Evaluation of the Peri-Implant Bone Level around Platform-Switched Dental Implants: A Retrospective 3-Year Radiographic Study

Assessment of the association between the Implant Disease Risk Assessment (IDRA) tool and peri-implantitis: a retrospective cohort study with up to 8 years of follow-up

The aim of this study was to evaluate the accuracy of the Implant Disease Risk Assessment (IDRA) tool in predicting the occurrence of peri-implantitis in patients who have received at least one implant, with a follow-up of up to 8 years. The records of patients who received one or more implants in the periodontology or oral surgery department of Saint Joseph University of Beirut between 2014 and 2018 were collected. Parameters related to the IDRA tool were obtained and the risk level calculated. Patients were recalled to assess their peri-implant status. The association between the IDRA risk level and the incidence of peri-implantitis was estimated. Overall, 145 patients were included in the study. A statistically significant association was found between the IDRA risk levels and the incidence of peri-implantitis (P = 0.003). High risk patients had 5.2 times higher odds of developing peri-implantitis than low-to-moderate risk patients (P < 0.001). Receiver operating characteristic curve analysis demonstrated a 69% probability that IDRA can identify patients at risk of developing peri-implantitis (P = 0.003). Further analysis found the percentage bleeding on probing to be the only significant IDRA vector. Within the limitations of this study, the IDRA tool is considered potentially useful for identifying patients at risk of developing peri-implantitis. It may serve as one component of a comprehensive peri-implant assessment, pending further enhancement of its predictive precision. Moreover, this tool can be considered before implant placement and during the periodontal maintenance phase. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04888572.

Risk factors and prediction model of peri-implantitis in post operative periodontitis patients

OBJECTIVES

To analyze the risk factors for peri-implantitis (PI) in patients with periodontitis after dental implantation and to establish a prediction model.

METHODS

A retrospective analysis was conducted using clinical data from 208 patients with periodontitis who required implant restoration due to tooth loss from various causes. These patients, meeting the indications for dental implantation, were treated at the Third People's Hospital of Shenzhen from January 2019 to December 2023. The dataset was divided into training and validation sets in a 7:3 ratio. Logistic regression was used to identify risk factors for PI in these patients. Significant variables from the regression analysis were incorporated into the prediction model. The model's accuracy was evaluated using Receiver Operating Characteristic (ROC) and calibration curves. A decision curve was also drawn to assess the clinical utility of the model. The model's performance was evaluated using the Area Under the Curve (AUC), accuracy, sensitivity, and specificity.

RESULTS

Among the 208 patients, 68 developed PI, resulting in an incidence rate of 32.69%. Independent risk factors for PI included smoking history, diabetes, irregular periodontal treatment, high alveolar bone resorption, and a high plaque index score (all P < 0.05). Based on these risk factors, a logistic regression model was constructed to predict the occurrence of PI. The AUC of the logistic regression model was 0.911 for the training set and 0.823 for the validation set. The calibration curve indicated that the predicted probabilities closely matched the actual probabilities. The decision curve showed that the threshold probabilities for the training and validation sets were 0.1 to 0.85 and 0.1 to 0.81, respectively, suggesting that the net benefit was maximized within these ranges.

CONCLUSION

Smoking history, diabetes, irregular periodontal treatment, high alveolar bone resorption, and a high plaque index score are significant risk factors for PI in patients with periodontitis. The logistic regression model constructed from these factors effectively predicts the probability of PI, providing a valuable reference for the prevention and management of PI.

Radiographic evaluation of the distance between the restoration margin and the alveolar bone crest in dental implant patients: A retrospective study

OBJECTIVES

The recently introduced Implant Disease Risk Assessment (IDRA) identifies a restoration margin-alveolar bone crest (RM-AC) distance of less than 1.5 mm as a key risk factor for peri‑implant disease among eight major risk factors. This study evaluated the impact of the RM-AC distance on marginal bone loss (MBL) through radiographic analysis.

METHODS

This retrospective cross-sectional study included 77 partially edentulous patients (39 females and 38 males, aged 22 to 76 years) with 202 platform-switched conical connection implants, cement-retained, implant-supported fixed restorations, and bone-level implants placed between 2016 and 2021. Dental implants were followed for least 6 to 36 months at follow up functional loading. Study participants were categorized into Group A (RM-AC distance ≤ 1.5 mm, n = 69) and Group B (RM-AC distance > 1.5 mm, n = 133). Twelve patients in Group B and five patients in Group A had no history of periodontal disease. The MBL was measured radiographically from the most coronal point of the implant shoulder to the alveolar bone, and the RM-AC distance was measured from the restoration margin to the alveolar crest. Multinomial logistic regression analysis was used for statistical evaluation.

RESULTS

The incidence of MBL in Group A was statistically significant and 3.42 times higher than that in Group B. The rate of MBL in periodontitis Stage 4 was found to be 26.31 times higher than that in periodontitis Stage 2. The incidence of MBL was 6.097 and 5.02 times higher with increasing implant diameter and length, respectively.

CONCLUSION

This study conclusively demonstrates that RM-AC distance ≤ 1.5 significantly increases the risk of MBL, particularly in patients with a history of periodontal disease.

CLINICAL SIGNIFICANCE

This study highlights the critical role of maintaining an RM-AC distance greater than 1.5 mm in the prevention of MBL, particularly in patients with a history of periodontal disease. Since implant diameter and length have a significant impact on the risk of MBL, it emphasizes that implant demographics should also be carefully evaluated.

Dental implant macrodesign features in the past 10 years: A systematic review

Dental implant is a material used in replacing missing teeth. The osseointegration process of dental implants will be affected by the macrodesign of the fixtures. This study aimed to review the dental implant macrodesign in the past 10 years. This study was conducted in a systematic review method using two electronic databases (PUBMED and Science Direct). Only randomized controlled trials (RCTs) published in the last 10 years were used for this review. All the search results were filtered using Preferred Reporting Items for Systematic Reviews And Meta-Analyses and should fulfill some predefined inclusion criteria. The last step was to assess the methodological quality of the studies using the JBI Checklist for RCT. The search identified 357 studies with only 23 that going through full-text analysis, resulting in 14 articles included in the review. In total, 19 different implant brands were used in 12 different countries. Dental implant macrodesigns were divided into collar design, implant shape, thread geometry, and platform design. The macrodesign features of the implant were mostly developed in the variation of thread geometry and collar design.

Marginal Bone Level and Biomechanical Behavior of Titanium-Indexed Abutment Base of Conical Connection Used for Single Ceramic Crowns on Morse-Taper Implant: A Clinical Retrospective Study

The goal of this retrospective clinical study was to evaluate the behavior of Morse-taper indexed abutments by analyzing the marginal bone level (MBL) after at least 12 months of function. Patients rehabilitated with single ceramic crowns between May 2015 and December 2020 received single Morse-taper connection implants (DuoCone implant) with two-piece straight abutment baseT used for at least 12 months, presenting periapical radiograph immediately after crown installation were enrolled. The position of the rehabilitated tooth and arch (maxilla or mandible), crown installation period, implant dimensions, abutment transmucosal height, installation site (immediate implant placement or healed area), associated with bone regeneration, immediate provisionalization, and complications after installation of the final crown were analyzed. The initial and final MBL was evaluated by comparing the initial and final X-rays. The level of significance was α = 0.05. Seventy-five patients (49 women and 26 men) enrolled had a mean period of evaluation of 22.7 ± 6.2 months. Thirty-one implant-abutment (IA) sets had between 12–18 months, 34 between 19–24 months, and 44 between 25–33 months. Only one patient failed due to an abutment fracture after 25 months of function. Fifty-eight implants were placed in the maxilla (53.2%) and 51 in the mandible (46.8%). Seventy-four implants were installed in healed sites (67.9%), and 35 were in fresh socket sites (32.1%). Thirty-two out of these 35 implants placed in fresh sockets had the gap filled with bone graft particles. Twenty-six implants received immediate provisionalization. The average MBL was −0.67 ± 0.65 mm in mesial and −0.70 ± 0.63 mm in distal (p = 0.5072). The most important finding was the statistically significant difference comparing the values obtained for MBL between the abutments with different transmucosal height portions, which were better for abutments with heights greater than 2.5 mm. Regarding the abutments’ diameter, 58 had 3.5 mm (53.2%) and 51 had 4.5 mm (46.8%). There was no statistical difference between them, with the following means and standard deviation, respectively, −0.57 ± 0.53 mm (mesial) and −0.66 ± 0.50 mm (distal), and −0.78 ± 0.75 mm (mesial) and −0.746 ± 0.76 mm (distal). Regarding the implant dimensions, 24 implants were 3.5 mm (22%), and 85 implants (78%) had 4.0 mm. In length, 51 implants had 9 mm (46.8%), 25 had 11 mm (22.9%), and 33 implants were 13 mm (30.3%). There was no statistical difference between the abutment diameters (p > 0.05). Within the limitations of this study, it was possible to conclude that better behavior and lesser marginal bone loss were observed when using abutment heights greater than 2.5 mm of transmucosal portion and when placed implants with 13 mm length. Furthermore, this type of abutment showed a little incidence of failures within the period analyzed in our study.

Onlay platelet-rich fibrin membrane versus free gingival graft in increasing the width of keratinized mucosa around dental implants: A split-mouth randomized clinical study

Background. This study aimed to compare the use of the platelet-rich fibrin membrane (PRF) versus the free gingival graft (FGG) during the second stage of the dental implant to increase the amount of keratinized mucosa around dental implants. Methods. Fifteen patients with bilaterally missing teeth and deficient width of the keratinized mucosa (KM) were recruited for a spit-mouth randomized controlled trial. After implant placement on the control sides, onlay FGG was used, whereas, on the other side (study side), onlay PRF membranes were applied to augment the KM. One month and three months after augmentation, the increase in keratinized mucosa width, bone level around the implants, and soft tissue health were evaluated and compared. The shrinkage percentage was also calculated for both grafts. Results. There was a significant increase in the width of KM in the FGG and PRF groups; however, it was observed that FFG resulted in significantly better results than PRF, with no significant difference in peri-implant soft tissue health or bone level. Conclusion. Within the limitations of this study, it was concluded that the onlay PRF membrane could increase the keratinized mucosa width around dental implants with the advantages of a lower surgical time and less postoperative discomfort and pain for the patients in comparison to the FGG. However, FGG had a significantly higher ability to augment and increase keratinized mucosa around dental implants.

Peri-Implant Marginal Bone Changes around Dental Implants with Platform-Switched and Platform-Matched Abutments: A Retrospective 5-Year Radiographic Evaluation

Preserving the marginal bone level (MBL) is essential for the long-term success of dental implant therapy, and bone remodeling around dental implants is considered to vary with time. Numerous studies comparing the platform-switching (PS) and platform-matching (PM) dental implants have indicated that PS dental implants showed a lesser reduction for the MBL, and the majority of them had a relatively short period. This study aimed to evaluate vertical and horizontal bone defects by using digital periapical radiographs to examine the changes in MBL around PM and PS dental implants over 5 years after functional loading. The vertical MBL (vMBL) was measured from the implant-abutment junction to the first bone-to-implant contact. The horizontal MBL (hMBL) was measured from the implant-abutment junction to the bone crest. All data were presented as means ± standard errors. Paired and independent t-tests with Welch's correction were used to analyze the data. A total of 61 dental implants in 38 patients after 5 years of functional loading were evaluated. Over time, PS dental implants were more likely to gain bone; by contrast, PM dental implants were more likely to lose bone during the observation time. Changes in vMBL for PS dental implants were significantly less than those for PM dental implants at 1-year (p = 0.045), 3-year (p = 0.021), and 5-year (p = 0.010) loading. Likewise, changes in hMBL for PS dental implants were significantly smaller than in those for PM dental implants at 3-year (p = 0.021) and 5-year (p = 0.006) loading; however, the changes were minimal in both approaches. PS dental implants had a significant increment in the percentage of bone integration, whereas that for PM dental implants dropped over time, with no significance. In PS dental implants that occlude with natural teeth, vertical and horizontal bone gain was observed, and it was significant at 3 years (p = 0.023). A significant horizontal bone gain was observed in the opposing natural teeth at 3-year (p = 0.002) and 5-year loading (p = 0.002). The PS concept appears to preserve more MBL around dental implants by stabilizing the vMBL and hMBL over a 5-year period. A minimal marginal bone change was detected in both concepts. The opposing natural teeth at PS dental implants showed a favorable effect on marginal bone tissues.

The Crucial Role of Plaque Control in Peri-Implant Mucositis Initiation as Opposed to the Role of Systemic Health Condition: A Cross-Sectional Study

Purpose

The aim of this study was to investigate the priority of periodontal plaque as a risk factor compared to other risk factors, namely hypertension and diabetes mellitus type II, regarding the initiation and severity of peri-implant mucositis, eventually reinforcing the importance of plaque control, periodic maintenance and supportive periodontic treatment after implant placement in order to prevent peri-implant diseases.

Patients and Methods

A total of 58 patients (84 implants) were enrolled; each individual implant was considered as a separate sample first, then sampling by patient was also applied, implants were divided into group A: systemically healthy patients and B: patients with hypertension and diabetes mellitus type II, the status of peri-implant tissue was followed after the healing abutment placement, with regard to implant mucosal index (IMI), probing pocket depth (PPD) and bleeding on probing (BOP); when sampling was done by patient, the mean of scores of all examined implants in each patient was taken to represent one sample.

Results

Group A implants showed higher mean scores of PPD (5.2 mm) than group B (4.2 mm) with significance (P = 0.014), and higher mean scores of BOP, group A = 0.71, group B = 0.45 with (P = 0.015); there was no statistical difference with regard to IMI, group A = 1.35, group B = 1.16 with (P = 0.172). Similar results were obtained when the sampling was calculated by patient; PPD: group A (5.31 mm), group B (4.75 mm) and P = 0.008, IMI: group A (1.34), group B (1.16) and P = 0.131, BOP: group A (0.75), group B (0.48) and P = 0.03.

Conclusion

In the absence of proper plaque control, systemic diseases showed no impact on the initiation and severity of peri-implant mucositis when compared to systemically healthy patients.

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The influence of the implant-abutment complex on marginal bone and peri-implant conditions: A retrospective study

PURPOSE

The design of the implant-abutment complex is thought to be responsible for marginal bone loss (MBL) and might affect the condition of the peri-implant tissues. This the present study aimed to evaluate the influence of the implant-abutment complex on MBL and the peri-implant tissues in partially edentulous patients treated with dental implants and determine the most advantageous design.

MATERIALS AND METHODS

A total of ninety-one endosseous implants with different designs of implant-abutment complex [tissue level-TL (n = 30), platform switch-PS (n = 18), and platform match-PM (n = 43)] were reviewed for MBL, Probing Pocket Depth (PPD) and Bleeding on Probing (BoP). MBL was calculated for first year of the insertion and the following years.

RESULTS

The median MBL for the PM implants (2.66 ± 1.67 mm; n = 43) in the first year was significantly higher than those for the other types (P =.033). The lowest rate of MBL (0.61 ± 0.44 mm; n = 18) was observed with PS implants (P =.000). The position of the crown-abutment border showed a statisticallysignificant influence (P =.019) and a negative correlation (r=−0.395) on MBL. BoP was found significantly higher in PM implants (P =.006). The lowest BoP scores were detected in PS implants, but the difference was not significant (P =.523). The relation between PPD and connection type revealed no statistically significant influence (P >.05).

CONCLUSION

Within the limitations of the present study, it may be concluded that PS implants seem to show better peri-implant soft tissue conditions and cause less MBL.

Attitude in Radiographic Post-Operative Assessment of Dental Implants among Italian Dentists: A Cross-Sectional Survey

There is a lack of evidence in the attitude and prescribing practice of implantologists in dental implant post-operative assessment; therefore, the aims of this cross-sectional study were to investigate these habits and the knowledge about radiographic aspect of retrograde peri-implantitis (RPI) among Italian implantologists. A questionnaire was sent via email to dentists randomly selected from the register of implantology and oral surgery societies. It included three questions: the preferred X-ray after implant placement, the timing of post-operative assessment and the knowledge of the RPI radiographic representation. A final sample of 434 implantologists was included in the study. The majority of them (84.3%) perform a periapical X-ray as control radiograph and picked the correct radiographic representation of RPI (74.3%), without statistically significant differences (p > 0.05) for sex, age, years of working practice and number of implants placed per year. Just 47.7% of dentists perform a control radiograph at prostheses delivery, to establish a proper baseline. A statistically significant difference (p < 0.05) was detectable only for the number of implants placed per year, with dentists placing > 80 implants selecting the correct choice. To the best of authors’ knowledge, this is the first study to report data on attitude of implantologists in radiographic imaging after implant placement.

Lithium Disilicate Crown, Zirconia Hybrid Abutment and Platform Switching to Improve the Esthetics in Anterior Region: A Case Report

The hybrid abutment emerged as an alternative to maintain a stable and favorable volume of peri-implant tissue; it is composed of a mesostructure in ceramic and a metallic connection, which can be machined according to the peri-implant emergence profile. This case report presented the clinical steps for a dental implant with immediate provisional restoration, followed by the installation of implant-supported all-ceramic crowns with zirconia abutment and platform switching. A 40-year-old male patient was rehabilitated with an implant-supported ceramic crown in the region of element 11 and a ceramic veneer was cemented on the upper right central incisor. To do so, an atraumatic extraction of the upper left central incisor was performed followed by implant placement and immediate loading. In this case, a zirconia hybrid abutment was used with a metallic link in the cervical region with a concave platform switching base. This association of clinical steps enabled improving the aesthetics in the anterior dental region.