Peri-implant Tissue Health Research Articles

Influence of the keratinized mucosa on the stability of peri-implant tissues and brushing discomfort: A 4-year follow-up study.

The purpose of the present prospective follow-up study was to evaluate the long-term influence of the peri-implant keratinized mucosa (KM) on marginal bone level (MBL), peri-implant tissues health, and brushing discomfort. Eighty patients were initially recruited during their maintenance visit from January to October 2013 and allocated in two groups according to KM width around implants: Wide Group (KM≥2mm) and Narrow Group (KM<2mm). In the four-year follow-up examination (T4), marginal bone level (MBL), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BoP), and brushing discomfort (BD) were reassessed and compared to the initial assessments (T0). Mann-Whitney, Wilcoxon signed-rank test, and a multilevel model were used for the statistical analysis. Fifty-four patients with 202 implants returned at T4. Mean mPI (0.91±0.60), BoP (0.67±0.21), and BD (12.28±17.59) were higher in the Narrow Group than in the Wide Group (0.54±0.48, 0.56±0.26, and 4.25±8.39, respectively). Marginal bone loss was higher in the Narrow Group (0.26±0.71) than in the Wide Group (0.06±0.48). Multilevel analysis suggested that KM width and time in function had a statistically significant effect on MBL. The findings of the present study indicate that KM width had an effect on MBL, plaque accumulation, tissue inflammation, and brushing discomfort over the studied period. Thus, the presence of a KM≥2mm around implants appears to have a protective effect on peri-implant tissues.

Evaluation of 0.2% delmopinol mouth rinse for prevention of peri-implant mucositis and peri-implantitis: A randomized controlled canine study.

To evaluate the effectiveness of 0.2% delmopinol mouth rinse in maintenance of peri-implant tissue health and prevention or inhibition of peri-implant mucositis and peri-implantitis. Four weeks following tooth extraction, eight titanium dental implants, were placed in six dogs' mandibles. Three dogs were assigned to the test or placebo mouth rinse. Eight weeks following implant installation (T2) ligature was placed to induce peri-implant disease. Clinical and radiographic assessment was performed during the study period as well as micro-CT analysis and histologic assessment to evaluate Bone-Implant Contact at the end of the follow-up (T4). Plaque at implant sites before ligature placement (T2) was lower for the test group (0.7 ± 1.0 vs 1.5 ± 1.3, P < .05). The ratio of affected implant (PD ≧4 mm) at T2 and T4 in the test group was significantly smaller than that of the placebo group (T2, 17% vs 47%, P < .01; T4, 67% vs 83%, P < .05). The test agent also seemed to be effective in partially preventing bone loss induced by ligature placement according to the Computed Tomography and histologic analysis (test, 1.1 ± 0.8 mm; placebo, 1.5 ± 0.9 mm). Within the limits of this animal model study, the results of the study indicate that the 0.2% delmopinol rinse might play a role in prevention of peri-implant disease development.

Limited Evidence Suggests That Zirconia Abutments Generate Less Bleeding on Probing Around Implants Compared to Titanium Abutments

Effects of modified abutment characteristics on peri-implant soft tissue health: a systematic review and meta-analysis. Sanz-Martín I, Sanz-Sánchez I, Carrillo de Albornoz A, Figuero E, Sanz M. Clin Oral Implants Res 2018; 29(1):118-29. Nonprofit foundation: Oral Reconstruction Foundation, Basel, Switzerland. Systematic review with meta-analysis of data.

Correlation between keratinized tissue width and periodontal indices around implant-supported fixed partial dentures.

Background The effect of keratinized tissue width on the peri-implant health has not been well elucidated. The results of previous studies on this topic are controversial and the role of keratinized tissue width in the long-term success of dental implants has not been confirmed. This cross-sectional study aimed to assess the correlation of keratinized tissue width with periodontal indices around implant-supported fixed partial dentures (FPDs). Methods This cross-sectional study evaluated 73 implants. Patients underwent periodontal examinations, including measurement of plaque index (PI), gingival index (GI), clinical probing depth (PD), bleeding on probing (BOP), marginal gingival recession, keratinized mucosa width and radiographic marginal bone level. Data were analyzed using SPSS. Results The mean GI, PI and marginal gingival recession around implants with <2 mm width of keratinized gingiva were greater than the corresponding values around implants with keratinized tissue width of ≥2 mm. However, this difference was not statistically significant (P>0.05). No significant differences were noted in PD and radiographic marginal bone level between the two implant groups with keratinized tissue width <2 mm and ≥2 mm. Thus, no correlation was found between the keratinized tissue width and the measured indices. Conclusion Although this study did not show a significant correlation between the keratinized tissue width and peri-implant tissue health and consequently the implant success rate, long-term interventional studies are required to make a final judgment in this respect.

Peri-implant tissue healing at implants with different designs and placement protocols: An experimental study in dogs.

To compare the peri-implant tissue response to subcrestal or crestal placement of implants with or without "platform-switched" implant/abutment connections. On each side of the mandible in six Labrador dogs, two "platform-switched" (PS) implants and two implants with matching implant/abutment diameters (PM) were placed in a crestal or a 1.5mm subcrestal position. Sulcus formers/abutments were connected, baseline radiographs obtained and the distance between the abutment-fixture junction (A/F) and the marginal bone level (B) was determined. Five months later, radiographic and clinical examinations were repeated and biopsies were obtained and processed for histological analysis. The radiographic analysis showed that marginal bone level changes occurred during the first observation period (13weeks). PS-implants showed minor marginal bone level alterations during the full observation period (20weeks), regardless of placement depth. For PM-implants, placement had a significant impact on bone level changes; crestal placement resulted in a mean bone loss of 0.4mm and subcrestal placement in a 1.5mm bone loss. The histometric measurements resulted in a distance A/F-B of 0.6 and 0.0mm for PS implants, placed in a crestal or subcrestal position, respectively. The corresponding distance at PM-implants was 1.5mm irrespective of placement protocol. The peri-implant mucosa was thicker at subcrestally placed implants as compared to a crestal placement. Bone remodeling occurred within the early healing phase. During the full 20weeks of observation, PS-implants demonstrated significantly less crestal bone loss compared to PM-implants.

Peri-implant Tissue Health and Bone Resorption in Patients with Immediately Loaded, Implant-Supported, Full-Arch Prostheses.

To evaluate plaque accumulation, peri-implant soft tissue inflammation, and bone resorption in patients with immediately loaded implants supporting fixed full-arch prostheses. A convenience sample of 72 patients treated with fixed full-arch prostheses supported by four to six immediately loaded implants was selected. Bleeding on probing (BOP), Plaque Index (PI), and peri-implant bone loss were measured. The Sixth European Workshop on Periodontology definitions of mucositis and peri-implantitis were used, and collected data were analyzed using a nonparametric test (Spearman's rank correlation). Correlation coefficients (ρ) were defined as follows: < 0.2 = very weak; 0.2 to 0.39 = weak; 0.4 to 0.59 = moderate; 0.6 to 0.79 = strong; 0.8 to 1.0 = very strong. A total of 331 implants were analyzed. The mean follow-up observation time was 5.8 years (range: 1 to 14 years); mean PI and BOP were 61.7% and 21.1%, respectively; and mean bone loss was 0.89 mm (standard deviation [SD] 1.09). The mean probing depth was 1.8 mm (range: 0.5 to 5 mm). Five patients presented with one implant each affected by peri-implantitis (6.9%), and 15 patients presented with at least one implant affected by mucositis (20.8%). No correlation was found between PI and bone resorption (P = .08). Very weak correlations were found between BOP and bone resorption (ρ = 0.18; P = .001) and between PI and BOP (ρ = 0.13, P = .019). The results suggest that plaque accumulation is correlated with peri-implant mucositis; however, plaque accumulation alone does not appear to be associated with bone resorption.

PD013: Importance of keratinized mucosa on peri‐implant tissue health

PD013: Importance of keratinized mucosa on peri‐implant tissue health

Microbiological Aspect in Dental Implants and Natural Teeth with the Impact of Aloe vera Gel

The health of peri-implant tissues is one of the most important aspects for the long-term success of dental implants. Thus the control of bacterial plaque which is the main etiological factor in peri-implant diseases by using an effective preventive regimen and a therapeutic agent is of vital importance in prevention of any irreversible pathological conditions of peri‑implant tissues. The purposeof this study wasto investigate and compare microbiological aspect of subgingival plaque at implants and contralateral natural teeth in the same patients with the impact of Aloe vera gel. 20 females aged 25- 45 year who exhibited the presence of one clinically stable implant carrying a full ceramic crown and one contralateral natural tooth were selected to be enrolled in a split-mouth study. All participants were apparently healthy with no history of any systematic diseases and they have been treated with a two-piece implant system which should be in function for at least 6 months. Samples of subgingival plaque were collected from implants and contralateral teeth for microbial analyses (Gram positive bacteria, Gram negative bacteria and Candida species) at base line and 2 weeks after the application of Aloe vera gel. Microbial analyses revealed no statistically significant difference (p&gt; 0.05) in the counts of microorganisms between implants and teeth, although they were lower in implant than that in teeth. Finding also revealed a significant reduction (p&lt; 0.01) in the count of Gram-positive bacteria and Candida speciesafter application of Aloe vera for both implants and teeth. On the other hand, the count of Gram-negative bacteria seems not to be affected by Aloe vera gel. No differences were found in microbiological analysis of subgingival plaque from dental implants and teeth in the same patient. Moreover, Aloe vera is a promising herb with antimicrobial activity that could be used as a beneficial agent in treatment and prevention of peri-implant diseases.

Effects of soft tissue augmentation procedures on peri-implant health or disease: A systematic review and meta-analysis.

To review the dental literature in terms of soft tissue augmentation procedures and their influence on peri-implant health or disease in partially and fully edentulous patients. A MEDLINE search from 1966 to 2016 was performed to identify controlled clinical studies comparing soft tissue grafting versus no soft tissue grafting (maintenance) or two types of soft tissue grafting procedures at implant sites. The soft tissue grafting procedures included either an increase of keratinized tissue or an increase of the thickness of the peri-implant mucosa. Studies reporting on the peri-implant tissue health, as assessed by bleeding or gingival indices, were included in the review. The search was complemented by an additional hand search of all selected full-text articles and reviews published between 2011 and 2016. The initial search yielded a total number of 2,823 studies. Eligible studies were selected based on the inclusion criteria (finally included: four studies on gain of keratinized tissue; six studies on gain of mucosal thickness) and quality assessments conducted. Meta-analyses were applied whenever possible. Soft tissue grafting procedures for gain of keratinized tissue resulted in a significantly greater improvement of gingival index values compared to maintenance groups (with or without keratinized tissue) [n=2; WMD=0.863; 95% CI (0.658; 1.067); p<.001]. For final marginal bone levels, statistically significant differences were calculated in favor of an apically positioned flap (APF) plus autogenous grafts versus all control treatments (APF alone; APF plus a collagen matrix; maintenance without intervention [with or without residual keratinized tissue]) [n=4; WMD=-0.175mm; 95% CI: (-0.313; -0.037); p=.013]. Soft tissue grafting procedures for gain of mucosal thickness did not result in significant improvements in bleeding indices over time, but in significantly less marginal bone loss over time [WMD=0.110; 95% CI: 0.067; 0.154; p<.001] and a borderline significance for marginal bone levels at the study endpoints compared to sites without grafting. Within the limitations of this review, it was concluded that soft tissue grafting procedures result in more favorable peri-implant health: (i) for gain of keratinized mucosa using autogenous grafts with a greater improvement of bleeding indices and higher marginal bone levels; (ii) for gain of mucosal thickness using autogenous grafts with significantly less marginal bone loss.

Comparison of peri-implant and periodontal marginal soft tissues in health and disease.

The integrity of the peri-implant soft-tissue seal is crucial for maintaining peri-implant tissue health. Whilst the transmucosal component of the restored implant shares some common features with teeth, namely the presence of a junctional epithelium and a connective tissue component, there are some important differences. A key difference is the nature of the relationship of the connective tissue with the implant surface, whereby there is 'adaptation' of collagen fibers in a parallel orientation in relation to the implant, but insertion of fiber attachment perpendicularly into cementum in the case of teeth. This, combined with reduced cellularity and vascularity in the peri-implant connective tissue, may make implants more susceptible to disease initiation and progression. Furthermore, the presence of a subgingival connection between the implant and the abutment/restoration poses some specific challenges, and maintaining the integrity of this connection is important in preserving peri-implant tissue health. Implant design features, such as the nature of the connection between the implant and the abutment, as well as the surface characteristics of the abutment and implants, may influence the maintenance of the integrity of soft tissue around implants. Iatrogenic factors, such as incorrect seating of the abutment and/or the restoration, and the presence of residual subgingival cement, will lead to loss of soft-tissue integrity and hence predispose to peri-implant disease.

Surgical treatment of peri-implantitis: 3-year results from a randomized controlled clinical trial.

This study reports on the 3-year follow-up of patients enrolled in a randomized controlled clinical trial on surgical treatment of advanced peri-implantitis. A total of 100 patients with advanced peri-implantitis were randomly assigned to one of four treatment groups. Surgical therapy aiming at pocket elimination was performed and, in three test groups, supplemented by either systemic antibiotics, use of an antiseptic agent for implant surface decontamination or both. Outcomes were evaluated after 1 and 3years by means of clinical and radiological examinations. Differences between groups were explored by regression analysis. Clinical examinations at 3years after treatment revealed (i) improved peri-implant soft tissue health with a mean reduction in probing depth of 2.7mm and a reduction in bleeding/suppuration on probing of 40% and (ii) stable peri-implant marginal bone levels (mean bone loss during follow-up: 0.04mm). Implant surface characteristics had a significant impact on 3-year outcomes, in favour of implants with non-modified surfaces. Benefits of systemic antibiotics were limited to implants with modified surfaces and to the first year of follow-up. It is suggested that surgical treatment of peri-implantitis is effective and that outcomes of therapy are affected by implant surface characteristics. Potential benefits of systemic antibiotics are not sustained over 3years.

Peri-implant Crestal Bone Changes Around Zirconia Implants in Periodontally Healthy and Compromised Patients

No consensus regarding the efficacy of zirconia implants in maintaining peri-implant hard and soft tissue health has yet been obtained. The aim of this retrospective follow-up study was to gain knowledge about peri-implant bone behavior and about implant survival and success after treatment with zirconia dental implants in patients with normal and compromised soft and hard tissue conditions. This follow-up study involved 86 patients with 123 zirconia implants (Straumann PURE Ceramic Implant) that were radiographically investigated directly after implant placement (day 0), 3 months after placement, and 1 year after the definitive implant crown placement. The clinical assessment was done at the 1-year postloading appointment and also included the modified Plaque Index, modified Sulcus Bleeding Index, and sulcus pocket depths. Eighteen patients with periodontally compromised conditions were compared to 68 patients with healthy periodontal conditions. The survival rate was 100% and success rate was 94.5%, with no differences between the two groups. The alveolar crest around the ceramic implants showed no significant difference between day 0 and 1 year postloading for both groups (P > .05). There was also no significant difference at 1 year postloading between the groups in the distance from the implant shoulder to the peri-implant bone crest (P = .67) or in pocket depth (P = .07). No significant peri-implant bone loss was observed in the first year. The survival and success rates showed no differences between the periodontally healthy and periodontally compromised groups; however, only a limited number of patients with periodontally compromised conditions were included in this study.

Comparison of two different techniques used for the maintenance of peri-implant soft tissue health: a pilot randomized clinical trial

Objectives: The aim of this pilot study was to compare the effectiveness of two different methods of debridement on maintaining and improving peri-implant soft tissue health over a period of 12 months.Materials and methods: Twenty adult patients (25 implants) were enrolled in a randomized, single-blinded, parallel group clinical trial. All implants included showed no signs of pathologic bone loss. Patients were scheduled to be reviewed every 3 months over a 12 months period. Nine patients (15 implants) were randomly allocated to a test group and treated with a low abrasive air polishing powder (Air-Flow® Perio, EMS) (AFP) and another nine (10 implants) to a control group and treated with titanium curettes (TC). Peri-implant crevicular fluid samples were analyzed to quantitatively measure the concentration of six interleukins (IL-6, IL-8, IL-1β, TNF, IL-10 and IL-12). A multilevel analysis was used to test the comparison between the two treatments. The same analysis was used to study the relationship between clinical parameters and cytokines while controlling for confounding factors.Results: There was no significant difference in bleeding on probing (BOP) between the two treatment methods (p = .35). Both debridement techniques resulted in a similar reduction of BOP (40.04% and 39.93%). IL-6 was the only cytokine of the six investigated that demonstrated a correlation with a clinical parameter (BOP) (p = .05).Conclusions: Both treatment methods were proven to be effective in reducing peri-implant inflammation and preventing further disease progression. Some cytokines may act as markers for peri-implant disease as the present study showed a significant relationship between IL-6 and BOP.

Clips vs Resilient Liners Used With Bilateral Posterior Prefabricated Bars for Retaining Four Implant-Supported Mandibular Overdentures.

The objective of this research was to clinically compare peri-implant tissue health of bar-clips vs silicone-resilient liners used with bilateral posterior bars for retaining 4 implant-supported mandibular overdentures. Thirty completely edentulous male patients (mean age, 65 years) were randomly assigned into 2 equal groups. Each patient received 4 implants in the canine and first molar regions of the mandible using a flapless surgical technique. Mandibular overdentures were immediately connected to the implants with bilateral prefabricated instant adjusting bars. According to the method of retention to the bar, 1 group was retained with clips (GI), whereas the other group was retained with a silicone-resilient soft liner (GII). Peri-implant tissue health was evaluated clinically in terms of plaque scores (MPI), bleeding scores (MBI), probing depth (PD), and implant stability (IS). MPI, MBI, and PD were measured at mesial, distal, buccal, and lingual surfaces of each implant. Evaluations were performed 2 weeks (T0), 6 months (T6), and 12 months (T12) after overdenture insertion. Implants of GI with clips demonstrated significant increase in plaque, bleeding, and PD scores compared with those of GII with silicone-resilient liner at all observation times. Implants in GI demonstrated a significant decrease in implant stability compared with those of GII at T6 and T12 anteriorly and at T12 posteriorly. Resilient liners are considered better than bar-clips when used with bilateral posterior bars for retaining implant-supported mandibular overdentures in terms of peri-implant soft tissue health. Bilateral posterior ready-made bars cannot be proposed as a promising design for supporting implant-assisted mandibular overdentures.

Prevention and Treatment of Peri-implant Diseases: Current Evidence on Cleaning of Titanium Dental Implant Surfaces

Decontamination of an implant surface is an important component of the prevention and treatment of peri-implant diseases. The most suitable instrument for surface cleaning should be chosen depending on surface characteristics, localization of the surface, and treatment goals. The best results in the available data have been reported for air-abrasive devices, and the selection of powders seems to be of importance. However, proper maintenance of peri-implant soft tissue health is largely in control of the patient and dependent on daily self-care. Subsequently, oral hygiene around dental implants should be a priority of the research agenda in dentistry. Prevention and early diagnosis are key for long-term success with dental implants.

Top-Cited Articles in Implant Dentistry.

Citation analysis is the field of bibliometrics that uses citation data to evaluate the scientific recognition and the influential performance of a research article in the scientific community. The aim of this study was to conduct a bibliometric analysis of the top-cited articles pertaining to implant dentistry, to analyze the main characteristics, and to display the most interesting topics and evolutionary trends. The 100 top-cited articles published in "Dentistry, Oral Surgery, and Medicine" journals were identified using the Science Citation Index Database. The articles were further reviewed, and basic information was collected, including the number of citations, journals, authors, publication year, study design, level of evidence, and field of study. The highly cited articles in implant dentistry were cited between 199 and 2,229 times. The majority of them were published in four major journals: Clinical Oral Implants Research, International Journal of Oral & Maxillofacial Implants, Journal of Clinical Periodontology, and Journal of Periodontology. The publication year ranged from 1981 to 2009, with 45% published in a nine-year period (2001 to 2009). Publications from the United States (29%) were the most heavily cited, followed by those from Sweden (23%) and Switzerland (17%). The University of Göteborg from Sweden produced the highest number of publications (n = 19), followed by the University of Bern in Switzerland (n = 13). There was a predominance of clinical papers (n = 42), followed by reviews (n = 25), basic science research (n = 21), and proceedings papers (n = 12). Peri-implant tissue healing and health (24%), implant success/failures (19.2%), and biomechanical topics (16.8%) were the most common fields of study. Citation analysis in the field of implant dentistry reveals interesting information about the topics and trends negotiated by researchers and elucidates which characteristics are required for a paper to attain a "classic" status. Clinical science articles published in high-impact specialized journals are most likely to be cited in the field of implant dentistry.

Augmentation of keratinized gingiva around dental implants

To date, there is no general consensus with respect to the amount of soft-tissue volume needed for esthetic and functional purposes on the buccal aspect of dental implants. Numerous studies have investigated the relationship between the width of keratinized mucosa and the health of peri-implant tissues. Our purpose was to discuss about the necessity of keratinized tissue to maintain the peri-implant health and to report clinical efficacy of different techniques used to increase the keratinized tissue around dental implants.

Long-term clinical and prosthetic outcomes of soft liner and clip attachments for bar/implant overdentures: a randomised controlled clinical trial.

Long-term clinical and prosthetic outcomes of soft liner attachments for bar/implant overdentures were not sufficiently investigated. The aim of this trial was to evaluate clinical and prosthetic outcomes of resilient liner and clip attachments for bar/implant-retained mandibular overdenture after 7 years. Thirty edentulous male participants received two implants in the canine areas of the mandible. Three months later, implants were splinted with a resilient bar. Mandibular overdentures were connected to the bars with either clip (CR group, n = 15) or resilient liner (RR group, n = 15) attachments. Plaque index (PI), gingival index (GI), probing depth (PD), vertical bone loss (VBL), horizontal bone loss (HBLO) and prosthetic complications (PCs) were evaluated at denture delivery (T0), 6 (T6m ), 12 (T1), 24 (T2), 36 (T3), 48 (T4), 60 (T5), 72 (T6) and 84 (T7) months after insertion. PI and GI increased significantly with time for CR and decreased significantly for RR (P < 0·001). PD increased at T1 (CR) and T6 m (RR) and then decreased thereafter (P < 0·05). VBL increased significantly with time in both groups (P < 0·005). HBLO increased at T2 (CR) and T1 (RR) and then decreased thereafter. CR recorded significant higher PI, GI, PD, VBLO and HBLO compared to RR at all observation times (P < 0·042). The survival rates were 96·6% and 100% for CR and RR after 7 years. The most common PCs for CR and RR were clip wears and separation of the resilient liner from the denture base, respectively. Within the limitations of this study, resilient liner attachments are recommended for bar/implant-retained mandibular overdentures than clip attachments in terms of peri-implant tissue health and prosthetic complications after 7 years.

Laser Biostimulation of Free Gingival Grafts Around Dental Implants

Objective : Peri-implant plastic surgery is often required in order to maintain peri-implant tissue health. Lack of keratinized tissue is especially a major problem in implants placed to edentulous patients. Long-term edentulousness causes big alterations in mandible such as keratinized tissue is reduced or lost, lips and cheeks lose support and vestibular sulcus becomes too shallow. As a consequence of keratinized tissue loss, lip covers the healing cap of the implants and free gingival autograft or vestibuloplasty is usually mandatory. The aim of this case report was to evaluate the effect of diode laser bio-stimulation on FGG procedure around dental implants in edentulous patients. Material and Methods : Material-Methods: 3 edentulous female patients (59 and 64 and 79 years old) were referred to our department in different time periods. All patients had serious alveolar bone loss because of prolonged edentulism. In clinical and radiographical examinations, it is observed that patients had lack of keratinized tissue around 6 dental implants placed in mandibular canine positions. The healing caps had been placed and there were severe soft tissue problems and disorientations and also ulcerations around healing caps. Patients were really uncomfortable and in pain because of ulcerated mucosa. Conventional vestibuloplasty and gingivectomy procedures were performed in one patient. The problem continued, lips covered healing caps again and patient was suffering from the pain again. After then in order to reduce the pain and stimulate soft tissue healing, diode laser bio-stimulation were performed in all three patients along with the FGG procedure. Totally six FGG procedures were performed in three patients. Results : Mild pain was observed in donor site and other than that there was no pain or discomfort. After 30 days, the keratinized tissues around dental implants were increased and the discomfort and pain were gone. Healing caps were placed again and the patients were treated successfully. Conclusion : FGG procedure is the gold standard for increasing the keratinized tissue around dental implants but it is a painful process. Diode laser bio-stimulation reduced the post-surgical pain and discomfort.

Implications of Wear at the Titanium-Zirconia Implant-Abutment Interface on the Health of Peri-implant Tissues.

To investigate the presence of metallic particles in the peri-implant mucosa around titanium dental implants after 5 years of loading using single-implant crowns with respect to clinical signs of peri-implant inflammation. Sixteen participants from an ongoing, prospective, single-arm clinical trial who had received titanium dental implants restored with single maxillary crowns veneered to zirconia abutments were available for the study. Exfoliative cytology samples were obtained from the peri-implant tissues and contralateral tooth sites using microbrushes and were evaluated by means of light microscopy (LM), scanning electron microscopy, and energy-dispersive spectroscopy (EDS). Trace elemental analysis was also carried out on the microbrushes using inductively coupled plasma mass spectrometry. Peri-implant and periodontal parameters (plaque, bleeding, attachment level, radiographic bone levels) were recorded. Titanium particles were found in both the single-implant crown and contralateral natural tooth sites. LM and EDS analyses showed significantly higher numbers of Ti particles at the implant-abutment interfaces (mean = 14.168; SD = 2.36) and in the internal aspects of peri-implant mucosa in contact with the prostheses (mean = 4.438; SD = 2.22) when compared with other test and control areas. Mean probing depths were ≤ 3 mm, and no differences were found in plaque or bleeding on probing between implant and tooth sites. Median bone levels were within the normal range for both implant (mesial: 0.5 mm; distal: 0.8 mm) and tooth (mesial: 1.5 mm; distal: 1.8 mm) sites. Loading of single-implant zirconia crowns can cause the release of Ti particles because of functional wear at the implant-abutment level. The presence of these metal particles in the peri-implant area did not appear to affect peri-implant health in this patient group.