Papillary Index Research Articles

Clinical analysis of the tooth-implant papilla for two narrow-diameter titanium-zirconium implants in the anterior area: prospective controlled clinical study

BackgroundRehabilitation of the anterior area when the mesio-distal space is reduced is a challenge for the clinician, due to the patient’s anatomical limitations and aesthetic requirements. Narrow Diameter Implants (NDI) are an option of treatment when the standard diameter implant is not possible, but the evidence is scarce. This prospective clinical study aims to analyze the formation of the tooth-implant papilla between the implant and the adjacent natural tooth in the maxillary lateral incisors and mandibular incisors.MethodsA total of 40 patients treated with NDI, of titanium-zirconium (Ti-Zr) alloy i.e., 2.9 mm Test Group (TG) and 3.3 mm Control Group (CG), were included. The mesiodistal distance between the adjacent natural teeth was used for implant selection, maintaining 1.5 mm between the fixation and the adjacent tooth. Clinical assessment was performed by a clinical examiner at 6 and 12 months after the final prosthesis. The primary variable was the Jemt Papillary Index. Also, implant survival rate (SR), complications, Implant Stability Quotient (ISQ), and patient-reported outcomes measures (PROMs) such as aesthetics, chewing, phonation, comfort, and self-esteem were analyzed.ResultsA significant amount of papilla filling was observed concerning the baseline, with a trend towards more formation of the papilla in the TG, with a JPI score of 3. No significant differences were observed between the two groups regarding implant SR, clinical parameters, and complications. In terms of PROMs, a higher satisfaction in the TG was observed, with significant intergroup differences for aesthetics, comfort, self-esteem, and primary stability ISQ (TG: 59.05 (SD: 5.4) vs. CG: 51.55 (SD: 5.7)).ConclusionsThe 2.9 mm diameter Ti-Zr implants achieved a formation of papilla similar to 3.3 mm implants in the anterior region at 12 months of follow-up after the final prosthetic restoration. The use of Ti-Zr implants with a diameter of 2.9 mm to rehabilitate single teeth in areas of the anterior region, where the mesiodistal distance is limited, showed favorable clinical results and a high degree of satisfaction during 1 year of observation similar to 3.3 mm dental implants.Trial registrationThis study was retrospectively registered in ClinicalTrials.gov with the number NCT05642520, dated 18/11/2022.

Efficacy of free gingival graft in the augmentation of keratinized tissue around implants: A prospective clinical study

Background:Effectuating adequate width of keratinized tissue (WKT) can lead to a healthy and stable implant/soft tissue interface which is important for the long term success of the implant. The use of free gingival grafts (FGG) for widening the WKT around dental implants increases the amount of attached gingival tissue and prevents clinical attachment loss.Aim:The aim of the study was to assess the ability of FGG to create a healthy implant/soft tissue interface.Methods and Material:A total of 10 edentulous sites in 10 patients with inadequate keratinized tissue indicated for replacement of missing teeth were treated. An implant was placed in edentulous sites and the keratinized tissue was augmented using FGG at the second stage of implant surgery. WKT was recorded at baseline, 3rd month and 6th month post-operatively. Plaque index (PI), gingival index (GI), probing depth (PD) and papillary index (PPI) and were recorded at 3 and 6 months post-operatively to evaluate the health of peri-implant tissues. Paired t-test was used for standard deviation and the level of significance was taken as 5% (P < 0.05).Results:The WKT at 3 (3.2±1.61mm) and 6 months (3±1.56 mm) compared to the baseline was statistically significant (P = 0.034). The other parameters PI, GI, PD, PPI showed no clinical significance from 3 and 6 months (P > 0.05).Conclusions:Augmentation of FGG created a significant gain in the WKT which resulted in a healthy implant/soft tissue interface.

Development of breast papillary index for differentiation of benign and malignant lesions using ultrasound images

Papillary breast lesions include a wide spectrum of pathologies ranging from benign to malignant. The word papillary originates from finger-like projections, or papules, which are seen when these lesions are projected under a microscope. Papillary breast lesions have an array of radiological features at presentations; hence differentiation between benign and malignant based on imaging features is challenging. Histopathological diagnosis is crucial for the distinction and further management of the lesions. Traditionally, tumor and ductal excision is the treatment of choice for malignant and atypical or benign papilloma with imaging discordance. However, current clinical practice guidance advocates complete surgical excision, even for asymptomatic and purely benign papillomas diagnosed on core needle biopsy, as they are highly associated with atypia and malignant upstage on subsequent surgery. Computer aided diagnosis (CAD) is a non-invasive method of diagnosing medical signals/images using advanced image processing followed by soft computing techniques. In this study, we have developed a non-invasive CAD system for differentiating benign versus malignant papillary breast lesions using bi-dimensional empirical mode decomposition (BEMD) and the discrete cosine transform (DCT) followed by locality sensitive discriminant analysis (LSDA). The developed model is validated using a large collection of ultrasound images of papillary breast lesions, and achieved a maximum performance of 98.63% accuracy. We have also developed a breast papillary index, which may in the future be used as a substitute for the conventional soft computing techniques. The developed model can be utilized as a tool to assist radiologists in their routine clinical practice after validation with a larger database.

Periodontal Evaluation of One-Piece and Two-Piece Single Implant Loaded in Esthetic Zone

Background: Soft tissue around dental implant is an important anatomical feature contributing to the long-term implant success and esthetics, different factors may influence the soft tissue-implant interface. The purposes of the current study were to evaluate the soft tissue profile around one-piece and two-piece implants loaded in esthetic zone. Method: Totally thirty patients who had single missing tooth in premaxillary region were included in the study. Fifteenth patients’ group-A were assigned to immediate loading one-piece implant and fifteen patients’ group-B were assigned to early loading two-piece implant protocol. Flapless approach was performed for both groups. In group-A, implants were loaded immediately with a temporary crown within 48h, while group-B, were loaded after two months following conventional impression for metal ceramic crown. Clinical outcomes were evaluated after two and six months in terms of success rate, papillary index, plaque index and width of keratinized mucosa. Results: The success rate in group-A found to be 80%, which was lower than the success rate in group-B (100%). On comparison, there was no statistically significant difference in success rate between the two study groups. There was no statistically significant difference between both groups over time in clinical parameters like plaque index, width of keratinized gingiva and papillary index. Conclusion: The results of this study indicated that using either immediately loading one-piece implants or early loaded two-piece implants protocol demonstrated the same enhancements of implant esthetics

Effect of Flap and Flapless Implant Surgical Techniques on Soft and Hard Tissue Profile in Single-Stage Dental Implants

Introduction: Over the past 30 years, flap designs for implant surgery have been modified and atraumatic technique was introduced. It has several potential advantages, including reduction of complications at the patient level. The aim of the present study to compare the soft tissue profile and heights of crestal bone levels around the single-stage implants after single-piece implant placement with two different surgical techniques, that is, open flap procedure and flapless (FL) procedure. Materials and Methods: Thirty participants were randomly selected and categorized into two groups. Group 1 (flap technique) and Group 2 (flapless technique) consisted of 15 participants each. All of these participants underwent evaluation of soft tissue parameters of papillary index, probing pocket depth, sulcus bleeding index, and hard tissue evaluation such as crestal bone levels by radiovisiography at 0, 3, and 6 months. Results: All clinical parameters improved in FL technique when compared with the flap technique. Conclusion: The results concluded that the FL implant surgery results in lesser loss of interproximal bone and also results in better soft tissue changes when compared with the flap technique. However, controlled, further studies are needed to confirm this possibility.

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.

The Effect of Platelet-Rich Fibrin on Soft Tissue and Crestal Bone in One-Stage Implant Placement in Fresh Extraction Sockets: A Randomized Controlled Clinical Trial

Introduction: The goal of modern dentistry is to prevent tooth loss and provide a healthy dentition with optimal functional efficiency, structural balance, and aesthetic harmony. The placement of an implant immediately after tooth extraction helps to maintain the bone crest and leads to ideal implant positioning from a prosthetic point of view and has the potential of decreasing the total treatment time for patients. Aim and Objective: To evaluate the platelet rich fibrin with or without bone ceramic on soft issue and crestal bone in one stage implant placement in fresh extraction socket. Materials and Methods: A total of 30 patients were randomly assigned into two groups—each group comprising 15 patients based on platelet-rich fibrin with and without bone ceramic and one-stage implant placement in fresh extraction socket. All patients were prospectively evaluated clinically and radiographically. All the data were analyzed using a software statistical package for social sciences (SPSS) version 11.5 (Chicago, Illinois, USA). Results: During the 6-month interval, no implant was lost; the mean bone level at the implants increased in platelet-rich fibrin (PRF) with bone ceramic group and decreased in PRF group and papillary index increased in both the groups, whereas modified sulcus bleeding index and probing pocket depth (PPD) decreased in both the groups. Conclusion: It can be concluded that mean crestal bone levels increased in PRF with bone ceramic group, whereas decrease in PRF group and both the groups are statistically significant. When the papillary levels are compared between the two groups, there was no statistical significance, but increased papillary levels were found in both the groups. The mean PPD was decreased in both the groups, but there was no statistical significance between the two groups.

Effect of Flapless Surgery on Single‐Tooth Implants in the Esthetic Zone: A Randomized Clinical Trial

Implant therapy is a highly predictable treatment option; however, insufficient data exist to show whether flapless implant surgery provides better esthetic outcomes and less bone loss than implant surgery with a flap approach. In this randomized, controlled study comparing the flapless and traditional flap protocol for implant placement, 24 patients received a single implant in the anterior maxillary region. A cone beam computed tomography-aided surgical guide was used for implant placement surgery for both groups. Implants were restored using a one-piece, screw-retained ceramic crown at 3 months. Radiographic and clinical measurements were assessed at baseline (implant placement) and at 3 (crown placement), 6, 9, and 15 months. Clinical parameters evaluated were plaque index, gingival index, papillary index (PPI) (0 = no papilla, 1 = less than half, 2 = more than half but not complete, 3 = complete fill, and 4 = overfill), marginal tissue levels, biotype, width of keratinized tissue, and soft tissue thickness. Implant success rate was 92% in both groups. Mean PPI values for the flap control group and flapless test group were 2.38 ± 0.51 versus 2.31 ± 0.48 at crown placement (P = 0.68) and 2.52 ± 0.52 versus 2.64 ± 0.54 at 15 months (P = 0.42), respectively. PPI increased over time in both groups, although the flapless group had a significantly larger change in PPI from crown placement to 6 and 9 months (P <0.01). Crestal bone levels in the flap group were more apical in relation to the implant platform than those in the flapless group for the duration of the study. No differences among groups were noted for all other measurements. Both flapless and flap implant placement protocols resulted in high success rates. A flapless protocol may provide a better short-term esthetic result, although there appears to be no long-term advantage.

The efficacy of flapless implant surgery on soft-tissue profile comparing immediate loading implants to delayed loading implants: A comparative clinical study

Aims and ObjectivesTo assess the efficacy of flapless implant surgery on soft-tissue profile and to compare the clinical outcomes of flapless implant therapy on immediate loading (IL) implants to delayed loading (DL) implants.Materials and MethodsThe study sample consisted of 20 patients who were partially edentulous in the anterior maxillary region. They were divided into two groups. In group I (IL) 10 implants were placed and immediately provisionalized and restored with a metal ceramic crown on the 14th day. In group II (DL) 10 implants were placed and loaded after 4 months. Single-piece implants were used for the IL group and two-piece implants were used for the DL group. All soft tissue parameters i.e., modified plaque index (mPI), modified bleeding index (mBI), papillary index (PPI), marginal level of soft tissue (ML) and width of keratinized mucosa (WKM) were recorded at baseline, Day 60, Day 120 and Day 180.Results:The success rate in group I was found to be 80%, which was lower than the success rate in group II which was found to be 90%. On comparison, there is no statistically significant difference in success rate between the two study groups. There was no statistically significant difference between the groups over time in parameters like mPI, mBI, ML and WKM. The mean PPI score in group II showed a significant increase from when compared to group I.Conclusion:The results of this study indicated that flapless implant surgery using either immediately loading implants or DL implants, demonstrate enhancement of implant esthetics.

Effects of Isoflavones on the Skin of Postmenopausal Women: A Pilot Study

OBJECTIVE:The aim of this study was to evaluate the effects of isoflavones on the skin of postmenopausal women.DESIGN:A prospective study was performed with 30 postmenopausal women before and immediately after the end of treatment with 100 mg/day of an isoflavones-rich, concentrated soy extract for six months. A skin punch was performed in the gluteal region for sample collection before and immediately after the treatment program. Morphometric determination of epidermal thickness, the papillary index (wrinkling), and the amount of dermal elastic and collagen fibers was assessed. In addition, the number of blood vessels in the sample was also evaluated. The paired Student’s t-test was used for statistical analysis (P ≤ 0.05).RESULTS:Isoflavone treatment resulted in a 9.46% increase in the thickness of the epidermis in 23 patients. In addition, the papillary index was reduced in 21 women. The papillary index was inversely proportional to skin wrinkling, i.e., there were a large number of papillae after treatment. The amount of collagen in the dermis was increased in 25 women (86.2%). In 22 women (75.8%) we observed that the number of elastic fibers increased. The number of dermal blood vessels was significantly increased in 21 women.CONCLUSION:Our data show that the use of a concentrated, isoflavone-rich soy extract during six consecutive months caused significant increases in epithelial thickness, the number of elastic and collagen fibers, as well as the blood vessels.

Soft and hard tissue assessment of immediate implant placement: a case series

The aim of this prospective study was to evaluate clinically and radiographically the success and esthetic result of immediate implant placement at the time of extraction. Twelve patients with 14 titanium screw-shaped implants (13-16 mm length and 4.3 or 5 mm diameters) were placed in the extraction sockets. Defects after implant placement were recorded, and then filled up with deproteinized bovine bone mineral, bioabsorbable collagen membrane, and absorbable pins. The defect was again re-evaluated at second-stage surgery. Clinical and radiographic parameters of the peri-implant conditions were assessed at the moment of prosthesis placement and at 1-year follow-up. The cumulative implant survival and success rate was 100% after a 1-year observation period. Analysis of the esthetic result showed that the mean pink esthetic score (PES) was 11.1 (SD 1.35) at 1-year follow-up. At 1 year, 64.3% papillae had a score of 2 and the remaining 35.7% score 3 according to the Jemt (1997) papillary index. Optimal value of width of the keratinized mucosa was recorded in 13 (92.9%) implant cases in both periods of follow-up. At 1-year follow-up, the linear distance between implant-shoulder to the bone peaks remains stable with a mean of 2.62+/-0.2 mm at the mesial and 2.9+/-0.58 mm at the distal aspect. Careful evaluation of potential extraction sites before immediate implant installation promotes optimal implant esthetics.

Soft Tissue Esthetics in Implant Dentistry

Dental implants have been considered to be a successful treatment modality. Recently, achieving a good osseointegration is not the ultimate goal for the restorative dentist. Successful implant treatment demands the best gingival esthetic success along with stability and function of the implant. This study was performed to obtain answers to some controversial points pertaining to esthetics and function of implants in maxilla. Immediate flapless implantation into the extraction sockets in maxillary anterior zone is an emerging treatment option in dentistry--the esthetic success of which was in debate for long. The proposed study compared the esthetic success of immediate flapless implants (ILA), to immediate implants with the need for flap (ILB) and, delayed implants (DSL) in single tooth restorations, in the anterior region of the maxilla. The other aim of the study was to find out if any relation exists between the interproximal crestal bone height and papilla height. Analysis was done irrespective of treatment procedure in the same study group using periodontal sounding and radiographs to find out the relation. From the study involving 106 participants, including 21 ILA, 22 ILB and 63 DSL cases, we received highest papillary index score of 2.6 average from group ILA, followed by ILB and DSL, after 3 months of prosthetic loading. From the periodontal sounding and radiographic study it was evident that, when the distance between the base of the contact point of crowns and height of interproximal bone was less than 5, the papilla was present 100% of the time, but when the distance increased to 6 and more than 7 mm, the papilla was present only 46.5 and 24 percentage of the time respectively.

Effect of Flapless Implant Surgery on Soft Tissue Profile: A Randomized Controlled Clinical Trial

Flapless implant surgery has been suggested as one possible treatment option for enhancement of implant esthetics. Twenty-four patients with a missing tooth in the premaxillary region were randomly assigned to one of two groups (12 each): immediate loading (IL) or delayed loading (DL) (loading after 4 months). An endosseous implant was placed in each patient via a flapless surgery. Clinical measurements including the papillary index (PPI) (0, no papilla; 1, less than half; 2, more than half but not complete fill; 3, complete fill; and 4, overfill), marginal levels of the soft tissue (ML), probing depths (PDs), modified bleeding index (mBI), modified plaque index (mPI), and the width of the keratinized mucosa (WKM) were performed at baseline (at the time of loading) and at 2, 4, and 6 months. The soft tissue profile remained stable up to 6 months, without significant differences between the two groups (mean PPI and ML at 6 months, 2.16 and 0.30 mm, respectively). Mean PPI in the IL group significantly increased from 1.50 at baseline to 2.09 at 2 months, and the significance remained up to 6 months (2.30 at 6 months) (P <0.05), whereas in the DL group, no significant changes were found from baseline to 6 months in mean PPI (2.06 at both time points). Mean PPI increased over time when two treatment groups were combined; however, no statistical significance was found. In ML, the difference at baseline between the two groups (-0.28 mm for DL versus 0.17 mm for IL; P <0.05) was no longer significant at 2 months (0 versus 0.08 mm for DL and IL, respectively) and thereafter (P >0.05). No significant differences were detected between groups at each time and over time in the other clinical parameters, PD, mBI, mPI, and WKM (P >0.05). The results of this study indicate that creeping attachment (i.e., soft tissue recovery) might occur within 2 months after IL. The study suggests that flapless implant surgery provides esthetic soft tissue results in single-tooth implants either immediately or delayed loaded. Other long-term randomized controlled clinical trials with a large sample size and comparison group (i.e., implant surgery with flap) are recommended to verify the conclusions drawn in this preliminary study.

Interproximal papillae reconstruction in maxillary implants.

Gingival esthetics has become an important factor in the overall success of most maxillary implant-supported restorations. Periodontal plastic surgery procedures may be used to enhance esthetics in the maxillary anterior region. The purpose of the present study was to evaluate a new surgical approach, performed at implant exposure, to reconstruct interdental papillae around maxillary implant-supported restorations. The surgical procedure was performed on 32 patients, in which 36 consecutive single tooth osseointegrated implants were exposed in the anterior and premolar maxillary region. Previous to implant exposure and 6 months postoperatively, once the implant-supported restoration was in place, mesial and distal papilla contour measurements were calculated, based on a modification of the papillary index score (PIS). Statistical analysis consisted of paired t test, Pearson's correlation, and ANOVA with repeated measures. Preoperative PIS ranged from 0 to 3 and from 1 to 3 at the 6 months follow-up control. A mean of mesial and distal papilla, within the same tooth, was used for paired t test statistical analysis. A mean increase of 1.07 (SD 0.43) in PIS was statistically significant (P<0.001). At the second measurement, in no site was PIS smaller (0%) while in 64 sites PIS was higher (89%). In 51 papilla (71%) there was an increase of 1 PIS unit and 13 (18%) of 2 PIS units between both measurements. The presented surgical technique performed at second stage implant surgery was useful for partial or total interproximal papilla reconstruction adjacent to maxillary single-implant restorations.