Peri-implant Soft Tissue Conditions Research Articles

The dental implant survival rate in 18 patients with post-operation revolutionary jaw reconstruction using free fibular flap, dental implants, and overdentures

Background/purposeThis retrospective study assessed the risks and complications associated with dental implants after jaw surgery and radiotherapy for large defects, highlighting challenges for reconstructive surgeons and prosthetic dentists. Materials and methodsFrom 2002 to 2008, National Taiwan University's Department of Maxillofacial Surgery used preoperative stereolithographic models and microvascular flaps for mandibular reconstruction in 18 patients with defects from ameloblastoma or advanced gingival cancer. They received free fibular flap grafts, followed by 46 osseointegrated dental implants. Patient outcomes, monitored for up to 60 months, were assessed through clinical and radiographic evaluations of implant success. ResultsThe overall survival rate of dental implants following tumor surgery and radiotherapy was 84.8%. Seven implants failed due to peri-implantitis (3), tumor recurrence (2), and osteoradionecrosis (ORN) (2). The ameloblastoma group did not contribute to implant failure, with 4 implant failures in the stage III gingival cancer group, and 3 implant failures in the stage IV gingival cancer group. ConclusionFollowing segmental mandibulectomy for mandible lesions, free fibular bone graft reconstruction restored mandible continuity, while subsequent dental implantation and overdenture fabrication restored occlusion and aesthetics for patients. Besides considering treatment strategies for ameloblastoma groups, similar approaches can be extended to oral cancer patients undergoing post-operative reconstruction. However, additional considerations (peri-implant soft tissue condition, tumor recurrence, ORN, etc.) are necessary for oral cancer patients predisposed to dental implant failure post-surgery.

The use of digital technologies in peri-implant soft tissue augmentation - A narrative review on planning, measurements, monitoring and aesthetics.

To identify the different uses and modalities of digital technologies to diagnose, plan and monitor peri-implant soft tissue conditions and aesthetics. A comprehensive narrative review of pertinent literature was conducted, critically appraising key digital technologies that may assist peri-implant soft tissue augmentation and assessment. An electronic search on four databases including studies published prior to 1st July 2023 was performed and supplemented by a manual search. Predominantly, tools such as cone beam computed tomography (CBCT), intraoral scanning (iOS), intraoral ultrasonography and digital spectrophotometry were commonly to assess and monitor peri-implant soft tissues. The main clinical and research applications included: (i) initial assessment of mucosal thickness, supra-crestal tissue height and keratinized mucosa width, (ii) evaluation of peri-implant soft tissue health and inflammation, (iii) monitoring profilometric changes and midfacial mucosal margin stability over time and (iv) aesthetic evaluation through colour assessment. While evidence for some digital tools may be limited, the integration of digital technologies into peri-implant soft tissue management holds great promise. These technologies offer improved precision, comfort and speed in assessment, benefiting both patients and clinicians. As digital technologies progress, their full potential in peri-implant soft tissue augmentation and their value will become more evident with ongoing research. Embracing these innovations and their potential benefits is recommended to ensure that during progress in implant dentistry, patient care is not hindered.

Long-Term Peri-Implant Health and Papilla Formation at Healed Sites by Chairside Provisionalization of Single-Tooth Implants: A Prospective Case Series.

Several procedures are performed to achieve optimal esthetic results in single-tooth implants. However, there is discordance regarding the potential benefit and risks of immediate implant loading/provisionalization. The aim of this prospective case series is to investigate the effect of immediate provisionalization of single-tooth implants at healed sites for periimplant soft-tissue conditions, focusing on papilla formation around single implants. Twelve patients received a total of 12 implants in the incisor, canine or premolar region of the upper and lower jaw at healed sites with immediate chair-side provisionalization. Four months later, the temporary crown was replaced by the permanent crown. After 40±13.1 months, clinical follow-up was conducted, assessing Probing pocket depth (PPD); Bleeding on Probing(BoP); Mucosal recession (MR) and Width of Keratinized Mucosa (KM). Papilla index (PI) was determined immediately after implant placement (baseline), before removing the temporary crown (t1), 4 weeks after insertion of the definitive crown (t2) and at the final follow-up examination (t3) to evaluate papilla formation and its change over time. None of the implants were lost. The mean PPD was 2.5±0.39 mm, BoP of 25% and 3.5 mm of KM were observed at the final follow-up. No implants showed MR. PI increased in all patients from 1.5±0.45 at baseline to 2.4±0.56 at t1, 2.6±0.47 at t2 and 3.02.6±0 at t3. The increase in PI between t0 and each individual timepoint from t1-t3 showed statistical significance. The present results indicate the suitability and benefit of immediate provisionalization to achieve favorable peri-implant soft-tissue conditions and papilla formation.

Clinical evaluation and quantitative occlusal change analysis of posterior implant-supported all-ceramic crowns: A 3-year randomized controlled clinical trial.

To compare the survival and complication rates of posterior screw-retained monolithic lithium disilicate (LS2 )/veneered zirconia (ZrO2 ) single implant crowns (SICs), as well as analyze the occlusal changes observed during a 3-year follow-up period. Thirty-three patients were included and randomly divided into two groups. The test group consisted of 17 patients who received monolithic-LS2 -SIC, while the control group consisted of 16 patients who received veneered-ZrO2 -SIC. Implant/prosthesis survival rates, technical complications, peri-implant soft tissue conditions, and quantitative occlusal changes of SIC (obtained by the intra-oral scanner and analyzed in reverse software Geomagic Control 2015) were assessed at 1- and 3-year follow-ups. Bone loss and Functional Implant Prosthodontic Score (FIPS) were evaluated at a 3-year follow-up. After a 3-year follow-up period, one patient dropped out of the follow-up. No implant loss was observed. One crown was fractured, resulting in prosthesis survival rates of 93.75% for the monolithic group and 100% for the veneered group. A technical complication rate of 25% (4/16) was observed in the veneered group (p = .333). No significant differences in the marginal bone loss were observed at the 3-year follow-up (0.00 (-0.22, 0.17) mm versus 0.00 (-0.12, 0.12) mm, p = .956). The total FIPS scores for the test group were 9.0 (9.0, 9.0), while the control group received scores of 9.0 (8.0, 10.0) (p = .953). The changes in mean occlusal clearance were 0.022 ± 0.083 mm for the test and 0.034 ± 0.077 mm for the control group (at 3 years, p = .497). The changes in occlusal contact area were 1.075 ± 2.575 mm2 for the test and 1.676 ± 2.551 mm2 for the control group (at 3 years, p = .873). After a 3-year follow-up, screw-retained monolithic LS2 and veneered ZrO2 SIC demonstrated similar survival rates. The occlusal performance of implant prostheses needs to be closely examined during follow-up, and appropriate occlusal adjustments need to be considered.

Radiological and Periodontal Evaluation of Stock and Custom CAD/CAM Implant Abutments—A One-Year Follow-Up Study

Implant abutment selection is an important step in implant treatment to restore one or more lost teeth. The aim of this study was to compare stock and individual CAD/CAM full-form abutments after one year in function. A total of 64 subjects with one missing tooth were divided into two groups according to the type of abutment: 34 patients were given a stock abutment, and 30 an individual CAD/CAM abutment. Patients were scheduled for check-ups seven days after functional loading and after four, eight, and twelve months. Peri-implant soft tissue status was checked at every check-up by monitoring parameters traditionally used in similar studies: plaque index; bleeding on probing; and probing depth. To assess the stability of the bone tissue, radiological methods of measuring the amount of bone level compared to the implant shoulder were used. When needed, data were analysed by χ2 test or by Fisher’s exact test. The normality of the distribution of quantitative measurements (properties) was tested by the Shapiro–Wilk test. Differences in the distribution of quantitative variables frequencies were analysed by Student’s t-test. Student’s t-test was used for repeated measurements, Mann–Whitney’s U test and ANOVA test for repeated measurements, and Friedmann’s two-way analysis of variance for repeated measurements. The predictive values of the chosen variables on the ABI index were assessed by the logistic regression model (Enter method). The results of this study showed that the impact of the abutment type (individual CAD/CAM or stock) on the average bleeding on probing was significant, especially after eight or twelve months. However, the abutment type did not show a significant correlation with the total crestal bone loss. The level of oral hygiene showed a significant correlation with the average bleeding on probing. The influence of smoking cigarettes on the total crestal bone loss evaluation was also significant. Overall, from a clinical perspective, custom CAD/CAM abutment performed slightly better than stock abutments during the one-year follow-up.

Implant–Prosthetic Rehabilitation of Maxillary Lateral Incisor Agenesis with Narrow Diameter Implants and Metal–Ceramic vs. All-Ceramic Single Crowns: A 16-Year Prospective Clinical Study

The main objectives of the present prospective clinical study were to evaluate the marginal bone resorption and the peri-implant soft tissue conditions around narrow diameter implants, as well as the clinical performances of metal–ceramic and all-ceramic single crowns in the implant–prosthetic treatment of maxillary lateral incisors agenesis. Seventy-two patients affected by monolateral or bilateral agenesis of the maxillary lateral incisors were included in the study, and a total of 105 narrow diameter implants were inserted. The final single crowns were fabricated 4 months after the surgical procedures by means of either titanium abutments with Auro-Galvan Crowns (AGC) veneered with feldspathic ceramics or zirconia abutments with all-ceramic (alumina or zirconia) crowns layered with dedicated veneering ceramics. Both marginal bone resorption and soft tissue quality were evaluated after a maximum period of 16 years. Two independent survival curves for patients wearing AGC or all-ceramic crowns were calculated by means of Kaplan–Meier analysis, and a log-rank test was performed in order to compare these curves (p < 0.05). After 16 years of clinical function, a mean marginal bone resorption of 1.2 ± 0.61 mm and good response of peri-implant soft tissues were observed. Descriptive statistics resulted in 80% and 87.1% cumulative success rates for patients provided with AGC prostheses onto titanium abutments and all-ceramic crowns on-to zirconia abutments, respectively. The cumulative survival rate calculated for AGC group was 93.3%, whereas all-ceramic group showed a cumulative survival rate of 95.7%. No statistically significant differences were found with the log-rank tests. The overall success and survival rates calculated were 85% and 95% for all the restorations, respectively. Mucositis, abutment unscrewing, loss of retention, chipping, core fracture, and esthetic failure were the major complications reported. The implant–prosthetic approach can be considered an effective and viable solution to treat cases of maxillary lateral incisor agenesis in the long term.

Extramaxillary Zygomatic Implant Coverage with a Pedicled Buccal Fat Pad Flap Through a Tunnel Approach: A Prospective Case Series.

To describe the benefits of covering the extrasinusal length of extramaxillary zygomatic implants with a pedicled buccal fat pad flap through a tunnel approach. Four extramaxillary zygomatic implants were placed in 10 patients and loaded immediately with an acrylic provisional fixed prosthesis. The extrasinusal length of every implant was covered with a pedicled buccal fat pad flap. Study variables were implant survival rate, peri-implant soft tissue recession (PISTR), peri-implant soft tissue condition (PISTC), modified Bleeding Index (mBI), and suppuration. The statistical analysis comprised the Brunner-Langer model of longitudinal data for each variable and the analysis of variance to assess main effects and interactions. All the zygomatic implants showed osseointegration, resulting in a survival rate of 100%. The PISTR was evaluated after surgery (T0) and after 12 months (T1), statistically significant differences being observed (P = .014). Recession also depended on specific implant positioning; zygomatic implants in the anterior were found to have a higher risk of recession vs implants in the posterior (P = .065). The PISTC was assessed at T0 and T1, and no statistically significant changes were observed (P = .718). Bleeding on probing was present in 10% of the implants at T0 and in 15% at T1, the difference being nonsignificant (P = .317). The use of a pedicled buccal fat pad flap to cover the extrasinusal length of extramaxillary zygomatic implants appears to reduce the risk of soft tissue recession and exposure of the implant surface to the oral cavity.

Effect of Ti-Base Abutment Gingival Height on Maintenance of Crestal Bone in Thick Biotype Patients: A Randomized Clinical Trial with 1-Year Follow-up.

To determine the effect of 0.7- and 2.4-mm transmucosal abutment height titanium bases on the crestal bone stability and peri-implant soft tissue condition of bone-level implants with platform switching in patients with vertically thick soft tissues. Sixty bone-level platform-switched implants were placed in the molar and premolar regions of both arches in 60 patients. All epicrestally inserted nonsubmerged implants had a 4.1-mm diameter and, after osteointegration, were randomly allocated into two groups: (1) the short group, with a titanium base of 0.7-mm transmucosal abutment height, and (2) the high group with a 2.4-mm height. Monolithic zirconia restorations were fabricated for all implants. Parallel intraoral radiographs were obtained after the delivery of restorations (T1) and after 1 year (T2). Crestal bone levels and peri-implant soft tissue conditions were calculated for each implant. The significance level was set at α = .05. After 1 year, 55 patients were evaluated, with a mean bone loss of 0.6 ± 0.51 mm (median: 0.71, range: 0 to 2.09 mm) in the short group (23 patients) and 0.45 ± 0.59 mm (median: 0.65, range: 0 to 2.12 mm) in the high group (22 patients), showing no significant difference between groups (P = .168). A significant increase in marginal bone height was noted between the T1 and T2 time points in the short and high (P = .029 and .001, respectively) groups. The peri-implant soft tissue health parameters did not show statistically significant differences. Crestal bone stability after 1 year of follow-up around epicrestally placed platform-switched implants is not influenced by transmucosal abutment height, if the vertical soft tissue thickness is ≥ 3 mm.

Clinical applicational comparison of digital impression and silicon rubber impression technique in posterior implant-supported single crown restoration

Objective: To investigate the clinical effect and satisfaction of partially edentulous patients restored with posterior implant-supported single crown by digital impression technique and traditional silicon rubber impression, in order to provide clinical reference. Methods: Sixty-four partially edentulous patients who visited the Department of Prosthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University between March 2018 and January 2021 were enrolled. There were 31 male and 33 female, and the age of the group of patients was (49.3±13.3) years. The 113 implants placed in this group of patients were divided into digital impression group (n=70) and silicone rubber impression group (n=43) according to different impression techniques, and were restored with screw-retained full zirconia single crown, and the patients were followed up for 3-36 months after treatment. The implant survival rate, upper prosthesis, peri-implant soft tissue status, marginal bone loss and patients satisfaction were recorded to evaluate the clinical effects of two impression techniques in posterior implant-supported single crown. Results: In sixty-four patients, digital impression accounted for 62% (40/64), and silicon rubber impression accounted for 38% (24/64), the survival rate of 113 implants was 100% (113/113). The prevalence of interproximal contact loss, food impaction and mechanical complication of the upper full zirconia single crown restorations were 22.7% (41/181), 8.0% (9/113) and 2.7% (3/113) separately. All the mechanical complications were abutment screw loosening. All patients maintained good oral hygiene status, the incidences of peri-implantitis and peri-implant mucositis were 0.9% (1/113) and 4.4% (5/113) respectively. The marginal bone loss was (0.24±0.11) mm. The median of satisfaction visual analogue scale score in patients was 9-10, but no statistically significant differences of all the above results were observed between the two impression techniques (P>0.05). Conclusions: The clinical effect of partially edentulous patients restored with posterior implant-supported single crown using two different impression techniques is good and the satisfaction of patients is high, but the long-term clinical effect remains to be further observed.

Assessment of periimplant soft tissue condition with morse taper abutment connection

Aim: This study aims to evaluate the clinical assessment results of periimplant soft tissue with morse taper (internal abutment connection). Methods: The study was conducted using a rapid review by searching the articles from PubMed NCBI and Cochrane by using keywords. All articles were selected by the year, duplication, title, abstract, full-text, and finally, all selected articles were processed for final review. Following clinical parameters were included; Periimplant Probing Pocket Depth (PPD), Plaque Score (PS), modified Plaque Index (mPI), Mucosal Thickness (MTh), Gingival Height (GH), periimplant mucosal zenith, Pink Esthetic Score (PES), Bleeding On Probing (BOP), Sulcus Bleeding Index (SBI), and modified Gingival Index (mGI). Results: 9 selected articles were obtained from the initial literature searching count of 70 articles. The overall samples included 326 morse taper implants. Based on the evaluation, 3 out of 4 articles reported pocket depth < 4 mm, no bleeding was reported in 2 out of 4 articles. 4 out of 4 articles reported low plaque accumulation, low soft tissue recession was reported in 3 out of 3 articles, and 4 out of 4 articles reported acceptable PES values. Conclusion: The evaluations indicate that the morse taper (internal abutment connection) has favorable assessment results based on various clinical parameters.

Clinical assessment of pterygoid and anterior implants in the atrophic edentulous maxilla: a retrospective study.

This study aims to evaluate the short-term clinical outcomes and patient satisfaction of anterior and pterygoid implants in the rehabilitation of edentulous maxilla with posterior atrophy. Given a minimum follow-up of 1 year, 25 patients with fixed maxillary rehabilitation over anterior and pterygoid implants were enrolled in this retrospective study. The implant survival rates, peri-implant soft tissue status (including probing depth, modified sulcus bleeding index, and plaque index), marginal bone loss, and patient satisfaction were measured. The survival rates for anterior and pterygoid implants at 1-year follow-up were 96.5% and 97.8%, respectively (P>0.05). No statistically significant difference in probing depth, modified sulcus bleeding index, and plaque index was observed between the two types of implants (P>0.05). The marginal bone losses of anterior implants were 0.62 mm± 0.44 mm (mesial) and 0.61 mm± 0.40 mm (distal), and those of pterygoid implants were 0.64 mm± 0.46 mm (mesial) and 0.68 mm± 0.41 mm (distal) mm. These results showed no statistical difference in mesial and distal sites (P>0.05). Patients indicated a high degree of satisfaction with the full-arch prostheses supported by anterior and pterygoid implants. For the edentulous maxilla with posterior atrophy, full-arch fixed prostheses supported by anterior and pterygoid implants has an acceptable short-term clinical outcome and excellent patient satisfaction. It may be considered as a predictable and feasible method for maxillary rehabilitation.

Locator versus stress free implant bar attachments for two -implants immediately loaded by mandibular overdentures. A one year randomized study

Aim: The purpose of this short-term randomized trial was to study clinical and radiographic outcomes of Locators and SFI bar attachments used for two -implants immediately loaded by mandibular overdentures Material and method: Twelve edentulous participants (6 males and 6 females) received new maxillary and mandibular dentures and wore them for 3 months to increase muscular control. Two fixtures were installed in the canine regions of the mandible and immediately loaded by mandibular overdentures using Locator (group 1) or SFI bar (group 2) attachments. Plaque index (PI), gingival index (GI), probing depth (PD), stability of the implants (IS), and marginal bone resorption (BL) were measured at base line (insertion), 6 and 12 months later. Results: The implant survival was 91.7% and 100% for Locator and SFI bar groups respectively. PI, PD and BL increased significantly with time in both groups. SFI bar group showed significant higher PI and PD than Locator group after 6 and 12 months. On the other hand, Locator group showed significant higher BL than bar group at 6 and 12 months. No significant difference in GI and IS between observation times or between groups was noted Conclusion: Within limitation of this study, it is concluded that both Locators and SFI bar anchors are recommended for immediately loaded 2 inter-foraminal implants by mandibular overdentures. However, Locators may be favorable regarding improved peri-implant soft tissue conditions and SFI bar may be favorable regarding reduced marginal bone loss around the implants

Single-implant mandibular overdentures: Clinical, radiographic, and patient-reported outcomes after a 5-year follow-up

Statement of problemPrevious studies on single-implant mandibular overdentures have reported favorable results for clinical and patient-reported outcomes. However, information from longer term clinical studies is lacking. PurposeThe purpose of this clinical study was to assess clinical, radiographic, and patient-reported outcomes of edentulous individuals rehabilitated with single-implant mandibular overdentures after a 5-year follow-up. Material and methodsA prospective clinical study was performed including completely edentulous individuals who received new conventional complete dentures and then an external hexagon implant in the mandibular midline region, followed by the incorporation of a retention system (O-ring/ball attachment; Neodent). Data collection occurred at baseline and 3, 6, 12, 24, and 60 months after implant loading. Assessed outcomes included implant stability, peri-implant soft tissue condition, peri-implant marginal bone level, satisfaction with the prostheses, and oral health–related quality of life (OHRQoL). Clinical maintenance events were also recorded. Descriptive statistics, incidence rates, Wilcoxon Signed Ranks test, and Generalized Estimating Equation regression were used for data analysis (α=.05). ResultsThirty of 34 eligible participants attended the 5-year follow-up visit, mean ±standard deviation age was 68.1 ±7.8 years, and 70% were women. The overall implant survival rate was 88.9%. After 5 years, the OHRQoL showed statistically significant improvement for all evaluation periods compared with baseline (P<.001). Regarding satisfaction with the mandibular denture, a significant increase was found between all evaluation periods compared with baseline in terms of comfort, stability, and ability to masticate (P<.001). Implant stability significantly increased (P=.003), and a mean bone loss of 1.46 mm was observed compared with baseline measures. The most frequent maintenance event was replacement of the O-ring matrix (n=80). Twenty-one midline fractures of the overdenture occurred in 14 study participants. No significant changes in peri-implant soft tissue conditions were observed. ConclusionsA single-implant mandibular overdenture effectively maintained the positive effect of the intervention on oral health–related quality of life and patient satisfaction, stable peri-implant condition, and acceptable rates of prosthetic events.

Facial mucosal level of single immediately placed implants with either immediate provisionalization or delayed restoration: An intermediate-term study.

Immediately placed single implants with either immediate provisionalization (test) or delayed restoration (control) were followed for up to 1 year in our previous randomized clinical trial. Peri-implant tissues continue to remodel after implants are in function. Therefore, the primary aim of this study was to evaluate the facial mucosal level changes in the intermediate term between the two groups and to study potential factors influencing the mucosal level change. Patients who had already completed the previous clinical trial by receiving a single immediately placed implant were re-invited to this study. The facial mucosal level as well as the other peri-implant hard and soft tissue dimensions and conditions were measured clinically, radiographically and with ultrasound. These data were compared between the test and control implants. The mucosal level change as the function of the final crown contour, measured as the abutment-crown angle (ACA), was estimated with a linear regression model. Twenty-eight patients (n of test/control=16/12) with a mean 30-month follow-up were recruited. The mean mucosal level change was -0.38mm (control) and 0.06mm (test), without statistical difference between the two groups. The other clinical, radiographic, and ultrasound parameters were not statistically different. ACA was statistically significant associated with the recession (P=0.02). The estimate effect was 0.25mm per 10° increase (adjusted R2 =0.18; 95% CI, 0.02 to 0.49mm). After adjusting for vertical implant position, implant abutment angle and the group, the effect became borderline significant (P=0.09). Peri-implant tissues, including the mucosal level change of immediately placed implants with either immediate provisionalization or delayed restoration remained stable and did not differ between the groups in the intermediate term. The final crown angle, influenced by implant position and abutment angle, might be associated with mucosal margin level change.

The influence of the implant-abutment complex on marginal bone and peri-implant conditions: A retrospective study.

PURPOSEThe design of the implant-abutment complex is thought to be responsible for marginal bone loss (MBL) and might affect the condition of the peri-implant tissues. This the present study aimed to evaluate the influence of the implant-abutment complex on MBL and the peri-implant tissues in partially edentulous patients treated with dental implants and determine the most advantageous design.MATERIALS AND METHODSA total of ninety-one endosseous implants with different designs of implant-abutment complex [tissue level-TL (n = 30), platform switch-PS (n = 18), and platform match-PM (n = 43)] were reviewed for MBL, Probing Pocket Depth (PPD) and Bleeding on Probing (BoP). MBL was calculated for first year of the insertion and the following years.RESULTSThe median MBL for the PM implants (2.66 ± 1.67 mm; n = 43) in the first year was significantly higher than those for the other types (P =.033). The lowest rate of MBL (0.61 ± 0.44 mm; n = 18) was observed with PS implants (P =.000). The position of the crown-abutment border showed a statisticallysignificant influence (P =.019) and a negative correlation (r=−0.395) on MBL. BoP was found significantly higher in PM implants (P =.006). The lowest BoP scores were detected in PS implants, but the difference was not significant (P =.523). The relation between PPD and connection type revealed no statistically significant influence (P >.05).CONCLUSIONWithin the limitations of the present study, it may be concluded that PS implants seem to show better peri-implant soft tissue conditions and cause less MBL.

Is gingival biotype a critical determinant of secondary stability of orthodontic mini-implants – A prospective clinical study using resonance frequency analysis

Objectives: The objectives of the study were to determine the association of gingival biotype and secondary stability of orthodontic mini-implants using resonance frequency analysis. Materials and Methods: Twenty patients, each receiving two mini-implants, were divided into two groups; thick and thin gingival biotype based on the thickness of gingiva before mini-implant placement. Implant stability was assessed at the time of placement; at the 1st, 2nd, 3rd, and 4th month by resonance frequency analysis. Peri-implant soft-tissue conditions were also examined at each month till 4 months interval using periodontal indices. Results: Thick and thin gingival biotype groups showed statistically different implant stability quotient (ISQ). Mini-implants showing signs of failure consistently displayed lesser ISQ. Statistically significant difference was observed in the scores of peri-implant indices of failure and no failure group of mini-implants. Conclusion: Mini-implants in thin gingival biotype are more susceptible to failure and peri-implantitis compared to thick gingival biotype. Longitudinal assessment of mini-implant stability may help predict failure so as to avoid long duration and cost of orthodontic treatment.

Long-term outcomes of osteotome sinus floor elevation with or without bone grafting: The 10-year results of a randomized controlled trial.

To assess the long-term clinical and radiographic results of implants placed using osteotome sinus floor elevation (OSFE) with or without bone grafting. Forty-five patients were randomly assigned into two groups: Group 1 (OSFE with deproteinized bovine bone mineral) and Group 2 (OSFE without grafting). The patients were recalled at 1, 3, 5 and 10years after surgery. The implant survival, endo-sinus bone gain (ESBG), marginal bone loss (MBL), peri-implant bone height (PBH, distance from the most coronal level to the most apical level of bone-to-implant contact), prosthesis survival and hardware complications, and peri-implant soft tissue conditions were assessed. Forty patients attended the 10-year examination. Mean residual bone height was 4.58±1.28mm. The 10-year cumulative survival rate was 90.7% for Group 1 and 95.0% for Group 2. The PBH was 5.89±1.24mm for Group 1 and 5.74±1.43mm for Group 2 at 10years. The ESBG of both groups remained stable after 3years. Two-thirds of the implants were free of hardware complications. No significant differences in MBL and peri-implant tissue parameters were found. OSFE with or without grafting both yielded predictable clinical outcomes with similar PBH (ClinicalTrials.gov. NCT01619956).

Clinical outcomes and bone-level alterations around one-piece mini dental implants retaining mandibular overdentures: 5-year follow-up of a prospective cohort study.

To report on the clinical outcomes of one-piece mini dental implants (MDIs) retaining mandibular implant overdentures (IODs), including marginal bone-level alterations (ΔMBLs), clinical peri-implant parameters, and technical- and biological complications during a 5-year follow-up. The null hypothesis was that ΔMBLs would be equal in subjects older than 65years relative to younger subjects. Four 1.8-mm diameter one-piece MDIs with ball attachments were placed in the interforaminal region of 20 edentulous subjects. The existing complete dentures were converted to IODs. Standardized radiographs of each implant were taken at implant placement (baseline) and during the five-year follow-up. ΔMBLs and potential influencing factors were evaluated, and peri-implant parameters, and biological and technical complications were recorded. The implant and prosthetic survival rates were both 100%. IODs fractured in seven participants. The overall mean ΔMBL after 5years was -1.18mm (standard deviation: 0.79mm). ΔMBLs per month were most pronounced within the first 3months after implant placement. ΔMBLs were not influenced by the implant location, the presence of keratinized mucosa, or gender. However, ΔMBLs were significantly smaller in subjects older than 65years (p=.007). One-piece MDIs retaining mandibular IODs with O-ring attachments are a predictable treatment option, providing stable peri-implant bone and soft tissue conditions over a mid-term follow-up. Incorporating a metal reinforcement can prevent denture fracturing when converting a complete denture into an IOD. The presence of keratinized mucosa does not necessarily lead to decreased bone-level changes. Advanced age might be beneficial in terms of peri-implant bone stability.

Peri-implant soft and hard tissue condition after alveolar ridge preservation with beta-tricalcium phosphate/type I collagen in the maxillary esthetic zone: A 1-year follow-up study

Background/Aim. Alveolar ridge dimensional alterations following tooth extraction in the anterior maxilla often result in an inadequate bone volume for a correct implant placement. In order to obtain optimal bone volume various bone graft substitutes have become commercially available and widely used for socket grafting. The aim of this study was to examine and compare long-term clinical outcomes of dental implant therapy in the maxillary esthetic zone, after socket grafting with beta-tricalcium phosphate (TCP) combined with collagen type I, either with or without barrier membrane and flap surgery, after a 12-month follow-up. Methods. Twenty healthy patients were allocated to either C group (beta-TCP and type I collagen without mucoperiosteal flap coverage) or C+M group (beta-TCP and type I collagen barrier membrane with mucoperiosteal flap coverage). Following clinical parameters were assessed: implant stability (evaluated by a resonance frequency analysis ? RFA), periimplant soft tissue stability (sulcus bleeding index ? SBI, Mombelli sulcus bleeding index ? MBI, periimplant sulcus depth, keratinized gingiva width, gingival level) and marginal bone level at the retroalveolar radiograms. Results. Within C+M group, RFA values significantly increased 12 weeks after implant installation compared to primary RFA values. Comparison between investigated groups showed a significantly reduced keratinized gingiva width in the C+M group compared to the C group after 3, 6, 9 and 12 months. Comparison between groups revealed significantly lower gingival level values in the C+M group at 9th and 12th month when compared to the C group. Conclusion. Implant treatment in the anterior maxilla could be effective when using a 9 months alveolar ridge preservation healing with combined treatment with beta-tricalcium phosphate and type I collagen, with regard to the peri-implant soft and hard tissue stability.

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.