Treatment of peri-implant soft tissue defects: a narrative review

[Validity of digital periapical radiography and cone beam computed tomography in the detection of peri-implant bone defects: in vitro study]

Abstract

To compare the diagnostic accuracy of digital radiography (DR) and cone beam computed tomography (CBCT) in the detection of peri-implant bone defects.

Materials and methods

Implants were placed in 5 fresh bovine ribs (3 without peri-implant bone defects, 12 with 1.4mm peri-implant bone defects) and images were taken using (i) portable x-ray system (DEXCOWIN 3000), (ii) intraoral x-ray sensor (SENSOR H1/SENSOR H2), (iii) volume-limited HSCT with 3D Accuitomo 80 (CASTELLINI). Images of each were randomly presented to 10 examiners. Confidence in the diagnosis of the presence or absence of a peri-implant radiolucency was recorded on a scale of bone defect definitely absent, doubts about the defect if absent or present, defect definitely present. Analyzes was performed using a kappa test.

Results

There has been a coincidence between the direct digital radiography and the cone beam computed tomography in piece A of 83.3%, in piece B of 100% and in piece C of 88%, giving an average total coincidence 90.43%.Conclusion: Direct digital radiography provided the same results as cone beam computed tomography in the detection of peri-implant bone defects at an early stage. Digital radiographs are a reliable and valid method and perform significantly better than cone beam computed tomography for detecting peri-implant bone defects at an early stage.

Metabolic Conditions and Peri-Implantitis

Dental implants to replace lost teeth are a common dentistry practice nowadays. Titanium dental implants display a high success rate and improved safety profile. Nevertheless, there is an increasing peri-implantitis (PI), an inflammatory disease associated with polymicrobial infection that adversely affects the hard and soft tissues around the implant. The present review highlights the contribution of different metabolic conditions to PI. The considerations of both local and systemic metabolic conditions are crucial for planning successful dental implant procedures and during the treatment course of PI. Un- or undertreated PI can lead to permanent jaw bone suffering and dental implant losses. The common mediators of PI are inflammation and oxidative stress, which are also the key mediators of most systemic metabolic disorders. Chronic periodontitis, low-grade tissue inflammation, and increased oxidative stress raise the incidence of PI and the underlying systemic metabolic conditions, such as obesity, diabetes mellitus, or harmful lifestyle factors (cigarette smoking, etc.). Using dental biomaterials with antimicrobial effects could partly solve the problem of pathogenic microbial contamination and local inflammation. With local dentistry considering factors, including oral microbiota and implant quality control, the inclusion of the underlying systemic metabolic conditions into the pre-procedure planning and during the treatment course should improve the chances of successful outcomes.

Association between IL-1A, IL-1B and IL-1RN Polymorphisms and Peri-Implantitis: A Systematic Review and Meta-Analysis

Recent studies report that individuals with polymorphisms in the genes that encode for interleukin (IL)-1α and IL-1β (IL-1A and IL1B, respectively) and for IL-1 receptor antagonist (IL-1RN) may be more susceptible in developing peri-implantitis. Therefore, the current systematic review evaluates what is reported about the role of genetics, more specifically of single nucleotide polymorphisms (SNP) on IL-1 and variable number of tandem repeats (VNTR) on IL-1RN, in the development of peri-implantitis. This systematic review was carried out by screening PubMed, B-on, Cochrane and Scopus databases, for articles English, Spanish, and Portuguese, with no limit regarding the publication year. Eight articles were selected for systematic review and four for meta-analytic syntheses. Our results show that although there is a lack of consensus in the literature, there seems to be an association between IL-1A, IL-1B, and IL-1RN polymorphisms with peri-implantitis. The results of the meta-analysis showed that patients who have the polymorphic allele at position +3954 of the IL-1B gene have on average almost twice the risk of developing peri-implantitis (odds ratio = 1.986, 95% confidence interval).

Preservation of Peri-Implant Papilla: A Narrative Review

Beside osseointegration and restoration of function, the patient's subjective satisfaction with the esthetic result is a touchstone of the success of implant therapy. The long-term maintenance and reconstruction of papilla-like soft tissue between two adjacent implants in the esthetic zone which is esthetically satisfactory is generally regarded as a challenge. The road to success is much more complicated with implants, because of biologic and anatomical limitations of peri-implant tissues. Numerous techniques have been proposed to manage the hard and soft tissues in an attempt to achieve ideal esthetic results which includes surgical and nonsurgical techniques. The goal of reconstructive procedures is to provide peri-implant bone that supports and maintains gingival contours. An interdisciplinary approach has an obvious advantage of long-term preservation of a healthy peri-implant tissue which is of key importance in ensuring acceptable function and subjective satisfaction of esthetics of dental implants. A detailed literature search was performed in English language from 1986 to 2012, which included review articles, original research, as well as case reports. The search was performed in National Library of Medicine's PubMed database, Google Search, and Science Direct. A manual search of hard copies of available journal was also performed using interdental papilla, peri-implant papilla, esthetics, and dental implant as key words, in an attempt to gain insight into the limitations of papilla preservation, the factors which may potentially affect the maintenance and reconstruction of inter-implant papilla, and the contemporary methods to augment it.

Soft-tissues stabilization after immediate implant; platform switch with supraperiosteal augmentation

The architecture around an oral implant pushes the clinicians for an equalization of biological and physiological requirements. An esthetic implant-supported restoration needs plethora of knowledge and expertise. Surgeon skills can be of use for correct tridimensional position of implant in the extraction socket, shaped abutment contours, and anatomical final crown. An immediate implant placement for a fresh socket requires existing oral parameters judgment and evidence-based treatment plan. They are hard- and soft-tissue relationship, gingival biotype, and the tooth position. In this article, we describe a case of immediate implant placement, provisional crown, bovine bone contraction, soft-tissue collapse, and its management.

Efficacy of free gingival graft in the augmentation of keratinized tissue around implants: A prospective clinical study

Background

Effectuating adequate width of keratinized tissue (WKT) can lead to a healthy and stable implant/soft tissue interface which is important for the long term success of the implant. The use of free gingival grafts (FGG) for widening the WKT around dental implants increases the amount of attached gingival tissue and prevents clinical attachment loss.

Aim

The aim of the study was to assess the ability of FGG to create a healthy implant/soft tissue interface.

Methods and Material

A total of 10 edentulous sites in 10 patients with inadequate keratinized tissue indicated for replacement of missing teeth were treated. An implant was placed in edentulous sites and the keratinized tissue was augmented using FGG at the second stage of implant surgery. WKT was recorded at baseline, 3rd month and 6th month post-operatively. Plaque index (PI), gingival index (GI), probing depth (PD) and papillary index (PPI) and were recorded at 3 and 6 months post-operatively to evaluate the health of peri-implant tissues. Paired t-test was used for standard deviation and the level of significance was taken as 5% (P < 0.05).

Results

The WKT at 3 (3.2±1.61mm) and 6 months (3±1.56 mm) compared to the baseline was statistically significant (P = 0.034). The other parameters PI, GI, PD, PPI showed no clinical significance from 3 and 6 months (P > 0.05).

Conclusions

Augmentation of FGG created a significant gain in the WKT which resulted in a healthy implant/soft tissue interface.

Application of digital prosthodontics and connective tissue grafting in the management of peri-implant mucosal recession around a malpositioned 1-piece implant: A clinical report

This clinical report describes a conservative approach to improve an unesthetic implant-supported crown and peri-implant mucosal recession around a malpositioned, 1-piece implant in the maxillary right central incisor region by using digital technology. In such clinical situations, the implants are usually removed because of an unpredictable definitive esthetic outcome. However, this clinical report describes the preservation of such a compromised implant by improving the esthetic outcome with a connective-tissue graft, and a digital approach used a 1-step preformed zirconia coping technique with an appropriate emergence profile.

Correlation between Buccal Bone Thickness at Implant Placement in Healed Sites and Buccal Soft Tissue Maturation Pattern: A Prospective Three-Year Study

Background: Optimal aesthetic implant restoration is a combination of a visually pleasing prosthesis and adequate surrounding peri-implant soft tissue architecture. This study describes the influence of the residual buccal bone thickness (BBT), measured at the time of implant placement, on the soft tissue maturation during three years of follow-up. Methods: Seventy-eight implants were enrolled in the present study. The BBT was assessed at the surgical stage and each case assigned to Group 1 (BBT values ≤0.5 mm), Group 2 (BBT values >0.5 and <1.5 mm), or Group 3 (BBT values ≥1.5 mm). Only native bone and healed sites were included. The tooth height (TH), based on the distance between the buccal free gingival margin at the zenith level and the crown incisal edge, according to the main axis of the tooth, was monitored at one, two, and three years from the final prosthodontic rehabilitation to determine any occurrence of recession or coronal repositioning of the gums over time. A Pearson Two-Tailed test was applied and the significance level set at p ≤ 0.05. Results: For BBT values ≤0.5 mm, the buccal gum at three years showed an average recession of 1.22 ± 0.41 mm. For BBT values >0.5 and <1.5 mm, the buccal gum also showed recession of 0.64 ± 0.29 mm. In contrast, for BBT values ≥1.5 mm, the buccal gum showed coronal growth of 0.77 ± 0.22 mm. The differences between the groups were significant (p ≤ 0.01) at all times. Conclusion: The BBT at the time of implant placement was found to affect the buccal gingival margin stability over three years of observation.