Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region

Impact of Vertical Inter-Implant Distance in Two Adjacent Single-Unit Posterior Implants: A Retrospective Cohort Study With 1-8 Years of Follow-Up

AIM

To investigate the impact of different vertical interimplant distances (VIDs) on the long-term success of two adjacent single-unit implants.

MATERIALS AND METHODS

This retrospective study categorized implants into two groups based on VID: Group 1 (VID < 2 mm) and Group 2 (VID ≥ 2 mm). Further classification was done according to horizontal inter-implant distance (HID). Statistical models were used to evaluate the primary outcome of implant survival, secondary outcomes of complication-free survival rates and radiological findings.

RESULTS

We included 290 patients with 376 two adjacent single-unit implants. Group 1 included 223 patients with 280 implants, whereas Group 2 comprised 89 patients with 96 implants. The implant survival rates were 93.2% in Group 1 and 96.8% in Group 2 over the 8 years, with no significant association between the groups. Similarly, the overall complication-free survival rates were 60.6% in Group 1 and 65.6% in Group 2, showing no significant association between the groups. Radiological assessments also showed no notable association between the groups. This trend was consistent in the subgroup analyses based on HID, with no significant differences in implant survival, complication-free survival rates or radiological outcomes.

CONCLUSIONS

Considering the study limitations of an 8-year post-prosthetic review period and despite varying VIDs, our findings showed no significant difference in implant survival, complication-free survival rates or radiological assessments. This underscores the positive prognosis of two adjacent single-unit implants and contributes to a deeper understanding of the success factors in implantology.

TRIAL REGISTRATION

The study was registered in the Chinese Clinical Trial Registry (ChiCTR2300073215).

Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial

OBJECTIVES

The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla.

MATERIALS AND METHODS

Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12).

RESULTS

No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups.

CONCLUSION

Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters.

CLINICAL RELEVANCE

There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.

The distally anchored connective tissue graft platform for papilla enhancement: A case report

BACKGROUND

As the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal papillae fill in single-tooth implant restorations remains a challenge. The distally anchored connective tissue platform is a novel soft tissue augmentation technique that consists of harvesting an autogenous connective tissue graft from the palate, folding it, and positioning it at the level of the distal occlusal and buccal surfaces with the help of a distal sling suture to the adjacent distal tooth.

METHODS

This case report describes how a maxillary central incisor with compromised hard and soft tissues were replaced using a comprehensive treatment plan.

RESULTS

The clinical outcomes showed stable mucosal margin levels and complete papillae fill. The patient expressed satisfaction with the achieved results.

CONCLUSIONS

The distally anchored connective tissue graft platform performed at the time of implant placement emerges as a viable and effective soft tissue augmentation technique that yields highly esthetic results.

KEY POINTS

Why is this case new information? To the best of our knowledge, this is the first case report in the literature using the distally anchored connective tissue platform. What are the keys to successful management of this case? Adequate diagnosis and decision-making, resulting in a treatment plan focused on reconstructing both soft and hard tissues in a single-tooth implant within the esthetic area, yield favorable clinical, radiological, and patient-reported outcomes. What are the primary limitations to success in this case? The primary limitation of this study is its reliance on a single case report.

Immediate implant placement with immediate or delayed provisionalization in the maxillary aesthetic zone: A 10-year randomized trial

AIM

To compare the marginal bone level of immediately placed implants, with either immediate or delayed provisionalization (IP or DP), in the maxillary aesthetic zone after 10 years of function.

MATERIALS AND METHODS

Participants with a failing tooth in the maxillary aesthetic zone were randomly assigned to immediate implant placement with either IP (n = 20) or DP (n = 20) after primary wound closure with a free gingival graft. The final restoration was placed 3 months after provisionalization. The primary outcome was change in marginal bone level. In addition, implant survival, restoration survival and success, peri-implant tissue health, mucosa levels, aesthetic indices, buccal bone thickness and patient satisfaction were evaluated.

RESULTS

After 10 years, the mean mesial and distal changes in marginal bone level were -0.47 ± 0.45 mm and -0.49 ± 0.52 mm in the IP group and -0.58 ± 0.76 mm and -0.41 ± 0.72 mm in the DP group (p = .61; p = .71). The survival rate was 100% for the implants; for the restorations, it was 88.9% in the IP group and 87.5% in the DP group. Restoration success, according to modified USPHS criteria, was 77.8% in the IP group and 75.0% in the DP group. The prevalence of peri-implant mucositis was 38.9% and 35.7% and of peri-implantitis 0.0% and 6.3%, respectively, in the IP group and DP group (p = 1.0; p = .40). The Pink Esthetic Score and White Esthetic Score was 15.28 ± 2.32 in the IP group and 14.64 ± 2.74 in the DP group, both clinically acceptable (p = .48). The buccal bone thickness was lower in the DP group. Patient satisfaction was similar in both groups (p = .75).

CONCLUSIONS

The mean marginal bone level changes after immediate implant placement with IP were similar to those after immediate placement with DP.

CLINICAL TRIAL REGISTRATION

Registered in the National Trial Register (NL9340).

The knowledge regarding the impacts and management of black triangles among dental professionals and laypeople

This study aimed to assess the knowledge regarding impacts, causes and management of black triangles (BT) among participants from different educational backgrounds including dental students, dentists and laypeople. This descriptive cross-sectional observational research included 435 participants who comprised 4 groups: pre-clinical (3rd year) dental students, clinical (4th and 5th year) dental students, dentists, and laypeople. A constructed self-reported questionnaire was utilized to assess participants' demographic data and their knowledge of the impacts, causes and management of BT. The VAS scale was used to assess participants' ratings for the impacts of BT on esthetics, with 0 meaning no impact and 10 meaning very severe negative impacts. The most reported treatments for BT were "cannot be treated" 99.3% and "non-surgical periodontal treatment" 67.1%. Meanwhile, the least reported was "modify the porcelain" 41.8%. The most reported cause of BT was "periodontal disease" 85.1%. However, the least reported were "parafunction" and "deep implants" 33.1% each. Dental professionals had better knowledge of the causes (t = 8.189, P < 0.001) and management (t = 8.289, P < 0.001) of BT than the non-dental participants. The dentists had the best knowledge, while the laypeople had the least knowledge of the causes (F = 62.056, P < 0.001) and treatment (F = 46.120, P < 0.001) of BT. The knowledge of the causes (t = 0.616, P = 0.538) and treatment (t = 1.113, P = 0.266) for BT was not significantly different between males and females. Age was not significantly related to the total knowledge about the causes (r = -0.034, P = 0.475) or treatment (r = -0.034, P = 0.482) for BT. Dental professionals had better knowledge of the impacts, causes and management of BT than the non-dental participants. The dentists were the best, while the laypeople were the worst in this regard. Age and gender had no relationships with the knowledge of causes or management of BT.

Clinical analysis of the tooth-implant papilla for two narrow-diameter titanium-zirconium implants in the anterior area: prospective controlled clinical study

BACKGROUND

Rehabilitation of the anterior area when the mesio-distal space is reduced is a challenge for the clinician, due to the patient's anatomical limitations and aesthetic requirements. Narrow Diameter Implants (NDI) are an option of treatment when the standard diameter implant is not possible, but the evidence is scarce. This prospective clinical study aims to analyze the formation of the tooth-implant papilla between the implant and the adjacent natural tooth in the maxillary lateral incisors and mandibular incisors.

METHODS

A total of 40 patients treated with NDI, of titanium-zirconium (Ti-Zr) alloy i.e., 2.9 mm Test Group (TG) and 3.3 mm Control Group (CG), were included. The mesiodistal distance between the adjacent natural teeth was used for implant selection, maintaining 1.5 mm between the fixation and the adjacent tooth. Clinical assessment was performed by a clinical examiner at 6 and 12 months after the final prosthesis. The primary variable was the Jemt Papillary Index. Also, implant survival rate (SR), complications, Implant Stability Quotient (ISQ), and patient-reported outcomes measures (PROMs) such as aesthetics, chewing, phonation, comfort, and self-esteem were analyzed.

RESULTS

A significant amount of papilla filling was observed concerning the baseline, with a trend towards more formation of the papilla in the TG, with a JPI score of 3. No significant differences were observed between the two groups regarding implant SR, clinical parameters, and complications. In terms of PROMs, a higher satisfaction in the TG was observed, with significant intergroup differences for aesthetics, comfort, self-esteem, and primary stability ISQ (TG: 59.05 (SD: 5.4) vs. CG: 51.55 (SD: 5.7)).

CONCLUSIONS

The 2.9 mm diameter Ti-Zr implants achieved a formation of papilla similar to 3.3 mm implants in the anterior region at 12 months of follow-up after the final prosthetic restoration. The use of Ti-Zr implants with a diameter of 2.9 mm to rehabilitate single teeth in areas of the anterior region, where the mesiodistal distance is limited, showed favorable clinical results and a high degree of satisfaction during 1 year of observation similar to 3.3 mm dental implants.

TRIAL REGISTRATION

This study was retrospectively registered in ClinicalTrials.gov with the number NCT05642520, dated 18/11/2022.

Evaluation of Survival Rates of Dental Implants and the Risk Factors: A Retrospective Follow-Up Study

Introduction The current research sets out to assess implant early survival rates and identify relevant parameters. Methods The research spanned the years 2021 and 2022 and included all individuals who had dental implants. Various criteria, such as age, sex, maxilla/mandible, implant location, immediate implant, implant diameter, implant length, and others, were used to determine the implant survival rate in the research. A multiple logistic regression model was used to show the risk variables for early survival rates of implants, and components with p < 0.05 were further included after the Chi-square test was employed to filter them. Results The current research included 128 patients who had a single implant procedure, including 70 males and 58 females. The early survival rate was 91.40%, and 117 implants were retained after implantation. Risk variables that were shown to be associated with early survival rates were patients aged 30-60 years (OR: 2.542), immediate implant placement (OR: 3.742), and implant length less than 10 mm (OR: 3.972). Conclusions Age, tooth location, implant length, and immediate implantation were risk variables that contributed to our subjects' above 91% early survival rate of implants.

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.

Achieving optimal implant esthetics using a team approach Part 1 a review of evidence-based criteria in implant treatment

As dental implants have evolved into a universally accepted treatment option, it is essential to identify nuances of the peri-implant complex and their impact on treatment given the increasing evidence of peri-implantitis and implant loss. A thorough knowledge of anatomy and biology, careful treatment planning, correct placement, prosthetic and occlusal design, and proper long-term maintenance all play a role in dental implant therapy. The goal of this part 1 presentation is to review evidence-based criteria in implant treatment including the surgical and restorative parameters, and the desired implant features, with the objective of achieving predictable results that improve the longevity of the implant and restoration, maintain peri-implant health, and optimize the esthetic outcome. By following science-based guidelines, implant treatment can be improved and simplified with more predictable results, especially in the esthetic zone, where demands are greater and there is less room for error.

Marginal bone loss around implants with platform switching and platform matched connection: A systematic review

STATEMENT OF PROBLEM

Platform switching using narrower abutments than the implant platform has been used to reduce marginal bone loss (MBL) surrounding dental implants. While platform switching has been reported to prevent initial peri-implant bone loss, available data regarding the use of the platform-switching implant abutment configuration with long-term follow-up has been sparse; thus, the systematic review was planned to evaluate the best available evidence for the use of the platform switching technique.

PURPOSE

The purpose of this systematic review was to answer the specific question, "Is there a difference between platform-matching implant abutment configurations and platform-switching implant abutment configurations in terms of MBL changes around endosseous implants"?

MATERIAL AND METHODS

The PubMed/Medline, Scopus, Google Scholar, and Lilac databases were searched by 2 independent reviewers for articles published between January 2000 and July 2022. Platform-switched versus platform-matched implants were examined for changes in MBL in human randomized clinical trials (RCTs) and potential clinically controlled cohort studies (PCCS).

RESULTS

Overall, 4 eligible studies were included and critically evaluated to summarize their findings. The follow-up period of the included studies was between 5 and 10 years. Two of the included studies showed a mean ±standard deviation of 0.6 ±0.20 mm MBL at 5 years and 1.20 ±0.21 mm at 10 years for the platform switched (PS) technique and 1.1 ±0.3 mm and 1.24 ±0.39 mm MBL for the platform matched (PM) technique. Another study showed marginal bone level changes for the platform-switched technique to be 0.18 ±0.14 mm as compared with the platform matched technique (0.80 ±0.40 mm). In one of the studies published in 2019, the mean estimated difference in the marginal bone levels of PS- and PM-restored implants after 5 years was reported to be 0.29 mm. The descriptive analysis of 4 RCTs indicated that platform-switched implant-to-abutment connections reduced average marginal bone loss surrounding implants compared with platform-matched implant-to-abutment connections, favoring the platform-switched approach.

CONCLUSIONS

Platform switching appears to be a beneficial approach for retaining the crestal bone around dental implants.

Current Knowledge on the Healing of the Extraction Socket: A Narrative Review

The concept of extraction socket healing has been severally researched and reported over the years, since tooth extraction remains one of the most common procedures performed in the dental clinic. Understanding this healing process is of utmost importance because the outcome has a direct bearing on future prosthetic rehabilitation and, by extension, on patients' esthetics and masticatory function, among others. This mini review, therefore, summarized the current knowledge on the different stages of socket healing, including the biologic and clinical events that occur following tooth extraction up until the complete closure of the socket. Additionally, the modeling of the alveolar bone/process post extraction, and the resultant dimensional changes that, altogether, shape the bone, were reviewed and documented. The effects of various socket preservation interventions to mitigate these dimensional changes, and therefore preserve the alveolar process in a condition suitable for future prosthetic rehabilitation, were highlighted. Finally, a review of some of the factors that influence the entire process was also carried out.

Evaluation of one-piece zirconia dental implants: An 8-year follow-up study

OBJECTIVES

Long-term studies of modern zirconia implants are still insufficient. This prospective 8-year follow-up study investigated one-piece zirconia implants.

MATERIALS AND METHODS

Patients who had received a one-piece zirconia dental implant (PURE ceramic implant, Institut Straumann GmbH, Basel, Switzerland) were included in this study. Next to the implant survival and success rates, the radiographic and clinical implant parameters were assessed.

RESULTS

The overall survival rate of 67 zirconia implants in 39 patients was 100%. The overall success rate was 89.6%. Around the immediate zirconia implants, the success rate was 94.7%, and around the delayed implants, 87.5%. The immediate implants showed a significantly higher bone crest compared to the delayed implants (p = 0.0120). According to the pink esthetic score, the immediate implants revealed more favorable esthetic results compared to the delayed implants after an 8-year follow-up (p = 0.0002).

CONCLUSIONS

After 8 years, the one-piece zirconia implants presented an 89.6% success rate. Regarding the timing of implantation, in individual cases, immediate implantation can have slight advantages over delayed implantation.

CLINICAL RELEVANCE

Immediate implants can also be considered for zirconia implants and should not be excluded on principle.

Effectiveness of palatally positioned implants in severely atrophic edentulous maxillae: a systematic review

The purpose of this systematic review was to define the effectiveness of palatally positioned dental implants placed in atrophic maxillae. Searches were performed in five databases including the gray literature, up to August 2021, by 2 independent reviewers, in order to answer the following research question: Is the palatal approach technique effective in the rehabilitation of atrophic maxillae? In the initial search, 1948 articles were found and after applying the inclusion and exclusion criteria, five studies were selected, none of which was a randomized clinical trial. A total of 681 implants were placed, 549 of them with a palatal approach and 132 at the alveolar crest, with an effectiveness of 98.38% and 99.5%, respectively, with no statistically significant difference between the groups. In assessing the risk of bias, only one of the studies had a low risk of bias. Implants installed with the palatal approach technique showed high effectiveness for rehabilitation of atrophic maxilla; however, few studies in the literature report this technique, requiring more controlled studies, and with less risk of bias, to confirm the results obtained in this systematic review.

Benchmark performance of anodized vs. sandblasted implant surfaces in an acute dehiscence type defect animal model

OBJECTIVES

Crestal bone formation represents a crucial aspect of the esthetic and biological success of dental implants. This controlled preclinical study analyzed the effect of implant surface and implant geometry on de novo crestal bone formation and osseointegration.

MATERIALS AND METHODS

Histological and histomorphometrical analysis was performed to compare three implant groups, that is, (1) a novel, commercially available, gradient anodized implant, (2) a custom-made geometric replica of implant "1," displaying a superhydrophilic micro-rough large-grit sandblasted and acid-etched surface, and (3) a commercially available implant, having the same surface as "2" but a different implant geometry. The study applied a standardized buccal acute-type dehiscence model in minipigs with observation periods of 2 and 8 weeks of healing.

RESULTS

The amount of newly formed crestal bone (BATA) around control groups (2) and (3) was significantly increased when compared to the test group (1) at the 8 weeks of healing time point. Similar results were obtained for all parameters related to osseointegration and direct bone apposition, to the implant surface (dBIC, VBC, and fBIC), demonstrating superior osseointegration of the moderately rough, compared to the gradient anodized functionalization. After 2 weeks, the osseointegration (nBIC) was found to be influenced by implant geometry with group (3) outperforming groups (1) and (2) on this parameter. At 8 weeks, nBIC was significantly higher for groups (2) and (3) compared to (1).

CONCLUSIONS

The extent (BATA) of de novo crestal bone formation in the acute-type dehiscence defects was primarily influenced by implant surface characteristics and their ability to promote osseointegration and direct bone apposition. Osseointegration (nBIC) of the apical part was found to be influenced by a combination of surface characteristics and implant geometry. For early healing, implant geometry may have a more pronounced effect on facilitating osseointegration, relative to the specific surface characteristics.

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.

Immediate implant placement vs. early implant treatment in the esthetic area. A 1-year randomized clinical trial

OBJECTIVES

To assess the impact of implant placement and temporization timing on esthetic outcomes of single maxillary anterior implants with intact bone walls and interproximal bone.

MATERIALS AND METHODS

Test group patients received an immediate implant with immediate provisional restoration and socket preservation, while patients in the control group received an early implant placement with guided bone regeneration and delayed loading. Patients were followed for 1 year after final prosthetic and pink esthetic score (PES), mid-buccal mucosal level (MBML), crestal bone changes (CBC), and peri-implant soft tissue parameters, and patient chair time was recorded.

RESULTS

Fifty patients received the intended treatment (25 test and 25 control). No implants failed. PES after 1 year was 12.8 ± 1.19 for the test group and 12.5 ± 1.36 for the control group (p = .362). MBML difference between baseline (after final crown delivery) and the 1-year follow-up was gain of 0.2 ± 1.02 mm for the test group (p = .047) and no change in the control group. CBC after 1 year were 0.1 mm ± 0.21 mm (mesial) and 0.2 mm ± 0.22 mm (distal) for the test group and 0.2 mm ± 0.25 mm (mesial) and 0.3 mm ± 0.19 mm (distal) for the control group, p = .540 (mesial) and p = .462 (distal). Test group required half the chair time (127 ± 13 min) when compared to the control group (259 ± 15 min, p < .001).

CONCLUSIONS

Within the limits of this trial, both treatment protocols resulted in excellent esthetic outcomes with PES >12 after 1-year follow-up.

Esthetic complications in implant dentistry

Esthetic complications in implant dentistry have become a significant consideration for patients and practitioners. This review presents an appraisal on the current knowledge of the physiological peri-implant soft-tissue dimensions and factors that may compromise peri-implant tissue esthetics. Factors such as papilla fill adjacent to the implant and midfacial mucosal height are critical parameters that determine the esthetic success of implant-supported restorations. Papilla fill adjacent to a single dental implant appears to depend upon the clinical attachment level of the neighboring tooth. A horizontal inter-implant distance of at least 3 mm is necessary to ensure optimal interproximal mucosal embrasure between two adjacent implants in the anterior maxilla. In cases where implants cannot be placed at least 3 mm apart, a single implant with a cantilever bridge should be considered. Buccolingual implant positioning plays a major role in midfacial mucosal height. Soft-tissue volume grafting following immediate implant placement in the presence of a thin soft-tissue phenotype or simultaneous to surgical peri-implantitis therapy might help to overcome facial mucosa recession.

Aesthetic Outcomes of Early Occlusal Loaded SLA Dental Implants with Hydroxyl Ion Modified Surface-A 12 Months Prospective Study

Background: Many efforts have been made recently to arrange a newer, more hydrophilic and more osteoconductive implant surface. One of the possible options in this matter is modification with hydroxyl ion. Materials and Methods: Forty implants with the diameters 3.5 and 4.0 mm were inserted as a single missing tooth restoration protocol in the frontal aspect of the maxilla. All implants were loaded early in a 4 week period. Prior to and during the surgery, the following indices were considered: height of keratinized tissue, the thickness of soft tissue, and the initial level of bone tissue. After 12 months, the implant and the tissues in its direct vicinity were evaluated once more with the following indices: marginal bone loss (MBL), height of keratinized tissue (HKT), probing pocket depth (PPD), pink and white aesthetics scores (PES, WES), as well as pain sensations combined with the procedure (VAS). All results were related to the diameter of the implant and thickness of periodontal biotype. Results: High aesthetic outcomes were reported regardless of soft tissue thickness and implant diameter. The VAS score was higher for the 4.0 implant group, and the thickness of soft tissue had no influence on VAS. In case of implantation in thin or soft tissue, higher MBL levels were reported (0.26 mm), while in case of a thick phenotype, MBL was 0.06 mm. Conclusions: Hydrophilic surface implants can be used for a protocol of early functional occlusal loading. The initial thickness of soft tissue does not influence aesthetic outcomes and does not raise pain perception, although it may elevate crestal bone resorption.

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.

3D Considerations and Outcomes of Immediate Single Implant Insertion and Provisionalization at the Maxillary Esthetic Zone: A Long-Term Retrospective Follow-Up Study of Up to 18 Years

AIM

Long-term studies addressing the outcomes of single immediate implantation and provisionalization at the maxillary esthetic zone are needed. The current study aimed to assess such outcomes along a follow-up period of up to 18 years.

MATERIALS AND METHODS

The current study is a continuation follow-up of our previously published up to 6-year follow-up study, dated between the years 2002-2008, performed in a private clinical practice in Tel-Aviv, Israel. A total of 15 patients (23 implants) who had been treated for single-tooth replacement at the maxillary esthetic zone since 2002, underwent clinical and radiographic follow-up evaluations. Primary outcomes included mean Marginal Bone Levels (MBL), with Bleeding on Probing (BOP), implant success rate, prosthetic and esthetic complications evaluated as secondary outcomes.

RESULTS

The implant success rate was at 100%. Bone remodeling processes were observed over the follow-up period, with 0.9 mm mean marginal bone loss observed during the first 6 years of observation, followed by -0.13 ± 0.06 mm mean loss after 6 to 18 years. The last finding suggests bone deposition, as reported by other studies (Donati et al., 2012). At the final radiographic evaluation, a mean MBL of 1.35 mm ± 0.16 was demonstrated. No differences with respect to implant type or site were found. A generalized absence of BOP and esthetic complications occurred in two cases as a result of continuous adjacent teeth eruption versus obvious implant ankylosis.

CONCLUSIONS

Adhering to careful clinical protocols and 3D bone to implant considerations while immediately placing an anterior implant, this treatment approach offers both stable and esthetically acceptable results for the replacement of missing teeth at the maxillary esthetic zone.

Esthetic Outcome and Oral Health-Related Quality of Life after Restoration with Single Anterior Maxillary Implants

Background/Aim: To evaluate the esthetic outcome of single implant restorations and the correlation of these esthetic results between patient satisfaction and oral health-related quality of life (OHRQoL).

Material and Methods: 15 patients with single-tooth implants in the anterior maxilla region were included in this study. Patients were clinically followed to evaluate the esthetic outcomes of implant prostheses and photographs of the implant site were obtained using a digital camera. A researcher evaluated the photographs according to the pink esthetic score/white esthetic score (PES/WES) index. Patients were asked to complete a questionnaire including 13 questions to evaluate their satisfaction with the overall implant and restoration treatments using by visual analogue scale (VAS). OHRQoL was evaluated by patients with the questionnaire Oral Health Impact Profile-14 (OHIP-14).

Results: The mean PES/WES was 13.6. In Ohip-14 questionnaire, the questions were answered ‘never’ generally. The mean VAS score was 9.01±0.9 and ranged from 7.6 to 9.7. There was no correlation between VAS and PES/WES (p= 0.484), similarly, there was no correlation between OHIP-14 and PES/WES (p= 0.763).

Conclusions: All of the implant restorations’ PES/WES scores were clinically acceptable. Professionals evaluated the esthetic outcome more suspicious than patients. Patients were satisfied with the esthetic results.

A Technique to Record and Transfer the Distance Between the Bone Crest and the Interproximal Contact Point to the Dental Laboratory to Maintain the Interdental Papilla While Fabricating Implant Supported Restorations

The interdental papilla plays an important role in terms of esthetics and function. Management of the interdental papilla, especially around implants can be challenging. One of the factors mentioned in the literature that affects the viability of the papilla is the distance of the interdental contact point from the crest of the bone. The following case report describes a technique to predictably achieve an interdental contact area within the proper distance from the crest of the bone to help maintain the papilla for the long term.

A Randomized Clinical Trial Comparing Immediate Loading and Delayed Loading of Single-Tooth Implants: 5-Year Results

The aim of this prospective randomized clinical study was to compare the clinical treatment outcome for single dental implants submitted to either immediate loading (IL) or delayed loading (DL) after 5 years of follow-up. Fifty patients with a missing maxillary tooth (15–25) were randomly allocated to either the IL or DL. The treatment procedures included implant installation in healed sites, temporary screw-retained crown and replacement with a permanent single implant crown. The two groups were evaluated with regard to implant survival, marginal bone level, papillae index, pink and white esthetic score (PES, WES). At the 5-year follow-up the implant survival rate was 100% and 95.8% for IL and DL, respectively. Implant success rate was 91.7% and 83.3% for IL and DL, respectively. The mean ± SD marginal bone loss for IL and DL was −0.50 ± 0.73 mm and −0.54 ± 0.65 mm, respectively. (p = 0.782). Statistically significant less marginal bone loss was found non-smokers (p = 0.021). No statistically significant differences were found for IL and DL concerning papillae index PES and WES after 5 years. This study suggests that implant-supported single crowns in the maxillary aesthetic zone can present similar results with respect to either IL or DL after 5 years.

Need for lateral bone augmentation at two narrow-diameter implants: A prospective, controlled, clinical study

OBJECTIVES

To detect the potential influence of implant diameter and anatomic factors on the need for bone augmentation procedures (BAPs) when replacing congenitally missing lateral incisors (MLIs).

MATERIALS AND METHODS

Patients with congenitally missing MLIs with a mesio-distal distance between the canine and the central incisor of 5.9-6.3 mm received a Ø2.9 mm implant while Ø3.3 mm implants were placed when the distance was 6.4-7.1 mm. The following linear measurements were recorded using a calliper: width of the alveolar process (WAP), width of the bony alveolar ridge (WAR) and thickness of the facial bone after implant osteotomy (TFB). Guided bone regeneration was performed in case of fenestration- or dehiscence-type defects or a thin TFB (<1.7 mm).

RESULTS

Fifty Ø2.9 mm and 50 Ø3.3 mm were included in 100 patients. WAP and WAR did not differ between the groups (p > .05). TFB was statistically significant larger in the Ø2.9 group (1.75 ± 0.59 mm) compared to the Ø3.3 group (1.5 ± 0.63 mm) (p = .041). Fenestration-type defects (p = .005) and a thin facial bone wall (p = .045) was observed more frequently in the Ø3.3 compared to the Ø2.9 group. Correspondingly, BAP was indicated more frequently in the Ø3.3 compared to the Ø2.9 group (p = .017). WAP, MD and WAR were statistically significant correlated to the need for BAP (p < .001). As independent variable, only WAR influenced the probability of BAP (p < .001).

CONCLUSION

The use of 2.9 diameter implants was correlated to a reduced frequency of BAP compared to 3.3 mm implants, without reaching a statistically significant difference. Measurement of the WAP provides the clinician useful information to predict BAP.

Evaluation of papilla levels following three different techniques for the second stage of implants - A clinical and radiographic study

Objective:

Papilla formation after placement of an implant is influenced by the underlying bone and the periodontal biotype. The second-stage surgery to uncover the implants may have an effect on the regeneration of papilla and various techniques such as the scalpel, diode laser, and punch technique are used. In the present study, an attempt has been made to evaluate papillary fill levels following three different techniques of second-stage implant surgery.

Materials and Methods:

A total of 35 patients with 45 implants (39 single implants and 3 sites with two adjacent implants) were randomly divided into three groups with 15 implants each: second-stage implant surgery with midcrestal incision using scalpel (Group I), with I-shaped incision using scalpel (Group II), and using diode laser (Group III). The mean papillary fill and mean crestal bone loss for all three groups were compared at baseline, 3 months, and 6 months of prosthesis delivery.

Results:

Complete papilla fill at 6 months was seen in 60% and 73.3% of sites in Group II and Group III, respectively. Bone level contacting implant and adjacent teeth was less in both Groups II and III. Bone level from the contact point to the bone crest was least in Groups II and III.

Conclusion:

The use of diode laser during second-stage surgery showed maximum papillary fill and minimal crestal bone loss when compared with other two techniques. Irrespective of technique used for second-stage surgery, bone loss did occur after prosthesis delivery.

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.

An enigmatic soft tissue creeping phenomenon: The spontaneous peri-implant mucosa margin and papilla growth. A retrospective clinical study

Objectives

The aim of the present retrospective study was to evaluate papillae filling rate and buccal margins coronal growth in implant‐supported prostheses which were over‐contoured at the apical buccal third to form a rearmost collar zone, thus mimicking a false root.

Material and methods

The influence of adjacent elements, teeth, implants, or pontics was examined. One‐hundred and three crowns have been assessed in photographs taken on 61 patients after prosthesis delivering and at last follow‐up (mean 2.8 years). The Jemt index was adopted to evaluate papillae growth at the baseline and follow‐up as follows: 0, absence of papilla; 1, less than half of interdental embrasure height; 2, more than half of interdental embrasure height; 3, fully papilla filled interdental embrasure. Index score 4, papilla hyperplasia was not included. Moreover, the coronal growth (or recession) of buccal mucosa in implant‐supported crowns was assessed.

Results

At baseline, a total of 29 papillae had a 0 score, while only two scored 3 with complete papilla formation. On follow‐up, only one papilla scored 0, while 46 scored 3 with complete interdental embrasures filling. The highest papilla score was registered from first year crown insertion and likewise in interdental embrasures located between two implants or implants and pontics. Moreover, the buccal margin growth was observed in almost 80% of crowns. Such findings seem to indicate that buccal margin and papilla around implant‐supported crowns presented a coronal growth over time, especially during its first year. The average papilla growth between two implants was no lower than that observed in papilla present between implants and natural teeth.

Conclusions

Recessed areas at collar of implant‐supported prostheses appear to positively influence papillae and buccal margin growth, especially in its first year. Papilla growth between two implants was similar to that observed between implants and natural teeth.

One-by-one immediate dental implants: A papillae preservation concept for adjacent implants in a compromised periodontal case

In an immediate implant placement and provisionalization strategy, the esthetic results of multiple adjacent implants can be obtained even with compromised periodontium by implementing the "one-by-one" protocol. Staged extractions of multiple adjacent teeth to maintain soft tissue architecture are a key feature of the technique described.

Hyaluronic Acid: Ray of Hope for Esthetically Challenging Black Triangles: A Case Series

Purpose

The purpose of this study is to evaluate the clinical efficacy of enhancing deficient interdental papilla with hyaluronic acid gel injection.

Materials and Methods

Eight patients (three males and five females) were included. Patients had papillary deficiency in the upper anterior area. Prior to treatment, photographic images were taken for each patient. After the administration of a local anesthetic, a 23G needle was used to inject <0.2 mL of a commercially available and Food and Drug Administration-approved hyaluronic acid gel this treatment was repeated up to 2-3 times. Clinical photographic measurements of the black triangle area (BTA), black triangle height, and black triangle width were undertaken before the treatment and during follow-up. The interdental papilla reconstruction rate was calculated to determine the percentage change of the BTA between the initial and final examinations of the interdental papilla by means of injectable hyaluronic acid gel were evaluated.

Results

Eight sites had complete interdental papilla reconstruction and six sites showed improvements ranging from 78.5 ± 19.83%. More specifically, when contact point and the bone crest reached 6 mm, virtually complete interdental papilla reconstruction was achieved.

Conclusions

The results from this study are encouraging and present evidence that small papillary deficiencies between teeth can be enhanced by the injection of a hyaluronic acid gel.

The fate of the distal papilla around tooth-bound implant-supported restorations in maxillary central incisor sites

The distal papilla around tooth-bound implant-supported restorations in maxillary central incisor sites tends to exhibit an atrophied aspect after tissue maturation following the delivery of the final prosthesis. This article provides an explanation to this phenomenon, as well as a set of therapeutic considerations to minimize its occurrence and optimize the outcomes of tooth replacement therapy with dental implants in this specific anatomic location.

[Relationships among the periodontal biotype characteristics in the maxillary anterior]

OBJECTIVE

To explore the correlation among gingival thickness (GT), underlying alveolar bone thickness (BT), and other periodontal biotype characteristics in the maxillary anterior.

METHODS

A total of 40 young volunteers with healthy periodontal were involved in this research. The periodontal probe was previously used to divide the gingiva from thick to thin. Two records were measured by cone beam CT (CBCT) GT, which was measured at the cement-enamel junction level; and BT, which was measured at 3 locations: 1, 3, 5 mm below the alveolar crest. Oral and gypsum measurements were used to analyze the associations of the crown width/crown length ratio (CW/CL), the keratinized mucosa width (KM), and the free gingival margin curvature.

RESULTS

Significant difference in the GT was observed between the thick and thin biotypes, which were divided by periodontal probe (P<0.01). Difference was observed in each periodontal biotype characteristic between the thick (GT≥1 mm) and thin biotypes (GT<1 mm) (P<0.05). BT was positively associated with GT (r=0.293, P=0.001), CW/CL (r=0.273, P=0.003), KM (r=0.291, P=0.001), and free gingival margin curvature (r=0.290, P=0.001).

CONCLUSIONS

The transparency of the probing in the sulcus could analyze the GT qualitatively. The thick and thin biotypes have different periodontal biotype characteristics. Compared with individuals with thick biotype, those with thin biotype are susceptible to risk dental aesthetic.

The effect of a 2-mm inter-implant distance on esthetic outcomes in immediately non-occlusally loaded platform shifted implants in healed ridges: 12-month results of a randomized clinical trial

BACKGROUND

Three millimeter is considered as the minimum distance to obtain soft and bone tissue stability in case of adjacent implants. The possibility to preserve peri-implant bone level using a platform switching connection has questioned this concept.

PURPOSE

The study evaluates soft tissue maintenance and marginal bone stability around implants, placed at 2 or 3 mm of distance.

MATERIALS AND METHODS

Thirty patients received two immediately loaded implants either at 2-mm (test) or at 3-mm (control) of distance in the premolar area. Soft tissue esthetics (papilla height and fill, keratinized tissue, recession) and radiographic peri-implant bone level changes were measured at 3, 6, and 12 months.

RESULTS

No significant differences between the two groups were detected neither for all soft tissue esthetic outcomes nor for bone level modifications up to 12 months.

CONCLUSION

The results suggested that up to 12 months post-loading, both 2- and 3-mm inter-distance platform-switched implants in healed site, supported adequate esthetic outcomes and peri-implant bone stability.

Topographic characterization and in vitro biofilm adhesion to titanium and polypropylene membranes used for alveolar preservation

Background

Nonresorbable membranes have been widely used in guided bone regeneration (GBR) procedures in posttooth extraction alveoli. In this context, one of the properties suggested by the GBR technique is that these barriers, when exposed to the oral environment, control or prevent the infiltration of connective and epithelial tissue cells, favoring the proliferation of bone cells inside the alveolus, without the growth of biofilm.

Materials and Methods

This in vitro study evaluated the topographic characteristics and in vitro biofilm adhesion on membranes used for alveolar preservation, bone Heal™ and Titanium Seal™. Fragments of these membranes (5 mm × 5 mm) were used for all experiments. The topographical morphology and chemical characterization of the membranes were analyzed by scanning electron microscope and dispersive energy X-ray spectroscopy, respectively. For the in vitro biofilm adhesion assay, samples were immersed in Candida albicans (American Type Culture Collection [ATCC] 10231) and Staphylococcus aureus (ATCC 25923) mixed biofilm for 7 and 14 days. Biofilm formation was measured by quantitative analysis with crystal violet aqueous solution, in a spectrophotometer, with a wavelength of 590 nm.

Results

The ultrastructural images showed a rough surface for the titanium membrane, without homogeneity in the surface structure, while the polypropylene membrane presented a smoother surface without depressions. The chemical composition of the membranes by Ehlers-Danlos syndrome has identified the presence of copolymer and traces of zinc for the polypropylene membrane; in contrast, the titanium membrane revealed the unique presence of titanium. In addition, there was a decrease in biofilm formation on the surface of the titanium membrane compared to polypropylene (P < 0.05), at both evaluated times.

Conclusions

It can be concluded that despite the greater heterogeneity of the titanium membrane surface, the results showed less biofilm formation on this membrane (P < 0.05), which may be indicated in cases of oral cavity exposure.

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.

Open-Healing Socket Preservation with a Novel Dense Polytetrafluoroethylene (dPTFE) Membrane: A Retrospective Clinical Study

Background and objectives: Non-resorbable dense polytetrafluoroethylene (dPTFE) membranes are widely used for regeneration procedures, alone or in combination with particulate materials. The aim of this work was to examine the efficacy of a newly developed dPTFE membrane in the management of extraction socket healing. Materials and Methods: The extraction premolar sockets of 44 patients (20 men and 24 women) were preserved. One group received prosthetic rehabilitation with a fixed partial denture (FPD) (PROS group, N = 19) and a second group received immediate implant placement (IMPL group, N = 25). The PROS group sockets were augmented with a bovine derived xenograft and covered with a newly developed dPTFE membrane prior to FPD rehabilitation. Results: In the IMPL group, socket preservation was combined with immediate implant placement. Before (T0) and 6 months after surgery (T1), horizontal and vertical dimensions were measured with customized stents. No significant differences in alveolar bone loss from T0 to T1 were observed between the PROS and IMPL groups in the horizontal dimension for any tooth type. There was a significant difference in alveolar bone loss from T0 to T1 between the two groups for only single-rooted maxillary premolars in the vertical dimension. Conclusions: The use of the examined new dPTFE membrane consistently led to the preservation of hard tissue in the extraction sites.

[Precise investigation of digital guide plates applied to implant surgery of anterior teeth]

OBJECTIVE

To study the precision of digital guide plates applied to the implant surgery of anterior teeth.

METHODS

Fifty patients scheduled to receive implant restoration treatment in anterior teeth were enrolled in this study and divided into two groups (n=25, each group): those who were given routine implant restoration treatment (control group, 45 implants) and those who received implant restoration treatment using a digital guide plate (test group, 51 implants). After implantation, planned and placed implants were superimposed using digital software, and deviations (corona, apex, depth, degree) were analyzed. Esthetic parameters were assessed at 1 week (baseline), 6 month, and 1 year post final restoration. Pink esthetic (PES) and white esthetic (WES) scores were respectively used to evaluate the soft tissue and restoration esthetic outcome.

RESULTS

The deviation parameters in the test group were significantly lower than those in the control group (P<0.05). PES and WES values recorded for the control group at 1 week, 6 month, and 1 year post final restoration were significantly lower than those in the test group (P<0.05).

CONCLUSIONS

The digital guide plate can improve the accuracy of the three-dimensional position of implants in the maxillary esthetic zone. As such, this device may play an important role in obtaining the ideal aesthetic effects of maxillary anterior teeth.

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.

Peri-implant health

OBJECTIVE

The aim is to define clinical and histologic characteristics of peri-implant tissues in health and describe the mucosa-implant interface.

IMPORTANCE

An understanding of the characteristics of healthy peri-implant tissues facilitates the recognition of disease (i.e., departure from health).

FINDINGS

The healthy peri-implant mucosa is, at the microscopic level, comprised of a core of connective tissue covered by either a keratinized (masticatory mucosa) or non-keratinized epithelium (lining mucosa). The peri-implant mucosa averages about 3 to 4 mm high, and presents with an epithelium (about 2 mm long) facing the implant surface. Small clusters of inflammatory cells are usually present in the connective tissue lateral to the barrier epithelium. Most of the intrabony part of the implant appears to be in contact with mineralized bone (about 60%), while the remaining portion faces bone marrow, vascular structures, or fibrous tissue. During healing following implant installation, bone modeling occurs that may result in some reduction of the marginal bone level.

CONCLUSIONS

The characteristics of the peri-implant tissues in health are properly identified in the literature, including tissue dimensions and composition. Deviation from the features of health may be used by the clinician (and researcher) to identify disease, including peri-implant mucositis and peri-implantitis.

The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review

OBJECTIVE

The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites.

IMPORTANCE

Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy.

FINDINGS

A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors.

CONCLUSIONS

Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.

The etiology of hard- and soft-tissue deficiencies at dental implants: A narrative review

OBJECTIVE

The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites.

IMPORTANCE

Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy.

FINDINGS

A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors.

CONCLUSIONS

Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing.

Is Peri-Implant Probing Causing Over-Diagnosis and Over-Treatment of Dental Implants?

Pocket probing depth (PPD) and bleeding on probing (BOP) measurements are useful indices for the assessment of periodontal conditions. The same periodontal indices are commonly recommended to evaluate the dental implant/tissue interface to identify sites with mucositis and peri-implantitis, which, if not treated, are anticipated to lead to implant failure. The aim of the present narrative review is to discuss the available literature on the effectiveness of probing at dental implants for identification of peri-implant pathology. There is substantial clinical evidence that PPD and BOP measurements are very poor indices of peri-implant tissue conditions and are questionable surrogate endpoints for implant failure. On the contrary, the literature suggests that frequent disturbance of the soft tissue barrier at implants may instead induce inflammation and bone resorption. Moreover, over-diagnosis and subsequent unnecessary treatment may lead to iatrogenic damage to the implant-tissue interface. Despite this, the recommendations from recent consensus meetings are still promoting the use of probing at dental implants. For evaluation of implants, for instance at annual check-ups, the present authors recommend a clinical examination that includes (i) a visual inspection of the peri-implant tissues for the assessment of oral hygiene and the detection of potential redness, swelling, (ii) palpation of the peri-implant tissues for assessment of the potential presence of swelling, bleeding, suppuration. In addition, (iii) radiography is recommended for the assessment of crestal bone level for comparison with previous radiographs to evaluate potential progressive bone loss even if there is a need for more scientific evidence of the true value of the first two clinical testing modes.

A 5-year longitudinal cohort study on crown to implant ratio effect on marginal bone level in single implants

BACKGROUND

A 5-year longitudinal cohort study was carried out to evaluate the influence of anatomical crown to implant ratio (CIR) on peri-implant marginal bone level (MBL) in single implants.

MATERIALS AND METHODS

The longest possible implants, according to the availability of pristine bone, were inserted, one per patient, among periodontally healthy teeth in consecutively recruited subjects. CIR and MBL changes were measured on standardized radiographs. The relationship between MBL and multiple predictors was investigated. A statistical analysis suitable for mixed type distributions was conducted: for the discrete component a logistic regression model was used and for the continuous component the impact of the variables on MBL was examined by using robust nonparametric comparison tests.

RESULTS

Seventy-eight dental implants were inserted in 34 mandibles and 44 maxillae, with one stage procedure in 40 cases and two stage in 38 cases. Thirty-five implants were <10 mm, while 43 were ≥ 10 mm long; 28 implants had a CIR ≤1 and 50 had a CIR >1. No drop-outs or implant loss were observed. Bone loss occurred only in a few cases, measuring less than 0.5 mm and being significantly more pronounced for implant length ≥10 mm, for lower CIR values and for the two stage procedure.

CONCLUSION

Higher CIR values were not related to increased peri-implant bone loss; a <10 mm long implant insertion may be safely considered for reduced bone heights.

How do peri-implant biologic parameters correspond with implant survival and peri-implantitis? A critical review

Objectives

The aim of this critical review was to evaluate whether commonly used biologic diagnostic parameters correspond to implant survival and peri‐implantitis prevalence.

Materials and methods

Publications from 2011 to 2017 were selected by an electronic search using the Pubmed database of the US National Library of Medicine. Prospective and retrospective studies with a mean follow‐up time of at least 5 years and reporting prevalence of peri‐implantitis as well as mean bone loss and standard deviation were selected. The correlation between reported prevalence of peri‐implantitis and reported implant survival, mean follow‐up time, mean bone loss, mean probing depth, and mean bleeding on probing was calculated. Mean bone loss and standard deviation were used for estimation of proportion of implants with bone loss exceeding 1, 2, and 3 mm.

Results

Full‐text analysis was performed for 255 papers from 4,173 available ones, and 41 met all the inclusion criteria. The overall mean weighted survival rate was 96.9% (89.9%–100%) and the reported prevalence of peri‐implantitis ranged between 0% and 39.7%, based on 15 different case definitions. The overall weighted bone loss was 1.1 mm based on 8,182 implants and an average mean loading time ranging from 5 to 20 years. No correlation was found between mean bone loss and the reported prevalence of peri‐implantitis. The estimated prevalence of implants with bone loss above 2 mm was 23%. The overall weighted mean probing depth was 3.3 mm, and mean weighted bleeding was 52.2%. Only a weak correlation was found between survival and function time (r = −0.49). There was no relation between the probing depth or bleeding and the mean bone loss, mean follow‐up time, and reported prevalence of peri‐implantitis.

Conclusion

Biologic parameters mean probing depth and mean bleeding on probing do not correlate with mean bone loss and this irrespective of follow‐up. Case definition for peri‐implantitis varied significantly between studies indicating that an unambiguous definition based on a specified threshold for bone loss is not agreed upon in the literature.

Papilla height in relation to the distance between bone crest and interproximal contact point at single-tooth implants: A systematic review

OBJECTIVES

The aim of this systematic review was to investigate the tooth-implant papilla formation in correlation with the distance between the interproximal bone level and the prosthetic contact point.

MATERIAL AND METHODS

A comprehensive search of the current literature (01/01/2000-01/01/2017) was performed to identify human trials that included 10 patients or more, with at least 12 months follow-up, in need of the replacement of one single tooth in the anterior maxillary region with an implant-supported single crown. To meet the inclusion criteria, studies had to provide both radiographic and clinical data regarding the distance between the interproximal bone level and the prosthetic contact point.

RESULTS

The search yielded 136 records. After evaluation of abstracts and full texts, 12 papers were included in the final review, even though various reference points, for the comparison between the vertical distance and the papilla height, were used. The vertical distance between the interproximal bone level and prosthetic contact point ranged between 2 and 11 mm, and the partial or complete papilla fill (Jemt's score 2-3) ranged between 56.5% and 100% of cases.

CONCLUSION

There is limited evidence that the vertical distance from the base of the interproximal contact point to the crestal bone level seems to affect the interproximal papilla height; that is, the lower is the distance the higher is the percentage of papilla fill. Complete embrasure fill between an implant restoration and the adjacent tooth seems to be correlated with the integrity of the periodontal ligament of the tooth. To reduce the risk of aesthetic failures, interproximal probing on the adjacent teeth should be encouraged before implant placement.