Influence of gingival phenotype on crestal bone loss at implants : A long-term 2 to 20-year cohort study in periodontally compromised patient.

PURPOSE: The aim of this long-term cohort study in periodontally compromised patients with implants was to analyze the correlation between gingival phenotype and peri-implant crestal bone loss, and between clinical measures and gingival phenotype. METHODS: Implant-supported single crowns and bridges were used to rehabilitate 162 implants in 57 patients. Patients were examined over a 2 to 20-year period on a recall schedule of 3 to 6 months. In addition to recording clinical parameters, intraoral radiographs were taken at baseline (immediately after superstructure insertion) and at 1, 3, 5, 10, 15, and 20 years. Patients were differentiated into phenotype 1 with thin, scalloped gingiva and narrow attached gingiva (n = 19), phenotype 2 with thick, flat gingiva and wide attached gingiva (n = 23), or phenotyp 3 with thick, scalloped gingiva and narrow attached gingiva (n = 15). RESULTS: The mean peri-implant crestal bone loss during the first 12 months was 1.3 ± 0.7 mm. Patients with gingival phenotype 1 had a significantly greater rate of increased crestal bone loss at implants (p = 0.016). No significant differences were present in subsequent years. The prevalence of mucositis at all implants was 27.2%, and the prevalence of peri-implantitis 9.3%. Univariate analyses indicated a significantly higher peri-implantitis risk in patients with gingival phenotype 2 (p-OR = 0.001; p-OR = 0.020). The implants of patients with phenotype 2 had significantly greater probing depths (1st year p < 0.001; 3rd year p = 0.016; 10th year p = 0.027; 15th year p < 0.001). Patients with gingival phenotype 3 showed no significantly increased probing depths, signs of inflammation and crestal bone loss. CONCLUSIONS: Patients with a gingival phenotype 1 have greater crestal bone loss at implants during the first year of functional loading. Patients with gingival phenotype 2 had significantly greater probing depth at implants and risk of peri-implantitis.

Complications and Patient-Centered Outcomes of an Implant- Supported Single Crown After Immediate and Delayed Loading: A Systematic Review and Meta-analysis.

PURPOSE: To assess the complications, satisfaction, and quality of life of patients rehabilitated with delayed and immediate loading of single crowns. MATERIALS AND METHODS: An electronic search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, and Embase databases up to February 2023. Only prospective studies and randomized and nonrandomized clinical trials comparing immediate and delayed loading were included. For the quantitative analysis, dichotomous and consistent variables were evaluated with a 95% confidence interval. RESULTS: A total of 20 studies were evaluated. No statistically significant difference was observed between protocols: satisfaction (I2: 0%; P = .42), quality of life (I2: 0 %; P = .05), biologic complications (I2: 9%; P = .17), mechanical complications (I2: 58%; P = .84), and survival rate (I2: 0%; P = .38). The subgroup analysis showed significant differences only for marginal bone loss (MBL) when immediate implants were placed in the mandible (I2: 15%; P = .01) and posterior zone (I2: 0%; P = .001). CONCLUSIONS: Complications and patient-centered outcomes for immediate single-implant crowns were comparable to delayed loading. Scientific evidence showed no significant difference between loading protocols for survival rates. Note that several factors could interfere with the complication events, implant failures, and MBL. The subgroup analysis showed that only immediate implants placed in the posterior mandible had a higher and statistically significant mean MBL.

Aesthetic and radiographic outcomes using the root membrane technique in immediate adjacent implant placement: A retrospective clinical study with a 5- to 9-year follow-up.

PURPOSE: The root membrane technique was designed to preserve the buccal portion of the root in situ, preventing postextraction bundle bone loss and overlying soft tissue recession. Nevertheless, maintenance of the aesthetic gingival architecture around two or multiple adjacent implants, particularly in the anterior maxilla, remains a challenge, notably regarding the gingival contour and the interimplant papillae. The present study aimed to evaluate the clinical, aesthetic and radiographic outcomes for immediate adjacent implants placed using the root membrane technique in the anterior maxilla in a sample with a 5- to 9-year follow-up. MATERIALS AND METHODS: A retrospective clinical study was designed using the medical records of two private dental practices. A total of 40 patients who were treated using the root membrane technique for at least two adjacent implants and single-crown restorations between January 2010 and February 2019 were selected (100 implants). The clinical and radiographic data were analysed to assess implant survival/success, marginal bone loss and the pink aesthetic score. RESULTS: The cumulative survival rate after a mean follow-up period of 81.5 ± 30.5 months was 99.0% (implant-based) and 97.5% (patient-based), respectively. Between 1 and 5 years (n = 99), the mean marginal bone loss changed from 0.39 ± 0.07 mm to 0.36 ± 0.07 mm and subsequently to 0.37 ± 0.07 mm at the 7-year follow-up (n = 71) and 0.33 ± 0.07 mm at the 9-year follow-up (n = 14). The improvement from 1 year was significant at all the follow-up time points (P = 0.000). The mean global pink aesthetic score increased from baseline (11.33 ± 1.03) to 3 months after placement of the final restoration (11.73 ± 0.95) and the final observation (12.01 ± 0.87). This was a significant increase (P = 0.000 baseline to 3 months, 3 months to final observation and baseline to final observation). CONCLUSIONS: In this non-controlled retrospective study, adjacent implants placed using the root membrane technique achieved a satisfactory survival and success rate. The variation in marginal bone loss showed a significant positive trend from 1 year to 5 and 7 years. The overall pink aesthetic scores improved significantly between sequential observation periods. CONFLICT-OF-INTEREST STATEMENT: Dr Leitão-Almeida receives personal fees (for sponsored lectures) and non-financial support from MegaGen (Daegu, South Korea) outside of the submitted work; the other authors declare no conflicts of interests relating to this study.

[Comparison of two-year stability between immediate implant action and delayed implantation for anterior teeth with periodontal disease].

PURPOSE: To investigate the feasibility of immediate implantation after extraction of anterior teeth in patients with periodontal disease and its clinical effect within 2 years. METHODS: Thirty patients (36 implants) who underwent anterior dental implant treatment for periodontal disease from 2016 to 2018 were randomly divided into immediate implantation group (17 implants) and delayed implantation group (19 implants). The patients were followed up for 2 years, the clinical parameters such as periodontal probing depth, pink esthetic score（PES）and implant neck bone resorption volume of implant neck were obtained. The data was statistically analyzed with SPSS 21.0 software package. RESULTS: During the 2-year follow-up period, no implant loss, and there was no significant difference in the depth of peri-implant probing between the two groups at each time point(P＞0.05). There was no significant difference in the volume of bone resorption at implant neck between the two groups(P>0.05). At 6, 12 and 24 months after completion of superstructure repair, there was no significant difference in pink esthetic score（PES）between the two groups (P＞0.05), but there was significant difference in pink esthetic score（PES) at the third month after restoration (P＜0.05). The immediate implantation group obtained more satisfactory soft tissue morphology around the implants. CONCLUSIONS: Under appropriate treatment conditions, there is no significant difference in implant success rate between immediate implantation and delayed implantation of anterior teeth in patients with periodontal disease. At the same time, it reduces the number of operations and shortens the course of treatment. In terms of soft tissue aesthetics, immediate implantation is slightly better than delayed implantation in the early stage after restoration, and can maintain a good soft tissue aesthetic effect.

The effect of loading time on marginal bone change of implants immediately placed after extraction: a retrospective study.

BACKGROUND: The purpose of this study is to compare and analyze the treatment outcomes between two groups which are both immediately placed implant cases, one is immediate loading, and the other is conventional loading group. METHODS: Medical records of the patients who underwent implant treatment which were immediately placed after tooth extraction were analyzed. Demographic data were collected and by using periapical or panoramic radiographic image, marginal bone level and distant crestal bone level were measured. Marginal bone change over time was analyzed and compared between immediate loading group and conventional loading group. RESULTS: A total of 71 patients, 112 immediately placed implants after tooth extraction were initially involved. Measuring was done with implants which had not failed (81). 10 implants were had failed and removed. The others were excluded because of follow-up loss, absence of radiographic image, etc. Demographic data were collected, and measured values were averaged at each follow-up and showed in linear graphs. CONCLUSIONS: In case of immediate implantation of dental implant after extraction, loading time could affect marginal bone level or biological width of the implant. Immediate loading group showed 0.92 mm (mean value) more bone loss compared to conventional loading group at bone-implant contact points 24 months after implantation. At distant crestal points, there was no noticeable difference in bone change pattern between two groups.

Assessment and aesthetic impact of a long-term vertical discrepancy between the single anterior maxillary implant-supported crown and adjacent teeth: A retrospective cross-sectional study.

OBJECTIVES: To assess the vertical discrepancy between implant-supported crowns and adjacent teeth in the maxillary anterior region at least 8 years after implant placement and to evaluate the influence of this discrepancy on the level of aesthetic awareness of patients. MATERIAL AND METHODS: The sample consisted of 23 adult individuals evaluated at least 8 years after placement of an implant-supported central or lateral single tooth-fixed partial denture. Patients had their crowns delivered at a mean age of 47.8 years (range: 18.9-65.8). The vertical discrepancy was measured by comparing initial and follow-up periapical radiographs using the implant as a stable structure. The patients' satisfaction with their anterior teeth condition and awareness of the possible vertical problem were evaluated using a questionnaire. The aesthetic outcome and patient awareness were related to the objective measurement of the vertical discrepancy. RESULTS: The implant showed a mean infraocclusion of 0.62 mm (range: 0.15-1.63 mm). The vertical discrepancy was not associated with the patient's gender, age at implant placement, and duration between initial and recall radiograph. Patients were generally satisfied with the long-term aesthetic outcome of their smile (mean: 3.9 on a 1-5 scale, 1 unsatisfied, and 5 completely satisfied). Out of 23 patients, 8 noticed the implant infraocclusion and 4 of them found the problem severe enough to be willing to improve the situation. The amount of vertical discrepancy was not associated with the patient's perception of the discrepancy and the pink aesthetic score. CONCLUSION: Implant-supported crowns in the anterior region may suffer infraocclusion over the long term. The amount of vertical discrepancy was not dependent on the gender and age of the patient. Patients were generally satisfied with the aesthetic result of the restoration. The amount of vertical discrepancy, at least in the range we have measured, was not perceived by the patients as a complication.

Recurrence Rate of Proximal Contact Loss Between Implant Restorations and Adjacent Teeth After Proximal Contact Repair: A Retrospective Study.

PURPOSE: Proximal contact loss (PCL) between implant-supported fixed dental prostheses (FDPs) and adjacent teeth has been reported as a common complication of implant therapy. The prevalence of PCL and its potential risk factors have been extensively studied. However, few studies have discussed the recurrent PCL after intervention to restore the proximal contacts. Thus, this retrospective study aimed to evaluate the recurrence rate of PCL and its potential risk factors. MATERIALS AND METHODS: This study included 41 patients (with 45 implants in the posterior region), who had experienced PCL between implant restorations and adjacent teeth and had received contact repair. Recurrent PCL was recorded and evaluated during routine follow-ups with an interval of 6 to 12 months. The recurrence rates and time were measured. The potential influential factors of PCL were also assessed. Fisher exact test, t test, univariate logistic regression analyses, and multivariate logistic regression model were utilized to identify factors influencing PCL. RESULTS: The recurrence rates of mesial PCL were high (> 50%) and the recurrence time became progressively rapid after each repair (5, 3.2, and 2.2 years). Implants with the first PCL recurrence were more likely to be splinted than those implants without recurrence (54.5% vs 18.8%; P = .032). In addition, patients with the first recurrence were slightly older than those without recurrence (55.8 vs 50.1 years; P = .087). Age, implant restoration (splinted vs single), frequent use of interdental brushes, and time to first complaint were the candidate factors associated with recurrent PCL in the univariate logistic regression analysis. The multivariate logistic regression model revealed that only splinted implant restoration was independently associated with a higher risk of recurrence (odds ratio 4.99; 95% confidence interval 1.02-24.31; P = .047). CONCLUSION: The recurrence rates of mesial PCL were high and associated with the splinted-type design. Also, the recurrence time of PCL accelerated after each repair. Therefore, routine follow-up monitoring PCL and carefully assessing patient compliance after implant therapy are recommended.

Survival Rates of Implants That Have Compromised the Adjacent Teeth and the Associated Complications: An Opg Retrospective Study.

This retrospective study evaluated survival rates of implants compromising adjacent teeth and associated complications. Medical records and orthopantomographic images of 1132 patients and 1478 implants were retrospectively analyzed. Finally, 96 patients (52 females, 44 males) with 111 malpositioned implants were included in the study. The mean follow-up of the study was 32 ± 14 months. The patients were divided into 2 core groups: (1) adjacent teeth and dental implants were considerably close but tangent to each other (TAN), and (2) dental implant cutting the roots of the adjacent tooth (CUT). In addition, the CUT group was divided into 2 subcategories considering the possible cause of malangulation as angled implant (AI) or angled adjacent tooth (AT). Damage to adjacent teeth, future treatment requirements, and the survival rates of the implants were recorded. Among the 111 implants, 4 (3.6%) implants failed, all of which belonged to the CUT category and the AI subgroup. Among the 88 preoperatively vital adjacent teeth, root canal treatment was performed in 18 (20.5%) teeth, whereas 2 (2.3%) teeth were extracted due to malpositioned implanting in follow-ups. The placement of implants too close to the adjacent teeth and even cutting direction did not have a statistically significant effect on the survival rates of implants. However, this could cause adjacent teeth to undergo unnecessary root canal treatment or extraction. Patients with malpositioned adjacent teeth or dilacerated root(s) adjacent to the edentulous area are at a higher risk for malpositioned implant complications. Most implant malposition complications are observed in the first premolar region (37% cases). Therefore, more attention should be given while placing implants in the first premolar region.

Prevalence and risk indicators of midfacial peri-implant soft tissue dehiscence at single site in the esthetic zone: A cross-sectional clinical and ultrasonographic study.

BACKGROUND: Esthetic complications of dental implants in the esthetic zone can have a major negative impact on patients' quality of life and perception of implant therapy. The aim of the present study was to evaluate the prevalence of peri-implant soft tissue dehiscence (PSTD) and the clinical and ultrasonographic risk indicators for this condition. METHODS: Subjects with ≥1 healthy single dental implants in the esthetic area were identified and recruited. Clinical and ultrasonographic measurements, including PSTD class and subclass, probing depth, keratinized mucosa width (KMW), mucosal thickness (MT) at 1 mm and 3 mm, buccal bone distance (BBD) and buccal bone thickness, were evaluated in healthy implants and implants with PSTD. RESULTS: A total of 153 subjects with a total of 176 dental implants were included. The prevalence of PSTD was 54.2% and 56.8% on a patient and implant level, respectively. The most frequent type of PSTD was the one characterized by having both an implant-supported crown longer than the clinical crown of the homologous tooth and a visible abutment/implant fixture exposed to the oral cavity. The multivariate analysis showed that the presence of an adjacent implant, a longer time of the implant in function, limited MT, reduced KMW, and increased BBD were significantly associated with the presence of PSTD. CONCLUSIONS: PSTDs are common findings in the esthetic region. Several risk indicators for this condition, such as presence of an adjacent implant, increased time in function of the implant, higher BBD, lower KMW, and MT were identified.

Assessment of Peri-Implant Soft Tissues Conditions around Short and Ultra-Short Implant-Supported Single Crowns: A 3-Year Retrospective Study on Periodontally Healthy Patients and Patients with a History of Periodontal Disease.

The aim of this retrospective study was to evaluate implant survival, marginal bone loss and peri-implant complications in 326 short and ultra-short implants. Implants were placed in the maxillary and mandibular posterior regions of 140 patients with (PP) and without (NPP) a history of periodontal disease. Clinical and radiographic examinations were performed at 3-year recall appointments. The 8.0, 6.0 and 5.0 mm-length implants placed in PP and NPP were respectively 43.75% and 38.46%, 35.10% and 34.19%, 21.15% and 27.35%; 325 implants (one early failure) were rehabilitated with single crowns in 139 patients. Overall implant survival after 3 years of follow-up was 97.55%, 98.08% and 96.61% for PP and NPP (p = 0.46). Crestal bone level variations were not statistically different among PP and NPP; 15.41% of implants presented signs of mucositis, 14.71% and 16.67% in PP and NPP (p = 0.64). Setting the threshold for bone loss at 2 mm after 36 months, peri-implantitis prevalence was 2.2%, 1.96% and 2.63% in PP and NPP (p = 0.7). Overall implant success was 82.39%, 83.33% and 80.7% for PP and NPP (p = 0.55). Short-term outcomes suggest that short and ultra-short locking-taper implants can successfully be restored with single crowns in the posterior jaws both in PP and NPP.

Association Between Early Implant Failure and Prosthodontic Characteristics.

PURPOSE: To identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care. MATERIALS AND METHODS: An implant-level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2-364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08-14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure. CONCLUSIONS: Use of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications.

Is there an effect of crown-to-implant ratio on implant treatment outcomes? A systematic review.

OBJECTIVES: High crown-to-implant ratios may lead to complications due to unfavorable occlusal forces, including nonaxial forces, on the bone surrounding the neck of the implant and within the connection of the crown and implant itself. The aim of this study was to perform a systematic review on the influence of crown-to-implant ratio of single-tooth, nonsplinted, implants on biological and technical complications. MATERIALS AND METHODS: MEDLINE (1950-January 2018), EMBASE (1966-January 2018), and Cochrane Central Register of Controlled Trials database (1800-January 2018) were searched to identify eligible studies. Inclusion criteria were as follows: crown-to-implant ratio of single-tooth, nonsplinted, implant-supported restorations in the posterior maxilla or mandible and follow-up of at least 1 year. Main outcome measures were as follows: implant survival rate, marginal bone level changes, biological complications, and technical complications. Two reviewers independently assessed the articles. A meta-analysis was carried out for implant survival rate and peri-implant bone changes. RESULTS: Of 154 primarily selected articles, eight studies fulfilled the inclusion criteria. Study groups presented a mean crown-to-implant ratio varying from 0.86 (with 10-mm implants) to 2.14 (with 6-mm implants). The meta-analysis showed an implant survival of more than 99% per year and mean peri-implant bone changes of <0.1 mm per year. Limited biological and technical complications were reported. CONCLUSION: Data reviewed in the current manuscript on crown-to-implant ratio, ranging from 0.86 to 2.14, of single-tooth, nonsplinted, implants did not demonstrate a high occurrence of biological or technical complications.

A retro-prospective long-term follow-up of Brånemark single implants in the anterior maxilla in young adults. Part 1: Clinical and radiographic parameters.

BACKGROUND: Single implant restorations have become the primary treatment option for young adults with missing anterior teeth. Yet, long-term studies of single-implants are limited in the literature. PURPOSE: To report long-term survival, success, and complications in young adults with single-implants in the anterior maxilla. MATERIALS AND METHODS: A group of 42 patients (mean age 20.7 years) received 53 anterior maxillary single-implants during 1996 and 1997. Data were collected at delivery of the crown, at 1-year examination, and at 14-20-year examination. Descriptive statistics, estimated cumulative survival rates, Pearson correlation test, and t-test were performed. RESULTS: After 14-20 years, 40 out of 42 patients were examined. Two patients were lost to follow-up, two implants failed and ten original single-crown restorations were replaced. Estimated cumulative survival rates were 96.1% for implants and 80.4% for implant-supported crowns. Complications were seen in 21 patients. Mean probing depth was 4.0 ± 1.8 mm and mean marginal bone loss was 0.1 ± 1.1 mm. No correlation was found between marginal bone loss and probing depth, occlusal contact in maximal intercuspal position or usage of nicotine. CONCLUSIONS: Long-term prognosis of single implant treatments in the anterior maxilla in young adults must be regarded as good, with high survival and success rates.

Peri-implant inflammation and marginal bone level changes around dental implants in relation to proximity with and bone level of adjacent teeth.

OBJECTIVES: This retrospective study assessed radiographic bone changes and prevalence of inflammation around teeth and neighbouring implants supporting a single-unit fixed dental prosthesis (FDP), in relation to implant- positioning and characteristics. MATERIAL AND METHODS: Patients with an implant-supported FDP in function for at least 1 year were recruited. The radiographic horizontal and vertical position of the implants were identified. Probing depth (PD), bleeding on probing (BOP) and radiographic bone level around implants and adjacent teeth at the time of placement, prosthesis delivery, and the most recent review were assessed. RESULTS: 98 patients with 195 implants were evaluated for a mean of 37.8 months. Survival rate was 99.6% and success ranged from 31.3% to 91.3% when different success criteria were utilized. Significantly greater interproximal bone loss around teeth and higher prevalence of interproximal peri-implant inflammation occurred when the horizontal distance of BL implants was <1 mm, but not with TL implants. There was no significant impact of the corono-apical positioning of the implants on marginal bone loss. CONCLUSION: Proximity of implants to adjacent teeth of <1 mm leads to increased prevalence of inflammation and interproximal bone resorption at the teeth adjacent to bone level implants.

Comparison of clinical and radiographic peri-implant parameters among obese and non-obese patients: A 5-year study.

BACKGROUND: It is postulated that peri-implant parameters are worse in obese individuals as compared to nonobese. OBJECTIVE: The aim of the present 5-year longitudinal study was to analyze and compare the changes in clinical and radiographic peri-implant parameters among obese and non-obese patients. MATERIALS AND METHODS: Twenty patients with body mass index ≥ 27.5 kg/m2 and 18 non-obese controls were included. All patients were indicated for single tooth maxillary or mandibular molar replacement with the adjacent teeth intact. Peri-implant clinical (plaque index [PI], bleeding on probing [BOP], probing depth [PD]) and radiographic (marginal bone loss [MBL]) parameters were measured at 12, 24, and 60 months of follow-up. RESULTS: All peri-implant parameters showed statistically significant difference between obese and non-obese individuals. Obese group recorded significant higher BOP, PD, and MBL at different observation times. Probing depth and MBL increased significantly with advance of time in both groups. After 60 months of follow-up period, greater PI and BOP was observed in obese patients (P < 0.01). At 60 months follow-up period, obese patients showed significant increased PD (3.69 mm) as compared to non-obese individuals (2.46 mm). Marginal bone loss in non-obese individuals varied from 0.30 mm after 12 months, reaching 0.55 mm after 60 months of follow-up period, while in obese patients MBL values went from 0.36 mm after 12 months to 0.91 mm at 60 months follow-up (P < 0.01). CONCLUSIONS: Patients with obesity are at risk of increased localized peri-implant soft and hard tissue inflammation. It is recommended that clinicians should educate obese patients about risk of increased peri-implant tissue inflammation and susceptibility to bone loss and stipulate stringent oral hygiene care for ideal peri-implant health.

Effect of PRF and Allograft Use on Immediate Implants at Extraction Sockets with Periapical Infection -Clinical and Cone Beam CT Findings.

Immediate implant placement can be successful, even at infected sites. The adjunctive effects of concomitant use of platelet-rich fibrin (PRF) and decalcified freeze-dried bone allografts (DFDBA) at periapically infected sites remains to be determined, however. The purpose of this prospective study was to investigate the effect of combined use of PRF and DFDBA on immediate implant survival at tooth extraction sites exhibiting periapical lesions. Implants were immediately placed in 8 patients under a standard chemotherapeutic protocol. Adin titanium implants were used in all cases. The combination of PRF and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months. The full-mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at 3, 6, and 12 months. Cone beam computed tomography images obtained at baseline and at 12 months after implant loading were analyzed. The plaque index scores showed statistically significant differences at 3, 6, and 12 months (p<0.05). The gingival bleeding index score showed no significant difference. No difference was noted in buccal gingival level on the implant surface or adjacent teeth at 91.7% of sites. Complete closure of the interproximal space was seen in 91.7% of the implant sites. Crestal bone levels on all implant surfaces were non-significant. Implant survival was 91.67% at 12 months. The adjunctive use of PRF with DFDBA at periapically infected sites yielded a significant reduction in bone resorption and accelerated bone healing during the initial post-extraction stage. A significant improvement was achieved in the gingival esthetic score at the interproximal and midfacial surfaces. The combined use of growth factors with pre- and postoperative broadspectrum antibiotics over a short time resulted in a higher implant survival rate at the end of the 1 year post-restoration period.

The Modified Socket Shield Technique.

OBJECTIVE: In the anterior regions, the resorption of the buccal bone after tooth extraction leads to a contraction of the overlying soft tissues, resulting in an esthetic problem, particularly with immediate implant placement. In the socket shield technique, the buccal root section of the tooth is maintained, to preserve the buccal bone for immediate implant placement. The aim of this prospective study was to investigate the survival, stability, and complication rates of implants placed using a "modified" socket shield technique. METHODS: Over a 2-year period, all patients referred to a dental clinic for treatment with oral implants were considered for inclusion in this study. Inclusion criteria were healthy adult patients who presented nonrestorable single teeth with intact buccal periodontal tissues in the anterior regions of both jaws. Exclusion criteria were teeth with present/past periodontal disease, vertical root fractures on the buccal aspect, horizontal fractures below bone level, and external/internal resorptions. The buccal portion of the root was retained to prevent the resorption of the buccal bone; the shield was 1.5 mm thick with the most coronal portion at the bone crest level. All patients then underwent immediate implants. In the patient with a gap between the implant and shield, no graft material was placed. All implants were immediately restored with single crowns and followed for 1 year. The main outcomes were implant survival, stability, and complications. RESULTS: Thirty patients (15 males, 15 females; mean age was 48.2 ±â€Š15.0 years) were enrolled in the study and installed with 40 immediate implants. After 1 year, all implants were functioning, for a survival rate of 100%; excellent implant stability was reported (mean implant stability quotient at placement: 72.9 ±â€Š5.9; after 1 year: 74.6 ±â€Š2.7). No biologic complications were reported, and the incidence of prosthetic complications was low (2.5%). CONCLUSIONS: The "modified" socket shield technique seems to be a successful procedure when combined with immediate implant placement, because the root fragment does not interfere with osseointegration and may be beneficial for the esthetics, protecting the buccal bone from resorption.

Prosthetic Complications Affecting Single-Tooth Morse-Taper Connection Implants.

PURPOSE: To evaluate the long-term cumulative implant survival rate (CISR%) and cumulative implant-crown success rate (CICSR%) of single-tooth Morse-taper connection implants, with particular attention to documenting the incidence of prosthetic complications. METHODS: The customized records of all patients who had been treated with single-tooth Morse-taper connection implants in 2 dental centers during the period between January 2002 and December 2012 were revisited. These records included patient-related (gender, age at surgery, smoking, bruxism), implant-related (date of insertion, site/location, and length/diameter of the implant, previous/concomitant bone regeneration), and restoration-related (date of delivery of the provisional and final crown) information. In addition, these records contained information about any implant failure and biologic and/or prosthetic complication that occurred during the follow-up period as well as the radiographic documentation. The follow-up period comprised between 5 and 15 years. The main outcomes were CISR% and CICSR%, with the latter being defined as the condition in which no complication had affected the surviving implant-supported crown during the entire follow-up. Life-table analysis was used for the analysis of CISR% and CICSR%. Peri-implant marginal bone resorption (PIMBR) at 5, 10, and 15 years was a secondary outcome of this study. RESULTS: In total, 578 patients who had received 612 implants were included in this study. The overall CISR% at 15 years was 94.8% (94.2% maxilla, 95.3% mandible). Among the surviving crowns, the overall CICSR% at 15 years was 94.5% (93.1% and 94.9% for anterior and posterior crowns, respectively), and the incidence of prosthetic complications was low (1.5%). The PIMBL amounted to 0.38 ±â€Š0.29 mm, 0.49 ±â€Š0.35 mm, and 0.94 ±â€Š0.58 mm at the 5-, 10-, and 15-year follow-ups, respectively. CONCLUSION: Morse-taper connection implants represent a reliable treatment procedure for the restoration of single-tooth gaps in the long term, with high CISR% (94.8%) at 15 years, a very low incidence of complications, and a high CICSR% (94.5%).

Longitudinal analysis on the effect of insertion torque on delayed single implants: A 3-year randomized clinical study.

BACKGROUND: Implant stability is commonly related to insertion torque. Recently, it has been suggested that higher insertion torque may lead to greater bone resorption. PURPOSE: The aim of the present randomized clinical study was to evaluate the role of different insertion torque values in terms of implant success, marginal bone loss, and facial soft tissues recession. MATERIALS AND METHODS: Patients requiring a single dental implant were recruited and randomized to receive one of two implants with the same macro-geometry but different cutting designs. First group consists of a 90 degrees cutting groove know as self-tapping implant, and the second group known as Blossom™ cutting groove. (Intra-Lock, Boca Raton, Florida). The insertion torque (IT) was assessed and two groups followed: high-IT (≥50 Ncm) group and regular-IT (<50 Ncm) group. After 3 months, all the implants were restored. At baseline, buccal bone thickness (BBT) was recorded. During the 3-year survey, the following outcomes had been registered: implant failures and success, radiographic marginal bone level around dental implant (MBL) and facial soft tissue level (FSTL). RESULTS: A hundred and sixteen implants were placed in healed sites. The overall survival rate after 3 years was 96.5%. The Cumulative Success Rate was 91.3% for the High IT group and 98.2% for the Regular IT group. The mean marginal bone loss and facial soft tissue recession, at a 3-year evaluation, were significantly greater for the High-IT group and in the mandible than that reached in the Regular-IT group and in the maxilla. CONCLUSION: Present findings showed that implants placed with higher insertion torque in mandible led to greater bone resorption and mucosal recession than that registered for implants placed with a regular IT. Moreover, sites with a thick buccal bone wall (≥1 mm) showed smaller recession at the facial soft tissue level after 3 years.

Immediate Reconstruction of Failed Implants in the Esthetic Zone Using a Flapless Technique and Autogenous Composite Tuberosity Graft.

We describe a technique for immediate reconstruction of bone after removal of failed dental implants in the esthetic region to optimize the esthetic outcome of retreatment. We conducted a study of 16 consecutive patients in whom the bony defect resulting from implant removal was immediately reconstructed with a combined autogenous bone and soft tissue graft harvested from the maxillary tuberosity. After a healing period of 3 months, implants were inserted. At 1 year after placement of the definitive restoration, no implants had been lost, the peri-implant tissues were healthy, the aesthetics scored with the pink esthetic score were favorable, and the patients were satisfied. With this technique, it appears that immediate reconstruction of the hard and soft tissue components with a combined bone-soft tissue graft after removal of an implant is a feasible treatment option, from the perspective of both patients and professionals. It expedites rehabilitation, reduces morbidity, and results in a favorable esthetic outcome.