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Tajti P, Solyom E, Váncsa S, Mátrai P, Hegyi P, Varga G, Hermann P, Borbély J, Sculean A, Mikulás K. Less marginal bone loss around bone-level implants restored with long abutments: A systematic review and meta-analysis. Periodontol 2000 2024; 94:627-638. [PMID: 37766634 DOI: 10.1111/prd.12534] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
The aim of this study was to investigate the biological outcomes of bone-level implants restored with long vs. short abutments, with regard to the 'one abutment at one time' protocol. The systematic search was performed in five databases: MEDLINE (PubMed), EMBASE, Web of Science, Scopus, and CENTRAL for randomized controlled trials up to January 14, 2023. Data were collected for marginal bone loss, bleeding on probing, and probing pocket depth by two reviewers. As effect size measure, mean difference (MD), and risk ratio (RR) were used for continuous and categorical outcomes, R-statistics software was used for conducting statistical analyses. For quality and certainty assessment, Risk of Bias Tool 2, ROBINS-I, and GRADE approach were used. The search resulted in 4055 records without any duplicates. After title, abstract, and full-text analysis, eight articles were found eligible for inclusion. Bone-level and platform-switched implants presented less marginal bone loss after 6 months and 1 year as well, when long abutments were used (MD 0.63, 95% CI: [-0.16; 1.42]) and (MD 0.26, 95% CI: [-0.02; 0.53]). However, subgroup analysis revealed no difference in marginal bone loss when applying 'one abutment at one time' protocol (p = 0.973). Bleeding on probing and probing pocket depth presented similarly good results in both groups without almost any differences (RR 0.97, 95% CI: [0.76; 1.23]) and (MD -0.05, 95% CI: [-1.11; 1.01]). Longer abutments on bone-level implants seem to be a favorable choice for decreasing early marginal bone loss, irrespective of connection timing.
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Affiliation(s)
- Péter Tajti
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Eleonora Solyom
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Periodontology, Semmelweis University, Budapest, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Mátrai
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary
| | - Gábor Varga
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Department of Oral Biology, Semmelweis University, Budapest, Hungary
| | - Péter Hermann
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Judit Borbély
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Krisztina Mikulás
- Department of Prosthodontics, Semmelweis University, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
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Toia M, Parpaiola A, Stevanello N, Tattan M, Saleh MHA, Ravidà A. Clinical outcomes of implant- versus abutment-level connection in screw-retained fixed dental prostheses: A 5-year randomized controlled trial. Clin Oral Implants Res 2024; 35:230-241. [PMID: 38012845 DOI: 10.1111/clr.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
AIM The aim of the study was to evaluate the 5 years clinical outcomes associated with implant-level connection (IL) versus abutment-level connection (AL) for implants with an internal conical connection (ICC) supporting a screw-retained fixed partial denture. MATERIALS AND METHODS Fifty patients with 119 implants were randomly allocated to either the AL or IL group. Radiographic (Marginal bone loss) and clinical outcomes (Bleeding on Probing, probing pocket depth, plaque accumulation, incidence of peri-implantitis and peri-implant mucositis as well as prosthetic complications) were collected and compared at 1, 2, 3, and 5 years. A linear mixed model was used to evaluate the differences between groups. RESULTS Five years after treatment, the MBL change was not significantly different between the groups at any point. The MBL was 0.23 ± 0.64 mm (AL) and 0.23 ± 0.29 mm (IL). The bleeding on Probing was 44% (AL) and 45% (IL) (p = .89). The mean probing depth was 2.91 ± 1.01 mm (AL) and 3.51 ± 0.67 mm (IL). This difference between the groups was statistically significant but clinical insignificant. Presence of plaque was slightly higher (p = .06) in the IL group (34.4%) compared with the AL group (26.3%). The overall technical, biological, and prosthetic complication rates were similar between groups. None of the implants developed peri-implantitis during the entire follow-up period. CONCLUSION The results of this clinical trial indicated that all clinical and radiographical parameters were clinically comparable between the study groups.
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Affiliation(s)
- Marco Toia
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Andrea Parpaiola
- Department Clinic-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Andrea Ravidà
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
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Muñoz M, Vilarrasa J, Ruíz-Magaz V, Albertini M, Nart J. Influence of the abutment height on marginal bone level changes around two-piece dental implants: Meta-analysis and trial sequential analysis of randomized clinical trials. Clin Oral Implants Res 2023; 34:81-94. [PMID: 36482067 DOI: 10.1111/clr.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/24/2022] [Accepted: 11/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The focused question was: "In systemically healthy individuals with at least one two-piece dental implant, what is the efficacy of long (≥2 mm; intervention) compared with short (<2 mm; comparison) shoulder height abutments in peri-implant marginal bone level (MBL) changes at <1 year and ≥1 year reported by randomized controlled clinical trials?" MATERIALS AND METHODS An electronic and hand search was conducted to identify RCTs published up to August 2022. The primary outcome variable was changed in MBL from implant surgery to subsequent follow-ups. Mean values and standard deviations for each study were extracted. Weighted mean differences and 95% confidence intervals were calculated. Meta-analysis for MBL changes was performed through a random-effect restricted maximum-likelihood model at early (<1 year) and late (≥1 year) stages of bone remodeling. Publication bias and sensitivity tests were also applied. Subgroup analysis was performed to further explore possible sources of heterogeneity in the estimated treatment effect. Trial sequential analysis was performed to assess the required information and false-positive results. RESULTS Six randomized clinical trials fulfilled the inclusion/exclusion criteria and were included in the qualitative and quantitative analysis with a follow-up range from 6 to 36 months after implant surgery. Meta-analysis revealed that long abutments significantly exhibited 0.27 mm (CI 95% -0.60, 0.06) and 0.33 mm (CI 05% -0.50, -0.16) lower MBL changes compared with short ones at <1 year and ≥1 year, respectively. Subgroup meta-analysis revealed that studies with implants placed in a more subcrestal position significantly exhibited less differences in MBL changes between long and short abutments. No meta-analysis was conducted for peri-implant clinical parameters, and soft-tissue changes provided that reported data were scarce. Trial sequential analysis revealed insufficient information size to provide a definitive answer on the effect of abutment height in MBL. CONCLUSIONS It might be cautiously concluded that two-piece implants with long abutments (≥2 mm) may display a protective role against marginal bone loss when compared with short ones (<2 mm) at <1 year and ≥1 year. A more subcrestal implant position seemed to minimize the effect of the abutment height in terms of MBL.
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Affiliation(s)
- Marta Muñoz
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Javi Vilarrasa
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Vanessa Ruíz-Magaz
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - Matteo Albertini
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
| | - José Nart
- Department of Periodontology, Universitat International de Catalunya, Barcelona, Spain
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Pérez‐Sayans M, Castelo‐Baz P, Penarrocha‐Oltra D, Seijas‐Naya F, Conde‐Amboage M, Somoza‐Martín JM. Impact of abutment geometry on early implant marginal bone loss. A double-blind, randomized, 6-month clinical trial. Clin Oral Implants Res 2022; 33:1038-1048. [PMID: 35869615 PMCID: PMC9796139 DOI: 10.1111/clr.13985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The objective of this study was to analyze the impact of the abutment width on early marginal bone loss (MBL). MATERIAL AND METHODS A balanced, randomized, double-blind clinical trial with two parallel experimental arms was conducted without a control group. The arms were "cylindrical" abutment and "concave" abutment. Eighty hexagonal internal connection implants, each with a diameter of 4 × 10 mm, were placed in healed mature bone. The main variable was the peri-implant tissue stability, which was measured as MBL at 8 weeks and 6 months. RESULTS The final sample consisted of 77 implants that were placed in 25 patients. 38 (49.4%) were placed using the cylindrical abutment, and the other 39 (50.6%) were placed using the concave abutment. The early global MBL of -0.6 ± 0.7 mm in the cylindrical abutment group was significantly higher than it was in the concave abutment group, in which the early global MBL was -0.4 ± 0.6 mm (p = .030). The estimated effect size (ES) was negative for the cylindrical abutment (ES = -1.3730, CI -2.5919 to -0.1327; t-value = -2.4893; p = .0139), therefore implying a loss of mean bone level, and it was positive for the concave abutment (ES = 2.8231; CI: 1.4379 to 4.2083; t-value = 4.0957; p = .0002), therefore implying an increase in the average bone level. CONCLUSIONS The concave abutments presented significantly less early MBL at 6 months post-loading than classical cylindrical abutments did.
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Affiliation(s)
- Mario Pérez‐Sayans
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and DentistryUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (IDIS)Santiago de CompostelaSpain
| | - Pablo Castelo‐Baz
- Department of Restorative Dentistry and Endodontics, Faculty of Medicine and DentistryUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | | | - Flavio Seijas‐Naya
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and DentistryUniversity of Santiago de CompostelaSantiago de CompostelaSpain
| | - Mercedes Conde‐Amboage
- CITMAgaSantiago de CompostelaSpain,Department of Statistics, Mathematical Analysis and Optimization, Models of Optimization, Decision, Statistics and Applications Reseach Group (MODESTYA)Universidade de Santiago de CompostelaSantiago de CompostelaSpain
| | - José M. Somoza‐Martín
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and DentistryUniversity of Santiago de CompostelaSantiago de CompostelaSpain,Health Research Institute of Santiago de Compostela (IDIS)Santiago de CompostelaSpain
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Rodriguez MV, Ravidà A, Saleh MH, Basma HS, Dukka H, Khurshid H, Wang H, Moreno PG. Is the degree of physiological bone remodeling a predictive factor for peri-implantitis? J Periodontol 2022; 93:1273-1282. [PMID: 35536150 PMCID: PMC9796402 DOI: 10.1002/jper.21-0723] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/19/2022] [Accepted: 04/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND The amount of initial physiological bone remodeling (IPBR) after implant placement varies and the ways it may play a role in peri-implantitis development remains unknown. The aim of this retrospective study was to investigate the association between the amount of IPBR during the first year of implant placement and incidence of peri-implantitis as well as the pattern of progressive bone loss. METHODS Clinical and radiographic documentation of implants at the time of implant placement (T0), 1 year ± 6 months after crown placement (T1), and at a ≥2-year follow-up from implant placement (T2) were retrospectively collected. IPBR was defined as the bone loss occurring from implant placement to the end of the bone remodeling (T1). Cases were grouped into those diagnosed with (test) or without peri-implantitis (PIm) (control). Linear regression model under generalized estimation equation approach was estimated to assess correlation between marginal bone loss (MBL) rates in both periods (T1-T0) and (T2-T1). Receiver operating characteristics curve was estimated to explore an optimal cut-off point of T1-T0 MBL to discriminate between PIm and no-PIm implants. RESULTS A total of 45 patients receiving 57 implants without PIm and 40 with PIm were included. There were no associations between PIm and IPBR (p > 0.05), nor between BML of (T2-T1) and (T1-T0). However, arch and total follow-up showed significant influence on the probability of PIm. Splinted implants showed an MBL rate of 0.60-mm/year higher than non-splinted implants (p < 0.001) from T1 to T2. CONCLUSION No statistically significant association was found between IPBR and incidence of peri-implantitis.
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Affiliation(s)
- Maria Vera Rodriguez
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Andrea Ravidà
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Muhammad H.A. Saleh
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA,Department of PeriodonticsUniversity of Louisville School of DentistryLouisvilleKentuckyUSA
| | - Hussein S. Basma
- Department of PeriodontologySchool of DentistryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Himabindu Dukka
- Department of PeriodonticsUniversity of Louisville School of DentistryLouisvilleKentuckyUSA
| | - Hadiya Khurshid
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Hom‐Lay Wang
- Department of Periodontics and Oral MedicineUniversity of Michigan School of DentistryAnn ArborMichiganUSA
| | - Pablo Galindo Moreno
- Oral Surgery and Implant Dentistry DepartmentSchool of DentistryUniversity of GranadaGranadaSpain
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Toia M, Stocchero M, Galli S, Papia E, Wennerberg A, Becktor JP. The use of implant-level connection in screw-retained fixed partial dentures: A 3-year randomised clinical trial. Clin Oral Implants Res 2021; 33:78-93. [PMID: 34617341 DOI: 10.1111/clr.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/18/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This randomised controlled trial compares the 3-year outcomes, that is, marginal bone-level (MBL) changes and clinical parameters, between an abutment-level (AL) and implant-level (IL) connection for implants with an internal conical connection (ICC) supporting a screw-retained fixed partial denture. MATERIAL AND METHODS Fifty patients with 119 implants were randomly allocated to either the AL or IL group. Radiographic and clinical examinations were performed after one, two, and 3 years. A linear mixed model was used to evaluate the differences between groups. RESULTS The MBL change was not significantly different between the groups at any point. The MBL was 0.12 ± 0.31 mm (AL) and 0.23 ± 0.26 mm (IL) after 1 year; 0.15 ± 0.34 mm (AL) and 0.17 ± 0.22 mm (IL) after 2 years; 0.18 ± 0.39 mm (AL) and 0.15 ± 0.21 mm (IL) after 3 years. The bleeding on probing was 43.44 ± 39.24% (AL) and 58.19 ± 41.20% (IL) after 1 year; 35.78 ± 39.22% (AL) and 50.43 ± 41.49% (IL) after 2 years; 51.27 ± 44.63% (AL) and 49.57 ± 37.31% (IL) after 3 years and was significantly different (p = .025) between 1 and 2 years. The probing depth showed a significant difference at each time point while the plaque was not significant between the groups. The overall technical, biological and prosthetic complication rates were 5.04%, 3.36%, and 16.00%, respectively. CONCLUSIONS The MBL change was similar in the groups. The slight differences in the soft tissue complications between the groups are likely not of clinical relevance. An IL connection is considered to be a valid alternative to an AL set-up in ICC implants.
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Affiliation(s)
- Marco Toia
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Michele Stocchero
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Silvia Galli
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Evaggelia Papia
- Department of Material Sciences and Technology, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ann Wennerberg
- Department of Prosthodontics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas P Becktor
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
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