable throughout the observation period. The mean Pink Esthetic Score and White Esthetic Score were 12.05 and 8.60, respectively, while the mean Gingival Papilla Index scores were 1.55 at the mesial papilla and 1.65 at the distal papilla at the 1-year follow-up. The mean visual analog scale scores for patient perception of the overall process, speech, mastication, and esthetics were 93.3 ± 7.8, 95.1 ± 5.3, 93.6 ± 7.6, and 94.5 ± 6.2 mm, respectively. For the 1-year results, 3.3-mm-diameter one-piece ceramic implants placed by computer-guided surgery showed favorable clinical performances with no failure when used for single-tooth replacement in anterior regions.

The fate of the distal papilla around tooth-bound implant-supported restorations in maxillary central incisor sites.

The distal papilla around tooth-bound implant-supported restorations in maxillary central incisor sites tends to exhibit an atrophied aspect after tissue maturation following the delivery of the final prosthesis. This article provides an explanation to this phenomenon, as well as a set of therapeutic considerations to minimize its occurrence and optimize the outcomes of tooth replacement therapy with dental implants in this specific anatomic location.

Contour Changes Following Immediate Placement of Ultra-Wide Implants in Molar Extraction Sockets without Bone Grafting.

The aim was to evaluate ridge reduction and mucosal recession following immediate placement of ultra-wide implants in molar sockets, without bone grafting. Impressions were taken prior to tooth extraction, 4 months and 1 year after implant placement. The casts were digitized and compared. Mucosal recessions and horizontal ridge reduction were measured. A total of 16 implants were in the maxilla and 11 in the mandible. At the buccal aspect, there was a mean reduction of 0.94 mm after 4 months and 0.89 mm after one year (p = 0.933). At the palatal/lingual aspect, this was 1.09 mm after 4 months and 0.69 mm after 1 year (p = 0.001). After 1 year, a recession of 0.59 mm was measured at the zenith, 1.04 mm at the mesial and 0.98 mm at the distal papilla. The mean midfacial horizontal ridge reduction was 1.23 mm after 4 months and 1.45 mm after 1 year. At the midpalatal/midlingual aspect, the mean horizontal reduction was 1.43 mm after 4 months and 1.16 mm after 1 year. Immediate implant placement without bone grafting in the posterior jaw yields a significant horizontal ridge reduction and minor mucosal recession. Clinicians should anticipate the amount of ridge reduction and consider augmentation at the time of implant placement.