Significance of keratinized mucosa/gingiva on peri‐implant and adjacent periodontal conditions in erratic maintenance compliers

Evaluation of peri-implant perfusion in patients who underwent avascular augmentation or microvascular reconstruction using laser Doppler flowmetry and tissue spectrophotometry: a prospective comparative clinical study

OBJECTIVES

The aim of this study was to evaluate the peri-implant perfusion, such as oxygen saturation, the relative amount of hemoglobin, and blood flow, in implants placed in pristine bone and avascular and microvascular grafts using a non-invasive measurement method.

MATERIALS AND METHODS

A total of 58 patients with 241 implants were included. Among them, 106 implants were based in native bone (group I), 75 implants were inserted into avascular bone grafts (group II), and 60 implants were placed in microvascular bone grafts (group III). Gingival perfusion was measured using laser Doppler flowmetry and tissue spectrophotometry (LDF-TS). Implants with signs of gingival inflammation were excluded to analyze healthy implant perfusion in different bony envelopes.

RESULTS

The mean values for oxygen saturation, relative hemoglobin levels, and blood flow did not differ significantly between the groups (p = 0.404, p = 0.081, and p = 0.291, respectively). There was no significant difference in perfusion between implants that were surrounded by mucosa and implants based within cutaneous transplants (p = 0.456; p = 0.628, and p = 0.091, respectively).

CONCLUSION

No differences in perfusion were found between implants inserted into native bone and implants involving bone or soft tissue augmentation. However, implants based in avascular and microvascular transplants showed higher rates of peri-implant inflammation.

CLINICAL RELEVANCE

Peri-implant perfusion seems to be comparable for all implants after they heal, irrespective of their bony surroundings. Although perfusion does not differ significantly, other factors may make implants in avascular and microvascular transplants vulnerable to peri-implant inflammation.

Associations between the keratinized mucosa width and the underlying alveolar bone dimensions at partial edentulous molar sites: a retrospective cross-sectional study

BACKGROUND

The assessment of hard and soft tissue at edentulous sites is important for subsequent implant treatment design. The aim of the present study was to explore the associations between the keratinized mucosa width (KMW) and the underlying alveolar bone dimensions at partial edentulous molar sites.

METHODS

In this retrospective study, a total of 110 patients with at least one missing molar were selected. The buccal KMW of the edentulous molar sites was evaluated. Cone-beam computed tomography scans were collected, and the height discrepancy between the alveolar crest and the buccal bone plate (HC-B) as well as the alveolar bone height (ABH) were measured. The KMW was compared among the HC-B and ABH groups at both maxillary and mandibular sites. Linear regression and generalized estimation equations (GEEs) were used to explore the associations between the KMW and alveolar bone dimensions at α = 0.05.

RESULTS

Among the 110 patients, 158 edentulous molar sites were analyzed. The average HC-B and ABH were significantly lower at the maxillary sites (1.26 ± 1.62 mm, 11.62 ± 3.94 mm) than at the mandibular sites (3.67 ± 2.85 mm, 14.91 ± 3.01 mm, p < 0.001). The KMW was significantly lower at sites with HC-B > 2 mm than at sites with HC-B ≤ 2 mm both in the maxilla and mandible (p < 0.001). No significant differences were found between the KMW at sites with ABH < 10 mm and sites with ABH ≥ 10 mm (p > 0.05). Linear regression and GEEs analyses revealed that the HC-B was significantly associated with the KMW (B = -0.339, p < 0.001), while the association between the KMW and the ABH was not statistically significant (B = -0.046, p = 0.352).

CONCLUSIONS

The buccal KMW at edentulous molar sites was significantly associated with the HC-B. Alveolar ridges presenting with a sloped configuration were more prone to possess a narrower band of keratinized mucosa. Both hard and soft tissue augmentation should be considered for implant treatment at these sites. The correlations of dynamic changes between the KMW and alveolar bone dimensions after tooth extraction should be further investigated.

Impact of vertical alveoloplasty on changes in keratinized mucosa width following full-arch immediate implant placement and rehabilitations: A prospective case series

PURPOSE

This prospective case series aimed to investigate the effect of vertical alveoloplasty on the changes in keratinized mucosa width (KMW) following full-arch immediate implant placement and rehabilitation.

MATERIALS AND METHODS

A total of 17 potential edentulous patients were enrolled and received implant placement and full-arch implant-supported immediate rehabilitations. The main outcome was to analyze the effect of vertical alveoloplasty on the changes in KMW. The amount of vertical alveoloplasty during implant surgery as well as the changes in KMW at buccal aspects from the day of surgery to 6 months post-surgery were recorded on the implant-level using a periodontal probe. The secondary outcome was to analyze the other possible factors that affected the changes in KMW. The included factors were the initial KMW, the distribution of implants in the maxilla and mandible, the distribution of implants in the anterior and posterior regions, the distribution of implants in extraction sockets and healed ridges, and gender. Mann-Whitney non-parametric tests and multiple linear regression adjusted by generalized estimating equations (GEE) were used to statistically analyze the data.

RESULTS

A total of 121 implant positions were analyzed. The KMW was 4.1± 2.0 mm on the day of the surgery and 4.1± 1.7 mm 6 months post-surgery. The mean changes in KMW following 6 months were -0.1± 1.6 mm (p = 0.824). From the results of GEE, the vertical amount of alveoloplasty had no significant effect on changes in KMW. Both initial KMW and the distribution of implants in the anterior and posterior regions had significant impacts on the changes in KMW (p < 0.0001).

CONCLUSION

The amount of vertical alveoloplasty during implant surgery has no significant impact on the KMW. The KMW remained stable from baseline to 6 months after alveoloplasty, implant placement, and immediate rehabilitations in potential edentulous arches. The initial KMW and the distribution of implants in the anterior and posterior regions were the possible factors affecting changes in KMW.

Soft tissue management around dental implant in esthetic zone - the current concepts and novel techniques

It has been said, 'Bone sets the tone, but tissue is the issue.' In the field of implantology, while significant breakthroughs have been achieved in hard tissue regeneration, clinicians find it more challenging to handle soft tissue complications around dental implants. Successfully managing soft tissue around dental implants requires clinicians to have comprehensive knowledge of proper implant placement, prosthetic design and tissue management, and a high level of surgical skills for soft tissue augmentation and grafting. Autogenous gingival grafts can be utilized in various clinical situations, providing surgeons with great potential and freedom to enhance the quality and quantity of peri-implant soft tissue. Emerging trends, such as digital tools for treatment planning, minimally invasive surgical approaches, and innovative biomaterials, can also contribute to a more pleasing outcome. By elucidating these multifaceted considerations, this review will serve as a valuable resource for clinicians aiming to achieve functional and aesthetic excellence in implant-based oral rehabilitation.

Diagnostic methods/parameters to monitor peri-implant conditions

The diagnostic accuracy of clinical parameters, including visual inspection and probing to monitor peri-implant conditions, has been regarded with skepticism. Scientific evidence pointed out that primary diagnostic tools (chairside) seem to be highly specific, while their sensitivity is lower compared with their use in monitoring periodontal stability. Nonetheless, given the association between pocket depth at teeth and implant sites and the aerobic/anaerobic nature of the microbiome, it seems plausible for pocket probing depth to be indicative of disease progression or tissue stability. In addition, understanding the inflammatory nature of peri-implant diseases, it seems reasonable to advocate that bleeding, erythema, ulceration, and suppuration might be reliable indicators of pathology. Nevertheless, single spots of bleeding on probing may not reflect peri-implant disease, since implants are prone to exhibit bleeding related to probing force. On the other side, bleeding in smokers lacks sensitivity owing to the decreased angiogenic activity. Hence, the use of dichotomous scales on bleeding in the general population, in contrast to indices that feature profuseness and time after probing, might lead to false positive diagnoses. The definitive distinction between peri-implant mucositis and peri-implantitis, though, relies upon the radiographic evidence of progressive bone loss that can be assessed by means of two- and three-dimensional methods. Accordingly, the objective of this review is to evaluate the existing clinical and radiographic parameters/methods to monitor peri-implant conditions.

Soft tissue elasticity at teeth and implant sites. A novel outcome measure of the soft tissue phenotype

AIM

To assess ultrasonographic tissue elasticity at teeth and implant sites and its variation after peri-implant soft tissue augmentation with a connective tissue graft (CTG).

METHODS

Twenty-eight patients, each contributing with one clinically healthy dental implant exhibiting a soft tissue dehiscence (PSTD), were included. Implant sites were augmented with CTG and monitored over 12 months. Ultrasonographic strain elastography, expressed as strain ratios (SR1, SR2, and SR3, respectively) was assessed at baseline, 6-, and 12-month, and compared with the corresponding contralateral homologous natural tooth. SR1 assessed the strain/elasticity of the midfacial coronal portion of the soft tissue in comparison to the natural tooth crown/implant-supported crown, SR2 evaluated the strain of the midfacial coronal soft tissue in relation to the one of the alveolar mucosa, while SR3 depicted the strain of the midfacial soft tissue in relation to the interproximal soft tissue on the transverse ultrasound scan.

RESULTS

SR1 in natural dentition and at implant sites was 0.20 ± 0.08 and 0.30 ± 0.14, respectively (p = .002), indicating that the coronal portion of the soft tissue around teeth is generally more elastic than its counterpart around dental implants. Soft tissue augmentation with CTG promoted an increased stiffness of the midfacial coronal portion of the soft tissue over 12 months (p < .001 for SR1, SR2, and SR3). Strain ratios at the 12-month time points were significantly higher than the values observed at 6 months (p < .001). Regression analysis demonstrated that strain elastography ratios in natural dentition were significantly associated with keratinized gingiva width, and gingival thickness. At implant sites, SR1 was significantly associated with keratinized mucosa width and mucosal thickness (p < .001 for both correlations), SR2 was significantly associated with keratinized mucosa width (p = .013), and SR3 was significantly associated with the surgical technique performed in combination with CTG (p = .022).

CONCLUSION

Ultrasound strain elastography captures and quantifies tissue elasticity and its changes after soft tissue augmentation. A different baseline tissue elasticity was observed between teeth and dental implants in the most coronal aspect of the soft tissue. The main factors affecting tissue elasticity-related outcomes were the keratinized tissue width, and mucosal thickness.

Multivariate analysis of the effect of keratinized mucosa on peri-implant tissues with platform switching: A retrospective study

BACKGROUND

In recent years, platform switching implant treatment has been increasing, which is believed to minimize bone loss around the implant after placement. However, there have been no reports on the relationship between keratinized mucosa width (KMW) and bone loss and soft tissue recession in platform switching implants.

OBJECTIVE

We evaluated the effect of the KMW on the amount of bone loss and soft tissue recession around a platform switching implant retrospectively using multivariate analysis.

MATERIALS AND METHODS

This one-year retrospective study included 91 implants in 48 patients. Age, sex, a history of periodontitis, implant location, oral hygiene status, and the KMW were included as explanatory variables to evaluate bone loss (BL) and buccal gingival height (GH). Generalized estimating equations (GEEs) were used to evaluate the effect of the KMW on platform switching peri-implant tissues.

RESULTS

The mean bone loss on the mesial (ΔBLm), distal (ΔBLd), and buccal (ΔBLb) sides of the implant were 0.16 ± 0.27 mm, 0.19 ± 0.34 mm, and 0.24 ± 0.50 mm, respectively, at 1 year after superstructure placement. The mean amount of change of GH (ΔGH) on the buccal side was 0.30 ± 0.47 mm. After correcting for confounders using GEEs, the results suggested that KMW <1.5 mm was a significant factor (P < 0.001) for bone loss over time in ΔBLm, ΔBLd, and ΔBLb. In addition, for soft tissues on the buccal side, KMW <1.5 mm was a significant factor for ΔGH reduction over time (P < 0.001).

CONCLUSIONS

Keratinized mucosa width ≥1.5 mm was associated with a higher probability less hard and soft tissue recession around the platform switching implant after 1 year from superstructure placement.

Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study

AIM

To investigate whether the lack of keratinized mucosa (KM) affects peri-implant health after 10 years of loading.

MATERIALS AND METHODS

Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index, marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5-year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri-implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one-piece or two-piece) and compliance.

RESULTS

A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri-implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri-implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two-piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two-piece implants were associated with reduced MBL and MBL changes (p < 0.05).

CONCLUSION

The lack of buccal KM appears to be linked with peri-implant parameters such as BOP and MBL, but the association is weak. The design of one-piece implants may account for their increased odds of exhibiting BOP.

Prevalence, risk indicators, and clinical characteristics of peri-implant mucositis and peri-implantitis for an internal conical connection implant system: A multicenter cross-sectional study

BACKGROUND

Peri-implant disease prevalence is associated with a multifactorial etiology and distinct clinical characteristics of inflammation.

METHODS

The present study aimed to assess the prevalence of peri-implant diseases, identify related risk indicators, and associate specific clinical characteristics to peri-implant biological complications in the medium term. Peri-implant diseases were classified according to established case criteria. Patients' data, implant and/or prosthetic features, and maintenance records were collected. Clinical characteristics such as bleeding on probing (BOP), suppuration (SUPP), keratinized mucosa (KM), probing depth (PD), marginal recession (MR), and modified plaque index (mPI) were recorded.

RESULTS

Ninety-nine patients with 266 implants with a mean functional duration of 30.26 months were evaluated. Peri-implant mucositis and peri-implantitis prevalence totaled to 49.5% and 15.15% (patient level), respectively. Peri-implant mucositis was associated with osteoporosis (odds ratio [OR] 6.09), age (OR 0.97), diabetes mellitus (OR 3.09), cemented-retained prosthesis (OR 3.81), and partial prosthesis (OR 2.21). Peri-implantitis was associated with osteoporosis (OR 7.74) and periodontitis (OR 2.74), cemented prosthesis (OR 10.12), partial and full arch prostheses (OR 12.35 and 19.86), implant diameter (OR 3.64), abutment transmucosal height (OR 3.39), and hygiene difficulty (OR 3.14). Furthermore, mPI score 3 (OR 3.27) and PD scores (OR 1.64) were associated with peri-implant mucositis, while mPI score 3 (OR 16.42), KM (OR 1.53), PD (OR 1.81), MR (OR 2.61), and the relationship between KM and PD (OR 0.63) were associated with peri-implantitis.

CONCLUSION

In the medium term, peri-implant diseases were correlated with factors inherent to the patient's conditions, presurgical treatment plan, and hygiene maintenance care. The knowledge of the mentioned factors and featured clinical characteristics can be crucial for disease prevention and establishment of a superior implant therapy prognosis.

Maintenance of peri-implant health in general dental practice

The long-term maintenance or restoration of peri-implant tissues' health depends on the strategic implementation of preventive measures and interventions. These measures should be initiated before implant placement and continued throughout a patient's lifetime, as part of a tailored and comprehensive supportive peri-implant care (SPIC) programme. Central to the clinical efforts of maintaining and rehabilitating peri-implant tissues are several key factors, including the ongoing assessment and frequent monitoring of tissue health and stability, proactive oral health promotion, the control of risk factors and indicators and the provision of professional plaque biofilm removal. It is of paramount importance to underline that SPIC should not limit its scope exclusively to patients already in a state of peri-implant health; in fact, it is imperative that it should extend its protective effect to individuals who have been previously diagnosed and treated for peri-implant diseases, focusing on preventing its recurrence and progression, thereby avoiding further complications, such as implant loss.This narrative review presents an overview of the current literature on the maintenance of peri-implant tissues' health and the steps of SPIC providing insights into the critical factors to be considered when managing dental implant patients in the general dental practice.

Peri-implantitis in patients without regular supportive therapy: Prevalence and risk indicators

OBJECTIVES

To determine the prevalence of peri-implant diseases in patients treated in a university setting without a regular peri-implant supportive therapy schedule, and to identify the risk indicators associated with peri-implantitis.

MATERIAL AND METHODS

A retrospective cohort study was made of patients with dental implants with at least 12 months of functional loading who did not receive regular peri-implant supportive therapy. Patient- and implant-related variables were retrieved, and clinical and radiological examinations were performed. Descriptive and bivariate analyses and multilevel logistic regression analyses were performed to identify factors associated with peri-implantitis.

RESULTS

A total of 213 implants in 88 patients were analyzed. The patient-level prevalence of peri-implantitis and peri-implant mucositis was 26.1% (95%CI: 16.7%-35.5%) and 44.3% (95%CI: 34.0%-54.6%), respectively. Peri-implant diseases were significantly more frequent when the width of the keratinized mucosa was < 2 mm (OR = 5.26; 95%CI: 1.24-22.26; p = 0.024), and when there was 12 month post-loading bone loss (OR = 2.96; 95%CI: 1.35-6.52; p = 0.007).

CONCLUSIONS

Peri-implantitis is a common finding in patients without regular peri-implant supportive therapy (prevalence 16.7-35.5%). A thin peri-implant keratinized mucosa (< 2 mm) and a higher degree of bone remodeling after loading seem to be the main risk factors for peri-implantitis in this patient profile.

CLINICAL RELEVANCE

Patients who do not engage in supportive peri-implant maintenance have a higher risk of peri-implantitis. A thin keratinized mucosa and bone loss during the first year of loading are predisposing factors for peri-implantitis.

How do the dimensions of peri-implant mucosa affect marginal bone loss in equicrestal and subcrestal position of implants? A 1-year clinical trial

INTRODUCTION

There is evidence that the apico-coronal implant position and the mucosal phenotype can affect the extent of peri-implant bone loss. This clinical trial analyzes the bone remodeling and marginal bone loss that occur around conical-connection implants placed equicrestally and subcrestally, assessing the effect of the peri-implant soft-tissue phenotype.

METHODS

Fifty-one patients received 56 implants of distinct diameters (3.5 mm Ø n = 6; 4.3 mm Ø n = 41; 5 mm Ø n = 9) in the posterior part of the maxilla or mandible. The implants were placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, depending on the initial supracrestal tissue height (STH). After 3 months of non-submerged healing, single metal-ceramic screw-retained implant-supported crowns were placed. Longitudinal measurements of STH, mucosal thickness and keratinized mucosa width (KMW) were made at the time of implant placement (T0), crown placement (T1), and after 3 (T2) and 6 months (T3) of prosthetic loading. At each of these points, a radiographic evaluation of bone remodeling and marginal bone loss was also performed.

RESULTS

STH was significantly greater for implants placed >1 mm subcrestally than for those placed 1 mm subcrestally. After 12 months of follow-up, a very significant (p < 0.001) loss of KMW was observed, in addition to a marginal bone loss of 0.08 ± 0.1, 0.15 ± 0.2, and 0.14 ± 0.2 mm in the groups placed equicrestally, 1 mm subcrestally and >1 mm subcrestally, respectively. After the multiple linear regression, marginal bone loss was found to depend primarily on KMW (β = -0.43), while also being affected by STH (β = 0.32) and implant diameter (β = -0.28).

CONCLUSIONS

Marginal bone loss may be influenced by the position with respect to the bone crest, as well as the KMW, STH, and implant diameter. However, more well-controlled studies are needed to verify these above-mentioned findings with different implant designs and connections.

Association of Peri-Implant Keratinized Mucosa Width and Mucosal Thickness with Early Bone Loss: A Cross-Sectional Study

Objective: The objective of this study was to evaluate the effects of keratinized mucosa width (KMW) and mucosal thickness (MT) around dental implants on marginal bone loss (MBL). The evaluation was performed one year after loading by comparing clinical, radiographic, and biochemical parameters. Methods: The study included 87 implants in 87 patients undergoing regular follow-ups without hard or soft tissue augmentation one year after loading. Clinical measurements included plaque index (PI), gingival index (GI), bleeding on probing (BoP), probing depth (PD), KMW, and MT. MBL was assessed with periapical radiography. The peri-implant crevicular fluid (PICF) was analyzed for tumor necrosis factor-alpha (TNF-α), receptor activator of nuclear factor-kB ligand (RANKL), osteoprotegerin (OPG), and microRNA-27a. Results: The MBL of implants with thin MT (<2 mm) was higher than that of implants with thick MT (≥2 mm) (p < 0.05). A significant negative correlation (r: -0.217) was established between MT and MBL. No significant association was found between KMW and MBL (p > 0.05). No significant associations was found between KMW and MT with TNF-α, RANKL, OPG and RANKL/OPG (p > 0.05), with the exception of increased microRNA-27a levels in implants with KMW ≥ 2 mm (p < 0.05). Conclusions: Implants with a thick MT had a lower MBL. There may be an association between adequate KMW and high miRNA-27a levels. The relationship between MBL and miRNA-27a remains unclear.

One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

Effect of argon plasma abutment activation on soft tissue healing: RCT with histological assessment

OBJECTIVE

To assess the peri-implant soft tissue profiles between argon plasma treatment (PT) and non-treated (NPT) healing abutments by comparing clinical and histological parameters 2 months following abutment placement.

MATERIALS AND METHODS

Thirty participants were randomly assigned to argon-plasma treatment abutments group (PT) or non-treated abutments (NPT) group. Two months after healing abutment placement, soft peri-implant tissues and abutment were harvested, and histological and clinical parameters including plaque index, bleeding on probing, and keratinized mucosa diameter (KM) were assessed. Specialized stainings (hematoxylin-eosin and picrocirious red) coupled with immunohistochemistry (vimentin, collagen, and CK10) were performed to assess soft tissue inflammation and healing, and the collagen content keratinization. In addition to standard statistical methods, machine learning algorithms were applied for advanced soft tissue profiling between the test and control groups.

RESULTS

PT group showed lower plaque accumulation and inflammation grade (6.71% vs. 13.25%, respectively; p-value 0.02), and more advanced connective tissue healing and integration compared to NPT (31.77% vs. 23.3%, respectively; p = 0.009). In the control group, more expressed keratinization was found compared to the PT group, showing significantly higher CK10 (>47.5%). No differences in KM were found between the groups.

SIGNIFICANCE

PT seems to be a promising protocol for guided peri-implant soft tissue morphogenesis reducing plaque accumulation and inflammation, and stimulating collagen and soft tissue but without effects on epithelial tissues and keratinization.

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

STATEMENT OF PROBLEM

Data 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.

PURPOSE

The 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 METHODS

A 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.

RESULTS

The 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 CONCLUSIONS: Free 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.

Technical Note on Vestibuloplasty around Dental Implants Using Erbium YAG Laser-Assisted Periosteal Fenestration (LA-PF)

Various vestibuloplasty techniques have been reported to increase the attached mucosa (AM) and vestibular depth around dental implants. However, these surgical methods have disadvantages, such as limitations in manipulation, necessity of suturing, postoperative discomfort, swelling, and pain. This study aimed to evaluate the efficacy of laser-assisted periosteal fenestration (LA-PF) in treating patients with a shallow vestibule and insufficient AM around dental implants. LA-PF was performed using an Erbium YAG laser (Er:YAG laser). First, a partial-thickness, apically positioned flap was used. A horizontal periosteal fenestration was performed using an Er:YAG laser to expose the bones. Periosteal suturing was not required. After 12 months, sufficient AM and deep vestibules were obtained and maintained. Thus, the LA-PF technique may be a simple and predictable treatment modality for shallow vestibules with insufficient AM around dental implants.

Is alveolar ridge preservation an overtreatment?

The morphology and dimensions of the postextraction alveolar ridge are important for the surgical and restorative phases of implant treatment. Adequate new bone formation and preservation of alveolar ridge dimensions following extraction will facilitate installation of the implant in a restorative position, while preservation of soft tissue contour and volume is essential for an aesthetic and implant-supported restoration with healthy peri-implant tissues. Alveolar ridge preservation (ARP) refers to any procedure that aims to: (i) limit dimensional changes in the alveolar ridge after extraction facilitating implant placement without additional extensive bone and soft tissue augmentation procedures (ii) promote new bone formation in the healing alveolus, and (iii) promote soft tissue healing at the entrance of the alveolus and preserve the alveolar ridge contour. Although ARP is a clinically validated and safe approach, in certain clinical scenarios, the additional clinical benefit of ARP over unassisted socket healing has been debated and it appears that for some clinicians may represent an overtreatment. The aim of this critical review was to discuss the evidence pertaining to the four key objectives of ARP and to determine where ARP can lead to favorable outcomes when compared to unassisted socket healing.

Keratinized mucosa width assessment at implant sites using high-frequency ultrasonography

BACKGROUND

The aim of this study was to describe the application of high-frequency ultrasonography (HFUS) for assessing keratinized mucosa (KM) width at implant sites.

METHODS

KM width was measured at 28 implant sites exhibiting a peri-implant soft tissue dehiscence at baseline and 12 months after soft tissue augmentation. KM width assessment was performed with a periodontal probe [clinical assessment (clKM)] and with HFUS, based on the echointensity of the keratinized epithelium compared to the adjacent structures. KM width measurements on ultrasound scans were performed linearly (lnKM) and along the soft tissue profile [surface distance (sdKM)].

RESULTS

No statistically significant differences were observed between clKM, lnKM, and sdKM at baseline, while at 12 months, sdKM (5.313 ± 1.188 mm) was significantly higher than clKM (3.98 ± 1.25 mm) and lnKM (4.068 ± 1.197 mm) (P < 0.001 for both comparisons). A linear relationship between mucosal thickness (MT) and the difference between sdKM and lnKM was observed. In 95.2% of cases with MT > 2.51 mm, the discrepancy between sdKM and lnKM was at least 1 mm.

CONCLUSIONS

HFUS is a noninvasive and valuable tool for measure KM width at implant site. Evaluating KM width along the soft tissue profile as a surface distance may improve the accuracy of the assessment.

Spontaneous regeneration of keratinized tissue at implants and teeth

AIM

To investigate the spontaneous regeneration of the implanto-mucosal and dento-gingival unit after complete removal of keratinized tissue (KT).

MATERIALS AND METHODS

One hemi-mandible per dog (n = 4) was allocated to receive three dental implants (test sites, premolar region), whereas three premolars on the contralateral side were controls. After osseointegration, the entire KT (buccal + lingual) was surgically excised on all test and control sites, leaving the bone exposed. Clinical measurements were performed before excision (T0 ) and after 12 weeks (T1 ). Following healing, the animals were euthanized, and the specimens were histologically processed. Descriptive statistical analyses were performed.

RESULTS

Clinical measurements revealed that at T1 , on all teeth, a band of KT was spontaneously regenerated (mean width: 2.60 ± 0.66 mm), whereas on implants, KT was detected only occasionally at mesial or distal but not at buccal sites (mean total: 0.35 ± 0.53 mm; p < .0001). Histologically, spontaneous regeneration of the dento-gingival unit was evident, displaying masticatory mucosa. At the implant sites, on the other hand, the implanto-mucosal unit was characterized by a non-keratinized epithelium and elastic fibres, indicating the characteristics encountered in alveolar mucosa.

CONCLUSION

After excision of KT at implant sites, the spontaneous regeneration of the soft tissue is characterized by a non-keratinized epithelium typical for alveolar mucosa, while at tooth sites the spontaneous regeneration was characterized by soft tissue resembling gingiva.

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study

BACKGROUND

Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG.

AIM

The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period.

MATERIALS AND METHODS

The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes.

RESULTS

Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001).

CONCLUSIONS

CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.

Peri-implantitis management by resective surgery combined with implantoplasty and Er:YAG laser irradiation, accompanied by free gingival graft: a case report

The optimal method for decontamination of implant surfaces for peri-implantitis treatment remains controversial. In recent years, erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and implantoplasty (IP) (i.e. mechanical modification of the implant) have been reported to be effective in decontaminating implant surfaces during the surgical treatment. Also, a lack of adequate keratinized mucosa (KM) around the implant is known to be associated with more plaque accumulation, tissue inflammation, attachment loss, and mucosal recession, increasing the risk of peri-implantitis. Therefore, free gingival graft (FGG) has been recommended for gaining adequate KM around the implant. However, the necessity of acquiring KM for the treatment of peri-implantitis using FGG remains unclear. In this report, we applied the apically positioned flap (APF) as resective surgery for peri-implantitis treatment in conjunction with IP and Er:YAG laser irradiation to polish/clean the implant surface. Furthermore, FGG was conducted simultaneously to create additional KM, which increased the tissue stability and contributed to the positive results. The two patients were 64 and 63 years old with a history of periodontitis. The removal of granulation tissue and debridement of contaminated implant surfaces were performed with Er:YAG laser irradiation post flap elevation and then modified smooth surfaces mechanically using IP. Er:YAG laser irradiation was also utilized to remove the titanium particles. In addition, we performed FGG to increase the width of KM as a vestibuloplasty. Peri-implant tissue inflammation and progressive bone resorption were not observed, and both patients maintained good oral hygiene conditions until the 1-year follow-up appointment. Bacterial analysis via high-throughput sequencing revealed proportional decreases in bacteria associated with periodontitis (Porphyromonas, Treponema, and Fusobacterium). To the best of our knowledge, this study is the first to describe peri-implantitis management and bacterial change before and after procedures by resective surgery combined with IP and Er:YAG laser irradiation for peri-implantitis treatment, accompanied by FGG for increasing KM around the implants.

Evaluation of the significance of keratinized mucosa on peri-implant tissue health: a prospective clinical trial

BACKGROUND

The effect of keratinized mucosa on peri-implant tissue health is still inconclusive. This study aimed to evaluate the importance of keratinized mucosa and investigate the impact of the free gingival graft procedure on peri-implant health.

METHODS

At prosthesis delivery, the implants were allocated into three groups, based on the width of keratinized mucosa (KM) and patients' agreement on the free gingival graft procedure: KMS (KM ≥2 mm), KMD (KM <2 mm), and FGG (KM <2 mm initially and having surgically increased keratinized mucosa). Modified plaque index (mPI), probing depth (PD), modified bleeding index (mBI), KM, and marginal bone loss (MBL) were assessed at the baseline, 6-, 12-, and 24-month follow-up periods.

RESULTS

Of the 47 patients, 17 belonged to the KMS group, 17 belonged to the KMD, and the remaining 13 patients belonged to the FGG. KMD demonstrated significantly fewer mPI and higher mBI than KMS and FGG at 6 and 12 months. At 24 months, MBL did not differ between the groups; however, PD was significantly greater in the KMD group.

CONCLUSIONS

Implants with inadequate keratinized mucosa had higher bleeding and pocket depth values despite less plaque accumulation. According to the results, soft tissue grafting should be performed as early as possible. © 2023 Australian Dental Association.

Soft tissue phenotype modification impacts on peri-implant stability: a comparative cohort study

OBJECTIVES

Soft tissue phenotype modification (STPM) could be performed to maintain peri-implant health. Therefore, the aim of the study was to analyze tissue alteration around implants following soft tissue phenotype modification during implant uncovering surgery.

MATERIALS AND METHODS

Patients who had STPM (either pouch roll or modified roll technique) during implant second-stage surgery with at least 12-month follow-up were included. Clinical and radiographic parameters including mucosal tissue thickness (MTT), recession (REC), keratinized mucosa width (KMW), probing pocket depth (PPD), marginal bone loss (MBL), emergence profile, and emergence angle were extracted from 2-week, 2-month, and 12-month visits after second-stage surgery.

RESULTS

Twenty-eight patients with 33 implants that fulfilled the inclusion criteria were included. After soft tissue phenotype modification, at 2 weeks, REC was negatively correlated to mean MTT at mid-buccal site (r =  - 0.41, p = 0.018) and borderline correlated at mid-lingual site (r =  - 0.343, p = 0.051). Stable KMW was maintained from 2 weeks to 12 months with minimal shrinkage rate (3 ~ 14%). MBL change was limited (0.24 ~ 0.47 mm) after STPM. All implants had shallow PPD (≤ 3 mm) with the absence of bleeding on probing. Emergence angle at the mesial side, however, was significantly correlated to surgical techniques, which indicated pouch roll technique would have 6.96 degrees more than modified roll technique (p = 0.024).

CONCLUSIONS

Soft tissue phenotype modification, either pouch roll or modified roll technique, during uncovering surgery resulted in favorable clinical outcomes. Thin mucosal tissue thickness and pouch roll technique are the factors related to more recession at 2 weeks. Pouch roll technique could influence the restorative design by having a wide emergence angle at the mesial side.

CLINICAL RELEVANCE

Modified and pouch roll techniques during uncovering surgery were viable methods to yield favorable peri-implant health, while the preciseness of pouch roll technique was required to avoid mucosal recession and inadequate restorative design.

Digital evaluation of facial peri-implant mucosal thickness and its impact on dental implant aesthetics

OBJECTIVE

The aim of the present study was to describe and compare the features of the buccal peri-implant mucosa to natural gingiva in the aesthetic area.

MATERIAL AND METHODS

Forty-nine periodontally healthy patients were included in this cross-sectional study. Mucosal and gingival dimensions at the mid-facial aspect were evaluated clinically and radiographically. Color assessments were performed using a reflectance spectrophotometer, and patient aesthetic satisfaction was further checked.

RESULTS

Implant sites revealed significant thicker mucosa when compared to tooth sites both at 1.5 (p < 0.001) and 3 mm (p < 0.001) apical to the mucosal margin. Both conventional and digital methods presented a good reliability. The spectrophotometric data revealed a statistically significant color difference between the peri-implant mucosa and the gingiva. However, there was no further significant relation between these color changes and the mucosal thickness.

CONCLUSIONS

Peri-implant mucosa revealed a darkish, greenish, and bluish discoloration when compared to the gingiva. More satisfactory patient´s aesthetic evaluation was reported in sites with thicker and comparatively lighter mucosa when compared to the adjacent dentition.

CLINICAL RELEVANCE

This article focuses on variables affecting color stability and aesthetics around dental implants. These can be assessed to identify the need for peri-implant phenotypic modification.

Effect of argon plasma pre-treatment of healing abutments on peri-implant microbiome and soft tissue integration: a proof-of-concept randomized study

PURPOSE

Biofilm-free implant surface is ultimate prerequisite for successful soft and bone tissue integration. Objective of the study was to estimate the effects of argon plasma healing abutment pre-treatment (PT) on peri-implant soft-tissue phenotype (PiSP), inflammation, plaque accumulation and the microbiome (PiM) between non-treated (NPT) and treated (PT) abutments following 3-months healing period. The hypothesis was that cell-conductive and antimicrobial properties of PT would yield optimal conditions for soft tissue integration.

MATERIAL AND METHODS

Two months following second-phase surgery, microbiological and clinical parameters were assessed around thirty-six healing abutments with two types of microtopography, smooth surface (MACHINED) and ultrathin threaded microsurface (ROUGH). A two level randomization schema was used to achieve equal distribution and abutments were randomly divided into rough and machined groups, and then divided into PT and NPT groups. PiM was assessed using next-generation DNA sequencing.

RESULTS

PiM bacterial composition was highly diverse already two months post-implantation, consisting of key-stone pathogens, early and late colonizers, while the mycobiome was less diverse. PT was associated with lower plaque accumulation and inflammation without significant impact on PiSP, while in NPT clinical parameters were increased and associated with periopathogens. NPT mostly harbored late colonizers, while PT exerted higher abundance of early colonizers suggesting less advanced plaque formation. Interaction analysis in PT demonstrated S. mitis co-occurrence with pro-healthy Rothia dentocariosa and co-exclusion with Parvimonas micra, Porphyromonas endodontalis and Prevotella oris. PiSP parameters were generally similar between the groups, but significant association between PiM and keratinized mucosa width was observed in both groups, with remarkably more expressed diversity in NPT compared to PT. PT resulted in significantly lower BOP and PI around rough and machined abutments, respectively, without specific effect on PiM and PiSP.

CONCLUSIONS

PT contributed to significantly the less advanced biofilm accumulation and inflammation without specific effects on PiSP.

Xenogeneic collagen matrix versus free gingival graft for augmenting keratinized mucosa around posterior mandibular implants: a randomized clinical trial

OBJECTIVES

To assess the clinical efficacy of xenogeneic collagen matrix (XCM) plus apically positioned flap (APF) in augmenting the keratinized mucosa (KM) width (KMW) and thickness (KMT) around posterior mandibular implants and compare it with free gingival graft (FGG) plus APF.

MATERIAL AND METHODS

Thirty patients with KMW ≤ 2 mm in the posterior mandibular implant site were randomly allocated to the FGG group (FGG plus APF) or the XCM group (XCM plus APF). Clinical assessments, including KMW and KMT, shrinkage rate of established KM, and peri-implant soft tissue health, were evaluated during a 6-month follow-up. Additionally, the esthetic outcomes and patient-reported postoperative morbidity were investigated.

RESULTS

At 6 months, the KMW measured 3.60 ± 0.79 mm in the FGG group and 3.28 ± 0.96 mm in the XCM group (p = 0.186). Both groups showed a tendency for graft contraction (FGG, 42.11%; XCM, 53.22%). The KMT measured 1.24 ± 0.34 mm in the FGG group and 0.95 ± 0.29 mm in the XCM group, with statistical difference (p = 0.002). No difference in the peri-implant soft tissue health was observed between the two groups (p > 0.05), but the esthetic outcomes were better in the XCM group (p < 0.05).

CONCLUSIONS

XCM plus APF rendered a similar clinical efficacy in augmenting KMW as that with FGG plus APF, but with higher shrinkage. XCM plus APF was inferior with respect to FGG plus APF in augmenting KMT. The esthetic outcomes were better with XCM plus APF than FGG plus APF. Clinical relevance XCM plus APF graft was inferior with respect to FGG plus APF in augmenting KMT.

TRIAL REGISTRATION

Trial registration number: ChiCTR2200058027 and date: 03/27/2022.

[Kinetics of mucosal blood flow in 3D modeling of the gingival contour around dental implants after bone reconstruction of the alveolar ridge in the lateral part of the jaws]

OBJECTIVE

To study the kinetics of mucosal blood flow in 3D modeling of the gingival contour around dental implants after bone reconstruction of the alveolar ridge in the posterior jaw.

MATERIAL AND METHODS

The work was performed at the clinical base of the Department of Surgical Dentistry and Maxillofacial Surgery of the Institute of Dentistry of the Privolzhsky Research Medical University, Nizhny Novgorod, Russia with the participation of 87 patients who were divided into two groups depending on the chosen method of treatment and a control group. The method of laser Doppler flowmetry was carried out using a multifunctional laser diagnostic complex LAKK-02. The terms of observation were 7, 14, 28, 42 days.

RESULTS

On the 7th postoperative day, the decrease in microcirculation index (MI) in the groups reflected moderately pronounced hemodynamic disorders with a predominance of a decrease in MI in the center (by 35.8%). The predominance of the stagnant-ischemic type of microcirculation disorders and low intensity of neoangiogenesis was established, especially in the central zone in group 1, and in group 2 signs of neoangiogenesis were noted by the 7th day. By the 14th day, there was a decrease in venous congestion and signs of arterial inflow. In the 2nd group there was a subsidence of inflammatory phenomena and an increase in the energy of the oscillatory process in the vessels. Gradually, by the 42nd day, the indicators in groups 1 and 2 approached in value to the control group and did not differ significantly.

CONCLUSION

A previously unknown mechanism of interaction between two heterogeneous grafts (xenograft and thin free gingival graft) was revealed, which determined neoangiogenesis by the traditional method (from the center to the periphery), and by the proposed method (from the periphery to the center). Understanding the wound process is necessary for the purpose of further correction of the surgical technique for the best restoration of the vascular network and an increase in the success rate of operations.

Impact of peri-implant soft tissue characteristics on health and esthetics

OBJECTIVE

To review the impact of key peri-implant soft tissue characteristics on health and esthetics.

MAIN CONSIDERATIONS

The keratinized mucosa width (KMW), the mucosal thickness (MT), and the supracrestal tissue height (STH) are essential components of the peri-implant soft tissue phenotype. An inadequate KMW (<2 mm) has been associated with local discomfort upon oral hygiene performance and increased risk for the onset of peri-implant diseases. A minimum buccal MT (≥2 mm) is generally required to prevent esthetic issues related to the effect of transmucosal prosthetic elements on the color of the mucosa and can also contribute to long-term mucosal stability. STH is directly related to marginal bone remodeling patterns during the early healing process that follows the connection of transmucosal prosthetic components. Short STH, generally defined as <3 mm, has been consistently associated with marginal bone loss resulting from the physiologic establishment of the mucosal seal. Insufficient STH may also derive into the fabrication of unfavorable transmucosal prosthetic contours, which frequently results in unpleasing esthetic outcomes and predisposes to submarginal biofilm accumulation. Peri-implant soft tissue dehiscences (PISTDs) are a type of peri-implant deformity that are associated with esthetic issues and often occur in sites presenting KMW, MT, and/or STH deficiencies. PISTDs should be correctly diagnosed and treated accordingly, usually by means of multidisciplinary therapy.

CONCLUSION

Understanding the impact of different dimensional and morphologic features of the peri-implant mucosa on health and esthetic outcomes is fundamental to make appropriate clinical decisions in the context of tooth replacement therapy with implant-supported prostheses.

Clinical evaluation and patient related outcomes of one- and two-piece zirconia implants at five years of loading: A case series study

OBJECTIVE

The objective of this study was to investigate the survival and biological and mechanical complications of one-piece and two-piece zirconia implants at five years of loading.

MATERIALS AND METHODS

Consecutive patients receiving zirconia implants were studied, collecting data at five years of loading on their clinical history, peri-implant health status, mechanical complications, esthetic results, and patient related outcomes.

RESULTS

The study included 18 patients with 29 implants. The survival rate was 86% in implant-based analysis and 78% in patient-based analysis. There were no cases of peri-implantitis, but mucositis was present in 53% of implants. A mean of 4.1 ± 0.81 mm was obtained for probing depth and 1.6 ± 0.9 mm for crestal bone loss (radiographic assessment). There were no implant fractures. Major (10%) and minor (10%) prosthesis complications were observed. The esthetic outcome was moderate to almost perfect, with a high level of patient satisfaction. No significant association was found between survival rate and the presence of mucositis around one- or two-piece implants or any other study variable.

CONCLUSIONS

The survival rate is low for one- and two-piece zirconia implants. Both types of implants demonstrated a low mechanical complication rate. The incidence of periimplantitis is low but mucositis is present in 50%. Patient satisfaction related to esthetics and function is moderate to high. They represent a good option for patients requiring an alternative to titanium implants.

CLINICAL RELEVANCE

Zirconia implants appear to be an alternative to the titanium option and may be indicated for patients requiring "metal-free" restorations.

The keratinized mucosa width at partially edentulous molar sites and its associated factors: a pilot study

BACKGROUND

Assessment of the keratinized mucosa width (KMW) at edentulous sites is important for the subsequent implant treatment design. This pilot study aimed to evaluate the characteristics of the KMW at edentulous molar sites and explore the associated factors.

METHODS

A total of 150 patients with 222 edentulous molar sites were included. The buccal KMW of the edentulous molar sites was measured during implant treatment planning. Potentially associated factors, including age, sex, smoking status, location, reasons for tooth loss/extraction, gingival phenotype (GP) and keratinized gingival width (KGW) of the adjacent teeth, were collected and analyzed. The Shapiro‒Wilk test, Student's t test, one-way ANOVA, generalized estimation equations (GEEs) and linear regression analysis were used for data analysis at α = 0.05.

RESULTS

The buccal KMW at edentulous molar sites was 3.97 ± 2.06 mm, and 41.9% of sites presented with KMW < 4 mm. The mean KMWs of the maxillary sites were significantly higher than that those of the mandibular sites (4.96 ± 2.05 mm vs. 3.41 ± 1.85 mm, respectively). In total, 54.7%, 46.5%, 29.8%, and 0.0% of mandibular first and second molar sites and maxillary first and second molar sites, respectively, displayed a KMW of < 4 mm. Statistically significant linear correlations were found between KMW and GP (r = 0.161, p = 0.025) and between KMW and KGW of the adjacent teeth (r = 0.161, p = 0.023), while other factors were found to have no significant association.

CONCLUSION

Within the limitations of the present study, the KMW at edentulous molar site was related to the location of molar tooth loss/extraction. The GP and KGW of the adjacent teeth of edentulous molar sites were also associated with their KMW, which was probably attributed to the continuity of the adjacent soft tissue.

Impact of local predisposing/precipitating factors and systemic drivers on peri‐implant diseases

BACKGROUND

Strong evidence suggests the infectious nature of peri-implant diseases occurring in susceptible hosts. Epidemiological reports, though, indicate that peri-implantitis is a site-specific entity. Hence, the significance of local factors that may predispose/precipitate plaque accumulation and the impact of systemic drivers that alter the immune response are relevant in the prevention and management of peri-implant disorders.

PURPOSE

The purpose of the present review is to shed light on the significance of local and systemic factors on peri-implant diseases, making special emphasis on the associations with peri-implantitis.

METHODS

The biologic plausibility and supporting evidence aiming at providing a concluding remark were explored in the recent scientific literature for local predisposing/precipitating factors and systemic drivers related to peri-implant diseases.

RESULTS

Local predisposing factors such as soft tissue characteristics, implant position and prosthetic design proved being strongly associated with the occurrence of peri-implant diseases. Hard tissue characteristics, however, failed to demonstrate having a direct association with peri-implant diseases. Robust data points toward the strong link between residual sub-mucosal cement and peri-implant diseases, while limited data suggests the impact of residual sub-mucosal floss and peri-implantitis. Systemic drivers/habits such as hyperglycemia and smoking showed a strong negative impact on peri-implantitis. However, there is insufficient evidence to claim for any link between metabolic syndrome, atherosclerotic cardiovascular disease, and obesity and peri-implant diseases.

CONCLUSION

Local predisposing/precipitating factors and systemic drivers may increase the risk of peri-implant diseases. Therefore, comprehensive anamnesis of the patients, educational/motivational programs and exhaustive prosthetically-driven treatment planning must be fostered aiming at reducing the rate of biological complications in implant dentistry.

GUIDED PERI-IMPLANT AUTOGENOUS SOFT TISSUE GRAFTING: CASE REPORT

This case report showed the proof-of-concept of a guided free gingival graft around a dental implant. A 65-year-old male presented to replace his 30 and 31. Once the osseointegration of the 2 implants placed by guided surgery has been achieved, a free gingival graft was indicated. The surgical planning of this graft was performed using the Cone Beam Computed Tomography and archs digital scanning already used for implant placement. The greater palatine foramen and gutter were radiologically located to protect their arterial content. Two surgical guides were designed, one for the palatal donor site and one for the recipient site. The first one will serve both as an incision guide and as a post-operative protective plate. The procedure was free of adverse events. At the 1-year recall, the average gain in keratinized tissue width amounted 2.5 mm. This guided surgery could be used in a patient with insufficient amount of keratinized tissue around a posterior implant. For the first time, it makes it possible to anticipate, accelerate and secure the intervention, to improve the practitioner's comfort and potentially the outcomes of free gingival grafts. Further research and clinical are needed to validate this protocol and to assess its long-term impact on peri-implant health.

Influence of vestibular depth on the outcomes of root coverage therapy: A prospective case series study

BACKGROUND

The purpose of this study was to investigate the influence of vestibular depth (VD) on the outcomes of root coverage therapy.

METHODS

Patients presenting gingival recession defects (GRD) with a minimum depth of 2 mm underwent root coverage therapy consisting of a coronally advanced flap plus a connective tissue graft (CAF + CTG). Clinical examinations were performed, and intraoral scans were obtained at baseline, 3 and 6 months after surgery to assess changes in probing depth (PD), keratinized tissue width (KTW), recession depth (RD), GRD area, marginal gingival thickness (MGT), and VD. The influence of VD on percentage of root coverage (%RC) and the likelihood of achieving complete root coverage (CRC) were explored.

RESULTS

A total of 20 patients were enrolled, and 44 teeth were treated. RD decreased and MGT increased in all treated sites. At 6 months, mean %RC was 87.47 ± 18.37 and CRC was observed in 61.4% of sites. Mean baseline VD was 7.33 ± 2.67 mm. Mean VD reduction from baseline to 6 months was 1.98 ± 1.27 mm. %RC and CRC were significantly correlated with baseline VD. Each additional 1 mm of baseline VD implied a gain of 6.58% for %RC and increased 2.75 times the probability of achieving CRC. Narrow baseline KTW and mandibular arch location were associated with inferior treatment outcomes.

CONCLUSION

Lower %RC and likelihood of achieving CRC can be expected after root coverage therapy via CAF + CTG in sites presenting a shallow vestibulum.

Soft tissue features of peri‐implant diseases and related treatment

BACKGROUND

The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic.

PURPOSE

The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites.

MATERIALS AND METHODS

This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies.

RESULTS

Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail.

CONCLUSIONS

Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.

Significance of barrier membrane on the reconstructive therapy of peri-implantitis: A randomized controlled trial

BACKGROUND

The objective of this trial was to investigate the clinical and radiographic significance of using a mixture of mineralized and demineralized allografts in combination (M) or not (NM) with a resorbable cross-linked barrier membrane in the reconstructive therapy of peri-implantitis defects.

METHODS

A two-arm randomized clinical trial was performed in patients diagnosed with peri-implantitis that exhibited contained defects. Clinical parameters were recorded at baseline (T₀ ), 6 months (T₁ ), and 12 months (T₂ ). Radiographic parameters were recorded at T₀ and T₂ . A composite criterion for disease resolution was defined a priori. A generalized linear model of repeated measures with generalized estimation equation statistical methods was used.

RESULTS

Overall, 33 patients (n_implants  = 48) completed the study. At T₂ , mean disease resolution was 77.1%. The use of a barrier membrane did not enhance the probability of disease resolution at T₂ (odds ratio [OR] = 1.55, p = 0.737). Conversely, the odds of disease resolution were statistically associated with the modified plaque index recorded at T₀ (OR = 0.13, p = 0.006) and keratinized mucosa width (OR = 2.10, p = 0.035). Moreover, women exhibited greater odds to show disease resolution (OR = 5.56, p = 0.02).

CONCLUSION

Reconstructive therapy by means of a mixture of mineralized and demineralized allografts is effective in clinically resolving peri-implantitis and in gaining radiographic marginal bone level. The addition of a barrier membrane to reconstructive therapy of peri-implantitis does not seem to enhance the outcomes of contained bone defects (NCT05282667).

Antibacterial and Anti-Inflammatory Properties of Peptide KN-17

Peri-implantitis, an infectious disease originating from dental biofilm that forms around dental implants, which causes the loss of both osseointegration and bone tissue. KN-17, a truncated cecropin B peptide, demonstrated efficacy against certain bacterial strains associated with peri-implantitis. This study aimed to assess the antibacterial and anti-inflammatory properties and mechanisms of KN-17. The effects of KN-17 on oral pathogenic bacteria were assessed by measuring its minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Moreover, the cytotoxicity and anti-inflammatory effects of KN-17 were evaluated. KN-17 inhibited the growth of Streptococcus gordonii and Fusobacterium nucleatum during in vitro biofilm formation and possessed low toxicity to hBMSCs cells. KN-17 also caused RAW264.7 macrophages to transform from M1 to M2 by downregulating pro-inflammatory and upregulating anti-inflammatory factors. It inhibited the NF-κB signaling pathway by reducing IκBα and P65 protein phosphorylation while promoting IκBα degradation and nuclear P65 translocation. KN-17 might be an efficacious prophylaxis against peri-implant inflammation.

Connective tissue graft versus xenogeneic collagen matrix for soft tissue augmentation at implant sites: a randomized-controlled clinical trial

OBJECTIVES

The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen matrix (XCM) versus subepithelial connective tissue graft (SCTG) to increase soft tissue thickness at implant site.

MATERIALS AND METHODS

The study was a randomized, parallel-group controlled investigation. Thirty patients underwent buccal soft tissue thickness augmentation at the stage of implant placement by two different methods: SCTG (control group) and XCM (test group). Primary outcome was the amount of buccal soft tissue thickness gain, 3 months after the intervention. Secondary outcomes were the operation time, the amount of keratinized mucosa (KM), pain syndrome (PS), and patients' quality of life (QL). Histologic evaluation was also performed.

RESULTS

The amount of soft tissue thickness gain was 1.55±0.11 mm in SCTG group, and 1.18±0.11mm in XCM group. The difference between the SCTG and XCM was -0.366 (-0.66 to -0.07; p=0.016). Operation time with XCM was 8.4 (3.737 to 13.06) min shorter than that with the SCTG (p=0.001). KT, PS, and QL for both groups were not statistically significantly different at any time point (p>0.05). At histological examination, the general picture in both groups was similar. No significant differences between the studied groups in most indices, except for the average and maximum formation thickness, cellularity of the basal, mitotic activity and also maximum length of rete ridges.

CONCLUSION

Within limitations, this study demonstrates that the use of SCTG provides a statistically significant superior soft tissue thickness gain than XCM for soft tissue augmentation procedures around implants.

CLINICAL RELEVANCE

XCM can be used as the method of choice for increasing the thickness of soft tissues.

Minimal invasiveness in soft tissue augmentation at dental implants: A systematic review and meta-analysis of patient-reported outcome measures

The aim of this study was to compare patient-reported outcome measures (PROMs) of soft tissue substitutes versus autogenous grafts for soft tissue augmentation procedures at implant sites. Comprehensive and systematic literature searches were performed until December 2021. A focused question was formulated based on the Population, Intervention, Comparison and Outcome criteria (PICO): In patients with dental implants undergoing soft tissue augmentation (P), do soft tissue substitutes (I) compared to autogenous soft tissue graft (SCTG [subepithelial connective tissue graft]) (C) limit the post-operative morbidity and other patient reported-outcomes measures (O). Randomized controlled clinical trials, prospective-, retrospective- and case-series studies were included. Meta-analyses were performed whenever possible and the results were expressed as weighted mean differences (WMD). A total of 29 clinical studies were included. For mucosal thickness gain, soft tissue substitutes significantly reduced the pain perception compared to SCTG (n = 4; WMD = 14.91 Visual Analog Scale [VAS] units; 95% confidence interval [CI] 6.42-23.40; P < .0006) based on a 0-100 VAS scale. Based on a 0-10 VAS scale, a borderline significance of pain reduction was found when soft tissue substitutes were applied (n = 4; WMD = 1.62 VAS units; 95% CI 0.01-3.23; P = .05). For keratinized tissue gain, soft tissue substitutes significantly reduced the pain perception after keratinized tissue augmentation compared to SCTG based on a 0-100 VAS scale (n = 2; WMD = 21.43 VAS units; 95% CI 12.58-30.28; P < .0001). Based on the 0-10 VAS scale, soft tissue substitutes significantly reduced the pain as compared to SCTG (n = 4; WMD = 1.65 VAS units; 95% CI 0.66-2.64; P = .001). Regarding pain medication, soft tissue substitutes required less painkillers (n = 6; WMD = 1.56 tablets; 95% CI 1.22-1.91; P < .00001) after soft tissue augmentation. The surgery time was significantly reduced when soft tissue substitutes were used (n = 5; WMD = 10.9 minutes; 95% CI 4.60-17.19; P < .00001). There were no significant differences in satisfaction, aesthetics, and quality of life (OHIP-14) between soft tissue substitutes and autogenous grafts following soft tissue augmentation at implants sites. Soft tissue substitutes, compared to autogenous grafts, significantly improve PROMs following soft tissue augmentation at implant sites. Soft tissue substitutes can reduce pain perception, amounts of painkillers and surgery time while achieving similar levels of patient´s satisfaction as autogenous grafts without impairing the clinical outcomes. The current evidence indicates that they constitute a valid and reliable alternative to minimize the invasiveness in soft tissue augmentation procedures at implant sites.

Minimal invasiveness in the reconstructive treatment of peri-implantitis defects

Peri-implantitis is a plaque-associated pathologic condition occurring in tissues around dental implants, clinically characterized by increased peri-implant probing pocket depth and progressive loss of supporting bone. Consequently, to arrest further disease progression and to increase the chance to obtain re-osseointegration, surgical reconstructive procedures have been adopted. In particular, following a paradigm gathered from periodontal therapy, recent protocols have underlined the importance of a minimally invasive approach to optimize the outcomes of therapy while minimizing the risks of postoperative complications. The present review summarizes the level of evidence on the surgical reconstructive protocols focusing on the new approaches aiming to minimize surgical trauma and patients' postoperative discomfort, underlining the pros and cons of each treatment modality.

Morphology of Peri-Implant Tissues around Permanent Prostheses with Various Emergence Angles Following Free Gingival Grafting

PURPOSE

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 free gingiva graft procedure.

MATERIAL AND METHODS

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.

RESULTS

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.

CONCLUSIONS

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. This article is protected by copyright. All rights reserved.

Influence of titanium implant macrodesign on peri-implantitis occurrence: a cross-sectional study

OBJECTIVES

To assess whether implant macrodesign parameters interacting with implant time in function (Tf) could influence the peri-implantitis occurrence.

MATERIALS AND METHODS

One hundred and two patients (55.17 ± 11.2 years old) with diagnosed early/moderate peri-implantitis around endosseous implants with implant-supported prosthetics reconstruction (n = 139) were recruited. Implant macrodesign (implant shape, thread number, implant collar), clinical parameters (peri-implant probing depth (PPD), clinical attachment level (CAL), keratinised tissue width (KTW), plaque index, bleeding on probe), implant placement localisation and region, and Tf were assessed and compared.

RESULTS

Peri-implantitis occurred approximately 6.1 ± 3.38 years after implant loading. There was a significant positive correlation between the implant macrodesign and Tf. Peri-implantitis rates were statistically significantly higher in implants with a cylindric shape and triple-thread in the posterior part of the mandible (p = 0.037 and 0.012, respectively). The thread number and implant shape interacting with Tf showed statistically significant influences on CAL and PPD increase (p < 0.05). Results indicated a statistically positive interaction between Tf and KTW decrease around the implants with microthreaded collar (p < 0.001).

CONCLUSION

Peri-implantitis might be presented as a time-dependent disease. Implant-based factors, such as Tf and implant macrodesign, could influence peri-implantitis occurrence, exacerbate clinical parameters, and promote progressive bone loss.

CLINICAL RELEVANCE

Peri-implantitis can be affected by implant macrodesign and Tf. The implant body shape, thread number, and design of the implant collar may be considered peri-implantitis-related risk indicators that should be taken into account in proper implant planning and therapy.

Prevention and management of peri-implant mucositis and peri-implantitis: a systematic review of outcome measures used in clinical studies in the last 10 years

OBJECTIVES

To evaluate outcome measures, methods of assessment and analysis in clinical studies on the prevention and management of peri-implant mucositis and peri-implantitis.

METHODS

Systematic electronic searches (CENTRAL/MEDLINE/SCOPUS) up to April 2021 were conducted to identify longitudinal clinical studies with ≥10 patients on either the prevention or management of peri-implant diseases. Outcome measures of this analysis were the choice of outcome measures, methods of assessment and analytical methods. Risk of Bias was evaluated according to study design. Data were extracted into evidence tables and outcomes were analyzed in a descriptive manner.

RESULTS

The analysis of the 159 selected studies revealed that probing pocket depth (PPD) and bleeding/suppuration on probing (BOP) were reported in 89% and 87% of all studies, respectively. Additional outcome measures included plaque scores (reported in 64% of studies), radiographic outcomes (49%), soft tissue dimensions (34%) and composite outcomes (26%). Adverse events (8%) and patient-reported outcomes (6%) were only rarely mentioned. A total of 36% of studies clearly defined a primary outcome measure. Data on PPD, radiographic outcomes and soft tissue dimensions were primarily reported as mean values and rarely as frequency distributions. For radiographic outcomes and soft tissue dimensions, it was frequently unclear how clustered data were handled.

CONCLUSIONS

PPD and BOP were routinely reported in studies on prevention and management of peri-implant mucositis and peri-implantitis, while composite outcomes, adverse events and patient-reported outcomes were infrequently described. This article is protected by copyright. All rights reserved.

Management and sequelae of dental implant removal

Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental implants. Often, these cannot be managed predictably to improve the condition or satisfy patients' demands. In such circumstances, implant removal needs to be considered. Currently, minimally invasive methods based on reverse torque engineering are key to preserve peri-implant soft and hard tissues. Implant replacement is now feasible, as evidenced by the high survival rates of implants placed at previously failed sites. Notwithstanding these data, clinicians should still consider carefully the expendability of an implant and whether its replacement will satisfy the prosthetic, biomechanical, and esthetic demands of the patient. In the scenario where future implant placement is desired, protocols undertaken for soft/hard tissue grafting and implant placement should be based upon defect morphology and soft and hard-tissue characteristics. Currently, however, a lack of knowledge of the biological events and dimensional changes that arise following implant removal renders decision-making complex and challenging, and recommendations remain largely based upon empirical speculation. This chapter will review the indications for implant replacement for prosthetic, biomechanical, and esthetic complications, alongside considerations in decision-making, planning, implementation, and outcomes of implant replacement.

Retrospective analysis of keratinized tissue augmentation using a xenogeneic collagen matrix for resolving peri-implant mucositis and peri-implantitis

PURPOSE

The significance of keratinized tissue for peri-implant health has been emphasized. However, there is an absence of clinical evidence for the use of a xenogeneic collagen matrix (XCM) to manage peri-implant mucositis and peri-implantitis. Therefore, the purpose of this study was to investigate outcomes after keratinized tissue augmentation using an XCM for the management of peri-implant diseases.

METHODS

Twelve implants (5 with peri-implant mucositis and 7 with peri-implantitis) in 10 patients were included in this study. Non-surgical treatments were first performed, but inflammation persisted in all implant sites. The implant sites all showed a lack of keratinized mucosa (KM) and vestibular depth (VD). Apically positioned flaps with XCM application were performed. Bone augmentation was simultaneously performed on peri-implantitis sites with an intrabony defect (>3 mm). The following clinical parameters were measured: the probing pocket depth (PPD), modified sulcular bleeding index (mSBI), suppuration (SUP), keratinized mucosal height (KMH), and VD.

RESULTS

There were no adverse healing events during the follow-up visits (18±4.6 months). The final KMHs and VDs were 4.34±0.86 mm and 8.0±4.05 mm, respectively, for the sites with peri-implant mucositis and 3.29±0.86 mm and 6.5±1.91 mm, respectively, for the sites with peri-implantitis. Additionally, the PPD and mSBI significantly decreased, and none of the implants presented with SUP.

CONCLUSIONS

Keratinized tissue augmentation using an XCM for sites with peri-implant mucositis and peri-implantitis was effective for increasing the KMH and VD and decreasing peri-implant inflammation.

Dimensional Changes in Free Epithelialized Gingival/Mucosal Grafts at Tooth and Implant Sites: A Prospective Cohort Study

BACKGROUND

A study was made of the dimensional changes in free epithelialized gingival/mucosal grafts (FEGs) used to augment keratinized tissue (KT) at tooth and implant sites, and of the confounders influencing the dynamic changes over 6 months of follow-up.

MATERIAL AND METHODS

A prospective cohort interventional study was made of implant and tooth sites needing keratinized tissue augmentation by means of an apically positioned flap and FEG. Six intraoperative variables were recorded at baseline (T0). In addition, graft width (GW), graft length (GL) and graft dimension (GD) were assessed at three weeks (T1), three months (T2) and 6 months of follow-up (T3). Univariate and multivariate analyses were performed to explore associations between the demographic and intraoperative variables and the outcomes over the study period.

RESULTS

Based upon an a priori power sample size calculation, a total of 56 consecutive patients were recruited, of which 52 were available for assessment. A total of 73 graft units were included in 122 sites. At T3, the mean change in GD in FEG was 40.21%. In particular, the mean changes in GL and GW were 12.13% and 33.06%, respectively. Statistically significant changes in GD were recorded from T0 to T1 (p<0.0005) and from T1 to T2 (p<0.0005), but not from T2 to T3 (p = 0.13). The change in GD at T3 was 33.26% at tooth and 43.11% at implant site level (p = 0.01). Age and GW assessed at T0 proved to be related to the changes in GD and GW in the univariate and multivariate analyses. The univariate analysis showed the avascular area (AA) to be related to the changes in GD and GW at the implant sites, while graft thickness (GT) was associated to changes in GD and GW at the tooth sites in the univariate and multivariate analyses.

CONCLUSIONS

Free epithelialized grafts are exposed to dimensional changes that result in a reduction of approximately 40% of the original graft dimension - the changes being approximately 10% greater at the implant sites than at the tooth sites (NCT04410614). This article is protected by copyright. All rights reserved.

Effectiveness of dental implantation with the partial split-flap technique on vertical guided bone regeneration: a retrospective study

PURPOSE

This study aimed to evaluate the effectiveness of the partial split-flap technique with a K-incision on vertical guided bone regeneration (vGBR) and to retrospectively analyze the clinical and radiographic outcomes of dental implantation using this approach.

METHODS

In total, 78 patients who received 104 dental implants with vGBR, categorized as (1) pre-GBR and post-implantation and (2) simultaneous GBR and implantation, were enrolled. Data analysis was based on periapical radiographs, clinical photos, and dental records. The 2-sample t-test was used to compare the 2 surgical procedures.

RESULTS

The baseline vertical bone level, augmented bone height (ABH), and treatment duration were significantly higher in the pre-GBR procedure group. The survival rates of the implants were 96.1% and 94.8% in implant- and patient-based analyses, respectively. In Cox regression analysis, high rates of implant failure were found in the presence of ABH of ≥4 mm, smoking, and diabetes.

CONCLUSIONS

Within the limitations of this retrospective study, the partial split-flap technique using a K-incision for vGBR showed stable clinical outcomes and favorable dental implant survival.

A customized subepithelial connective tissue graft for interdental papilla reconstruction and soft tissue augmentation

OBJECTIVE

Due to the minimal blood supply and other reasons, stable reconstruction of interdental papilla is difficult. This article presented three cases, which describe a customized subepithelial connective tissue graft aiming to overcome the clinical challenge, with the combination of tunneling technique.

CLINICAL CONSIDERATIONS

An original customized subepithelial connective tissue graft combined with tunnel technique aimed to reconstruct interdental papilla (IP). The subepithelial connective tissue graft was partially spilt to create a bowtie-like shape, with four lateral wings and a main body. The four wings were tightly wrapped around the adjacent abutments, and the body part was used to reconstruct the IP.

CONCLUSIONS

With the customized subepithelial connective tissue graft, a favorable outcome has been preliminarily confirmed in these cases. Facing patients with a lack of gingival papilla and soft tissue fullness, the customized subepithelial connective tissue graft may be a good choice.

CLINICAL SIGNIFICANCE

This study provides a new method to reconstruct IP. The customized subepithelial connective tissue graft may be a good choice when a lack of gingival papilla and soft tissue fullness occurs, which will be of great benefit to meet the aesthetic needs of patients.

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

BACKGROUND

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.

OBJECTIVES

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.

MATERIAL AND METHODS

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, 3 months). 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).

RESULTS

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 3 months, 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.

CONCLUSIONS

Within the limitations of this investigation, it was observed that the KM width from the baseline to the 3 months 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.