Soft Tissue Color Research Articles

Clinical, radiographic and patient-reported outcomes of zirconia and titanium implants in the posterior zone after 1 year of loading-A randomized controlled trial.

To assess the clinical, radiographic and patient-reported outcomes (PROMs) of posterior zirconia and titanium implants at 1 year of implant loading. Forty-two patients with two adjacent missing teeth were enrolled in a randomized controlled trial with a within-subject controlled design. Each patient received one zirconia (Zr) and one titanium (Ti) implant, with the mesial and distal positions randomized. The implant restoration consisted of multiple layered zirconia, with the buccal aspect veneered. In group Zr, the restoration was intraorally cemented onto the one-piece Zr implant, whereas in group Ti, the restoration was extraorally cemented onto the titanium base abutment and intraorally screw-retained onto the Ti implant. Examinations were performed following restoration delivery at baseline (BL) and at 1 year. Measurements included clinical parameters, radiographic outcomes (MBL) and PROMs. Bleeding on probing showed an increase from BL to 1 year (34 ± 30% for Zr; 25 ± 21% for Ti). MBL remained stable with minimal changes from BL to 1 year, measuring 0.1 ± 0.4 mm (mean ± SD) for Zr and -0.1 ± 0.7 mm for Ti. Veneering fractures were the most frequent technical complication and amounted to 17.5% in group Zr and 5% in group Ti (p = .100). Patients preferred Zr implants for their soft tissue color, with a significant difference in perception between patients and clinicians (p < .017). The study showed that both Zr and Ti implants had similar clinical outcomes, despite a high prevalence of mucositis and a few technical complications. Both implant types demonstrated stable marginal bone levels and similar patient-reported outcome measures.

Long-term evaluation of combined prosthetic-surgical approach and soft tissue augmentation in the esthetic zone.

There is no standard protocol for immediate implant placement and subsequent loading in the smile zone. We aimed to evaluate the long-term outcomes of simultaneous implant placement, soft tissue grafting, and immediate prosthetic loading in the esthetic zone. Thirty-five implants were placed in the maxillary aesthetic zone. Twenty-two patients were evaluated using the Pink Esthetic Score (PES) and White Esthetic Score (WES). Also, the degree of peri-implant bone resorption and patient survey were applied for the esthetic and functional outcomes. The esthetic and harmonizing outcomes were achieved according to the mean total PES/WES value (17.9±2.0). The mean overall PES was 8.5±1.66. The papilla level had the highest mean score (1.8±0.36). Furthermore, the combination of root convexity/color and soft tissue color and texture was one of the key values in evaluating the effectiveness of this method (the mean value was 1.5±0.5). The mesial and distal papillae were 1.6±0.5 and 1.8±0.4, respectively. None of the 35 implants reached below 6 points (which is considered an esthetically unsatisfactory result). The mean WES score was 9.5±0.57. The average degree of total peri-implant bone resorption was 1.05±0.3 mm after 12 months. According to the questionnaire, all the patients smiled without hesitation and were satisfied with the treatment (100%). This study showed that restoring one or more teeth in the smile zone using the concept of one-stage implant placement, soft tissue flap augmentation, and loading with provisional crowns was an esthetically successful and predictable method.

Clinical Effect and Aesthetic Evaluation of Minimally Invasive Implant Therapy.

To explore the clinical effect and aesthetic evaluation of minimally invasive implant in the treatment of dentition defect. From April 2020 to May 2021, 60 patients who received implant restoration were collected as the research objects. Randomly divided into minimally invasive surgery group (30 patients) and routine surgery group (30 patients). The postoperative antibiotic use time, pain disappearance time, swelling degree, and pain degree of the two groups were compared. Follow-up for one year, record and compare the success rate of implants and aesthetic evaluation of restoration between the two groups. The evaluation of patients' satisfaction with restoration was collected and compared. The operation time and antibiotic use time of patients in minimally invasive surgery group were significantly shorter than those in conventional surgery group, and the swelling degree rating was significantly better than that in conventional surgery group, with statistical significance (P < 0.05). The number of patients with no pain (0 degree) and mild pain (degree) in minimally invasive surgery group was significantly higher than that in routine surgery group, and the difference was statistically significant (P < 0.05). One year after the repair, the success rate of implants in minimally invasive surgery group was 100.00% compared with that in routine surgery group (93.33%), and the difference was not statistically significant (P > 0.05). The aesthetic effect scores of patients in minimally invasive surgery group were higher than those in routine surgery group in seven items: proximal gingival papilla, distal gingival papilla, labial gingival margin curvature, labial gingival margin height, root convexity, soft tissue color, and soft tissue texture, with statistical significance (P < 0.05). The satisfaction scores of the patients in minimally invasive surgery group in chewing function, comfort, aesthetics, retention function, and language function were higher than those in conventional surgery group, and the differences were statistically significant (P < 0.05). Minimally invasive implant can achieve the same effect as conventional implant, and it has the advantages of lower postoperative swelling, shorter pain time, better aesthetic effect, and higher satisfaction after restoration.

Comparative evaluation of the relationship of teeth color and soft tissue color of the face in individuals with natural dentition

Introduction The aim of this study is to make it easier for dentists to choose artificial tooth color in fully and partially edentulous patients by evaluating the relationship between the color of the soft tissues of the face and the color of the teeth. Methodology The CIEL*a*b* color values of the maxillary central teeth of the volunteers participating in the study were measured by spectrophotometer, and skin, lip and eye color were measured from facial images containing ceramic blocks to standardize the light and color values using Adobe Photoshop software. The Kolmogorov-Smirnow test and Spearman Rank Correlation test were used to evaluate the data. Results It was observed that there was a higher correlation between the L* values of the teeth and the L* and b* values of the skin.When the analysis between the color measurements taken from the lip photographs and the teeth was examined, it was seen that there was a statistically significant positive correlation between the L* values of the upper central teeth and the a* values of the lip. Conclusion The results showed that the CIEL*a*b* parameters of skin color and lip color can be used in the selection of tooth color in case of loss of natural teeth or discoloration of existing teeth

Comparative evaluation of the relationship of teeth color and soft tissue color of the face in individuals with natural dentition

Introduction: The aim of this study is to make it easier for dentists to choose artificial tooth color in fully and partially edentulous patients by evaluating the relationship between the color of the soft tissues of the face and the color of the teeth. Methodology: The CIEL*a*b* color values of the maxillary central teeth of the volunteers participating in the study were measured by spectrophotometer, and skin, lip and eye color were measured from facial images containing ceramic blocks to standardize the light and color values using Adobe Photoshop software. The Kolmogorov-Smirnow test and Spearman Rank Correlation test were used to evaluate the data. Results: It was observed that there was a higher correlation between the L* values of the teeth and the L* and b* values of the skin.When the analysis between the color measurements taken from the lip photographs and the teeth was examined, it was seen that there was a statistically significant positive correlation between the L* values of the upper central teeth and the a* values of the lip. Conclusion: The results showed that the CIEL*a*b* parameters of skin color and lip color can be used in the selection of tooth color in case of loss of natural teeth or discoloration of existing teeth. Keywords: Color Measurement; Digital Camera; Spectrophotometer; Skin Color; Tooth Color.

Is Zirconia Better Than Titanium Abutments for Soft Tissue Color? A Systematic Review and Meta-analysis of Spectrophotometric Evaluation.

The aim of this systematic review was to evaluate the influence of zirconia and titanium as abutment materials on peri-implant soft tissue color. The searched electronic databases included MEDLINE/PubMed, LILACS, Web of Science, Scopus, and LIVIVO. Two types of studies were included: randomized clinical trials (RCTs) and controlled clinical trials (CCTs) that compared zirconia (Zr) and titanium (Ti) abutments. The outcomes measured were as follows: implant crown esthetic index, visual analog scale, esthetic index, gingiva discoloration index-spectrophotometry, papilla index, recession index, and pink esthetic score. Two reviewers selected the records, assessed quality, and extracted data of included studies independently. A total of 323 patients enrolled in 13 studies were included in this analysis with 11 RCTs and 2 CCTs. Due to the wide variety of methodologies used, meta-analysis was only possible for RCTs that performed spectrophotometric analysis. The use of zirconia or titanium for implant abutments does not seem to be the principal factor for influencing peri-implant soft tissue color. The meta-analysis showed no difference between zirconia and titanium abutments. This study does not support any better advantage of the use of zirconia in comparison to the use of titanium related to peri-implant tissue color.

Optical Efficacy of Titanium Nitride-Coated Abutment Material on Soft Tissue Discoloration: A Spectrophotometric In Vitro Analysis.

The objective of this investigation was to assess the extent of mucosal discoloration caused by different CAD/CAM abutment materials and to determine the influence of mucosa thickness on the subsequent color, with a particular focus on titanium nitride. In a pig maxilla, a trapdoor-shaped mucosa flap was prepared unilaterally. Several CAD/CAM abutment materials were used to assess a number of clinical scenarios. Varying mucosa thicknesses were simulated by connective tissue grafts harvested at the contralateral side of the palate, resulting in layer thicknesses of 1.5, 2, and 3 mm. Titanium (Ti), zirconia (ZrO2), and titanium nitride (TiN) served as test specimens with and without ceramic veneering. Color differences (ΔE) and deviations in brightness (L), chroma (C), and hue (H) were determined spectrophotometrically, comparing the measured value of the native tissue and the results obtained with different materials at varying mucosa thicknesses. All tested specimens caused a mucosa discoloration in comparison to the native tissue, diminishing with increasing mucosa thickness. The use of TiN demonstrated the least mucosa discoloration in thin soft tissue of 1.5 mm, with a mean ΔE value of 1.93 (P = .004). While ZrO2 revealed a comparable ΔE value of 2.13 (P = .022) at a tissue thickness of 1.5 mm, Ti showed the highest mucosa discoloration above the visibility threshold of ΔE = 3.1, with a mean ΔE value of 4.07 (P = .002). Ceramic veneering of the Ti samples led to a considerable reduction in soft tissue discoloration, with a resulting ΔE value of 2.2. The veneering of TiN and ZrO2 samples with porcelain, on the other hand, had no noticeable effect on the mucosa color. CAD/CAM abutment materials cause an adverse soft tissue color shift that decreases with increasing mucosa thickness. In thin peri-implant mucosa, titanium nitride and zirconia lead to the least discoloration. Due to their positive optical properties and mechanical superiority compared with ceramic abutments, gold-hue titanium nitride-coated CAD/CAM abutments could be a clinical alternative in cases of thin peri-implant mucosa.

The impact of autologous concentrated growth factors on the alveolar ridge preservation after posterior tooth extraction: A prospective, randomized controlled clinical trial.

Alveolar ridge preservation can effectively decrease alveolar ridge resorption following tooth extraction, but it can be limited by reducing new bone formation and residual bone graft material. Efforts to develop more efficacious approaches are thus an area of active research. To assess the impact of autologous concentrated growth factors (CGF) on alveolar ridge absorption and osteogenesis following posterior tooth extraction. Fifty patients were randomly assigned to have extraction sockets treated with CGF or no treatment. At 10 days, 1 month, and 3 months postextraction, soft tissue color and texture were examined and evaluated with healing score. Cone-beam computed tomography (CBCT) scans were performed before and 3 months after extraction, while radiographic analyses were used to assess vertical and horizontal bone changes. Bone samples were collected from the extraction sockets during implant placement, and micro-computed tomography (micro-CT) scans and histological analysis were performed to evaluate new bone formation. t-Test or Mann-Whitney U test was used to compare data and the level of statistical significance was set at 0.05 for all analyses. Forty-six patients completed the trial. Sockets in the experimental group exhibited significantly better healing score on Day 10 postextraction relative to the control group, whereas comparable healing was observed in both groups at 1 and 3 months postextraction. Experimental group exhibited reduced vertical bone changes relative to the control (p < 0.05). Significant reductions were observed in ridge width changes at 1 and 2 mm apical to the crest (p < 0.05), although differences at 3 and 5 mm apical to the crest were not significant. Significant differences of bone mineral density (BMD) and microarchitecture of trabecular bone were observed via micro-CT analyses, and the experimental group had better results. CGF application following posterior tooth extraction may reduce vertical and horizontal bone resorption and promote new bone formation.

A 5-year cohort study on early implant placement with guided bone regeneration or alveolar ridge preservation with connective tissue graft.

To assess on the one hand the 5-year outcome of early implant placement with guided bone regeneration (EIP/GBR) and on the other hand of alveolar ridge preservation with late implant placement and connective tissue graft (ARP/CTG). Patients who had been treated with a single implant in the anterior maxilla in 2014 were selected for reevaluation in 2019. In the EIP/GBR cohort, implants were installed 4 to 8 weeks following extraction and the buccal contour was overbuilt by means of GBR. In the ARP/CTG cohort, collagen-enriched deproteinized bovine bone mineral was applied at the time of extraction and implants were installed 5 months later. All ARP/CTG cases received a buccal CTG 3 months after implant installation to reestablish buccal convexity. Primary outcomes were the pink esthetic score (PES) (Belser et al 2009) and the mucosal scarring index (MSI) (Wessels et al 2019). Clinical and radiographical parameters were secondary outcomes. Eighteen patients (9 females; mean age 52) in the EIP/GBR cohort, and 20 patients (9 females; mean age 38) in the ARP/CTG cohort were evaluated. PES was 6.28 following EIP/GBR. A (nearly) perfect aesthetic outcome defined as PES ≥8 was found in 3/18 cases. Perfect root convexity / soft tissue color and texture seemed most difficult to achieve. PES was 7.80 following ARP/CTG. A (nearly) perfect aesthetic outcome was found in 11/20 cases. MSI was 2.94 following EIP/GBR with 14/18 cases showing scarring. MSI yielded 0.50 following ARP/CTG with 6/20 cases showing scarring. In both cohorts, all implants survived, and none had developed periimplantitis. However, implants in the ARP/CTG cohort demonstrated a 5.4 times higher risk for periimplant mucositis than implants in the EIP/GBR cohort at 5 years follow-up. EIP/GBR and ARP/CTG showed acceptable long-term outcomes. The aesthetic outcome was particularly favorable following ARP/CTG, yet this should be interpreted with caution due to selection bias and because soft tissue grafting was not performed in the EIP/GBR cohort. Randomized controlled trial (RCTs) comparing EIP with ARP are required to assess the need for soft tissue grafting and to evaluate clinical, aesthetic, volumetric, and patient-reported outcomes. Only on the basis of such studies clinical recommendations can be made.

Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Aim of this systematic review (SR) of randomized controlled trials (RCTs) was to evaluate effect of different flap designs and graft materials for root coverage, in terms of aesthetics, patient satisfaction and self-reported morbidity (post-operative pain/discomfort). A comprehensive literature search was performed. A mixed-modelling approach to network meta-analysis was utilized to formulate direct and indirect comparisons among treatments for Root Coverage Esthetic Score (RES), with its individual components, and for subjective patient-reported satisfaction and post-operative pain/discomfort (visual analogue scale (VAS) of 100). Twenty-six RCTs with a total of 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p=.005)), Tunnel (TUN) + CTG (0.84 (95% CI [0.15, 1.53]), p=.01) and CAF+Graft substitutes (GS) (0.55 (95% CI [0.006, 1.094], p=.04)) were significantly associated with higher RES than CAF. No significant difference between CAF+CTG and TUN+CTG was detected (0.09 (95% CI [-0.54, 0.72], p=.77)). Addition of CTG resulted in less natural tissue texture (-0.21 (95% CI [-0.34, -0.08]), p=.003) and gingival colour (-0.06 (95% CI [-0.12, -0.03], p=.03)) than CAF. CTG techniques were associated with increased morbidity. Connective tissue graft procedures showed highest overall aesthetic performance for root coverage, although graft integration might impair soft tissue colour and appearance. Additionally, CTG-based techniques were also correlated with a greater patient satisfaction and morbidity.

Immediate implant placement and provisionalization: Aesthetic outcome 1 year after implant placement. A prospective clinical multicenter study.

Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking. To analyze the aesthetic outcome after IIPP. One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used. In the first year postsurgery, the mean total-WES and total-PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3. Within the limitations of this 1-year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved.

Gambaran sementoblastoma tahap awal pada cone beam computed tomography (CBCT) 3D

Objectives: The purpose of this study was to report a case of mandibular cementoblastoma with radiologic approach and describe its characteristics.&#x0D; Case Report: A 32-year-old female came to the Hospital and complained of swelling of the left side of the lower jaw. Clinical examination showed a strong swelling in the buccal region of teeth 44-45, with the same soft tissue color as the surrounding tissue. In the picture cone beam computed tomography appears as a rounded lesion, the internal structure of the radiointermediet with clear and firm boundaries, surrounded by a halo radiolucent. Cementoblastoma radiodiagnosis is established. The patient was referred for surgery.&#x0D; Conclusion: Cementoblastoma was a benign tumor with radiographic characteristics in the form of clearly demarcated radiopaque lesion with radiolucent halo. Some early-stage lesions can show lower density.

Clinical Recommendations for Implant Abutment Selection for Single-Implant Reconstructions: Customized vs Standardized Ceramic and Metallic Solutions.

The present paper presents clinical guidelines for the selection of the abutment material and level of customization for single-implant reconstructions. A systematic literature search was conducted previous to a Consensus Conference, resulting in two systematic reviews. One review focused on esthetic clinical outcomes, including esthetic indices and linear measurements, and the second focused on peri-implant soft tissue color outcomes, evaluated with spectrophotometry. The outcomes of esthetic indexes and linear measurement were highly heterogenic, hence, a meta-analysis was not feasible. All-ceramic and customized solutions showed a trend for improved results of the esthetic outcomes. Regarding soft tissue color outcomes, all-ceramic abutments induced significantly less soft tissue color changes. Both metallic and all-ceramic abutments/standard and customized components may result in clinically and esthetically acceptable reconstructions.

Comparison of Peri-implant Soft Tissue Color with the Use of Pink-Neck vs Gray Implants and Abutments Based on Soft Tissue Thickness: A 6-Month Follow-up Study.

To compare the optical effects of an immediately placed anodized pink-neck implant and abutment vs a conventional gray implant and abutment in relation to soft tissue thickness 6 months after the restoration was completed. Forty patients with a hopeless maxillary anterior tooth received an immediate implant and an immediate provisional or custom healing abutment after flapless extraction. Participants were randomized to receive either a conventional titanium implant (control) or a pink-neck implant (test). All patients then received two identical CAD/CAM titanium abutments (one conventional gray, delivered first, and one anodized to appear pink, delivered 3 weeks after) and a zirconia crown. A spectrophotometer was used to record the color of the peri-implant mucosa and gingiva 3 weeks after delivery of each abutment and 6 months after the final restoration was delivered. The color difference between the two sites was calculated (ΔL*, Δa*, Δb*), and correlations with soft tissue thickness, change in ridge dimension, and implant position were assessed. Irrespective of the randomization group, changing the abutments from gray to pink showed a change in color between the peri-implant mucosa and the natural gingiva. Patients with a thin gingival biotype showed a statistically significant color change (P = .00089) in the a* axis, meaning that the gingiva appeared more pink (Δa*). No significant correlation between the soft tissue color and buccolingual collapse, vertical recession, or implant position was observed in either group. The difference in color observed between the peri-implant mucosa and the gingiva was considerable in all groups. Anodized pink implants and abutments could reduce the difference in the red aspect (Δa*) of the peri-implant mucosa compared to the adjacent gingiva in patients with a thin biotype.

A Systematic Review and Meta-Analysis of the Influence of Abutment Material on Peri-implant Soft Tissue Color Measured Using Spectrophotometry.

To systematically review the current literature on the influence of abutment material (metal vs ceramic) and soft tissue thickness on peri-implant soft tissue discoloration in partially edentulous patients restored with implant-supported single crowns. An electronic MEDLINE search was performed to identify randomized controlled clinical trials (RCTs) up to and including March 2017. The search was complemented by a manual search of related bibliographies. Selection of studies was made independently by two reviewers based on the inclusion criteria. Spectrophotometric data (ΔE values) and soft tissue thickness values were extracted, and, whenever applicable, a meta-analysis using a random-effects approach was performed. The search resulted in 208 titles and 30 abstracts. Full-text analysis was performed for 13 articles, resulting in 6 included RCTs. Meta-analysis of a total of 266 abutments revealed significantly lower ΔE values for ceramic abutments when compared to the overall metal abutments (z test value = 1.99, P = .05), with a mean difference of 1.41 (95% CI 0.02, 2.80). Nonsignificant differences were found between titanium and zirconia (z test value = 1.59, P = .11). Limited information on the correlation between soft tissue thickness and ΔE values was found. Hence, it was not possible to perform a meta-analysis of this question. The color outcome of the peri-implant soft tissue might be influenced by the abutment material. Ceramic abutments appear to provide an improved color matching between peri-implant soft tissues and soft tissues around natural teeth when compared to metallic abutments. These findings support the preference for all-ceramic or "white" abutments in esthetically demanding cases.

Evaluation of esthetic parameters related to a single implant restoration by laypeople and dentists

Statement of problemCurrently available assessment tools for evaluating the esthetic outcome of implant restorations consist of objective indices created for dentists. The investigation of esthetic parameters according to the patient's perspective is lacking. PurposeThe purpose of this observational study was to evaluate and compare the importance of different soft-tissue and restoration-related esthetic parameters for patients and clinicians. Material and methodsA photoediting software program (Photoshop CC; Adobe Corp) was used to produce 10 photographs with modified smiles from the original photograph by altering 1 parameter of the pink esthetic score and white esthetic score (PES/WES) at a time. A total of 120 participants were recruited in the study, including 40 laypeople, 40 prosthodontists, and 40 periodontists. A total of 440 visual analog scale (VAS) values were obtained for each group to record participants' subjective esthetic assessments of all photographs (10 modified and 1 original photograph). Repeated-measures ANOVA and post hoc mean comparison (t grouping) were used to identify whether the individual alteration on the PES and WES indices was significant for each group. ResultsFor the laypeople, color (hue and value) appeared to be the most important parameter. After color, the order of importance was as follows: root convexity along with soft-tissue color and texture, level of facial mucosa, distal papilla, mesial papilla, translucency or characterization, surface texture, and tooth form. For the periodontists, color (hue and value) was also the most important parameter, but it was not separable from a cluster of other parameters: level of facial mucosa, root convexity along with soft-tissue color and texture, mesial papilla, and distal papilla. For the prosthodontists, color (hue and value) and level of facial mucosa were the most important parameters affecting esthetic assessment, followed by root convexity along with soft-tissue color and texture, mesial papilla, and distal papilla. ConclusionsAll groups graded color (hue and value) as the most important parameter affecting the esthetic outcome and the original unaltered photograph as the most esthetically pleasing image. All participants (laypeople and dental specialists) appeared to be able to perceive the same 5 parameters including color (hue and value), level of facial mucosa, mesial papilla, distal papilla, and root convexity along with soft-tissue color and texture that are negatively affecting esthetic outcomes. Except for color (hue and value), restoration-related esthetic parameters had a lesser effect on the overall esthetic assessments for all groups.

Flapless Postextraction Socket Implant Placement, Part 3: The Effects of Bone Grafting and Provisional Restoration on Soft Tissue Color Change-A Retrospective Pilot Study.

This article presents the results of a soft tissue color study on flapless immediate implant therapy from a sample of 23 patients who received either a provisional restoration alone or with bone grafting. The gingival color in clinical photographs was measured for the implant and for the contralateral tooth site at 2.0 and 5.0 mm below the free gingival margin using Photoshop software (Lightroom CC, Adobe). The average color difference (ΔE) values for the two groups were 2.6 and 2.4 at 2.0 mm and 1.9 and 2.5 at 5.0 mm from the free gingival margin, respectively. Approximately 80% of the sites were below the visibly perceptible threshold (ΔE = 3.1 ± 1.5) and not detectable by the human eye. The use of provisional restorations has shown positive outcomes on the stability of peri-implant soft tissue thickness and lower ΔE values. Further research is required to assess esthetic outcomes inclusive of color change relative to the clinical treatment rendered.

The Biocompatibility of Cyanoacrylate Tissue Adhesive in Conjunction with a Collagen Membrane for Providing Soft and Hard Tissue Regeneration in Extraction Socket Preservation Procedures.

This clinical investigation was performed to determine the efficacy of cyanoacrylate tissue adhesive to enhance soft and hard tissue healing of extraction wounds requiring a regenerative effort. Fourteen patients requiring a total of 25 tooth extractions were selected. Twenty sockets were treated with cyanoacrylate tissue adhesive over an exposed collagen barrier membrane without altering the mucogingival junction, while five extraction sockets were allowed to heal by the secondary healing intention as well but without tissue adhesive application. The results were evaluated with emphasis on soft tissue color and form as well as bone surface morphology. All sites received dental implants. There was a clear advantage to using cyanoacrylate tissue adhesive as a protective mechanism over an exposed collagen barrier membrane.

The effect of resorbable membranes on one-stage ridge augmentation in anterior single-tooth replacement: A randomized, controlled clinical trial.

To evaluate the effect of resorbable membranes on one-stage ridge augmentation procedures in small (2-4mm) buccal bony dehiscences in anterior maxillary single-tooth replacement. Patients with a buccal bony dehiscence after implant placement in the esthetic zone were randomly allocated to one-stage ridge augmentation with (M+) or without a membrane (M-). Second-phase surgery was performed after 8weeks, and follow-up was performed 1, 6, and ≥12months after loading. Outcomes included implant survival and success, complications, clinical and radiographic parameters, esthetic results and patient satisfaction. Fifty-two patients were randomized to one-stage ridge augmentation with (n=25) or without use of a membrane (n=27). No significant differences in implant survival and success have been observed. The risk of having a small mucosal dehiscence was more than six times higher in the M+ group than in the M- group (RR 6.24, 95% CI 0.81 to 48.21). At the last follow-up, the bleeding index (BI) was marginally higher in the M+ group (14/9/2/0) compared to the M- group (24/2/0/0) (U=205, Z=-2.97, p=.003, r=.42). The median change in marginal bone level was statistically lower in the M+ group (0.06mm) than the M- group (0.60mm) at last follow-up (U=120, Z=-2.73 a p=.006 r=.42). Total pink esthetic index (PES) and white esthetic score (WES) and combined PES/WES were not significantly different between treatment groups at more than 12months after loading. Only the subcategory root convexity/soft tissue color scored significantly lower in the M+ group (1.5) compared to the M- group (2.0) at the last follow-up (U=172, Z=-2.34, p=.019 r=.34). No differences were found in patient satisfaction. The use of a resorbable membrane in small buccal bony dehiscences in anterior maxillary single-tooth replacement resulted in less marginal bone loss, but showed more mucosal dehiscences, higher bleeding scores and lower scores on root convexity and soft tissue color after at least one year of loading. No effect was seen on implant survival and success, overall esthetic results, and patient satisfaction. The research protocol was registered at the Dutch Trial Register (NTR) with ID NTR6137.

Esthetic Evaluation of Implant-Supported Single Crowns: The Implant Restoration Esthetic Index and Patient Perception.

To test the validity and reliability of a newly developed Implant Restoration Esthetic Index (IREI) and to compare esthetic outcomes reported by patients and professionals. Ten graduate students and 10 prosthodontists assessed esthetic outcomes of 27 single-tooth implants with the IREI. Six peri-implant soft tissue parameters were measured using visual analog scales: mesial papilla presence, distal papilla presence, gingival trigone, soft tissue curvature, alveolar process deficiency, and soft tissue color and texture, as well as the six crown parameters: crown contour, crown position, crown labial convexity, crown characterization, crown color and translucency, and abutment visibility. The validity was tested based on Pearson's correlation. The internal consistency reliability was analyzed by Cronbach's alpha. Interclass correlation coefficients (ICC) were calculated to express the test-retest reliability and the inter-rater reliability. The correlations between patient and professional evaluations were analyzed by Pearson's correlation. The IREI demonstrated significant correlation (p < 0.05) to the pink esthetic score and white esthetic score (PES/WES). The internal consistency reliability showed a Cronbach's Alpha of 0.830. The test-retest reliability was excellent in both the graduate student group and the prosthodontist group, with ICCs of 0.961 and 0.952, respectively (p < 0.05). The inter-rater reliability was acceptable, with ICCs of 0.649 and 0.667, respectively (p < 0.05). Low correlation coefficients were found between patient and professional evaluations. The results of this study indicated that the IREI was considered a valid and reliable index involving sufficient parameters for professional esthetic evaluation of single-tooth implant restorations. The patient-reported esthetic outcomes had poor or no significant correlation to professional-reported outcomes.