Buccal Bone Thickness Research Articles

Repairing Dehiscence Defects at Implant Sites using β-Tricalcium Phosphate/Calcium Sulfate versus Xenograft Combined With Membrane: A Randomized Clinical Trial.

Guided bone regeneration (GBR) typically involves bone grafts and a membrane to enhance bone formation. Beta-tricalcium phosphate calcium sulfate (β-TCP/CS) is a novel material with self-hardening and tissue growth inhibition properties and can potentially replace the need for a membrane. This study compares β-TricalciumPhosphate/CalciumSulfate with deproteinized bovine bone mineral and a collagen membrane (DBBM/CM) to repair bone defects at implant sites over six months. Sixteen implant defects were divided into β-TCP/CS (n = 8) and DBBM/CM (n = 8). The results showed no significant differences in vertical and horizontal defect fill in millimeters between β-TCP/CS (2.87±1.25 and 2.37±1.06 mm., respectively) and DBBM/CM (3.5±0.92 and 2.87±1.12 mm. , respectively). Buccal bone thickness (BT) alterations at the implant platform levels (BT0) were similar for both materials. However, β-TCP/CS exhibited greater bone alteration at the 2-mm level (BT2: -1.85 mm vs. -0.47 mm) and 4-mm level (BT4: -1.79 mm vs. 0.12 mm) apical to the implant platform compared to DBBM/CM. When assessing volume alteration, β-TCP/CS showed a significantly greater reduction at the platform to the 2 mm level (-61.98% vs. -23.76%) than DBBM/CM. In conclusion, β-TCP/CS demonstrated promise for treating buccal bone defects around implants but exhibited higher graft reduction. This suggests that while β-TricalciumPhosphate/CalciumSulfate may offer clinical benefits, its potential for greater graft reduction should be considered. Further research and evaluation are warranted to fully understand the long-term implications of using β-TCP/CS in guided bone regeneration procedures.

Evaluation Of Bone Thickness At Different Anatomical Sites In Infrazygomatic Crest For Miniscrew Insertion In Skeletal Class II Patients – A CBCT Study

AIM: To assess infrazygomatic crest bone thickness at different anatomical sites at a distance of 5mm, 7mm, 9mm and 11mm apical to cementoenamel junction, 70 degree to occlusal plane in skeletal class II patients using cone beam computed tomography (CBCT). Materials and Methods: The sample consists of cone beam computed tomography images of 23 class II subjects were evaluated. Infrazygomatic crest bone thickness was evaluated at the six horizontal regions (i) interdental area between maxillary second premolar (PM2) and first molar(M1) (ii) Mesiobuccal root of maxillary first molar (MB root of M1) (iii) Distobuccal root of maxillary first molar(DB root of M1) (iv) interdental area between maxillary first molar(M1) and second molar(M2) (v) Mesiobuccal root of maxillary second molar(MB root of M2) (vi) Distobuccal root of maxillary second molar (DB root of M2) at a vertical distance of 5mm,7mm,9mm and 11mm apical to cementoenamel junction, 70 degree to occlusal plane. Results: The buccal bone thickness increase from mesial surface of maxillary first molar to mesial surface of maxillary second molar from cement enamel junction at the level of 11mm, 70 degree to the occlusal plane. The bone thickness decreases at the second molar level. Conclusion: The safe site for insertion of miniscrews in the infrazygomatic crest were the interdental region between the maxillary first and second molars at the heights of 11 mm from cementoenamel junction and 70 degree to the occlusal plane

Anatomical Factors Affecting the Complexity of Maxillary Sinus Augmentation in Saudi Patients: A Cone Beam Computed Tomography (CBCT) Study.

This study aims to evaluate the anatomical variations of the maxillary sinus and determine the difficulty score of maxillary sinus augmentation (MSA) in Saudi patients seeking dental implant rehabilitation of the posterior maxilla using cone beam computed tomography (CBCT). CBCT records of dental patients seeking treatment at a University Dental Teaching Hospital between 2019 and 2023 were retrospectively analyzed. Measurements were obtained from CBCT images, including membrane thickness, sinus width, buccal bone thickness, presence of maxillary sinus septa, residual alveolar ridge height, angle of the buccolingual sinus wall, and the presence of the alveolar antral artery (AAA). The difficulty score for MSA was determined based on these anatomical factors. A total of 107 maxillary sinuses in 86 subjects were evaluated. The average membrane thickness was 2.23 mm, with males showing significantly higher thickness than females. Sinus septa were found in 54 (50.5%) sinuses, with 18 (17%) of sinuses having interfering septa. Twenty-three (21.5%) sinuses had a residual alveolar ridge height of less than 4 mm. The average angle of the buccolingual sinus wall was 79.39°, indicating a high prevalence of wide-shaped sinuses. The average sinus width was 14.09 mm, with 55 sinuses (51.4%) less than 15 mm. The average buccal bone thickness was 1.07 mm, in29 (27%) sinuses, the thickness was more than 2 mm. AAA was visualized in 60 (56%) of sinuses, with 45 (42%) of sinuses having AAA interfering with the MSA window. In this study, most sinuses were classified as simple or moderate difficulty, with higher membrane thickness, presence of septa, and AAA being the significant risk factors for complications. These findings provide valuable insights for implant surgeons in Saudi patients seeking dental implant rehabilitation of the posterior maxilla, enabling them to anticipate and minimize potential complications during MSA procedures.

A Randomized Controlled Trial on the Timing of Soft-Tissue Augmentation in Immediate Implant Placement: Hard-Tissue Changes and Clinical Outcome.

To assess the impact of the timing of soft-tissue augmentation (STA) on mean buccal bone changes following immediate implant placement (IPP) in the anterior maxilla. Patients with a failing tooth and intact buccal bone wall in the anterior maxilla (15-25) were enrolled in this randomized controlled trial. Following single IIP and socket grafting, they were randomly allocated to the control group (immediate STA performed during the same surgical procedure) or the test group (delayed STA performed 3 months later). Implants were placed with a surgical guide and immediately restored with an implant-supported provisional crown. Changes in bone dimensions were assessed using superimposed CBCT images taken prior to surgery and at 1-year follow-up. Clinical outcomes were registered at 1-year follow-up. Twenty patients were randomized to each group (control: 16 females, 4 males, mean age 57.6; test: 9 females, 11 males, mean age 54.2). Ten patients in the control group and 13 patients in the test group had a thick bone wall phenotype. Estimated marginal mean horizontal buccal bone loss at 1 mm below the implant shoulder was -0.553 and -0.898 mm for the control and test group, respectively. The estimated mean difference of 0.344 mm in favour of the control group was not significant (95% CI: -0.415 to 1.104; p = 0.363). Also at all other horizontal and vertical levels, no significant differences could be observed between the groups. The combination of socket grafting and STA enabled counteraction of any buccal soft-tissue loss (≥ 0 mm) at 1 mm below the implant shoulder in 82% of the patients in the control group and in 75% of the patients in the test group (p = 1.000). The clinical outcome was favourable in both groups, yet implants in the control group demonstrated slightly less marginal bone loss (median difference 0.20 mm; 95% CI: 0.00-0.44; p = 0.028). In patients with an intact and mainly thick buccal bone wall in the anterior maxilla, the timing of STA following IIP had no significant impact on mean buccal bone loss. ClinicalTrials.gov identifier: NCT05537545.

Effectiveness of using implant fixture as a ridge expander.

Adequate bone thickness around dental implants is vital for their stability and to reduce resorption. This study evaluated the ability of implant fixtures to serve as ridge expanders by measuring width changes pre- and post-implantation. Measurements including initial alveolar bone width, post-osteotomy width, post-expansion width, and buccal bone thickness were recorded for patients undergoing implant placement. Bone quality was assessed using established criteria. Of the 102 subjects (52% male, 48% female), significant ridge width increases at 0mm and 2mm levels were noted (p < 0.05). Larger implant diameters resulted in greater ridge expansion. Absence of prior augmentation was linked to higher bone quality (B = -1.684, p = 0.001), explaining 15% of bone quality variance. Ridge expansion effects also correlated with the site, implant diameter, and design. Dental implant fixtures can effectively expand the ridge, with expansion influenced by implant diameter, anatomical location, prior augmentation, and implant design. These factors must be considered for tailored treatment planning in implant dentistry. This study's clinical relevance lies in its exploration of the potential benefits of dental implant fixtures can effectively to expand the ridge taking into consideration implant diameter, anatomical location, prior augmentation, and implant design.

Impact of labially inclined implant axes on immediate implant placement and provisionalization in anterior maxilla: A prospective cohort study.

To investigate whether a labially inclined implant axis compromises the clinical outcomes of immediate implant placement and provisionalization (IIPP) in the anterior maxilla. Patients with unsalvageable central or lateral maxillary incisors were enrolled. IIPP with simultaneous connective tissue graft (CTG) was performed in all participants. In the control group, the alveolar ridge had a long axis aligned with the tooth, which ensured that the immediate implant was aimed at the incisor edge or the cingulum of future restoration. The test group had a large angle between the axes of the ridge and tooth. To avoid bone fenestration, the implants were placed labially inclined and emerged from the labial side of future restoration. Intra-oral scanning and cone-beam computed tomography were performed to record soft and hard tissue profiles at baseline and 1 year later. Soft tissue stability, bone remodeling, and pink esthetic score (PES) were evaluated and compared between two groups. Thirty-nine participants (19 tests and 20 controls) completed the study. At 1-year post-surgery, the mid-facial gingival margin migrations were 0.85 ± 0.37 mm (test) and 0.81 ± 0.33 mm (control), without significant differences. No differences were identified in buccal profile alteration, linear ridge reduction, buccal bone thickness, or PES scores. The test group demonstrated thinner buccal soft tissue at the crestal level than the control group. When large tooth-ridge angulation presented, labially inclined implant, avoiding buccal ridge fenestration in IIPP with CTG, did not compromise the clinical outcome in short term.

Immediate single-tooth implant placement in bony defect sites: A 10-year randomized controlled trial.

It is unclear whether an intact buccal bony plate is a prerequisite for immediate implant placement in postextraction sockets. The aim of this 10-year randomized controlled trial was to compare peri-implant soft and hard tissue parameters, esthetic ratings of, and patient-reported satisfaction with immediate implant placement in postextraction sockets with buccal bony defects ≥5mm in the esthetic zone versus delayed implant placement after alveolar ridge preservation. Patients presenting a failing tooth in the esthetic region and a buccal bony defect ≥5mm after an extraction were randomly assigned to immediate (Immediate Group, n=20) or delayed (Delayed Group, n=20) implant placement. The second-stage surgery and provisional restoration placement occurred 3months after implant placement in both groups, followed by definitive restorations 3months thereafter. During a 10-year follow-up period, marginal bone levels (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded. The mean marginal bone level change was -0.71±0.59mm and -0.36±0.39mm in the Immediate Group and the Delayed Group after 10years (p=0.063), respectively. The secondary outcomes were not significantly different between both groups. Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in postextraction sockets with buccal bony defects ≥5mm, were not statistically different to those following delayed implant placement after ridge preservation in the esthetic zone. Immediate implant placement in case of a failing tooth is a favorable treatment option for patients because it considerably shortens treatment time and the number of surgical treatments. The question is if an intact buccal bone wall is necessary for immediate implant placement. A 10-year study was performed in which 20 patients with a failing tooth in the frontal region of the upper jaw were treated with immediate implant placement and were compared with 20 patients in whom a more conventional treatment strategy was followed in which the failing tooth was first removed and the bone gap restored and the implant placed in a second step. After a 10-year follow-up period, it appeared that the bone around the implant was very stable, gums were healthy, and patients were very satisfied with the result. There was no difference between the two treatment procedures. Such results mean that professionals can discuss the procedure with the patient and apply the individual's preference.

Periodontal evaluation after maxillary expansion with atooth-bone-borne expander in growing patients : Arandomized clinical trial.

This two-arm parallel randomized controlled trial aimed to evaluate and compare periodontal changes due to rapid maxillary expansion (RME) using tooth-bone-borne and tooth-borne devices in growing patients via clinical examinations and cone-beam computed tomography (CBCT). Forty-two eligible patients (aged 11-14years; transverse maxillary deficiency, posterior crossbite) were screened and divided into two groups based on the treatment received (randomization was performed using computer-generated numeric sequences): hybrid hyrax tooth-bone-borne group (TBB) and hyrax tooth-borne group (TB). The primary outcome was the change in cortical bone thickness (by CBCT). In addition, the clinical attachment level (CAL), gingival recession, and bleeding were assessed. Both examinations were performed before and 3months after the activation phase. Intergroup comparisons were performed using analysis of covariance (ANCOVA; P < 0.05). Twenty-one patients (12girls and 9boys; mean initial age, 13.3years) were included in the TBB group and 21 (5girls and 16boys; mean initial age, 13.2years) were included in the TB group. The TB group exhibited adecrease in buccal bone thickness in the first premolars and first molars at all three evaluated levels. Specifically, tooth 14 at 3 mm from the enamel-cement junction showed asignificant width reduction (0.7 mm; p < 0.001), accompanied by anotable increase in palatal cortical thickness at 6 mm of enamel-cement junction (1.13 mm; p < 0.001). RME resulted in buccal bone thickness reduction at the first premolar with hyrax treatment. In the molar region, both devices resulted in cortical bone alterations that were less pronounced in the TBB group.

Effect of Sagittal Root Position, Angle, and Bone Thickness on Peri-implant Tissue Phenotype and Bone Level in Socket Shield Technique: A Retrospective Case Series.

There were only a few studies investigating the effect of sagittal root position (SRP), sagittal root angle (SRA), and buccal bone thickness (BBT) on peri-implant tissues using the socket shield technique (SST). This retrospective case series aimed to evaluate the SRP, SRA, and BBT in socket shield cases and examine the effect of these anatomical factors on the peri-implant tissue phenotype and bone level. Data from 27 patients (14 women, 13 men) treated with SST in the maxillary esthetic region between July 2019 and September 2021 were included. Clinical indices (modified plaque and bleeding indices, probing depth, keratinized mucosa width, mucosal thickness) and periapical radiographic recordings (marginal bone level) taken immediately after permanent prosthesis placement and 1 year later were used. Cone beam computerized tomography images were used to examine BBT, SRP, and SRA before implant placement and horizontal and vertical bone levels before implant placement and 1 year after prosthetic rehabilitation. The data were divided into groups based on BBT (<1 and ≥1 mm) and SRA values (<10° and ≥10°). There were no significant differences in 1-year clinical factors between the SRA <10° and SRA ≥10° groups. However, higher vertical bone loss was found in the SRA ≥10° group (P = .01, d = 0.53). There were no significant differences in clinical or radiographic factors between the BBT <1 mm and BBT ≥1 mm groups. In conclusion, BBT showed no significant effect on tissue phenotype and bone level, but SRA affected bone level in socket shield cases.

Alveolar ridge bone changes in patients treated with the split-crest technique with simultaneous implant placement: Aretrospective longitudinal observational study.

To investigate long-term alveolar ridge bone changes in patients treated with the split-crest technique (SCT) with simultaneous implant placement. Alveolar ridge width (ARW) was measured with a caliper immediately before (ARW1) and after SCT (ARW2) with a caliper. Existing CBCT scans taken at least 5 years postoperatively were used to assess the healed ARW (ARWF), buccal bone thickness (BBT), and lingual/palatal bone thickness (L/PBT) at 0, 3, and 5 mm apically from implant platform level (IPL). The distance between IPL and buccal bone crest (IPL-BBC) was also measured. Findings were compared with Wilcoxon and Student's t tests (p < .05). Records of thirty patients with 85 implants were included. Eleven patients (31 implants) presented CBCT scans taken in two separate occasions, resulting in 116 measurements. Tomographic follow-up ranged from 5 to 18 years (11.5 ± 4.18 years). Mean ARW increased from 3.2 ± 0.6 to 6.6 ± 0.48 mm after SCT, but significantly reduced overtime to 4.46 ± 0.83 mm (ARWF) (p < .0001). Mean BBT was 0.5 ± 0.9, 1.3 ± 0.9, and 2.0 ± 1.2 mm, while mean L/PBT was 0.9 ± 0.7, 1.6 ± 0.9, and 2.1 ± 1.0 mm at 0, 3, and 5 mm from IPL, respectively. IPL-BBC distance varied up to 8.7 mm (1.4 ± 2.0 mm), with 56/116 measurements (51/85 implants) showing IPL-BBC = 0 mm. Although SCT with simultaneous implant placement can predictably increase ARW postoperatively, ARW tended to significantly reduce over time, due to reductions in BBT and L/PBT, especially coronally. Nonetheless, 60% of the implants still presented some buccal bone at IPL.

Protocolo de tratamento ortodôntico em adultos jovens com endognatia maxilar utilizando o expansor rápido palatino ancorado em mini-implante

Introduction: Maxillary endognathia is a skeletal malocclusion that, if left untreated, can evolve into a complex malocclusion, which hinders facial development and creates breathing problems due to nasal constriction. In 2010, Lee and collaborators created a mini-implant-assisted rapid maxillary expansion (MARPE) technique. Objectives: To describe the MARPE protocol and its clinical effects. Materials and methods: A bibliographic search was carried out in the Pubmed, Science Direct, Scielo and Google Scholar databases referring to the last 10 years. Results: The search strategies described enabled 150 articles to be obtained which went through various selection stages. In the end, 15 articles were evaluated and selected for this review. Discussion: The MARPE technique has reduced the skeletal, dento-alveolar and periodontal side effects caused by conventional appliances, optimizing the potential for skeletal expansion in individuals with advanced stages of skeletal maturation. Conclusion: The MARPE appliance has bone and dental anchorage. The clinical effects include the opening of the maxilla in the frontal plane, an increase in the volume of the nasal cavity after expansion, an increase in the interzygomatic distance, an increase in the average width of the face and the width of the alar base and widening of the nose. There was also a decrease in buccal bone thickness and alveolar crest height and a buccal inclination in the premolars and molars. In carrying out this research, we found that there are few or practically no studies on the effect on the pulp cavity, root resorption and orbital volume.

Comparative Evaluation of Hard- and Soft-tissue Changes in Immediate Implant Placement Using Flapless Approach with and without Demineralized Freeze-dried Bone Allograft Clinically and Radiographically Using Cone-beam Computed Tomography.

The present study evaluated hard- and soft-tissue changes in immediate implants using flapless approach with and without demineralized freeze-dried bone allograft (DFDBA) clinically and radiographically using cone-beam computed tomography (CBCT). Thirty-two sites in patients requiring immediate implants in the maxillary anterior region including the premolars were grouped according to the treatment provided with (test group) or without (control group) DFDBA. Plaque index, probing depth, soft-tissue assessment using Testori Esthetic Score (TS), and ridge width were recorded at baseline and postoperatively at 6 and 12 months, while crestal bone height (CBH), buccal bone thickness (BBT), jump space (JS), and gingival thickness were evaluated using CBCT at baseline and 12 months. Considerable differences among the different time lines and the groups in favor of the test group were prominently seen on the midfacial aspects at 12 months, with CBH values of -0.28 ± 0.17 mm in the test group as compared to -0.78 ± 0.34 in the control group (P < 0.0001). The JS was maximum on the buccal aspects being 1.42 ± 0.87 mm in the test group and 1.12 ± 0.81 mm in the control group which reduced at 12 months to 0.13 ± 0.35 mm and 0.73 ± 0.79 mm, respectively. Immediate implants with DFDBA augmentation using a flapless protocol demonstrated reduced CBH with resolution of JS and increased BBT, especially at the coronal aspects which influence the tissue stability and overall esthetics.

Efficacy of the Sausage Technique in Rebuilding the Crestal Buccal Bone Thickness: A Retrospective Analysis.

The goal was to evaluate the efficacy of the sausage technique in reconstructing the crestal buccal bone thickness, focusing on the distribution shape of the regenerated volume. Ten implants were placed in five patients with Cawood-Howell class IV defects. A cone beam computed tomography (CBCT) was executed at T0 (before surgery). Guided bone regeneration (GBR) with the sausage technique utilized a resorbable collagen membrane, made of a 50% autologous bone and a 50% anorganic bovine bone matrix (ABBM) mixture. After 6 months, a CBCT (T1) was performed before implant placement. Using CBCT software, a plane parallel to the implant axis intersected perpendicular planes every 1.5 mm from the crest level. T0 and T1 CBCT sections were analyzed, yielding 140 measurements. Statistical analysis via SPSS revealed a significant increase in thickness (average 2.82 ± 1.79 mm). Maximum gains occurred at 4.5 mm from the coronal crest line (3.8 ± 1.51 mm). The GBR sausage technique was effective with minimal post-operative complications, yielding the biggest gain at the mid-ridge sagittal area. Within the analysis limitations, it can be assumed that the sausage technique is effective for horizontal GBR in the maxilla, but a lesser volume might be achieved at the crestal level because it seems to follow a bowed regeneration shape.

The effect of a barrier membrane on the incorporation of deproteinized bovine bone mineral (DBBM) in experimental defects at the time of early implant placement. A preclinical study

ObjectivesThis study aimed to assess membrane use with a bone substitute graft for guided bone regeneration (GBR) in experimental dehiscence defects.Materials and methodsMaxillary second incisors (I2) in 9 dogs were extracted. Six weeks later, implants were inserted and experimental dehiscence defects (5 × 3 mm) created on the buccal aspect. The defects and surrounding bone were grafted with deproteinized bovine bone mineral. One side (test) was covered with a resorbable collagen membrane whereas the contralateral side (control) was not. After 6 weeks, histomorphometrical analysis was performed to evaluate: (a) first bone-to-implant contact (fBIC), (b) buccal bone thickness at 1 mm increments from implant shoulder, (c) regenerated area (RA), (d) area and percentages of new bone (B), bone substitute (BS) and mineralized tissue (MT).ResultsThe histological appearance was similar between test and control sites. At central and lateral sections, there were no differences between groups for fBIC, buccal bone thickness, RA, BS, B, %B, MT and %MT. At central sections, membrane use favoured more %BS and %MT (p = 0.052). There was significantly more B, %B and MT at lateral compared to central sections.ConclusionsMembrane use tended to retain more bone substitute, but had no effect on new bone ingrowth. Lateral sections showed significantly more bone ingrowth and mineralized tissue compared to central sections, confirming that new bone ingrowth takes place mainly from the lateral walls of the defect.Clinical relevancePreclinical research to clarify the dynamics of bone regeneration in GBR procedures is relevant in clinical practice.

Risk factors for gingival invagination: A retrospective study.

This study aimed to identify the risk factors for gingival invagination during orthodontic treatment after premolar extraction. The medical records of 135 patients who had undergone interdental space closure after premolar extraction were collected, and cone beam computed tomography was performed to determine the presence of gingival invagination. The risk factors were examined using mixed-effects models and generalized propensity score weighting (GPSW) to develop a predictive model. Univariate analysis revealed that the extraction site, buccal bone thickness 4 mm apical to the cemento-enamel junction (MB1), mid-root buccal bone thickness (MB2) and vertical skeletal relationships were related to gingival invagination (p < .05). Furthermore, a subsequent multivariable mixed-effects model analysis indicated a significantly increased risk of gingival invagination at MB1 < 1 mm (p < .001; odds ratio [ORMB1≤0.5mm] = 29.304; 95% confidence interval [CI]: 8.986-93.807; OR0.5<MB1<1mm = 22.309; 95% CI: 9.890-50.320). Row mixing model analysis performed after balancing covariates using GPSW showed that MB1 and vertical skeletal relationships were associated with gingival invagination (p < .05) with an increase in ORs. Therefore, in addition to MB1, the risk of gingival invagination is higher in hyperdivergent and normodivergent patients. During the establishment and internal validation of the predictive model, the area under the curve for all three models exceeded 0.7. The risk of gingival invagination is higher in patients with MB1 < 1 mm and in normodivergent or hyperdivergent patients.

Influence of CBCT filters and contrast adjustments on peri-implant buccal bone thickness measurement and blooming expression.

To assess whether filter and contrast adjustments can improve the accuracy of CBCT in measuring the buccal bone thickness (BBT) adjacent to dental implants by reducing blooming artifacts. Homogeneous bone blocks with peri-implant BBT of 0.3mm, 0.5mm, and 1mm were scanned using the Orthophos SL system. Three dentists measured the BBT in 234 CBCT scans under different settings of contrast adjustments and 'Sharpen' filter activation. Additionally, implant diameter measurements were taken to assess blooming artifact expression. The differences between tomographic and actual measurements of BBT and implant diameter [(CBCT - actual) * 100 / actual] were subjected to Mixed ANOVA (α = 0.05). The group with the thinnest BBT (0.3mm) had the greatest difference between tomographic and actual measurements (79.9% ± 29.0%). Conversely, the 0.5mm (36.1% ± 38.4%) and 1mm (29.4% ± 12.3%) groups exhibited lower differences (p < 0.05). 'Sharpen' filter activation reduced blooming expression since it resulted in a lower difference for implant diameter (p < 0.05), but it did not influence BBT measurements (p = 0.673). Contrast settings had no impact on BBT (p = 0.054) or implant diameter measurements (p = 0.079). Although filter activation reduced blooming artifacts, neither filter nor contrast adjustments improved the accuracy of CBCT in measuring peri-implant BBT; actual BBT influenced this task. When assessing the peri-implant buccal bone plate in the CBCT system studied, dental surgeons may find it beneficial to adjust contrast and apply filters according to their preferences, since such adjustments were found to have no adverse effects on the diagnostic accuracy of this task. The use of the 'Sharpen' filter may lead to improved representation of implant dimensions.

Immediate Placement and Loading of Maxillary Single-Tooth with Scalloped Shape Implants and Digitalized Customized Restoration: A 5-Year Prospective Study of Marginal Bone Level.

To evaluate, within a period of 5 years, the bone level in mesial, distal, palatal, and buccal areas around scalloped shape implants immediately placed and loaded with temporary crowns fixed on final prefabricated abutments, and also to evaluate the thickness of buccal bone. 18 implants were inserted and loaded immediately using computer-assisted design/computer-assisted manufacturing technology on 18 patients to replace single tooth in the esthetic part of the maxilla. The marginal bone level across the scalloped implant neck was measured mesially and distally using intraoral standardized radiographs after crown fixations and 1, 3, and 5 years later. Cone beam computed tomography para-axial cuts images were used to measure bone level buccally and palatally from the implant neck to the implant-to bone contact after 5 years of loading and to evaluate the thickness of the buccal bone at the implant neck and 4 mm apically, immediately after implant placement and 5 years later. All implants were assessed clinically and radiologically after 5 years. No implant failure was recorded, and the average marginal bone variation on mesial and distal sites was 0.114 ± 0.135 mm at crown cementation, 0.239 ± 0.158 mm 1 year later, 0.233 ± 0.182 mm 3 years later, and 0.180 ± 0.182 mm 5 years later. Our findings indicate that at T0, the average thickness of the buccal bone was 2.27 mm at implant neck M0 (ranging from 1.9 to 2.4) and 2.33 mm at 4 mm apically to the implant neck M1 (ranging from 1.9 mm to 2.9 mm). By T4, the mean had decreased to 1.94 mm at M0 (with a range of 1.7 mm to 2.3 mm) and 2.14 mm at M1 (with a range of 1.8 mm to 2.4 mm). After 5 years the mean changes at buccal and palatal bone for all implants were &#43;0.187 ± 0.52 mm and &#43;0.06 ± 0.38 mm respectively. Minor prosthetic problems were observed over the five years: incisal ceramic chipping occurred in two crowns, and two crowns were replaced for esthetic reasons after one year. No loosening of crowns or abutments was reported. Scalloped neck implants demonstrated a comparable behavior to regular neck implants with similar designs in an immediate implantation and temporization protocol over a five-year period.

The Socket Shield Technique: Stability of the Buccal Peri-implant Bone after Partial Root Removal - A Prospective Case Series of 20 patients, with 18 Months Follow-up.

This study aims to collect data on implant survival, bone volume maintenance, and complications associated with the socket shield technique. The socket shield technique was introduced in 2010. Since then, several systematic reviews have been published, showing good clinical outcomes. The behaviour of the buccal bone plate is so far not completely understood. The study involved the placement of 23 implants using the socket shield technique in 20 patients. AstraTech EV implants were used, and no bone substitutes or connective tissue grafts were applied. Patients were monitored for 18 months, recording implant survival, volumetric bone analysis on CBCT scans, interproximal bone levels, bone sounding, pink esthetic scores, and complications. Prosthetic procedures were also described, including temporary and final restorations. A 95.7% cumulative 18-month implant survival rate was obtained using the socket shield technique, with a significant but limited reduction in buccal bone thickness (BBT) after implant placement. One implant did not integrate and two shields were partially exposed. The mean pink esthetic score, 1 year after loading was 12.93 ± 1.22. The study suggests that the socket shield technique can result in limited reduction of the buccal bone volume, with a high implant survival rate. Re-entry studies are recommended to investigate the causes of bone resorption.

Immediate versus early implant placement for single tooth replacement in the aesthetic area: A systematic review and meta-analysis.

To compare immediate implant placement (IIP) with early implant placement (EIP) for single tooth replacement in the aesthetic area in terms of aesthetic, clinical, and patient-reported outcomes. Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction. Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta-analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta-analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [-0.23; 0.86], p = .260; I2 = 83%, p < .001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [-0.23; 2.07], p = .120; I2 = 89%, p < .001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p = .480; I2 = 0%, p = .980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [-0.12, 0.17], p = .700; I2 = 0%, p = .470). Insufficient data were available for meta-analyses of other secondary outcomes. In low-risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state-of-the-art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient-reported outcomes since these have been underreported.

Crestal Bone Remodeling in Polished Collar Implants

OBJECTIVE: This study aimed to evaluate the amount of crestal bone remodeling in polished collar implants. METHODOLOGY: Thirty patients with a missing maxillary or mandibular 1st or 2nd premolar tooth requiring simultaneous bone grafting were recruited and implant placed at the level of crest with polished collar placed 1mm apical to the level of bone and bone augmentation was performed to graft the buccal threads. Buccal bone thickness was measure at crestal level as well as 1mm apical to polished collar. The implants were uncovered at 6 months and restored and patients followed up for 12 months from the time of implant placement. Cone beam computed tomography scans were taken at two time points, immediately after implant placement and at 12-month time point. RESULTS: At clinical re-entry (6 months), there was significant difference in mean buccal bone thickness found between crestal level and 1mm apical to polished collar (p&lt;0.05). Radiographically (at 12 months), the mean buccal bone change was -1.82mm 0.57mm at crest and -0.94mm 0.31mm at 1mm apical to crest. CONCLUSION: Bone regenerative techniques were unable to prevent biologic bone remodeling around the implant platform; therefore, the outcomes of bone augmentation might be affected by the polished collar of implant. KEY WORDS: Dental implants, polished collar, bone augmentation, bone remodeling, cone beam computed tomography