The Long-Term Evaluation of Two-Unit Fixed Partial Dentures on Short, Threaded Implants: Delayed Versus Immediate Loading.

Placement of short implants is a common approach to rehabilitate edentulous areas. The objective of this study was to evaluate the long-term survival of 7.0- and 8.5-mm implants placed in either a delayed or immediate loading protocol. Life table analysis revealed the implants treated with the delayed loading protocol had a 90.9% survival rate and the implants treated with the immediate loading protocol had a survival rate of 92.0%. The results of this 8-year prospective study demonstrate similar survival rates of short, cylindrical threaded implants placed by either a delayed or immediate loading protocol.

The Creeping Attachment Induced Technique (CAIT) in Natural and Restored Teeth: Case Reports with 24 Months of Follow-Up.

This article describes a nonsurgical approach for treating gingival recessions and increasing gingival thickness around the natural teeth. Two female patients, presenting gingival recessions at the maxillary frontal teeth, were treated. Patient #1 had a discrepancy among the central maxillary incisors' gingival margin, and tooth UL1 needed to be restored. Patient #2 presented a buccal gingival recession at tooth UL3. In both cases, the sulcular gingival margin was gently disephitelized with a diamond bur leaving the soft tissue healing by itself. After 4 weeks, the procedure was reperformed. After 6 months, the gingival margins appeared thicker and a creeping attachment was achieved in both cases, obtaining gingival symmetry, related to the adjacent or contralateral teeth, and root coverage. Gingival asymmetry, gingival recessions, and gingival thickness may be improved by means of a guided gentle nonsurgical stimulation, providing creeping attachment in the natural and also restored teeth, with a healthy and stable tissue after 24 months of follow-up.

Plasma of Argon Cleaning Treatment on Implant Abutments in Periodontally Healthy Patients: Six Years Postloading Results of a Randomized Controlled Trial.

The aim of this randomized, match-paired, triple-blinded, controlled clinical trial was to assess the 6-year radiographic changes around customized platform-switched abutments placed according to the one abutment-one time concept, with and without plasma of argon cleaning treatment. A total of 20 periodontally healthy patients received one maxillary implant between the premolars. Immediately before stage 2 surgery and abutment connection, patients were randomly assigned to the control (cleaning protocol by steam) or test group (plasma of argon treatment). Periapical standardized digital radiographs were taken at the time of crown connection (T0) and at 12 (T1), 24 (T2), 48 (T4), 60 (T5), and 72 months (T6) after the final restoration delivery. Primary outcome measures were the success rates of the implants and prostheses and the occurrence of any technical and biologic complications during the follow-up period. Secondary outcome measures were peri-implant marginal bone level changes, bleeding on probing, and plaque score. Two patients (one in test and one in control group) dropped out at the last follow-up. Neither implant nor prosthetic complications were detected in the analyzed patients of both groups during the 6-year follow-up examinations. Radiographic analysis revealed a statistically significant higher mean bone loss in the control group than in the test group at T2 (0.4 ± 0.28 mm; P = .018), T4 (0.52 ± 0.63 mm; P = .037), T5 (0.61 ± 0.70 mm; P = .038), and T6 (0.71 ± 0.66 mm; P = .011), but not at T1 (P = .131). From baseline to the 6-year follow-up, intragroup comparisons showed an absence of statistically significant difference in the test group (P = .08). Conversely, significant differences were found in the control group (P = .01). All implants demonstrated successful periodontal parameters, with no significant differences between groups. The results of this present study indicate that contaminant and bacterial removal from abutments in two-stage implants using plasma of argon could represent a positive strategy to minimize peri-implant bone resorption and longitudinally stabilize esthetic outcomes.

Sinus Floor Elevation with Modified Crestal Approach and Single Loaded Short Implants: A Case Report with 4 Years of Follow-Up.

Tooth extraction is usually followed by bone reduction. In the maxillary posterior region, this remodelling combined with sinus pneumatisation and periodontal defects may lead to a reduced basal bone height available for implant placement. Sinus floor elevation can be performed with different surgical techniques. Crestal approach has demonstrated to be effective, less invasive, and associated with a reduced morbidity. This article reports a modified sinus floor elevation by means of rotary, noncutting instruments, addition of xenograft, and 2 short-threaded implant placements. The aim of the study was to evaluate the implant's success and intrasinus radiographical bone gain after 4 years of functional loading. The premolar implant site presented a starting basal bone height of 6 mm, while the molar site was of 2 mm. In the first surgical step, sinus floor elevation was performed mesially and the implant was inserted, and distally only sinus floor elevation was performed. After 6 months, the mesial implant was uncovered and the second implant was inserted; 4 months later, the second fixture was uncovered, and both fixtures were loaded with single provisional screw-retained crowns and later with single screw-retained porcelain fused to metal crowns. Implants integrated successfully, and crestal bone remodelling did not exceed the smooth collar. Bone gain was 3 mm for the mesial implant and more than 5 mm for the distal one.

Implant-supported prostheses esthetic outcomes after socket preservation technique.

Bone and soft tissue remodeling after tooth extraction may have dramatic effects. The socket preservation technique has demonstrated to be effective in maintaining volume before implant placement. The Pink Esthetic Score (PES) is an easy and complete evaluation of esthetic parameters. The aim of this study was to compare the PES index of anterior teeth needing to be replaced and the correspondent implant-supported prostheses after the socket preservation technique with 1 year of follow-up. Twenty-four patients were enrolled in this study. Eighteen maxillary central incisors and 6 maxillary lateral incisors were extracted, and then, every alveolar site was treated with the socket preservation technique and filled with Bio-Oss, mixed with fibrin glue, and covered with a collagen sponge. After 6 months of undisturbed healing, implants were placed and left healing for 4 months. After they were regularly loaded and at 1 year of follow-up, peri-implant PESs were recorded. All implants integrated successfully. No dropouts were recorded. Comparing PES results before extraction (mean, 12.25) and after implant loading (mean, 12.35), those around implants are similar if not better, and there are no statistically significant differences as analyzed with the t-test. The socket preservation technique combined with delayed implant placement and a standard healing time before implant loading has demonstrated to be effective in maintaining volumes and also esthetic values around implants compared with PES values before tooth extraction.

Short (5 and 7 mm long) porous implants in the posterior atrophic maxilla: a 5-year report of a prospective single-cohort study.

PURPOSE: The aim of this ongoing prospective study was to determine the 5-year survival rate of short porous dental implants in the posterior atrophic maxilla combined, when necessary, with crestal sinus floor elevation and often adding anorganic bovine bone. MATERIALS AND METHODS: In 87 partially edentulous patients, 110 short porous implants were placed and followed up for 5 years. The implants used were of two lengths (5 and 7 mm) and two diameters (4.1 and 5 mm) and were chosen according to the available crestal height and width. In 47 sites, osteotome sinus floor elevation was performed (in 8 cases compacting basal bone, in 39 adding a xenograft). The unloaded healing period was 6 months. A total of 63 implants were restored with single crowns and 47 were splinted to the adjacent implants. Outcome measures were prosthesis and implant failures, any complications, and peri-implant marginal bone resorption. RESULTS: Five years after loading, no patients dropped out. Eleven implants failed: 2 implants at uncovering and 9 after prosthetic loading. Eleven patients (12.6%) lost 1 implant. In 6 patients (6.9%) a prosthesis failure occurred (implants loaded with single crowns). One surgical complication (membrane perforation) occurred but the implant was normally inserted. No complications occurred during the healing period. In 3 patients, severe peri-implantitis occurred post loading and the implants had to be removed. Two abutments became loose and one crown chipped. At the end of the follow-up period the implant survival rate was 90%, and 93.1% with regard to prosthetic reconstruction. The mean peri-implant marginal bone loss was 1.4 mm. CONCLUSIONS: The use of short porous implants showed an acceptable clinical outcome in the treatment of the posterior maxilla in this interim 5-year report. Longer follow-ups are needed to confirm these results.

Short (5 and 7 mm long) porous implant in the posterior atrophic mandible: a 5-year report of a prospective study.

PURPOSE: The aim of this ongoing prospective study was to determine the 5-year survival rate of short porous implants in the posterior atrophic mandible. MATERIALS AND METHODS: In 40 partially edentulous patients, 55 short porous implants were placed. The implants used were of two lengths (5 and 7 mm) and two different diameters (4.1 and 5 mm) and were chosen according to the available crestal height and width. The unloaded healing period was 4 months. Twenty-one implants were restored with single crowns, 32 were splinted to the adjacent implant, 2 were used with an overdenture and were followed for 5 years. Outcome measures were prosthesis failures, implant failures and complications. RESULTS: No patients dropped out. Nine implants were removed: 1 implant at uncovering and 8 after prosthetic loading. Eight patients lost 1 implant and 1 patient lost 2 implants. Four crowns failed. No complications occurred during the healing period. In 2 patients severe peri-implantitis occurred after loading and the implants had to be removed. At the end of the follow-up period the survival rate was 84% at implant level and 80% at patient level. CONCLUSIONS: The use of short porous implants showed an acceptable clinical outcome in the treatment of the posterior mandible in this interim 5-year report. These preliminary results must be confirmed by longer follow-ups.

Short porous implants in the posterior maxilla: a 3-year report of a prospective study.

The aim of this ongoing prospective study was to determine the 36-month survival rate of short porous implants in the posterior maxilla with 2 to 7 mm of initial bone height in 48 patients. Forty-eight implants were placed; 35 were in sites with a bone height of 5 mm or less and 13 patients required sinus elevation with osteotomes in addition to a xenograft. All implants were loaded with single crowns. At the end of the follow-up period the survival rate was 97.92%. The use of short porous implants showed good predictability in the treatment of the posterior maxilla in this interim 3-year report.

A connective tissue graft envelope technique for the treatment of single gingival recessions: a 1-year study.

Root coverage is the goal of periodontal plastic surgery when treating gingival recessions. The aim of the present study was to evaluate the clinical results 1 year after treatment with an envelope connective tissue graft technique for single recessions. Forty consecutive patients with single recessions were treated. At baseline and 1 year after surgery, recession, probing pocket depth, clinical attachment level, and keratinized tissue height were recorded. After 1 year, the mean differences in recession (3.12 +/- 0.90 mm), clinical attachment level (3.92 +/- 1.00 mm), keratinized tissue height (3.75 +/- 0.95 mm), and probing pocket depth (0.50 +/- 0.64 mm) were statistically significant. Mean root coverage was 95.54% +/- 11.43%; 85% of the treated cases achieved complete root coverage. The envelope connective tissue graft technique showed high predictability in the treatment of single recessions.

The Papilla Presence Index (PPI): a new system to assess interproximal papillary levels.

The present article describes a classification system used to assess the interdental papillary height on natural teeth; the index can also be used in cases of lack of contact points and presence of diastemata. This system is particularly useful to define the loss of the interdental papilla because of periodontal disease and papilla reconstruction after periodontal treatment, particularly if tooth repositioning is involved. The index, based on esthetic evaluations, measures interproximal soft tissue height in relation to the CEJ, adjacent teeth, and the point corresponding to the ideal contact point. The four index scores are useful for an easy clinical assessment with respect to patient esthetics.

Reconstruction of the maxillary midline papilla following a combined orthodontic-periodontic treatment in adult periodontal patients.

OBJECTIVE: The aim of the present study was to evaluate the role of a combined orthodontic-periodontic treatment in determining the reconstruction of midline papilla lost following periodontitis. MATERIAL AND METHODS: Twenty-eight patients, with infrabony defect and extrusion of one maxillary central incisor, were treated. At baseline, all patients presented opening of the interdental diastema and loss of the papilla. At 7-10 days after open-flap surgery, the intrusive movement started. For each patient, probing pocket depth (PPD), clinical attachment level (CAL) and papilla presence index (PI) were assessed at baseline, end of treatment and after 1 year. PI was also evaluated independently in patients with narrow or wide periodontal biotype (NPB-WPB). RESULTS: All parameters showed statistical improvement between the initial and final measurements, and showed no changes at follow-up time. The mean residual PPD was 2.50 mm, with a decrease of 4.29 mm, while the mean CAL gain was 5.93 mm. Twenty-three out of 28 patients improved the PI score at the end of therapy. No statistical difference was recorded in PI values between groups NPB and WPB. CONCLUSION: The presented clinical protocol resulted in the improvement of all parameters examined. At the end of orthodontic treatment, a predictable reconstruction of the interdental papilla was reported, both in patients with thin or wide gingiva.

Orthodontic movement into infrabony defects in patients with advanced periodontal disease: a clinical and radiological study.

BACKGROUND: In cases of advanced periodontal disease with a pathologic flaring of frontal teeth, a combined periodontic-orthodontic therapy may be a reliable approach in order to solve both functional and esthetic problems. The aim of the present study was to evaluate the periodontal tissue alterations following periodontal surgery and orthodontic intrusion in migrated upper central incisors with intrabony defects. METHODS: Ten patients with advanced periodontal disease and an extruded maxillary central incisor infrabony defect at its mesial aspect and probing depth (PD) > or = 6 mm were included in the present study. At baseline, PD and clinical attachment level (CAL) were measured. The vertical and horizontal dimensions of the defects were assessed on standardized radiographs. Seven to 10 days after surgery the active orthodontic treatment started using the segmented arch technique, in order to intrude and move the teeth into the defects. Maintenance therapy was performed every 2 to 3 months until the orthodontic treatment was completed. RESULTS: At the end of treatment, mean PD reduction was 4.35 mm, with a residual mean PD of 2.80 mm. Mean CAL gain was 5.50 mm. The mean radiological vertical and horizontal bone fills were, respectively, 1.35 mm and 1.40 mm. All differences were of statistical significance (P<0.001). CONCLUSION: The present study showed that the combined orthodontic and periodontic therapy performed resulted in the realignment of extruded teeth with infrabony defects, obtaining a significant probing depth reduction, clinical attachment gain, and radiological bone fill.

The use of orthodontic intrusive movement to reduce infrabony pockets in adult periodontal patients: a case report.

Clinicians often encounter osseous defects that are best treated by conventional surgical techniques, including bone grafting and guided tissue regeneration, with a goal of establishing a new connective tissue attachment. On occasion, the recognition of an infrabony defect proximal to a tooth with a large diastema may present an opportunity to consider resolution by orthodontic tooth movement. Ideally, the tooth could be moved in the proximal direction until there was no further radiographic or clinical evidence of the predisposing defect. The authors decided to treat an advanced case of adult periodontitis, with extrusion and migration of a maxillary central incisor, using a multidisciplinary approach. Radiologically, a large infrabony defect was present on the mesial aspect of the incisor, with an initial probing depth of 9 mm. After the surgical periodontal therapy, the orthodontic movement started and the incisor was repositioned using an intrusive mechanism, also leading to the closure of the diastema. At the end of the treatment, there was a significant clinical decrease in the probing depth values, and radiographs showed a remarkable reduction of the infrabony defect volume.

Orthodontic movement into bone defects augmented with bovine bone mineral and fibrin sealer: a reentry case report.

Periodontal disease can lead to migration of anterior teeth with the presence of infrabony defects. This creates the opportunity for treating such patients with a combined orthodontic-periodontic treatment. In the presented clinical case, an adult periodontal patient with extrusion of the maxillary central incisors and an infrabony defect on their lingual aspects was treated. During the surgical procedure, the bone defects were augmented with a combination of porous bovine bone mineral (Bio-Oss) and a fibrin-fibronectin sealing system (Tissucol). Ten days after surgery, the active orthodontic treatment started, and the teeth were intruded and realigned, moving the roots into the defects. After 6 months, the orthodontic appliances were removed and the teeth were retained by means of a resin-bonded splint. At this time, reduction in probing pocket depth and gingival recession was detected. Twelve months after the initial surgery, a reentry procedure was performed, showing complete filling of the predisposing defects with the presence of bone-like hard tissue. These clinical results suggest that teeth can be successfully moved and intruded into bone defects previously augmented with bovine bone substitute and fibrin glue. During the orthodontic treatment, this combined augmentation material was able to be replaced by bone-like hard tissue. At the end of the therapy, an improvement in esthetics and periodontal health status was registered.