Healing Abutments Research Articles

Oral microbial colonization on titanium and polyetheretherketone dental implant healing abutments: An in vitro and in vivo study

Although polyetheretherketone (PEEK) implant healing abutments have become popular because of their esthetic, mechanical, and chemical properties, studies analyzing oral polymicrobial adhesion to PEEK abutments are lacking. The purpose of this in vitro and in vivo study was to evaluate oral microbial adhesion and colonization on titanium (Ti) and PEEK healing abutments. Ti (N=35) and PEEK substrates (N=35) were evaluated in vitro in terms of the initial adhesion (1 hour) or biofilm accumulation (48 hours) of Candida albicans and a polymicrobial inoculum using stimulated human saliva to mimic a diverse oral microbiome. Surface decontamination ability was evaluated after 24 hours of in vitro biofilm formation after exposure to an erbium-doped yttrium aluminum garnet (Er:YAG) laser. Conventional and flowable composite resin veneering on PEEK was also tested for microbial adhesion. In addition, an in vivo model with 3 healthy volunteers was conducted by using a palatal appliance containing the tested materials (3 or 4 specimens of each material per appliance) for 2 days to evaluate the effect of substrate on the microbial profile. Biofilms were evaluated by live cell counts and scanning electron microscopy images, and the microbial profile by Checkerboard deoxyribonucleic acid (DNA)-DNA hybridization. The t test and Mann-Whitney test were used to compare the groups (α=.05). PEEK and Ti materials showed similar fungal adhesion (P>.05). Although the PEEK surface limited the initial in vitro polymicrobial adhesion (approximately 2 times less) compared with Ti (P=.040), after 48 hours of biofilm accumulation, the microbial load was statistically similar (P=.209). Er:YAG laser decontamination was more effective on PEEK than on Ti surfaces, reducing approximately 11 times more microbial accumulation (P=.019). Both composite resins tested showed similar microbial adhesion (1 hour). In vivo, the PEEK material showed reduced levels of 6 bacterial species (P<.05), including the putative pathogen Treponema denticola. Although PEEK and Ti had similar bacterial and fungus biofilm attachment and accumulation, PEEK promoted a host-compatible microbial profile with a significantly reduced T. denticola load.

Peri-implant Outcomes from Customized Healing Abutments Using Immediate Implants: A Systematic Review.

To evaluate the peri-implant outcomes of customized healing abutments (CstHA) placed on dental implants inserted in fresh tooth extraction sockets. The study was registered on PROSPERO: CRD42022304320. A systematic search in PubMed, Scopus, and Web of Science was conducted between April 2022 and October 2022 to identify clinical studies involving immediate implant surgery associated with CstHA placement. The Joanna Briggs Institute Critical Appraisal and RoB2 tool were performed for the risk of bias analysis. A total of 12 studies were included, most of them with low risk of bias. Four studies compared CstHA vs conventional healing abutments (CnvtHA), two compared CstHA vs cover screw and collagen matrix (CMa), and six were clinical case series. For the CstHA vs CnvtHA comparison, favorable results were observed for CstHA considering papilla maintenance and probing depth, yet the mean marginal bone level was statistically similar between CstHA and CnvtHA. CstHA showed advantages when compared to CMa for total bone volume, papilla height, and midfacial mucosa maintenance. Significantly less horizonal bone loss was reported when using CstHA compared with CMa. Horizontal and vertical bone loss was observed in a few (or no) sites in the case series using CstHA. CstHA provides favorable peri-implant response because in general it does not result in a significant loss of soft and hard tissues.

Impact of scannable healing abutment type on implant impression accuracy

Impact of scannable healing abutment type on implant impression accuracy

Comparative study on the efficacy of gingival retraction using Retraction cord and Expasyl paste in implant patients In-vivo study

Introduction: The precise reproduction of the abutment (implant) provides clinician with crucial clinical information of the relative position and orientation of the implant to other implants, teeth and soft tissue that allow them to fabricate exact- fitting, bio-integrated restoration. For that it is necessary to expose, access &amp; isolate the implant region, especially when cement retained implant prosthesis are in consideration, where conventional crown and bridge impression and optical impression technique is used. Material and Method: Patient who accepted to participate were chosen for the study. Coincidentally all 15 patients were female. They were explained the purpose and methodology, agreed for periodic follow up at the interval of one month after placement of healing abutment and 7 days after using the retraction cord. Conclusion: The conclusions that were drawn from this study are: Both materials showed clinically and statistically significant amount of vertical soft tissue displacement. Among the both soft tissue displacement agents, non-impregnated retraction cord showed the more vertical soft tissue displacement than Expasyl Paste. But, the amount of retraction offered by this paste is limited with extremely subgingival margins. But the advantages with Expasyl paste over the retraction cord were its ease of application, painless, quick, and without agony to the patient.

Accuracy of torque controllers on healing abutments in implant dentistry-an in vitro study.

To evaluate the accuracy of three torque-control devices used on healing abutments in implant prosthodontics. In this in vitro experiment, three torque controllers, Ankylos friction-based, Straumann spring-based, and Anthogyr pre-calibrated torque control devices were used to tighten the healing abutments of Ankylos and Straumann dental implants to a pre-determined value of 15 Ncm. A digital torque meter (DT), Cedar DID-4A, was used to assess removal torque as a surrogate for the accuracy of the torque controllers to apply a tightening force of 15 Ncm on healing abutments. One-way analysis of variance (ANOVA) was used to identify differences between each torque controller and the digital torquemeter, a p < 0.05 was considered significant. The torque required to remove the healing abutments was 16.05 ± 0.66 Ncm for the Ankylos ratchet, 12.61 ± 0.90 Ncm for the Straumann ratchet, and 14.37 ± 1.08 Ncm for the Anthogyr torque-control device. Significant statistical differences were observed between Ankylos and the control digital torquemeter (p = 1.84E-8; F = 50.3); Anthogyr and control digital torquemeter (p = 0.01; F = 6.79); and Straumann and control digital torquemeter (p = 0.01; F = 141.15). Friction-based (Ankylos), spring-based (Straumann), and pre-calibrated (Anthogyr) torque control devices present over-torque and under-torque values when used over healing abutments of Ankylos and Straumann implant systems.

Electron Microscopy (EM) Analysis of Collagen Fibers in the Peri-Implant Soft Tissues around Two Different Abutments.

The design of the implant prosthesis-abutment complex appears crucial for shaping healthy and stable peri-implant soft tissues. The aim of the present animal study was to compare two implants with different healing abutment geometries: a concave design (TEST) and a straight one (CTRL). Transmission electron microscopy (TEM) was used to quantify the three-dimensional topography and morphological properties of collagen at nanoscale resolution. 2 swine were included in the experiment and 6 implants per animal were randomly placed in the left or right hemimandible in either the physiologically mature bone present between the lower canine and first premolar or in the mandibular premolar area, within tooth extraction sites. Each CTRL implant was positioned across from its respective TEST implant on the other side of the jaw. After 12 weeks of healing, 8 specimens (4 CTRL and 4 TEST) were retrieved and prepared for histological and TEM analysis. The results showed a significantly higher percentage of area covered by collagen bundles and average bundle size in TEST implants, as well as a significant decrease in the number of longitudinally oriented bundles with respect to CTRL implants, which is potentially due to the larger size of TEST bundles. These data suggest that a concave transmucosal abutment design serves as a scaffold, favoring the deposition and growth of a well-organized peri-implant collagen structure over the implant platform in the early healing phase, also promoting the convergence of collagen fibers toward the abutment collar.

Modified Periosteal Inhibition (MPI) Technique for Immediate Implants: A Multi-Center Retrospective Case Series Study

Background: Alveolar socket preservation is a topic of serious interest, and researchers have investigated this problem quite extensively. In terms of aesthetics, it is very important to avoid bone resorption if the clinician decides to insert the implant immediately after the extraction. Recently, a new approach utilizing a barrier external to the socket has been developed, which has advanced the evolution of this technique. Immediate implants have also created some difficulty when re-evaluated in long-term follow-up, especially when an aesthetic result is part of the goal of the procedure. Methods: The modified periosteal inhibition (MPI) technique, which has shown interesting outcomes, is evaluated in this paper on a large group of patients. In this case series, among 14 patients, 11 received immediate implants using the MPI technique and immediate provisionalization, and 3 received immediate implants using the MPI technique and customized healing abutment. All patients showed ridge preservation to different degrees, ranging from 0.02 to 1.17 mm, with an average gain of 0.51 mm. Results: all of the 14 patients maintained the original ridge shape, and 1 showed an increase in bucco-lingual size. Conclusions: This case series confirms the promising information reported in earlier studies on this technique. Larger samples will be necessary to confirm the predictability of this new approach.

A comparative review one-stage and two-stage dental implants

Dental implants have been used as an effective treatment for missing teeth. Dental implantology has a long history that reaches back to ancient times when attempts were made to replace missing teeth with various materials. Modern dental implants are designed to osseointegrate, where the implant fixture fuses with the jawbone. The surgical procedure involves placing the implant, followed by the adaptation of the surrounding tissue. There are two main surgical techniques: one-stage surgery and two-stage surgery. One-stage surgery involves placing the implant and allowing a healing abutment to protrude through the gums. This eliminates the need for a second surgery but carries the risk of overloading the implant during the healing phase. Two-stage surgery is the standard approach, where the implant is initially submerged, and a second surgery is performed to connect the abutment. The choice between one-stage and two-stage surgery depends on many factors, including bone quality, clinical parameters, and aesthetic considerations. One-stage surgery offers quick aesthetics but can pose a higher risk of implant failure due to early loading. Two-stage surgery provides a higher success rate but requires two surgical procedures.

The Antibacterial Effects of Healing Abutments Coated with Gelatin-curcumin Nanocomposite.

For the long-term success of implant treatment, prevention of biological complications, including pre-implant diseases, plays an important role. The use of antimicrobial coatings is one of the prosperous methods in this field. The aim of this study is to evaluate the antimicrobial effects of healing abutments coated with gelatin-curcumin nanocomposite. This study included 48 healing abutments in the form of a control group (titanium healing abutments without coating) and an intervention group (titanium healing abutments coated with gelatin-curcumin nanocomposite). The disc diffusion method was used to evaluate the antimicrobial effects of coated healing abutments against Escherichia coli, Staphylococcus aureus and Enterococcus faecalis and the results were reported in a non-growth zone area. Gelatin-curcumin nanocomposite caused significant non-growth aura for all three bacteria compared to the control group. For the control group (healing abutments without coating), the antimicrobial effects (non-growth zone) were zero. Besides, gelatin-curcumin nanocomposite had the greatest inhibiting effect on the growth of S. aureus, then E. coli and finally E. faecalis. The results of our study showed that the coating used was able to significantly demonstrate a non-growth zone against all three bacteria compared to the control group without coating. Further evaluations in various physicochemical, mechanical, and antimicrobial fields are necessary for the animal model and clinical phase.

Assessment of the alveolar bone loss in fresh socket implant procedures with immediate implant loading via temporary preformed anatomical healing caps: Comparison of two different lengths of the implant collar

PurposesThe aim of the present clinical and radiologic retrospective study was to evaluate alveolar bone remodeling, in terms of alveolar width and peri‑implant bone level, two years after immediate implant positioning (with two different collar lengths, 0.8 mm and 2.0 mm) and loading of preformed healing cap. The Null hypothesis, H0 is: there was no difference between the two groups of implants. MethodsPatients suffering from single-tooth edentulous areas in premolar, cuspid, and incisive areas were treated with fresh-socket implants and immediate preformed anatomical healing caps. Each final crown restoration was fabricated 3 months later. Primary outcomes (related to loss of the alveolar width and peri‑implant bone level) and secondary outcomes (testing adverse events, and measuring implant/prosthesis survival) were acquired and analyzed. ResultsA two-year retrospective analysis was conducted on 31 patients (19 female and 12 male), who underwent dental implant placement with implants having two different lengths of the collar: group A, 0.8 mm, and group B, 2.0 mm. As for the width of the alveolar crest, there was a negligible loss (less than half a millimeter) reported for both the groups, anyway reaching a statistical significance. Preoperative alveolar widths (9.50±0.67 mm and 9.45±0.90 mm, respectively for groups A and B) were different from the two-year alveolar widths (9.20±0.74 mm and 8.93±0.99 mm, respectively for groups A and B) with p-values ≤ 0.0049. When the marginal bone loss was assessed, significant differences were registered between the two procedure groups (-1.42±0.34 mm for group A and -0.11±0.15 mm for group B with a p-value < 0.0001). ConclusionsThe proper design of a healing abutment was very important to preserve the emergence profile immediately after extraction and implant placement. The length of the implant collar used with an immediate healing abutment appeared to affect the preservation of the alveolar crest with predictable final results.

Peri-implant mucosal enhancement using leukocyte platelet rich fibrin under Sohn's poncho technique: A randomized controlled clinical trial.

A biological seal that protects the implant from any biological or external impingement is created by the supracrestal attached tissues. Sohn's poncho technique is a technique that utilizes a healing abutment at the implant site to stabilize the platelet rich fibrin (PRF) membrane. Thus, the aim of this study is to evaluate the efficacy of Sohn's poncho technique used for placement of leukocyte PRF (L-PRF) membrane in improving the peri-implant mucosal thickness and width of keratinized mucosa as well as in the acceleration of healing process compared to the peri-implant mucosa surrounding healing abutments placed without the L-PRF membrane. A split mouth randomized controlled clinical trial was designed in which implants were placed in the mandibular posterior region. Healing abutment is placed along with the L-PRF membrane at the test site using Sohn's poncho technique and at control site conventional healing abutment placement was done at second stage. The thickness of peri-implant mucosa as primary outcome and the Width of keratinized tissue and healing as secondary outcomes were measured and assessed at various time intervals. Statistically significant difference was seen in inter-group analysis when peri-implant mucosal thickness (3.8 ± 0.4mm vs. 2.3± 0.4 mm) and width of keratinized mucosa (3.6± 0.6mm vs. 2.7± 0.3 mm) in test and control groups respectively and intragroup analysis of test and control groups at 4 weeks and 6 weeks' time points. The control group showed faster healing when compared to the test group. Sohn's poncho technique in combination with L-PRF has the potential to improve the thickness of peri-implant mucosa and the width of keratinized mucosa around implants.

Efficacy of Socket Shield Technique for Immediate Implant Placement in Maxillary Anterior Region – A Case Series with Review.

&#x0D; &#x0D; The socket-shield technique is the most crucial treatment modality for esthetic enhancement and ridge preservation technique but it has been less discussed and documented. This case series describes the placement of implants immediately following extraction of a non-restorable which are all fractured and hopeless maxillary teeth and using this technique and functional and esthetic outcomes of the treatment was a successful event.&#x0D; In this review, immediate implant were placed using socket shield protocol to treat ten patients with non-restorable teeth. Dissection was performed along the long axis of the roots in a mesiodistal direction; and atraumatically the buccal fragment of the root was left attached to the bone while the palatal fragment was extracted. Implants were placed after sequential osteotomy drilling. A customized healing abutment was fabricated chairside to create an emergence profile. During the prosthetic phase, patients had follow-up visits after 4 weeks and after 6 months. The definitive prosthesis was cemented using a cement-retained porcelain fused to metal.&#x0D; &#x0D;

A custom auricular implant healing abutment: A dental technique

Skin overgrowth is a complication that hinders bone-anchored prosthetic ear rehabilitation. In order to accurately transfer the healing skin for prosthetic reconstruction, this article introduces a custom-made autopolymerizing acrylic resin auricular cap (button) through indirect pick up of the metal housing. The caps are secured during the healing stage to shape the skin, preventing surgical edema, swelling, and skin overgrowth in patients suffering from keloid reactions from covering the implant abutments. Since skin height and form are changeable, the caps can be relined directly or indirectly if greater skin compression is required. Moreover, these custom-made caps can be utilized during prosthetic silicone ear fabrication to retain the metal housing.

COMPARATIVE EVALUATION OF CRESTAL BONE LOSS AROUND SUBMERGED AND NON-SUBMERGED IMPLANTS WITH DIFFERENT TYPES OF HEALING ABUTMENT DESIGNS - AN IN VIVO STUDY

Successful osseointegration is observed predictably for submerged implants requiring a two-stage procedure as well as for non-submerged implants characterized by one-stage surgical procedure. This study was aimed at evaluating and comparing crestal bone alterations around submerged and non-submerged implant radiographically. Total 45 patients aged between 20 to 50 years with missing mandibular posterior teeth were divided into 3 groups [Submerged implants (n=15), Non-submerged implants with anatomic healing abutment (n=15) and Non-submerged implants with esthetic healing abutment (n=15)]. Radiographic evaluation of mesial and distal marginal bone loss was done at 1 month and 3 months. Statistically significant differences were found between submerged dental implants and non-submerged dental implants with anatomical type of healing abutment designs (P &lt; 0.001) and between the two non-submerged dental implant groups with different types of healing abutments (P &lt; 0.001) at 1 month and 3 months. But there was no statistically significant difference between submerged dental implants and non-submerged dental implants with esthetic type of healing abutments (P &gt; 0.05) at 1 month and 3 months. It was concluded from this study that bone resorption during the osseointegration period using the non-submerged technique varied significantly depending on the morphology of the healing abutment used. The non-submerged technique with an esthetic healing abutment produced an equally predictable outcome compared with the submerged technique.

Volumetric analysis on the use of customized healing abutments with or without connective tissue graft at flapless maxillary immediate implant placement: A randomized clinical trial.

To evaluate buccal volume change after using a customized healing abutment with or without connective tissue grafts (CTG) in flapless maxillary immediate implant placement (IIP). The present study was designed as a randomized clinical trial (RCT). Patients treated with flapless maxillary IIP were allocated into two groups, both receiving a customized healing abutment, and additionally, the test group received a CTG. A cone-beam computerized tomography (CBCT) allowed to access the initial buccal bone thickness (BT). Digital impressions were taken prior to extractions (T0), 1 month (T1), 4 months (T2), and 12 months (T3) after implant insertion and superimposed with computer software allowing to compute variables related to buccal volume variation (BVv) and total volume variation (TVv) (ClinicalTrials.gov: NCT05060055). Thirty-two patients (mean age 48 ± 11 years), sixteen in each group, were evaluated after a 12-month period. After 1 year of treatment, no significant differences were found between groups, although in participants with BT ≤1 mm, control and test groups showed a BVv of -14.18 ± 3.49% and -8.30 ± 3.78%, respectively (p = .033). Regarding mucosa height variation variables, the control group showed approximately the triple vertical recession in both papillae. The placement of a CTG was not capable of completely maintaining the initial peri-implant tissue architecture, although in thin-bone phenotypes, less dimensional changes are expected when a CTG was used.

Impact on peri-implant connective tissue of laser treated versus traditional healing abutments: a human clinical trials

BackgroundDental implant is the principal treatment for edentulism and the healthiness of the peri-implant tissue has a pivotal role for its longterm success. In addition, it has been shown that also the topography of the healing abutment can influence the outcome of the restoration. The objective of this human clinical trial was to assess the impact of a novel laser-treated healing abutment on peri-implant connective tissue and extracellular matrix proteins compared to the conventional machined surface, which served as the control group.MethodsDuring second surgical stage a customized healing abutment were inserted on 30 single dental implants. Healing abutments were realized with two alternated different surface (two side laser-treated surfaces and two side machined surfaces) in order to be considered both as test and control on the same implant and reduce positioning bias. Following the soft tissue healing period (30 ± 7 days) a 5 mm circular biopsy was retrieved. Immuno-histochemical and quantitative real-time PCR (qPCR) analyses were performed on Collagen, Tenascin C, Fibrillin I, Metalloproteinases (MMPs) and their inhibitor (TIMPs). 15 were processed for qPCR, while the other 15 were processed for immunohistochemical analysis. Paired t-test between the two groups were performed. A value of p < 0.05 was considered statistically significant.ResultsResults revealed that the connective tissue facing the laser-treated surface expressed statistically significant lower amount of MMPs (p < 0.05) and higher level of TIMPs 3 (p < 0.05), compared to the tissue surrounding the machined implant, which, in turn expressed also altered level of extracellular matrix protein (Tenascin C, Fibrillin I (p < 0.05)) and Collagen V, that are known to be altered also in peri-implantitis.ConclusionsIn conclusion, the laser-treated surface holds promise in positively influencing wound healing of peri-implant connective tissue. Results demonstrated that topographic nature of the healing abutments can positively influence mucosal wound healing and molecular expression. Previous studies have been demonstrated how laser treatment can rightly influence integrity and functionality of the gingiva epithelium and cell adhesion. Regarding connective tissue different molecular expression demonstrated a different inflammatory pattern between laser treated or machined surfaces where laser treated showed better response. Targeted interventions and preventive measures on peri- implant topography could effectively minimize the risk of peri-implant diseases contributing to the long-term success and durability of restoration. However, new studies are mandatory to better understand this phenomenon and the role of this surface in the peri-implantitis process. Trial registrationThis trial is registered with ClinicalTrials.gov Identifier: (Registration Number: NCT05754970). Registered 06/03/2023, retrospectively registered.

Influence of abutment macro- and micro-geometry on morphologic and morphometric features of peri-implant connective tissue.

The aim of the present human observational study is to provide morphologic and morphometric analysis of peri-implant connective tissue next to abutments with divergent or convergent macro-geometry and different surface micro-characteristics. Thirty patients were rehabilitated with single implants in the posterior area and one out of three different healing abutments with a one-stage technique: machined divergent abutment (DIV-MAC), machined convergent abutment (CONV-MAC) or convergent abutment with ultrathin threaded surface (CONV-UTM). At 3 months postimplant insertion, peri-implant soft tissue was harvested; the following outcomes were investigated: histomorphometry (vertical width of connective and epithelial components) as detected by histology and polarized light; and connective tissue vertical width and 3D organization as detected by synchrotron-based high-resolution phase-contrast-based tomography (PhC-μCT). Significant differences in connective tissue vertical dimension (aJE-AM) were found between DIV-MAC and both CONV-MAC and CONV-UTM, both by histology and PhC-μCT, with significantly higher values for the last two groups. Moreover, 2D histological analysis did not find significant differences in the junctional epithelium vertical dimension (PM-aJE). Importantly, PhC-μCT analysis revealed, at 3D level, significant greater amount and density of collagen bundles for CONV-UTM compared with the other two groups. Convergent abutment profiles, regardless of their surface micro-geometry, seem to favor axial development of peri-implant connective tissue. Moreover, ultrathin threaded surfaces seem associated with denser and greater connective tissue organization, which might improve peri-implant soft tissue seal.

Soft tissue dimensional change using customized titanium healing abutment in immediate implant placement in posterior teeth

BackgroundThe morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics.PurposeTo evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth.MethodDigital impressions using the intraoral scanner (MEDIT i500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test.ResultsCustomized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months.ConclusionsImmediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management.

Radiographic marginal bone level evaluation around two different tissue-level implant systems: a one-year prospective study.

Marginal bone loss, is a frequently reported variable in the evaluation of dental implants. The primary objective of this study was to evaluate radiographic marginal bone level changes around the two different tissue-level implant systems placed adjacently in the posterior maxilla or mandible. The influence of implant macro-geometry and vertical soft tissue thickness on marginal bone loss were also evaluated. Seven patients were included in the study and a total of 18 implants were analyzed. Each patient received two different implants placed adjacently in the maxilla or the mandible. The implants used in our study were either Straumann® SP cylindrical implants or JD Octa® tapered implants. During the surgery, vertical soft-tissue thickness was measured with a periodontal probe placed on the top of the bony crest and in the center of the future implant site. Healing abutments were then seated. Three months following implant placement, impressions were taken, and screw-retained metal ceramic prostheses were delivered. Standardized intraoral radiographs were taken immediately after implant placement and one year following implant loading in order to assess marginal bone level changes. Results showed a mean marginal bone loss of 0.55±0.5 mm for Straumann® SP implants and 0.39±0.49 mm for JD Octa® implants after one year of loading and the difference was not statistically significant between the two systems. A statistically significant correlation was found between soft tissue thickness and marginal bone loss; in sites with thin mucosal tissues (≤2 mm), there was significantly greater bone loss compared to sites with thick, soft tissues (> 2 mm) in both implants. Radiographic marginal bone loss was not statistically different between the two implant systems at the one-year examination period. Moreover, vertical soft tissue thickness influenced marginal bone loss regardless of the implant system used.

Alternative soft tissue management techniques in posterior region of immediate implant

Management of soft tissues in posterior region after immediate implant placement is a treatment widely performed in the dentists’ clinical practice. However, due to many particularities of this kind of treatment it is still considered a great challenge. Objective: In this way, the aim of this paper is to report three cases that describe an alternative and simpler direct technique of customized immediate posterior healing abutment after immediate implant placement. Case report: The cases were performed using an alternative technique of customized immediate posterior healing abutment, which aims to guide the peri-implant tissue healing, preserving the anatomic emergence form and avoiding the need of a second surgery. Conclusion: We could observe that customized healing abutments assist in tissue stability, facilitate hygiene during the healing period, reduce the number of surgery steps, reduce the amount of consultations for tissue conditioning and it is a more cost-effective treatment for the patient and professional.