Peri-implant Soft Tissue Parameters Research Articles

Comparing Small Buccal Dehiscence Defects Treated with or without Guided Bone Regeneration. A Sub-Analysis of a RCT.

to assess clinical and radiographical outcomes of single tooth posterior implants with a dehiscence defect treated with or without guided bone regeneration (GBR). In a randomized clinical trial of 59 patients, single-tooth posterior implants were placed. For the subanalysis of 16 patients with a buccal dehiscence defect (≤ 5mm), the implants were randomly assigned to GBR or spontaneous healing (SH). In 8 patients, the implants were surrounded by native bone (Native bone). A transmucosal healing approach was chosen for all sites. Patients were examined at restoration delivery (RD) and at one year (1y). Measurements included: soft tissue thickness (STT), bone tissue thickness (BTT) and buccal contour, based on cone-beam computed tomography (CBCT), optical scans, clinical parameters. All data were analyzed descriptively. The mean STT at implant shoulder (IS) showed a gain of 0.15 mm (Q1: - 0.16, Q3: 0.49) for the GBR group and 0.03 mm (Q1: -0.49, Q3: 0.13) for the SH group. The mean BBT 1 mm below IS showed a loss of 0.25 mm (Q1: -0.85, Q3: -0.09) for the GBR group and 0.04 mm (Q1: -0.14, Q3: 0.17) for the SH group. All peri-implant soft tissue parameters indicated healthy peri-implant tissues with no clinically relevant differences between the groups. Patient-reported outcomes regarding pain one day after surgery were similar among the study groups. The present sub-analysis resulted in a similar buccal contour and similar radiographic outcomes as well as peri-implant health for sites treated with or without GBR.

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.

Implant survival rate and marginal bone loss of 174 implants with different variables associated over a minimum observational period of 20 years: A retrospective study.

To investigate the long-term implant survival rate and marginal bone loss (MBL) of implants with different variables associated over an observational period of at least 20 years. Patients with at least one implant placed prior to 2001 were recalled and visited. Data on implant macro-design, prosthetic aspects, site distribution, and patient-related factors were collected. MBL was evaluated on intraoral X-rays and peri-implant soft tissue parameters were recorded. The patients were asked to fill out a questionnaire to evaluate their satisfaction with the treatment received. Descriptive statistics indicators were estimated. Analysis of variance and analysis of covariance models were used to investigate any differences in the MBL and peri-implant probing depth (PPD) among the variables. A chi-square analysis was performed to investigate any association between different types of prosthetic implant-supported rehabilitations and survival/success outcomes. Forty-one (41) patients and 174 implants were included with a mean observational period of 23.3±2.8 years. The implant survival and success rates were 96.5% and 83.3% respectively, while 3.5% of early failures were detected. The lowest success rates were observed for implants supporting fixed full-arch rehabilitations (71.05%) and overdenture rehabilitations (86.11%). A mean MBL of 1.81±0.71mm and a mean PPD of 3.38±1.62mm were recorded. The interaction between the collected data with MBL and PPD did not reveal any statistically significant differences between the variables (p>0.05). A statistically significant difference was recorded when analyzing the association between the different types of prosthetic implant-supported rehabilitations and success rates (p=0.014), with fixed and removable full-arch rehabilitations presenting with lower success rates. Answers to the questionnaire showed a generally high level of satisfaction. Within the limits of this retrospective study and based on the results, an implant survival rate higher than 96% was observed after a mean observational period of 23.3±2.8 years. Both the implant survival rate and MBL seemed stable after a mean observational period of 23.3±2.8 years. Implants supporting fixed and removable full-arch rehabilitations seemed to present lower success rates over time. Implant rehabilitation seemed to provide patients with optimal long-term outcomes in terms of functional and psychological aspects.

Randomized controlled pilot study comparing small buccal defects around dental implants treated with a subepithelial connective tissue graft or with guided bone regeneration.

To compare subepithelial connective tissue grafts (SCTG) versus guided bone regeneration (GBR) for the treatment of small peri-implant dehiscence defects in terms of profilometric (primary outcome), clinical, and patient-reported outcome measures (PROMs). Sixteen patients who presented with small buccal bone dehiscences (≤3 mm) following single implant placement were recruited. Following implant placement, buccal bone defect sites were randomly treated either with a SCTG or GBR. Six patients who lacked bone dehiscences after implant placement were assigned to a negative control. Transmucosal healing was applied in all patients. Patients were examined prior (T1) and after (T2) implant placement, at suture removal (T3), at implant impression (T5), at crown delivery (T6), and 12 (T7) months after crown delivery. Measurements included profilometric outcomes, marginal bone levels, buccal bone and soft tissue thickness, PROMs, and clinical parameters. All data were analyzed descriptively. The median changes in buccal contour as assessed by profilometric measures between T1 and T5 showed a decrease of 1.84 mm for the SCTG group and 1.06 mm for the GBR group. Between T2 and T7, the median change in the buccal contour amounted to 0.45 mm for SCTG and -0.94 mm (=loss) for GBR. Patients' pain perception tended to be higher in SCTG than in GBR. All peri-implant soft tissue parameters showed healthy oral tissues and no clinically relevant differences between groups. Within the limitations of this pilot study, treating small peri-implant dehiscence defects with a SCTG might be a viable alternative to GBR. The use of a SCTG tended to result in more stable profilometric outcomes and comparable clinical outcomes to GBR. However, patient-reported outcome measures tended to favor GBR.

Application of Implant Healing Abutment Supporting Vertical Bone Augments in the Posterior Mandibular Area.

To address the problem of insufficient bone mass in the implant area, we focused on the vertical increment of the posterior mandibular area to increase bone mass with the aid of a healing abutment. Data of patients with insufficient vertical bone height in the posterior mandibular area were collected, and vertical increment of alveolar bone operations was performed with the aid of a healing abutment. Preoperative residual alveolar bone height, immediate postoperative alveolar bone height, and 6-month postoperative alveolar bone height were recorded, with peri-implant soft tissue results 6 months after surgery using the modified plaque index and sulcus bleeding index. Twelve patients, aged 42-73 years, with an average age of 55.91 ± 11.58 years, received vertical bone augmentation in the posterior mandibular region supported by implant healing abutments. Fifteen SLA TSIII OSSTEM implants were utilized in the 12 patients; one patient failed in vertical bone augmentation at one site (H0 = 0 mm). The vertical bone augmentation effect of two patients at two sites was 0 mm < H0 < 1 mm, and the vertical bone augmentation effect of 12 sites in nine patients was H0 ≥ 1 mm. The implant success rate was 93.3%, and the mean vertical bone gain was 2.91 mm. Peri-implant soft tissue parameters are as follows: mean modified plaque index, 1.92; mean modified sulcus bleeding index, 1.21; and mean probing depth, 3.18. No clinically observable complications occurred. Bone augmentation supported by the implant healing abutment showed the characteristics of "platform transfer", with good formation of the implant-bone interface. The bone augmentation surgery was completed at the same time as the implant placement, which reduced the pain of multiple operations and shortened waiting times. We provide a novel idea to solve the problem of insufficient vertical bone height in the posterior mandibular region.

Association between Peri-Implant Soft Tissue Health and Different Prosthetic Emergence Angles in Esthetic Areas: Digital Evaluation after 3 Years' Function.

The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI95% -0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.

Immediate implant placement vs. early implant treatment in the esthetic area. A 1-year randomized clinical trial.

To assess the impact of implant placement and temporization timing on esthetic outcomes of single maxillary anterior implants with intact bone walls and interproximal bone. Test group patients received an immediate implant with immediate provisional restoration and socket preservation, while patients in the control group received an early implant placement with guided bone regeneration and delayed loading. Patients were followed for 1year after final prosthetic and pink esthetic score (PES), mid-buccal mucosal level (MBML), crestal bone changes (CBC), and peri-implant soft tissue parameters, and patient chair time was recorded. Fifty patients received the intended treatment (25 test and 25 control). No implants failed. PES after 1year was 12.8±1.19 for the test group and 12.5±1.36 for the control group (p=.362). MBML difference between baseline (after final crown delivery) and the 1-year follow-up was gain of 0.2±1.02mm for the test group (p=.047) and no change in the control group. CBC after 1year were 0.1mm±0.21mm (mesial) and 0.2mm±0.22mm (distal) for the test group and 0.2mm±0.25mm (mesial) and 0.3mm±0.19mm (distal) for the control group, p=.540 (mesial) and p=.462 (distal). Test group required half the chair time (127±13min) when compared to the control group (259±15min, p<.001). Within the limits of this trial, both treatment protocols resulted in excellent esthetic outcomes with PES >12 after 1-year follow-up.

Marginal Bone Maintenance and Different Prosthetic Emergence Angles: A 3-Year Retrospective Study.

The aim of the present retrospective study was to assess marginal bone changes around implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Marginal bone levels (MBL) measured at the prosthesis installation (t0) and at the 3-year follow-up visit (t1) were considered. The MBL change from t0 to t1 was investigated. Two groups were considered: Group 1 for restorations with an angle between implant axis and prosthetic emergence profile >30°, and Group 2 for those with an angle ≤30°, respectively. Moreover, peri-implant soft tissue parameters, such as the modified bleeding index (MBI) and plaque index (PI) were assessed. Seventy-four patients were included in the analysis and a total of 312 implants were examined. The mean EA in groups 1 and 2 was 45 ± 4 and 22 ± 7 degrees, respectively. The mean marginal bone level change (MBL change) of 0.06 ± 0.09 mm and 0.06 ± 0.10 mm were, respectively, in groups 1 and 2. The difference in the MBL change between the two groups was not statistically significant (p = 0.969). The MBL change does not seem to be influenced by the emergence angle for implants with a stable internal conical connection and platform-switching of the abutment diameter.

Assessing the Effects of L-PRF on the Peri-implant Soft and Hard Tissue Parameters in Immediate Implants: A Randomised Controlled Trial

Background and aim: Platelet-rich fibrin is a healing biomaterial with greater potential for enhancing tissue and osseous healing and regeneration without inflammatory reactions and can be used alone or in combination with bone grafts to promote blood coagulation bone maturation and growth. Although the use of platelet-rich plasma in dentistry, enhancing peri-implant healing with immediate implants placement is not well authenticated. The main aim of this study is to assess the effect of Leukocyte-and Platelet-Rich Fibrin (L-PRF) on the peri-implant soft and hard tissue parameters in immediate implants. Materials and methods: The split-mouth, randomized controlled trial on 10 systematically healthy subjects with adequate and maintainable oral hygiene. Subjects were enrolled, and sites were specified. On one site, atraumatic extraction was followed by immediate implant placement, while at another site, atraumatic extraction was done, followed by immediate implant placement with L-PRF application. Patients were recalled after 1, 3, and 6 months to evaluate various parameters, including tissue biotype, whether thick or thin, radiographic radiolucency (present or absent), modified plaque index, modified sulcus bleeding index, probing depth. The data was compiled and evaluated with an ANOVA test with a significant p-value of 0.05. Results: Statistically significant values were observed in all the parameters evaluated after the surgical procedure at 1, 3, and 6-month intervals with immediate implant placement along with Leukocyte-and Platelet-Rich Fibrin (L-PRF) membrane in extraction sockets. Conclusion: Within the study's limitation, it can be concluded that L-PRF can be used as a therapeutic adjuvant in clinical conditions of one-stage single tooth implant placements.

Implant-prosthetic rehabilitation of patients with severe horizontal bone deficit on mini-implants with two-piece design\u2014retrospective analysis after a mean follow-up of 5 years

BackgroundAs a consequence of tooth loss due to trauma or extraction, a reduced alveolar crest volume limits the deployment of standard implants in certain patient cases. For this reason, minimal-invasive treatment with mini-dental implants (MDI) might be an option to allow implant treatment even in cases with severe horizontal bone loss without augmentation measures. The aim of this retrospective cohort study was to investigate clinical and radiological implant, as well as patient-related parameters after treatment with MDI.ResultsClinical and radiological records of 19 female (82.6%) and 4 male patients (17.4%) (N = 23), who received 52 mini-dental implants with a two-piece design in a single surgical center between November 2011 and October 2018, were retrospectively analyzed. Implants were submitted to conventional loading on different types of screwed superstructures. Crestal bone loss was measured on standardized periapical radiographs. Patient-related outcome parameters (PROMs) were recorded during follow-up period. Mean clinical and radiological follow-up was 69.6 months (5.8 years) and 51.6 months (4.3 years), respectively. Three implants were lost in two patients, leading to an implant survival rate of 94.2%. Mean radiological crestal bone loss was 1.6 mm. Both amount of peri-implant recession and crestal bone loss were significantly correlated (r = 0.65; p < 0.001). Likewise, a significant correlation was observed between deeper probing depths and increased peri-implant bone loss (r = 0.41; p = 0.012). Alveolar ridges with a reduced alveolar crest width were significantly correlated with higher peri-implant bone loss as well (r = − 0.33; p = 0.011). No prosthetic complications were reported during follow-up. Extent of midfacial recession and papilla height loss had a significant negative impact on most of the PROMs.ConclusionsTreatment with MDI seems to be a successful alternative treatment option, especially for elderly patients with reduced crest width at implant sites. Due to the good clinical results and high survival and success rates, this treatment option was associated with high patient satisfaction. Despite the promising results, particular consideration should be given to appropriate treatment planning in these patients due to the strong correlation between peri-implant soft-tissue parameters, crestal bone loss, and reduced alveolar crest width.

Immediate single-tooth implant placement with simultaneous bone augmentation versus delayed implant placement after alveolar ridge preservation in bony defect sites in the esthetic region: A 5-year randomized controlled trial.

It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post-extraction sockets. The aim of this 5-year randomized controlled trial was therefore comparison of peri-implant soft and hard tissue parameters, esthetic ratings, and patient-reported satisfaction of immediate implant placement in post-extraction sockets with buccal bony defects of ≥ 5mm in the esthetic zone, with delayed implant placement after ridge preservation. Patients presenting a failing tooth in the esthetic region and a buccal bony defect of ≥ 5mm after extraction were randomly assigned to immediate (Immediate group, n=20) or delayed (Delayed group, n=20) implant placement. Second-stage surgery and placement of a provisional restoration occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. The follow-up was 5 years. Marginal bone level (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded. Mean marginal bone level change was -0.71 ± 0.35mm and -0.54 ± 0.41mm in respectively the Immediate group and the Delayed group after 5 years (P=0.202). This difference, and in other variables, was not significant. Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in post-extraction sockets with buccal bony defects of ≥ 5mm, were comparable to those following delayed implant placement after ridge preservation in the esthetic zone.

Retrospective long-term clinical evaluation of implant-prosthetic rehabilitations after head and neck cancer therapy.

To assess clinical and patient-reported outcomes of implant-prosthetic rehabilitations in patients with a history of head-neck cancer (HNC), treated with tumor resection without (TR) or with adjuvant radiotherapy (TR/RT). A healthy cohort rehabilitated with the same reconstructive protocols served as control group (C). A total of 28 women and 29 men were considered in the present retrospective study. Participants received 322 implants, finally supporting 79 prosthetic reconstructions. Primary outcome was the assessment of implant and prosthetic survival rates. Furthermore peri-implant soft tissue parameters (attached peri-implant mucosa, AM; modified bleeding and plaque indices, mBI/mPI; probing depth, PD) and prosthetic technical complications were documented. Patient-reported outcome measures (PROMs) by means of visual analog scales (VAS) and the Oral Health Impact Profile German 14 form (OHIP G14) were collected. For statistical purposes Chi-square and Mann-Whitney-U-Test were adapted. After a mean follow-up of 81.2±50.3months, implant survival rate was 98.1% (HNC-TR), 98.2% (HNC-TR/RT) and 100.0% (C), respectively (four implants failed in the HNC groups). HNC-TR/RT showed significant higher mPI and mBI compared to C. Within HNC-TR/RT, vestibuloplasty significantly reduced mBI and PD values. No failures occurred at the prosthetic level. Overall, higher VAS scores were reported for bar- compared with Locator-retained prostheses. Furthermore, increased OHIP G14 values resulted for HNC-TR/RT. High survival rates on implant and prosthetic level were observed. The use of soft tissue grafts resulted in stabilization of the peri-implant mucosa in irradiated patients. In terms of retention and chewing ability, participants preferred bars over Locator attachments.

Evaluation of hard and soft tissue changes around implant in partially edentulous patients: a aclinico-radiographic study

Introductionimplant supported prosthesis has become a viable treatment option for missing teeth. An important tool to detect early changes around implants is the standardized assessment of peri-implant hard and soft tissue parameters. The purpose of this prospective study was to clinically and radiographically assess the soft and hard tissues around implants.Methodsten (10) patients with 13 implant supported prosthesis were included in the study. Clinical parameters plaque index (PI), gingival index (GI), modified sulcus bleeding index (mSBI), peri-implant Probing Depth (PD), gingival margin Level, width of keratinized mucosa (WKM) and implant mobility were measured at loading and at 3 and 6 months. The radiographic crestal bone loss and peri-apical implant radiolucencies were also evaluated at loading and at 3 and 6 months. Student paired t test and correlation and regression analysis was done to evaluate the effect of clinical variables over bone loss.Resultsthere was decrease in the site specific PI, GI, mSBI and peri-implant PD and an increase in the gingival recession from baseline to 6 months. The WKM remained stable throughout the study. Significant crestal bone loss was observed around implants more on the distal as compared to the mesial aspect. No mobility or peri-apical implant radiolucency was observed. Regression analysis of the confounding variables with bone loss showed no significant effect.Conclusionthe occlusal loading of implants after 6 months showed significant bone loss (<1mm), which was within acceptable limits and the soft tissues around implants were in good health.

Early Loading of Mandibular Molar Single Implants: 1 Year Results of a Randomized Controlled Clinical Trial.

The purpose of this study was to compare the implant survival, peri-implant marginal bone level, and peri-implant soft tissue of three different types of implants. This was performed with an early loading protocol, using a complete digital workflow, for one year of follow-up. Twenty-four patients with a single missing tooth in the mandibular posterior region were randomly assigned to the control group (SLActive Bone level implant; Institut Straumann AG, Basel, Switzerland), experiment group 1 (CMI IS-III Active implant; Neobiotech Co., Seoul, Korea), and experiment group 2 (CMI IS-III HActive implant; Neobiotech Co., Seoul, Korea). For each patient, a single implant was installed using the surgical template, and all prostheses were fabricated using a computer-aided design/computer-aided manufacturing system on a 3-dimensional model. A provisional prosthesis was implanted at 4 weeks, and a definitive monolithic zirconia prosthesis was substituted 12 weeks following the implant placement. The implant stability quotient (ISQ) and peri-implant soft tissue parameters were measured, and periapical radiographs were taken at 1, 3, 4, 8, 12, 24, 36, and 48 weeks after implant placements. Seven implants in the control group, nine implants in the experiment 1 group, and eight implants in the experiment 2 group were analyzed. There were no significant differences among the three groups in terms of insertion torque, ISQ values between surgery and 8 weeks of follow-up, marginal bone loss at 48 weeks of follow-up, and peri-implant soft tissue parameters (P > 0.05). Statistically significant differences in ISQ values were observed between the control and experiment 1 groups, and the control and experiment 2 groups at the 12 to 48 weeks’ follow-ups. Within the limits of this prospective study, an early loading protocol can be applied as a predictable treatment modality in posterior mandibular single missing restorations, achieving proper primary stability.

Influence of antihypertensive medications on the clinical parameters of anodized dental implants: a retrospective cohort study

BackgroundHypertension is a chronic medical condition in which blood pressure in the arteries is elevated. Given the large proportion of dental implant patients using antihypertensive medications, it is crucial to evaluate the effects of these drugs on the clinical parameters of osseointegrated implants. The aim of the present retrospective cohort study was to evaluate the influence of antihypertensive medications on clinical peri-implant tissue parameters.MethodsThirty-five patients received a total of 77 anodized dental implants. Based on the history of the use of antihypertensive medications, the patients were divided into two groups: the group taking antihypertensive medications (AH group) and the group of healthy patients (H group). Implants were followed up clinically and radiologically, with a focus on the peri-implant soft tissue parameters probing pocket depth, bleeding on probing, modified plaque index, and marginal peri-implant bone level stability.ResultsNone of the implants were lost, and no technical failures occurred. The mean follow-up duration was 7 years and 1 month. A significant difference was observed in the probing pocket depth 3.8 ± 1.3 mm in the AH group and 3.0 ± 0.7 mm in the H group. In the AH and H groups, 26.5% (9/34) and 4.7% (2/43) of the patients were diagnosed with peri-implantitis at the implant level, respectively.ConclusionsOur findings suggest some correlations between antihypertensive medication use and clinical parameters in anodized peri-implant tissue.

The influence of titanium base abutments on peri-implant soft tissue inflammatory parameters and marginal bone loss: A randomized clinical trial.

Some techniques in implant dentistry have been suggested that may potentially alter peri-implant soft and hard tissue parameters. To evaluate the peri-implant soft tissue inflammatory parameters and crestal bone loss around titanium base abutments. Fifty two implants were placed in 21 patients and restored by single crowns. Subjects were randomly allocated into two groups: cement-retained abutment (n = 24) and titanium base (n = 28). Peri-implant probing depth, and mesial and distal marginal bone loss (MBL) were evaluated at implant loading (T1), 6 and 12 months (T2 and T3, respectively). Peri-implant bleeding-on-probing was evaluated at T2 and T3. Two-way repeated measures analysis of variance, Tukey test, Man Whitney, and Pearson correlation were performed for statistical analysis at P < .05. The mean difference of peri-implant MBL from implant installation to 12 months in function was 1.15 ± 0.82 mm for the cement-retained group, and 1.23 ± 0.79 mm for the titanium base group. No statistically significant difference was found between the two groups for clinical and radiographic peri-implant evaluation. Titanium base abutments present no negative effect on peri-implant soft tissue and MBL. When used to support single crowns, both approaches performed likewise regarding clinical and radiographic parameters.

Papilla stability around Single‐Tooth implant in the esthetic area – A 4‐year retrospective study

Background Soft tissue stability over time in the esthetic area is mandatory to avoid mucosal recession and loss of papilla surrounding dental implants. Several approaches have been described to maximize soft and hard tissue integration. These include the timings for implant placement, guided bone regeneration, and different loading protocols. Therefore, Identifying clinical parameters that may prevent dental implant mucosa recession and dental implant papilla levels loss is key for dental implant success. Aim/Hypothesis The aim of the present study was (1) to evaluate the relationship between dental implant mucosa and dental implant papilla levels, and (2) to identify the clinical parameters associated with dental implant papilla levels stability over time. Material and Methods This is a retrospective study on a cohort of patients seeking a single-tooth implant therapy in a private practice. Two independent examiners analyzed photographs and radiographs taken the day of definitive crown load (baseline) and the last follow-up visit (at least 12 months later) in order to measure peri-implant soft and hard tissue parameters – Mesial and distal Papilla height, Single Implant-crown height, keratinized tissue height, Implant platform bone peak and Mesial bone level-contact point. Repeated measure ANOVA was used to compare soft and hard tissue changes over time. Survival analyses were carried out using the Kaplan-Meier method and groups were compared by log-rank tests. Results Seventy-four patients corresponding to 90 implants were analyzed. No difference was observed between papillae that gained in height (n = 85) and papillae that lost in height (n = 73) except for the timing of the surgical protocol and an incomplete papilla fill (distance from the top of the papilla to the contact point) at baseline (P = 0.006). The probability of developing a mid-buccal peri-implant recession ≥ 1 mm was significantly higher when a papilla loss ≥ 1 mm occurred (P = 0.048). The Cox regression analysis showed that the distance between the interproximal bone peak and the implant platform was significantly and positively associated with the probability of observing a papilla gain (HR = 1.48 + 95% CI 1.06–2.05). Conclusion and Clinical Implications The present findings indicate a dependent association between dental implant mucosa and dental implant papilla levels. The risk of papilla loss is significantly higher with a delayed protocol than with an immediate or immediate-delayed protocol for implant placement. An increased papilla height is more likely to be observed when an increase in the distance between the interproximal bone peak and the dental implant platform is observed between baseline and follow-up.

Immediate versus delayed loading of mandibular implant-retained overdentures: A 60-month follow-up of a randomized clinical trial.

The purpose of this observational, post-trial follow-up study was to evaluate 60-month outcomes of a randomized controlled clinical trial that compared immediately and delayed loaded two unsplinted implants, supporting a locator-retained mandibular overdenture. Patients from a randomized controlled clinical trial, treated with either immediate or delayed loading of two implants, supporting a locator-retained mandibular overdenture, were recalled for 60-month evaluation. Patients underwent a clinical and radiographic examination to evaluate the peri-implant soft tissue parameters and bone. Prosthetic maintenance needs and complications were also recorded. Twenty three of the 30 patients were available for the 60-month follow-up. The mean radiographic bone level change measured using standardized periapical radiographs from baseline to 60months was 0.89mm (±0.74) and 0.18 (±0.41) for delayed loading and immediate loading groups, respectively. A statistically significant difference was observed at 60months with a smaller radiographic bone level change in the immediate loading group. No implants were lost between 12 and 60months. At 60months, per-protocol implant survival rate was 100% for both the groups. No difference was found in the peri-implant soft tissue parameters and prosthetic needs between the groups. Both immediately and delayed loaded implants supporting a locator-retained mandibular overdenture showed similar clinical outcomes.

Soft-Tissue Conditions Around Dental Implants: A Literature Review.

The aim of this article is to review the current understanding regarding periimplant soft-tissue conditions to minimize risk of periimplant mucositis and periimplantitis. An electronic search was performed in 4 different databases. Articles were reviewed and summarized if the following criteria were met: published evidence with recommendations on soft-tissue conditions around dental implants. An evaluation of various soft-tissue parameters, including the need of keratinized mucosa, periimplant mucosal height and phenotype, midfacial tissue level, and papillary fill, was performed based on the currently available evidence. The need of keratinized mucosa is the parameter investigated the most. A trend favors a need of a wide band of nonmobile keratinized mucosa is seen with the benefit of less incidence of periimplant mucositis. In addition, the influence of the mucosal height and tissue phenotype on periimplant tissue health remains inconclusive. Although other soft-tissue parameters, including papillary fill and midfacial tissue level, are not yet proven to be related to periimplantitis, they play a crucial role to achieve successful esthetics. A limited amount of evidence was identified to correlate periimplant soft-tissue parameters with periimplantitis. However, a wide band of nonmobile keratinized mucosa, an adequate periimplant mucosal height, and a thick tissue phenotype might reduce the incidence of tissue inflammation and future complications.

One-Year Results of a Randomized Controlled Clinical Trial of Immediately Loaded Short Implants Placed in the Lower Posterior Single Molar Using a Complete Digital Workflow

The purpose of this randomized clinical trial is to evaluate immediately loaded single implants with varying lengths in the posterior mandible using a fully digital, model-free prosthetic-driven implant planning pathway, and to compare clinical and radiological outcomes of short and long implants. The 52 patients with the single tooth missing in the posterior molar regions of the mandible were randomly assigned to the control (CMI IS-III active® long implant; 5.0 × 10 mm) and experimental (CMI IS-III active® short implant; 5.5 × 6.6, 7.3, 8.5 mm) groups. For each patient, a single implant was placed using the computer aided surgical template and all prostheses were fabricated by means of computer-aided design/computer-aided manufacturing (CAD/CAM) system on the virtual model. The patients received provisional and definitive monolithic zirconia prostheses at 1 week and 12 weeks after implant surgery, respectively. The implant stability quotient (ISQ) measurements and periapical radiographs were taken and peri-implant parameters were evaluated at 1, 3, 4, 8, 12, 24, 36, and 48 weeks after surgery. Nineteen long implants and 27 short implants were finally used for the statistical analysis. There was no significant difference between the groups in terms of insertion torque, ISQ values (except 3 weeks), marginal bone loss, and peri-implant soft tissue parameters (p &gt; 0.05). Both groups exhibited no stability dip during the early phase of healing. The average marginal bone loss from the baseline of implant placement for the control and experimental groups was −0.07 and 0.03 mm after 12 weeks and 0.06 and 0.05 mm after 48 weeks. All of the soft tissue parameters were within normal limits. Within the limits of the short term follow up, immediate loading of short single implants can be considered as one of predictable treatment modality in mandible with reduced bone height when primary stability can be achieved.