Radiographic Marginal Bone Levels Research Articles

Platform-switched implants vs platform-matched implants placed in different implant-abutment interface positions: A prospective randomized clinical and microbiological study.

Placement of the implant-abutment interface (IAI) away from the bone crest has been suggested to have positive impacts on maintenance of peri-implant tissues. To assess the effects of platform-switched and platform-matched implants, taking into consideration the IAI at different positions relative to the bone crest, on clinical, radiographic, and microbiological outcomes during 12 months following functional loading. The present prospective randomized study was performed upon 70 patients. Group I (n = 23) implants presenting a platform-switched implant-abutment connection design was inserted 1 mm subcrestally. Group II (n = 22) implants with similar properties were inserted crestally. Group III (n = 25) implants presenting a platform-matched approach with an internal hexagon connection design was inserted crestally. The periodontal parameters were assessed at baseline, and 3, 6, and 12 months postloading. Radiographic marginal bone level (MBL) changes were analyzed at the 12-month follow-up. The amount of DNA copies of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Provetalla intermedia and total bacterial mean load in peri-implant sulcus fluid (PISF) were assessed at the same periods. There were no significant differences among the groups with respect to the periodontal parameters for all time periods. At 12-month follow-up, the MBL changes were 0.16 ± 0.29 mm and 0.17 ± 0.23 mm for group I, 0.15 ± 0.25 mm and 0.17 ± 0.26 mm for group II, 0.17 ± 0.26 mm and for group III in mesial and distal sites, respectively. The mean total bacterial load was found significantly higher for group III compared to the other groups in the three interval times (P < .05). Implants restored with platform-switching and platform-matching performed equally regarding clinical and radiographic outcomes. Platform-matched implants inserted at the crestal level presented higher the mean bacterial total load in PISF.

Implant-Gingival Unit Stability Around One-Stage Implant with Laser-Microgrooved Collar: Three-Year Result of a Prospective Study.

The aim of the present prospective study was to evaluate the stability of peri-implant soft tissue and the stability of the implant-gingival unit (IGU) around one-stage titanium implants with a laser-microgrooved collar surface following 3 years of loading. Thirty one-stage titanium implants with a laser-microgrooved collar surface were placed in 30 partially edentulous patients. Clinical and radiographic examinations were carried out at implant placement, after a period of 4 to 6 months free of masticatory loading, and after 3 years of function. Plaque Index (PI), modified sulcus bleeding index (SBI), probing depth (PD), distance between the implant coronal margin and the mucosal margin (DIM), clinical attachment level (CAL), and keratinized tissue width (KTW) and thickness (KTT) were recorded. Radiographic marginal bone levels (MBL) were assessed at the mesial (MI) and distal (DI) aspects of implant sites. In addition, the influence of KTT on IGU stability was investigated. No implants failed during the follow-up period. Compared to baseline, PI, BPI, PD, DIM, CAL, KTW, MBL, and IGU showed differences that were not statistically significant (P > .05). Moreover, IGU didn't show a statistical correlation with KTT. Within the limitations of the present study, it can be concluded that around one-stage implants with laser-microgrooved collar, the peri-implant tissues and IGU remain stable over the three evaluation periods.

Prospective randomized controlled clinical study comparing two types of two-piece dental implants supporting fixed reconstructions-Results at 5years of loading.

Compare clinical outcomes of two types of dental implants with non-matching implant-abutment junctions loaded with fixed implant-borne reconstructions at 5years of loading. In 64 patients, one of two implant systems (S1, S2) was randomly used to support fixed dental prostheses (FDP). At loading (TL ), after 1 (T1 ), 3 (T3 ) and 5years (T5 ), the implant and reconstruction survival, biological and technical complications, radiographic marginal bone levels, clinical outcomes were recorded. The implants of the groups S1 and S2 contained of two-piece titanium implants with a non-matching implant-abutment junction. Data were analyzed on the patient level (1 implant/patient) using the non-parametric Wilcoxon-Mann-Whitney test. Ninety-seven implants were placed and loaded with fixed reconstructions in 64 patients. At T5 , 29 S1 and 28 S2 implants were available for the patient-level analysis. Two implants in group S1 had to be removed in the same patient due to severe peri-implantitis, resulting in a survival rate of 96.1% on the implant level and 96.6% on the patient level. No implant in group S2 was lost. The technical complication rate on patient-levelamounted of 24.2% (S1) and of 6.5% (S2) (p>.05). Biological complicationson patient-level were observed in 15.2% (S1) and 16.1% (S2) (p>.05).From TL to T5, the medians of the mean marginal bone level changes wer a gain of 0.15 mm in group S1 and a loss of 0.14 mm in group S2 (p > .05). Both implant systems revealed high survival rates and minimal changes of the marginal bone levels during 5years. Few biological complications occurred in both groups. S1 revealed a high rate of technical complications. Therefore, both implant systems can be recommended for fixed reconstructions.

Tissue integration of zirconia and titanium implants with and without buccal dehiscence defects-A histologic and radiographic preclinical study.

To histologically and radiographically evaluate soft (primary outcome) and hard tissue integration of two-piece titanium and zirconia dental implants with/without buccal dehiscence defects. In six dogs, five implants were randomly placed on both sides of the mandible: (a) Z1: a zirconia implant (modified surface) within the bony housing, (b) Z2: a zirconia implant (standard surface) within the bony housing, (c) T: a titanium implant within the bony housing, (d) Z1_D: a Z1 implant placed with a buccal bone dehiscence (3mm in height, identical width to implant body), and (e) T_D: a titanium implant placed with a buccal bone dehiscence. Two weeks of healing and 6months of loading were applied on each hemi-mandible, respectively. The median level of the margo mucosae shifted more apically over time in all groups (borderline statistical significance in groups Z1_D: -0.52mm and T_D: -1.26mm). The median height of the peri-implant mucosa in groups Z1_D and T_D was greatest at 2weeks and 6months, but the linear change in the peri-implant mucosa was statistically significant only for group T_D over time (-1.45mm). Z1 demonstrated a higher bone-to-implant contact compared to Z2 and T. Minimal change of radiographic marginal bone levels in all groups was observed (<1mm). When buccal dehiscence was presented, titanium implants presented significant loss of peri-implant mucosal height compared to zirconia implants with a modified surface, due to greater apical shift of the margo mucosae. A modified zirconia surface enhanced osseointegration.

Clinical and patient-reported outcomes of implants placed in autogenous bone grafts and implants placed in native bone: A case-control study with a follow-up of 5-16years.

To compare the radiographic marginal bone levels of implants placed in sites previously augmented with autogenous bone grafts and implants placed in native bone. Secondary outcomes included: implant survival, periodontal/peri-implant parameters as well as short- and long-term patient-reported outcome measures. The study was designed as a case-control study including 38 patients equally distributed into two groups (previously augmented with autogenous bone blocks [AB] and implants placed in native bone [NB]). In total, 67 implants were placed. Clinical, radiographic and patient-reported outcome measures (PROMs), and complication rates were assessed based on a chart review and at a follow-up examination (≧5years after implant placement). Nonparametric mixed models were applied for the comparison of the two groups because of the clustered data. The data were analyzed descriptively, and p-values were calculated using nonparametric mixed models to account for the clustered data. The mean follow-up time was 10.2years (range 6-13years; AB) and 8.3years (range 5-16years; NB). One implant was lost in group NB (97.5% survival rate) and none in group AB (100%). Following primary augmentation, six major complications (wound dehiscences, acute pulpitis, intra- and extraoral sensitivity disturbances) were observed at the donor sites. At time of implant placement, only minimal complications occurred and only in group NB. Median marginal bone levels at the follow-up were significantly higher in group NB (1.15; Q1: 0.50mm/Q3: 1.83mm) than in group AB (1.58; Q1: 1.01mm/Q3: 2.40mm; p=0.0411). Probing depth, bleeding on probing and recession values were similar in both groups. PROMs revealed high visual analog scale values (i.e., high satisfaction) for both procedures. Dental implants placed in sites augmented with autogenous bone or in native bone revealed healthy peri-implant tissues after 5-16years. Marginal bone levels were significantly higher for implant placed in native bone. Complications following primary augmentation encompassed every third patient but were mostly transient.

Impact of a zoledronate coating on early post-surgical implant stability and marginal bone resorption in the maxilla-A split-mouth randomized clinical trial.

The objective of this clinical study was to evaluate the effect of a bisphosphonate coating on a titanium implant on the implant stability quotient (ISQ) and the radiographic marginal bone levels at implants during early healing (2-8weeks). In a randomized double-blind trial with internal controls, 16 patients received a dental implant coated with zoledronate and one uncoated implant as a control. The coated and uncoated implants which were visually indistinguishable were bone level titanium implants with a moderately rough surface and a microthreaded neck. ISQ values were obtained at insertion and at 2, 4, 6, and 8weeks. Radiographs were obtained at insertion and at 8weeks. The primary outcome was the difference in ISQ values between the coated implants and the control implants at 4 and 6weeks, corrected for insertion values. The secondary outcome was loss of marginal bone level from insertion to 8weeks. Implant stability quotient values remained largely constant over the 8weeks, and there was no significant difference between coated and uncoated implants at any time point. There was 0.12 (SD 0.10) mm marginal bone loss at the control implants and 0.04 (SD 0.08) mm at the coated implants. The difference was 0.17mm; SD 0.14; p<0.006). On blind qualitative scoring, 13 of the 15 control implants and two of 15 coated implants showed small marginal bone defects (p=0.003). There were no statistically significant differences observed in ISQ values between the coated and uncoated implants during the early healing. There was less marginal bone loss at the coated implants.

Influence of restorative margins position on one-stage laser-microgrooved implants-supported single screwed crowns: A clinical, biochemical, and microbiological analysis.

To clinically, biochemically, and microbiologically evaluate the influence of crown margins position on one-stage laser-microgrooved implants. Twenty-one-stage titanium implants with a laser-microgrooved collar surface, supporting screwed, single crown restorations, were placed in 20 partially edentulous patients and evaluated. Clinical parameters included modified plaque index, modified gingival index, peri-implant probing pocket depth, bleeding on probing, and distance between implant shoulder and mucosal margin. The parameters were recorded at baseline (crowns delivery) and at every 6-month recall visit, until the end of the 3 years follow-up period. At the same time intervals, radiographic marginal bone levels were assessed at the mesial and distal aspect of the implant sites. For biochemical analysis, the volume of the peri-implant sulcus fluid, and its levels of interleukin-1beta (IL-1β), interleukin-6 (IL-6), and of tumor necrosis factor-α, were utilized to evaluate the peri-implant health conditions at the end of the 3-year follow-up period. At the same time, microbiological analysis, including the concentration of five putative periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, and Tannerella forsythensis), were assessed. The crown margins positions were classified into four groups (A = intracrevicular position >2 mm, B = intracrevicular position ≤2 mm/<1 mm, C = intracrevicular position ≤1 mm/<0 mm, and D = extracrevicular position), and the biochemical, and microbiological parameters were evaluated at 3 years. No statistical differences of clinical and biochemical parameters were found between the four groups. In group A, compared to groups B, C, and D, a statistically significant higher concentration of putative periodontal pathogens was found. Results showed that the intracrevicular deeper position of the restoration margin does not influence the clinical and biochemical peri-implant parameters. The deeper position of the crown margin is associated with a greater amount of putative periodontal pathogenic microflora colonization.

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.

Evaluation of peri-implant marginal tissues around tissue-level and bone-level implants in patients with a history of chronic periodontitis.

To evaluate clinical and radiographic characteristics in peri-implant marginal tissues in patients with a history of chronic periodontitis, rehabilitated using tissue-level or bone-level implants. Using a split-mouth design, 20 patients with a history of chronic periodontitis were selected and received two different implants, tissue-level group (n=20) and the bone-level group (n=20). Peri-implant probing depth, relative peri-implant mucosal margin position, relative peri-implant clinical attachment level, peri-implant plaque index and peri-implant bleeding on probing were evaluated at prosthesis installation, 1, 3, 6, 12 and 24months after implant loading. Radiographic marginal bone level was evaluated at implant insertion, prosthesis installation, 6 and 24months after implant loading. The mean difference of peri-implant marginal bone resorption from implant installation to 24months in function was 0.75±1.12mm for the tissue-level group and 0.70±0.72mm for the bone-level group. No statistically significant difference was found between groups at all assessment periods for clinical and radiographic peri-implant evaluation. Under a rigid supportive therapy, both approaches performed likewise regarding clinical and radiographic parameters for rehabilitation of patients with a history of chronic periodontitis.

Evaluation of Subantimicrobial Dose Doxycycline Effects on Dental Implant Osseointegration in Type II Diabetic Patients

Objective : The present study was carried out to compare radiographic outcomes of dental implant in type II diabetic patients with or without adjunctive administration of subantimicrobial dose doxycycline. Subjects and Methods : This study included 20 patients with controlled type II diabetes mellitus of both genders, their age ranged from 40-48years.The study groups were designed in two groups, test group treated with dental implant with systemic administration of subantimicrobial dose doxycycline(SDD) for twice per day for 3 months and control group received dental implant alone. Results: Regarding radiographic marginal bone levels measurements; in both groups the mean marginal bone loss increased by time, with significant difference between both groups where the test group (SDD received group) showed the lower marginal bone loss values. In both groups, bone density measurements increased by time, with significant percentage change recorded for test group (SDD received group) 55.22% while control group recorded 17.40% from base line values. Conclusions: The use of sub-antimicrobial dose doxycycline with dental implants in type II diabetic patients was effective as an adjunctive host modulatory drug. Systemic administration of subantimicrobial dose doxycycline with dental implants in type II diabetic patients resulted in greater increase in bone density and less marginal bone loss thus subantimicrobial dose doxycycline can enhance the osseointegration of dental implants.

Intra- and inter-examiner agreement when assessing radiographic implant bone levels: Differences related to brightness, accuracy, participant demographics and implant characteristics.

Evaluate intra- and inter-examiner agreement of radiographic marginal bone level (MBL) assessment around Brånemark single implants; and whether agreement related to radiograph brightness, discrimination level (accuracy), participant demographics or implant characteristics. Seventy-four participants assessed MBLs of 100 digital radiographs twice with normal brightness, and twice with increased brightness. Intra-examiner agreement with and without increased brightness to the same thread, and within one thread; and inter-examiner agreement as compared with the group (defined by the mode) for the first assessments with and without increased brightness, to the same thread, and within one thread were calculated with Cohen's Kappa. Relationships between agreement, thread discrimination level (accuracy), brightness, participant and implant characteristics were explored. When assessing 100 "Normal" radiographs twice, a participant on average assessed 24% differently to themselves (poor intra-examiner agreement, median Kappa 0.58, range 0.21-0.82); and 28% differently to other participants (poor inter-examiner agreement, median Kappa 0.53, range 0.05-0.80). Agreement within examiners improved when radiographs were "Bright" (median Kappa 0.58 vs. 0.62, p<0.001, accuracy to same thread; median Kappa 0.94 vs. 0.96, p<0.001, accuracy within one thread). Agreement between examiners was neither better nor worse when radiographs were "Bright" (median Kappa 0.53 vs. 0.55, p=0.64, accuracy to same thread; median Kappa 0.93 vs. 0.93, p=0.23, accuracy within one thread). Intra- and inter-examiner agreements were lower when accuracy to the same thread was required (p<0.001, p<0.001). Neither intra- nor inter-examiner agreement related to age, time since graduation, specialty, viewing device, implant experience, external hex familiarity, periimplantitis treatment experience, implant location or width (p-values 0.05-0.999). Intra-examiner agreement increased across dental assistants (n=11), general dentists (n=16) and specialists (n=47) ("Bright" assessments, p=0.045, median Kappa's 0.55, 0.60, 0.65 respectively); and for females (n=8, males=58) ("Normal" assessments, p=0.019, median 0.68 vs. 0.55), but female numbers were low. Agreement within and between examiners when assessing MBLs was poor. Disagreement occurred around 25% of the time, potentially affecting consistent disease assessments. No participant or implant characteristic clearly affected agreement. Brighter radiographs improved intra-examiner agreement. Overall, perceived MBL changes below 1mm are likely due to human, not biological variation.

Longitudinal analysis on the effect of insertion torque on delayed single implants: A 3-year randomized clinical study.

Implant stability is commonly related to insertion torque. Recently, it has been suggested that higher insertion torque may lead to greater bone resorption. The aim of the present randomized clinical study was to evaluate the role of different insertion torque values in terms of implant success, marginal bone loss, and facial soft tissues recession. Patients requiring a single dental implant were recruited and randomized to receive one of two implants with the same macro-geometry but different cutting designs. First group consists of a 90 degrees cutting groove know as self-tapping implant, and the second group known as Blossom™ cutting groove. (Intra-Lock, Boca Raton, Florida). The insertion torque (IT) was assessed and two groups followed: high-IT (≥50 Ncm) group and regular-IT (<50 Ncm) group. After 3 months, all the implants were restored. At baseline, buccal bone thickness (BBT) was recorded. During the 3-year survey, the following outcomes had been registered: implant failures and success, radiographic marginal bone level around dental implant (MBL) and facial soft tissue level (FSTL). A hundred and sixteen implants were placed in healed sites. The overall survival rate after 3 years was 96.5%. The Cumulative Success Rate was 91.3% for the High IT group and 98.2% for the Regular IT group. The mean marginal bone loss and facial soft tissue recession, at a 3-year evaluation, were significantly greater for the High-IT group and in the mandible than that reached in the Regular-IT group and in the maxilla. Present findings showed that implants placed with higher insertion torque in mandible led to greater bone resorption and mucosal recession than that registered for implants placed with a regular IT. Moreover, sites with a thick buccal bone wall (≥1 mm) showed smaller recession at the facial soft tissue level after 3 years.

Modeling of Crestal Bone After Submerged vs Transmucosal Implant Placement: A Systematic Review with Meta-Analysis.

To determine differences in marginal bone changes when using submerged or transmucosal dental implants through a systematic review of the literature. PubMed, Embase, and the Cochrane Library were electronically searched for trials comparing marginal bone loss between submerged and transmucosal dental implants with a minimum follow-up of 12 months published between January 1980 and January 2016. Manual searches of the bibliographies of the included studies were also carried out. Screening of titles and abstracts, data extraction from the included studies, and quality assessment following the PRISMA statement were conducted in duplicate. Outcome measures were radiographic marginal bone level changes, implant survival, prosthesis failure, prosthetic complications, and esthetics. The search strategy identified a total of 4,991 studies. Two of the authors independently screened 855 abstracts, resulting in a total of 12 studies; however, the total included in the systematic review was 11, as 2 studies were based on data from the same patients and were therefore counted as 1. A total of 998 implants (413 submerged and 585 transmucosal) were observed in 542 patients. Seven of the studies had a randomized study design and a follow-up of 12 months; therefore, they were included in the meta-analysis of bone loss and implant survival. The overall estimate of the bone loss difference was -0.01 mm (95% confidence interval [95% CI] -0.11 to 0.09 mm), and there was less bone loss in the transmucosal implants than in the submerged implants (P = .811, I² = 63.7%). The estimated relative risk for implant loss at 12 months was 0.31 (0.09 to 1.09, P = .068, I² = 0%) in favor of the submerged healing protocol. Augmentation procedures seemed to be successful irrespective of the implant placement modality, but owing to few clinical data no evidence could be found. Because of the lack of clinical data, esthetic outcomes could be reported only in a descriptive way. In the present meta-analysis, no evidence was found of differences between submerged and transmucosal implant placement protocols with regard to changes in marginal crestal bone levels or implant survival at 12 months follow-up. Therefore, it can be concluded that in many clinical situations it seems questionable whether a closed healing protocol offers an advantage over a transmucosal protocol.

Immediate Loading of Anterior Single-Tooth Implants Placed in Healed Sites: Five-Year Results of a Randomized Clinical Trial.

The aim of this study was to compare the 5-year outcome of immediate loading with that of conventional loading for anterior single-tooth implants placed in healed sites. It was hypothesized that immediate loading is not inferior to conventional loading. A total of 62 patients with a missing maxillary anterior tooth were included. At random, patients were treated with an implant that was restored either with a nonoccluding temporary crown within 24 hours after implant placement (immediate group) or according to a two-stage procedure after 3 months (conventional group). All implants were placed in healed sites. Follow-up visits were performed after definitive crown delivery and 1 and 5 years thereafter. Outcome measures were radiographic marginal bone level changes, implant survival, complications, soft tissue aspects (probing depth, plaque, bleeding, soft tissue level changes), esthetic outcome, and patient satisfaction. Three patients in each study group were lost to follow-up. No significant differences were found in terms of marginal bone loss (1.16 ± 0.93 mm in the immediate group and 1.20 ± 1.10 mm in the conventional group), survival (one implant lost in the immediate group), complications, soft tissue aspects, esthetic outcome, and patient satisfaction. For anterior single-tooth implants placed in healed sites, the outcome of immediate loading is not inferior to conventional loading.

Six-Year Radiographic, Clinical, and Soft Tissue Outcomes of Immediately Loaded, Straight-Walled, Platform-Switched, Titanium-Alloy Implants with Nanosurface Topography.

This prospective, longitudinal study evaluated the survival, marginal bone levels, and soft tissue conditions for immediately loaded, straight-walled, platform-switched, titanium-alloy implants with an internal connection and nanosurface topography. Patients were enrolled at a single center. The immediate loading protocol required a final insertion torque ≥ 25 Ncm, an implant stability quotient (ISQ) > 55, and placement of the provisional prosthesis on the same day as implant placement. Posttreatment follow-up examinations were scheduled at 3, 6, and 12 months and annually thereafter. Soft tissue evaluation consisted of assessment of the implant sites for signs of peri-implant infection including mucosal inflammation, bleeding on probing or suppuration, and progressive bone loss. Oral hygiene was evaluated, and radiographic marginal bone levels were analyzed and compared to baseline at the time of provisional loading. Forty-eight consecutively treated patients received 122 implants; 112 qualified for immediate loading and were included. ISQ scores ranged from 51 to 87, with a mean value of 75.1 (SD = 6.8). One implant failed (after 3 months). After an average follow-up period of 6.2 years (SD = 0.37; range, 5.4 to 6.9), no further losses occurred, leading to an overall cumulative survival rate of 99.1%. Average bone loss for the 111 implants after 6 years was 0.35 mm (SD = 0.45; range: -0.35 to 2.20). Four implants (3.6%) in two patients showed concomitant peri-implant infections associated with bleeding on probing and/or purulence after 2 years in function. Exploratory surgery revealed residual submucosal cement. After its removal, the progressive bone loss stopped, and peri-implant tissue in both patients returned to a healthy condition. This study based on 40 patients treated with 112 straight-walled, platform-switched, titanium-alloy implants with nanosurface topography yielded a 99.1% survival rate after a mean follow-up time of 6.2 years. Additionally, mean crestal bone loss was limited to 0.26 mm (SD = 0.38) after 1 year and 0.35 mm (SD = 0.45) after 6 years. Peri-implant infection associated with excessive bone loss above 2 mm was only encountered in one implant, and residual cement was shown to be responsible.

Prevalence of Peri-implantitis in Medically Compromised Patients and Smokers: A Systematic Review.

To verify whether the diversity of systemic medical conditions and smoking act as biologic associated factors for peri-implantitis. The PICO question was: "In patients with osseointegrated dental implants, does the presence of smoking habits or a compromised medical status influence the occurrence of peri-implantitis compared with the presence of good general health?" Smoking and systemic conditions such as type 2 diabetes mellitus, cardiovascular diseases, rheumatoid arthritis, lung diseases, obesity, cancer, deep depression, and osteoporosis were screened. Selection criteria included at least 10 patients per condition, 1 year of follow-up after implant loading, and strict cutoff levels (probing pocket depth [PPD], bleeding on probing [BOP] and/or pus, marginal bone loss) to define peri-implantitis. From the 1,136 records initially retrieved, 57 were selected after title and abstract analyses. However, only six papers were considered for qualitative evaluation. No randomized controlled clinical trial was found. Smoking was associated with peri-implantitis in only one out of four studies. Poorly controlled type 2 diabetes accentuated only PPD and radiographic marginal bone level prevalence rates in peri-implant patients (one study). Cardiovascular disease was considered a risk (one out of two studies). The chance of peri-implant patients harboring the Epstein-Barr virus was threefold in one report. No associations were found for rheumatoid arthritis. Data from existing studies point to smoking and diabetes as biologic associated factors for peri-implantitis. However, the body of evidence is still immature, and the specific contribution of general health problems to peri-implantitis requires additional robust epidemiologic and clinical investigations.

Does a large dehiscent implant surface at placement affect the 5-year treatment outcome? An assessment of implants placed to support a maxillary overdenture.

The aim of this study was to assess the 5-year clinical and radiographic outcome of implants with a dehiscent surface at implant placement. A total of 26 consecutive patients (mean age 61.6 years; SD 8.0 years) with at least one implant with a dehiscent implant surface of ≥ two thirds of the implant length on the labial side were included. All implants were placed to support a maxillary overdenture. The implants were placed with adequate primary stability and the dehiscent surface was covered with autologous bone, inorganic bovine bone and a resorbable membrane. Outcome measures were soft tissue conditions, change of radiographic marginal bone level and implant survival. Baseline data (at loading, T0) were compared with 1-year (T1) and 5-year (T5) post loading data. Of the 116 implants, 40 implants had no dehiscence, 16 had a buccal dehiscence < two thirds of the implant length, and 60 implants had a dehiscence ≥ two thirds. The peri-implant tissues were healthy and 5-year marginal bone changes were well within normal limits (-0.4 mm; range: -0.8 to -0.1). One implant was lost during the osseointegration period. Even when implants are placed with a dehiscence ≥ two thirds of the buccal implant surface, favorable 5-year peri-implant health can be achieved provided these dehiscences are covered with autologous bone, inorganic bone and a resorbable membrane, and there is good initial stability of the implants.

Implants with an Oxidized Surface Placed Predominately in Soft Bone Quality and Subjected to Immediate Occlusal Loading: Results from an 11-Year Clinical Follow-Up.

The purpose of this clinical follow-up was to document the 11-year outcome of implants with a moderately rough oxidized surface subjected to immediate occlusal loading. Twenty-six of 38 patients enrolled in a 5-year prospective study were available for this follow-up analysis, with 33 restorations supported by 66 slightly tapered implants (Brånemark System MkIV, Nobel Biocare, Gothenburg, Sweden). The majority of implants were placed in posterior regions (88%) and into soft bone (76%). Parameters included cumulative survival rate (CSR), radiographic marginal bone level, bleeding on probing (BOP), intrasulcular counts of perio-pathogenic markers (DNA probes), and total bacterial load (TBL). The CSR was 97.1% at 11.2 years mean follow-up. Mean marginal bone remodeling was 0.47 mm (SD 1.09, n = 65) from 1 year postplacement to 11-year follow-up. BOP was absent at most sites (63.6%). No statistically significant differences in TBL or perio-pathogenic marker species were observed at implants and teeth. The results of the present follow-up show high long-term survival, stable marginal bone levels, and soft tissue outcomes of oxidized surface implants placed predominately in posterior regions and soft bone. The quantity and quality of intrasulcular microbiota were comparable at implants and teeth.

Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients.

Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical template and to demonstrate that immediate function can be easily performed with immediate implants in postextraction sites supporting full-arch rehabilitation. Material and Methods. 14 subjects were consecutively rehabilitated (13 maxillae and 1 mandible) with 99 implants supporting full-arch fixed prostheses followed between 6 and 24 months (mean of 16 months). Outcome measures were prosthesis and implant success, biologic and prosthetic complications, pain, oedema evaluation, and radiographic marginal bone levels at surgery and then at 6, 12, 18, and 24 months. Data were analyzed with descriptive statistics. Results. The overall cumulative implant survival rate at mean follow-up time of 16 months was 97.97%. The average marginal bone loss was 0,9 mm. Conclusions. Within the limitations of this study, the results validate this treatment modality for full-arch rehabilitations with predictable outcomes and high survival rate after 2 years.

Early radiographic diagnosis of peri-implantitis enhances the outcome of peri-implantitis treatment: a 5-year retrospective study after non-surgical treatment.

PurposeThis retrospective study evaluated the relationship between the timing of peri-implantitis diagnosis and marginal bone level after a 5-year follow-up of non-surgical peri-implantitis treatment.MethodsThirty-three patients (69 implants) were given peri-implantitis diagnosis in 2008-2009 in Seoul National University Bundang Hospital. Among them, 31 implants from 16 patients were included in this study. They were treated non-surgically in this hospital, and came for regular maintenance visits for at least 5 years after peri-implantitis treatment. Radiographic marginal bone levels at each interval were measured and statistical analysis was performed.ResultsTiming of peri-implantitis was one of the significant factors affecting initial bone loss and total bone loss not additional bone after peri-implantitis diagnosis. Patients with cardiovascular disease and diabetic mellitus were positively influenced on both initial bone loss and total bone loss. Patients who needed periodontal treatment after implant placement showed a negative effect on bone loss compared to those who needed periodontal treatment before implant placement during entire periods. Implant location also significantly influenced on amounts of bone loss. Mandibular implants showed less bone loss than maxillary implants. Among surgical factors, combined use of autogenous and xenogenic bone graft materials showed a negative effect on bone loss compared to autogenous bone graft materials. Use of membrane negatively affected on initial bone loss but positively on additional bone loss and total bone loss. Thread exposure showed positive effects on initial bone loss and total bone loss.ConclusionsEarly peri-implantitis diagnosis led to early non-surgical intervention for peri-implantitis treatment, which resulted in the maintenance of the bone level as well as preservation of the implant.Graphical