Peri-implant Soft Tissue Research Articles

Peri-implant soft tissue conditioning of immediate posterior implants by CAD-CAM socket sealing abutments: a randomized clinical trial

BackgroundAnatomically formed healing abutments were suggested in literature to address many of the issues associated with immediate posterior implant insertion such as large extraction sockets that are extremely hard to seal without reflecting the mucoperiosteal flap, extraction sockets anatomy that are not suitable for regular healing abutment placement, and potentially high occlusal stresses when planning a temporary implant supported prothesis to improve the conditioning of supra implant tissue architecture and the emergence profile of the implant supported restorations.PurposeTo clinically evaluate the peri-implant soft tissue profile of single posterior implant retained restorations and to assess patient related outcomes of the implant restorations that were conditioned immediately by CAD-CAM socket sealing abutments (SSA) versus those conditioned by Titanium (Ti) standard healing abutments (SHA).MethodsTwenty participants received twenty-two single maxillary immediate implants after flapless minimally invasive tooth extraction and 3D guided implant placement in the posterior area (premolar and molar) and allocated randomly into two groups (n = 11), the intervention group: patients received PEEK SSA and the control group: the patients received Ti SHA. Modified Pink Esthetic Score (PES) was evaluated at 3 observation periods: Baseline T0 (immediate after implant supported crown insertion), 6 months T1 and 1 year of clinical performance T2. Patient satisfaction was assessed one week and one year after crown insertion using visual analogue scale (VAS).ResultsAt base line, after six as well as 12 months, SSA group showed statistically significant higher total modified PES scores than SHA group (P-value < 0.001). At the 2 clinical observation periods (baseline and after one year), SSA group showed statistically significantly higher overall satisfaction score than SHA group (P-value < 0.001).ConclusionAfter one year of clinical observation period, CAD-CAM PEEK socket sealing abutments together with flapless minimally invasive tooth extraction and 3D guided implant placement provided superior outcomes compared to Ti SHA in terms of peri-implant soft tissue profile.Trial registrationThis study was registered on clinicaltrials.gov with ID no. NCT05276765 on 03/03/2022.

Peri-Implant Soft Tissue in Contact with Zirconium/Titanium Abutments from Histological and Biological Perspectives: A Concise Review.

Dental implants are crucial in contemporary oral rehabilitation, necessitating optimal integration with the surrounding soft tissues for durable success. The attachment between the implant surface and peri-implant mucosa should establish a secure seal to prevent bacterial infiltration and subsequent tissue inflammation. This concise review examines the histological and biological perspectives of peri-implant soft tissue reactions to zirconium and titanium abutments, shedding light on their respective advantages and limitations. While titanium has been the gold standard, zirconia has gained attention due to its biocompatibility and aesthetic appeal. Histological studies show comparable soft tissue attachment and inflammatory responses between the two materials. Further research is needed to explore surface treatments and optimize outcomes in dental implant rehabilitation.

Comparative Study between Two Adjacent Implants Supported Crowns and One Implant Supported Cantilever Fixed Dental Prosthesis: An In Vivo Study.

To assess hard as well as soft peri-implant tissues within cases having two lost adjacent anterior teeth treated through placing either two implants with two separate crowns or only an implant along with a crown with a cantilever, and evaluating the effect of polyetheretherketone (PEEK) restoration on cantilever design up to 18 months after functional loading. Twenty-seven participants (15 males and 12 females; mean age, 38.6 years; range 20-50 years) with missing two adjacent anterior teeth were treated with implant system (Flotecno implant system, Italy). In the first group (implant-implant metal ceramic group), we treated nine participants utilizing two adjacent implants with two separate single metal ceramic crowns. In the second group (implant-cantilever metal ceramic group), we treated nine participants by placing single implant with cantilever metal ceramic fixed dental prosthesis (FDP). In the third group (implant-cantilever PEEK group), we treated nine cases utilizing single implant with a cantilever PEEK FDP framework. Clinical and radiographic examinations were recorded. Marginal bone level, implant stability, and prosthetic complications were assessed during an 18-month follow-up period. Marginal bone loss (MBL) exhibited similar measurements among all groups. The clinical outcomes did not address significant variance among all groups as regards implant stability within the period of follow-up. We also observed minor prosthetic complications. Participants were very satisfied within all groups. Based on the limitations of our research, utilizing cantilever extensions has no influence on MBL as well as implant stability. Mean marginal bone level exhibited a significant rise from baseline to 18 months for all groups, however, still within the clinically accepted range. Regarding implant stability, no significant variance was observed among all groups for 18 months. The cantilever FDP design facilitated prosthesis fabrication among those having laterals of narrow diameters. Further research is required to investigate such a particular concern due to a limited sample size in our research. How to cite this article: Hussain MR, Shrif MM, Othman HI, et al. Comparative Study between Two Adjacent Implants Supported Crowns and One Implant Supported Cantilever Fixed Dental Prosthesis: An In Vivo Study. J Contemp Dent Pract 2024;25(10):983-991.

Influence of buccal mucosa width/height ratio, emergence profile and buccal bone width on peri-implant tissues: a prospective one-year study

BackgroundThe stability of soft and hard tissues surrounding the implant is not only a matter of aesthetics, but also affects the long-term stability of the implant. The present study was to explore the influence of buccal mucosa width/height (W/H) ratio, emergence profile and buccal bone width on peri-implant soft and hard tissue changes in the posterior region.MethodsFifty-eight posterior implant restoration cases were recruited in this study. Evaluations were performed at the time of restoration placement (T0), and 1 year later (T1). Buccal mucosa width (BMW), buccal bone width (BBW), implant buccal inclination angle, and emergence angle were evaluated. The variables that may affect buccal mucosa recession (MR) as well as vertical bone loss (VBL) were analyzed.ResultsThe BMW at baseline was 2.93 ± 1.01 mm. The BBW at baseline was 1.50 ± 0.82 mm. The buccal mucosa W/H ratio at 1 year (1.23 ± 0.38) was significantly lower than that at baseline (1.42 ± 0.45). Buccal MR was − 0.22 ± 0.47 mm while VBL was 0.81 ± 0.80 mm. The correlation between MR and initial BMW (r=-0.381), initial W/H ratio (r=-0.422), BBW (r=-0.290) was statistically significant. The correlation between VBL and initial BMW (r=-0.421), initial W/H ratio (r=-0.305), implant buccal inclination angle (r = 0.507), BBW (r=-0.556) was statistically significant.ConclusionsWithin the scope of this study, implant sites in the posterior region presenting a thin BMW, a thin BBW, and a small W/H ratio are more prone to exhibit buccal mucosa recession and vertical bone loss.

USE OF THE ELECTRICAL DEVICE ON DENTAL IMPLANT’S BACTERIAL BIOFILM: A PRELIMINARY IN VITRO STUDY

Background. Mucositis and peri-implant disease are pathological conditions found following bacterial colonization on the peri-implant soft tissues and on the implant fixture during implant-prosthetic rehabilitation, from single edentulism to full-arch rehabilitation. The therapeutic approaches to the two pathological conditions use surgical and non-surgical therapeutic protocols, with the aim of eliminating the bacterial biofilm from the implant surface, through the use of mechanical, chemical or photodynamic agents. The aim was to evaluate the effect of the electric field generated by the Ximplant machine on the bacterial load and on the biofilm grown on the dental implants. Materials and methods. Twenty-eight dental implants were contaminated with the saliva of a donor, and subsequently fifteen implants were treated with the electric field generating machine while twelve were not treated. The bacterial biofilm was then measured by resazurin assay, both on treated and untreated implants. Results. The results revealed a difference between treated and untreated implants in terms of biofilm activity,as assessed by color change using the resazurin assay. Treated implants (n = 15) showed no color change across all observation time points (2 hours, 1 day, 2 days, 3 days), indicating an absence of bacterial activity or residual biofilm. Conversely, all untreated implants (n = 12) exhibited a consistentcolor change starting at 2 hours, suggesting persistent biofilm activity. A sterile implant used as a negative control (n = 1) showed no color change throughout the experiment, confirming the absenceof contamination. Conclusion.The study showed preliminary success of the electrofield in reducing microbial populations and destroying clinical biofilm, compared to a sterile implant as a control

Influence of gingival color and abutment material on the final color of peri-implant soft tissue: An in vitro analysis.

The study aimed to investigate the influence of different gingival colors and abutment materials on the final color of peri-implant soft tissue. A total of 30-cylinder shaped specimens having 1.0- and 2.0-mm buccal thicknesses using five different gingivacolored composites [light pink (LP), dark pink (DP), orange (Or), brown (Br), and purple (Pr)] were prepared. Implants were placed straight into the center of cylinders and connected to abutments [Titanium (Ti) and Zirconia (Zr)]. Color parameters were assessed using a spectroradiometer. Color differences (ΔE*ab and ΔE00) were calculated and compared to 50:50% perceptibility (PT) and acceptability (AT) visual thresholds. Color variation data were statistically analyzed using 2-way analyses of variance followed by Tukey HSD tests (a=.05). Significantly higher ΔE*ab and ΔE00 values were recorded in LP and Or groups with 1.0 mm buccal thickness and Ti abutments (p<.05). Regardless of the thickness applied, all the gingival color groups with Zr abutment presented ΔE*ab and ΔE00 values below AT. The mean ΔE*ab value decreased as the gingiva thickness increased in the LP, DP, and Or groups with Ti abutments. Abutment material significantly affected the mean ΔE00 values in the groups of LP, DP, and Or with a buccal gingiva thickness of 1.0 mm (p<.05). Gingival color and abutment material was found to be effective on the final color of peri-implant soft tissue. However, further clinical research is required to confirm these findings.

Peri-implant tissue definition and registration with a 3D-printed emergence profile former on titanium stock healing abutment: A dental technique and clinical report.

Recent focus has shifted toward refining the soft tissue emergence profile to enhance aesthetics, support peri-implant health, and ensure long-term success. Traditionally, titanium stock healing abutments or chairside-customized abutments were used to shape peri-implant tissues and develop the emergence profile for implant-supported prostheses. However, advancements in digital dentistry now allow for more precise customization and increased treatment efficiency. This case report introduces a novel approach to shape the peri-implant tissues using a 3D-printed emergence profile former retained by a titanium stock healing abutment. The 3D-printed emergence profile former reduced chairside time and simplified registering the gingival tissue contours and implant position with an intraoral scanner. Following removal, the peri-implant soft tissues displayed enhanced volume buccally, creating an aesthetically pleasing restoration in a site with a notable horizontal tissue deficiency.

Esthetic and Colorimetric Assessment of Peri-implant Soft Tissue Augmented with the Strip Gingival Graft Harvested Either from the Buccal Soft Tissue or the Palate: A Retrospective Study.

It is well known that keratinized mucosa (KM) plays a crucial role for maintaining peri implant health and esthetic outcomes. The Strip Gingival Graft (SGG) technique, which involved an apically positioned flap (APF), in combination with an autogenous SGG and a xenogeneic collagen matrix (XCM), demonstrated its efficacy in re-establishing an adequate amount of KM width at implant sites. Nevertheless, it is still unclear whether harvesting the SGG from the palate (pSGG) or from the buccal aspect of natural dentition (bSGG) affects the esthetic outcomes at the augmented implant sites. Therefore, the objective of the present study was to compare the esthetic outcomes of dental implants augmented with either bSGG &#43; XCM or pSGG &#43; XCM. The present study was designed as a single-center retrospective study, assessing the esthetic and colorimetric outcomes of peri-implant KM augmentation with either pSGG &#43; XCM or bSGG &#43; XCM in cohort of 49 subjects. The two groups were compared in terms of colorimetric outcomes, assessed on clinical photograph using specific software able to identify and quantify the predominant color within the peri implant soft tissue. Colorimetric comparisons with adjacent untreated sites were also investigated. In addition, the Pink Esthetic Score (PES) and the Subjective Esthetic Score (SEE) were performed to further assess the esthetic outcomes of pSGG &#43; XCM and bSGG &#43; XCM. The colorimetric analysis did not show statistically significant differences among sites augmented with pSGG &#43; XCM, sites augmented with bSGG &#43; XCM, and untreated sites. Implants treated with bSGG &#43; XCM showed significantly greater PES (in terms of shape of the mesial and distal papilla, level of the soft tissue margin, soft tissue contour, anatomy of the alveolar process, and final PES) and SEE compared to implants augmented with pSGG &#43; XCM. The present study demonstrated that implant sites augmented with APF with either pSGG &#43; XCM or bSGG &#43; XCM did not show different colorimetric outcomes compared to adjacent untreated sites, while bSGG &#43; XCM obtained superior professional and subjective esthetic scores compared to pSGG &#43; XCM.

Comparative Clinical Outcomes of Two Different Zygomatic Implant Protocols for the Rehabilitation of Severely Atrophic Maxillae: A Retrospective Analysis.

This retrospective study aimed to compare extended sinus lift and extramaxilla surgical protocols for restoring severely atrophic maxillae with zygomatic implants (ZIs) and evaluate their clinical effectiveness. The study includes patients who were treated at a dental clinic in Italy from 2012 to 2022. These patients received fixed screw-retained complete dentures supported by either two or four zygomatic implants (ZIs). The patients underwent a minimum one-year follow-up post-loading, following two protocols: the hybrid and the quad protocol. Digital planning incorporated CBCT scans, intraoral scans, and digital prosthetic plans within implant planning software. Surgical techniques involved extended sinus lift and extramaxilla techniques methods, utilizing the ZAGA approach for ZI placement. The results showed that out of 19 patients with a mean age of 65.3, a total of 56 zygomatic implants (ZIs) and 20 standard implants were used, with no failures observed in either the implants or the definitive prostheses, resulting in a 100% survival rate. According to the ORIS criteria, overall success was achieved in terms of implant stability, sinus health, peri-implant soft tissue condition, and prosthetic function. Only two ZIs (3.6%) exhibited minor gingival recession and moderate thread exposure, which were closely monitored through professional hygiene maintenance. Both the extended sinus lift and extramaxilla protocols demonstrated comparable clinical outcomes and minimal complications in the restoration of severely atrophic maxillae with Zygomatic Implants (ZIs). However, further extensive studies involving larger, multicenter designs and longer follow-up periods are needed to validate and refine these outcomes.

3D analysis of soft tissue dimensional changes after dental implant placement with butt-joint vs. conical connection: a 12-month randomized control trial

Purposeto quantify the soft tissue dimensional changes after single-gap implant placement, during healing abutment and crown delivery phase for butt-joint and conical implant-abutment connection type.Methodsforty patients were enrolled in the study and received randomly allocated implants with butt-joint and conical implant-abutment connection type. A standard healing abutment was placed after 6 months for two weeks. The definitive screw retained full-ceramic crowns were manufactured in a digital workflow. The soft tissue profile was digitized using IOS on following stages: pre-op, immediately, two, 7 and 14 days post-op, pre-exposure, immediately after exposure, two weeks after exposure (pre-delivery), immediately after crown delivery, 6 and 12 months after delivery. The intraoral scans were matched in the metrology software (Geomagic Control X). The mean maximum and mean average differences in mm were gathered to assess the soft tissues change. Various anamnesis parameters have been taken into account.Resultsthe conical connection implant system exhibited more soft tissue gain and less recession, compared to the butt-joint connection type within the 12 months follow-up period. A higher loss of soft tissue was observed in the distal papilla than in the mesial one.Conclusionsthe implant-abutment connection type may influence the reaction of peri-implant soft tissue within the 12 months follow-up period.

Influence of Implant Component Materials on Peri-Implant Soft Tissue Healing: A Comparative Histological and Immunohistochemical Study in Humans.

Recently, the importance of peri-implant soft tissue integration quality has been recognised as an essential factor in the long-term success of dental implant rehabilitation. The aim of this study was to explore the influence of three materials commonly used in implant dentistry, namely titanium (Ti), dental adhesive resin (Re) and polyetheretherketone (PEEK), on the peri-implant soft tissues. In this clinical randomised comparative study, 37 bone-level implants were placed, and experimental transmucosal healing abutments made of different materials were randomly assigned to each implant. These abutments were removed together with the surrounding soft tissues after 8 weeks. Immunohistochemical analyses were performed to determine the presence and localisation of different immune cells. In addition, clinical and radiographic data were collected and peri-implant bone remodeling was assessed. Compared to the Ti and PEEK groups, Re abutments revealed a higher infiltration of macrophages in the connective tissue (p = 0.04) and neutrophils in the adjacent epithelium (p = 0.03). In the Re abutments, peri-implant bone remodeling was higher compared to the other groups (p = 0.01). The use of resin material as a transmucosal healing abutment should be carefully considered as it was associated with a higher presence of inflammatory cells at 8 weeks post-implantation as well as superior bone remodeling compared to PEEK and Ti.

Progress in diagnosis of peri-implantitis

Peri-implantitis is one of the most common biological complications after implant restoration which is difficult to be cured. Early and correct diagnosis is of great significance for the prevention and treatment of peri-implantitis. Although there have been consensus reports to make guiding suggestions in diagnosis, the diagnostic criteria are not uniform, resulting in many confusions. This review summarizes published consensuses on the diagnosis of peri-implantitis, analyzes the diagnostic values and limitations of traditional examination methods, and summarizes the recent advances in examination methods for peri-implant soft and hard tissues, aiming to provide a reference for clinical diagnosis of peri-implantitis.

Effect of CAD/CAM Abutment Morphology on the Outcomes of Implant Therapy: A Randomized Controlled Trial.

Variations in transmucosal abutment contour design may affect the outcomes of implant therapy. This randomized controlled trial was primarily aimed at testing the effect that CAD/CAM zirconia abutments with either a concave or linear divergent transmucosal morphology have on peri-implant mucosal dynamics and indicators of peri-implant health at 1 year after final implant-supported prosthesis insertion in the anterior maxilla. Following computer-guided implant placement and osseointegration, eligible subjects were randomized into either the experimental (concave morphology) or the control (linear divergent morphology) group. A comprehensive set of outcomes of interest related to peri-implant soft tissue dynamics, phenotypical features, and indicators of peri-implant health were assessed at different time points over a 1-year period after insertion of the final restoration. Out of 60 initially recruited subjects, a total of 54 completed the study (n = 29 in the experimental group concave/n = 25 in the control group). Overall implant survival and restoration rates between master impression and 12 months were 100% and 98.2%, respectively. Although a trend for coronal migration of the buccal mucosa zenith, gain in mucosal thickness, and increased probing depth and bleeding on probing was observed in both groups, these changes were clinically negligible, and no substantial differences were observed between study groups regardless of variations in transmucosal abutment morphology. The use of either linear divergent or concave custom CAD/CAM zirconia abutments in a screw-retained, delayed loading approach yielded no significant differences.

Impact of Platelet-Rich Fibrin (PRF) Versus Freeze-Dried Bone Allograft (FDBA) on Peri-Implant Soft and Hard Tissue in Alveolar Ridge Preservation

ABSTRACT Context: After tooth extraction, alveolar ridge preservation (ARP) is essential to maintain the hard and soft tissue dimensions for future implant placement. Two frequently employed biomaterials in ARP are freeze-dried bone allograft (FDBA) and platelet-rich fibrin (PRF), each possessing unique biological characteristics. Materials and Methods: In a randomized controlled study, sixty individuals requiring ARP after tooth extraction were included. The patients were divided into two groups: Group A (n = 30) received PRF, and Group B (n = 30) received FDBA. Clinical measurements, such as soft tissue thickness, keratinized tissue width, and radiographic bone density, were recorded at baseline, three months, and six months after surgery. Cone-beam computed tomography (CBCT) was used to assess changes in hard tissue, such as the width and height of the alveolar ridge. Results: Group A (PRF) showed a significant increase in soft tissue thickness over six months, with an average gain of 2.5 mm (P &lt; 0.01). In contrast, Group B (FDBA) showed a 30% increase in bone density compared to baseline (P &lt; 0.05). Group B experienced a decrease in alveolar ridge height and width of 1.2 mm and 1.8 mm, respectively, while Group A showed a reduction of 1.6 mm and 2.3 mm. Conclusion: In conclusion, peri-implant soft and hard tissues benefit from both PRF and FDBA during alveolar ridge maintenance. Soft tissue thickness can be improved more effectively with PRF, while FDBA is superior for preserving hard tissue.

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.

Survival Rate and Esthetic Outcomes of 2-Piece Zirconia Dental Implants: A 1-Year Single Clinical Trial of Partially Edentulous Patients.

Titanium dental implants, traditionally used for tooth replacement, face certain biological and esthetic limitations. Recently, zirconia has become a notable alternative, valued for its esthetics and biocompatibility. This study evaluated the efficacy of 2-piece zirconia dental implants, particularly their impact on inflammatory cytokines and their survival rate over 1 year. This study was a single-center, prospective trial and included adults aged 18 and above. From 2021 to 2022, 9 2-piece, tissue-level zirconia implants were placed in 8 patients. Following a 3-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 was quantified using the enzyme-linked immunosorbent assay. Eight subjects (ages 31-63) participated. One implant failed after 6 months, resulting in a 1-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 with the baseline, and 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% 1-year survival rate. They maintained stable soft tissue and bone levels, indicating their potential as effective dental restoratives.

Complications and risk factors associated with zygomatic implants: retrospective analysis with 73 consecutive patients followed for 3.5 years.

This retrospective study analyzed zygomatic implant (ZI) survival and implant success (based on ORIS criteria) in patients treated for maxilla atrophy or after reconstruction failure. Implants were placed as quads (4 ZIs) or hybrids (ZIs and conventional implants in premaxilla) in edentulous patients using various surgical approaches, evolving from the sinus slot to Chow's extended sinus lift technique with or without Bichat fat pad. The procedure was followed by immediate loading, while clinical and radiographic evaluations spanned at least 1 year after implantation. The primary outcome was the implant survival at follow-up, and the secondary was the implant success, assessed as complications according to ORIS criteria: prosthetic offset, sinus status, peri-implant soft tissue health, and implant stability. A total of 73 consecutive patients, treated with 217 ZIs and 76 conventional implants, were included, with mean follow-up of 3.5 years (range, 1-9.8 years). Four ZIs failed in 3 patients, including 1 patient with a zygomatic bone fracture. The cumulative survival rate was 98.16%. Although in 2 additional cases, implants lost stability, they achieved delayed osseointegration. Other complications included 21 sinus reactions (excluding the 4 failures) and 28 peri-implant inflammatory reactions. ZIs offered a predictable treatment option for extreme upper jawbone atrophy with a relatively low complication rate and no severe injuries. The Chow technique with the Bichat fat pad positively impacted ZI success and survival, whereas smoking, implantation in fresh sockets, and the limited experience of the surgeon negatively affected the outcomes.

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.