Disparity in embrasure fill and papilla height between tooth- and implant-borne fixed restorations in the anterior maxilla: a cross-sectional study

Effects of socket-shield therapy on inter-implant papilla preservation between upper central and lateral incisors: A case series with 3-5 year follow-up

OBJECTIVE

Despite significant progress within implant prosthetic therapy, preserving the papilla between two adjacent implants in the esthetic zone, particularly between central and lateral incisors, remains challenging. This case series aims to report a papilla preservation approach between adjacent upper central-lateral incisor implants using the socket-shield technique.

CLINICAL CONSIDERATIONS

Six patients with natural dentition received unilateral adjacent central-lateral incisor implants with different socket shield configurations. The esthetic outcomes were clinically assessed after 3-5 years of follow-up. Post-operative papilla fill was evaluated on intraoral images compared to baseline characteristics and the contralateral papilla. Papilla height was preserved in all cases, with minimal alterations observed.

CONCLUSIONS

Within the limitations of the present case series, the socket-shield technique demonstrated favorable outcomes in preserving the papilla between adjacent upper central-lateral incisor implants in the midterm follow-up. Clinical studies are warranted to validate these results.

CLINICAL SIGNIFICANCE

The socket-shield technique seems promising in preserving the inter-implant papilla between adjacent central-lateral incisor implants.

Four single implant-supported crowns replacing the maxillary incisors: A retrospective report of 10 cases with 2-9 years of follow-up

OBJECTIVE

This retrospective case series aimed to assess the stability of the papilla around four single crowns supported by narrow-diameter implants replacing all maxillary incisors. Secondary objectives included assessment of marginal bone level stability, incidence of technical and biological complications, and patient satisfaction.

MATERIALS AND METHODS

Individuals with four adjacent implants in maxillary incisor sites, placed with a 3 mm inter-implant distance and rehabilitated with single crowns were included. Retrospective data were obtained from photographs and radiographs taken at the delivery of the prosthesis (baseline-T0). Patients were then recalled (≥2 years after T0) for clinical and radiographic examination (follow-up-T1). Photographs were obtained and patient satisfaction was assessed using a visual analogue scale. Papilla height and marginal bone level were compared over time.

RESULTS

Data from 10 patients with medium-low smile lines and rehabilitated with 40 implants, in function for 5.4 ± 1.9 years, were analyzed. The papilla height between implants (T0: 2.3 ± 0.9 mm; T1: 2.6 ± 0.7 mm; p = .011) and between tooth and implant (T0: 3.4 ± 0.9 mm; T1: 3.8 ± 0.8 mm; p = .025) increased significantly over the years. The marginal bone level remained stable over time (T0: 0.88 ± 0.57 mm; T1: 0.71 ± 0.67 mm; p = .007). Patients were highly satisfied (97.7 ± 0.3%) with the treatment outcome.

CONCLUSION

Within its limitations, this study demonstrated that four single implant-supported crowns placed at maxillary incisor sites may exhibit soft tissue and marginal bone stability over a long period of time. This treatment approach, however, should be restricted to few patients as it requires a proper case selection and skillful execution of all surgical and prosthetic steps.

Average and Maximum Papilla Heights around Dental Implants in the Anterior Maxillary Region: A Retrospective Clinical Study

Objective

The aim of this study was to determine the average and maximum height of the papilla around maxillary anterior implants in respect of neighboring structures and location of implants.

Materials and Methods

92 dental implants from 63 patients were investigated in this study. Those implants were placed in the anterior maxillary region and had been loaded for a minimum of one year. After receiving written consent, clinical data including the height of interproximal papillae adjacent to the tooth/implant/pontic were obtained through clinical observation. The independent t-test or ANOVA, the regression modeling, and generalized estimating equation (GEE) models were used for statistical analysis (p < 0.05).

Results

Papilla height was calculated as 2.8 mm (1–5.5 mm) for implant-tooth sites, 2.6 mm (1–4 mm) in implants beside pontics, and 2.5 mm (1–3.5 mm) for implants adjacent to implants. Despite the lack of a significant difference in the mean papilla height in the studied groups, the maximum values of papilla heights were significantly different.

Conclusions

In this study, no significant differences were found in papilla height mean values in relation to neighboring structures or location of implants in the anterior maxilla. However, the maximum values of papilla heights were observed around implants next to natural teeth.

Soft tissue metric parameters, methods and aesthetic indices in implant dentistry: A critical review

OBJECTIVES

The primary objective was to provide an overview of soft tissue metric parameters, methods, and aesthetic indices in implant dentistry. The secondary objective was to describe reliability and validity of aesthetic indices.

MATERIALS AND METHODS

Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase, and Cochrane databases up to October 2020 to identify studies on soft tissue metric parameters, methods, and aesthetic indices. Aesthetic indices were evaluated in terms of reliability and validity. Data extraction was performed by the same reviewers.

RESULTS

Five metric parameters (papilla height, linear changes in soft tissue level, color assessment, soft tissue thickness, and profilometric soft tissue changes) registered by means of several methods (intra-oral registrations, radiographic assessments, digital analyses, and ultrasonic assessments), and 15 aesthetic indices (Papilla Index (PI), ad hoc questions scored with Visual Analogue Scales, Pink Esthetic Score (PES), Implant Crown Aesthetic Index (ICAI), Implant Aesthetic Score (IAS), Rompen Index, Subjective Esthetic Score, White Esthetic Score, Copenhagen Index, Complex Esthetic Index, Californian Dental Association Index (CDAI), Peri-Implant, and Crown Index, Functional Implant Prosthodontic Score, Implant Restoration Esthetic Index (IREI), and Mucosal Scarring Index (MSI)) could be identified. With respect to metric parameters and methods, intra-oral registrations were least accurate whereas profilometric soft tissue changes on the basis of digital surface models were most accurate. Six aesthetic indices showed good inter-rater reliability (PI, PES, ICAI, CDAI, IREI, and MSI). Good validity could only be shown for two indices (PES and CEI). Given this and on the basis of ease of use and ease of interpretation, PES qualified best for clinical research on single implants. None of the indices fulfilled the quality criteria for clinical research on multiple implants.

CONCLUSION

Many soft tissue assessment methods with varying reliability and validity have been described and used, which hampers uniform reporting in implant dentistry. Clinical investigators are advised to measure linear and profilometric soft tissue changes using digital surface models, and to use a reliable and validated aesthetic index. Currently, PES qualifies best for aesthetic evaluation of single implants. An index is to be developed to assess the aesthetic outcome of rehabilitations on multiple implants.

Aesthetic aspects of adjacent maxillary single-crown implants-influence of zirconia and titanium as implant materials

The purpose of this retrospective survey was to assess the esthetic aspects of adjacent zirconia and titanium implants in the anterior maxillary area. A total of 40 patients and 109 adjacent implants (17 patients with 47 titanium implants and 23 patients with 62 zirconia implants) was included. The primary aim of this survey was to assess the papillary fill (Jemt score). Additionally, further esthetic aspects were assessed. Papillae were fully present (Jemt score 3) around 39.1% of adjacent zirconia implants and 17.4% of adjacent titanium implants (p<0.01). The papilla deficit was significantly higher 1.64 mm (SD 1.35) around titanium compared to zirconia implants 0.92 mm (SD 0.94, p<0.01). The evaluation of the soft tissue recessions revealed no differences between implant materials, whereas titanium implants presented more visible implant shadows (p<0.01). Zirconia implants had more implants with papillae that filled the entire proximal space compared to titanium implants. Furthermore, titanium implants had a greater frequency of visible implant shadowing than the zirconia implants. Esthetic rules such as the interdental contact area and golden percentage rules did not differ significantly between the titanium and zirconia implants.

Factors Influencing the Presence of Papilla between Adjacent Implants and between a Tooth and an Implant

Aim

The aim this study was to evaluate the factors that influence the presence or absence of the interproximal papilla between implants adjacent to the teeth or other implants, through clinical and radiographic evaluation.

Material and Methods

The non-probabilistic sample comprised 44 patients of both genders aged between 21 and 68 years, rehabilitated with 114 osseointegrated implants. Through a retrospective clinical study, the patients were divided according to the presence or absence of the interproximal papilla: Group 1 - Absence of Papilla, Group 2 - Partial Presence of Papilla and Group 3 - Total Presence of Papilla. The success of the implants, the periodontal biotype, and the vertical and horizontal distances of the interproximal regions included in the study were evaluated.

Results

Of the 114 implants, 46.5% were considered unsuccessful, and bleeding was present in 29.8%. The periodontal biotype presented as thin and scalloped was found in 85.1% of the regions. The evaluation of the groups according to the confirmation of the interproximal space showed a statistically significant difference (p = 0.007), with 61.9% of the wide and long interproximal spaces classified as Group 1, while 31% of the narrow and short interproximal spaces were classified as Group 3.

Conclusion

It was concluded that the morphology of the interproximal space was the factor that was most strongly associated with the presence or absence of the interproximal papilla.

Etiology and classification of food impaction around implants and implant-retained prosthesis

BACKGROUND

Food impaction is a common risk factor for the initiation of peri-implant inflammation and failure of the osseointegrated implant. Although clinicians do acknowledge the presence of food impaction around implants and implant-retained prosthesis, no classification system has yet classified the food impaction around the implant and implant-retained prosthesis.

PURPOSE

The present paper aims to identify and classify the plausible etiology of food impaction around implants and implant-related prosthesis.

MATERIALS AND METHODS

The following search terms were utilized for data search: "Food Impaction" AND "Implants" AND "Food Impaction" AND "Perimplantitis" AND "Food Impaction" AND "Classification." Articles that were written in the English language in PubMed and Cochrane Library database from 1930 till September 2018 were scrutinized. A total of 24 articles were scrutinized, out of which only 15 articles were selected.

RESULTS

Food impaction around implants is broadly classified into five categories based on the number of implants, nature of implants prosthesis involved for replacement and relation of the implant prosthesis to the adjacent tooth, restoration, or prosthesis.

CONCLUSION

This is the first classification designed to classify food impaction around dental implants and implant-retained prosthesis. The classification can be used by clinicians for optimal diagnosis, interpretation, and treatment plan for patients.

A systematic review on the influence of the horizontal distance between two adjacent implants inserted in the anterior maxilla on the inter-implant mucosa fill

OBJECTIVES

To address the following focused question: "Does the horizontal distance between two adjacent implants inserted in the anterior maxilla affect the inter-implant mucosa fill?".

MATERIAL AND METHODS

A comprehensive literature screening was performed in MEDLINE and Cochrane databases from January 1, 2000 until July 1, 2017. Clinical human studies including ≥10 patients treated with at least two adjacent implant-supported crowns in the anterior maxilla with a minimum of 12 months of follow-up were searched. Studies reporting on inter-implant mucosa fill in relation to the radiographic horizontal distance between the two adjacent implants were included. The reporting of this systematic analysis adhered to the Preferred Reporting items for Systematic Review and Meta-analyses (PRISMA) statement.

RESULTS

The initial search resulted in 208 publications. From 13 full-text articles reviewed, 4 were included in the final analysis. Depending on the reference points used, the horizontal inter-implant distance ranged between 2.01 and 4.0 mm. In 21 to 88.5% of the cases, inter-implant-mucosa filled more than half of the inter-implant space. When interpreting results of inter-implant mucosa fill, time of implant placement (immediate or delayed) and restoring (immediate or conventional) were taken into consideration. A tendency towards incomplete inter-implant mucosa fill at a distance of <3 mm was noted in the 3 included papers. One of the studies found this trend to be statistically significant (p = .008).

CONCLUSIONS

Based on the available evidence, it is not possible to define a precise threshold for the optimal horizontal distance between two adjacent implants.

Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients

In recent years the scientific community has shown a clear interest in the esthetic outcome of implant treatment. The present paper provides an overview of the esthetic ratings that have been used in implant dentistry. A distinction can be made between objective evaluations by clinicians and subjective evaluations by patients. The former mainly include: midfacial and interproximal soft-tissue levels; two-dimensional/three-dimensional soft-tissue alterations; assessment of the color match between the natural dentition, on the one hand, and the peri-implant tissues and the reconstruction, on the other hand; and ordinal indices, such as the pink and white esthetic score. Patient's needs and judgment may differ from objective indicators of implant success and esthetics. As a result, assessing treatment on the basis of patient-reported outcomes measures should be considered important. Validated questionnaires have been used that mainly assess the impact of oral health on the overall well-being of individuals. The esthetic judgment of patients is usually based on nonstandardized questions with varying scoring methods, including visual analog scales, Likert and other category scales and open questions. The heterogeneity in scoring systems between studies may compromise proper comparison of objective and subjective esthetic outcomes between studies and therapeutic concepts.

Aesthetics and Survival of Immediately Restored Implants in Partially Edentulous Anterior Maxillary Patients

This retrospective study was undertaken to determine survival rates and aesthetic outcomes of immediate placement of multiple implants at anterior maxilla sites. One hundred and eighteen implants placed in 39 patients (21 women and 18 men; average age 58.3 years) were immediately restored (24–72 h after placement). Aesthetic assessment, radiographic bone loss, and biological and prosthetic complications were evaluated. Data collection between 12 and 84 months (mean 32.2 ± 18) after final prosthetic installation revealed that no implants were lost, and that 106/118 (89.8%) implants had no more than 1.5 mm of bone loss by the end of the first year and an additional 0.2 mm for each successive year. The marginal bone loss was higher for extractions due to periodontitis compared to extractions due to caries (mean mesial loss of 1.37 mm vs. 1.01 mm, respectively, and mean distal loss of 1.37 mm and 0.99 mm, respectively, p = 0.001). The mesial papilla was present in 83/118 implants (70.3%), while the distal papilla was present in 76/118 implants (64.4%). The cervical metallic part of the abutment was exposed in 16/118 (13.5%) implants. There was a higher ratio of recessions and missing papillae in patients in whom the extractions were performed due to periodontal reasons. Within the limitations of the present study, aesthetic and radiographic parameters support immediate restoration of partially edentulous maxillae.

Rehabilitation of the severely atrophied dentoalveolar ridge in the aesthetic region with corticocancellous grafts from the iliac crest and dental implants

Background

The aim of this study was to assess changes in bone volume after block bone augmentation and placement of dental implants and further evaluate the aesthetic outcome of the treatment.

Material and Methods

9 Patients with atrophied anterior maxilla were included in this study. They received total of 21 implants. Dimensions of the alveolar ridge were measured from cone-beam computed tomography x-rays. The bone level at the implant sites was analysed from intraoral x-rays and the aesthetic outcome was assessed from clinical photographs using a pink aesthetic score (PES) scaling.

Results

The mean gained horizontal bone width at the marginal crest and 5 mm apically was accordingly 2.7mm and 5.0 mm. The mean PES rating was 9.8/14. The survival rate of.

Conclusions

Reconstruction of the atrophied anterior maxilla with bone blocks and dental implants is a safe procedure with high survival rate and acceptable aesthetic outcome.

Key words:Dental implants, aesthetic region, corticocancellous bone grafts, pink aesthetic score, survival rate.