Peri-implant Soft Tissue Research Articles

Survey on Patient Perception of At-Home Bacterial Biofilm Control in Relation to Peri-Implant Soft Tissue Health.

Bacterial biofilm control around dental implants is critical for the health of the peri-implant soft tissue and longevity of dental implants. The patient's role in regular biofilm removal around dental implants is just as important as that of the dental hygienist. The purpose of this study is to identify the relationship between at-home dental implant care and patients' perceptions of peri-implant soft tissue health. A 15-item paper survey was distributed to adult patients undergoing professional dental hygiene maintenance at a specialty dental practice within a 3-month period and had at least one dental implant. Survey items included participant demographics, patient-reported adjunctive aids for dental implants and patient perceptions of dental implant oral hygiene practices and peri-implant soft tissue health. There was a statistical difference between time spent cleaning dental implants and peri-implant soft tissue health. An association was found between patients who reported spending more time cleaning their dental implants and less bleeding (p = 0.046/54%), gingival inflammation (p = 0.026/58%) and gingival tissue redness (p = 0.036/53%). Additionally, patients who more frequently underwent professional dental hygiene maintenance perceived less gingival inflammation (p = 0.001/66%). To promote peri-implant soft tissue health and reduce oral biological complications, best practice guidelines should be implemented, including optimal at-home dental implant care and regular professional dental hygiene maintenance.

Effect of soft tissue volume on midfacial gingival margin alterations following immediate implant placement in the esthetic zone: a 1-year randomized clinical and volumetric trial.

The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm3) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. The midfacial gingival margin changes demonstrated a significant difference (P ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm3) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference (P > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm3) after 1 year and mid-facial gingival margin changes (P ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group (P = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups (P ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant(P > 0.05). This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm3) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Soft tissue response to titanium healing abutments treated by Er: YAG laser or plasma spray: A randomized controlled feasibility clinical study with SEM and histological analysis.

Soft tissue seal around implants ensures stable osseointegration and a long-term survival of dental implants. Different surface modification and decontamination for implant abutments were endorsed in order to improve peri-implant soft tissue healing, such as laser, plasma spray, acid etching, and steaming. The aim of this study was to evaluate the response of peri-implant soft tissue to titanium abutments treated with Erbium-doped: Yttrium-Aluminum-Garnet (Er:YAG) laser versus plasma spray. Twenty-four patients who required implant placement in the maxillary arch participated in this study. Patients were divided into three groups, abutments treated with Er:YAG laser versus cold plasma spray and untreated abutments. Fourteen days following the implant abutment insertion, soft tissue peri-implant biopsies were taken for histological, histochemical, and immunohistochemical evaluation. Scanning electron microscopy was done for the abutments; plaque index (PI) and gingival index (GI) were assessed 14 days and 3 months following final restoration. Regarding the histological results, the least mean inflammatory cell count was in the plasma group (174.09 ± 40.67), followed by the laser group (654.27 ± 85.95) and the control group (852.00 ± 117.98), with statistically significant differences between them. The mean area fraction of collagen fibers showed the highest value in the plasma group (9.73 ± 1.91), followed by the laser group (3.25 ± 0.49), while the lowest value was found in the control group (1.17 ± 0.51). The immunohistochemical expression of E-cadherin was significantly higher and uniformly distributed in the plasma group (42.4 ± 11.2%) followed by the laser group (15.4 ± 4.07%) and the control group (6.8 ± 1.7%). SEM analysis of healing abutments showed fibroblast-like cells, which were more developed with dense fibers in the plasma group; laser group fibers showed fewer and more delicate fibers than the plasma group, while no fibers were detected in the control group. Within the limitations of this feasibility study, the present data concluded that plasma spray and Erbium: YAG laser can be used for abutment surface treatment to achieve better peri-implant soft tissue healing. Clinically and histologically, plasma spray showed a better effect on the peri-implant soft tissues by reducing the inflammatory reaction, promoting collagen fiber formation, higher fibroblast-like cell attachment, and upregulating E-cadherin expression than Erbium: YAG laser and control groups.

Preformed customized healing abutments in a biologically oriented preparation technique procedure: a 3-year retrospective case-control study.

The objective of the present study was to determine the 3-year clinical and dimensional soft tissue change following implant placement in healed sites before and after loading with either customized or conventional healing abutments. Premolar/molar implants were immediately loaded with either provisional and customized abutments without finishing lines according to the principles of the biologically oriented preparation technique (BOPT; test group) or conventional healing abutments (control group). Three months later, the definitive crowns were fabricated. Primary outcomes (soft tissue changes) and secondary outcomes (adverse events) were registered. A total of 50 of the 87 subjects who were originally included were finally selected for the present retrospective analysis: 23 in the test group and 27 in the control group. During the first days after surgery, two adverse events of mucositis occurred, one in each group. A few technical complications were recorded such as the unscrewing of four screw-retained crowns. A significant increase in the alveolar width was observed in both groups (test: +2.5 ± 0.5 mm; control: +1.0 ± 0.9 mm). The widths appeared unchanged from 3 months to 3 years in both groups. There were no significant differences regarding the width of the keratinized mucosa measured at baseline and after follow-up. The Jemt papilla index showed a higher increase in the test group compared with the control group. Within the 3-year follow-up period, the peri-implant soft tissue outcomes of single, immediately loaded implants with customized healing abutments showed better results in terms of thickness and width compared with those of the conventional group. The number of side effects (mucositis and dehiscence) appeared to be very similar for both groups. In addition, customized healing abutments led to significant augmentation of the alveolar width, which was more than twice of that registered in the conventional group.

The Efficacy of Leukocyte-Platelet-Rich Fibrin in Combination with Sub-Epithelial Connective Tissue Graft in Peri-Implant Soft Tissue Augmentation: A Randomized Controlled Clinical Trial

Aims and Background The aim of the current study is to assess and compare the efficacy of the leukocyte-platelet-rich fibrin [L-PRF] in combination with sub-epithelial connective tissue graft [SCTG] and SCTG only in promoting aesthetic results and strengthening the state of the soft tissue surrounding implants. Materials and Methods A parallel-arm randomized controlled clinical trial was used for this investigation. A total of 120 patients who had missing teeth with a thin gingival biotype [less than 1.5 mm] were included in this study. The patients of Group I were treated with PRF and SCTG during second-stage implant surgery, while the patients of Group II were treated with SCTG only. Treatment outcomes included the assessment of the width and thickness of the keratinized tissue at the baseline, 3 and 6 months postoperatively; pro- and anti-inflammatory cytokines [IL-1β, TNF-α, and IL-4] in the peri-implant crevicular fluid on the 1st, 7th and 30th days after surgical procedure; swabs from the surface of postoperative wounds of the mucous membrane on days 3, 5, 7, and 10; Pink aesthetic score [PES] 6 months after prosthesis placement; and laser Doppler flowmetry on days 1, 7, and 14 after augmentation. Results and Discussion Patients who received L-PRF+SCTG had a significant increase in keratinized tissue thickness [KTT] [p = 0.08] than those who received SCTG only [KTT 1.86 ± 0.17 Vs 1.48 ± 0.15] 6 months after surgery. The mean [±SD] of PES was found to be 13.1 [±0.02] for Group I and 11.3 [±0.08] for Group II. The cytology, LDF, and local immunoassay analysis demonstrated faster epithelialization and better revascularization in Group I. Conclusion The use of L-PRF and SCTG is an effective method in augmenting peri-implant soft tissue and improving gingival biotype and aesthetic outcomes, which would help overcome complications and increase patients’ satisfaction.

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.

Peri-implant Hard and Soft Tissue Changes around Nonsubmerged and Submerged Implants Under Different Loading Conditions: A Split-mouth Randomized Clinical Trial

Peri-implant Hard and Soft Tissue Changes around Nonsubmerged and Submerged Implants Under Different Loading Conditions: A Split-mouth Randomized Clinical Trial

Peri-implant soft tissue management with commercial healing abutment and customized sealing socket abutment after immediate implantation on upper molars: A case report of profilometric analysis

The purpose of this case report is to compare the mucosal change that occurs at the coronal aspect on the posterior teeth with commercial healing abutment (HA) and sealing socket abutment (SSA). A total of 4 cases are introduced in the present case report. Two cases of immediate implant using HA (one premolar and one molar) and two cases using SSA (one premolar and one molar) method are compared. Intra-oral scanned stereolithographic (STL) images are used to compare the horizontal and vertical change before extraction and 6 months post-surgery. Less horizontal and vertical changes were observed when SSAs are used compared to HAs. With the aid of digital dentistry, SSA is a prompt and effective method to maintain peri-implant mucosal contour after the immediate implantation in the posterior site.

Current view of inflammatory postprosthetic complications of dental implantation and methods of their prevention (literature review)

Subject. A literature review was conducted on a current topic in dental implantology – long-term complications of dental implantation of inflammatory nature detected after the placement of prosthetic structures. The purpose of this literature review is to analyze studies that address inflammatory complications in dental implant treatment. Methods: The study reviewed full-text publications in English and Russian that deal with postprosthetic complications of dental implantation. The following search engines were used in the literature search process: Pubmed, e-Library, Cyberleninka by keywords. The time period was designated as 2019-2024. There were 948 publications identified on this topic. Of these, 32 publications corresponded to the purpose of our study. Results. Studies on the prevalence and identification of risk factors of late complications encountered in dental implantation are extremely important for planning complex rehabilitation of patients with partial secondary oral adentia, for understanding the occurrence and progression of these complications. The study of measures to eliminate one of the main causes of these complications, namely the lack of attached keratinized gingiva, will improve the strategy of prevention and treatment of this pathology to improve the quality of life of patients. Conclusions. Current trends in dental implantation require not only achieving implant osseointegration, but also obtaining healthy peri-implant soft tissues to avoid late implant complications such as peri-implant mucositis and peri-implantitis. There are many studies describing surgical methods of increasing the volume of attached keratinized gingiva necessary for stable implant functioning.

Comparative Evaluation of Soft Tissue Reaction to Titanium and Polyetheretherketone Customized Healing Abutments: a Split-Mouth Randomised Clinical Trial

Aim. This study aimed to evaluate the peri-implant soft tissue response to customized healing abutments (CHAs) made of titanium and polyetheretherketone (PEEK). Methods. Titanium and PEEK CHAs were mounted on bone-level dental implants in bilateral edentulous patients in a randomized split-mouth study design. After a three-week healing period, the clinical parameters of the peri-implant soft tissues were assessed. The value of marginal bone resorption was measured by cone-beam computed tomography. In addition, peri-implant crevicular fluid samples were obtained to identify periodontal pathogenic bacteria, cytokine levels, and active neutrophil collagenase (aMMP-8) concentration. Microcirculation and oxygenation parameters were assessed using laser Doppler flowmetry and optical tissue oximetry. In addition, wavelet analysis was conducted to study blood flow control mechanisms. Results. Out of the 23 participants initially recruited, 20 were assessed after titanium and PEEK CHA installation due to losses to follow-up. The peri-implant soft tissue around 27 titanium and 25 PEEK CHAs was evaluated during follow-ups. No differences were found in the values of marginal bone resorption, cytokine levels, or total bacterial load (p>0.05). PEEK CHAs demonstrated lower bleeding on probing values, less plaque accumulation, and faster relief of ischemia and hypoxia. Although aMMP-8 concentration was higher in the PEEK group, the values were within normal limits. Conclusions. The results of this comparative study showed a positive soft tissue response to PEEK CHAs. However, further studies comparing the effectiveness of different materials for CHAs should be carried out, considering their specific physical properties and processing protocols.

Porcine Cross-Linked Collagen Matrix for Peri-Implant Vertical Soft Tissue Augmentation: A Randomized Prospective Observational Study.

The mucosa height has always been of interest in modern implant dentistry to obtain biomimetic results. Papilla height, mucosa scalloping, and free mucosal margin level are crucial to achieve "pink aesthetics". The aim of this study was to investigate the vertical increase in the peri-implant soft tissues with a porcine cross-linked collagen matrix (Geistlich Fibro-Gide®). Methods: A total of 60 patients were divided into the following three groups: Group 1-patients who received porcine cross-linked collagen matrix for vertical soft tissue augmentation and a cover screw combined with a coronally advanced flap (CAF); Group 2-patients who received the collagen matrix combined with a healing abutment and CAF; Group 3 (control group)-patients who received a traditional surgical approach based on crestal incision and no collagen matrix as well as no CAF. Results: The average horizontal tissue thickness growth after 3 months was more effective for Group 1 (1.35 ± 1.23 mm) compared to Group 2 (0.85 ± 0.67 mm) and the control group (0.20 ± 0.41 mm). The average tissue height growth was 1.05 ± 1.39 mm for Group 1, 0.32 ± 1.28 mm for Group 2, and -0.05 ± 0.39 mm for the control group. Finally, the average increase in the band of keratinized mucosa was 0.60 ± 1.23 mm for Group 1, -0.60 ± 0.94 mm for Group 2, and 0.45 ± 0.60 mm for the control group. Conclusions: The combination of the CAF, porcine cross-linked collagen matrix, and cover screw resulted in better clinical results compared to Group 2 and 3.

Immediate Insertion and Restoration of a Single Implant to Replace Two Adjacent Periodontally Compromised Lower Incisors: A Technique Report with up-to-8 Years Follow-up.

The study investigated the cumulative survival rate (CSR) and marginal bone loss (MBL) of single implants immediately placed and restored with two-unit cantilevered fixed dental prostheses after extraction of two adjacent mandibular incisors with a compromised periodontal condition. Patients in need of extraction and replacement of two adjacent mandibular incisors due to advanced periodontal loss of attachment were treated consecutively. Following a flapless procedure, a single implant was inserted at the time of extraction in one of the two fresh alveoli sockets and immediately restored with a screw retained two-unit provisional FDP. The area of extraction was grafted using xenograft particulate material. Peri-implant soft tissue and hard tissue condition at the last follow-up appointment, marginal bone loss at the last follow-up appointment at least 1 year after the delivery of the final prosthesis, and the final aesthetic result were evaluated. Twenty patients were recruited between January 2014 and December 2019 in a single private practice and each received single implants and immediate provisional restoration with a two-unit cantilevered fixed dental prosthesis. Patients were followed for 22 to 94 months (average follow-up = 4 years) and none of the implants failed resulting in 100% CSR. Cumulative MBL -measured using the VixWin Platinum software -was 1.08 +/- 0.35. A lower MBL was observed in the presence of platform switching (0.63 +/- 0.11 mm) compared to the absence of platform switching (1.27 +/- 0.20 mm). The preliminary results obtained from this study suggest that patients in need of replacing two adjacent periodontally compromised mandibular incisors can be treated with an immediately inserted and restored single implant.

Fibrin clot adherence on cleaned and decontaminated titanium abutment surfaces: An in vitro study.

Osseointegration is now primarily established, but soft tissue integration is still susceptible to failure and problematic on implant surfaces. So, implant dentistry is increasingly focusing on improving peri-implant soft tissue integration. The present study aimed to evaluate the blood fibrin clot formation and adhesion on the abutment after cleaning and decontamination and determine the suitable abutment surface associated with fibrin clot attachment. Forty-two abutments (14 per group) were used in the present study: a brand-new (BN), contaminated with biofilm (CO) and decontaminated with an enzymatic cleaner and autoclave sterilization (DEC). For a fibrin clot, 9 mL of whole human blood and abutments was centrifuged at 2700 rpm for 12 min. Clots were divided into two parts for histomorphometry and scanning electron microscopy (SEM) analysis. Twelve abutments disconnected from the clot and two not treated with blood were observed under SEM. Residual debris and biofilm were observed on the abutment surface in the CO group but not in other groups. Healthy and organized fibrin clots formed on all abutments. The fibrin extension areas are distributed uniformly in BN and DEC groups but irregularly in CO. The surface percentage of the fibrin clot extensions was 41.76% ± 6.73, 26.99% ± 6.40, and 37.83% ± 9.72 for the BN, CON, and DEC groups, respectively. The blood clot-attached areas in the CO group were statistically lower than the other groups. No difference was observed between the BN and DEC groups. This study confirmed that surface contamination could influence blood clot attachment on the abutment surfaces. Cleaning and sterilization can have a favorable effect on soft tissue healing on abutment surfaces.

Histological and immunohistochemical soft-tissue response to cylindrical and concave abutments: Multicenter randomized clinical trial.

This study aimed to analyze the influence of concave and cylindrical abutments on peri-implant soft tissue. Dimensions, collagen fiber orientation, and immunohistochemical data were assessed. A multicenter, split-mouth, double-blind randomized clinical trial was conducted. Two groups were analyzed: cylindrical abutments and concave abutments. After a 12-week healing period, peri-implant soft tissue samples were collected, processed, and evaluated for dimensions, collagen fiber orientation, and immunohistochemical data. Inflammatory infiltration and vascularization were assessed, and the abutment surfaces were analyzed using scanning electron microscopy. The statistical analysis was performed using the SPSS version 20.0 statistical package. A total of 74 samples in 37 patients were evaluated. Histological evaluation of peri-implant soft tissue dimensions revealed significant differences between concave and cylindrical abutments. Concave abutments exhibited greater total height (concave: 3.57±0.28 - cylindrical: 2.95±0.27) and barrier epithelium extension (concave: 2.46±0.17 - cylindrical: 1.89±0.21) (p<0.05), while the supracrestal connective tissue extension (concave: 1.11±0.17 - cylindrical: 1.03±0.16) was slightly greater (p>0.05). Collagen fiber orientation favored concave abutments (23.76±5.86), with significantly more transverse/perpendicular fibers than for cylindrical abutments (15.68±4.57). The immunohistochemical analysis evidenced greater inflammatory and vascular intensity in the lower portion for both abutments, though concave abutments showed lower overall intensity (concave: 1.05±0.78 - cylindrical: 1.97±0.68) (p<0.05). The abutment surface analysis demonstrated a higher percentage of tissue remnants on concave abutments (42.47±1.32; 45.12±3.03) (p<0.05). Within the limitations of this study, concave abutments presented significantly greater peri-implant tissue height, linked to an extended barrier epithelium, versus cylindrical abutments in thick tissue phenotype. This enhanced soft tissue sealing, favoring a greater percentage of transversely oriented collagen fibers. The concave design reduced chronic inflammatory exudation with T and B cells, thus minimizing the risk of chronic inflammation. This study looked at how 2 different shapes of dental implant abutments (the parts that connect the implant to the crown), specifically concave and cylindrical, affect the soft tissue around the implants. We wanted to see how these shapes influenced the tissue's size, structure, and health. We conducted a clinical trial with 37 patients, comparing the 2 types of abutments in the same mouth over 12weeks. Our findings showed that the concave abutments led to a taller and more extensive layer of protective tissue around the implant compared to the cylindrical ones. This protective tissue had more favorable collagen fiber orientation, which is important for the strength and health of the tissue. Additionally, the concave abutments resulted in less inflammation and better tissue integration. In conclusion, concave abutments may provide better support and health for the soft tissue around dental implants, reducing the risk of chronic inflammation and potentially leading to better long-term outcomes for patients with dental implants.

Consensus Report by the Italian Academy of Osseointegration on the Importance of Peri-Implant Soft Tissues.

Background and Objectives: The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions: The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.

Survival rate and aesthetic outcomes of two-piece zirconia dental implants: A one-year single clinical trial of partially edentulous patients.

Titanium dental implants, traditionally used for tooth replacement, face certain biological and aesthetic limitations. Recently, zirconia has become a notable alternative, valued for its aesthetics and biocompatibility. This study evaluated the efficacy of two-piece zirconia dental implants, particularly their impact on inflammatory cytokines and their survival rate over one year. This study was a single-center, prospective trial and included adults aged 18 and above. 2021-2022, nine two-piece tissue-level zirconia implants were placed in eight patients. Following a three-month osseointegration phase, crowns were cemented. Over a year, we assessed Plaque and Gingival indices, Pocket Depth, and tissue color and texture. Peri-apical radiographs measured bone levels, and IL-1β in peri-implant crevicular fluid (PICF) was quantified using ELISA. Eight subjects (ages 31-63) participated. One implant failed after six months, resulting in a one-year survival rate of 88.8%. Plaque and Gingival indices rose, but peri-implant soft tissue remained stable in color and texture. At 12 months, average bone loss was minimal and insignificant compared to the baseline. IL-1β levels were similar to those at contralateral teeth, with no correlation between IL-1β, Pocket Depth, and Bleeding on Probing. Two-piece zirconia implants emerged as a viable tooth replacement option, with an 88.8% one-year survival rate. They maintained stable soft tissue and bone levels, indicating their potential as effective dental restoratives.

Clinical outcomes of free gingival graft vs. palatal pedicle graft in peri-implant soft tissue phenotype modification: A randomized controlled trial comparing patient reports.

Clinical outcomes of free gingival graft vs. palatal pedicle graft in peri-implant soft tissue phenotype modification: A randomized controlled trial comparing patient reports.

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.

Clinical efficacy of two vertical soft tissue augmentation techniques for peri-implant crestal bone level stability: A randomized clinical trial.

This study aimed to compare the efficacy of two techniques-acellular dermal matrix (ADM) grafting and tenting technique (TT)-for soft tissue height (STH) augmentation simultaneous to implant placement to minimize peri-implant crestal bone level (CBL) changes. Forty patients with a healed single mandibular posterior edentulous site with a thin soft tissue phenotype were enrolled. Twenty patients received simultaneously to implant placement ADM grafting, while the others received submerged healing abutment (TT). Clinical peri-implant soft tissue height and radiographic CBL changes were measured at restoration delivery and 1-year follow-up. Both techniques effectively increased soft tissue thickness, resulting in a final average STH of 3.4 ± 0.5 mm after augmentation. On average, soft tissue increased by 1.6 ± 0.5 mm in group ADM and by 1.8 ± 0.4 mm in group TT after augmentation. In Group ADM, mesial CBL decreased from 0.4 ± 0.3 mm to 0.1 ± 0.2 mm, and distal CBL decreased from 0.5 ± 0.3 mm to 0.2 ± 0.3 mm over 1 year. In Group TT, mesial CBL remained stable at 0.3 ± 0.2 mm, while distal CBL reduced slightly from 0.5 ± 0.5 mm to 0.3 ± 0.2 mm. Both groups showed minimal changes in CBL, indicating great stability (pmesial = 0.003, pdistal = 0.004). TT was particularly effective in preventing mesial bone loss (pmesial = 0.019). The mesial CBL changes significantly differed between groups (p = 0.019), and not significantly at distal sites (p = 0.944). Neither treatment exhibited significant bone remodeling below the implant shoulder. This study suggests that both techniques were successful in STH augmentation, and they may effectively reduce peri-implant crestal bone level changes, with TT being slightly superior. TT was more prone to post-surgical complications. This RCT was not registered before participant recruitment and randomization.

Peri-implant soft tissue management: a clinical guide.

Peri-implant soft tissue management: a clinical guide.