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Stacchi C, Lamazza L, Rapani A, Troiano G, Messina M, Antonelli A, Giudice A, Lombardi T. Marginal bone changes around platform-switched conical connection implants placed 1 or 2 mm subcrestally: A multicenter crossover randomized controlled trial. Clin Implant Dent Relat Res 2023; 25:398-408. [PMID: 36725016 DOI: 10.1111/cid.13186] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION This study analyzes early marginal bone modifications occurring around platform-switched implants with conical connection placed 1 or 2 mm subcrestally. METHODS This crossover randomized controlled trial enrolled partially edentulous patients needing two implants in either the posterior maxilla or mandible. Each patient received two platform-switched implants with conical connection inserted 2 mm (Test) and 1 mm (Control) subcrestally. Definitive abutments were immediately connected and, after 4 months of unsubmerged healing, screwed metal-ceramic crowns were delivered. Radiographs were taken at implant placement (T0), prosthesis delivery (T1), and after 1 year of prosthetic loading (T2). RESULTS Fifty-one patients (25 males and 26 females; mean age 61.2 ± 12.1 years) totaling 102 implants were included in the final analysis. Mean peri-implant bone level (PBL) reduction from T0 to T2 was not significantly different around Test (0.49 ± 0.32 mm) and Control implants (0.46 ± 0.35 mm; p = 0.66). Multivariate linear regression models highlighted a significant positive correlation between history of periodontitis and PBL reduction. At T2, no Test group implant and 6 Control group implants exhibited PBL below the implant platform (11.8% of Control group implants). CONCLUSION No significant differences in peri-implant marginal bone changes were demonstrated after 1 year of prosthetic loading between platform-switched implants with conical connection inserted either 1 or 2 mm subcrestally. However, 2 mm subcrestal placement resulted in deeper implant positioning at T2, with no exposure of treated implant surface and potential preventive effect against subsequent peri-implant pathology.
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Affiliation(s)
- Claudio Stacchi
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luca Lamazza
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Rapani
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Troiano
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | | | | | - Amerigo Giudice
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Teresa Lombardi
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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Fixed Prosthetic Restorations and Periodontal Health: A Narrative Review. J Funct Biomater 2022; 13:jfb13010015. [PMID: 35225978 PMCID: PMC8883934 DOI: 10.3390/jfb13010015] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
Periodontal health plays an important role in the longevity of prosthodontic restorations. The issues of comparative assessment of prosthetic constructions are complicated and not fully understood. The aim of this article is to review and present the current knowledge regarding the various technical, clinical, and molecular aspects of different prosthetic biomaterials and highlight the interactions between periodontal health and prosthetic restorations. Articles on periodontal health and fixed dental prostheses were searched using the keywords “zirconium”, “CAD/CAM”, “dental ceramics”, “metal–ceramics”, “margin fit”, “crown”, “fixed dental prostheses”, “periodontium”, and “margin gap” in PubMed/Medline, Scopus, Google Scholar, and Science Direct. Further search criteria included being published in English, and between January 1981 and September 2021. Then, relevant articles were selected, included, and critically analyzed in this review. The margin of discrepancy results in the enhanced accumulation of dental biofilm, microleakage, hypersensitivity, margin discoloration, increased gingival crevicular fluid flow (GCF), recurrent caries, pulp infection and, lastly, periodontal lesion and bone loss, which can lead to the failure of prosthetic treatment. Before starting prosthetic treatment, the condition of the periodontal tissues should be assessed for their oral hygiene status, and gingival and periodontal conditions. Zirconium-based restorations made from computer-aided design and computer-aided manufacturing (CAD/CAM) technology provide better results, in terms of marginal fit, inflammation reduction, maintenance, and the restoration of periodontal health and oral hygiene, compared to constructions made by conventional methods, and from other alloys. Compared to subgingival margins, supragingival margins offer better oral hygiene, which can be maintained and does not lead to secondary caries or periodontal disease.
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Severely Atrophic Mandibles Restored With Fiber-Reinforced Composite Prostheses Supported by 5.0-mm Ultra-Short Implants Present High Survival Rates Up To Eight Years. J Oral Maxillofac Surg 2021; 80:81-92. [PMID: 34666033 DOI: 10.1016/j.joms.2021.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Encouraging results have been reported for ultrashort single implants; however, long-term investigations are warranted for full-arch reconstructions. This study evaluated marginal bone loss, implant, and reconstruction survival of fiber-reinforced composite full-arch prostheses supported by 4 ultrashort implants. METHODS Patients with severely atrophic mandibles (Cawood and Howell class V and class VI) were included in this cohort study. Study predictors included time (initial and last follow-up) and vertical (epicrestally or subcrestally) and horizontal implant position (medial or lateral). Outcome variables included bone level changes over time, implant/prosthesis survival. Peri-implant bone level was measured on panoramic radiographs. Descriptive statistics, Kaplan-Meier, mixed model analysis of variance, and univariate and multivariate Cox Proportional Hazards Regression models, adjusted for multiple implants in the same patient, were used for data analyses. RESULTS Eighteen patients (mean 61.22 years old), with 72 implants placed in atrophic mandibles with an average follow-up of 55.4 months (CI, ±4.6/ SD, ±10.6 months) were analyzed. The implant survival rate was 97.2% as 2 implants were not loaded due to non-osseointegration and sensorial disturbances. Average marginal bone level at baseline (1.93 mm) and at the time of last recall (1.91 mm) was not significantly different. While implants placed subcrestally showed no significant difference between baseline (1.91 mm) and last follow up bone level (2.12 mm), implants placed epicrestally demonstrated a significant reduction on their bone level over time (initial: 1.97 mm/ final:1.33 mm). Systemic disorders were a risk factor for implant survival and bone loss. Prostheses cumulative survival rate was 100% (mean observation period of 55 months). The estimated survival rate after the 96-month follow-up was 75% (1 framework fracture after 84 months). CONCLUSION Fixed fiber-reinforced composite full-arch prostheses retained by 4 ultrashort implants showed a stable bone level and high implant/prostheses survival rates up to 8 years.
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Doornewaard R, Sakani S, Matthys C, Glibert M, Bronkhorst E, Vandeweghe S, Vervaeke S, De Bruyn H. Four-implant-supported overdenture treatment in the maxilla. Part I: A randomized controlled split mouth trial assessing the effect of microthreads and abutment connection type on 4 years peri-implant health. Clin Implant Dent Relat Res 2021; 23:671-679. [PMID: 34378860 DOI: 10.1111/cid.13037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND According to literature, peri-implant bone loss is minimized on implants with microthreaded neck design and internal type of abutment connection. However, most clinical studies may be biased due to confounding factors. PURPOSE This nonblinded RCT assessed the effect of implant neck (microthreaded vs non-microthreaded) as well as the type of abutment connection (internal conical vs external flat-to-flat) on peri-implant bone stability and peri-implant health after at least 36 months. MATERIALS AND METHODS Twenty-five patients were treated with a maxillary implant-supported bar-retained overdenture on four different implant types: internal connection with microthreads (I-MT), internal connection without microthreads (I-NMT), external connection with microthreads (E-MT), and external connection without microthreads (E-NMT). To control confounding factors, all other design features were similar. A linear mixed-model analysis or mixed-model logistic regression analysis was used to determine the effect of implant type on bone level, probing pocket depth, bleeding on probing, and plaque. RESULTS Four out of 98 implants (4.1%) placed in 25 patients failed during provisionalization and were replaced. Mean overall bone loss after 6 months was 0.39 mm (SD 0.62, range 0.00-3.48) with limited additional bone loss of 0.04 mm (SD 0.54, range -1.80-1.63) after at least 3 years. Microthreads or connection type had no effect on the bone level, probing pocket depth, bleeding on probing, nor plaque. CONCLUSIONS With 96% of implant survival, the maxillary overdenture supported with a bar on four implants yield a predictable outcome and the implant-abutment connection type (internal vs external) and implant neck design (microthreaded vs non-microthreaded) have no influence on peri-implant bone remodeling after initial bone remodeling nor up to 4 years of function. Peri-implant bone levels are within international success standards and peri-implant health is indicative of absence of peri-implantitis.
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Affiliation(s)
- Ron Doornewaard
- Department of Periodontology & Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium.,Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Samir Sakani
- Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Carine Matthys
- Department of Periodontology & Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Maarten Glibert
- Department of Periodontology & Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Ewald Bronkhorst
- Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Stefan Vandeweghe
- Department of Reconstructive Dentistry, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Stijn Vervaeke
- Department of Periodontology & Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium
| | - Hugo De Bruyn
- Department of Periodontology & Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium.,Department of Dentistry, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Wychowański P, Starzyńska A, Osiak M, Kowalski J, Jereczek-Fossa BA, Seklecka B, Morawiec T, Adamska P, Woliński J. The Anatomical Conditions of the Alveolar Process of the Anterior Maxilla in Terms of Immediate Implantation-Radiological Retrospective Case Series Study. J Clin Med 2021; 10:jcm10081688. [PMID: 33920026 PMCID: PMC8071063 DOI: 10.3390/jcm10081688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
The feasibility and the level of difficulty of immediate flapless implantation depend largely on the residual alveolar bone. The purpose of the study was to determine how often immediate flapless implantation in the anterior maxilla is feasible and assess the difficulty level using cone-beam computed tomography (CBCT) scans. A radiological retrospective case series study was conducted. In total, 1200 CBCT scans from 300 consecutive patients were analyzed with dedicated planning software. Immediate flapless implants were possible in 78.33% of cases. Drilling direction was either through the apex or the palatal slope. Bimodal was conducted in 9% of the cases; only through the apex in 13.08% of the cases and in 56.25% only in the slope. In 21.67%, immediate flapless implants were excluded. The feasibility and degree of difficulty differed statistically to the disadvantage of the lateral incisors compared to the central incisors. Drilling direction caused that BASE classification reflects the difficulty level of immediate implantation. CBCT is a helpful diagnostic tool for assessing the feasibility of immediate flapless implants due to the residual bone shape and volume. BASE classification helps to determine a challenge level that may also facilitate communication and result in comparison. The alveolar bone condition allows for immediate flapless implants in most cases in the aesthetic region of the maxilla, but they should be performed by an experienced specialist with regard to the bone and soft tissue quality.
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Affiliation(s)
- Piotr Wychowański
- Department of Oral Surgery, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland; (P.W.); (M.O.)
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
- Correspondence:
| | - Martyna Osiak
- Department of Oral Surgery, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland; (P.W.); (M.O.)
| | - Jan Kowalski
- Department of Periodontology and Oral Diseases, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland;
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20-112 Milan, Italy;
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20-141 Milan, Italy
| | - Blanka Seklecka
- Early Clinical Trials Unit, University Clinical Centre, 17 Smoluchowskiego Street, 80-214 Gdańsk, Poland;
- Department of Oncology and Radiotherapy, Medical University of Gdansk, 3a M. Skłodowskiej-Curie Street, 80-210 Gdańsk, Poland
| | - Tadeusz Morawiec
- Department of Oral Surgery Silesian Medical University, 17 Plac Akademicki Street, 41-902 Bytom, Poland;
| | - Paulina Adamska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Jarosław Woliński
- Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 3 Instytucka Street, 05-110 Jabłonna, Poland;
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