Peri-implant esthetics assessment and management

Potency of hyaluronic acid from eggshell-membrane for open gingival embrasure reconstruction following orthodontic tooth movement (a histomorphological study)

Background

The aim of this research was to assess the effectiveness of eggshell-membrane (ESM)-containing hyaluronic acid (HA) in the treatment of open gingival embrasure (OGE) following orthodontic tooth movement (OTM).

Materials and Methods

This study is an in vivo quasi experimental research. A total of 24 Cavia cobaya were equally divided into two groups, treatment (10% HA injection) and control (phosphate-buffered saline [PBS]). A separator was inserted between mandibular incisors to induce an OGE. A volume of 20 μl of either PBS (n = 12) or ESM extract (n = 12) was locally injected within the interdental papilla. Decapitation of animals was made on day 1, 4, and 7 postinjection. The staining was done using hemotoxylin and eosin to observe angiogenesis and Mallory to observe the collagen density. Fourier-transform infrared spectroscopy (FTIR) and thin-layer chromatography (TLC) analysis were performed to detect the amount of HA available in ESM. The results were then compared with independent t-tests and the Mann-Whitney test. The level of statistical significance was set at 0.05.

Results

The FTIR and TLC analysis showed that HA was successfully identified in the ESM samples. Local injection of 10% HA induced an increase of angiogenesis compared to the control group on day 1 and 4 postinjection (P < 0.05). Significant differences (P < 0.05) were also noted in the collagen density and the growth of interdental papilla on day 4 and 7 postinjection.

Conclusion

ESM has the potential effect of regenerating the interdental papilla construction after OTM by increasing the collagen fiber density and inducing angiogenesis.

Immediately provisionalized tapered conical connection implants for single-tooth restorations in the maxillary esthetic zone: a 5-year prospective single-cohort multicenter analysis

Objectives

This open, single-cohort, multicenter, prospective study investigated the efficacy of immediately provisionalized tapered conical connection implant for single-tooth restorations in the anterior and premolar regions of the maxilla after 5 years of function.

Materials and methods

All implants were placed in healed sites and immediately provisionalized. MBLs, soft-tissue parameters, and oral-health impact profile (OHIP) were evaluated at implant insertion, 6, 12, 24, 36, and 60 months. Paired Wilcoxon signed-rank tests and Kaplan–Meier survival analysis was used for statistical and implant survival/success analyses, respectively.

Results

Seventy-seven patients (81 implants) completed the 5-year follow-up. The 5-year cumulative survival and success rates were 97.8%, and the mean MBL change from implant insertion to 5 years was − 0.80 ± 1.13 mm. Optimal papilla index scores were observed at 90.1% of sites at 5 years compared with 32.8% of sites at insertion. Pink esthetic score, modified bleeding and plaque indices, and OHIP showed statistically significant improvement at the 5-year follow-up.

Conclusions

Immediately provisionalized tapered conical connection implants promote marginal bone stability and excellent esthetic outcomes after 5 years of function.

Clinical relevance

This treatment is a viable option for patients requiring immediately provisionalized single-tooth restorations in the esthetic zone and shows favorable long-term clinical outcomes, including marginal bone stability and excellent esthetics.

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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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.