RCT comparing implants with turned and anodically oxidized surfaces: A pilot study, a 3-year follow-up

Influence of rough micro-threaded and laser micro-textured implant-neck on peri-implant tissues: A systematic review

Background and objective

This systematic review aimed to explore clinical outcomes of marginal or crestal bone level (MBL) and soft tissue status around implants, following the placement of rough micro-threaded/laser-microtextured surface (LMS) implants. These outcomes are compared with those following the placement of smooth machined-neck implants.

Materials and methods

Using EBSCO Information Services, we conducted a web-based search of databases such as the PubMed, Scopus, and EMBASE, for relevant English-language scientific papers published between January 2013 and August 2022. Prospective or retrospective controlled cohort studies and randomized controlled trials (RCTs) investigating the role of rough micro-threaded/LMS implant necks on MBL, sulcular probing depth (PD), and/or clinical attachment loss, were included in this review.

Results

From a comprehensive literature search of 247 articles, 6 RCTs, 5 prospective studies, and 4 retrospective studies (n = 15) fulfilled the eligibility criteria. MBL with rough micro-threaded implant necks ranged from 0.12 ± 0.17 mm to 3.25 ± 0.4 mm after loading. The smooth machined-neck implants without a micro-threaded neck had a loading MBL of 0.38 ± 0.51 mm to 3.75 ± 0.4 mm. Micro-threaded implant necks showed much lower MBL than machined-neck implants. LMS implant necks had a lower peri-implant PD than machined-neck implants after 3 years of early loading (2.3 ± 0.7 mm vs. 3.8 ± 0.8 mm). The experimental and control groups showed similar gingival recessions (1.08 ± 0.4 mm vs. 2.46 ± 0.3 mm). Meta-analysis was not feasible owing to heterogeneity of the studies.

Conclusion

Under functional loading, a roughened micro-threaded design for the implant neck could significantly lower MBL. Furthermore, PD and MBL were much lower around LMS neck implants than those around machined-neck or micro-threaded implants.

Surface Modifications of Commercial Dental Implant Systems: An Overview

The aim of this review was to perform a comprehensive overview of evidence pertaining to the influence of various surface modifications on the surface roughness, bone implant contact, and the success and complication rates of the implants. Modified sandblasted, large-grit, acid-etched (SLA) implants (SLActive implants) have a higher implant stability quotient compared with conventional SLA implants. Also, when compared between the implant surfaces from various manufacturers, Biomet 3i Nanotite implants were shown to have a relatively higher implant stability quotient compared to Straumann implants as well as the Biomet Osseotite implants. Only one study reports the insertion torque values as obtained by the various implant surfaces, with the findings being statistically similar for all the types, and a higher mean value for Biomet 3i Nanotite implants. Among SLA and SLActive surfaces, the latter was found to have a lower marginal bone loss, and among Astratech implants, the marginal bone loss levels were similar for Osseospeed and Tioblast surfaces. When Osseospeed, TiUnite and SLActive surfaces were compared, Osseospeed was found to have the minimum bone loss while TiUnite was found to have the highest. The bone implant contact percentages are similar and satisfactory for most of the implant surface modifications that are available currently. Upon assessing the recent literature on the survival rates for implants with various surface modifications, it was found that among Nobel Biocare implants, the survival rate was higher for TiUnite implants, compared with the turned surfaces. Surprisingly, among the Straumann implant surfaces, the survival rates were found to be higher for the SLA implants when compared to the modified SLA implants. Only one of the included studies evaluated the survival rate for Astratech implant surfaces and found a 100% survival rate for both the Osseospeed and Tioblast surface implants. Therefore, major advancements have been made in developing novel surfaces of dental implants. The numerous innovations set the stage for rehabilitating patients with high success and predictable survival rates even in challenging conditions.

Fitting pieces into the puzzle: The impact of titanium-based dental implant surface modifications on bacterial accumulation and polymicrobial infections

Polymicrobial infection is the main cause of dental implant failure. Although numerous studies have reported the ability of titanium (Ti) surface modifications to inhibit microbial adhesion and biofilm accumulation, the majority of solutions for the utilization of Ti antibacterial surfaces have been testedin in vitro and animal models, with only a few developed surfaces progressing into clinical research. Motivated by this huge gap, we critically reviewed the scientific literature on the existing antibacterial Ti surfaces to help understand these surfaces' impact on the "puzzle" of undesirable dental implant-related infections. This manuscript comprises three main sections: (i) a narrative review on topics related to oral biofilm formation, bacterial-implant surface interactions, and on how implant-surface modifications can influence microbial accumulation; (ii) a critical evidence-based review to summarize pre-clinical and clinical studies in an attempt to "fit pieces into the puzzle" to unveil the best way to reduce microbial loads and control polymicrobial infection around dental implants showed by the current in vivo evidence; and (iii) discussion and recommendations for future research testing emerging antibacterial implant surfaces, connecting basic science and the requirements for future clinical translation. The findings of the present review suggest no consensus regarding the best available Ti surface to reduce bacterial colonization on dental implants. Smart release or on-demand activation surface coatings are a "new piece of the puzzle", which may be the most effective alternative for reducing microbial colonization on Ti surfaces, and future studies should focus on these technologies.

Miniplates coated by plasma electrolytic oxidation improve bone healing of simulated femoral fractures on low bone mineral density rats

The treatment of polytrauma patients represents a great challenge in the maxillofacial and orthopedic surgery fields. Therefore, this study tested the hypothesis that the use of a bioactive coating (by plasma electrolytic oxidation, PEO) on titanium microplates could improve the fracture healing of low bone mineral density (BMD) rats. Thirty female rats underwent bilateral ovariectomy surgery (OVX), and 35 rats underwent fake surgery (SHAM). Three months later, animals were subjected to femoral fracture simulation and were fixed with either non-coated (CONV) or coated (PEO) titanium miniplates. Eight weeks postoperatively, microplate/bone complexes were analyzed through computed microtomography, histometric, confocal microscopy, molecular, and biomechanical analysis. Bioactive elements (Ca and P) were incorporated on the PEO microplate and the surface was modified in a volcano-like structure. In the microCT analysis the OVX/PEO group had greater values for Tb.Th (bone trabecular thickness), Tb.Sp (separation of bone trabeculae) and Tb.N (number of trabeculae) parameters compared to the OVX/CONV group. According to histometric analysis, the OVX/PEO group showed significantly higher new bone formation than the OVX/CONV group (P < 0.05). For the fluorochrome area, the OVX groups (PEO and CONV) showed greater values for calcein precipitation (old bone) than alizarin red (new bone). Molecular results showed greater values for proteins related to the final phase of bone formation (P < 0.05) in the OVX/PEO group. The OVX/PEO group showed higher bone/miniplate system resilience compared to the others (P < 0.05). It was concluded that PEO coating optimizes bone healing on simulated femoral fractures in low bone mineral density rats. This sheds new light in the treatment of osteoporotic patients with bone fractures.

WITHDRAWN: Interventions for replacing missing teeth: different types of dental implants

BACKGROUND

Dental implants are available in different materials, shapes and with different surface characteristics. In particular, numerous implant designs and surface modifications have been developed for improving clinical outcome. This is an update of a Cochrane review first published in 2002, and previously updated in 2003, 2005 and 2007.

OBJECTIVES

Primary: to compare the clinical effects of different root-formed osseointegrated dental implant types for replacing missing teeth for the following specific comparisons: implants with different surface preparations, but having similar shape and material; implants with different shapes, but having similar surface preparation and material; implants made of different materials, but having similar surface preparation and shape; different implant types differing in surface preparation, shape, material or a combination of these.Secondary: to compare turned and roughened dental implants for occurrence of early implant failure (before prosthetic loading) and occurrence of peri-implantitis.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 17 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 12), MEDLINE via OVID (1946 to 17 January 2014) and EMBASE via OVID (1980 to 17 January 2014). We placed no restrictions on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included any randomised controlled trial (RCT) comparing osseointegrated dental implants of different materials, shapes and surface properties having a follow-up in function of at least one year. Outcome measures were success of the implants, radiographic peri-implant marginal bone levels changes and incidence of peri-implantitis.

DATA COLLECTION AND ANALYSIS

At least two review authors independently conducted screening, risk of bias assessment and data extraction of eligible trials in duplicate. We expressed results using fixed-effect models (if up to three studies were present in a meta-analysis) or random-effects models (when there were more than three studies) using mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We reported the following endpoints: one, three, five and 10 years after functional loading.

MAIN RESULTS

We identified 81 different RCTs. We included 27 of these RCTs, reporting results from 1512 participants and 3230 implants in the review. We compared 38 different implant types with a follow-up ranging from one to 10 years. All implants were made of commercially pure titanium or its alloys, and had different shapes and surface preparations. We judged two trials to be at low risk of bias, 10 to be at unclear risk of bias and 15 to be at high risk of bias. On a 'per participant' rather than 'per implant' basis, we found no significant differences between various implant types for implant failures. The only observed statistically significant difference for the primary objective regarded more peri-implant bone loss at Nobel Speedy Groovy implants when compared with NobelActive implants (MD -0.59 mm; 95% CI -0.74 to -0.44, different implant shapes). The only observed statistically significant difference for the secondary objective was that implants with turned (smoother) surfaces had a 20% reduction in risk to be affected by peri-implantitis than implants with rough surfaces three years after loading (RR 0.80; 95% CI 0.67 to 0.96). There was a tendency for implants with turned surfaces to fail early more often than implants with roughened surfaces.

AUTHORS' CONCLUSIONS

Based on the results of the included RCTs, we found no evidence showing that any particular type of dental implant had superior long-term success. There was limited evidence showing that implants with relatively smooth (turned) surfaces were less prone to lose bone due to chronic infection (peri-implantitis) than implants with much rougher surfaces (titanium-plasma-sprayed). These findings were based on several RCTs, often at high risk of bias, with few participants and relatively short follow-up periods.

Prevalence of Peri-Implantitis in Implants with Turned and Rough Surfaces: a Systematic Review

Objectives

Moderately-rough implant surface may improve implant therapy in terms of bone integration, but the increased surface roughness might affect the initiation and development of peri-implantitis. The aim of the present review was to compare the prevalence of peri-implantitis in implants with rough and turned (machined) implant surfaces.

Material and Methods

An electronic literature search was conducted of the MEDLINE and EMBASE databases for articles published between 1 January 1990 and 1 March 2018. Clinical human studies in the English language that had reported on prevalence of peri-implantitis in tuned and rough surface implants were searched. The initial search resulted in 690 articles.

Results

Eight articles with 2992 implants were included in the systematic review. The incidence of peri-implantitis for two implant surfaces varied between studies. A meta-analysis was not feasible due to the heterogeneity among studies. Implant with rough surfaces were more favourable for plaque accumulation during short-term follow-up. On a long-term, turned implants surfaces were associated with more plaque and higher peri-implant bone loss. Peri-implant clinical parameters and survival rate for two implant surfaces was similar.

Conclusions

Within the limitations of the present study, rough implant surface does not seem to increase the incidence of peri-implantitis in comparison to turned implants surface.

Effect of dental implant surface roughness in patients with a history of periodontal disease: a systematic review and meta-analysis

BACKGROUND

To review the literature on the effect of dental implant surface roughness in patients with a history of periodontal disease. The present review addresses the following focus question: Is there a difference for implant survival, mean marginal bone loss, and the incidence of bleeding on probing in periodontally compromised patients receiving a machined dental implant or rough surface dental implant?

METHODS

Electronic and manual literature searches were conducted on PubMed/MEDLINE and the Cochrane Library on studies published until May 2018 to collect information about the effect of machined, moderately rough, and rough dental implant surfaces in patients with a history of periodontal disease. The outcome variables implant survival, mean marginal bone level, and the incidence of peri-implantitis and bleeding on probing were evaluated. Meta-analysis was performed to obtain an accurate estimation of the overall, cumulative results.

RESULTS

Out of 2411 articles, six studies were included in this systematic review. The meta-analysis of the implant survival and implant mean marginal bone loss revealed a risk ratio of 2.92 (CI 95% 0.45, 18.86) for implant failure and a total mean difference of - 0.09 (CI 95% - 0.31, 0.14) for implant mean marginal bone loss measured in a total group of 215 implants, both not statistically significant.

CONCLUSIONS

Due to lack of long-term data (> 5 years), the heterogeneity and variability in study designs and lack of reporting on confounding factors, definitive conclusions on differences in implant survival, and mean marginal bone loss between machined and moderate rough implants in periodontally compromised patients cannot be drawn. Future well-designed long-term randomized controlled trials are necessary to reveal that machined surfaces are superior to moderately rough and rough surfaces in patients with a history of periodontal disease.

Hydroxyapatite Nanorod-Modified Sand Blasted Titanium Disk for Endosseous Dental Implant Applications

BACKGROUND

Sand blasted titanium (Ti) is commonly used in designing endosseous dental implants due to its biocompatibility and ability to form bonds with bone tissues. However, titanium implants do not induce strong interactions with teeth bones. To increase strong interactions between Ti disk implants and teeth bones, the l-glutamic acid grafted hydroxyapatite nanorods (nHA) were immobilized on albumin modified Ti disk implants (Ti-Alb).

METHODS

For modification of Ti disk implants by nHA, the l-glutamic acid grafted nHA was synthesized and then immobilized on albumin modified Ti disk implants. Fourier transformed infrared spectroscopy, X-ray photoelectron spectroscopy, scanning electron microscope; energy dispersive spectroscopy and confocal laser scanning microscopy were used to confirm the modification of Ti disk implants. The bioactivity of nHA-modified Ti disk implants was evaluated by seeding MC3T3-E1 cells on Ti-nHA implants.

RESULTS

Characterization techniques have confirmed the successful modification of Ti disk implants by l-glutamic acid grafted nHA. The nHA-modified Ti disk implants have shown enhanced adhesion, proliferation and cytotoxicity of MC3T3-E1 cells in comparison to pristine Ti implants.

CONCLUSIONS

The modification of Ti implants by l-glutamic acid grafted nHA has produced highly osteogenic Ti disk plants in comparison to pristine Ti disk implants due to the formation of bioactive surfaces by hydroxyapatite nano rods on Ti disk implants. Ti-nHA disk implants showed enhanced adhesion, proliferation, and MC3T3-E1 cells viability in comparison to pristine Ti disk implants. Thus nHA might be to be useful to enhance the osseointegration of Ti implants with teeth bones.

Effects of modified abutment characteristics on peri-implant soft tissue health: A systematic review and meta-analysis

Objectives

The purpose of this systematic review was to evaluate the impact of the abutment characteristics on peri‐implant tissue health and to identify the most suitable material and surface characteristics.

Methods

A protocol was developed aimed to answer the following focused question: “Which is the effect of the modification of the abutment design in regard to the maintenance of the peri‐implant soft tissue health?” Further subanalysis aimed to investigate the impact of the abutment material, macroscopic design, surface topography and surface manipulation. Randomised controlled trials (RCTs) with a follow‐up of at least 6 months after implant loading were considered as inclusion criteria. Meta‐analyses were performed whenever possible.

Results

Nineteen final publications from thirteen investigations were included. The results from the meta‐analysis indicated that zirconia abutments (Zi) experienced less increase in BOP values over time [n = 3; WMD = −26.96; 95% CI (−45.00; −8.92); p = .003] and less plaque accumulation [n = 1; MD = −20.00; 95% CI (−41.47; 1.47); p = .068] when compared with titanium abutments (Ti). Bone loss was influenced by the method of abutment decontamination [n = 1; MD = −0.44; 95% CI (−0.65; −0.23); p < .001]. The rest of the studied outcomes did not show statistically significant differences.

Conclusions

The macroscopic design, the surface topography and the manipulation of the implant abutment did not have a significant influence on peri‐implant inflammation. In contrast, the abutment material demonstrated increased BOP values over time for Ti when compared to Zi abutments.

Long-Term Retrospective Clinical and Radiographic Follow-up of 205 Brånemark System Mk III TiUnite Implants Submitted to Either Immediate or Delayed Loading

BACKGROUND

Studies are needed to evaluate long-term performance of immediately loaded implants with moderately rough surface. This retrospective study evaluated long-term survival and periimplant soft and hard tissue conditions in patients treated with TiUnite implants.

MATERIALS AND METHODS

Forty-one consecutive patients (mean age, 52.6 years) received 205 Brånemark System Mk III TiUnite implants (145 maxillary, 60 mandibular). The indication was single tooth (n = 7 implants), partial (n = 94), or full arches (n = 104). One hundred thirteen implants were immediately loaded. Cumulative survival rate (CSR) of implants was assessed. Long-term marginal bone remodeling, probing pocket depth (PPD), and periimplant mucosa conditions were assessed.

RESULTS

Follow-up averaged 8.8 years (range, 6.6-10.6 years). Eight implants in 5 patients failed. CSR was 96.1% (implant basis) and 87.8% (patient basis) up to 10 years. At the longest follow-up, bone loss averaged 0.43 ± 1.15 mm (n = 173), PPD averaged 3.64 ± 0.74 mm, and periimplant mucosa was healthy in 74.6% of cases. Furthermore, 50.3% and 35.5% of implants scored negative for plaque and bleeding, respectively. No significant difference in CSR and hard and soft tissue conditions was found in the long term between immediately and delayed loaded implants.

CONCLUSION

Implants with TiUnite surface demonstrated excellent long-term survival, marginal bone response, and soft tissue conditions, despite a nonoptimal level of oral hygiene.

Turned versus anodised dental implants: a meta-analysis

The aim of this meta-analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post-operative infection for patients being rehabilitated by turned versus anodised-surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty-eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95-4·06, P < 0·00001) for failure of turned implants, when compared to anodised-surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference-MD 0·02, 95%CI -0·16-0·20; P = 0·82) in comparison to anodised implants. The results of a meta-regression considering the follow-up period as a covariate suggested an increase of the MD with the increase in the follow-up time (MD increase 0·012 mm year(-1) ), however, without a statistical significance (P = 0·813). Due to lack of satisfactory information, meta-analysis for the outcome 'post-operative infection' was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.

Reality of dental implant surface modification: a short literature review

Screw-shaped endosseous implants that have a turned surface of commercially pure titanium have a disadvantage of requiring a long time for osseointegration while those implants have shown long-term clinical success in single and multiple restorations. Titanium implant surfaces have been modified in various ways to improve biocompatibility and accelerate osseointegration, which results in a shorter edentulous period for a patient. This article reviewed some important modified titanium surfaces, exploring the in vitro, in vivo and clinical results that numerous comparison studies reported. Several methods are widely used to modify the topography or chemistry of titanium surface, including blasting, acid etching, anodic oxidation, fluoride treatment, and calcium phosphate coating. Such modified surfaces demonstrate faster and stronger osseointegration than the turned commercially pure titanium surface. However, there have been many studies finding no significant differences in in vivo bone responses among the modified surfaces. Considering those in vivo results, physical properties like roughening by sandblasting and acid etching may be major contributors to favorable bone response in biological environments over chemical properties obtained from various modifications including fluoride treatment and calcium phosphate application. Recently, hydrophilic properties added to the roughened surfaces or some osteogenic peptides coated on the surfaces have shown higher biocompatibility and have induced faster osseointegration, compared to the existing modified surfaces. However, the long-term clinical studies about those innovative surfaces are still lacking.

Interventions for replacing missing teeth: different types of dental implants

BACKGROUND

Dental implants are available in different materials, shapes and with different surface characteristics. In particular, numerous implant designs and surface modifications have been developed for improving clinical outcome. This is an update of a Cochrane review first published in 2002, and previously updated in 2003, 2005 and 2007.

OBJECTIVES

Primary: to compare the clinical effects of different root-formed osseointegrated dental implant types for replacing missing teeth for the following specific comparisons: implants with different surface preparations, but having similar shape and material; implants with different shapes, but having similar surface preparation and material; implants made of different materials, but having similar surface preparation and shape; different implant types differing in surface preparation, shape, material or a combination of these.Secondary: to compare turned and roughened dental implants for occurrence of early implant failure (before prosthetic loading) and occurrence of peri-implantitis.

SEARCH METHODS

We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 17 January 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 12), MEDLINE via OVID (1946 to 17 January 2014) and EMBASE via OVID (1980 to 17 January 2014). We placed no restrictions on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included any randomised controlled trial (RCT) comparing osseointegrated dental implants of different materials, shapes and surface properties having a follow-up in function of at least one year. Outcome measures were success of the implants, radiographic peri-implant marginal bone levels changes and incidence of peri-implantitis.

DATA COLLECTION AND ANALYSIS

At least two review authors independently conducted screening, risk of bias assessment and data extraction of eligible trials in duplicate. We expressed results using fixed-effect models (if up to three studies were present in a meta-analysis) or random-effects models (when there were more than three studies) using mean differences (MD) for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CI). We reported the following endpoints: one, three, five and 10 years after functional loading.

MAIN RESULTS

We identified 81 different RCTs. We included 27 of these RCTs, reporting results from 1512 participants and 3230 implants in the review. We compared 38 different implant types with a follow-up ranging from one to 10 years. All implants were made of commercially pure titanium or its alloys, and had different shapes and surface preparations. We judged two trials to be at low risk of bias, 10 to be at unclear risk of bias and 15 to be at high risk of bias. On a 'per participant' rather than 'per implant' basis, we found no significant differences between various implant types for implant failures. The only observed statistically significant difference for the primary objective regarded more peri-implant bone loss at Nobel Speedy Groovy implants when compared with NobelActive implants (MD -0.59 mm; 95% CI -0.74 to -0.44, different implant shapes). The only observed statistically significant difference for the secondary objective was that implants with turned (smoother) surfaces had a 20% reduction in risk to be affected by peri-implantitis than implants with rough surfaces three years after loading (RR 0.80; 95% CI 0.67 to 0.96). There was a tendency for implants with turned surfaces to fail early more often than implants with roughened surfaces.

AUTHORS' CONCLUSIONS

Based on the results of the included RCTs, we found no evidence showing that any particular type of dental implant had superior long-term success. There was limited evidence showing that implants with relatively smooth (turned) surfaces were less prone to lose bone due to chronic infection (peri-implantitis) than implants with much rougher surfaces (titanium-plasma-sprayed). These findings were based on several RCTs, often at high risk of bias, with few participants and relatively short follow-up periods.

Monitoring bone morphogenetic protein-2 and -7, soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin levels in the peri-implant sulcular fluid during the osseointegration of hydrophilic-modified sandblasted acid-etched and sandblasted acid-etched surface dental implants

BACKGROUND AND OBJECTIVE

The implant surface plays a major role in the biological response to titanium dental implants. The aim of this study was to investigate levels of soluble receptor activator of nuclear factor-κB ligand (sRANKL), osteoprotegerin (OPG), bone morphogenetic protein-2 (BMP-2) and -7 (BMP-7) in the peri-implant crevicular fluid (PICF) of different implants during the osseointegration period.

MATERIAL AND METHODS

Forty-seven patients (22 females and 25 males, mean age 47.34 ± 10.11) were included in this study. Forty-seven implants from two implant systems (group A1 (sandblasted acid-etched [SLA]-16), group A2 (hydrophilic-modified SLA [SLActive]-16), and group B (sandblasted acid-etched [SLA]-15) were placed using standard surgical protocols. PICF samples, plaque index, gingival index and probing depth measurements were obtained at 1 and 3 mo after surgery. PICF levels of sRANKL, OPG, BMP-2/-7 were analyzed by ELISA.

RESULTS

No complications were observed during the healing period. No significant differences were observed in the PICF levels of sRANKL, OPG, BMP-2 and BMP-7 for all groups at any time point (p > 0.05). A significant decrease was observed in BMP-2 levels in group A1 (p < 0.05). A significant increase in BMP-7 levels was observed only for group A2 (p < 0.05). There was a strong negative correlation between OPG and gingival index and a negative correlation between BMP-7 and plaque index (p < 0.05).

CONCLUSION

Considering the correlations between clinical and biochemical parameters, the levels of these cytokines in PICF during early healing of implants reflects the degree of peri-implant inflammation, rather than differences in the implant surfaces.