Are Nongrafting Solutions Viable for Dental Implant Treatment in Limited Bone Volume?

Dental implant therapies must be planned and executed to meet both the immediate and longer-term expectations of patients. The early developmental success of dental implants was dependent on the quality and quantity of a patient's bone. Implants were commonly placed into the parasymphyseal mandibular and anterior maxillary bone. Building on this success, bone grafting allowed patients lacking sufficient bone to obtain implant-supported prosthetic solutions for treatment of partial or complete edentulism. More recently, several nongrafting solutions for implant therapy, including pterygoid implants, zygomatic implants, tilted implants, and short implants, have reported success. This article will consider the rationale for graftless solutions in implant therapy as well as the data supporting the use of various graftless protocols as alternatives to grafting and conventional dental implant therapy. It will discuss factors concerning graftless versus grafted approaches to treatment of patients with limited bone volume and will describe the use of short dental implants as a graftless solution in the edentulous maxilla.

The Role of MicroRNAs in the Osseointegration Process

Regulation of cellular function is key to bone formation at endosseous implant surfaces. Osseointegration was "discovered" prior to the discovery of genetic regulation of osteoinduction or characterization of mesenchymal stem cells. Understanding osseointegration in cellular and molecular terms has benefited from genome-wide characterization of this healing process at endosseous implants in vivo. These in vivo studies also demonstrate a role for osteoprogenitor cells and cells involved in immune regulation and osteoclastogenesis. The identification of noncoding RNAs, including microRNAs, as key factors controlling cell function has highlighted the role of microRNAs in cell differentiation control. This review summarizes emerging in vitro and in vivo investigations emphasizing the role of microRNAs in the osseointegration process. Many microRNAs influence key osteoinductive pathways controlling Osterix, runt-related transcription factor 2 (RUNX2), and bone morphogenetic protein (BMP)/SMAD function. Others influence the monocyte/macrophage lineage. While significant progress has been made in elucidating the mechanisms associated with the regulation of surface modulation of osteoblast differentiation by microRNAs, knowledge gaps are evident in the identification and characterization of microRNAs linked to osseointegration. Given existing knowledge regarding the varied expression of microRNAs and their role in inflammation, it is important to understand how microRNA expression may influence the process of bone accrual at implant surfaces during osseointegration.

Retrospective cohort analysis of maxillary overdentures retained by unsplinted implants

STATEMENT OF PROBLEM

Implant therapy involving an unsplinted 2-implant-retained overdenture is well defined as a successful treatment for a patient with an edentulous mandible. However, a similar unsplinted implant therapy supporting a maxillary overdenture is not well characterized.

PURPOSE

The purpose of this retrospective study was to evaluate maxillary overdentures retained by 4 unsplinted implants measuring implant survival, overdenture survival, and patient-reported outcomes.

MATERIAL AND METHODS

Participants who had received an unsplinted implant-retained maxillary overdenture were included in the study. Participants presented for one denture recall appointment, during which comprehensive examination, including radiographs, was performed and clinical findings were recorded. Participants also completed the Oral Health Impact Profile-49 (OHIP-49) and a 20-item visual analog scale (VAS) satisfaction questionnaire. Nonparametric statistical tests were used to compare OHIP-49 and VAS scores across age, sex, time since overdenture insertion, mandibular dental status, smoking status, maxillary mucosal health, and overdenture hygiene.

RESULTS

For the 44 participants, 3 of 4 implants failed in 1 individual. The cumulative implant survival rate was 98% (97.7% patient level). No prosthetic failures (that is, overdenture replacement) occurred, indicating a 100% prosthesis survival rate. The mean ±standard deviation OHIP-49 severity score was 23.6 ±26.0, and the mean ±standard deviation total VAS score was 179.2 ±29.4. Increased age was associated with lower OHIP-49 severity score (P=.036), and participants with unhealthy oral mucosa or denture stomatitis demonstrated significantly higher OHIP-49 severity scores (P=.003).

CONCLUSIONS

In this retrospective evaluation, unsplinted implant-retained maxillary overdenture therapy was associated with high implant and prosthetic survival, as well as high patient satisfaction and quality of life. Age, sex, maxillary mucosal health, and mandibular dental status resulted in significant differences with respect to oral health-related quality of life and patient satisfaction, indicating that this treatment option may be ideal for certain patients.

Management of Implant/Prosthodontic Complications

Dental implants continue to grow in popularity because they are a predictable treatment to replace missing teeth. They have a high success rate; however, they are still associated with some clinical complications. This article discusses a diverse range of complications related to the restorative and mechanical aspects of dental implants and the management of such complications, as well as potential factors contributing to them.

Prosthodontic Management of Implant Therapy: Esthetic Complications

The essential promise of implant dentistry is the ability to imperceptibly replace missing teeth. To achieve this, careful planning, execution, and maintenance is required by the dentist and patient to maintain a long-term esthetic and functional result. Unfortunately, as a result of biological, prosthetic, and iatrogenic factors, unesthetic results can occur. This article explores the potential causes for the unesthetic dental implant and the possible solutions that may improve the clinical situation. Whereas relatively simple errors may be corrected through prosthetic means, greater complications may require surgical intervention to achieve the desired result.

C5L2 Regulates DMP1 Expression during Odontoblastic Differentiation

The presence of stem cells within the dental-pulp tissue as well as their differentiation into a new generation of functional odontoblast-like cells constitutes an important step of the dentin-pulp regeneration. Recent investigations demonstrated that the complement system activation participates in 2 critical steps of dentin-pulp regeneration: pulp progenitor's recruitment and pulp nerve sprouting. Surprisingly, its implication in odontoblastic differentiation has not been addressed yet. Since the complement receptor C5a receptor-like 2 (C5L2) is expressed by different stem cells, the aim of this study is to investigate if the dental pulp stem cells express C5L2 and if this receptor participates in odontoblastic differentiation. Immunohistochemistry performed on human third molar pulp sections showed a perivascular co-localization of the mesenchymal stem cell markers STRO1 and C5L2. In vitro immunofluorescent staining confirmed that hDPSCs express C5L2. Furthermore, we determined by real-time polymerase chain reaction that the expression of C5L2 is highly modulated in human dental pulp stem cells (hDPSCs) undergoing odontoblastic differentiation. Moreover, we showed that this odontogenesis-regulated expression of C5L2 is specifically potentiated by the proinflammatory cytokine TNFα. Using a C5L2-siRNA silencing strategy, we provide direct evidence that C5L2 constitutes a negative regulator of the dentinogenic marker DMP1 (dentin matrix protein 1) expression by hDPSCs. Our findings suggest a direct correlation between the odontoblastic differentiation and the level of C5L2 expression in hDPSCs and identify C5L2 as a negative regulator of DMP1 expression by hDPSCs during the odontoblastic differentiation and inflammation processes. This work is the first to demonstrate the involvement of C5L2 in the biological function of stem cells, provides an important knowledge in understanding odontoblastic differentiation of dental pulp stem cells, and may be useful in future dentin-pulp engineering strategies.

C5L2 Silencing in Human Pulp Fibroblasts Enhances Nerve Outgrowth Under Lipoteichoic Acid Stimulation

INTRODUCTION

We recently reported that caries-associated C5a receptor (C5aR) expression and activation result in up-regulation of brain-derived neurotropic factor secretion by pulp fibroblasts inducing prominent neurite outgrowth toward the carious site. Our data further showed a negative regulation of this brain-derived neurotropic factor secretion by C5L2, another C5aR. C5L2 was considered a nonfunctional receptor and thus has received much less attention than C5aR. The aim of this study was to identify the role of C5L2 in pulp fibroblast-mediated neurite outgrowth.

METHODS

In this study, lipoteichoic acid (LTA) was used to mimic dental caries-like inflammation. To evaluate the role of C5L2 in pulp neurite outgrowth, human pulp fibroblasts were C5L2 small interfering RNA silenced and cocultured with human neurons in a nerve growth assay system.

RESULTS

C5L2 silencing drastically increased the neurite outgrowth toward the LTA-stimulated pulp fibroblasts. The number of neurites detected was increased in the LTA-treated pulp fibroblasts.

CONCLUSIONS

Our results show that C5L2 constitutes a negative regulator of the neurite outgrowth under LTA stimulation. Of the events occurring during dentin-pulp regeneration, nerve regeneration is the key factor for maintaining tooth viability after infection or injury. Our study provides a foundation for creating therapeutic tools that target pulp fibroblasts during pulp/nerve regeneration.

Immediate provisionalization of dental implants in grafted alveolar ridges in the esthetic zone: a 5-year evaluation

This clinical study assessed at 5 years both implant survival and peri-implant tissue architecture of immediately provisionalized implants placed 4 to 6 months following augmentation with demineralized bovine bone allograft and collagen membrane. Of 23 implants in 19 patients, one implant failed prior to loading (95.6% survival). Implant tissue relationships were stable following implant placement; marginal bone level changes from implant placement to 5 years (mean ± SD: -0.18 ± 0.79 mm, range: -1.6 to 1.4 mm, P = .51), the mesial and distal papilla length changes (mesial mean ± SD: 1.14 ± 0.92 mm, P < .001; distal mean ± SD: 0.74 ± 1.46 mm, P = .04), and the unchanged mucosal zenith location (mean ± SD: 0.24 ± 0.93 mm, P = .15) were recorded. There were no major surgical complications during the 5-year period. When augmentation is required, subsequent dental implant placement in the anterior maxilla may be achieved using immediate placement and provisionalization protocol to attain osseointegration success and stable peri-implant tissue responses.

Fracture rate of monolithic zirconia restorations up to 5 years: A dental laboratory survey

STATEMENT OF PROBLEM

The demand for ceramic restorations has increased over the past years because of their esthetic properties and the high cost of noble metals. However, the lack of long-term clinical studies and the difficulty of interpreting in vitro studies have placed the durability of ceramic restorations in doubt.

PURPOSE

The purpose of this study was to determine the failure rate of monolithic zirconia restorations due to fracture up to 5 years of clinical performance.

MATERIAL AND METHODS

Data were collected over 5 years from 2 commercial dental laboratories. Restorations that were returned to the laboratory for remake because of catastrophic failure (fracture) were identified and included. Restorations were categorized as anterior or posterior. Each category was further divided into complete-coverage single crowns (SCs) and multiple-unit fixed dental prostheses (FDPs). Fracture rates were compared and analyzed using a chi-square test (α=.05).

RESULTS

A total of 39827 restoration records were reviewed and included 3731 anterior restorations (1952 SC; 1799 FDP) and 36096 posterior restorations (29808 SC; 6288 FDP). The overall fracture rate of up to 5 years for all restorations (anterior and posterior) was 1.09%. Fracture rates were 2.06% for all anterior restorations and 0.99% for all posterior restorations. Fracture rates were 0.97% for anterior SCs and 0.69% for posterior SCs, and the combined fracture rate (anterior and posterior) was 0.71%. For FDPs, 3.26% restorations fractured anteriorly and 2.42% fractured posteriorly, and the combined fracture rate (anterior and posterior) was 2.60%.

CONCLUSION

Within the relative short-term evaluation of 5 years, restorations fabricated from monolithic zirconia material displayed relatively low fracture rates. Anterior restorations fractured at a slightly higher rate than posterior restorations, and FDPs fractured at a rate double that of SCs.

A Digital Approach to Improved Overdentures for the Adolescent Oligodontia Patient

OBJECTIVE

The use of overdentures for treatment of oligodontia in adolescent patients using conventional techniques has described limitations. The aim of the case report is to demonstrate the use of CAD (Computer Aided Design) CAM (Computer Aided Manufacture) technology to produce an esthetic monolithic polymethylmethacrylate prosthesis that is retentive and stable on insertion.

CLINICAL CONSIDERATIONS

Adolescent oligodontia patients are typically not suitable candidates for dental implant therapy. Overdentures provide interim or definitive restorative advantages. Given the important esthetic, psychological, and social functions of the prosthesis, an important therapeutic goal for the overdenture prosthesis is esthetics. A CAD-CAM approach to overdenture manufacture can provide a highly esthetic, strong, and retentive prosthesis.

CONCLUSIONS

CAD-CAM manufacture of monolithic acrylic overdentures offer several advantages that include (1) improved planning and clinical communication, (2) high fidelity manufacture, (3) improved flexural strength, impact strength, and porosity, (4) improved prosthesis integrity and durability (due to the monolithic design), (5) CNC control of occlusal contacts, (6) high esthetic potential due to quality of bulk material and iterative design, and (7) archival nature of the digital prosthesis. CAD-CAM manufacture of monolithic overdentures is a viable approach to completing high value esthetic management of the adolescent oligodontia patient.

CLINICAL SIGNIFICANCE

This case report identifies a new way to utilize CAD CAM technology to produce an improved overdenture for the oligodontia patient. It will be of interest to many and underscores the fundamental principles of smile design transfer to the digital environment. (J Esthet Restor Dent, 2016).

RhoA-Mediated Functions in C3H10T1/2 Osteoprogenitors Are Substrate Topography Dependent

Surface topography broadly influences cellular responses. Adherent cell activities are regulated, in part, by RhoA, a member of the Rho-family of GTPases. In this study, we evaluated the influence of surface topography on RhoA activity and associated cellular functions. The murine mesenchymal stem cell line C3H10T1/2 cells (osteoprogenitor cells) were cultured on titanium substrates with smooth topography (S), microtopography (M), and nanotopography (N) to evaluate the effect of surface topography on RhoA-mediated functions (cell spreading, adhesion, migration, and osteogenic differentiation). The influence of RhoA activity in the context of surface topography was also elucidated using RhoA pharmacologic inhibitor. Following adhesion, M and N adherent cells developed multiple projections, while S adherent cells had flattened and widespread morphology. RhoA inhibitor induced remarkable longer and thinner cytoplasmic projections on all surfaces. Cell adhesion and osteogenic differentiation was topography dependent with S < M and N surfaces. RhoA inhibition increased adhesion on S and M surfaces, but not N surfaces. Cell migration in a wound healing assay was greater on S versus M versus N surfaces and RhoA inhibitor increased S adherent cell migration, but not N adherent cell migration. RhoA inhibitor enhanced osteogenic differentiation in S adherent cells, but not M or N adherent cells. RhoA activity was surface topography roughness dependent (S < M, N). RhoA activity and -mediated functions are influenced by surface topography. Smooth surface adherent cells appear highly sensitive to RhoA function, while nano-scale topography adherent cell may utilize alternative cellular signaling pathway(s) to influence adherent cellular functions regardless of RhoA activity.

Complete-arch implant-supported monolithic zirconia fixed dental prostheses: A systematic review

STATEMENT OF PROBLEM

Monolithic zirconia prostheses are emerging as a promising option in the implant-based rehabilitations of edentulous patients, yet their clinical performance is not fully documented.

PURPOSE

The purpose of this systematic review was to assess the clinical performance of complete-arch implant-supported monolithic zirconia fixed dental prostheses.

MATERIAL AND METHODS

The electronic databases PubMed, Science Direct, and Cochrane Library were searched for clinical studies on complete-arch implant-supported monolithic zirconia fixed dental prostheses. Human studies with a mean follow-up of at least 1 year and published in an English-language peer-reviewed journal up to June 2015 were included. Two independent examiners conducted the search and the review process.

RESULTS

The search generated 903 titles. Eighteen qualifying studies were retrieved for full-text evaluation. Nine studies were included on the basis of preestablished criteria. Eight studies reported satisfactory clinical and esthetic outcomes. One study demonstrated prosthesis failure. Clinical studies are lacking on the long-term outcome of complete-arch implant-supported monolithic zirconia prostheses.

CONCLUSIONS

Complete-arch dental implant restoration with monolithic zirconia is associated with high short-term success. Despite the many advantages and short-term favorable reports, studies of longer duration are necessary to validate the broad application of this therapy.

Titanium nanotubes induce osteogenic differentiation through the FAK/RhoA/YAP cascade

TNT topography restricts cell spreading, impairs the FAK recruitment in FAs, and thereby attenuates RhoA activity as well as cytoskeleton formation, which in turn expels YAP from that cell nucleus to the cytoplasm and initiates osteodifferentiation.

Gene Expression Profiles of Early Implant Adherent Cells in Smokers and Nonsmokers

The objective of this study was to evaluate the impact of smoking on the early molecular events involved in peri-implant healing at either a micro-roughened or a micro-roughened with superimposed nanofeatures surface implant in humans. Twenty-one subjects, 10 smokers and 11 nonsmokers received 4 mini-implants (2.2 × 5.0 mm; 2 of each surface). After 3 and 7 days, paired mini-implants were retrieved by reverse threading and RNA isolated from implant adherent cells. Whole genome microarrays were used interrogate the gene expression profiles. The study failed to identify differences in the gene expression profiles of implant adherent cells at this early stage of osseointegration (up to day 7) comparing smoker and nonsmoker individuals.

Topography Influences Adherent Cell Regulation of Osteoclastogenesis

The importance of osteoclast-mediated bone resorption in the process of osseointegration has not been widely considered. In this study, cell culture was used to investigate the hypothesis that the function of implant-adherent bone marrow stromal cells (BMSCs) in osteoclastogenesis is influenced by surface topography. BMSCs isolated from femur and tibia of Sprague-Dawley rats were seeded onto 3 types of titanium surfaces (smooth, micro, and nano) and a control surface (tissue culture plastic) with or without osteogenic supplements. After 3 to 14 d, conditioned medium (CM) was collected. Subsequently, rat bone marrow-derived macrophages (BMMs) were cultured in media supplemented with soluble receptor activator of NF-κB ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) as well as BMSC CM from each of the 4 surfaces. Gene expression levels of soluble RANKL, osteoprotegerin, tumor necrosis factor α, and M-CSF in cultured BMSCs at different time points were measured by real-time polymerase chain reaction. The number of differentiated osteoclastic cells was determined after tartrate-resistant acid phosphatase staining. Analysis of variance and t test were used for statistical analysis. The expression of prominent osteoclast-promoting factors tumor necrosis factor α and M-CSF was increased by BMSCs cultured on both micro- and nanoscale titanium topographies (P < 0.01). BMSC CM contained a heat-labile factor that increased BMMs osteoclastogenesis. CM from both micro- and nanoscale surface-adherent BMSCs increased the osteoclast number (P < 0.01). Difference in surface topography altered BMSC phenotype and influenced BMM osteoclastogenesis. Local signaling by implant-adherent cells at the implant-bone interface may indirectly control osteoclastogenesis and bone accrual around endosseous implants.

Proliferation of preosteoblasts on TiO2 nanotubes is FAK/RhoA related

Topographies promote surface-dependent behaviors which may positively influence peri-implant bone healing. In this study the topological effects of TiO2 nanotubes (TNTs) on aspects of preosteoblast behavior was investigated. Specifically, we hypothesize that TNTs can influence cell proliferation of preosteoblasts through cell adhesion and related modulation of FAK and RhoA. By culturing MC3T3-E1 cells on TNTs with different diameters (40nm and 150nm diameters), topography-dependent modulation in cell morphology and cell growth were observed. The average spreading area of the cell on Flat Ti, 40nm TNTs and 150nm TNTs were respectively 2176.05 μm2, 1510.44 μm2 and 800.72 μm2. Proliferation increased among cells cultured on the 150nm TNTs (28.6%) compared with on Flat Ti (17.06%). The expression of FAK was 86.2% down regulated superimposition of TNTs topography. RhoA expression only slightly decreased (45.9%). Increasing TNT diameter enhanced initial adherent cell growth, which was relevant to the increased RhoA-to-FAK ratio in the cell. Increased TNT diameter was associated with higher ratio and greater proliferation in the first 24 hours. These findings not only support our hypothesis, but suggest that RhoA might be critically involved in TNTs mediated cell proliferation. Future investigation using functional gain and loss of RhoA may further reveal its mechanism.

Electromyographic evaluation of masticatory muscles in dentate patients versus conventional and implant-supported fixed and removable denture wearers- a preliminary report comparing model foods

PURPOSE

To evaluate differences in masticatory muscle function during chewing of model foods designed to differ in fracture strength between dentate subjects (n = 5, ages 59 to 68 years) versus patients treated with a maxillary conventional complete denture opposing natural dentition or one of the following types of mandibular complete dentures: conventional, implant-supported overdenture, implant-supported fixed denture (n = 20, ages 45 to 83 years). The authors hypothesized that denture wearers would differ in duration of chewing, frequency of chewing, and masticatory muscle activity while preparing a bolus for swallowing.

MATERIALS AND METHODS

Surface electromyography was recorded bilaterally from the masseter, anterior temporalis, and anterior digastric. Masticatory muscle activity was evaluated using scaled values of the area under the electromyographic curve, while subjects chewed agar-based model foods with different fracture strengths. Chewing duration and frequency also were calculated from electromyographic recordings. Mixed model analysis of variance with "subject" as a random factor was used during statistical analysis. Logarithmic transformation was required to achieve normalization of residuals for the duration of chewing and the relative masticatory muscles activity, but not for the chewing frequency.

RESULTS

Relative masticatory muscle activity was 2.57 times higher for the denture wearers than for the dentate subjects during chewing of model foods (P < .0001). The reduction in masticatory muscle activity from the 1st to the 10th chewing cycle was proportionally less in magnitude and occurred more gradually for denture wearers compared to dentate subjects. While chewing sequence duration increased with food fracture strength, it did not differ significantly in treatment versus dentate groups. Chewing cycle frequency did not differ between groups or with food fracture strength.

CONCLUSIONS

The observed increases in relative masticatory muscle activity for denture wearers compared to the dentate subjects during oral food processing likely reflect supplemental mechanical efforts to accommodate the use of dentures for preparing a bolus for swallowing.

Esthetic outcomes in relation to implant-abutment interface design following a standardized treatment protocol in a multicenter randomized controlled trial--a cohort of 12 cases at 1-year follow-up

The design of an implant-abutment interface may have an impact on the peri-implant soft tissue esthetics. In an ongoing randomized controlled trial (RCT) with 141 participants, the authors evaluated the peri-implant tissue responses around three different implant-abutment interface designs used to replace single teeth in the esthetic zone. The aim of this report is to describe the treatment protocol utilized in this ongoing RCT by (1) demonstrating in detail a clinical case treated under this protocol and (2) reporting peri-implant soft tissue responses in a cohort of 12 representative cases from the RCT at 1-year follow-up. Male and female adults requiring single implants in the anterior maxilla were enrolled in the RCT according to the study protocol. Five months following any required extraction and/or socket bone grafting/ridge augmentation, one of the following three implant-abutment interfaces was placed and immediately provisionalized: (1) conical interface (CI; OsseoSpeed, Dentsply Implants), n = 4; (2) flat-to-flat interface (FI; NobelSpeedy Replace, Nobel Biocare), n = 4; or (3) platform-switch interface (PS; NanoTite Certain Prevail, Biomet 3i), n = 4. Twelve weeks later, definitive crowns were delivered. Throughout the treatment, peri-implant buccal gingival zenith height and mesial/distal papilla height were measured on stereotactic device photographs, and pink esthetic scores (PES) were determined. The demographics of the participants in each of the three implant-abutment interface groups were very similar. All 12 study sites had ideal ridge form with a minimum width of 5.5 mm following implant site development performed according to the described treatment protocol. Using this treatment protocol for single-tooth replacement in the anterior maxilla, the clinicians were able to obtain esthetic peri-implant soft tissue outcomes with all three types of implant-abutment interface designs at 1-year follow-up as shown by the Canfield data and PES. The proposed treatment protocol for single-tooth replacement in the esthetic zone provides a reliable method to obtain and assess the esthetic outcome as a function of implant-abutment interface design and is now in its fifth year of follow-up.

Immediate provisionalization of dental implants placed in healed alveolar ridges and extraction sockets: a 5-year prospective evaluation

PURPOSE

This 5-year prospective multicenter study compared implant survival and success, peri-implant health and soft tissue responses, crestal bone level stability, and complication rates following immediate loading of single OsseoSpeed implants placed in anterior maxillary healed ridges or extraction sockets.

MATERIALS AND METHODS

Individuals requiring anterior tooth replacement with single implants were treated and immediately provisionalized. Definitive all-ceramic crowns were placed at 12 weeks. Implant survival, bone levels, soft tissue levels, and peri-implant health were monitored for 5 years.

RESULTS

One hundred thirteen patients received implants in fresh sockets (55) and healed ridges (58). After 5 years, 45 and 49 patients remained for evaluation, respectively. During the first year, three implants failed in the extraction socket group (94.6% survival) and one implant failed in the healed ridge group (98.3% survival); this difference was not significant. No further implant failures were recorded. After 5 years, the interproximal crestal bone levels were located a mean of 0.43 ± 0.63 mm and 0.38 ± 0.62 mm from the reference points of implants in sockets and healed ridges (not a significant difference). In both groups, papillae increased over time and peri-implant mucosal zenith positions were stable from the time of definitive crown placement in sockets and healed ridges. Compared to flap surgery for implants in healed ridges, flapless surgery resulted in increased peri-implant mucosal tissue dimension (average, 0.78 ± 1.34 mm vs 0.19 ± 0.79 mm).

CONCLUSION

After 5 years, the bone and soft tissue parameters that characterize implant success and contribute to dental implant esthetics were similar following the immediate provisionalization of implants in sockets and healed ridges. The overall tissue responses and reported implant survival support the immediate provisionalization of dental implants in situations involving healed ridges and, under ideal circumstances, extraction sockets.