Immediately provisionalized OsseoSpeed™Profile implants inserted into extraction sockets: 3-year results

Rehabilitation Using Implants with Sloped Platform Edge vs. Standard Platform with Guided Bone Regeneration: A Randomized Control Clinical Trial

The purpose of this study was to evaluate the vertical bone loss after using different techniques: sloped implants or standard implants with guided bone regeneration. Patients with tooth gap and horizontal bone deficiency were randomly allocated to the test group (implants with sloped platform-SLP) and control group (standard design implants with guided bone regeneration-GBR). The primary outcome was bone loss (6 months after finishing the prosthetic treatment). Secondary outcomes included the following: patient-reported outcome measures (PROMs), post-operative edema, keratinized mucosa width, and pink aesthetic score (PES). The average bone loss at 6 months was 0.23 ± 0.15 mm and 1.03 ± 0.37 mm in the SLP and GBR groups, respectively. The SLP group was characterized by lower pain intensity the first 7 days (p < 0.001), lower post-operative edema (p < 0.001), lower consumption of NSAIDs on days 1, 3, 5, and 7 (p = 0.002, <0.001, <0.001, and 0.008), and lower total OHIP-14 (p = 0.047) on day 7. The keratinized mucosa width was 3.7 (3.4-4.0) mm and 2 (1.4-2.0) mm in the SLP and GBR groups, respectively. The preservation of the mesial, distal papillae, and the level of soft tissue correspondence were significantly higher in the SLP group (p = 0.003, 0.038, <0.001). In the SLP group, more natural color and better texture of soft tissues were found (p = 0.048, p = 0.041). The use of implants with a sloped platform resulted in superior outcomes compared to the standard-design implants with GBR.

The influence of connective tissue grafting on the reconstruction of a missing facial bone wall using immediate implant placement and simultaneous bone reconstruction: a retrospective long-term cohort study

PURPOSE

This retrospective cohort study evaluates the influence of connective tissue grafts (CTG) on bone regeneration at implant sites with total loss of the buccal bone wall treated with flapless immediate implant placement (IIP) and reconstruction with autogenous bone chips (AB) within a follow-up of up to 13 years.

METHODS

Sixty implants were inserted in 55 patients in sites with total loss of the buccal bone wall between 2008 and 2021. The implants were inserted and the buccal gaps were grafted by AB. A subgroup of 34 sites was grafted additionally with CTG using tunnel technique. Primary outcome was the vertical bone regeneration in height and thickness. Secondary outcome parameters were interproximal marginal bone level, recession, soft tissue esthetics (PES), width of keratinized mucosa (KMW) and probing depths (PPD).

RESULTS

Mean follow-up period was 60.8 months. In 55 sites a complete vertical bone regeneration was documented. The mean buccal bone level increased by 10.6 mm significantly. The thickness of the buccal bone wall ranged between 1.7 and 1.9 mm, and was significantly thicker in sites without CTG. Interproximal marginal bone level was at implant shoulder level. The mean recession improved significantly by 1.2 mm. In sites with CTG, recessions and PES improved significantly more.

CONCLUSIONS

Additional CTG in extraction sites with total buccal bone loss followed by IIP with simultaneous AB grafting led to improved PES and recession, but also to a thinner buccal bone wall compared to sites grafted just with AB.

Effectiveness of immediate implant placement into defective sockets in the esthetic zone: A systematic review and meta-analysis

STATEMENT OF PROBLEM

A defective socket is common after tooth extraction in the esthetic zone, but whether an implant can be immediately placed in a defective socket is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to summarize relevant studies within the last 20 years on implant survival and changes in soft and hard tissues after immediate implant placement in esthetic areas with socket defects.

MATERIAL AND METHODS

A search was conducted for the relevant studies in the PubMed/Medline, the Cochrane Library, Web of Science, and Embase databases from January 2000 to March 2022. The literature review, data retrieval, and judgment whether the included studies had a risk of bias were handled independently by 2 reviewers, and a single-arm meta-analysis was performed using a statistical software program.

RESULTS

A total of 23 studies evaluating the immediate implant placement of 630 implants (9 studies without a flap and 14 studies with a flap) were included. A 98.1% implant survival rate (95% confidence interval (CI): 96.2%, 100.0%) was determined. Marginal bone loss (MBL) at 6, 12, and ≥24 months were 1.03 mm (95%CI: 1.02, 1.03), 0.72 mm (0.72, 0.73), and 1.15 mm (1.14, 1.16). Gingival recession at 12 months was 0.25 mm (95%CI: 0.17, 0.33). The pink esthetic score (PES) were 12.34 (95%CI: 12.16, 12.52) at 12 months and 12.58 (12.39, 12.76) at ≥24 months.

CONCLUSIONS

Current evidence shows that immediate implant placement into defective sockets in esthetic areas is feasible. Immediate implant placement can have a relatively good therapeutic effect in terms of implant survival rate, MBL, gingival recession, and PES.

Impact of immediate interim restoration on peri-implant tissues around immediately placed single dental implants in the esthetic region: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Immediate implant placement with an immediate interim restoration is a well-established protocol. Nevertheless, a consensus regarding the impact of immediate interim restoration on peri-implant tissues around single dental implants is lacking.

PURPOSE

The purpose of this systematic review and meta-analysis was to address the research question: "Does the placement of an immediate interim restoration influence the mid-facial mucosal (MFM) marginal and interdental papilla (IDP) levels around single dental implants placed in the anterior esthetic region by using an immediate implant placement protocol?"

MATERIAL AND METHODS

A comprehensive literature search was made in the Medline/PubMed, Scopus, Cochrane, and Science Direct electronic databases for articles published in English evaluating the impact of immediate interim restoration on peri-implant tissues around single dental implants in the anterior esthetic region. The primary outcomes assessed were changes in the MFM marginal and IDP levels. Additional outcomes were marginal bone (MB) loss, esthetic outcomes involving the pink and white esthetic scores (PES and WES), implant survival rates, and patient reported outcome measures (PROMs). The risk of bias assessment was performed by using the RoB 2 tool for randomized trials and the Newcastle-Ottawa scale for nonrandomized studies. Meta-analysis was performed by using random and fixed effects model (α=.05) in the RevMan software program.

RESULTS

Sixteen studies were included that analyzed 836 single dental implants involving 823 patients. The meta-analysis showed no significant differences in implants with and without interim restoration in terms of MFM marginal level (MD=0.01; 95% CI=-1.23 to 1.25; P=.98), mesial IDP level (MD=0.12; 95% CI=-0.23 to 0.47; P=.50), distal IDP level (MD=0.20; 95% CI=-0.40 to 0.79; P=.52), and MB loss (MD=0.01; 95% CI=-0.42 to 0.43; P=.97). The systematic analysis for survival rates determined no notable difference in implants with or without an interim restoration. However, the esthetic outcomes and PROMs substantially improved with immediate interim restorations. The RoB 2 tool showed a moderate to low risk of bias, and the Newcastle-Ottawa scale indicated high-quality studies.

CONCLUSIONS

After a 12-month follow-up, immediate interim restoration had no significant impact on peri-implant soft (MFM marginal and IDP levels) and hard tissues (MB loss) around immediately placed single dental implants. Nevertheless, additional well-designed and well-implemented clinical trials with long-term follow-up periods are needed to provide more precise evidence-based recommendations.

Marginal bone level change of immediately restored implants with simultaneous guided bone regeneration: A systematic review

AIM

To assess marginal bone level change (MBLc), clinical outcomes for soft tissue, and survival rates for immediately restored implants with simultaneous guided bone regeneration (GBR).

MATERIALS AND METHODS

Electronic and manual searches were conducted in PubMed/MEDLINE, EMBASE, and CENTRAL for studies that investigated immediately restored implants in simultaneously grafted sites with a mean follow-up of over 12 months. MBLc was the primary outcome. Soft tissue clinical parameters and implant survival rate (ISR) were the secondary outcomes.

RESULTS

Twenty-five studies (5 randomized controlled trials, 6 prospective studies, 2 retrospective studies, and 12 case series) were included, from which 692 immediately restored implants were analyzed. For studies that investigated bone grafts in the gap between the implant and the peripheral bone wall, the weighted mean MBLc was -0.73 ± 1.52 mm (range: -1.50 to 0.26 mm) for 475 implants. Pink esthetic score (PES) was improved in eight studies and the weighted cumulative ISR was 98.99% (Median: 100%) in 622 implants. Mean MBLc was -1.19 ± 0.26 mm for 30 implants in studies that reported gap with dehiscence and/or fenestration augmentation. Weighted cumulative ISR was 97.25% in 70 implants. A meta-analysis was not possible due to the lack of studies with an eligible control group. Therefore, the data should be interpreted with caution.

CONCLUSION

Less marginal bone loss and more predictable soft tissue parameters can be achieved for immediately restored implants with simultaneous peri-implant gap filling compared with gap with dehiscence/fenestration grafting. Increased ISR for implants with gap filling was observed. However, more evidence is needed to confirm whether immediate provisional prostheses should be utilized when bone defects are simultaneously augmented around the implants.

Single geometry abutment for narrow and extra-narrow implant systems: Survival and failure modes

The use of identical prosthetic components for all implant diameters could reduce the production costs by companies and the complexity of component selection for the clinician and his team. However, it would imply in reduction of thickness of the cervical walls of tapered internal connection implants, which could compromise the reliability of narrow and extra-narrow implants. Therefore, this study aims to evaluate the probability of survival and failure modes of extra-narrow implant systems with the same internal diameter as standard-diameter implants using the same prosthetic components. It was used eigth different implant system configurations, including narrow (Ø 3.3 mm) (N) extra-narrow (Ø 2.9 mm) (EN) and extra-narrow-scalloped (Ø 2.9 mm) (ENS) implants, both with cementable abutments (Ce) or titanium bases (Tib) and one-piece implants (Ø 2.5 mm and Ø 3.0 mm) (OP) (Medens, Itu, SP, Brazil), comprising the following groups: OP 3.0; OP 2.5; N Ce; N Tib; EN Ce, EN Tib, ENS-Ce and ENS-Tib. The implants were embedded using polymethylmethacrylate acrylic resin in a 15 mm matrix. Standardized maxillary central incisor crowns were virtually designed and milled to fit on the different studied abutments and cemented using a dual self-adhesive resin cement. The specimens were submitted to SSALT (Step Stress Accelerated Life Testing) at 15 Hz in water until failure or suspension of the test, until a maximum load of 500 N. Fractographic analysis of the failed specimens were realized in scanning electron microscopy. All implant systems demonstrated high probability of survival (90-100%) for missions at 50 and 100 N and values of characteristic strength superior to 139 N. Failure modes were restricted to the abutment in all the implant configurations tested. Therefore, the use extra-narrow implants with standardized prosthetic components for different implant diameters is a viable option for the replacement of anterior teeth.

Factors Associated with Esthetic Outcomes of Flapless Immediate Placed and Loaded Implants in the Maxillary Incisor Region—Three-Year Results of a Prospective Case Series

Flapless immediate implant placement and provisionalization (FIIPP) is often associated with an increased risk of buccal soft-tissue recession. This study aims to assess the 3-year esthetic outcome. In 100 consecutive patients, one maxillary incisor, with or without a pre-extraction buccal bone defect (≤5 mm), was replaced by an implant installed in a maximal palatal position (buccal gap ≥2 mm). The created gaps were filled with bovine bone substitute. Patient satisfaction (PS), pink esthetic scores (PES/modPES), and white esthetic score (WES) were calculated at different time points. A multilevel regression analysis (MRA) was performed to analyze which factors may be associated with the esthetics. After three years, PS scored 8.9 ± 0.84 on a scale of 10 (n = 83), and the soft-tissue esthetics were high (PES = 12.2; modPES = 8.5), as was the WES (8.2), showing no decrease from one year. Buccal bone defect size and smoking could not be associated with the soft-tissue outcome; however, implant location, gap size, and emergence profiles could. Performing FIIPP, the final crown (WES) scored highest when it was cemented, the soft tissue (PES/modPES) in central-incisor positions, and all (WES/PES/modPES) with concave emergence profiles.

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

Implants placed in an alveolar ridge with a sloped configuration. A 3-year prospective multicenter study

AIM

The aim of the present study was to evaluate soft and hard tissue alterations around implants with a modified marginal portion placed in a healed, sloped ridge over 3 years of follow-up.

MATERIAL AND METHODS

65 patients with a single recipient implant site in an alveolar ridge with a lingual-buccal sloped configuration were recruited. Implants with a modified geometry in the marginal portion were installed in such a way that the sloped part of the device was located at the buccal and most apical position of the osteotomy preparation. Crowns were placed 21 weeks after implant placement. Radiologic examinations were performed at implant installation and at 1 and 3 years of follow-up. Bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL; from the crown margin) were recorded at the insertion of the prosthesis and after 1 and 3 years.

RESULTS

57 patients with 57 implant-supported restorations attended the 3 years follow-up examination. The radiographic analysis revealed a mean marginal bone loss of 0.57 mm during the 3 years period. While the average bone loss between 1 and 3 years amounted to 0.30 mm, approximately 50% of the implants showed no bone loss during this period. The results from the clinical examinations showed a CAL gain of 0.11 ± 0.85 mm between baseline and 3 years of follow-up. About 65% of the implants showed no loss of attachment between 1 and 3 years. BoP and PPD ≥5 mm were identified at <10% of implants at the 3 years examination.

CONCLUSION

Hard and soft tissues formed around dental implants that were designed to match the morphology of an alveolar ridge with a lingual-buccal sloped configuration remained stable over 3 years.

Clinical Evidence on a Novel Macrohybrid Design Dental Implant with 12° Angled Platform: A Systematic Review

Background: Immediate implant placement with immediate esthetics has become a more common procedure over time, though ensuring good emergence of the axis of the implant has been a challenge. A novel macroimplant design with an angled platform (Co-Axis^®) has been developed to ensure exit of the head of the implant in the correct prosthetic position. A systematic literature review was carried to determine the survival rate and marginal bone loss associated with these implants. Material and Methods: An electronic and manual literature search was made in accordance with the PRISMA statement. The search strategy was limited to human studies, retrospective and prospective clinical trials, cross-sectional studies, and cohort studies reporting outcomes of a novel macrohybrid implant with a 12° angled implant connection. Results: Three articles met the inclusion criteria and were reviewed in the analysis. The estimated success rate was 95.9%. The global marginal bone loss was estimated to be −0.17 ± 0.58 mm in an environment characterized by great heterogeneity (I² = 99%). The estimated mean implant stability was 69.6 ± 0.92 (ISQ). As only two studies provided the required information, it was not possible to determine publication bias. Lastly, mean recession was estimated to be practically zero (0.06 ± 0.23 mm), with great heterogeneity. Conclusions: Within the limitations of this systematic review, it can be affirmed that immediate implant treatment with Co-Axis^® implants shows a survival rate of 95.9% at one year of follow-up, with low marginal bone loss values, near-zero soft tissue recession, and favorable papilla index values. Nevertheless, the great heterogeneity of the data requires the findings to be interpreted with caution.

Immediate implant placement vs. early implant treatment in the esthetic area. A 1-year randomized clinical trial

OBJECTIVES

To assess the impact of implant placement and temporization timing on esthetic outcomes of single maxillary anterior implants with intact bone walls and interproximal bone.

MATERIALS AND METHODS

Test group patients received an immediate implant with immediate provisional restoration and socket preservation, while patients in the control group received an early implant placement with guided bone regeneration and delayed loading. Patients were followed for 1 year after final prosthetic and pink esthetic score (PES), mid-buccal mucosal level (MBML), crestal bone changes (CBC), and peri-implant soft tissue parameters, and patient chair time was recorded.

RESULTS

Fifty patients received the intended treatment (25 test and 25 control). No implants failed. PES after 1 year was 12.8 ± 1.19 for the test group and 12.5 ± 1.36 for the control group (p = .362). MBML difference between baseline (after final crown delivery) and the 1-year follow-up was gain of 0.2 ± 1.02 mm for the test group (p = .047) and no change in the control group. CBC after 1 year were 0.1 mm ± 0.21 mm (mesial) and 0.2 mm ± 0.22 mm (distal) for the test group and 0.2 mm ± 0.25 mm (mesial) and 0.3 mm ± 0.19 mm (distal) for the control group, p = .540 (mesial) and p = .462 (distal). Test group required half the chair time (127 ± 13 min) when compared to the control group (259 ± 15 min, p < .001).

CONCLUSIONS

Within the limits of this trial, both treatment protocols resulted in excellent esthetic outcomes with PES >12 after 1-year follow-up.

Long-term outcomes of maxillary single-tooth implants in relation to timing protocols of implant placement and loading: Systematic review and meta-analysis

OBJECTIVES

The aim of the present systematic literature review was to determine whether long-term treatment results with single-tooth implants may differ depending on the timing of implant placement in relation to tooth extraction (immediate IP/early EP/delayed DP) and the timing of prosthetic loading (immediate IL/early EL/delayed DL).

MATERIAL AND METHODS

Electronic and manual searches were performed to identify studies reporting on long-term results (survival rate and/or marginal bone resorption after ≥3 years) of maxillary single-tooth implants in the aesthetic zone using defined placement and loading protocols. Comparative trials were subjected to meta-analyses whilst data from single-arm studies were pooled to evaluate differences between timing protocols.

RESULTS

A total of 7 controlled trials were considered for meta-analyses: immediate loading was compared to delayed loading in 3 studies on immediate placement (IPIL vs. IPDL, p = .306) and in 2 studies on delayed placement (DPIL vs. DPDL, p = 1.000) whilst 2 studies compared early versus delayed placement with delayed loading (EPDL vs. DPDL, p = .600), however, without significant differences. Pooled data analysis of 29 studies (965 implants) did not show differences between timing of placement or loading as well as marginal bone remodelling. No impact of the one abutment - one time concept, flap design and simultaneous bone or soft tissue augmentation could be established.

CONCLUSIONS

Insufficient data are available for meta-analytic comparison of all combinations of implant placement and loading protocols.

Ten Year Clinical and Aesthetic Outcomes of an Immediately Placed and Restored Implant in the Anterior Maxilla: A Case Report

The nature of immediate implant placement followed by an immediate restoration protocol makes it particularly suited to the anterior maxilla. In addition to saving treatment time and avoiding additional surgical procedures, this protocol has been reported to improve aesthetic outcomes by supporting the peri-implant tissues during the implant healing phase through the use of a provisional restoration. This case report documents the use of this protocol in a patient with a failing maxillary anterior tooth and reports on the soft and hard tissue changes over an observation period of 10 years. An implant was immediately placed after removal of a failing maxillary central incisor followed by the provision of a screw retained provisional crown on the same day. A definitive restoration was placed after a 3-month healing period. Not only did this protocol manage to maintain peri-implant bone levels over the 10-year follow-up period, excellent aesthetic outcomes and very limited soft tissue recession were observed with the use of this technique.

Immediate implant placement with or without connective tissue graft: A systematic review and meta-analysis

OBJECTIVES

To assess the effect of connective tissue graft (CTG) in terms of vertical mid-facial soft tissue change when applied at the buccal aspect following single immediate implant placement (IIP).

MATERIALS AND METHODS

Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, EMBASE and Cochrane databases as well as a manual search to identify eligible clinical studies up to January 2020. Randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) comparing IIP with CTG and without CTG over a mean follow-up of at least 12 months were included for a qualitative analysis. Meta-analyses were performed on data provided by RCTs.

RESULTS

Out of 1814 records, 5 RCTs and 3 NRSs reported on 409 (IIP + CTG: 246, IIP: 163) immediately installed implants with a mean follow-up ranging from 12 to 108 months. Only 1 RCT showed low risk of bias. Meta-analysis revealed a significant difference in terms of vertical mid-facial soft tissue change between IIP + CTG and IIP pointing to 0.41 mm (95% CI [0.21; 0.61], p < .001) in favour of soft tissue grafting. This outcome was clinically relevant since the risk for ≥1 mm asymmetry in mid-facial vertical soft tissue level was 12 times (RR 12.10, 95% CI [2.57; 56.91], p = .002) lower following IIP + CTG. Soft tissue grafting also resulted in a trend towards less bleeding on probing (MD 17%, 95% CI [-35%; 1%], p = .06). Meta-analyses did not reveal significant differences in terms of pink aesthetic score, marginal bone level change and probing depth. Results were inconclusive for horizontal mid-facial soft tissue change and papilla height change. Based on GRADE guidelines, a moderate recommendation for the use of a CTG following IIP can be made.

CONCLUSION

CTG contributes to mid-facial soft tissue stability following IIP. Therefore, CTG should be considered when elevated risk for mid-facial recession is expected in the aesthetic zone (thin gingival biotype, <0.5 mm buccal bone thickness).

Comparison of regular- and slope-configured dental implants placed in the edentulous ridge with height discrepancy: A pilot randomized controlled trial

BACKGROUND/PURPOSE

Edentulous ridges with height discrepancies (RHDs) could jeopardize the outcome of implant placement. This study aimed at evaluating the outcomes of placing regular- and slope-configured implants in RHDs.

METHODS

Patients with >1 mm RHDs requesting implant rehabilitation were recruited and randomly assigned to regular- (control) or slope-configured (test) implant treatment using a submerged installation protocol. Thread exposure (TE) and implant stability quotient (ISQ) were evaluated during implant installation (S1) and uncovered surgery (S2), and marginal bone level (MBL) was evaluated after implant installation (T1) and uncovery (T3), and one year after implant placement (T4). Periodontal status and gingival crevicular fluid (GCF) biomarkers of adjacent teeth were evaluated before implant installation (T0), before uncovery (T2), and at T4. Peri-implant clinical status and peri-implant crevicular fluid (PICF) biomarkers of examined implants were evaluated at T4.

RESULTS

Nineteen patients with 17 control and 13 test implants were included. All of the implants survived with acceptable peri-implant health, and PICF biomarkers were at equivalent levels as GCF biomarkers of the adjacent teeth at T4. Compared with the control group, the test group showed reduced TE and equivalent ISQ at S1 and S2, and the loss of MBL was reduced at T4. Regarding the adjacent teeth, all periodontal parameters and GCF biomarkers were slightly decreased from T0 to T2, and the reductions in probing pocket depth and clinical attachment level were slightly greater at T4.

CONCLUSION

Slope-configured implants maintained the implant-supporting structures and minimally altered periodontal status of the adjacent teeth in RHDs.

Immediate and flapless implant insertion and provisionalization using autogenous bone grafts in the esthetic zone: 5-year results

OBJECTIVES

As the 2-year results for immediately inserted and provisionalized implants have been reported, it remained an open issue, whether the initially high success rates and the esthetic outcome remain stable for longer observation periods. Therefore, this prospective study examines the 5-year hard and soft tissue changes at implants placed in the anterior maxilla.

MATERIAL AND METHODS

Meanwhile, 37 microthreaded implants were placed in 21 patients into extraction sockets with and without facial bone deficiencies by a flapless approach. Facial gaps and bony defects were grafted with autogenous bone chips. The implants were immediately provisionalized. The primary outcome parameters were the interproximal marginal bone level and the thickness of the facial bony wall. Implant success and Pink Esthetic Score (PES) were considered as secondary outcome parameters.

RESULTS

Two patients with four implants withdrew from the study (dropouts), and the remaining 33 implants were still in function at a follow-up period of 68 months. Marginal bone height averaged 0.04 mm coronal to the implant shoulder. The thickness of the facial bony lamellae increased significantly between pre-op examination and 1-year follow-up (p = .002) and thereafter remained stable. Within 5 years of follow-up, 24 of 33 implants were clinically stable, free of signs and symptoms, and showed bone loss less than 1 mm. The mean PES ratings improved slightly from 10.7 pre-operatively to 11.7 at the last follow-up (p = .02).

CONCLUSIONS

Interproximal marginal bone levels, survival rates, and esthetic results remain stable at the 5-year follow-up in implants used in an immediate insertion, reconstruction, and provisionalization concept. Facial marginal bone levels decreased slightly; however, this reduction did not affect the PES so far.

Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla

BACKGROUND

Resorption of hard and soft tissues following immediate implant insertion is frequently reported. Data regarding the influencing factors on facial tissue thickness are rare.

PURPOSE

This retrospective study investigated the impact of connective tissue grafting, the orofacial angulation and position of immediately inserted and provisionalized implants on the facial hard and soft tissue thickness in the anterior maxilla within a 1- to 5-year follow-up.

MATERIAL AND METHODS

Implants with the prerequisite of having preoperative and postoperative cone beam computed tomography (CBCT) and a follow-up of 1 to 5 years were included. Facial bone deficiencies were grafted flaplessly with autogenous bone in all sites. In a subgroup of implants additional connective tissue grafting was performed, whereas the remaining implants were not grafted with soft tissue. The orofacial tooth and implant angulation, the change of horizontal position and the facial bone thickness were measured by CBCT, the facial mucosa thickness by an ultrasonic device.

RESULTS

In total, 76 implants were placed in 55 patients. Sixty-nine sites showed a facial bone defect. Thirty-eight received a connective tissue graft additionally. All implants were still in function after a mean follow-up of 36 months. The mean thickness of the facial mucosa was 1.72 mm at 1 mm, 1.63 mm at 4 mm, 1.52 mm at 6 mm, and 1.66 mm at 9 mm apically to mucosal margin. The bone thickness was 0.02, 0.25, and 0.36 mm initially and 1.32, 1.26, and 1.11 mm finally at 1, 3, and 6 mm apically to implant shoulder level. Mixed model analysis revealed an impact of the preoperative bone status on the facial bone increase. The facial soft tissue thickness was significantly influenced by the gingival biotype.

CONCLUSIONS

The results indicate that an initial severe hard tissue defect allows for significant bone regeneration. The facial soft tissue thickness is primarily influenced by the gingival biotype.

Survival and Success Rates of Different Shoulder Designs: A Systematic Review of the Literature

Objectives

To identify whether there is a relationship between different implant shoulder positions/orientations/designs and prosthetic and/or implant failures, biological or mechanical complications, radiographic marginal bone loss (MBL), peri-implant buccal recession (RC), aesthetic scores (Papilla Index, PES, and WES), and patient satisfaction after a minimum of 1 year function in the aesthetic zone, compared to the two-piece, conventional implant neck architecture.

Materials and Methods

The systematic review was written according to the PRISMA guidelines. The search strategy encompassed the English literature from 1967 to September 2016 and was performed online (in the PubMed database of the U.S. National Library of Medicine, Embase, and the Cochrane Library) to identify relevant studies that met the inclusion criteria. The assessment of quality and risk of bias of the selected manuscripts was performed according to the guidelines provided by CONSORT and STROBE statements.

Results

A total of 16 articles (7 randomized controlled trials, 4 observational comparative studies, and 5 systematic reviews) were selected to fulfill the inclusion criteria. A trend of higher implant failure and prosthetic complications were experienced in the one-piece group compared to the two-piece group, although no statistically significant differences were found. Higher marginal bone loss was found in the test group (one-piece, scalloped implants) compared to the control group (two-piece, flat implants). No comparative studies reporting data on sloped implants were found that fulfilled the inclusion and exclusion criteria of this systematic review. No differences were experienced between groups regarding aesthetic outcomes and patient satisfaction.

Conclusions

There was sufficient evidence that different implant shoulder positions/orientations/designs (scalloped, sloped, and one piece) offer no benefit when compared to two-piece, conventional flat implants. Current evidence is limited due to the quality of available studies.

Evaluation of the influence of implant placement timing on the esthetic outcomes of single tooth implant treatment in the anterior maxilla: A retrospective study

OBJECTIVES

The purpose of this retrospective study was to investigate the influence of implant placement timing on the esthetic outcomes for single implants in the anterior maxilla.

MATERIALS AND METHODS

One hundred and ten patients (48 males; 62 females) who received a single-tooth implant after extraction either immediately (Type 1); after 4-8 weeks (Type 2); after 8-16 weeks (Type 3); or more than 16 weeks (Type 4) were evaluated in terms of esthetic outcomes after a mean post-placement interval of 26.3 months (range 12-116). Esthetic outcomes were measured using the Pink and White Esthetic Score (PES; WES). Stepwise regression analysis was performed to analyze the effect of timing of placement, as well as patient demographics and other clinical parameters on the esthetic outcomes.

RESULTS

No statistically significantly differences in PES were found between the various treatment modalities with Type 1 implants (n = 33) scoring 10.58 ± 1.65 (median: 11), followed by 10.36 ± 2.09 (median: 10.5), 9.68 ± 2.43 (median: 10), and 9.63 ± 2.21 (median: 10) for Type 2 (n = 14), Type 3 (n = 19), and Type 4 (n = 44), respectively. For immediate implants, a trend towards better esthetic outcomes was observed when implant placement was done flaplessly in cases with intact buccal bone (Type 1A, median PES 11) as compared to cases with partial/complete missing buccal plates where a flap was raised (Type 1B, median PES 10). Overall, the only parameter that influenced esthetic outcomes (as measured by PES) was gender, with females having significantly superior results. The median WES was 8 and 96% of the crowns were deemed esthetically acceptable, with crowns placed by specialist prosthodontists yielding higher scores than those placed by general practitioners.

CONCLUSIONS

Single tooth implants in the anterior maxilla showed satisfactory outcomes when measured with objective esthetic criteria. Timing of implant placement did not significantly influence the esthetic outcomes, although a trend towards better outcomes was seen with immediate implant placement as observed by higher median PES values.

CLINICAL SIGNIFICANCE

Single tooth implant placement in the anterior maxilla is a predictable treatment modality for achieving acceptable esthetic outcomes regardless of the timing of placement.

An open prospective single cohort multicenter study evaluating the novel, tapered, conical connection implants supporting single crowns in the anterior and premolar maxilla: interim 1-year results

OBJECTIVES

The aim of this multicenter prospective clinical study was to evaluate anodized tapered implants with a conical connection and integrated platform shifting placed in the anterior and premolar maxilla.

MATERIALS AND METHODS

The study enrolled patients requiring single-tooth restorations in healed sites of maxillary anterior and premolar teeth. All implants were immediately temporized. Clinical and radiographic evaluations were conducted at implant insertion, 6 months, and 1 year. Outcome measures included bone remodeling, cumulative survival rate (CSR), success rate, soft-tissue health and esthetics, and patient satisfaction. Bone remodeling and pink esthetic score were analyzed using Wilcoxon signed-rank tests. CSR was calculated using life table analysis. Other soft-tissue outcomes were analyzed using sign tests.

RESULTS

Out of 97 enrolled patients (102 implants), 87 patients (91 implants) completed the 1-year visit. Marginal bone remodeling was -0.85 ± 1.36 mm. After the expected initial bone loss, a mean bone gain of 0.11 ± 1.05 mm was observed between 6 months and 1 year. The CSR was 99.0%, and the cumulative success rate was 97.0%. Partial or full papilla was observed at 30.8% of sites at baseline, 87.2% at 6 months, and 90.5% at 1 year. Soft-tissue response, esthetics, and patient satisfaction all improved during the study period.

CONCLUSIONS

Bone gain was observed following the expected initial bone loss, and soft-tissue outcomes improved suggesting favorable tissue response using anodized tapered conical connection implants.

CLINICAL RELEVANCE

Rapid stabilization of bone remodeling and robust papilla regeneration indicate favorable tissue healing promoted by the conical connection, platform-shift design.

TRIAL REGISTRATION

clinicaltrials.gov NCT02175550.

Minimizing the discrepancy between implant platform and alveolar bone for tilted implants with a sloped implant platform: A clinical report

In a patient with edentulism, distally tilted implants with a novel sloped implant platform were used to minimize the discrepancy between the implant platform and alveolar bone crest and to restore complete-arch monolithic zirconia implant-supported fixed prostheses.

Graduate Periodontics Programs' Integration of Implant Provisionalization in Core Curricula: Implementation of CODA Standard 4-10.2.d

The aim of this descriptive study was to provide an overview of the status of implementation of Commission on Dental Accreditation (CODA) Standard 4-10.2.d (Provisionalization of Dental Implants) by U.S. graduate periodontics programs since its introduction in 2013. Surveys were sent in May 2015 to 56 accredited postdoctoral periodontics program directors to ascertain program director characteristics; status of planning, implementation, and curriculum resulting from adoption of Standard 4-10.2.d; preferred clinical protocols for implant provisionalization; interdisciplinary educational collaborators; and competency assessment mechanisms. The survey response rate was 52% (N=29); the majority were male, aged 55 or older, and had held their position for less than ten years. Among the responding programs, 93% had formal educational curricula established in implant provisionalization. Graduate periodontics (96%) and prosthodontics (63%) faculty members were predominantly involved with curriculum planning. Of these programs, 96% used immediate implant provisionalization, with direct (chairside) provisionalization protocols (86%) being preferred over indirect protocols (14%) and polyethylethylketone provisional abutments (75%) being preferred to titanium (25%) provisional abutments. Straight and concave transmucosal emergence profile designs (46% each) were preferred in teaching, with only 8% of programs favoring convex transmucosal profiles. A majority of responding programs (67%) lacked protocols for communicating to the restorative referral a mechanism to duplicate the mature peri-implant mucosal architecture. Regional location did not play a significant role in any educational component related to implant provisionalization for these graduate periodontal programs. Overall, this study found that a clear majority of graduate periodontics programs had established formal curricula related to implant provisionalization, with substantial clinical and philosophical consensus within the specialty.

Immediate implant placement and restoration in the anterior maxilla: Tissue dimensional changes after 2-5 year follow up

BACKGROUND

Immediate implant placement followed by an immediate restoration has proven to be a viable technique in the anterior maxillary region.

PURPOSE

This prospective study evaluated the mid-long term (2-5 years) tissue changes around immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous hard tissue augmentation.

MATERIALS AND METHODS

Thirty AstraTech implants were immediately placed in 30 patients, followed by the delivery of an immediate provisional restoration on the same day. All participating 30 patients underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth, immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft, followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic Score (PES).

RESULTS

All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15 months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae, respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES 10.27) (P = .001).

CONCLUSIONS

In addition to a favorable implant success rate and peri-implant bony response, the soft tissue levels and overall aesthetics around single immediately placed and restored implants can also be maintained in the mid-long term.