Soft-tissue dehiscence coverage at peri-implant sites

Periodontal conditions of teeth adjacent to dental implants with or without peri-implantitis after non-surgical therapy in patients treated for periodontitis: A retrospective study

OBJECTIVES

To retrospectively assess the periodontal conditions of teeth adjacent to and contralateral to implants presenting with or without peri-implantitis, following non-surgical periodontal and peri-implant mechanical therapy.

MATERIALS AND METHODS

One hundred and one patients with existing dental implants and chronic periodontitis, who underwent non-surgical periodontal and peri-implant mechanical therapy, were included. The periodontal clinical probing depth (PPD), gingival recession (GR), and bleeding on probing (BOP) were recorded at six sites around the adjacent (Adj-) teeth and the contralateral (CL-) teeth relative to the implant. The potential factors influencing the periodontal conditions of 316 teeth were analyzed by multivariate linear regression models with generalized estimating equation methods and α = .05.

RESULTS

The PPD of Adj-teeth was significantly different from that of CL-teeth before and after non-surgical therapy when the implant was diagnosed with peri-implantitis (PI) (p < .05). The PPD of teeth was shown to be affected by neighboring implants diagnosed with peri-implantitis (β = .825 mm, p < .001), teeth adjacent to implants (β = .245 mm, p = .004), a molar tooth type (β = .435 mm, p = .019), and non-surgical therapy (β = -.522 mm, p < .001).

CONCLUSIONS

Relatively compromised periodontal conditions at Adj-teeth after non-surgical PI therapy were detected. Therefore, clinicians should be aware that non-surgical therapy may be less successful at teeth adjacent to implants with PI.

Novel approach to soft tissue regeneration: in vitro study of compound hyaluronic acid and horizontal platelet-rich fibrin combination

OBJECTIVE

This study aims to develop a compound biomaterial to achieve effective soft tissue regeneration.

METHODOLOGY

Compound hyaluronic acid (CHA) and liquid horizontal-platelet-rich fibrin (H-PRF) were mixed at a ratio of 1:1 to form a CHA-PRF gel. Human gingival fibroblasts (HGFs) were used in this study. The effect of CHA, H-PRF, and the CHA-PRF gel on cell viability was evaluated by CCK-8 assays. Then, the effect of CHA, H-PRF, and the CHA-PRF gel on collagen formation and deposition was evaluated by qRT‒PCR and immunofluorescence analysis. Finally, qRT‒PCR, immunofluorescence analysis, Transwell assays, and scratch wound-healing assays were performed to determine how CHA, H-PRF, and the CHA-PRF gel affect the migration of HGFs.

RESULTS

The combination of CHA and H-PRF shortened the coagulation time of liquid H-PRF. Compared to the pure CHA and H-PRF group, the CHA-PRF group exhibited the highest cell proliferation at all time points, as shown by the CCK-8 assay. Col1a and FAK were expressed at the highest levels in the CHA-PRF group, as shown by qRT‒PCR. CHA and PRF could stimulate collagen formation and HGF migration, as observed by fluorescence microscopy analysis of COL1 and F-actin and Transwell and scratch healing assays.

CONCLUSION

The CHA-PRF group exhibited greater potential to promote soft tissue regeneration by inducing cell proliferation, collagen synthesis, and migration in HGFs than the pure CHA or H-PRF group. CHA-PRF can serve as a great candidate for use alone or in combination with autografts in periodontal or peri-implant soft tissue regeneration.

Long-term outcome of implants exhibiting buccal soft tissue dehiscence in the esthetic zone

OBJECTIVE

Increasing aesthetic demands require that the color and contour of the peri-implant soft tissues be in harmony with the neighboring teeth. Recession, migration toward the apical, is a frequent clinical finding. Its presence can lead to inflammation and increased marginal bone loss. These complications, in addition to affecting the aesthetic results of our treatment, are difficult to treat and can threaten the survival of the implant. There are fewer studies showing the outcome of treatment of soft-tissue defects around implants. The aim of this article is to describe the treatment of a soft-tissue defect around an implant-supported prosthesis treatment, performed on two neighboring implants, in the esthetic zone in a patient with a high smile and to evaluate both the coverage achieved and the patient's esthetic satisfaction.

CLINICAL CONSIDERATIONS

This study showed that a mucogingival approach, using a surgical technique designed for the treatment of alveolar ridge defects, together with tissue management with temporaries and a new restoration, achieved an optimal result.

CONCLUSIONS

The case has been closely followed up, for 10 years, and the authors have been able to confirm the long-term stability of the result.

CLINICAL SIGNIFICANCE

The following paper shows the result of an innovative approach. Connective tissue platform technique, usually performed for soft-tissue augmentation, was used for a defect in soft-tissue dehiscence. The authors followed the results for 10 years, and the results achieved were satisfactory in terms of esthetic.

Coverage stability of peri-implant soft tissue dehiscence: A systematic review and meta-analysis

OBJECTIVE

The occurrence of peri-implant soft tissue dehiscence, especially in the esthetic zone, can be challenging. This study sought to investigate how the passage of time affects the outcomes of treatment for peri-implant soft tissue dehiscence coverage.

MATERIALS AND METHODS

A literature search was performed up to April 2023 via PubMed, Scopus, and Web of Science to retrieve studies reporting the data on peri-implant soft tissue dehiscence of at least 2-time points (baseline and follow-up). Clinical trials with a minimum of 5 participants, reporting at least 1 primary outcome, and with a minimum follow-up of 3 months were included. The primary outcomes were the changes in dehiscence depth, complete coverage, and mean coverage at different time points.

RESULTS

Seven studies with 112 participants and 119 implants were included. Dehiscence depth increased insignificantly between 3 to 6 months. Although the dehiscence depth increased from 6 to 12 months in the tunnel group, it decreased in the coronally advanced group, and a slight decrease was observed from 12 to 72 months. Soft tissue thickness was the predictor for soft tissue margin stability. However, no significant relationship was found between the baseline dehiscence depth and complete coverage.

CONCLUSIONS

Within the limitations of this study, it seems prudent to wait at least 6 months to achieve a stable soft tissue margin.

CLINICAL SIGNIFICANCE

The occurrence of peri-implant soft tissue dehiscence, especially in the esthetic zone, can be a challenging complication. It is important not only to achieve coverage but also to ensure that the treatment results remain stable in the long term, in order to satisfy both patients and clinicians. A reasonable approach would be to wait for at least 6 months to achieve a stable soft tissue margin.

Long-term treatment outcomes of single maxillary buccal peri-implant soft tissue dehiscences: A 10-year prospective study

INTRODUCTION

To evaluate the 10-year clinical outcomes following surgical treatment of shallow isolated peri-implant soft-tissue dehiscences (PSTD) at single tissue level dental implants.

METHODS

The baseline population included 16 patients (16 implants) displaying an isolated peri-implant maxillary buccal soft-tissue dehiscence. The recipient bed was prepared with a minimally-invasive split-thickness flap limited to the buccal aspect to stabilize the tuberosity connective tissue graft (CTG) onto the periosteum. At the end of treatment, patients were enrolled in an individualized supportive peri-implant care (SPC) program. The aesthetic outcome was evaluated on photographs by three clinicians using a visual analog scale (VAS).

RESULTS

SPC during the 10-years proceeded uneventfully in all patients. A total of 12 patients completed the 10-year examination, as 3 patients dropped-out and 1 implant was lost. Complete PSTD coverage was obtained at 7 implant sites (i.e., 58%) while the mean PSTD coverage amounted to 89.6% ± 17.1% without statistically significant differences between 1 and 10 years (p > 0.05). Stable peri-implant parameters (i.e., PD and BoP) and full-mouth scores (i.e., FMPS, FMBS) were recorded throughout the observation period (p > 0.05). The aesthetic improvements obtained in the short-term were maintained up to 10 years.

CONCLUSION

Within their limits, the present results indicate that the proposed surgical technique is a simple and reliable treatment option for the treatment of single maxillary buccal PSTDs in selected cases with positive results up to 10 years in patients under regular SPC (NCT04983758-this clinical trial was not registered prior to participant recruitment).

Coronally advanced flap versus tunnel technique for the treatment of peri-implant soft tissue dehiscences with the connective tissue graft: A randomized, controlled clinical trial

AIM

To evaluate the efficacy of coronally advanced flap (CAF) versus tunnel technique (TUN) in covering isolated mid-facial peri-implant soft tissue dehiscences (PSTDs).

MATERIALS AND METHODS

Twenty-eight participants presenting with isolated non-molar implants exhibiting PSTDs were enrolled and randomized to receive either CAF or TUN, both with a connective tissue graft (CTG). The primary outcome of the study was the percentage of mean PSTD coverage at 12 months. Secondary endpoints included the frequency of complete PSTD coverage, changes in keratinized mucosa width (KMW) and horizontal mucosal thickness (MT), as assessed with transgingival probing, 3D optical scanning and ultrasonography, professional aesthetic evaluation and patient-reported outcome measures (PROMs).

RESULTS

At 12 months, the mean PSTD coverage of the CAF and TUN groups was 90.23% and 59.76%, respectively (p = .03). CAF-treated sites showed a substantially higher frequency of complete PSTD coverage (p = .07), together with significantly greater gain of KMW (p = .01), increase in MT (p = .02), volumetric gain (p < .01) and professional aesthetic outcomes (p = .01). Both interventions showed an improvement in patient-reported aesthetics and a reduction of the anxiety related to the appearance of the implant compared to baseline, with the CAF group obtaining significantly higher scores (p = .03 for both PROMs).

CONCLUSIONS

CAF + CTG resulted in superior PSTD coverage outcomes, greater gain in KMW and MT, and better PROMs than TUN + CTG for the treatment of isolated PSTDs (ClinicalTrials.gov NCT03498911).

Maxillary labial peri-implant hard and soft tissue alteration observed on cross-sectional dimension: a 2-year prospective observational study

OBJECTIVES

To evaluate how peri-implant hard and soft tissue height (BH, MH) alter after final prostheses placement related to labial hard and soft tissue thickness (BW, MW).

MATERIALS AND METHODS

Forty-five platform-switched implants were classified into four groups according to BW and MW: type 1 (thick BW and thick MW), type 2 (thick BW and thin MW), type 3 (thin BW and thick MW), type 4 (thin BW and thin MW). Tissue resorption was evaluated on cone-beam CT images taken at final prostheses placement, at 1-year follow-up, and at 2-year follow-up. Kruskal-Wallis test and post hoc Mann-Whitney test were applied; significance was set to 0.05.

RESULTS

BH resorption was 0.13 ± 0.12 mm in type 1, 0.26 ± 0.17 mm in type 2, 0.09 ± 0.09 mm in type 3, 0.94 ± 0.19 mm in type 4. Differences between type 1 and 4, type 2 and 4, and type 3 and 4 were statistically significant (p < 0.001, p = 0.005, p < 0.001, respectively). MH resorption was 0.10 ± 0.09 mm in type 1, 0.36 ± 0.16 mm in type 2, 0.12 ± 0.12 mm in Type 3, 0.79 ± 0.23 mm in type 4. Differences between type 1 and 2, type 1 and 4, type 2 and 3, type 2 and 4 and type 3 and 4 were statistically significant (p < 0.001).

CONCLUSIONS

Significantly less BH/MH resorption occurs around implants with thick BW/MW than those with thin BW/MW in 2 years. Implants with thick peri-implant soft tissue resulted in significantly less tissue resorption in second year after final prostheses placement.

Avoiding errors and complications related to immediate implant placement in the esthetic area with a mucogingival approach

Immediate implant placement is considered the treatment of choice for single tooth replacement in the esthetic area. However, this treatment is associated with several critical drawbacks related to the inadequate assessment/management of the soft and hard peri-implant tissues and their subsequent remodeling, resulting in peri-implant soft-tissue defects that can lead to impaired esthetic outcomes in time. We describe in detail how the mucogingival approach to immediate implant placement ensures a standard result regardless of the baseline soft-hard tissue situation. Fully guided implant placement guarantees an adequate three-dimensional implant placement, the flap design makes it possible to perform bone augmentation with complete visibility of the area being treated, allows soft tissue augmentation with proper fixation of the connective tissue graft, and the placement of an immediate provisional ensures stabilization of the peri-implant tissues throughout the healing period.

Evaluation of esthetic outcome of delayed implants with de-epithelialized free gingival graft in thin gingival phenotype with or without immediate temporization: a randomized clinical trial

AIM

The current study investigates the effect of immediate temporization on the pink esthetics of delayed implants in patients with thin gingival phenotype in combination with a De-epithelialized Free Gingival Graft in the maxillary premolar area.

METHODOLOGY

The study population was randomly assigned into two groups. The two groups were treated with delayed implants with simultaneous placement of a de-epithelialized free gingiva graft. The test group was immediately temporized while the control group had no temporization. The pink esthetic score was assessed as the primary outcome. Additional secondary outcomes were assessed such as the keratinized tissue width and the soft tissue thickness.

RESULTS

Twenty implants were placed in the current study, split into 10 implants per group. The results showed that the Pink Esthetic Score of the IT group was 11.88 ± (1.13) and 11.33 ± (1.25) for the CTG group, which showed no statistical difference between the groups after 1 year of follow-up. There was also no significant difference between the two groups at 12 months regarding the keratinized tissue width and the soft tissue thickness.

CONCLUSIONS

Immediate and delayed temporizations have no effect on the Pink Esthetics of the delayed implants; however, immediate temporization allowed earlier provisional crown delivery. Soft tissue augmentation of the thin gingival phenotype improved esthetics for both groups. Trial registration Name of the registry: clinicaltrials.gov; trial registration number: NCT03792425. Date of registration: January 3, 2019. URL of trial registry record: https://clinicaltrials.gov/ct2/show/NCT03792425?term=NCT03792425&draw=2&rank=1.

Vertical soft tissue augmentation to treat implant esthetic complications: A prospective clinical and volumetric case series

INTRODUCTION

Challenging implant esthetic complications are often characterized by implant malpositioning and interproximal attachment loss of the adjacent teeth. However, limited evidence is available on the treatment of these conditions. The aim of this study was to evaluate the clinical, volumetric, and patient-reported outcome following treatment of peri-implant soft tissue dehiscences (PSTDs) exhibiting interproximal attachment loss on adjacent teeth, performed through vertical soft tissue augmentation with implant submersion.

METHODS

Ten subjects with isolated PSTD in the anterior maxilla characterized by adjacent dentition exhibiting interproximal attachment loss were consecutively enrolled and treated with horizontal and vertical soft tissue augmentation, involving crown and abutment removal, two connective tissue grafts, and submerge healing. Clinical outcomes of interest included mean PSTD coverage, mean PSTD reduction, clinical attachment level (CAL) gain at the implant and adjacent sites and soft tissue phenotype modifications at 1 year. Optical scanning was used for assessing volumetric changes. Professional assessment of esthetic outcomes was performed using the Implant Dehiscence coverage Esthetic Score (IDES), while patient-reported esthetic assessment involved a 0-10 visual analogue scale.

RESULTS

The mean PSTD depth reduction and mean PSTD coverage at 1 year were 2.25 mm, and 85.14%, respectively. A mean keratinized tissue width (KTW) gain of 1.15 mm was observed, while the mean gain in mucosal thickness (MT) was 1.58 mm. A mean CAL gain of 1.45 mm was obtained at the interproximal aspect of the adjacent dentition at 1 year. Greater linear dimensional (LD) changes were observed at the midfacial aspect of the implant compared to the interproximal sites. The mean final IDES was 6.90 points, while patient-reported esthetic evaluation was 8.83 points.

CONCLUSIONS

The present study demonstrated that vertical soft tissue augmentation with a submerged healing is an effective treatment approach for the treatment of challenging PSTDs with adjacent dentition exhibiting interproximal attachment loss. This technique can be effective in resolution of esthetic complications in most cases, providing a substantial gain in interproximal attachment levels at the adjacent dentition.

Clinical, radiographic, and esthetic evaluation of immediate implant placement with buccal bone dehiscence in the anterior maxilla: A 1-year prospective case series

OBJECTIVES

To evaluate the clinical, radiographic, and esthetic outcomes of immediate implant placement with buccal bone dehiscence in the anterior maxilla.

METHODS

In this case series, implants were inserted immediately after tooth extraction in sockets with buccal bone dehiscence. Guided bone regeneration (GBR) with a papilla preservation flap and simultaneous connective tissue grafting (CTG) was used. The following outcome variables were measured: mid-facial mucosal recession, probing depth, bleeding on probing, Pink Esthetic Score (PES), marginal bone loss, and thickness of buccal bone plate (TBP).

RESULTS

12 patients were recruited. Stable mid-facial mucosal level (-0.03 ± 0.17 mm) and excellent soft-tissue esthetic outcomes (PES, 9.17 ± 0.72) were achieved at 1 year. The TBP at platform level was 2.01 ± 0.31 mm at 1-year follow up with a resorption rate of 28.90% ± 15.14%.

CONCLUSIONS

Immediate implant placement using GBR performed with a papilla preservation approach and simultaneous CTG is a feasible treatment procedure in compromised extraction sockets in the anterior region. Favorable esthetic outcomes and buccal bone thickness were obtained. Further studies were needed to evaluate the long-term tissue alteration.

Soft tissue features of peri‐implant diseases and related treatment

BACKGROUND

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

PURPOSE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

A Novel Muco-Gingival Approach for Immediate Implant Placement to Obtain Soft- and Hard-Tissue Augmentation

The aim of this article is to describe a novel approach combining muco-gingival, regenerative and prosthetics concepts for immediate implant insertion that overcomes the limits traditionally considered as contraindications for Type 1 flapless implant positioning, simultaneously obtaining soft- and hard-tissue augmentation. After pre-surgical CBCT evaluation, the surgical technique consisted in the execution of a lateral-approach coronally advanced envelope flap, with oblique submarginal interproximal incisions directed towards the flap’s center of rotation (the tooth to be extracted); after buccal-flap elevation, the atraumatic extraction of the tooth was performed. Following guided implant insertion, a mixture of biomaterial and autologous bone was placed, stabilized by a pericardium membrane and a connective-tissue graft sutured in the inner aspect of the buccal flap. The peri-implant soft tissues were conditioned with a provisional crown until the shape and position for the mucosal scallop to resemble the gingival margin of the adjacent corresponding tooth were obtained; then, the definitive screw-retained restoration was placed. Within the limitations of this case report, the proposed immediate implant placement approach combining CTG application and buccal bone regeneration showed the possibility of obtaining 1-year-follow-up implant success, stable bone level, good esthetic results and high patient satisfaction.

Treatment of multiple adjacent RT 1 gingival recessions with the modified coronally advanced tunnel (MCAT) technique and a collagen matrix or palatal connective tissue graft: 9-year results of a split-mouth randomized clinical trial

OBJECTIVES

To evaluate t he long-term outcomes following treatment of RT 1 multiple adjacent gingival recessions (MAGR) using the modified coronally advanced tunnel (MCAT) with either a collagen matrix CM or a connective tissue graft (CTG).

MATERIAL AND METHODS

Sixteen of the original 22 subjects included in a randomized, controlled split-mouth clinical trial were available for the 9-year follow-up (114 sites). Recessions were randomly treated by means of MCAT + CM (test) or MCAT + CTG (control). Complete root coverage (CRC), mean root coverage (MRC), gingival recession depth (GRD), probing pocket depth (PD), keratinized tissue width (KTW), and thickness (KGT) were compared with baseline values and with the 12-month results.

RESULTS

After 9 years, CRC was observed in 2 patients, one in each group. At 9 years, MRC was 23.0 ± 44.5% in the test and 39.7 ± 35.1% in the control group (p = 0.179). The MRC reduction compared to 12 months was - 50.1 ± 47.0% and - 48.3 ± 37.7%, respectively. The upper jaw obtained 31.92 ± 43.0% of MRC for the test and 51.1 ± 27.8% for the control group (p = 0.111) compared to the lower jaw with 8.3 ± 46.9% and 20.7 ± 40.3%. KTW and KGT increased for both CM and CTG together from 2.0 ± 0.7 to 3.1 ± 1.0 mm (< 0.0001). There were no statistically significant changes in PD.

CONCLUSION

The present results indicate that (a) treatment of MAGR using MCAT in conjunction with either CM or CTG is likely to show a relapse over a period of 9 years, and (b) the outcomes obtained in maxillary areas seem to be more stable compared to the mandibular ones.

CLINICAL RELEVANCE

The mean root coverage at 12 months could not be fully maintained over 9 years. On a long-term basis, the results seem to be less stable in the mandible as compared to maxillary areas.

Occurrence, associated factors and soft tissue reconstructive therapy for buccal soft tissue dehiscence at dental implants: Consensus report of group 3 of the DGI/SEPA/Osteology Workshop

OBJECTIVES

To systematically assess the literature and report on (1) the frequency of occurrence of buccal soft tissue dehiscence (BSTD) at implants, (2) factors associated with the occurrence of BSTD and (3) treatment outcomes of reconstructive therapy for the coverage of BSTD.

MATERIALS AND METHODS

Two systematic reviews addressing focused questions related to implant BSTD occurrence, associated factors and the treatment outcomes of BSTD coverage served as the basis for group discussions and the consensus statements. The main findings of the systematic reviews, consensus statements and implications for clinical practice and for future research were formulated within group 3 and were further discussed and reached final approval within the plenary session.

RESULTS

Buccally positioned implants were the factor most strongly associated with the risk of occurrence of BSTD, followed by thin tissue phenotype. At immediate implants, it was identified that the use of a connective tissue graft (CTG) may act as a protective factor for BSTD. Coverage of BSTD may be achieved with a combination of a coronally advanced flap (CAF) and a connective tissue graft, with or without prosthesis modification/removal, although feasibility of the procedure depends upon multiple local and patient-related factors. Soft tissue substitutes showed limited BSTD coverage.

CONCLUSION

Correct three-dimensional (3D) positioning of the implant is of utmost relevance to prevent the occurrence of BSTD. If present, BSTD may be covered by CAF +CTG, however the evidence comes from a low number of observational studies. Therefore, future research is needed for the development of further evidence-based clinical recommendations.

Etiology and Treatment of Peri-Implant Soft Tissue Dehiscences: A Narrative Review

Implant soft tissue dehiscences compromise not only the aesthetics of the supported restorations but implant survival in the long run. The aim of this narrative review was to briefly present the causative factors of buccal peri-implant soft tissue dehiscences (PSTDs), how these are classified, and the current therapeutic approaches. Implant malposition and the thin peri-implant phenotype are the two major determinants for the occurrence of PSTDs, but other risk factors have also been identified. The most common surgical procedure for treating PSTDs is the split-thickness coronally advanced flap combined with either a connective tissue graft or acellular dermal matrix materials. However, depending on the class and subtype of the dehiscence, the combination of surgical techniques with modifications in the restoration may further ameliorate the final result. In general, within a five-year follow-up period, most techniques lead to a satisfactory aesthetic result, although full coverage of the implant/abutment surface is not always achievable, especially in more extended lesions.

Stability of contour augmentation of implant-supported single crowns in the esthetic zone: One-year cone-beam computed tomography results of a comparative, randomized, prospective, two-center clinical study using two different bone grafting techniques in early implant placement

BACKGROUND

Early implant placement with contour augmentation could provide support and volume to the hard and soft tissues. Herein, we aimed to ascertain whether freeze-dried bone allograft (FDBA) shares with deproteinized bovine bone material (DBBM) the results for esthetic outcomes for anterior teeth and stability of peri-implant facial bone thickness and height by conducting guided bone regeneration.

METHODS

Forty-eight patients were randomly assigned into two groups. In the control group, autogenous bone chips was used to cover the exposed implant surface, followed by a layer of DBBM. This graft combination was then covered with two layers of collagen membrane. In the test group, the exposed implant surface was covered with FDBA, combined with the collagen membrane. During this study, the hard tissue dimensional changes were measured at 12-months post-implant loading by using cone-beam computed tomography.

RESULTS

At 12 months postoperatively, all 48 implants were clinically successful. The mean thickness of facial bone walls ranged from 1.6 to 2.45 mm at the three levels of measurement in the control group and ranged from 1.6 to 2.10 mm in the test group. The mean facial vertical bone wall peak (IP-FC) after loading 1 year presented with values of 0.8 mm (range, 0.0 to 1.25 mm) and 0.5 mm (range, 0.1 to 1.1 mm) coronal to the implant platform in control and test implants, respectively. There were no significant differences in facial bone wall thickness and IP-FC between groups.

CONCLUSIONS

This study demonstrated that autogenous bone chips plus DBBM or FDBA showed similar outcome of peri-implant buccal bone stability in early implant placement after 1 year.

3D-based buccal augmentation for ideal prosthetic implant alignment—an optimized method and report on 7 cases with pronounced buccal concavities

Objectives

Screw-retained restoration of implants is advantageous for biological and esthetic reasons. Due to buccal concavities, however, this preferred type of restoration can only be used in about half of the anterior indications. Based on case series, an optimized method for the treatment of such indications is to be described; the clinical reliability is to be ascertained by means of measurements (before and after augmentation) and assigned to the current literature.

Material and methods

A case series of seven cases with buccal concavities of the anterior alveolar ridge were treated with optimized method, which is presented step-by-step until the prosthetic restoration. The depths of the bone concavities were measured and related to the bone gain after augmentation procedure respectively after implantation.

Results

Linear measurements of the buccal concavities showed an average undercut of 4 mm [SD ± 1.13]. After healing period of six months, the buccal concavities could be compensated bony to such an extent that implants could be inserted in correct position and angulation. On average, there was a horizontal bone gain of 3.7 mm [SD ± 0.59]. Even after implantation and another six months of healing, stable bone dimensions could be assumed with an average of 4.3 [SD ± 0.83] mm of bone gain compared to baseline. In six of the seven cases, the favorite screw-retained, one-piece full-ceramic restoration could be fixed on the implants. Due to the implant axis, one case had to be treated with a cemented two-part full-ceramic system.

Conclusions

With the described optimized method the most favorable screw-retained restoration can also be used in situations with unfavorable concavities of buccal bone. Especially for this indication, a special form of the horizontal deficit, the customized bone regeneration with titanium meshes is highly reliable in terms of healing and extent of augmentation. However, long-term results and a study/control group are required to evaluate the effectiveness of the presented protocol.

Clinical relevance.

Since these situations require an augmentation that is up to 5 mm thick and a procedure that is as minimally invasive as possible appears to be necessary in the visible area, an optimized method is described in this publication.

Prevalence and risk indicators of midfacial peri-implant soft tissue dehiscence at single site in the esthetic zone: A cross-sectional clinical and ultrasonographic study

BACKGROUND

Esthetic complications of dental implants in the esthetic zone can have a major negative impact on patients' quality of life and perception of implant therapy. The aim of the present study was to evaluate the prevalence of peri-implant soft tissue dehiscence (PSTD) and the clinical and ultrasonographic risk indicators for this condition.

METHODS

Subjects with one or more healthy single dental implants in the esthetic area were identified and recruited. Clinical and ultrasonographic measurements, including PSTD class and subclass, pocket depth, keratinized mucosa width (KMW), mucosal thickness (MT) at 1 mm and 3 mm, buccal bone distance (BBD) and buccal bone thickness, were evaluated in healthy implants and implants with PSTD.

RESULTS

153 subjects with a total of 176 dental implants were included. The prevalence of PSTD was 54.2% and 56.8% on a patient and implant level, respectively. The most frequent type of PSTD was the one characterized by having both an implant-supported crown longer than the clinical crown of the homologous tooth and a visible abutment/implant fixture exposed to the oral cavity. The multi-variate analysis showed that the presence of an adjacent implant, a longer time of the implant in function, limited MT, reduced KMW and increased BBD were significantly associated with the presence of a PSTD.

CONCLUSIONS

PSTDs are common findings in the esthetic region. Several risk indicators for this condition, such as presence of an adjacent implant, increased time in function of the implant, higher BBD, lower KMW and MT were identified. This article is protected by copyright. All rights reserved.

Patient-reported outcome measures following soft-tissue grafting at implant sites: A systematic review

OBJECTIVES

To review the available literature on patient-reported outcome measures (PROMs) following soft tissue augmentation at implant sites.

MATERIALS AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported PROMs, including post-operative morbidity, painkillers intake, quality of life, aesthetics and satisfactions.

RESULTS

Nineteen articles were included in the qualitative analysis. Autogenous grafts (free gingival graft and connective tissue graft), acellular dermal matrix and xenogeneic collagen matrix were utilized, either with a bilaminar- or an apically positioned flap approach. PROMs reported in the literature included perceived hardship of the procedure and pain during the surgery, post-operative morbidity, painkillers intake, number of days with discomfort, satisfaction, aesthetic evaluation, quality of life and willingness to undergo the treatment again. Most of the included studies showed similar PROMs between autogenous grafts and substitutes, in terms of post-operative morbidity, painkillers intake, quality of life, aesthetic assessment and satisfaction. Nevertheless, a trend towards lower post-operative discomfort was observed for graft substitutes. High scores for patient satisfaction and aesthetic evaluation were observed in all the interventions compared to non-grafted sites.

CONCLUSIONS

PROMs represent a crucial endpoint of clinical studies evaluating the outcomes of soft tissue grafts at implant sites. Most of the studies did not find significant differences in terms of patient morbidity and painkillers between autogenous grafts and substitutes. Soft tissue grafting can enhance patient satisfaction and aesthetic evaluation compared to non-grafted sites.

Design of customized soft-tissue substitutes for posterior single-tooth defects: A proof-of-concept in-vitro study

OBJECTIVES

Soft-tissue volume augmentation treatments do not provide the satisfactory long-term functional and esthetic outcomes. The aim of the study was to develop a standardized digital procedure to design individual soft-tissue substitutes (STS) and apply mathematical modeling to obtain average shape STS for single posterior tooth defects.

MATERIAL AND METHODS

Thirty-three casts from 30 patients were scanned. STS were designed with a computer-aided design software and a systematic procedure standardized the measurements across all STS using 3D-analysis software. The occlusal, mesial-distal, and buccal-lingual planes were defined to partition, each STS and produce a mesh. The thickness values of each 3D slice were documented in a coordinate system chart to generate a scatter graph. Graphs were embedded into images (Orange software) and images were analyzed via hierarchical clustering.

RESULTS

Three STS groups were identified according to shape. Two shapes corresponded to the maxilla defects: a square (n = 13) with dimensions of 10 mm in a lingual-buccal (length) and 7-10 mm in a mesial-distal (width) direction; a rectangle (n = 11) of 11 mm in length and 4-7 mm in width. The average shape for mandible defects (n = 9) was smaller (6-8 mm in length, 5-10 mm in width). The highest thickness in all STS was in the buccal portion, above the alveolar ridge, with median values of 2 mm. The lowest thickness of 0.2 mm was at the edges.

CONCLUSIONS

The study developed novel methodology to design customized, as well as average shape STS for volume augmentation. Future STS harboring adapted geometry might increase volume augmentation efficiency and accuracy, while reducing surgical time.

Is there any biomaterial substitute for peri-implant soft tissue phenotype modification? A network meta-analysis of the appraisal literature

Evidence shows that an increased width and thickness of the keratinized mucosa favours peri-implant health. The aim of this network meta-analysis was to compare the clinical effects of alternative biomaterials for peri-implant soft tissue phenotype modification (PSPM) in patients with dental implants when compared to autologous tissue grafts. An electronic search without language or date limitations was performed in four databases and the grey literature for articles published until November 2020. The eligibility criteria included randomized clinical trials (RCTs) evaluating the clinical outcomes of biomaterials for PSPM. A pairwise and network meta-analysis was conducted for each parameter to assess and compare the outcomes between the different treatment arms for the primary and secondary outcomes. A total of 11 RCTs were included in this review. The free gingival graft (FGG) showed the best clinical effect for increasing keratinized mucosa width (KMW). When compared in a network, the FGG demonstrated the best treatment ranking of probability results, followed by connective tissue graft (CTG), acellular dermal matrix (ADM), and xenogeneic collagen matrix (XCM). For the parameters 'mucosa thickness' and 'participant satisfaction with aesthetics', the results were CTG > ADM > XCM and XCM > ADM > CTG, respectively. Autogenous tissue grafts (FGG/CTG) demonstrate the best results in increasing KMW and mucosa thickness when compared to the other biomaterials.

Survival and success rates of soft-milled cobalt-chromium-ceramic full-arch screw-retained implant-supported prostheses: a 2- to 7-year follow-up retrospective study

OBJECTIVES

To retrospectively assess implant and prosthesis survival and success and patient satisfaction in edentulous patients treated with soft-milled cobalt-chromium-ceramic full-arch screw-retained implant-supported prostheses (SCCSIPs) over a mean clinical follow-up period of 4 years.

MATERIALS AND METHODS

Twenty-one edentulous patients, aged 47-80 years, underwent restoration with 27 SCCSIPs (210 implants, 349 crown units). After definitive prosthesis insertion, patients participated in a yearly dental check-up recall program, including clinical and radiographic examinations. All supporting implants were examined for biological and technical complications, and the restorations were evaluated using modified California Dental Association (CDA) criteria. Life table and Kaplan-Meier survival analyses were performed. Patient satisfaction regarding chewing, esthetics, comfort, and phonetics was evaluated using a visual analog scale (VAS).

RESULTS

After a mean of 4 years, two implants (3.8%) failed, with no effect on prosthesis survival. The cumulative survival rate was 98.6% and 100% for implants and prostheses, respectively. The most frequent minor biological complication was soft tissue recession (11%). Porcelain fracture was the only major technical complication (0.6% of crown units), while the only minor technical complication was porcelain chipping (4% of crown units), which required only polishing. Overall, 66.7% of the prostheses were free of technical complications. Patient satisfaction was high to very high. Less satisfaction was noted with comfort due to soft tissue recession and food impaction.

CONCLUSIONS

Within the limitations of this study, we conclude that the survival and success rates of SCCSIPs in edentulous patients were excellent.

CLINICAL RELEVANCE

SCCSIPs should be considered when planning metal-ceramic implant-supported restorations.

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores

OBJECTIVES

To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability.

MATERIALS AND METHODS

Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables.

RESULTS

Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters.

CONCLUSION

The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.

Prevalence and risk/protective indicators of buccal soft tissue dehiscence around dental implants

AIM

To evaluate the prevalence of buccal peri-implant soft tissue dehiscence (PISTD) in anterior implants and to identify the risk/protective indicators of PISTD in implants not suffering peri-implantitis.

MATERIALS AND METHODS

240 randomly selected patients from a university clinic database were invited to participate in the present cross-sectional study. Those who accepted, after the evaluation of their medical and dental records, were clinically examined to assess the prevalence of buccal PISTD in non-molar implants. Multilevel multivariate logistic regression analyses were then carried out to identify those factors associated either positively (risk) or negatively (protective) with buccal PISTD in implants without peri-implantitis.

RESULTS

92 patients with a total of 272 dental implants were analysed. At implant-level, the prevalence of buccal PISTD was 16.9%, while when selecting only implants without peri-implantitis it was 12.0%. Buccal PISTD was present in 26.7% of the implants diagnosed with peri-implantitis. The following factors were identified as risk/protective indicators of buccal PISTD in implants without peri-implantitis: malposition (too buccal vs. correct: OR=14.67), thin peri-implant phenotype (OR=8.31), presence of at least one adjacent tooth (OR=0.08) and presence of abutment (OR=0.12).

CONCLUSIONS

PISTD are highly prevalent among patients with dental implants in this university-based population, and several factors were identified as risk and protective indicators of PISTD in implants not suffering peri-implantitis.

The peri-implant phenotype and implant esthetic complications. Contemporary overview

OBJECTIVE

To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications.

OVERVIEW

The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications.

CONCLUSIONS

While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications.

CLINICAL SIGNIFICANCE

Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

Peri-implant marginal mucosa defects: Classification and clinical management

Peri-implant marginal mucosa defects (PMMDs) are alterations of the peri-implant soft tissue architecture characterized by an apical discrepancy of the mucosal margin respective to its ideal position with or without exposure of transmucosal prosthetic components or the implant fixture surface. PMMDs may not only represent an esthetic concern but also predispose to biofilm accumulation and subsequent initiation and progression of peri-implant inflammatory diseases. A treatment-driven classification for tooth-bound, facial PMMDs in non-molar sites, consisting of three different levels of complexity, is proposed. Clinical recommendations pertaining to the prosthetic and surgical management of each type of PMMD, illustrated with practical examples, are provided with the purpose of facilitating decision-making processes in daily practice.

Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis

BACKGROUND

The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous approaches to augment soft tissue volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for peri-implant health has been subject of debate in the field of implant dentistry. The aim of this systematic review was to analyze the evidence regarding the efficacy of soft tissue augmentation procedures aimed at modifying the PSP and their impact on peri-implant health.

METHODS

A comprehensive search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported findings on KMW, MT, and/or STH changes. The effect of the intervention on peri-implant health was also assessed. Selected articles were classified based on the general type of surgical approach to increase PSP, either bilaminar or an apically positioned flap (APF) technique. A network meta-analysis including only randomized-controlled trials (RCTs) reporting on PSP outcomes was conducted to assess and compare different techniques.

RESULTS

A total of 52 articles were included in the qualitative analysis, and 23 RCTs were included as part of the network meta-analysis. Sixteen RCTs reported the outcomes of PSP modification therapy with bilaminar techniques, whereas 7 involved the use of APF. The analysis showed that bilaminar techniques in combination with soft tissue grafts (connective tissue graft [CTG], collagen matrix [CM], and acellular dermal matrix [ADM]) resulted in a significant increase in MT compared to non-augmented sites. In particular, CTG and ADM were associated with higher MT gain as compared to CM and non-augmented sites. However, no significant differences in KMW were observed across different bilaminar techniques. PSP modification via a bilaminar approach utilizing either CTG or CM showed beneficial effects on marginal bone level stability. APF-based approaches in combination with free gingival graft (FGG), CTG, CM, or ADM showed a significant KMW gain compared to non-augmented sites. However, compared to APF alone, only FGG exhibited a significantly higher KMW gain. APF with any evaluated soft tissue graft was associated with with reduction of probing depth, soft tissue dehiscence and plaque index compared to non-augmented sites compared to non-augmented sites. The evidence regarding the effect of PSP modification via APF-based approaches on peri-implant marginal bone loss or preservation is inconclusive.

CONCLUSIONS

Bilaminar approach involving CTG or ADM obtained the highest amount of MT gain, whereas APF in combination with FGG was the most effective technique for increasing KMW. KMW augmentation via APF was associated with a significant reduction in probing depth, soft tissue dehiscence and plaque index, regardless of the soft tissue grafting material employed, whereas bilaminar techniques with CTG or CM showed beneficial effects on marginal bone level stability.

The lack of keratinized mucosa is associated with poor peri-implant tissue health: a cross-sectional study

OBJECTIVES

The aim of this cross-sectional study is to determine the association between the absence of keratinized mucosa and peri-implant tissue health.

METHODS AND MATERIALS

This cross-sectional study comprised 412 implants from 200 patients from faculty-based clinics. Demographic, medical, and clinical information were collected. The modified sulcus bleeding index, modified plaque index, mucosal recession, probing depth, bone level, the width of keratinized mucosa, and implant status were evaluated by three calibrated examiners. Each implant was categorized into either of two peri-implant mucosa groups: keratinized mucosa (KM) or non-keratinized mucosa (NKM). The chi-square test was performed to the association between the keratinized mucosa groups and peri-implant clinical parameters and peri-implant status. Multiple logistic regression models were analyzed to test potential associations between peri-implant clinical parameters and the presence or absence of keratinized mucosa.

RESULTS

Thirty-two implants (7.8%) were categorized into the NKM group. The prevalence of peri-implantitis was 12.5% and 8.3% at the subject level and implant level, respectively. The NKM group was associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis (p < 0.05). After controlling for confounding factors, the NKM group demonstrated higher plaque accumulation, mucosal recession, and interproximal bone level ≥ 3 mm with adjusted odds ratios of 2.98 (1.33-6.66), 3.20 (95% CI, 1.03-9.90), and 4.62 (1.70-12.58), respectively.

CONCLUSION

Within the limitation of this study, the lack of keratinized mucosa around the dental implants was significantly associated with more plaque accumulation, mucosal recession, interproximal bone level ≥ 3 mm, and peri-implantitis.

Early implant placement and peri-implant augmentation with a porcine-derived acellular dermal matrix and synthetic bone in the aesthetic area: a 2-year follow-up prospective cohort study

The aim of this study was to evaluate the 2-year follow-up results of early implant placement with simultaneous peri-implant augmentation using an acellular dermal matrix (ADM) and a synthetic bone substitute in the aesthetic zone. Twenty subjects were enrolled in this study, they were either males (eight) or females (12), with a mean age of 47.8±4.45 years and each patient was treated with one implant. Simultaneous contour augmentation with guided bone regeneration was performed using synthetic bone particles (maxresorb®) and an ADM (mucoderm®). Keratinized mucosa width (KMW) and gingival thickness (GT) were assessed at baseline, 1, 3, 6, 12 and 24 months. Marginal bone loss, probing pocket depth, bleeding on probing and plaque index were also recorded. GT and KMW increased between baseline and 1 month, slightly decreased between 1 month and 12 months (P<0.001) and remained stable between 12 and 24 months (P<0.001). After 2 years, mean marginal bone loss level was 0.51 ± 0.63mm, with no probing pocket depth values >5mm and no concomitant signs of inflammation registered. Pink aesthetic score was 8.3. Combining an ADM and guided bone regeneration with early implant placement revealed a significant increase of 1.9mm for GT and 1.6mm for KMW after 2 years, showing good patient satisfaction regarding the aesthetic outcomes of soft tissues and prosthetic crown.

Soft-Tissue Grafting Solutions

Many soft-tissue grafting solutions are available for reconstruction and restoration of volume and esthetics of keratinized attached mucosa at compromised periodontal and peri-implant interfaces. Presence of healthy soft tissues is crucial for functional and esthetic implant success as well as longevity of natural dentition. The options available each provide unique characteristics with different indications. This article is intended to provide an efficient and comprehensive overview of this topic, covering the essentials of periodontal anatomy and physiology, indications for soft-tissue grafting, and keys in recipient and donor-site preparation, and exploring the available procedural arsenal in soft-tissue grafting.

A new technique for peri-implant recession treatment: Partially epithelialized connective tissue grafts. Description of the technique and preliminary results of a case series

BACKGROUND

Data on implant recession coverage (RC) are very scarce.

PURPOSE

To present a new surgical approach and preliminary results for the treatment of peri-implant soft tissue recession via partially epithelialized connective tissue grafts (PECTGs).

MATERIALS AND METHODS

We harvested PECTGs from the palate using a double-blade scalpel. All donor sites were sutured and covered with a stent. Dissection lines were placed minimally coronal to the mucogingival border. The recipient areas were prepared epiperiostally. All PECTGs were sutured with the keratinized mucosa (KM) portion toward the local KM tissue and were subsequently widely covered by the local mucosal tissue layer.

RESULTS

Fifteen patients with 22 implants were available for follow-up. The recession depth at baseline was 2.4 ± 1.1 mm (median: 2.5). After a mean observational period of 5 years, we found a mean recession value of 0.4 ± 0.5 mm (median: 0). We found a mean increase in the peri-implant KM width of 2.2 ± 1.1 mm (median: 1.5). In all cases, progression of the recession had stopped. None of the grafts was lost. The mean RC was 2 ± 0.9 mm (median: 1.5 mm) [88 ± 20% (median: 100)]. Complete RC was found in 64% of the implants. The results have remained stable for up to 13 years.

CONCLUSION

Soft tissue recession around dental implants may successfully be treated using the PECTG technique.

Platform switch hybrid zygoma implants improve prosthetics and marginal bone protection after extra-sinus placement

PURPOSE

The aim of our studdy is clinical evaluation of Platform switch hybrid zygoma implants.

MATERIALS AND METHODS

117 zygomatic implants were followed up during this time. They included 55 Brånemark System zygoma implants, 38 Noris implants, and 24 novel iRES hybrid implants with platform switch.

RESULTS

Bone quality and quantity are the prerequisite for successful implant treatment. Zygomatic implants are intended for patients with severely resorbed maxilla that cannot accommodate conventional implants without prior extensive bone grafting. Such regenerative procedures, like sinus lifts, prolong implant rehabilitation to several months (12-18). Furthermore, extensive grafts are less predictable showing varying degrees of graft resorption. Zygoma implants enable full, often immediate, reconstruction of the upper dental arch without the need for sinus lift treatment. The original zygoma protocol runs the implants through the sinus, requires general anesthesia, and positions the prosthetic platform of the implants on the palate, which makes prosthesis cumbersome. It also induces risk for post-op sinusitis. Extra-sinus approach with novel zygoma hybrid implants bypasses sinuses and positions the implant prosthetic platform on the crest allowing for same good prosthetics as on conventional dental implants. Furthermore, crestal threads and a platform-switch, of the novel zygoma design, increase implant anchorage and minimize marginal bone loss. The study presents evolution of zygoma implant rehabilitation protocol and zygoma implant design in our clinical practice over 15 years (2004-2019).

CONCLUSION

Extra-sinus zygomatic implant placement lowers the risk of post-op sinusitis and makes procedure possible to be done in local anesthesia.

Sectional Connective Tissue Technique Combined With an Emergence Profile Provisional for Gingival Margin Stabilization During Immediate Implant Placement: A Case Report With a 2-Year Follow-Up

INTRODUCTION

Little is known regarding maintaining free gingival margin stability after immediate implant placement. Therefore, we present a sequential technique incorporating a sectional connective tissue graft with an emergence tissue provisional to stabilize the free gingival margin position during immediate implant placement in the esthetic zone.

CASE PRESENTATION

A 57-year-old male was referred for assessment and treatment of a failing maxillary right central incisor. Clinical examination revealed poor retentive features, recurrent caries, and exposed endodontic material rendering a poor prognosis for the remaining tooth root system. After comprehensive evaluation, as well as understanding important patient case expectations, a decision was made to remove the existing tooth and place an immediate implant with a staged-provisional approach. To maintain the free gingival mid-facial height, a sectional-connective tissue graft technique was used concurrently with a custom emergence profile provisional to stabilize the gingiva immediately post-implant placement.

CONCLUSION

Patients undergoing implant replacement of failing anterior maxillary teeth are at risk of esthetic complications. Marginal stability of the facial gingival is an important component of establishing and maintaining the final esthetic outcome. In cases where the initial hard or soft tissue thickness may put the patient at risk, combining soft and hard tissue augmentation with attention to emergence profile provisionalization appears to aid in the initial stability of the buccal free gingival margin. This report details the steps associated with a sectional connective tissue technique combined with emergence profile provisonalization and characterizes the gingival stability up to 2.5 years obtained with this approach.

The association between gingival recession and buccal bone at maxillary anterior teeth

BACKGROUND

Gingival recession and a thin or absent buccal plate occur frequently at maxillary anterior teeth and necessitate careful treatment planning to prevent future complications. However, the association between these two conditions is unclear and the ability of gingival recession to predict underlying buccal bone deficiencies is unknown. Therefore, the aim of this study is to use clinical and radiographic data to test this association and determine the influence of demographic and clinical parameters on both conditions.

METHODS

This investigation comprised a single-center, retrospective study. Data were derived from periodontal examinations performed on 66 adult subjects. Corresponding cone-beam computed tomography images were used to measure the width of buccal bone at two points along the root surface and the distance between the bone crest and cemento-enamel junction (CEJ). Results were then analyzed to determine the association between the presence of gingival recession and the condition of radiographic buccal bone, as well as the relative contribution of demographic parameters and other clinical findings to gingival recession and buccal bone conditions.

RESULTS

Gingival recession was present at 32.9% of maxillary anterior teeth and was most common at canines, followed by lateral incisors and central incisors. Mean buccal bone widths were significantly less, and the distance between the CEJ and bone crest was significantly greater for teeth with recession. Accordingly, gingival recession was a significant predictor for buccal bone thickness <1 mm at the level of 4 mm apical to the CEJ (odds ratio 2.733, 95% confidence interval 1.644 to 4.543, P < 0.0001). Probing depths were related to the presence or absence of gingival recession, while patient sex, age, and the apico-coronal height of the gingiva were related to buccal bone thickness.

CONCLUSION

Within the limitations of this study, maxillary anterior teeth with pre-existing gingival recession were more likely to have thin (<1 mm) buccal bone.

Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction

This state-of-the-art review presents the latest evidence and the current status of autogenous soft tissue grafting for soft tissue augmentation and recession coverage at teeth and dental implant sites. The indications and predictability of the free gingival graft and connective tissue graft (CTG) techniques are highlighted, together with their expected clinical and esthetic outcomes. CTGs can be harvested from the maxillary tuberosity or from palate with different approaches that can have an impact on graft quality and patient morbidity. The influence of CTGs on soft tissue thickness and keratinized tissue width are also discussed.

Classification of facial peri-implant soft tissue dehiscence/deficiencies at single implant sites in the esthetic zone

BACKGROUND

The incidence of a peri-implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of peri-implant PSTD at a single implant site.

METHODS

Four classes of PSTDs were discussed based on the position of the gingival margin of the implant-supported crown in relation to the homologous natural tooth. In addition, the bucco-lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae.

RESULTS

Subsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prosthetic-surgical approach or soft tissue augmentation with a submerged healing) was also suggested.

CONCLUSION

This paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.