Peri-implant Soft Tissue Conditions Research Articles

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.

Short implants in the posterior maxilla to avoid sinus augmentation procedure: 5-year results from a retrospective cohort study

BackgroundShort implants present a promising approach for patients with advanced atrophy to avoid augmentative procedures. However, concerns about increased biological and technical complications due to an unfavorable implant-crown ratio are still present.PurposeThe aim of the present retrospective study was to evaluate whether a reduced implant length has any impact on implant success and peri-implant hard and soft tissue health in implants placed in the posterior maxilla to avoid sinus augmentation procedures.Materials and methodsFourteen patients received a total of 30 implants of 7-mm length in the posterior maxilla. Implants with a mean loading period of 5 years (range 2–7 years) were followed up clinically and radiologically, with a focus on the peri-implant soft tissue parameters probing pocket depth (PPD), bleeding on probing (BoP), and the stability of the marginal peri-implant bone level.ResultsNone of the implants were lost, and no technical failures occurred. A mean PPD of 2.5 mm, a mean BoP of 13.3%, and a mean marginal bone loss (MBL) of 0.5 mm indicate healthy peri-implant hard and soft tissue conditions without signs of peri-implantitis.DiscussionThe present results indicate the suitability of implants of 7-mm length to replace missing teeth in the posterior maxilla. An unfavorable implant-crown ratio or reduced bone-implant contact length seems to have no negative influence on midterm implant success or on peri-implant hard and soft tissue health.

Mandibular Overdentures Supported by Two vs Four Endosteal Implants: A Retrospective Cohort Study

Documentation of marginal bone resorption caused by implant-supported mandibular overdentures is scarce. This study sought to evaluate marginal bone resorption, survival rate, patient satisfaction, peri-implant soft tissue status, and prosthetic aftercare of mandibular overdentures supported by two vs four implants. This retrospective cohort study evaluated 92 edentulous patients presented to the Implant Center of Tehran University of Medical Sciences; out of which, 46 patients received overdentures supported by two Implantium implants (group A), while the remaining 46 received overdentures supported by four Implantium implants (group B). Standard radiographic indices were assessed following the delivery of overdenture and after 2 years of functional loading. Clinical evaluation was performed after 2 years of function. Data were analyzed using the t test (for continuous variables) and the Mann-Whitney test (for ordinal variables). In group A, two implants were lost in one patient. The groups were not significantly different in terms of clinical or radiographic parameters (p > 0.05). Patient satisfaction and prosthetic aftercare were not significantly different in groups A and B (p > 0.05). During the 2-year evaluation period, the clinical and radiographic parameters were the same in patients who received overdentures supported by two or four implants. Successful results may be obtained by the use of mandibular overdentures supported by two or four implants.

Peri-implant soft tissue status and crestal bone levels around adjacent implants placed in cigarette smokers and never smokers: Five-year follow-up results.

It is hypothesized that peri-implant soft tissue inflammation and crestal bone loss (CBL) are higher around adjacent implants placed in cigarette smokers compared with never smokers. The aim of the present 5-years follow-up retrospective clinical study was to compare the peri-implant soft tissue status and CBL around adjacent implants placed in cigarette smokers and never smokers. Cigarette smokers (group 1) and never smokers (group 2) with adjacent dental implants were included. Demographic information regarding age, sex, duration of smoking (pack-years), daily frequency of toothbrushing and most recent visit to a dentist or dental hygienist were recorded using a questionnaire. Information regarding implant dimensions (length × diameter), duration of implants in function, loading protocol (and type of restoration was recorded. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mesial and distal CBL were measured. P<0.05 were considered statistically significant. Seventy-two male participants (37 in group 1 and 35 in group 2) were included. The mean age of individuals in groups 1 and 2 were 50.3 ± 5.4 and 48.5 ± 3.8 years, respectively. In group 1, the mean duration of cigarette smoking was 22.3 ± 1.6 pack years. A family history of smoking was more often reported by individuals in group 1 compared with group 2. In groups 1 and 2, 54 and 70 adjacent implants, respectively were placed in the regions of missing premolars and molars. All implants were delayed loaded and were fixed with non-splinted screw-retained restorations. In groups 1 and 2, toothbrushing twice daily was reported by 78.3% and 74.2% individuals, respectively. There was no statistically significant difference in peri-implant PI, BOP, PD, and mesial and distal CBL among individuals in groups 1 and 2. Peri-implant soft tissue status and crestal bone levels were comparable around adjacent dental implants placed in cigarette smokers and never smokers.

Peri-implant soft tissue status and crestal bone levels around adjacent implants placed in patients with and without type-2 diabetes mellitus: 6 years follow-up results.

The long-term success and survival of dental implants type-2 diabetic subjects is debatable. The present 6 years' follow-up prospective clinical study compared the peri-implant soft tissue status and crestal bone loss (CBL) around adjacent implants placed among type-2 diabetic and nondiabetic subjects. Type-2 diabetic (Group-1) and nondiabetic individuals (Group-2) with adjacent dental implants were included. Hemoglobin A1c (HbA1c) levels were recorded; and a questionnaire was used to collect demographic information. Information regarding implant dimensions, duration in function, loading protocol, and type of restoration was recorded. Peri-implant bleeding-on-probing (BOP), plaque index (PI), probing depth (PD), and mesial and distal CBL were measured. P < .05 were considered statistically significant. Eighty-six male participants (44 in Group-1 and 42 in Group-2) were included. The mean age of individuals in groups 1 and 2 were 57.6 ± 5.5 and 61.6 ± 4.3 years, respectively. In Group-1, the mean duration of type-2 diabetes was 10.1 ± 3.5 years. A family history of diabetes was more often reported by individuals in Group-1 than Group-2. In groups 1 and 2, 44 and 42 pairs of adjacent implants, respectively were placed in the regions of missing premolars and molars in both arches. All implants were delayed loaded and were fixed with non-splinted screw-retained restorations. In groups 1 and 2, tooth-brushing twice daily was reported by 79.5% and 85.7% individuals, respectively. There was no difference in peri-implant PI, BOP, PD, mesial and distal CBL and HbA1c levels among individuals in groups 1 and 2. Adjacent implants can remain esthetically and functionally stable in type 2 diabetic patients in a manner similar to healthy individuals provided glycemic levels are strictly controlled and maintained.

A clinical assessment of periimplant marginal bone loss and soft tissue status in dental implant placed by flapless implant surgery. (A one-year prospective study)

Despite several studies have been conducted to evaluate the clinical outcomes offlapless implant surgery limited information presents regarding the clinical conditionsafter flapless implant surgery, for this reason this study was carried out to evaluate theperi-implant marginal bone loss and soft tissue status in dental implant placed byflapless implant surgery.In the present study, 143 implants were placed in 68 patients by using a flapless 1-stage procedure. In these patients, peri-implant soft tissue conditions and radiographicmarginal changes were evaluated one year after surgery.Results: None of the implants was lost during follow-up, giving a success rate of100%. The mean score of GI was (0.28 mm SD = 0.21), the average BOP index was(0.12, SD= 0.05) and the mean pocket probing depth was (2.7 mm, SD= 1.1).The mean marginal bone loss (0,4 mm, SD = 0.49) range ( 0.0 – 1.2 mm ).Whereas 34 implants showed no bone loss at all.The results of this study demonstrate that flapless implant surgery is a predictableprocedure. In addition, it is advantageous for preserving crestal bone and mucosalhealth surrounding dental implants.

A prospective, multi-center study assessing early loading with short implants in posterior regions. A 3-year post-loading follow-up study.

Few prospective studies about early loading of short implant have been available and very little evidence exists on the outcomes longer than 3 years. To assess clinical and radiographic outcomes of 6 mm-short implants placed in the posterior maxilla and mandible applying an early loading protocol. Ninety-five short implants (6 mm-short, Ø 4 mm) were placed in 45 subjects at 3 study sites, 2 or 3 implants per subject, using a one-stage surgical procedure and loaded with a screw-retained splinted fixed prosthesis 6 weeks later. Follow-up took place at 6, 12, 24, and 36 months after loading. Marginal bone level changes, implant survival, clinical variables, and adverse events were assessed. The survival rate for all implants placed was 95.8%. From implant loading to 3 years follow-up, mean marginal bone level changes were minimal (0.07 ± 0.49 mm) and the peri-implant soft tissue status was healthy. No major technical or biological complications occurred except for the 4 early implant losses. Three-year data indicates that the use of splinted 6 mm-short implants is a viable treatment in posterior regions with low marginal bone resorption. Early loading after 6 weeks should be taken cautiously in patients with known risk factors.

Esthetic Assessment of Implants Placed into Fresh Extraction Sockets for Single-Tooth Replacements Using a Flapless Approach.

To validate the concept of immediate implant placement and nonfunctional loading for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria. This study analyzed procedural results as graded by the pink esthetic score and white esthetic score (PES/WES). Thirty-nine suitable patients (mean follow-up 44.82 ± 28 months) were evaluated. Thirty-eight implants fulfilled stringent criteria for successful osseointegration: absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 15.50 ± 2.67 (range: 10-20). The mean total PES of 7.92 ± 1.60 (range: 5-10) indicated favorable overall peri-implant soft-tissue conditions. Root convexity and texture (1.63 ± 0.54) and curvature of the facial mucosa (1.68 ± 0.47) and distal papilla (1.66 ± 0.48) had the highest mean values, whereas acceptable levels of facial tissue (1.53 ± 0.73) and mesial papilla (1.42 ± 0.64) were the most difficult to fully achieve. The mean mesial and distal bone loss at data collection was, was 1.19 ± 0.54 and 1.15 ± 0.51, respectively. Periodontal disease severity (advanced chronic and aggressive periodontitis) was significantly associated with a low total PES (p = .048). Objective PES/WES assessment validated immediate anterior maxillary single-tooth replacement and restoration as being a successful and esthetically predictable treatment modality in sites where the buccal bone had been preserved during the extraction at 1 year of follow-up.

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

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

Survival and tissue maintenance of an implant with a sloped configurated shoulder in the posterior mandible-a prospective multicenter study.

Clinical studies evaluating the influence of the implant design on the preservation of peri-implant keratinized mucosa are rare. The aim of this prospective multicenter study was to investigate the survival, and soft and hard tissue maintenance of an implant with a sloped shoulder configuration, when placed in the posterior mandible. In this study, 24 centers participated and 184 patients receiving 238 implants (OsseoSpeed™ Profile TX implants) were included. Clinical assessments of soft tissue parameters were performed before implant placement, immediately after implant placement, at prosthetic delivery and at 6, 12 and 24months after implant placement and marginal bone adaptation was examined. After an average time insitu of 28.7±4.7months (2.4±0.4years), the survival rate was 99.2%. Analysis of the peri-implant soft tissues during follow-up showed a slight but significant increase in peri-implant keratinized mucosa width after 2years (P<0.001). All patients with reduced peri-implant keratinized mucosa width of ≤ 2mm at postoperative examination (n=95) showed a pronounced and statistically significant increase in the peri-implant keratinized mucosa width over time (P<0.001). After a mean follow-up of 20.7±8months (1.7±0.7years), mean inter-proximal marginal bone loss was 0.30±0.6mm, indicating high bone stability around the sloped implant neck. These results indicate that sloped configurated implants have a high survival rate after 2years in function. The sloped implant shoulder configuration helps to support the hard and soft tissue around the implant neck and supports the regain of a physiological peri-implant keratinized mucosa in patients with compromised peri-implant soft tissue conditions (Clinicaltrials.gov: NCT01400321).

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

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

Radiological and Biological Assessment of Immediately Restored Anterior Maxillary Implants Combined with GBR and Free Connective Tissue Graft.

Radiologic and biologic assessment of immediately restored Implants combined with guided bone regeneration (GBR) and free connective tissue graft. 1-4 year retrospective study involving 34 patients treated with maxillary immediately restored anterior single-implants. Soft tissue dimensions, radiographic bone loss, and biological and prosthetic complications were assessed. During the mean follow up period of 29 months the study group presented a mean mesial bone loss of 1.10 ± 0.39 mm (range: 0.5-2.4 mm), and mean distal bone loss of 1.19 ± 0.41 mm (range: 0.4-2.1 mm). Mean periimplant probing depth of 3.49 mm (SD ± 1.06) and 2.35 (SD ± 0.52) for the contralateral tooth (highly significant p < 0.001). Bleeding on probing was present in 29.4% of the examined implant supported crown sites and 10.4% of the contralateral teeth (p < 0.001). Anterior maxillary single-tooth replacement, using GBR and connective tissue graft according to the concept of immediate implant placement, and non-functional restoration is an accepted treatment modality achieving favorable peri-implant soft tissue condition.

Esthetic assessment of immediately restored implants combined with GBR and free connective tissue graft.

Esthetic assessment of immediately restored implants combined with GBR and free connective tissue (CT) graft METHODS: A case-control, retrospective study involving 34 patients treated with maxillary anterior single implants, immediately placed and restored. Clinical and esthetic results were analyzed using standard clinical examination and a comprehensive index, comprising pink esthetic and white esthetic scores (PES/WES). The height of the implant crown and the corresponding height of the contralateral tooth crown were measured to identify mucosal recessions. The distance from the mucosal margin to the implant shoulder (DIM) was measured on the master model. Thirty of 34 implants fulfilled the strict success criteria set for dental implants with regard to osseointegration. Success was defined as implants with bone loss not exceeding 1.5mm during the first year and loosing not more than 0.2 for each successive year. The other four implants were stable but did not meet the bone loss criteria mentioned above and defined as survived implants. Mean PES/WES was 14.44±2.34 (range: 9-20). Mean PES was 7.12±1.89 (range: 1-10). The highest mean values were achieved for the variable of root convexity/soft tissue color and texture (1.71±0.46) whereas the mesial papilla (1.09±0.62) proved to be the least pleasing. The mean WES was 7.32±1.25 (range: 5-10). The difference between IC and contralateral TC was 0.54mm. The mean value for the facial DIM was 3.82±0.87mm. An evaluation of soft and hard tissue augmentation in immediately restored immediate implant procedures was employed to obtain stable hard and soft tissues. The combined GBR and CT graft procedure achieved favorable peri-implant soft tissue condition and esthetic results. However, recession and incomplete papillas were frequently observed.

Minimizing excess cement in implant-supported fixed restorations using an extraoral replica technique: a prospective 1-year study.

Cementation of implant-supported restorations poses two major challenges: (1) minimizing excess cement (reducing the risk of peri-implantitis), and (2) establishing sufficient retention (reducing the risk of decementation). This study presents the first data on a clinical cementation technique that might address both problems. Between 2011 and 2013, 39 patients were provided with 52 implants supporting 52 single crowns (SCs). All restorations were cemented extraorally using replicas made of pattern resin and zinc oxide cement. All decementation events and the peri-implant soft tissue status were assessed and compared with those from a group of 29 patients with 40 conventionally cemented SCs (control). In the experimental group, after 12 months, decementation was recorded in three individuals (7.69%) with 3 SCs (5.77%). In the control group, after 12 months, no case of decementation was recorded. No cases of peri-implantitis were detected in either group. Within the limitations of this study, the authors conclude that the use of zinc oxide cement initially establishes sufficient retention of implant-supported fixed restorations independent of conventional or replica cementation techniques.

Long-Term Retrospective Clinical and Radiographic Follow-up of 205 Brånemark System Mk III TiUnite Implants Submitted to Either Immediate or Delayed Loading.

Studies are needed to evaluate long-term performance of immediately loaded implants with moderately rough surface. This retrospective study evaluated long-term survival and periimplant soft and hard tissue conditions in patients treated with TiUnite implants. Forty-one consecutive patients (mean age, 52.6 years) received 205 Brånemark System Mk III TiUnite implants (145 maxillary, 60 mandibular). The indication was single tooth (n = 7 implants), partial (n = 94), or full arches (n = 104). One hundred thirteen implants were immediately loaded. Cumulative survival rate (CSR) of implants was assessed. Long-term marginal bone remodeling, probing pocket depth (PPD), and periimplant mucosa conditions were assessed. Follow-up averaged 8.8 years (range, 6.6-10.6 years). Eight implants in 5 patients failed. CSR was 96.1% (implant basis) and 87.8% (patient basis) up to 10 years. At the longest follow-up, bone loss averaged 0.43 ± 1.15 mm (n = 173), PPD averaged 3.64 ± 0.74 mm, and periimplant mucosa was healthy in 74.6% of cases. Furthermore, 50.3% and 35.5% of implants scored negative for plaque and bleeding, respectively. No significant difference in CSR and hard and soft tissue conditions was found in the long term between immediately and delayed loaded implants. Implants with TiUnite surface demonstrated excellent long-term survival, marginal bone response, and soft tissue conditions, despite a nonoptimal level of oral hygiene.

Decementation Rates and the Peri-Implant Tissue Status of Implant-Supported Fixed Restorations Retained via Zinc Oxide Cement: A Retrospective 10-23-Year Study.

Long-term data on clinical outcomes of restorations attached to implants via zinc oxide (ZnO) cement have been sparse. The purpose of this study was to retrospectively investigate decementation rates and peri-implant tissue status of implant-supported fixed restorations retained by ZnO cement. Between 1989 and 2003, 63 partially edentulous patients received 93 implants. Of these, 27 patients received 36 screwed single crowns (SC) and served as a control (C group). The other 36 patients had their restorations cemented using ZnO cement. They were subdivided into a SC group and a fixed dental prosthesis (FDP) group. After between 10 and 23 years (mean: 13.22 ± 3.21), all decementation events and peri-implant soft tissue status were evaluated using patient records. Decementation was assessed in 57 implants supporting 30 SCs and 16 FDPs. Five cases of decementation (8.77%) were recorded after a mean of 9.27 ± 7.05 years (range: 4.81-21.79). In the control group of vertically screwed SCs, five events of screw loosening (13.89%) were recorded in five patients (18.52%) after a mean of 5.84 ± 5.96 years (range: 0.56-15.05) within a 14.30 year observation period. No cases of peri-implantitis were observed in any group. The mean values of periodontal probing depths and bleeding on probing (BOP+) were 3.74 mm and 31.58%, respectively, for ZnO-cemented restorations, versus 3.76 mm and 25%, respectively, for the C group. No significant correlations regarding technical/biologic complications between the groups were detected. Within the limitations of this study, we conclude that the use of ZnO cement provides sufficient retention of implant-supported fixed restorations over long periods without biologic complications in form of peri-implantitis.

Soft tissue grafting to improve the attached mucosa at dental implants: A review of the literature and proposal of a decision tree.

Scientific data and clinical observations appear to indicate that an adequate width of attached mucosa may facilitate oral hygiene procedures thus preventing peri-implant inflammation and tissue breakdown (eg, biologic complications). Consequently, in order to avoid biologic complications and improve long-term prognosis, soft tissue conditions should be carefully evaluated when implant therapy is planned. At present the necessity and time-point for soft tissue grafting (eg, prior to or during implant placement or after healing) is still controversially discussed while clinical recommendations are vague. To provide a review of the literature on the role of attached mucosa to maintain periimplant health, and to propose a decision tree which may help the clinician to select the appropriate surgical technique for increasing the width of attached mucosa. The available data indicate that ideally, soft tissue conditions should be optimized by various grafting procedures either before or during implant placement or as part of stage-two surgery. In cases, where, despite insufficient peri-implant soft tissue condition (ie, lack of attached mucosa or movements caused by buccal frena), implants have been uncovered and/or loaded, or in cases where biologic complications are already present (eg, mucositis, peri-implantitis), the treatment appears to be more difficult and less predictable. Soft tissue grafting may be important to prevent peri-implant tissue breakdown and should be considered when dental implants are placed. The presented decision tree may help the clinician to select the appropriate grafting technique.

Critical soft-tissue dimensions with dental implants and treatment concepts.

Dental implants have proven to be a successful treatment option in fully and partially edentulous patients, rendering long-term functional and esthetic outcomes. Various factors are crucial for predictable long-term peri-implant tissue stability, including the biologic width; the papilla height and the mucosal soft-tissue level; the amounts of soft-tissue volume and keratinized tissue; and the biotype of the mucosa. The biotype of the mucosa is congenitally set, whereas many other parameters can, to some extent, be influenced by the treatment itself. Clinically, the choice of the dental implant and the position in a vertical and horizontal direction can substantially influence the establishment of the biologic width and subsequently the location of the buccal mucosa and the papilla height. Current treatment concepts predominantly focus on providing optimized peri-implant soft-tissue conditions before the start of the prosthetic phase and insertion of the final reconstruction. These include refined surgical techniques and the use of materials from autogenous and xenogenic origins to augment soft-tissue volume and keratinized tissue around dental implants, thereby mimicking the appearance of natural teeth.

Masticatory rehabilitation following upper and lower jaw reconstruction using vascularised free fibula flap and enossal implants-19 years of experience with a comprehensive concept.

Conventional prosthesis is generally inapplicable following reconstruction with free fibula flaps (FFF) due to impaired bone and soft tissue conditions, and rehabilitation via enossal implants in FFF is relatively novel. This retrospective study aimed to document the surgical aspects of this option and to describe related supplementary procedures that can help optimise the definitive outcome. One hundred nineteen implants were inserted within FFFs in 37 patients (mean age 51.8 ± 10.6 years), who underwent ablative surgery of the maxilla (3) and mandible (34). In a cross-sectional study design with a follow-up period of 3-172 months, we analysed types and configurations of graft design, patterns of implant insertion and methods for prosthetic rehabilitation as well as primary stability and survival rate. Most patients underwent jaw reconstruction using a mono-barrel FFF (14 osseous and 18 osteocutaneous/osteomyocutaneous); three patients received double-barrel reconstruction of the mandible. Three patients with maxillary defects were reconstructed using mono-barrel grafts (one osteocutaneous and two prefabricated grafts). Pre-prosthetic procedures were required in 23 patients to optimise conditions in the peri-implant soft tissue. Iliac bone onlay graft was used in six patients to achieve appropriate vertical height in mono-barrel grafts. A total of 10 implants in eight patients (five irradiated) could not be loaded. All other implants showed stable osseous integration and satisfactory peri-implant soft tissue conditions. Masticatory rehabilitation can be achieved using enossal implants inserted in FFF. Special requirements can be met through selection of an appropriate graft configuration and optimal implant positioning. Supplementary pre-prosthetic procedures are usually required as they improve long-term survival. This overview provides a reliable and comprehensive algorithm for standard implant-borne rehabilitation of patients with fibula grafts.

Pre-fabricated zirconium dioxide implant abutments for single-tooth replacement in the posterior region: success and failure after 3 years of function

Objective. Zirconia implant abutments have gained a much broader clinical use over the past few years. The aim of the present study was to assess the clinical performance of a pre-fabricated zirconium dioxide implant abutment for single-tooth replacement in the posterior region. Materials and methods. Forty implants of the XiVE® S plus screw type (DENTSPLY Friadent, Mannheim, Germany) were inserted in the posterior region of 24 patients and provided with zirconium dioxide abutments (FRIADENT® CERCON® Abutment, DENTSPLY Friadent). The following parameters were used to document the state of soft tissue: modified plaque index, modified sulcus bleeding index and pocket depth. Mesial and distal bone levels were determined on radiographs during the prosthetic treatment and at the 36-month recall. Results. Thirty-seven implants could be followed up after 36 months in function. One patient wearing two abutments was lost to follow-up. One abutment exhibited a rotational misfit after 2 years in function. A further abutment showed the same failure at the 36-months recall appointment. In the remaining 36 implants the soft and hard tissue parameters were indicative of a low inflammatory status. Compared to the baseline situation, a partly significant bone apposition could be observed. Chipping of parts of the veneering ceramic was registered in 22% of the remaining implant restorations. Conclusions. The use of zirconia abutments in this study lead to mainly healthy peri-implant hard and soft tissue conditions but, considering the observed failures after 3 years in function, clinical long-term results should be awaited before recommending full zirconia implant abutments in a posterior indication.