Width Of Keratinized Mucosa Research Articles

Outcome measures and methods of assessment of soft-tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years.

The aim of the study was to identify and report outcome measures and methods of assessment on soft-tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10years. The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and the frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes. Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position/recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft-tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed. Clinical research on peri-implant soft-tissue augmentation has progressively increased in the last 10years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies.

Morphology of Peri-Implant Tissues Around Permanent Prostheses With Various Emergence Angles Following Free Gingival Grafting.

To analyze the tissue morphology around implant-supported prostheses by digital technology and to evaluate the effect of prosthetic contours on the changes in tissues following the free gingiva graft procedure. A total of 53 implants in 32 patients receiving free gingiva grafts were selected. These had previously presented insufficient keratinized mucosa width (KMW). At the follow-up visits (mean: 16.66 ± 9.97 months), the implant position and tissue condition were documented with an oral scanner. Vertical soft tissue thickness (VT), measured from the implant-abutment connection to the marginal tissues, and horizontal soft tissue thickness (HT), at the level of the platform, were calculated. The VT, HT, and emergence angle (EA) of prostheses were assessed by 3Shape analyzing software. The final KMW was measured by clinical assessment. Marginal bone loss (MBL) was calculated in the follow-up bitewing radiographs. The mean VT in the study was 2.65 ± 0.75 mm at the mid-buccal sites, 3.74 ± 1.22 mm at the mesial, 3.16 ± 1.08 mm at the distal, and 2.53 ± 0.92 at the mid-lingual aspects. The mid-buccal HT was 1.45 ± 0.53 mm while the mid-lingual was 1.05 ± 0.43 mm (p = 0.008). Interestingly, prostheses with mid-buccal EA 30° exhibited slightly lower VT, but higher HT, than the ones with EA 30°. Prostheses with proximal EA > 30° displayed slightly more MBL, compared to prostheses with EA 30°. The mean KMW was 4.08 ± 1.10 mm. Free gingival grafting is a predictable treatment approach to augmenting soft tissue 3-dimensionally. Prostheses with EA 30° were preferable for preserving the maximal VT and maintaining crestal bone stability.

The role of keratinized mucosa width as a risk factor for peri-implant disease: A systematic review, meta-analysis, and trial sequential analysis.

BackgroundStudies have examined the benefit of having keratinized peri‐implant mucosa width with mixed results.PurposeThis study examines whether the lack of a prespecified (2 mm) amount of keratinized mucosa width (KMW) is a risk factor for peri‐implant diseases.MethodsA systematic electronic and manual search of randomized or nonrandomized controlled or noncontrolled clinical trials was conducted. Qualitative review, quantitative meta‐analysis, and trial sequence analysis (TSA) of implants inserted at sites with <2 mm or ≥2 mm of KMW were analyzed to compare all the predetermined outcome variables. The level of evidence concerning the role of KMW in peri‐implant health was evaluated via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system guide.ResultsNine studies were included in the qualitative analysis and four in the meta‐analysis and TSA. No significant inter‐group difference (p > 0.05) and a low power of evidence were found for probing depth, soft‐tissue recession, and marginal bone loss. A significant difference favoring ≥2 mm KMW had a lower mean plaque index (MD = 0.37, 95% CI: [0.16, 0.58], p = 0.002) (3 studies, 430 implants, low‐quality evidence). GRADE system showed very low and low quality of evidence for all other outcome measures.ConclusionBased on the available studies, the impact of amount of KMW (either <2 mm or ≥ 2 mm) as a risk factor for developing peri‐implant disease remains low. Future control studies with proper sample size and longer follow‐up are needed to further validate current findings.

Peri-implant soft tissue stability through vestibular extension procedure: a retrospective study.

The present retrospective study assessed the width of keratinized mucosa (WKM) and vestibular depth (VD) adjacent to dental implants subsequent to vestibular extension procedure in patients exhibiting inadequate WKM. A correlation between these two parameters with peri-implant soft tissue stability and the incidence of peri-implant soft tissue dehiscence (PSTD) was also examined. The study included 36 patients (age range 30 to 50 years) with implant restoration. The patients with an inadequate WKM and VD underwent vestibular extension procedure in areas of implant placement. The Modified Plaque Index, Gingival Index, Sulcus Bleeding Index, WKM, VD, and the peri-implant probing depth were measured and compared at baseline, 3 months, and after 1 and 2 years post vestibular extension procedure. A significant enhancement was observed in VD dimensions for both men and women from baseline (1.73 ± 1.10 mm and 1.57 ± 0.98 mm, respectively) to 2 years posttherapy (6.93 ± 0.88 mm and 7.95 ± 1.12 mm, respectively). Similarly, there was an increase in WKM of 4.14 ± 0.24 mm in men and 4.84 ± 0.14 mm in women. However, a weak and insignificant negative correlation was observed between WKM, VD, and PSTD after 2 years. The results of the present study indicate that the vestibular extension procedures around dental implants enable the clinician to achieve greater WKM and VD posttherapy, which is maintainable for a considerable time. The peri-implant soft tissue stability achieved thereafter ensures proper oral hygiene at the site and also negatively correlates with the PSTD.

Prevalence and risk indicators of midfacial peri-implant soft tissue dehiscence at single site in the esthetic zone: A cross-sectional clinical and ultrasonographic study.

Esthetic complications of dental implants in the esthetic zone can have a major negative impact on patients' quality of life and perception of implant therapy. The aim of the present study was to evaluate the prevalence of peri-implant soft tissue dehiscence (PSTD) and the clinical and ultrasonographic risk indicators for this condition. Subjects with ≥1 healthy single dental implants in the esthetic area were identified and recruited. Clinical and ultrasonographic measurements, including PSTD class and subclass, probing depth, keratinized mucosa width (KMW), mucosal thickness (MT) at 1mm and 3mm, buccal bone distance (BBD) and buccal bone thickness, were evaluated in healthy implants and implants with PSTD. A total of 153 subjects with a total of 176 dental implants were included. The prevalence of PSTD was 54.2% and 56.8% on a patient and implant level, respectively. The most frequent type of PSTD was the one characterized by having both an implant-supported crown longer than the clinical crown of the homologous tooth and a visible abutment/implant fixture exposed to the oral cavity. The multivariate analysis showed that the presence of an adjacent implant, a longer time of the implant in function, limited MT, reduced KMW, and increased BBD were significantly associated with the presence of PSTD. PSTDs are common findings in the esthetic region. Several risk indicators for this condition, such as presence of an adjacent implant, increased time in function of the implant, higher BBD, lower KMW, and MT were identified.

Efficacy of free gingival grafting to augment keratinized mucosa around dental implants in posterior regions after restorative procedures: A retrospective clinical study

Statement of problemData on the shrinkage of free gingival grafts (FGGs) vary. Most studies have analyzed grafts in nonmolar sites because of measurement limitations and have addressed the changes in grafts and keratinized mucosa width (KMW) only in the early healing phase. PurposeThe purpose of this retrospective clinical study was to assess the dimensional changes of an FGG in the posterior regions and their influencing factors, with the aim of obtaining sufficient and stable KMW after restoration. Material and methodsA total of 77 implants in 40 participants who had undergone an FGG surgery were recruited. Graft sizes during surgery and the surface areas of keratinized mucosa at the follow-up visit after restorations were compared by digital analysis and verified by clinical measurements and photographs. The association between shrinkage and the graft sizes, implant location, and sex and age of the participants was evaluated. The influence of the shrinkage of FGG on the KMW after restoration was analyzed by multivariable linear regression with generalized estimating equation (GEE) models. ResultsThe mean ±standard deviation shrinkage of FGG around implants in the posterior regions was 24.76 ±14.77%, and the mean ±standard deviation KMW was 4.16 ±1.77 mm at the follow-up visit. Larger grafts had a statistically higher shrinkage ratio (P<.001). No statistically significant difference was found regarding the effect of implant location, sex, and age on the shrinkage of FGG and final KMW (P>.05). The mean ±standard deviation follow-up period after restoration was 12.45 ±7.73 months ConclusionsFree gingival grafting was found to be a predictable treatment approach for augmentation of KMW around implants in the posterior region after the fabrication of prostheses as long as grafts of sufficient size were placed. Stable outcomes were shown in the study participants in the follow-up period of up to 3 years

Keratinized mucosa changes around one-stage implants: A prospective case series.

The need of an adequate band of keratinized tissue (KT) to maintain periodontal health around teeth as well as around implants has been a debated topic over many years but still no conclusions have been drawn. This prospective case series evaluates the changes undergone by the keratinized mucosa (KM) and the soft tissue volume around non-submerged implants before the prosthetic rehabilitation. A total of 40 patients were included. The primary outcome was to analyze the width of the KM at both buccal and lingual aspects compared to the pre-existing KT in the edentulous ridge only in mandibular (pre)molar area. The mucogingival line was marked with a surgical pen and an intra-oral scanner was used to take the impression of the implant area the day of the surgery (T0, baseline) and before the crown placement (T1, 3months). Buccal soft tissue volume was measured at 1, 3, and 5 mm apical to the healing abutment position and a comparison between T0 and T1 was performed. Student t-test was used according to the distribution of the data (Shapiro-Wilk). The mean KT width at baseline was 4.54 ± 1.31 mm at buccal side and 5.04 ± 1.88 mm at lingual side. After 3months, the mean KM values were 3.15 ± 1.03 mm and 3.72 ± 1.56 mm at the buccal and lingual aspects, respectively. The differences, 30.6% of KM reduction buccally and 26.1% of reduction lingually, were statistically significant for both sides. Within the limitations of this investigation, it was observed that the KM width from the baseline to the 3months follow up presented a significant dimensional change in both the buccal and lingual aspects, whereas buccal soft tissue volume showed an increase between baseline and follow up.

Early soft tissue changes following implant placement with or without soft tissue augmentation using a xenogeneic cross‐link collagen scaffold: A volumetric comparative study

Soft tissue augmentation (STA) at implant sites has the potential of improving peri-implant health, esthetics, and marginal bone level stability. The present study aimed at evaluating the volumetric changes occurring following implant placement in sites that received STA compared to non-augmented sites. A total of 26 subjects received a dental implant in a posterior edentulous site. Simultaneous STA with a xenogeneic cross-linked collagen scaffold was performed for the first 13 patients, while the remaining subjects served as the negative control. An intraoral optical scanner was used at baseline and at 12 weeks to generate digital models. The mean volume (Vol) gain of the test group was 38.43 mm3 , while a mean Vol of -16.82 mm3 was observed for the control group (p <0.05). The mean thickness of the reconstructed volume (ΔD) was 0.61 and -0.24 mm, for the test and control group, respectively (p <0.05). Higher linear dimensional changes were observed for the test group (p <0.05), while no significant differences were observed in terms of keratinized mucosa width and pocket depth changes between the two groups. Simultaneous STA with xenogeneic collagen scaffold obtained statistically significant higher volumetric outcomes compared to the non-augmented group. STA at the time of implant placement using a xenogeneic cross-linked collagen scaffold can prevent remodeling of the ridge during the first 12 weeks, as compared to non-grafted implant sites.

Clinical outcomes of keratinized mucosa augmentation in jaws reconstructed with fibula or iliac bone flaps

This prospective study was undertaken to evaluate the treatment outcomes of keratinized mucosa augmentation (KMA) on the buccal and palatal/lingual sides of implants in jaws reconstructed after oncological surgery. Forty-two implants in 12 patients whose jaws had been reconstructed with a fibula or iliac bone flap were included. KMA was performed at 3 months after implant placement; this included an apically displaced partial-thickness flap and a free gingival graft (FGG) around the implants to increase the keratinized mucosa width (KMW). Patients were followed up for at least 6 months post-surgery. KMW, shrinkage, and patient pain and discomfort measured on a visual analogue scale were analysed. A histological analysis was performed of tissue epithelium from two patients. The results showed that KMW was >2 mm on both the buccal and palatal/lingual sides during follow-up. Before surgery, histological analysis showed epithelium with no epithelial spikes; normal keratinized epithelial spikes were observed at 8 weeks after KMA. Greater KMW was observed around implants in reconstructed maxillae than around those in reconstructed mandibles (P < 0.001). Patients felt more pain at the donor site than at the recipient site during the first 3 days post-surgery. KMA with FGG was predictable in reconstructed jaws and may help maintain the long-term stability of implants.

Impact of 0.12% Chlorhexidine Gluconate Mouthwash on Peri-Implant Mucositis and Gingivitis After Nonsurgical Treatment: A Multilevel Analysis.

This study investigated the impact of 0.12% chlorhexidine gluconate mouthwash on dental implants with periimplant mucositis and contralateral teeth with gingivitis at 6 months of follow-up after nonsurgical treatment. This was a secondary analysis of data from a previous controlled, randomized, double-blinded clinical trial of 30 patients diagnosed with peri-implant mucositis and gingivitis in contralateral teeth, at 6 months following treatment. Patients were randomly assigned into a test group (basic periodontal therapy + 0.12% chlorhexidine mouthwash) or a control group (basic periodontal therapy + placebo). Therapy consisted of an adaptation of the full-mouth scaling and root planing protocol. The clinical parameters of visible Plaque Index, Gingival Bleeding Index, probing depth, bleeding on probing, keratinized mucosa width, and gingival and peri-implant phenotype were evaluated at baseline and at 1, 3, and 6 months posttherapy. Data were analyzed using Poisson multilevel regression analysis with a significance level of .05. The study analyzed 47 implants and contralateral teeth (376 sites) in the test group and 49 implants and contralateral teeth (392 sites) in the control group. No differences were found between the groups at the patient level. At the site level, the teeth and implants presented statistical differences in bleeding on probing, probing depth, and keratinized mucosa width at 3 months for both treatment groups. However, no difference was observed in bleeding on probing in the test group (P = .484) at 6 months, whereas the control group demonstrated increased bleeding on probing (indicating more inflammation) at implant sites than at teeth sites (P = .039). Additionally, implant sites with a thin peri-implant phenotype (P < .001) and located posteriorly (P = .002) presented greater inflammation. Use of a 0.12% chlorhexidine mouthwash for 14 days was beneficial for implant sites with peri-implant mucositis, compared to contralateral teeth sites with gingivitis, as indicated by the reduced percentage of teeth with bleeding on probing.

Efficacy of keratinized mucosal augmentation with a collagen matrix concomitant to the surgical treatment of peri-implantitis: A dual-center randomized clinical trial.

The aim of this study was to evaluate the efficacy of a xenogeneic collagen matrix to augment the width of keratinized mucosa (KM), concomitantly to the surgical treatment of peri-implantitis, when compared to the use of an autologous soft tissue graft. In this 12-month parallel-arm randomized controlled clinical trial, patients with peri-implantitis were randomly assigned, one month after non-surgical therapy, to surgical resective treatment of peri-implantitis consisting on an apically positioned flap (APF) in combination with a KM augmentation procedure, either with an autologous free gingival graft (FGG) or a collagen matrix (CM). Primary outcomes were the increase in the width of KM and probing pocket depth (PPD) reduction at 12months. As secondary outcomes, peri-implant radiographic and patient-reported outcomes were assessed. The intention-to-treat population consisted of 49subjects, assigned to either the APF+FGG (n=23) or APF+CM (n=26) group. PPDs were reduced by 1.6mm (SD 1.0) and 1.7mm (SD 1.2), respectively, being these differences non statistically significant (p=.782). However, the increase in KM was significantly higher in the APF+FGG compared with APF+CM (2.5mm [SD 1.6] vs. 1.6mm [SD 1.2], respectively (p=.033). The tested surgical modalities resulted in similar improvements of the clinical parameters. Both free gingival graft and collagen matrix significantly increased the peri-implant keratinized mucosa, but this KM gain was significantly higher with the free gingival graft. Use of CM, however, was better appreciated by the patients, in terms of pain perception and analgesic consumption, although the surgical time was similar.

The Effect of Three Surgical Therapies to Increase Keratinized Mucosa Surrounding Dental Implants with Peri-Implantitis: A Pilot Study.

Background and Objectives: The purpose of this pilot study was to evaluate the clinical outcomes of three different methods for increasing the keratinized mucosa (KM) surrounding dental implants with peri-implantitis. Materials and methods: Twenty implant sites with peri-implantitis were divided into: (1) porcine collagen matrix (CM) group: seven implant sites; (2) apically positioned flap (APF) group: eight implant sites; and (3) free gingival graft (FGG) group: five implant sites. The KM width and clinical parameters (probing pocket depth (PPD) and bleeding on probing (BOP)) were measured at time points: before surgery (T0) and 30 (T1), 60 (T2), 90 (T3), and 180 (T4) days after surgery. Results: Regarding KM width, all the groups had significant differences for increasing horizontal and vertical KM width. The CM and FGG groups had greater KM than the APF group. There was a decrease in PPD in all three groups. APF and FGG showed significant differences in PPD at T1 and T2 compared to T0. Only the FGG group showed a significant difference in PPD at T3 and T4 compared with that at T0. BOP values were also reduced in all the groups at T1–T4 compared to T0. The APF and FGG groups showed a significant decrease in BOP. Conclusions: Three surgical therapies presented favorable results for increasing the KM surrounding implants. Compared with the FGG group, the CM showed similar results in increasing the KM around the dental implants with peri-implantitis.

Effect of free gingival graft before implant placement on peri-implant health and soft tissue changes: a randomized controlled trial

BackgroundTo evaluate the clinical outcome and changes in posterior buccal soft tissue following implant restoration in groups with and without a free gingival graft (FGG) before implant placement.MethodsTwenty-six individuals who required implant restoration and displayed lack of keratinized mucosa (KM) were recruited and assigned to the FGG group (with FGG before implant placement) or Control group (without FGG before implant placement) randomly. A screw-retained conventional implant restoration was performed for each patient. Peri-implant soft tissue was captured by an intraoral scanner and analyzed by an image processing software. Clinical parameters (plaque index, gingival index, probing depth, and bleeding on probing) were assessed at baseline and 1, 3, 6, and 12 months. Buccal soft tissue changes (mucosal margin, soft tissue thickness, and width of keratinized mucosa) on the buccal side of implant site were assessed at 1, 3, 6, and 12 months. Two-way ANOVA and Bonferroni test were used to analyze significant difference between groups at each time point (α = 0.05).ResultsThe clinical parameters were lower in the FGG group than that in the Control group, although there were no significant differences between the two groups (P > 0.05). Peri-implant soft tissue collapsed and the changes (mucosal margin and soft tissue thickness) were significantly greater in the Control group than the FGG group (P < 0.05). Width of KM was larger in the FGG group than the Control group, although there was no significant difference between the two groups (P > 0.05).ConclusionsMinimal peri-implant soft tissue changes occurred in two groups. Performing FGG before implant placement is a viable procedure to maintain peri-implant soft tissue but might not affect peri-implant health during 12 months follow-up. However, small sample size must be considered.Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000037954; Date of registration: 6 September 2020).

An assessment of the relationship between peri-implant status and dental anxiety and oral health-related quality of life

Background: The purpose of this study is to evaluate the relationship between peri-implant diseases and dental anxiety and oral health-related quality of life.&#x0D; Methods: In a total of 101 subjects (44 females, 57 males, mean age 56.9 ± 12.1), 325 implants were examined using modified plaque index, modified sulcus bleeding index, probing depth, bleeding on probing, clinical attachment level, suppuration, and keratinized mucosa width. The Oral Health Impact Profile (OHIP-14) was used to measure the impact of oral health-related quality of life. For the purpose of assessing the dental anxiety level, Corah’s Dental Anxiety Scale (DAS) was performed. In addition to dental implant measurements, the periodontal status of the participants' natural teeth was assessed by the Community Periodontal Index (CPI) of the World Health Organization.&#x0D; Results: All created groups as peri-implantitis, peri-implant mucositis, and peri-implant healthy were compatible with each other in terms of gender, age, income level, smoking status, and oral hygiene practices. However, a statistically significant correlation was found indicating that the peri-implant condition worsened as the educational status worsened (p=0.033). There was no statistically significant difference between study groups in terms of DAS, OHIP-14, and CPI. There was a significant correlation between the scores of DAS and OHIP-14 (p

A single application of chlorhexidine gel reduces gingival inflammation and interleukin 1-β following one-stage implant placement: A randomized controlled study.

Chlorhexidine (CHX) is a broad-spectrum antimicrobial agent commonly used in medicine. Application of (CHX) during abutment connection reduced the bacterial load at the implant-abutment interface. We hypothesize this treatment may consequently reduce peri-implant soft tissue inflammation and marginal bone loss. To evaluate the effect of a single application of CHX gel inside the dental implant internal hexagon on peri-implant tissue. Forty patients were recruited to this randomized, double-blinded, clinical trial. At the time of implant installation, a 4-mm healing abutment was connected to the implant. In the test group, chlorhexidine gel 1% was applied inside the implant hex, whereas control implants did not receive any gel. Clinical and radiographic measurements included soft tissue recession (REC), plaque index (PI), gingival index (GI), plaque index (PI), keratinized mucosa width (KM), probing depth (PD), and a peri-apical parallel x-ray. Peri-implant crevicular fluid (PICF) was collected for cytokine analysis. t-Test was used to compare changes from baseline to 3months. Mann-Whitney U test and t test were used to compare test and control groups. Twenty patients in the test group and 17 in the control group completed the study. One implant in the control group failed to osteointegrate. There were no significant differences between the control and test groups for REC changes, bone loss, and PD. GI was significantly lower in the test group after 1week (1.79 ± 0.24 vs 0.75 ± 0.18, respectively) and 3months (1.18 ± 0.21 vs 0.25 ± 0.12, respectively) although PI was equal. At 3months, interleukin 1-β (IL1-β) was higher in the control group (p < 0.01) and a positive correlation was found between GI and IL1-β (rs =0.60424, p=0.00032). Application of chlorhexidine gel reduced inflammation and IL1-β levels in the peri-implant soft tissue.

Is there any biomaterial substitute for peri-implant soft tissue phenotype modification? A network meta-analysis of the appraisal literature

Evidence shows that an increased width and thickness of the keratinized mucosa favours peri-implant health. The aim of this network meta-analysis was to compare the clinical effects of alternative biomaterials for peri-implant soft tissue phenotype modification (PSPM) in patients with dental implants when compared to autologous tissue grafts. An electronic search without language or date limitations was performed in four databases and the grey literature for articles published until November 2020. The eligibility criteria included randomized clinical trials (RCTs) evaluating the clinical outcomes of biomaterials for PSPM. A pairwise and network meta-analysis was conducted for each parameter to assess and compare the outcomes between the different treatment arms for the primary and secondary outcomes. A total of 11 RCTs were included in this review. The free gingival graft (FGG) showed the best clinical effect for increasing keratinized mucosa width (KMW). When compared in a network, the FGG demonstrated the best treatment ranking of probability results, followed by connective tissue graft (CTG), acellular dermal matrix (ADM), and xenogeneic collagen matrix (XCM). For the parameters ‘mucosa thickness’ and ‘participant satisfaction with aesthetics’, the results were CTG > ADM > XCM and XCM > ADM > CTG, respectively. Autogenous tissue grafts (FGG/CTG) demonstrate the best results in increasing KMW and mucosa thickness when compared to the other biomaterials.

Patient-reported outcome measures and clinical outcomes following peri-implant vestibuloplasty with a free gingival graft versus xenogeneic collagen matrix: a comparative prospective clinical study

BackgroundThe objective of this study was to compare patient-reported outcome measures (PROMs) and clinical outcomes after augmentation with xenogeneic collagen matrix (XCM) or free gingival graft (FGG) during different postoperative phases.MethodsForty-two patients (21 per group) with keratinized mucosa width (KMW) of < 2 mm at buccal implant sites in the posterior mandible were enrolled. All underwent vestibuloplasty and were allocated to either FGG (control) or XCM (test) group. Intraoperative morbidity of pain, stress, nausea, tolerance to time, and acceptance of surgery were evaluated immediately after surgery. The severity and duration of subjective pain, swelling, and bleeding were compared within a 2-week postoperative period. The willingness to retreat and satisfaction were assessed at 6 months. All PROMs were obtained using questionnaires and visual analog scales. The buccal KMW and other peri-implant parameters were also evaluated.ResultsNo significant between-group differences were observed in PROMs immediately after surgery, except acceptance of surgery (0, 0–30.0 vs. 30, 0–50.0, p = 0.025). At 2 weeks, pain severity (46.7 ± 25.9 vs 61.9 ± 20.2, p = 0.040) and duration (5.52 ± 3.57 vs 8.48 ± 2.80, p = 0.005) were significantly lower in the test group, and pain perception during speaking and chewing was significantly higher for FGG, with no significant between-group differences in swelling and bleeding. At 6 months, the test group showed a higher willingness to retreat (76% vs 43%, p = 0.021); however, satisfaction with treatment outcomes was similar in both groups. At 6 months, the gain of KMW was significantly higher in FGG than in XCM (XCM: 1.57 ± 1.69 mm, FGG: 2.68 ± 1.80 mm, p = 0.003). Other peri-implant parameters did not show significant differences.ConclusionsWithin the limitation of the present nonrandomized study, XCM demonstrated more positive PROMs than FGG during different postoperative phases, mainly for less pain perception during the early healing stage, but was inferior to FGG in terms of gain of KMW. For KMW augmentation in the posterior mandible, XCM may be indicated when patients can bear little pain.Clinical trial registrationChiCTR1900022575, date of registration: 17/4/2019, retrospectively registered,

Clinical evaluation of xenogeneic collagen matrix versus free gingival grafts for keratinized mucosa augmentation around dental implants: A randomized controlled clinical trial.

To evaluate the outcomes of an apically repositioned flap (ARF) plus xenogeneic collagen matrix (XCM) in augmenting keratinized mucosa width (KMW) around dental implants when compared with ARF plus free gingival grafts (FGG). Twenty-six participants with at least one site with KMW ≤2 mm were randomized into FGG or XCM group. Clinical examinations were performed at baseline and at 2 and 6months after surgery, including KMW, keratinized mucosa thickness, gingival index (GI), and probing depth (PD). Post-operative pain and patient satisfaction were also evaluated. At 6months, FGG attained a greater increase of KMW and thicker mucosa than XCM (4.1 ± 1.6 mm vs. 1.8 ± 1.0 mm, p < .001; 1.7 ± 0.6 mm vs. 1.2 ± 0.3 mm, p < .01). Regarding GI, PD, post-operative pain, aesthetic outcomes, and patient satisfaction, no significant difference could be detected. Moreover, the operation time of XCM group was shorter (60 ± 9min vs. 39 ± 8min, p < .001). FGG could result in greater increase of KMW than XCM, though both could increase KMW, maintain peri-implant health, and attain comparable aesthetic outcomes. The use of XCM was associated with reduced operation time.

Study of Immediate Implants Placed in Mandibular Alveolar Bone Reconstructed with Screw-Guided Bone Regeneration Technique: A 24-Months Follow-Up

Aim: Study aimed to test whether implants inserted in posterior mandible sites augmented with screw-guided bone regeneration (S-GBR) technique differ from implants placed in non-grafted sites regarding the success and survival rate. Materials and Methods: 20 edentulous patients (mean age 59.45 ± 15.220) were divided in a test group (S-GBR) (immediate implants placed simultaneously with grafting procedures) and control group (implants placed in naturally healed sites). Primary outcomes (implants success; implants survival) and secondary outcomes (clinical parameters of soft tissues: mPI; mGI; probing depth; keratinized mucosa; marginal-bone-level) were evaluated at 24-months follow-up. Results: Plaque levels were higher (p = 0.046) in S-GBR group (0.97 ± 0.882 mm) when compared with control (0.66 ± 0.695 mm). Keratinized mucosa width was higher in S-GBR group (4.13 ± 1.033 mm) than control (3.34 ± 0.821 mm) (p = 0.000) Probing depth (PD) width was higher in S-GBR group (3.50 ± 1.372 mm) than control (2.56 ± 1.332 mm) (p = 0.000). mGI was higher among implants placed in S-GBR group (0.90 ± 1.020 mm) than control (0.56 ± 0.794 mm) (p = 0.061). The difference between the average bone loss (MBL) for implants placed in grafted sites (Group S-GBR: 2.20 ± 1.867 mm) and for those placed in naturally healed sites (Group B: 1.09 ± 1.678 mm) was statistically significant (p = 0.000). The overall implant success rate after 24-month follow-up was 76.7% in S-GBR group and 90.6% in control group (p = 0.001). The survival rate after 24-month follow-up was 86.7% in S-GBR group and 93.8% in control group (p = 0.182). The reconstruction of the alveolar bone using S-GBR technique and immediate implant placement is a valid guided bone regeneration strategy for mandibular alveolar bone with severe horizontal resorption. The choice of S-GBR technique should be based on specific indications as implants placed in grafted sites recorded worse marginal success rate, survival rate and bone resorption than those placed in non-grafted sites.

Resolution of peri-implantitis by means of implantoplasty as adjunct to surgical therapy: A retrospective study.

There is a paucity of data on the effectiveness of implantoplasty as adjunct to the surgical management of peri-implantitis. The purpose of this study was to evaluate the resolution of peri-implantitis by means of implantoplasty as adjunct to surgical resective (RES) and reconstructive (REC) therapies and supportive maintenance. Patients that underwent surgical therapy to manage peri-implantitis with a follow-up of ≥12 months and enrolled in a regular peri-implant supportive care were recruited. RES group consisted of two interventions that included osseous recontouring and apically position flap (APF) and soft tissue conditioning (STC). REC was performed in the infra-osseous compartment of combined defects. Implant survival rate was recorded. Clinical and radiographic parameters were evaluated to define a "dogmatic" (case definition #1) and a "flexible" (case definition #2) therapeutic success. Univariate and multivariate multilevel backward logistic regression were applied for statistical analysis. Overall, 43 patients (nimplants =135) were retrospectively assessed. Mean observational period was ∼24 months. Implant survival rate was 97.8%, being significantly higher for APF, STC, and APF + STC (RES) when compared with REC (P=0.01) therapy, in particular for advanced lesions (>50% of bone loss). The overall therapeutic success rate at implant-level was 66% and 79.5% for case definition #1 and #2, respectively. APF group displayed more efficient disease resolution when considered success definition #1 (72%). Contrarily, when the data were adhered to success definition #2, STC group showed a slightly higher disease resolution rate (87%). For RES group, location, favoring anterior (P=0.04) and defect type, favoring class II (P=0.02) displayed statistical significance for therapeutic success. For REC group, implants exhibiting a wider band of keratinized mucosa (KM) demonstrated higher therapeutic success (P=0.008). Implantoplasty as an adjunct to surgical therapy proved effective in terms of disease resolution and implant survival rate. Implant location, defect morphology as well as the buccal width of KM are indicators of therapeutic success.