Marginal Bone Level Research Articles

Oro-Dental Characteristics in Patients With Adult-Onset Hypophosphatasia Compared to a Healthy Control Group-A Case-Control Study.

Hypophosphatasia (HPP) is a rare inherited disease that affects multiple organ systems including bone and teeth. Limited knowledge exists on dental and oral health in patients with adult-onset HPP (aHPP). The aim of this study was to investigate oro-dental characteristics in patients with aHPP compared to healthy controls. This case-control study included 20 patients with aHPP compared to 31 healthy controls. Oro-dental manifestations were examined by standardised interviews, clinical examinations as well as radiological registrations on panoramic radiograph (OP) and cone-beam computed tomography (CBCT) scans. The subjective experience of tooth fractures (p = 0.010), caries in permanent teeth (p = 0.032) and early loss of permanent teeth (p = 0.002) was significantly higher in patients with aHPP compared to the controls. In the aHPP group, the presence of specific teeth (p ≤ 0.045) and attrition of 11 were significantly lower (p = 0.012) compared to the controls. Opacity of a few teeth (p ≤ 0.049), presence of denticles (p = 0.024), the distance between the enamel-cement junction (CEJ) and the marginal bone level at specific sites (p ≤ 0.021) and crown height of 11 (p = 0.017) were significantly higher in patients with aHPP than in healthy controls. The results indicate that patients with aHPP have a subjective experience of having poorer dental health. Loss of permanent teeth, less attrition, tooth opacities, denticles and larger distance between CEJ and marginal bone level are possible oro-dental findings in patients with aHPP.

Full-arch prostheses supported by implants with different macrostructures: A multicenter randomized controlled trial.

This study evaluates the clinical performance of implants with hydrophilic surface and two different macrostructures: cylindrical with perforating triangular threads (CT) and cylindrical-tapered with the association of square and condensing and perforating triangular threads (TST). This was a multicenter split-mouth, simple-blinded, randomized, and controlled trial. Thirty patients with edentulous mandible received two CT and two TST implants. Primary stability was determined by insertion torque and resonance frequency analysis (RFA). Implants were loaded with full fixed-arch prostheses within 24 h after insertion. Clinical parameters (visible plaque index, marginal bleeding index; bleeding on probing; probing depth; and clinical attachment level) and the RFA were assessed at 2, 6, 12, and 24 months after implant loading. Marginal bone level changes were measured by comparison of standardized radiographs taken on the day of implant placement and 6, 12, and 24 months thereafter. Twenty-eight patients completed the 2-year follow-up. The survival rates were 99.16% for CT implants and 100% for TST implants. One CT implant was lost until the 2 months follow-up. No significant differences were found between the two implant types for marginal bone level changes (CT 0.34 [0.24; 0.55 mm]; 0.33 [0.18; 0.55 mm]; 0.41 [0.12; 0.7 mm] vs TST 0.36 [0.14; 0.74 mm]; 0.33 [0.23; 0.63 mm]; 0.30 [0.20; 0.64 mm] at 6, 12, and 24 months, respectively) and other clinical parameters. The macrostructure of the implants had no influence on survival rate, primary and secondary stability, marginal bone level changes, and peri-implant clinical parameters outcomes. Both implants can be predictably used for immediate loading of full-arch mandibular prostheses.

Comparison of three approaches for treating the bony access window in lateral sinus floor elevation: a retrospective analysis

The aim of this study was to retrospectively determine the effects of applying different treatment methods to the bony access window on the healing outcomes in lateral sinus floor elevation (SFE). Lateral SFE with implant placement was performed in 131 sinuses of 105 patients. The following three treatment methods were applied to the bony access window: application of a collagen barrier (group CB), repositioning the bone fragment (group RW) and untreated (group UT). Radiographic healing in the window area, augmented bone height changes and marginal bone level changes were examined. Mixed logistic and mixed linear models were analyzed. Over 4.3 ± 1.4 years of follow-up, the implant survival rate was 100% in groups CB and UT, and 96.9% in group RW. The treatment applied to the window did not significantly influence the radiographic healing in the window area, augmented bone height changes or marginal bone level changes (p > 0.05). The healed window areas had generally flat morphologies and were fully corticalized. The mean changes in the augmented bone were less than 1.5 mm in all groups. Marginal bone level changes were minimal. In conclusion, Healing outcomes were not different among three different methods to treat the bony access window in lateral SFE.

Horizontal Guided Bone Regeneration of the Posterior Mandible to Allow Implant Placement: 1-Year Prospective Study Results.

Assess whether horizontal ridge augmentation with guided bone regeneration (GBR) using deproteinized bovine bone mineral (DBBM), autologous bone, and a resorbable collagen membrane supports successful implant placement. This open, prospective, single-cohort, multicenter clinical study included patients with ridge defects that required GBR prior to implant insertion. The primary endpoint was radiologically assessed bone gain after 8 months post-GBR, measured at the center of planned implant sites. Secondary endpoints included implant survival and success, marginal bone levels (MBLs), MBL changes, and soft tissue health. Of 45 patients evaluated 8 months post-GBR, nine experienced dehiscence in the first 3 weeks of the healing period. GBR led to radiologically determined mean bone width gain of 4.0 ± 1.5 mm and 4.8 ± 1.7 mm, measured 1 and 3 mm from the top of the crest, respectively, allowing successful implant placement in 44 patients (97.8%). The cumulative implant survival and success rates were 98.9% and 95.5%, respectively. MBLs were stable: -1.18 ± 0.64 mm at definitive prosthesis placement (DPP) and - 1.07 ± 0.74 mm at 1 year. Soft tissue health and esthetics (plaque and bleeding indices, papilla, keratinized mucosa, and pink esthetic score) improved from DPP to 1 year. Patients were highly satisfied with implant function and esthetics, and their oral health-related quality of life improved. GBR using DBBM and a collagen membrane offered a safe and effective treatment option for horizontal ridge augmentation sufficient to support implant-based tooth rehabilitation. Registered at ClinicalTrials.gov NCT03028922 (registrations sites, as above listed affiliations, first posted January 23, 2017).

The Role of Keratinized Mucosa in Peri-Implant Tissue Stability after Treatment of Peri-Implantitis. Clinical and Radiographic Outcomes of a Prospective Cohort Study after 3 Years.

This study prospectively evaluated the effect of keratinized mucosa (KM) on the healing of the peri- implant tissues after resective surgical therapy for peri-implantitis. It addressed the question of whether the absence of KM has a negative effect on peri-implant tissue stability after treatment. Patients referred to a private practice for peri-implantitis treatment were surgically treated with resective flap surgery and implantoplasty. They were followed for 3 years and measurements at implant level included presence of plaque, bleeding on probing, probing pocket depth, radiographically visible bone loss and the presence and width of KM before therapy, 3 month post-operatively, 1 year, 2 years, and 3 years after the surgical intervention. All clinical parameters improved and marginal bone levels remained stable 3 years after therapy. The width of the KM decreased significantly after the therapy. Soft tissue recession was frequently observed. The absence of KM does not seem to have a negative effect on healing after therapy for the studied period of 3 years. The authors conclude that resective surgery combined with implantoplasty seems to be a reliable method for arresting the progression of peri-implantitis.

Radiographic identification of symptomless mandibular third molars without clinical pericoronitis

ObjectivesThe aim was to identify radiographic characteristics of mandibular third molars in young adults without symptoms or clinical signs of pericoronal infection.Materials and methodsAn existing cross-sectional material, including records from clinical oral examination and panoramic radiographs (PANs) of university students, was submitted to retrospective analysis. The outcome variable was a symptomless and clinically pericoronitis-free mandibular third molar. Predictor variables for the third molar were clinical eruption level, pathological signs in the follicle, marginal bone level, radiographic depth in bone, inclination, stage of root development, and available space for eruption. Statistics included χ2 and Mann-Whitney U tests.ResultsAnalysis included 345 mandibular third molars in 189 participants (20% men, 80% women; mean age 20.7 years; SD ± 0.6). Symptomless and clinically pericoronitis-free mandibular third molars were characterized as follows: clinically unerupted in 78% of teeth, associated with reduced marginal bone level in 70%, located deeper in the bone in 87%, mesially inclined in 73%, and stage of root development incomplete in 68% (p ≤ 0.001 for all).ConclusionsRadiographic characteristics of symptomless mandibular third molars without clinical pericoronitis in young adults can be assessed from a PAN with 68–87% certainty.Clinical relevanceThese findings may prove useful when trying to exclude non-pathological mandibular third molars from diseased teeth.

Surgical Extrusion of Three Premolars to Re-establish the Biological Width: Case Series.

This case series was to describe the use of surgical extrusion for three different cases as a technique to re-establish the biological width in patients with insufficient crown height. Surgical extrusion serves as an important means to reestablishing a proper biological width. Such method provides an excellent alternative for the restoration of teeth with insufficient ferrule and ensuring a suitable dental restoration. This case series describes the management of three different cases with compromised teeth #25, #35, and #44, respectively. The approach involved the surgical extrusion of the compromised sites from subgingival to supragingival and the splinting of the teeth using a semi-rigid splint. A successful prognosis was observed on follow-up visits. This technique is a good alternative for general practitioners because of its easy implementation and time efficiency. In addition, the method requires less equipment and provides for adequate space for the re-establishment of biological width. Such technique can re-establish a healthy biological width, the existing occlusion can be maintained without alterations, and it demonstrated the suitability of surgical extrusion technique in such clinical situations. Case selection is equally important. Cases with single-rooted teeth with fractures or caries in proximity to the marginal bone level without vertical root fractures generally provide positive outcomes on providing this treatment. How to cite this article: Boreak N, Al Moaleem MM, Zain AA, et al. Surgical Extrusion of Three Premolars to Re-establish the Biological Width: Case Series. J Contemp Dent Pract 2024;25(6):593-598.

Similar short-term outcomes for bone-level implants with or without intermediate abutments.

A single-center (university-setting), prospective, longitudinal, split-mouth, single-blind, randomized controlled clinical trial investigated peri-implant parameters of bone-level implants restored with either screw-retained prostheses connected directly to the implants or with intermediate abutments over a 3-year period. The study adhered to the ethical principles of the Helsinki Declaration and the CONSORT guidelines. Ethical approval was granted, and the trial was registered at Clinicaltrials.gov . Participants included were over 18 years of age, had a plaque index below 25%, and were missing at least two adjacent teeth, allowing for rehabilitation with screw-retained fixed partial prostheses over two implants and 2-4 prosthetic units. Exclusion criteria included long-term use of medications affecting bone metabolism, smoking more than 10 cigarettes per day, history of local radiotherapy, untreated periodontitis, and the need for rehabilitation in the anterior sextant of the maxilla. The primary clinical outcome was marginal bone loss (MBL), while secondary outcomes included probing pocket depth (PPD), plaque index (PI), bleeding on probing (BOP), and patient-reported outcomes (PROs). The study schedule included a screening (visit 1), implant surgery (visit 2), stage-two 8 weeks post-surgery (visit 3), impressions taken 4 weeks post stage-two (visit 4), baseline standardized radiograph (visit 5), followed by 6-month (visit 6), 12-month (visit 7), and 36-month (visit 8) follow-up visits. Descriptive statistics and quantitative measures included means, standard deviations (SDs), minimum and maximum values, and 95% confidence intervals (CIs). Clinical parameters (six sites per implant) measured were MBL, PPD, PI, and BOP. Paired t tests were utilized for intragroup comparisons across different time points and intergroup comparisons at each time point. PROs at 36 months were compared using Student's t test. The alpha significance level was set at 0.05. The study included 36 patients (72 implants), with two not completing the follow-up due to death and relocation. No implants showed signs of inflammation or mobility. Mean interproximal bone level (IBL) at baseline was 0.13 mm ± 0.15 mm for the control group and 0.10 ± 0.13 mm for the test group. At the 36-month follow-up, mean IBL was 0.13 ± 0.18 mm for the control group and 0.20 ± 0.24 mm for the test group, with no significant differences (F(1, 32) = 1.06; p > 0.05). Clinical parameters (PPD, BOP, PI) at 36 months showed no significant differences between groups. Minor complications occurred in 6.7% of the control group and 5.3% of the test group. PROs indicated no significant differences in general satisfaction, esthetics, comfort, phonetics, and masticatory function between the groups. After a 36-month follow-up, bone-level implants restored with CAD/CAM prostheses directly connected to the implants displayed similar clinical outcomes, PROs, and marginal bone level changes as those restored with intermediate standardized abutments.

Guided bone regeneration at dehiscence comparing synthetic bone substitute versus bovine bone mineral: A multicenter, noninferiority, randomized trial.

To evaluate the efficacy of guided bone regeneration (GBR) for the treatment of peri-implant dehiscence defects using a synthetic bone substitute (SBS) or a deproteinized bovine bone mineral (DBBM) as a bone substitute. Patients with expected dehiscence defects following implant placement were randomized to use either SBS or DBBM together with a bioabsorbable collagen membrane over dehiscenced implant surfaces aimed for GBR. The changes in the bone defect size were measured before the GBR procedure and 6 months after implant placement at the re-entry surgery. Secondary outcomes included peri-implant health outcomes, implant cumulative survival rates, bone level changes, and patient-reported outcomes (PROMs) at prosthesis delivery and 1-year follow-up. Of the 49 included patients, 24 were treated with SBS and 25 with DBBM. In the SBS group, the defect height (DH) at implant insertion was 5.1 ± 2.6 mm and was reduced at re-entry to 1.3 ± 2.0 mm (74.5%). In the DBBM group, the respective changes in DH were 4.1 ± 1.7 mm and 1.5 ± 1.9 mm (63.4%). These differences were not statistically significant (p = 0.216). The complete defect resolution rate was also comparable in both groups without statistical difference (62.5% of patients (15/24) vs. 44% of patients (11/25)). Overall, the marginal bone levels remained stable during the 1-year follow-up in both groups. The SBS is noninferior to DBBM for simultaneous GBR to implant placement at implant sites with buccal dehiscences in terms of defect resolution and evaluated secondary outcomes (KCT0008393 - this clinical trial was not registered before participant recruitment and randomization).

10 Years of Convergent Neck Implants: A Systematic Review of Clinical Outcomes, Initial Original Concepts, and Changes in Surgical and Prosthetic Protocols

The study reviewed the state of the art of the clinical use of a convergent-neck-designed Prama implant. This implant was introduced approximately 10 years ago and was characterized by a specific and unique convergent neck with a microtextured surface (UTM surface) and Zirconium Titanium (ZirTi) implant body surface. The neck design was developed to adopt the biologically oriented preparation technique (BOPT). A critical analysis of the published clinical studies and an evaluation of the adopted clinical protocols were performed. A total of forty-six articles were eligible to be reviewed. Only sixteen clinical studies reported clinical outcomes on Prama implants, and nine of these were selected having the longest follow-up from different research groups. The clinical follow-up/duration of the studies ranged from 12 months to 6 years. The initially proposed protocols explored neck supracrestal–transmucosal placement and gained interest due to its minimally invasive concept and the ability to proceed without a pre-prosthesis second surgery. The following investigations dedicated attention to the subcrestal or equicrestal implant placement with the conventional flap approach. The clinical studies characterized by the transmucosal exposed neck approach reported high survival rates with a stable bone morphology and reduced bone loss during the follow-up. Further recent implementations included the introduction of different convergent neck heights that need to be evaluated. The use of intraoral scanner technologies and digital workflow resulted in a simpler methodology with control of the marginal crown morphology. The studies support the concept that the hard tissue parameters (such as marginal bone level, MBL) and soft tissue parameters (such as pink esthetic score, PES) were stable or improved during the follow-up. Definitive crowns, designed with low invasiveness for soft tissues, were possible thanks to the morphology of the neck. The clinical studies support the use of the Prama implant with the different neck positions, demonstrating hard tissue preservation and optimal esthetic results in the first years following insertion. However, the current body of evidence is not robust enough to draw definitive conclusions, especially in the long term, and further high-quality research (long-term randomized trials) is required to consolidate these early observations.

Guided versus freehand single implant placement: A 3-year parallel randomized clinical trial

ObjectivesThe present parallel randomized clinical trial aimed to assess, after a 3-year follow-up period, whether the choice of surgical technique—either manual or guided—and of the operator - non-expert operator or skilled - can affect the stability of peri‑implant marginal bone levels in implants placed 1 mm sub-crestal. Materials and methodsPatients received platform-switched implants (Anyridge, MegaGen Implant Co., Gyeongbuk, South Korea) featuring a 5-degree internal conical connection and supporting single screw-retained fixed crowns. The implants were randomly assigned to be placed through a digitally static guided surgery procedure (Test group - GS) or a freehand surgical technique (Control Group - FH). A non-expert operator (fewer than 20 implants placed in his professional activity) was selected to perform procedures for the GS Group, while a skilled operator (with over 1000 implants placed in his professional activity) was chosen for the FH Group. Marginal bone level (MBL) was measured at prosthesis installation (t0) and at 1 (t1), 2 (t2) and 3 years (t3) of follow-up. Changes in MBL from t0 to t3 were analyzed through periapical radiographs. Moreover, MBL changes at all time points were correlated to different supra-crestal soft tissue heights (STH): less than 3 and ≥ 3 mm, respectively. Results60 implants in 18 patients were examined, with 30 implants allocated to the GS group and 30 to the FH group. The difference in MBL change between the two groups was 0.11 ± 0.22 mm, which was not statistically significant (p = 0.61). At the time of prosthetic loading, the mean MBL for implants with STH less than 3 mm was 0.33 mm higher than implants with STH ≥ 3 mm, though this difference was not statistically significant (P = 0.065). ConclusionsDigitally static guided implant placement, performed by a non-expert operator, does not limit marginal bone remodeling, when compared to a freehand procedure performed by an experienced operator. Clinical significanceAfter correct and careful planning, early marginal bone levels (MBL) around conical connection, platform-switched implants placed sub-crestally may be stable in time. Digital planning and surgery have the potential to assist non-expert clinicians in achieving implant placements with comparable outcomes to those performed by experts.

Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extensions: A systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to analyze the clinical and radiographic outcomes of patients rehabilitated using a single implant supporting a crown with a cantilever extension or two implants supporting two single crowns. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines, a systematic review of relevant literature published from 2000 was conducted in the Cochrane Library, Scopus, and MEDLINE databases. Moreover, a manual search was performed. A meta-analysis of the resulting data was carried out. Peri-implant marginal bone level, probing pocket depth, prevalence of technical and mechanical complications, implant survival rate, and prosthesis survival rate were assessed. The meta-analysis showed a non-statistically significant change in the peri-implant marginal bone level and probing pocket depth in the cantilever group and revealed a non-significant prevalence of technical complications, showing a 27% rate in the cantilever group. The analysis of the prosthesis survival rate in the cantilever group showed a mean survival rate of 99% while the comparison of the implant survival between the two groups revealed an odds ratio of 0.50. The use of a single implant supporting a crown with a cantilever extension does not result in lower implant survival rate if compared with two implants supporting two single crowns. Moreover, a high prosthesis survival rate was observed in the cantilever group even if the high prevalence of complications should be carefully considered by the clinician.

Alveolar ridge preservation and its impact on marginal bone level changes around dental implants: A retrospective, cohort comparative study.

This retrospective study compared the outcomes of implants placed in alveolar ridge preservation (ARP) treated sites with those in spontaneously healed (SH) sites. The study included patients presenting with one implant placed in an ARP-treated socket and one in an SH site. The primary outcome was the comparison of Marginal Bone Level Changes (MBLC). Statistical analysis was performed to identify factors influencing MBLC, including age, gender, smoking, parafunctional habits, and prosthetic emergence angle. Of these, 28 patients (23 females, 82.1%) were included in this analysis. Sockets in the SH group were classified as type I, whereas type II sockets were more common in the ARP group. The SH group exhibited significantly higher MBLC than the ARP group (p = 0.032), with values, respectively, of 1.00 [0.25; 1.62] and 0.40 [0.00; 1.00] mm. Among all evaluated parameters, the performance of ARP was the only factor significantly affecting MBLC (β = -0.72, SE: 0.32, p = 0.026). Age, gender, smoking, parafunctional habits, and prosthetic emergence angle did not significantly affect MBLC. The study shows the potential role of ARP in maintaining stable marginal bone levels around implants. In our sample, ARP significantly reduced MBLC compared with spontaneous healing, highlighting its possible impact in clinical practice for better peri-implant bone stability.

Marginal Bone Level Changes Evaluation of Long-term Functional Dental Implants with the Implant Disease Risk Assessment Diagram: A 2 to 6 Years Follow-up Retrospective Study.

Purpose: This study aimed to evaluate the relationship between risk profile assessments of dental implants that have been in function for at least two-year and peri-implant marginal bone loss during the follow-up period using the Implant Disease Risk Assessment Diagram. Material and Methods: A total of 70 patients and 170 implants who had been functionally loaded for at least two years and who attended follow-up sessions were included in the study. Full-mouth plaque index (PI), gingival index (GI), probing depth (PD), bleeding on probing, clinical attachment level (CAL), and peri-implant modified plaque index, modified bleeding index, PD, keratinized mucosal width (KMW), CAL and GR were recorded. According to the IDRA risk diagram, participants and dental implants were divided into low, moderate, and high-risk groups. Marginal bone level (MBL) was measured on periapical radiographs obtained at functional loading (T0) and at the last follow-up session (T1), and mesial and distal marginal bone level changes (ΔMBL) were calculated as T1-T0. Results: A statistically significant correlation was found between the periodontitis history and periodontitis susceptibility and IDRA classification at the patient-level. Full-mouth GI, PD, and BOP were found to be statistically higher in the high-risk IDRA group. No statistically significant result was found between the mesial and distal ΔMBL between the IDRA risk groups.Conclusions: In this study, IDRA risk level increased especially by periodontitis susceptibility and periodontitis history, but no significant difference was found between risk groups in terms of ΔMBL.

Clinical outcomes of single implant supported crowns utilising the titanium base abutment: A 7.5-year prospective cohort study

ObjectiveTo assess radiographic, clinical and patient-reported outcomes of single zirconia implant-supported crowns on titanium base abutments (TBA) over a 7.5-year period. MethodsTwenty-four patients received bone-level titanium implants and screw-retained zirconia implant crowns utilising TBA. Marginal bone level (MBL), clinical parameters (probing depth-PD, bleeding on probing-BoP, plaque control record-PCR), technical complications (USPHS criteria) and patient satisfaction were assessed at crown delivery (baseline), 1 year (FU-1) and at 7.5 years (FU-7.5) of follow-up. ResultsEighteen patients were available for re-examination at 7.5 years. The mean MBL at FU-7.5 (0.35 ± 0.20mm) did not significantly change compared to baseline (0.54 ± 0.39, p=.352) and to FU-1 (0.54 ± 0.45mm, p=0.524). From baseline to 7.5 years, the mean PD increased significantly, from 3.0 ± 0.6mm to 3.7 ± 0.8mm (p=0.005). However, BoP and PCR did not significantly change; (BOP: from 27.1 ± 20.7% to 25.0 ± 20.0%, p=0.498; PCR: from 11.1 ± 21.2% to 25.0 ± 25.1%, p=0.100). Nine patients presented with more than one bleeding site. This denoted a peri-implant mucositis prevalence of 50%, whilst none of the implants presented peri-implantitis. One incidence of minor and major ceramic chipping were reported on 2 out of the 18 crowns, resulting in a prosthetic survival rate of 94.4%. Seventeen patients were highly satisfied with their result. ConclusionSingle implant-supported zirconia crowns on TBA displayed: (i) minor number of technical complications, (ii) high prosthetic survival rate, (iii) stable marginal bone level and (iv) high patient satisfaction at 7.5 years. Clinical implicationsTitanium base abutments despite their high use in clinical practice, lacked medium- and long-term studies. The presented findings highlight their clinical performance at 7.5 years as they display satisfying radiographic, clinical and patient-related outcomes. TBA appear to be a suitable abutment choice for medium-term implant-supported restorations.

Immediate single-tooth implant placement in bony defect sites: A 10-year randomized controlled trial.

It is unclear whether an intact buccal bony plate is a prerequisite for immediate implant placement in postextraction sockets. The aim of this 10-year randomized controlled trial was to compare peri-implant soft and hard tissue parameters, esthetic ratings of, and patient-reported satisfaction with immediate implant placement in postextraction sockets with buccal bony defects ≥5mm in the esthetic zone versus delayed implant placement after alveolar ridge preservation. Patients presenting a failing tooth in the esthetic region and a buccal bony defect ≥5mm after an extraction were randomly assigned to immediate (Immediate Group, n=20) or delayed (Delayed Group, n=20) implant placement. The second-stage surgery and provisional restoration placement occurred 3months after implant placement in both groups, followed by definitive restorations 3months thereafter. During a 10-year follow-up period, marginal bone levels (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded. The mean marginal bone level change was -0.71±0.59mm and -0.36±0.39mm in the Immediate Group and the Delayed Group after 10years (p=0.063), respectively. The secondary outcomes were not significantly different between both groups. Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in postextraction sockets with buccal bony defects ≥5mm, were not statistically different to those following delayed implant placement after ridge preservation in the esthetic zone. Immediate implant placement in case of a failing tooth is a favorable treatment option for patients because it considerably shortens treatment time and the number of surgical treatments. The question is if an intact buccal bone wall is necessary for immediate implant placement. A 10-year study was performed in which 20 patients with a failing tooth in the frontal region of the upper jaw were treated with immediate implant placement and were compared with 20 patients in whom a more conventional treatment strategy was followed in which the failing tooth was first removed and the bone gap restored and the implant placed in a second step. After a 10-year follow-up period, it appeared that the bone around the implant was very stable, gums were healthy, and patients were very satisfied with the result. There was no difference between the two treatment procedures. Such results mean that professionals can discuss the procedure with the patient and apply the individual's preference.

Dimensional changes in free gingival grafts at implant sites in the reconstructed mandible: a retrospective study.

To evaluate the dimensional changes in free gingival grafts (FGG) at implant sites in mandibular reconstruction patients. Patients who received FGG 4 months after implant placement in the reconstructed mandible with no keratinized mucosa (KM) present were invited for re-examination after 36.7 ± 16.8 months (3.06 ± 1.4 years). Immediately after graft extraction (T0), graft width (GW), graft length (GL), graft thickness (GT), graft dimension (GD), and vertical bone height were documented. Re-examination (T1) included clinical examinations (GW, GL, GD, peri-implant probing depths, and modified Sulcus Bleeding Index), radiographic examination (marginal bone level), and medical chart review. Twenty patients and 62 implants (47 in fibula flaps and 15 in iliac flaps) were included. A significant decrease in GW (51.8%), GL (19.2%), and GD (60.2%), were found between T0 and T1 (p < .001). The univariate analysis showed that GW change was not significantly associated with reconstruction technique, baseline GL, baseline GT, baseline GD, implant location, or type of prosthesis. Implant survival rate of 100% was observed at follow-up. Within the limitations of the study, free gingival grafts at implant sites in the reconstructed mandible undergo dimensional change that result in a reduction of approximately 60% of the original graft dimension. Graft width decreased over 50%. FGG is the standard of care intervention for increasing the amount of KM around implants. This study was the first to evaluate the dimensional change in FGG at implant sites in mandibular reconstruction patients after a medium-term follow-up. Clinical trial registration is not applicable as this study comprehends a retrospective analysis.

Clinical efficacy of a two-piece abutment conforming to the concept of one abutment one time in the posterior region: A clinical pilot study.

To assess the impact of a two-piece abutment workflow on enhancing the stability of the alveolar bone and gingiva surrounding the dental implant, and to determine the level of patient satisfaction. A total of 48 patients with dentition defect in the posterior region were included and divided into two groups: the two-piece abutment workflow (TAW) and the sealing screw with submerged healing workflow (SHW). Marginal bone level (MBL), soft tissue indicators, oral hygiene indicators, and patient satisfaction were assessed and recorded partially at 0, 3, 6, and 12 months after surgery. The primary outcome was the change of MBL in different time periods. A generalized linear mixed model (GLMM) was used to take into account the correlated nature of the data, and adjust for potential confounding factors within inter-group differences. The survival rate of implants and prosthesis reached 100% at 12-month follow-up, with an average decrease of 0.25 mm (SD 0.23 mm) of MBL in the TAW group and 0.48 mm (SD 0.45 mm) in the SHW group. The change of MBL in the TAW group (0.15 ± 0.31 mm) was significantly lower than the SHW group (0.41 ± 0.41 mm) through the analysis of GLMM within 6 months, while no significance was found in 12 months. Moreover, less gingival pain and oppression during prosthesis loading, and less time consumption overall duration were showed in the TAW group through Visual Analogue Scale (VAS, p < 0.05). Within a 6-month period, the two-piece abutment workflow showed superior efficacy in preserving the integrity of the marginal bone level. Furthermore, it streamlined treatment procedures and mitigated discomfort, hence increasing patient satisfaction.

Effect of Sagittal Root Position, Angle, and Bone Thickness on Peri-implant Tissue Phenotype and Bone Level in Socket Shield Technique: A Retrospective Case Series.

There were only a few studies investigating the effect of sagittal root position (SRP), sagittal root angle (SRA), and buccal bone thickness (BBT) on peri-implant tissues using the socket shield technique (SST). This retrospective case series aimed to evaluate the SRP, SRA, and BBT in socket shield cases and examine the effect of these anatomical factors on the peri-implant tissue phenotype and bone level. Data from 27 patients (14 women, 13 men) treated with SST in the maxillary esthetic region between July 2019 and September 2021 were included. Clinical indices (modified plaque and bleeding indices, probing depth, keratinized mucosa width, mucosal thickness) and periapical radiographic recordings (marginal bone level) taken immediately after permanent prosthesis placement and 1 year later were used. Cone beam computerized tomography images were used to examine BBT, SRP, and SRA before implant placement and horizontal and vertical bone levels before implant placement and 1 year after prosthetic rehabilitation. The data were divided into groups based on BBT (<1 and ≥1 mm) and SRA values (<10° and ≥10°). There were no significant differences in 1-year clinical factors between the SRA <10° and SRA ≥10° groups. However, higher vertical bone loss was found in the SRA ≥10° group (P = .01, d = 0.53). There were no significant differences in clinical or radiographic factors between the BBT <1 mm and BBT ≥1 mm groups. In conclusion, BBT showed no significant effect on tissue phenotype and bone level, but SRA affected bone level in socket shield cases.

Esthetically driven immediate provisionalization in the anterior zone: 5-year results from a prospective study evaluating 3.0-mm-diameter tapered implants

ObjectivesEvaluate the 5-year safety and efficacy of a narrow-diameter (3.0 mm) implant that was immediately provisionalized with a single crown in the maxillary lateral incisor or mandibular central or lateral incisor area.Materials and methodsAn open, prospective, single-cohort, multicenter study was conducted, in which narrow-diameter implants were placed in fresh, healed extraction, or congenitally missing sites. All patients were required to meet strict criteria for immediate loading. The primary endpoints were marginal bone levels (MBL) and MBL changes (MBLC) from implant placement to 5-year follow-up. Secondary endpoints included cumulative 5-year survival and success rates, soft tissue health, and esthetic parameters.ResultsA total of 91 implants were placed in 77 patients. The mean MBL remained stable from the 1-year (− 0.79 ± 0.73 mm, n = 75) to 5-year (− 0.74 ± 0.87 mm, n = 65) follow-up. A marginal bone gain of 0.11 ± 0.83 mm was observed from the 1-year to 5-year follow-up. The cumulative 5-year survival rate was 96.5%, and the cumulative 5-year success rate was 93%. The clinical parameters, including the modified plaque index, modified sulcus bleeding index, Jemt’s papilla index, and pink esthetic score improved throughout the 5-year study.ConclusionsThe study demonstrated that narrow-diameter implants represent a safe and predictable treatment option for subjects suitable for immediate loading and with limited bone volume or limited inter-dental space.Clinical relevanceNarrow-diameter implants with immediate provisionalization can be considered for use to restore missing or damaged teeth with predictable functional and esthetic outcomes. This trial was registered with ClinicalTrials.gov (NCT02184845).