Modified Bleeding Index Research Articles

Immediate implant placement: A longitudinal study to assess soft and hard tissue

Objectives: The aim of this prospective study was to evaluate clinically the success and esthetic result (soft-tissue and hard-tissue changes) of immediate implant placement after 1 year. Materials and Methods: Eighteen patients with 23 titanium screw-shaped implants (13–16-mm length and 4.3–5-mm diameters) were placed in the extraction sockets. The jumping distance after implant placement was filled up with G bone synthetic hydroxyapatite granules and platelet-rich fibrin. It was again reevaluated at second-stage surgery. Clinical parameters of the peri-implant conditions were assessed after 1-year follow-up. Statistical Analysis: Statistical Package for Social Sciences (SPSS) for Windows, Version 22.0. released 2013. Armonk, NY: IBM Corp, was used to perform statistical analyses. Descriptive Statistics: It includes expression of the study variables with categorical data regarding number and percentage whereas in mean and standard deviation for continuous data. Results: The cumulative implant survival and success rate were determined after 1-year observation period. The analysis of the esthetic result, papillary index, interdental bone, gingival biotype, modified plaque index, and modified bleeding index was analyzed. Conclusion: This study determines us the success rate and esthetics of immediate implant placement after tooth extraction.

Long-Term Clinical and Radiographic Observation of Periimplant Tissues After Autogenous Soft Tissue Grafts: A 15-Year Retrospective Study.

The aim of this study was to evaluate the periimplant tissues after autogenous soft tissue graft (ASTG) during 15 years of follow-up. The clinical parameters, dimension of keratinized mucosa (KM), and marginal bone loss of 50 patients with 127 implants were followed up and their relationships were assessed at 15-year follow-up. In addition, clinical and radiographic parameters of 11 patients who had both autogenous soft tissue grafted (n = 21 implants) and nongrafted (n = 21 implants) sides were compared. The thickness of the KM was related to the width of the KM (P < 0.01) and mucosal recession (P < 0.05); however, there was no significant association between marginal bone loss and dimension of the KM. The autogenous soft tissue grafted group showed statistically significantly lower modified bleeding index, wider and thicker KM than the nongrafted group. However, the modified plaque index, probing depth, and marginal bone loss did not show any significant differences between 2 groups. This 15-year follow-up study shows that the thickness or width of KM is not related to the marginal bone loss around implants. However, it seems that ASTG can be beneficial for preventing mucosal recession and soft tissue inflammation around dental implants.

The effects of Lactobacillus reuteri probiotics combined with azithromycin on peri-implantitis: A randomized placebo-controlled study

PurposeThe aim of this randomized placebo-controlled clinical study was to investigate the effects of a probiotic tablet containing Lactobacillus reuteri in peri-implantitis patients. MethodsSubjects comprised 30 patients with mild to moderate peri-implantitis. A baseline clinical examination and microbiological assessment were conducted, followed by an antibiotics treatment (azithromycin, 500mg, once a day for 3 days). Subjects were divided into probiotic and placebo groups. The clinical examination and bacterial sampling were performed 0, 4, 12 and 24 weeks after the intake of probiotics. The clinical examination included probing pocket depth (PPD), bleeding on probing (BOP), the modified plaque index (mPI), and modified bleeding index (mBI). The number of bacteria was assessed using the PCR-invader method. The Wilcoxon rank-sum test and Wilcoxon signed-rank test with Bonferroni corrections were used for data analyses. ResultsAlthough the number of bacteria decreased after the administration of azithromycin in both groups, they increased again thereafter. No significant difference was observed in bacterial numbers between the two groups. Although PPD in the probiotics group was significantly lower at 4 and 24 weeks than at 0 weeks (p<0.05), a significant decrease did not occur in the placebo group. The mBI score at 24 weeks was significantly lower in the probiotics group than in the placebo group (p<0.05). No significant difference was observed in BOP or mPI between the two groups. ConclusionThese results suggested that probiotics prevent inflammation by affecting host responses rather than improving microbial flora in peri-implant sulci in peri-implantitis patients.

Retrospective Cohort Study of 4,591 Straumann Implants Placed in 2,060 Patients in Private Practice with up to 10-Year Follow-up: The Relationship Between Crestal Bone Level and Soft Tissue Condition.

The purpose of this report is to describe the crestal bone level (CBL) around implants of various designs, describe the peri-implant soft tissue condition, and evaluate the relationship between the two over time. This retrospective cohort study reports on 2,060 patients with 4,591 implants evaluated after 3 months; 1, 3, 5, and 7 years; and up to 10 years. Periapical radiographs were used to evaluate changes in CBL. The peri-implant soft tissue was evaluated using a modified Bleeding Index termed the Implant Mucosal Index (IMI) where: 0 = no bleeding; 1 = minimal, single-point bleeding; 2 = moderate, multipoint bleeding; 3 = profuse, multipoint bleeding; and 4 = suppuration. At 3 months, the mean CBL was 0.06 ± 0.22 mm; by 8 to 10 years, it had increased to 0.44 ± 0.81 mm. The median CBL remained stable throughout the study at < 0.1 mm. At 8 to 10 years, 15% of implants exhibited a CBL > 1.02 mm, and 5% exhibited a CBL > 2.28 mm. More than 50% of patients experienced some bleeding, as seen by an IMI ≥ 1 during follow-up. A positive correlation was found between IMI and CBL, as shown by a mean CBL after 4 years of 0.33 mm, 0.71 mm, and 1.52 mm for IMI = 2, 3, and 4, respectively. One exception was between IMI = 0 and IMI = 1, where no significant difference was found and bone loss was minimal. Bone loss, as measured by changes in CBL during the first 10 years of implant life spans, was minimal for most implants. Nevertheless, it is not unusual to observe implants with advanced bone loss. The soft tissue condition is a good indicator of bone loss. Time alone and minimal bleeding did not correlate with bone loss, but care should be taken for implants with profuse bleeding or suppuration.

Long-Term Outcomes of Early Loading of Straumann Implant-Supported Fixed Segmented Bridgeworks in Edentulous Maxillae: A 10-Year Prospective Study.

There have been few studies investigating the long-term outcome of early-loaded implants with segmented bridgeworks on fully edentulous maxillae. To evaluate the long-term predictability of early-loaded Straumann implant-supported fixed segmented bridgeworks in edentulous maxillae. Ninety-one implants were placed in 12 patients with edentulous maxillae. After a healing period of 6 weeks, the abutments were tightened followed by cementing of fixed full-arch prostheses. The patients were recalled after 1, 3, 5, and 10 years of loading for clinical evaluation. Implant success rate, peri-implant soft tissue condition, technical complications, marginal bone loss and patients' satisfaction was assessed. Eleven of the 12 patients attended the 10-year follow-up. Two implants were lost. The implant success rate was 97.6% at implant level and 81.8% at patient level. The mean marginal bone loss was found to be 0.41 ± 0.55mm, 0.53 ± 0.43mm, 0.68 ± 0.76 mm and 1.01 ± 0.85 mm at the 1, 3, 5, and 10-year follow-up respectively. None of the 11 patients showed a modified plaque index (mPLI) or modified bleeding index (mBI) of 3. Only one patient was found to have pocket probing depth (PPD) exceeding 3 mm. Peri-implantitis was found around one of the implants in a patient after 4 years of loading. The success rate of prostheses was 55.3% at prosthesis level and 27.3% at patient level. The most common technical complication of the prostheses was chipping of the ceramic veneer. Damaged veneers were observed in five patients. Other complications were loss of retention and abutment loosening. Early loading of Straumann SLA implants for support of full-arch segmented bridgeworks represents a viable therapy for the fully edentulous maxillae in the long term. High success rate of implants, acceptable peri-implant soft tissue condition and excellent patient satisfaction can be achieved, while technical complications of prostheses are common.

Clinical Outcomes of Implants Placed in Extraction Sockets and Immediately Restored: A 7-Year Single-Cohort Prospective Study.

The placement of implants immediately after tooth extraction has proven to be a predictable treatment strategy with a very high success rate. The aim of the present 7-year prospective single cohort study was to evaluate the success rate, marginal bone level (MBL), soft tissue stability of implants placed in fresh extraction sockets and immediately restored. This prospective cohort study included 37 implants in 32 patients (19 females and 13 males) with an average age of 40.1 ± 13.3 (range: 21-63 years) who received immediate implants and immediate single unit restorations. Outcome evaluations were: implant failures, complications, MBL, width of keratinized gingiva, facial soft tissue (FST) levels, modified Plaque Index and modified Bleeding Index. The cumulative survival rate was of 94.6% at 7-year visit. The mean MBL was -0.6 ± 0.49 mm at baseline and 1 ± 0.2 mm after 7 years. The FST Level was 0.4 ± 0.69 mm at baseline and 0.02 ± 0.70 mm at the 7-year follow-up. The Width of Keratinazed Gingiva was 3.8 ± 0.47 mm at baseline and 3.1 ± 0.42 mm at 7-year follow-up. Implants placed immediately after tooth extraction and immediately restored showed predictable clinical outcomes in this prospective study.

COMPARATIVE STUDY OF RETENTION AND PERI-IMPLANT OUTCOME OF FOUR IMPLANTS USED TO RETAIN MANDIBULAR SINGLE OVERDENTURE PLACED IN LINEAR VERSUS QUADRILATERAL DISTRIBUTION

Purpose: To compare the effect of linear versus quadrilateral distribution of four implants retained mandibular single overdenture using ball attachments on the retention of mandibular overdenture and on peri-implant outcome. Materials and Methods: Twelve patients were selected for this study with average age from 40-60 .They had maxillary dentulous arches opposing mandibular edentulous arches. Maxillary occlusal plane rehabilitation was made .Mandibular single denture was constructed and duplicated in clear acrylic resin to be used as surgical stent. According to the distribution of implants, the patients were randomly divided into two groups; Group I where the four implants were distributed in a linear form in the interforaminal distance, two in the site of mandibular lateral incisor, and two in the mandibular canine site, group II where the implants were distributed in quadrilateral distribution in the canine, second premolar region. After osseointegration period, ball attachments were used to retain the mandibular single overdenture. The retention of the mandibular overdenture and the peri-implant outcome were evaluated using the following variables: (1) modified plaque index; (2) modified bleeding index; (3) probing depth; (4) implant mobility using the Periotest instrument. The measurements were evaluated at time of mandibular single overdenture insertion (T0), six month (T1), and twelve month (T2) after mandibular overdenture insertion. Results: The descriptive statistics of retention showed statistically insignificant difference in the retention measurements at the three periods of time within the same group (p= 0.493 in group I and p= 0.255 in group II). However, there was statistically significant difference between the two studied groups at each observation time (p < 0.001at the three observation times). The comparison of periimplant outcome showed statistically insignificant difference between two groups and statistically significant difference within each group, except implant mobility as it was zero mobility in both groups and along all the period of the study. Conclusion: Quadrilateral distribution of four implants used to retain mandibular single denture is more advantageous than linear distribution, however further radiographic evaluation, and study the effect of using different attachments are recommended.

Periodontal parameters around implants and natural teeth.

Introduction:Nowadays, dental implants permit consideration of as one of the most reliable therapeutic modalities during the establishment of any prosthetic treatment plan. In numerous clinical situations, implants can clearly contribute to a notable simplification of therapy, frequently enabling removable prostheses to be avoided, keeping it less invasive with respect to remaining tooth structure. The aim of the present study was to clinically assess the peri-implant and periodontal conditions after the placement of crowns in partially edentulous patients.Materials and Methods:Twenty-five participants with 28 implant supported crowns were recruited in the study. After the insertion of suprastructure, meticulous scaling and root planing were performed on adjacent teeth which served as control. The clinical examination was carried out by a single examiner after placement of crowns at an interval of 1, 3, 6, 9, and 12 months and included the assessment of modified plaque index (mPlI), bleeding score, calculus score, probing pocket depth (PPD), and recession on the four aspects of each implant and adjacent teeth.Results:The mPlI, modified bleeding index (mBlI), calculus score, PPD, and recession decreased from 1 month to 12 months in both implants and in control teeth. The mean mPlI, mBlI, and calculus score were comparatively high in control teeth than implants. PPD was found to be more on implants than in control teeth. Recession was slightly higher in control teeth than implants throughout the study period, but it was not statistically significant.Conclusion:An implant patient must always be enrolled in a supportive therapy program that involves recall visits at regular intervals.

Clinical and Patient-reported Outcomes of a Zirconia Oral Implant

The objective of this study was to determine the clinical, radiographic, and patient-reported outcomes of a 1-piece alumina-toughened zirconia implant restored with single crowns (SCs) or 3-unit fixed dental prostheses (FDPs) after 3 y of observation. Forty patients received 53 implants, placed in a 1-stage operation with immediate temporization. Finally, 50 implants were restored with 24 SCs and 13 FDPs. To evaluate peri-implant bone loss, standardized radiographs were taken at implant insertion, at final restoration delivery, and after 1 and 3 y. Additionally, several soft tissue parameters and patient-reported outcome measures were evaluated. Linear mixed models with random intercept for each patient and patients as clusters were used to compare subgroups. Three patients did not receive a SC due to early implant loss, and 1 patient died. As a result, 36 patients with 49 implants were followed-up for 3 y, giving a cumulative survival rate of 94.2%. The average marginal bone loss amounted to 0.79 mm (SCs, 0.47 mm; FDPs, 1.07 mm; P < 0.001). After the delivery of the final prosthetic restoration, further bone loss was not statistically significant (0.09 mm; P = 0.700). Probing depth, clinical attachment level, and modified bleeding index increased significantly at the implant sites, whereas gingival recession decreased significantly. Compared with the pretreatment questionnaires, the patient-reported outcome measures showed a permanently improved perception of function, aesthetics, sense, speech and self-esteem. The survival rate of the investigated ceramic implant system seems to be comparable to reported survival rates of titanium implants when immediately restored. The recorded parameters suggest its potential for clinical utilization.

Immediate occlusal loading of one-piece zirconia implants: five-year radiographic and clinical evaluation.

To evaluate radiographic and clinical outcomes of immediate occlusally loaded one-piece zirconia implants after 5 years of follow-up. This longitudinal clinical investigation included patients older than 18 years, in need of implant-supported single-unit dental rehabilitations. One-piece zirconia in healed and postextraction sites and immediately restored with provisional crowns in light occlusal contact. Definitive zirconia-ceramic restorations were delivered 3 to 4 months after surgery. Primary estimated outcomes were implant survival and success. Periapical radiographs were taken at implant insertion (T0), after 1 year (T1), and after 5 years (T2) to assess marginal bone loss (MBL). Probing depth (PD), modified Bleeding Index (mBI), modified Plaque Index (mPI), and gingival recession (REC) were also measured repeatedly for implants and reference teeth. Changes in parameters over time were assessed using the Wilcoxon signed rank test. In addition, multilevel mixed effects linear and logistic regression models were fitted to take into account within-subject correlations and baseline values. Thirty-two implants were inserted in postextraction and healed sites (n = 16 of each) in 17 patients. One immediate implant was lost after 3 months, and one patient with one implant dropped out after T1. Therefore, the cumulative survival rates were 96.9% at T1 and 96.8% at T2 (4.3 to 6 years). No significant differences were observed in mean MBL between immediate and delayed implants at either T1 or T2. Moreover, different baseline parameters (sex, arch, implant location, smoking habits, grafting) did not show any influence on MBL at either time. In general, for all clinical parameters (PD, mBI, mPI, REC), implants seemed to perform similar to if not better than natural teeth. Radiographic and clinical evaluations after 5 years showed satisfactory amounts of MBL and acceptable soft tissue health.

Transalveolar sinus floor elevation using osteotomes without grafting in severely atrophic maxilla: a 5-year prospective study.

The aim of this study was to assess the clinical success of dental implants placed in severely atrophic maxilla (residual bone height ≤4mm) using transalveolar sinus floor elevation (TSFE) without grafting. Furthermore, the implant stability during the healing period was also evaluated. Twenty five generally healthy patients with 37 Straumann(®) Standard Plus SLA implants were included in the study. After a modified Summers TSFE without grafting was performed, the smooth collar was embedded 0.5-1mm beneath the cortical bone level. Follow-ups were conducted at 12, 36, and 60months after crown placement. Implant survival rate, resonance frequency analysis (RFA), and clinical and radiographic parameters were evaluated. At 5-year follow-up, 35 implants fulfilled the survival criteria, representing a 5-year cumulative survival rate of 94.6% at implant level and 92% at subject level. The mean value of implant stability quotient (ISQ) ranged from 67.8 to 72.8, and the lowest values were reached at 4weeks. No significant difference was found with the passage of time in modified plaque index (P=0.92), pocket probing depth (P=0.34), and modified bleeding index (P=0.4). The average residual bone height was 2.81mm (SD: 0.74mm) in this study. The average crestal bone loss (CBL) significantly increased from 0.83mm at 1-year examination to 1.47mm at 3-year examination (P<0.001). The average CBL remained stable at years 3 and 5 (1.47 vs. 1.54mm, P=0.083). According to the current evidence, it is feasible to place cylindrical implants in severely atrophic maxilla. High survival rate could be achieved following TSFE without grafting at least within 5-year follow-up.

Platelet-rich Plasma with Scaling and Root Planing: A Double-blind Split-mouth Randomized Study

Background and aims. Along with conventional periodontal therapy, subginigval application of platelet-rich plasma (PRP) may provide more effective improvements in clinical parameters due to the presence of multiple growth factors. The aim of this double-blind, split-mouth, randomized study was to evaluate the adjunctive use of PRP with scaling and root planing (SRP) in the treatment of chronic periodontitis. Materials and methods. A total of 87 non-smokers suffering from moderate to severe chronic periodontitis were selected. Parameters were probing pocket depth (PPD), clinical attachment level (CAL), plaque index (PI) and modified bleeding index (mBI). After full-mouth SRP the sites were randomly divided into experimental sites receiving subgingival application of autologous PRP and controls treated with placebo gel. Measurements were recorded at baseline, 3 months and 6 months. Paired t-test was used to compare response to treatment between the two sites. Results. Statistically significant changes in parameters were seen in both groups from baseline to 6 months. Inter-group comparison revealed significantly more clinical attachment gain for the experimental group (P&gt;0.05). The mean CAL gain was 2.40±0.4 mm for control sites and 2.68±0.5 mm for experimental sites. Conclusion. This study supports the use of PRP during nonsurgical debridement of periodontal pockets measured 6 months after SRP.

Esthetic outcome and alterations of soft tissue around single implant crowns: a 2-year prospective study.

The aim of this prospective study was to assess the esthetic outcome and alterations of peri-implant soft tissue using tissue-level implants. Furthermore, the influencing factors, including grafting and gingival biotype, of esthetic outcome of peri-implant soft tissue were also evaluated. Of 38 patients with single missing anterior tooth in maxilla were treated with a Straumann (®) Standard Plus SLA implant. Bone augmentation was performed in 24 patients. Follow-up was conducted at 12 and 24 months after definitive crowns placement. Esthetic outcome using the pink esthetic score/white esthetic score (PES/WES) and clinical parameters were evaluated. The mean PES/WES value at baseline, 1-year, and 2-year examination was 13.79, 14.87, and 14.96. Significant improvement was found between baseline and 1-year examination (P < 0.01). And the improvement between 1-year and 2-year examination was not significant (P = 0.40). The mean PES changing value in patients with thick biotype was significantly higher than those with thin biotype at 2-year after definitive crowns placement (P = 0.03). Graft procedure had an unfavorable effect on mean PES value both at baseline and at follow-up (P < 0.01). No implants were lost at 2-year examination. Three patients experienced peri-implant infection. No significant difference was found with the passage of time in modified plaque index (mPI), probing pocket depth (PPD), and modified bleeding index (mBI). According to the present prospective clinical study, it can be concluded that it is feasible to use tissue-level implant to support single crowns in esthetic area. Favorable short-term esthetic outcome and stability of soft tissue around single implant crowns can be expected in patients with or without graft. However, graft procedures might have an unfavorable effect on the esthetic outcome. Gingival biotype can be considered as prognostic factor for esthetic outcome. RCTs with long-term follow-up are needed to provide evidence for the long-term stability of peri-implant soft tissue using tissue-level implant systems.

Fresh‐Socket Implants of Different Collar Length: Clinical Evaluation in the Aesthetic Zone

The aim of this clinical study was to compare clinical evaluations of implants in the aesthetic zone with smooth collars of different length. Sixty-six patients requiring extractions of one, two, or three teeth in the aesthetic zone of the maxilla were enrolled in this study. Ninety-four implants were positioned and were loaded immediately after tooth extraction. Forty-seven implants with a short smooth collar of 0.5 mm (SCI) and 47 implants with a long smooth collar of 1.8 mm (LCI) were utilized in this study and were placed using a nonsubmerged approach. Clinical (gingival index, modified plaque index, modified bleeding index, probing depth, gingival recession) and intraoral digital radiographic parameters were measured at baseline and after 6, 12, 24, and 36 months of healing to evaluate crestal bone loss levels over time. After a follow-up period of 36 months, a survival rate of 100% was reported. The SCI group showed a mean bone loss of 1.07 ± 0.38 mm at 12 months and 1.09 ± 0.38 mm at 36 months. The LCI group showed a mean bone loss of 0.46 ± 0.14 mm at 12 months and 0.53 ± 0.12 mm at 36 months. After the 36-month follow-up period, both groups showed stable bone levels over time. Statistically significant differences were found between groups (p < .05). No statistically significant differences were found between SCI and LCI groups with regard to clinical parameters over time. This study revealed significant differences in radiographically observed marginal bone loss between the two types of implant with different smooth-collar lengths, but no differences in gingival vestibular margin outcome were observed.

Prevalence of peri-implantitis in patients with implant-supported fixed prostheses.

The purpose of this study was to evaluate periimplantitis prevalence in patients using implant-supported fixed prostheses that did not have any routine maintenance care. A total of 161 implants (27 patients) were evaluated in patients using implant-supported fixed prostheses. Collected data included information related to patient general health and local factors such as characteristics of implants, time in function, type of loading, positioning, Modified Bleeding Index, bacterial plaque, bleeding on probing (BOP), marginal recession, probing depth (PD), keratinized mucosa, and radiographic bone loss (BL). Factors related to the prostheses were also evaluated. The exclusion criteria were patients that have had any follow-up visit for plaque control of the prosthesis and/or the implants. From a total of 161 implants, 116 (72%) presented without peri-implantitis (PD > 4 mm + BOP + BL > 2 mm) while 45 (28%) had some sign of the disease. Implants placed in the maxilla were 2.98 times more likely to develop the disease (P < .05). Moreover, patients aged ≤ 60 years old were 3.24 times more likely to develop peri-implantitis (P < .05). Another analysis with statistical relevance (P < .05) was that implants with less than 3 mm interimplant distance were three times more likely to have peri-implantitis. There was no statistical relevance considering other analyses. It can be concluded that patients aged ≤ 60 years have a greater chance of presenting periimplantitis, as well as for implants positioned in the maxilla and those placed with an interimplant distance < 3 mm.

Maxillary Sinus Floor Elevation Using the Osteotome Technique in the Presence of Antral Pseudocysts: A Retrospective Study with an Average Follow-up of 27 Months

This retrospective study investigated the predictability of the osteotome technique for sinus floor elevation in the presence of antral pseudocysts. A retrospective study was carried out in patients treated with the osteotome technique for sinus floor elevation in the presence of antral pseudocysts and simultaneous implant placement between 2005 and 2009. Pseudocyst cases were collected from the patient population during that period based on faint dome-shaped radiographic findings in the elevated sinus floor. Data were recorded and evaluated in terms of bone gain and alterations in the sinus floor and peri-implant parameters. Twenty-one patients were diagnosed with antral pseudocysts in the sinus floor, with 21 implants placed underneath. All implants osseointegrated uneventfully, and all but one implant radiographically appeared to gain bone around the apex. Mean residual bone height was 6.85 ± 1.22 mm and the mean length of implants protruding into the sinus was 2.96 ± 1.16 mm. The mean endosinus bone gain after the healing period was 3.40 ± 1.78 mm, with an average crestal bone loss of 0.85 ± 0.42 mm. Thirteen implants showed healed bone graft extending all around the apices, three implants had major bony coverage (50% to 100%) of the apically protruding portion, and four implants showed less coverage (< 50%). The survival rate of implants was 100% (mean follow-up, 27.26 ± 15.22 months), and at that time, mean crestal bone loss was 0.50 ± 0.33 mm, modified Plaque Index was 1.30 ± 0.67, modified Bleeding Index was 0.60 ± 0.70, and mean probing depth was 3.35 ± 0.74 mm. Based upon a retrospective study of 21 implants placed beneath pseudocysts for a mean time of 27 months, it appears that implants that extend into the maxillary sinus can remain functionally stable after osteotome sinus elevation in the presence of antral pseudocysts.

Immediate implants in anterior maxillary arch

Aim:The aim of the study was to evaluate the osseo-integration and soft tissue status of the endosseous implants placed in immediate extraction socket.Methodology:Seven patients (4 males and 3 females) aged 20-30 years were selected for the study. Nine implants were placed in seven patients in the maxillary arch. All the patients were clinically αnd thoroughly examined. Under local anesthesia, the indicated tooth was extracted. The extracted socket was prepared using standard drills with palatal wall as guide. The longest and widest implants were placed (Hi-Tec Implants). All implants showed good primary stability. The implants used in the study were tapered design endosseous implants with Threaded implants (TI) unit plasma-sprayed surface. Surgical re-entry (secondary surgery) was performed to remove the healing cap after 6 months for supra crestal fabrication. All patients were reviewed periodically at 3rd and 6th month interval and the following clinical parameters including modified plaque index (mPlI), modified bleeding index (mBI), probing depth (PD), attachment level (AL), and distance between the implant shoulder and mucosal margin (DIM), distance between the implant shoulder and first bone-implant contact, and Clinical Mobility Index were recorded. The results were computed and subjected to statistical evaluation.Results:The mPlI, mBI, PD, AL, and DIM were evaluated around the implants at baseline, 3rd and 6th month intervals and analyzed statistically by Friedman T-test. The results of the above were shown to be statistically non-significant. The distance between the implant shoulder and first bone implant contact was evaluated around the implants at base line, 3rd and 6th month intervals. The results proved to be statistically significant (0.01) implying that there was a bone apposition around the implants.Conclusion:During the course of the study, soft tissue status around implants was found to be healthy. Osseointegration as assessed by clinical and radiographic findings was found to be sound.

The Significance of Keratinized Mucosa on Implant Health: A Systematic Review

Whether a minimal width of keratinized mucosa (KM) is required to maintain peri-implant tissue health has been a topic of interest. This systematic review and meta-analysis aims to investigate the effect of KM on various peri-implant health-related parameters. An electronic search of five databases (from 1965 to October 2012) and a hand search of peer-reviewed journals for relevant articles were performed. Human cross-sectional or longitudinal studies with data on the relationship between the amount of KM around dental implants and various peri-implant parameters, with a follow-up period of at least 6 months, were included. Eleven studies, seven cross-sectional and four longitudinal, were included. Weighted mean difference (WMD) and confidence interval (CI) were calculated with meta-analyses for each clinical parameter. The results showed statistically significant differences in plaque index (PI) and modified PI (WMD = -0.27, 95% CI = -0.43 to -0.11), modified gingival index (mGI) (WMD = -0.48, 95% CI = -0.70 to -0.27), mucosal recession (MR) (WMD = -0.60 mm, 95% CI = -0.85 to -0.36 mm), and attachment loss (AL) (WMD = -0.35 mm, 95% CI = -0.65 mm to -0.06 mm), all favoring implants with wide KM. However, comparisons of other parameters (bleeding on probing, modified bleeding index, GI, probing depth, and radiographic bone loss) did not reach statistically significant differences. The result of heterogeneity test showed only one parameter (AL, P value for the χ(2) test = 0.30 and I(2) test = 18%) had a low degree of heterogeneity among analyzed studies; meta-analyses of other parameters presented moderate-to-high degree of heterogeneity. Limitations of the present review include limited number of selected studies (n = 11), existence of heterogeneity and publication bias, and only English-written articles searched. Based on current available evidence, a lack of adequate KM around endosseous dental implants is associated with more plaque accumulation, tissue inflammation, MR, and AL.

One‐piece zirconia oral implants: one‐year results from a prospective case series. 2. Three‐unit fixed dental prosthesis (FDP) reconstruction

To evaluate the clinical and radiological outcome of one-piece zirconia oral implants for three-unit fixed dental prosthesis (FDP) replacement after 1year. Twenty eight patients were recruited for the investigation and signed an informed consent. All patients were treated with a one-stage implant surgery and a three-unit immediate temporary restoration on two one-piece zirconia implants. The implants were fabricated of yttria-stabilized tetragonal zirconia (y-TZP). The endosseous part of the implants was tapered with a porous surface. A total of 56 implants were inserted in the 28 patients. A total of 12 implants were placed in the upper jaws (six in the anterior area and six in the posterior area) and 44 in mandibles (all in the posterior area). At implant insertion and after 1year, standardized radiographs were taken to evaluate the peri-implant bone loss. To evaluate any influences from different baseline parameters on the marginal bone loss a univariate analysis was performed. Clinical soft tissue parameters probing depth (PD), clinical attachment level (CAL), modified bleeding index (mBI) and modified plaque index (mPI) were recorded. Implant cumulative survival rates were calculated using actuarial life table analysis. Changes in the clinical variables were assessed using the Wilcoxon Signed Ranks test (PD, CAL) and the Sign test (mBl, mPl). All significance tests were conducted at a 5% level of significance. After 1year, one implant was lost resulting in a survival rate of 98.2%. The patient was excluded from further analysis. The marginal bone loss after 1year amounted to 1.95mm. In 40% of the patients a bone loss of at least 2mm and in 28% of the patients a loss of more than 3mm were observed. The PD decreased for implant and tooth sites over time, the values being significantly higher for implants than for teeth. Over 1year, the CAL increased slightly around the implants and decreased around the teeth. At the 1-year follow-up, the CAL at the implant sites was statistically significantly higher than at the reference teeth. The mBI was significantly lower at implants than at teeth. The same result was found for the plaque index. A high frequency of increased radiographic bone loss (>2mm) after 1year around the presented one-piece zirconia implant system was found. The bone loss seems to be higher compared to the very limited availability of zirconia implant data. Therefore, within the limits of the present investigation, it may be concluded that the presented zirconia implant system possibly performs inferior to conventional titanium implants and to other zirconia implants regarding peri-implant bone loss.

Differences in peri‐implant conditions between fully and partially edentulous subjects: a systematic review

The aim of this study was to compare peri-implant conditions between fully edentulous (FES) and partially edentulous subjects (PES). A systematic review was conducted. The MEDLINE, EMBASE and COCHRANE databases were searched for publications up to January 1st 2012. Studies reporting on the bleeding tendency of the peri-implant mucosa and/or studies reporting on the prevalence of peri-implant mucositis and/or peri-implantitis were considered. Fifty-five publications describing 46 studies were selected. One study described both FES and PES, and all other studies described either FES or PES. Subgroup analyses were performed according to dental status (fully/partially edentulous), follow-up time (≥5years and ≥10years) and study design (prospective/cross-sectional). FES harboured more plaque at their implants than PES. Modified bleeding index scores were significantly higher in FES, but no differences in bleeding on probing, implant loss and probing pocket depth were observed between FES and PES. No meta-analysis could be performed on prevalence of peri-implant mucositis and peri-implantitis. Overall prevalence of peri-implantitis was 0-3.4% after 5years and 5.8-16.9% after 10years of implant evaluation. FES and PES show comparable implant survival rates. However, no conclusion can be drawn regarding differences in prevalence of peri-implant mucositis and peri-implantitis between FES and PES.