Effect of customized healing abutments on the peri-implant linear and volumetric tissue changes at maxillary immediate implant sites: A 1-year prospective randomized clinical trial.

BACKGROUND: Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices (CM) seems to reduce the amount of resorption at peri-implant areas. Recently, customized healing abutments (CA) appeared as another solution in order to seal the socket and preserve the original soft tissue contour. PURPOSE: To evaluate peri-implant tissues dimensional changes after using customized healing abutments compared with the use of xenogeneic collagen matrices as socket sealing options in flapless maxillary immediate implant placement. MATERIAL AND METHODS: The present study was designed as a prospective, randomized, controlled clinical trial. Patients were allocated into two groups depending on the socket sealing option: in the CM group a collagen matrix was used and in the CA group a customized abutment. Digital impressions were taken prior to extraction, 1, 4, and 12 months after implant insertion and the digital files allowed to evaluate linear buccal changes (MBC) and the buccal volumetric variation (BVv) between the different time points at peri-implant tissue areas. Additionally, mucosa variation was computed assessing the papilla presence and the midfacial mucosa height. Statistical significance was set at 0.05. RESULTS: Twenty-eight patients were observed during a 12-month period. Significant differences between mean values of BVv at the first month were observed at the CM and CA group (-9.75 ± 6.65% and -4.76 ± 5.29%, respectively) (p = 0.043). At the 1-year follow-up, no significant differences were found in terms of BVv between the two groups, although the thin bone phenotype (≤1 mm) significantly influenced the volumetric variations that occurred in each group. No significant differences were noticed in midfacial mucosa and papillae alteration between groups, after 1 year of treatment. CONCLUSION: Both treatment options are predictable solutions for socket sealing in IIP, although a higher volumetric variation can be expected in the presence of thin bone phenotypes.

Radiological infrabony defects after impacted mandibular third molar extractions in young adults.

PURPOSE: To estimate the prevalence of infrabony defects and their healing at the distal aspect of mandibular second molars (M2s) after extraction of impacted mandibular third molars (M3s). MATERIALS AND METHODS: This prospective clinical study included 22 young healthy patients (21.03 ± 4.51 yr old). Thirty-seven surgical extractions of high-risk periodontal and mesioangular impacted M3s in close contact with adjacent M2s were performed. Radiographic bone height (RBH), radiographic infrabony defects (RIDs), and bone loss (BL) were recorded at baseline and 3, 6, and 12 months after surgery. RBH and RIDs were measured from the tip of a periodontal gauge to the root apex and to the cementoenamel junction of the M2, respectively; BL was calculated by dividing the length of the M2 root into thirds and categorized as slight, moderate, or severe. RESULTS: Only 26 extracted teeth were included in all radiographic assessments. Mean RID size at baseline was 4.54 ± 1.87 mm. At 12 months, an average recovery of 2.80 ± 2.36 mm (P < .001) was recorded, for a mean RID size of 1.78 ± 1.65 mm. Statistically significant differences in RBH and RIDs were found at all assessments (P < .05). Improved bone healing was registered during the postoperative period, with higher values during the first 3 months (1.3 mm; P < .01). Most RIDs of at least 4 mm associated with moderate or slight BL decreased to no larger than 3 mm without BL. For moderate BL, the bone gain pattern was gradual and continuous, whereas for slight BL, the pattern was variable. CONCLUSIONS: In young healthy patients, a high-risk periodontal impacted M3 leads to an RID of at least 4 mm associated with slight or moderate BL at the distal aspect of the M2, which decreases to no larger than 3 mm 12 months after surgery. Bone healing is clinically and statistically significant at 12 months, with the most notable changes at the first 3-month follow-up.