Immediate implant placement with immediate or delayed provisionalization in the maxillary aesthetic zone: A 10-year randomized trial.

AIM: To compare the marginal bone level of immediately placed implants, with either immediate or delayed provisionalization (IP or DP), in the maxillary aesthetic zone after 10 years of function. MATERIALS AND METHODS: Participants with a failing tooth in the maxillary aesthetic zone were randomly assigned to immediate implant placement with either IP (n = 20) or DP (n = 20) after primary wound closure with a free gingival graft. The final restoration was placed 3 months after provisionalization. The primary outcome was change in marginal bone level. In addition, implant survival, restoration survival and success, peri-implant tissue health, mucosa levels, aesthetic indices, buccal bone thickness and patient satisfaction were evaluated. RESULTS: After 10 years, the mean mesial and distal changes in marginal bone level were -0.47 ± 0.45 mm and -0.49 ± 0.52 mm in the IP group and -0.58 ± 0.76 mm and -0.41 ± 0.72 mm in the DP group (p = .61; p = .71). The survival rate was 100% for the implants; for the restorations, it was 88.9% in the IP group and 87.5% in the DP group. Restoration success, according to modified USPHS criteria, was 77.8% in the IP group and 75.0% in the DP group. The prevalence of peri-implant mucositis was 38.9% and 35.7% and of peri-implantitis 0.0% and 6.3%, respectively, in the IP group and DP group (p = 1.0; p = .40). The Pink Esthetic Score and White Esthetic Score was 15.28 ± 2.32 in the IP group and 14.64 ± 2.74 in the DP group, both clinically acceptable (p = .48). The buccal bone thickness was lower in the DP group. Patient satisfaction was similar in both groups (p = .75). CONCLUSIONS: The mean marginal bone level changes after immediate implant placement with IP were similar to those after immediate placement with DP. CLINICAL TRIAL REGISTRATION: Registered in the National Trial Register (NL9340).

Single crown restorations supported by 6-mm implants in the resorbed posterior mandible: A 10-year prospective case series.

PURPOSE: To assess marginal bone level changes, implant and restoration survival, condition of the peri-implant mucosa, and the patient's satisfaction with the single restoration supported by a 6-mm long implant in the posterior mandible after 10 years in function. MATERIALS AND METHODS: Twenty-one consecutive patients missing premolars or molars in the posterior mandible, with a bone volume consisting of a width of at least 6 mm and an estimated height of 8 mm between the top of the ridge and alveolar nerve, were included. Each patient received one or more 6-mm implants. After 3 months, the implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns. The clinical examination and radiograph data were assessed at restoration placement and after 12, 60, and 120 months. The patients answered a questionnaire to score their satisfaction before treatment and after 12, 60, and 120 months with the restoration in function. RESULTS: A total of 31 implants were placed. Implant survival was 100%. The 10-year mean marginal bone loss was 0.18 mm (SE: 0.08). The plaque, calculus, gingiva, and bleeding indices scores were low as was the mean pocket probing depth. The patients' satisfaction was high. CONCLUSION: The 10-year follow-up data of this limited case series study reveal that 6-mm dental implants inserted in the resorbed posterior mandible provide a solid basis for single tooth restorations.

Digital versus conventional surgical guide fabrication: A randomized crossover study on operator preference, difficulty, effectiveness, and operating time.

AIM: If surgical guide fabrication is introduced in a dental education program, a digital and conventional workflow can be used. This study evaluated operator preference, perceived difficulty and effectiveness and operating time of both fabrication methods. MATERIALS AND METHODS: Forty participants in a university setting (students, n = 20; dentists, n = 20) with varying levels of dental experience, but no experience in surgical guide fabrication, were randomly assigned to consecutively fabricate surgical guides on a standardized training model, with either the digital or conventional workflow first. The operating time was measured, and operator preference and the perception of difficulty and effectiveness were assessed with a questionnaire. T tests were used for statistical analysis (α = .05). RESULT: Of the students, 95% preferred the digital workflow and of the dentists 70%. The perceived difficulty of the digital workflow was significantly lower than the conventional workflow in the student group. Both groups perceived the digital workflow to be more effective. The mean operating time (mm:ss) amounted 12:34 ± 2:24 (students) and 18:07 ± 6:03 (dentists) for the digital, and 22:20 ± 3:59 (students) and 20:16 ± 4:03 (dentists) for the conventional workflow. CONCLUSION: Both students and dentists prefer the digital workflow for surgical guide fabrication. Students perceive the digital workflow as less difficult and more effective than the conventional workflow. The operating time for surgical guide fabrication is shorter with a digital workflow. This study indicates that digital fabrication techniques for surgical guides are preferred to be incorporated into the dental curriculum to teach students about treatment planning in implant dentistry.

Single immediate implant placement in the maxillary aesthetic zone with and without connective tissue grafting: Results of a 5-year randomized controlled trial.

AIM: To assess the 5-year effects of grafting connective tissue while undertaking single immediate implant placement and provisionalization at the mid-buccal mucosa level (MBML). Secondary outcomes were buccal bone wall thickness (BBT), marginal bone level (MBL) and patient satisfaction. MATERIALS AND METHODS: Sixty patients with a single failing tooth in the maxillary anterior region were provided with an immediately placed and provisionalized implant. At implant placement, the patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). The alveolar socket classification was mainly Type 2A. Data were collected before removing the failing tooth (T0 ), and at 1 (T1 ), 12 (T12 ) and 60 (T60 ) months after final crown placement. The primary outcome was the change in MBML compared with the pre-operative situation. Additionally, the change in BBT, MBL, aesthetics (using the Pink Aesthetic Score-White Aesthetic Score), soft-tissue peri-implant parameters and patient satisfaction were assessed. RESULTS: At the 5-year follow-up, 27 patients could be analysed from each group. In each group, one implant was lost during the osseointegration period, within 3 months of placement, resulting in an implant survival rate of 96.7% in both groups. MBML change at T60 was -0.6 (-1.1 to -0.1) mm in the control group and 0.1 (-0.4 to 0.5) mm in the test group (p = .008). BBT and MBL, aesthetics, soft-tissue peri-implant parameters and patient satisfaction showed stable results and satisfied patients, without clinically relevant differences between the groups. CONCLUSIONS: This 5-year follow-up study shows that grafting connective tissue when replacing a single failing tooth with immediately placed and provisionalized implant results in favourable peri-implant tissues and fewer MBML changes.

The Peri-Implant Microbiome-A Possible Factor Determining the Success of Surgical Peri-Implantitis Treatment?

The objective was to assess the effect of peri-implantitis surgery on the peri-implant microbiome with a follow-up of one year. A total of 25 peri-implantitis patients in whom non-surgical treatment has failed to solve peri-implantitis underwent resective surgical treatment. Their peri-implant pockets were sampled prior to surgical treatment (T0) and one year post treatment (T12). The natural dentition was sampled to analyse similarities and differences with the peri-implantitis samples. Treatment success was recorded. The change in microbial relative abundance levels was evaluated. The microbiota was analysed by sequencing the amplified V3-V4 region of the 16S rRNA genes. Sequence data were binned to amplicon sequence variants that were assigned to bacterial genera. Group differences were analysed using principal coordinate analysis, Wilcoxon signed rank tests, and t-tests. Beta diversity analyses reported a significant separation between peri-implantitis and natural dentition samples on T0 and T12, along with significant separations between successfully and non-successfully treated patients. Eubacterium was significantly lower on T12 compared to T0 for the peri-implantitis samples. Treponema and Eubacterium abundance levels were significantly lower in patients with treatment success on T0 and T12 versus no treatment success. Therefore, lower baseline levels of Treponema and Eubacterium seem to be associated with treatment success of peri-implantitis surgery. This study might aid clinicians in determining which peri-implantitis cases might be suitable for treatment and give a prognosis with regard to treatment success.

Single crowns in the posterior maxilla supported by either 11-mm long implants with sinus floor augmentation or by 6-mm long implants: A 10-year randomized controlled trial.

OBJECTIVES: To compare the clinical performance of single crowns in the posterior maxilla supported by either 11-mm long implants combined with maxillary sinus floor augmentation (MSFA) surgery or by 6-mm long implants during a 10-year follow-up period. MATERIALS AND METHODS: Subjects were randomly allocated to receive one 11-mm long implant in combination MFSA or to receive one 6-mm long implant without any grafting. Twenty-one implants in 20 patients were placed in the 6-mm group and 20 implants in 18 patients were placed in the 11-mm group. Both groups were followed by clinical and radiographic examinations up to 10 years. Patients' satisfaction was also scored before treatment. RESULTS: Two patients died and eight patients moved during the follow-up. Two patients lost an implant in the 6-mm group and one implant was lost in the 11-mm group (implant survival 89.5% and 90.9%, respectively). From loading to 10 years' follow-up, mean ± SE marginal bone loss in the 6-mm group and 11-mm group was 0.18 ± 0.10 mm and 0.26 ± 0.12 mm, respectively, without a significant difference between the groups at 10 years (p = .650). In both groups, indices scores for plaque, calculus, gingiva and bleeding were low as well as mean pocket probing depth. Patients' satisfaction at 10 years was high in both groups; mean overall satisfaction in the 6-mm group and 11-mm group was 9.6 ± 0.6 and 9.2 ± 0.8, respectively (p = .168). CONCLUSIONS: Placement of 6-mm implants or 11-mm implants combined MFSA are equally successful during a 10-year follow-up period when applied for supporting a single restoration.

Two adjacent implant-supported restorations in the aesthetic region: A 10-year prospective case series.

INTRODUCTION: The treatment outcome of two adjacent implant-supported restorations in the maxillary aesthetic region was assessed regarding peri-implant soft and hard tissues, and satisfaction during a 10-year follow-up period. METHODS: Twenty patients missing two adjacent teeth in the maxillary aesthetic region and treated with two implant-supported restorations were followed prospectively. The patients' clinical and radiographic parameters, as well as their satisfaction, were scored for a 10-year follow-up period. RESULTS: Seventeen patients' data were available for the 10-year follow-up. The survival rate of the implants and restorations was 100%. The 10-year mean peri-implant bone change at the side facing the adjacent tooth was +0.11 ± 0.57 mm and at the side facing the adjacent implant was -0.08 ± 0.50 mm. The peri-implant soft tissues were healthy and the patients' satisfaction was high, but the papilla-index showed compromised inter-implant papillae and low Pink Esthetic Scores. These figures were of the same magnitude at all time points. CONCLUSION: While it is difficult to obtain sufficient inter-implant papillae and satisfactory Pink Esthetic Scores, the initial treatment results remained stable and the patients were satisfied with the final result throughout the 10-year follow-up period.

Two or four implants for maxillary overdentures in edentulous patients: 1-year results of a randomized controlled trial.

INTRODUCTION: Maxillary implant overdenture therapy is a good treatment option for treating patients experiencing problems with their conventional maxillary denture. Retaining the overdenture with four implants and a bar attachment system serves as the current gold standard. However, there is a demand for less costly and less invasive treatment options. The aim of this randomized controlled trial was to compare marginal bone level change (MBLC), implant and overdenture survival, clinical, masticatory, and patient-related outcomes (PROMs) of maxillary implant overdentures with either two or four implants and a bar attachment system. MATERIALS AND METHODS: Forty edentulous participants were randomly allocated to two groups (n = 20), to receive either two or four implants in the maxilla. After healing, all the participants received an implant overdenture retained by a bar attachment system. All the participants were evaluated 1 and 12 months after overdenture placement. The primary outcome was MBLC. Secondary outcomes were implant and overdenture survival, clinical, masticatory, and PROMs. The outcomes were analyzed using parametric and non-parametric tests. RESULTS: MBLC was -0.03 mm in the 2-implant group and -0.16 mm in the 4-implant group (p = 0.21). Implant survival was 83.3% in the 2-implant group and 94.4% in the 4-implant group (p = 0.03). The median pocket depth change and clinical outcomes were low, and masticatory performance along with PROMs improved in both groups and did not differ significantly between them. CONCLUSION: Maxillary 4-implant overdentures perform better than maxillary 2-implant overdentures with a bar attachment system in terms of implant and overdenture survival and therefore remains the gold standard. However, both overdentures perform similarly in terms of MBLC, clinical, masticatory, and PROMs.

Dental implant treatment for two adjacent missing teeth in the esthetic region: A systematic review and 10-year results of a prospective comparative pilot study.

OBJECTIVES: The aim of the systematic review was to compare studies on implant-supported two-unit cantilever crowns with two adjacent implant-supported crowns in the anterior region. The second aim was to assess in a 10-year prospective comparative pilot study, hard and soft peri-implant tissue changes in patients with a missing central and adjacent lateral upper incisor, treated with either an implant-supported two-unit cantilever crown or two single implant-supported crowns. MATERIALS AND METHODS: Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched (last search March 1, 2023). Inclusion criteria were studies reporting outcomes of two missing adjacent teeth in the esthetic region and treated with a single implant-supported two-unit cantilever fixed dental prosthesis, or with two solitary implant-supported crowns. Outcome measures assessed included implant survival (primary), changes in marginal bone and gingiva level, restoration survival, subjective and objective esthetic scores, papilla volume, mid-facial marginal mucosa level, probing depth, bleeding on probing, and biological and technical complications with ≥1-year follow-up. In addition, in a 10-year pilot study, the same outcome measures were assessed of five patients with a single implant-supported two-unit cantilever crown and compared with five patients with two adjacent single implant-supported crowns in the esthetic zone. RESULTS: Nine articles with 11 study groups were found eligible for data extraction. Meta-analyses of implant survival rates were 96.9% (mean follow-up 3.4 ± 1.4 years) for the implant-cantilever treatment and 97.6% (mean follow-up 3.0 ± 1.8 years) for the adjacent implants treatment (p = .79). In the 10-year comparative pilot study, no clinically relevant changes in hard and soft peri-implant tissue levels occurred in both groups. Patient satisfaction was also high in both groups. CONCLUSION: Single implant-supported two-unit crowns can be a viable alternative to the placement of two adjacent single implant crowns in the esthetic zone.

Maxillary overdentures supported by four or six implants in the anterior region: 10-year randomized controlled trial results.

AIM: To evaluate bar-supported maxillary implant overdenture treatment when supported by either four or six implants after 10 years. MATERIALS AND METHODS: Edentulous subjects with maxillary denture complaints and ample bone volume to facilitate implants in the anterior region of the maxilla were planned for implant overdenture treatment, randomized to receive either four implants (n = 25) or six implants (n = 25) and subsequently evaluated after 10 years of function. Outcome variables included peri-implant bone-level changes, implant and overdenture survival, complications, presence of plaque, calculus and bleeding, degree of peri-implant inflammation, probing depth and patient satisfaction. Differences between the groups and between evaluation periods were tested with a Student's t-test. RESULTS: Fourteen patients with totally 72 implants were lost to follow-up. Two patients from the six-implant group experienced implant loss (four implants), resulting in 96.1% implant survival in this group versus 100% survival in the four-implant group. Clinical, radiographical and patient-reported outcome measures did not differ statistically significant between the two groups. Patients from both groups were generally quite satisfied with the result after 10 years. CONCLUSIONS: Similar and favourable outcomes are seen in bar-supported maxillary overdentures on either four or six anteriorly placed implants after a 10-year evaluation period.

The performance of two-implant overdentures in the atrophic maxilla: a case series with 1-year follow-up.

PURPOSE: To assess the implant and prosthesis survival rates, the clinical, radiographical and patient-related outcome measures, and the masticatory performance of maxillary overdentures supported by two implants in patients with an atrophic maxilla. METHODS: In this case series, 15 consecutive patients who were eligible for maxillary implant overdenture therapy, but who had insufficient bone volume to place at least four implants and were unwilling to be treated with reconstructive surgery were asked to participate. After giving consent, participants received two implants in the maxilla under local anaesthesia. After 3 months of osseointegration, a maxillary overdenture with palatal coverage and solitary attachments was fabricated. Implant and overdenture survival, marginal bone level change, clinical outcome measures, masticatory performance and patient-related outcomes were evaluated at baseline and 1 year after overdenture placement. RESULTS: Fourteen out of 15 participants completed the follow-up period of 12 months. Implant and overdenture survival rate were 89.3% and 85.7%, respectively. Change in marginal bone level (- 0.5 ± 0.7 mm), change in probing depth (0.0 ± 1.0 mm), and clinical outcomes were favourable. Masticatory performance and patient-related outcomes improved significantly compared to baseline. Complications were minimal. CONCLUSIONS: Within the limitations of this study, it can be concluded that patients with extreme resorption of the maxilla that are unwilling to be treated with reconstructive surgery, benefit from two-implant maxillary overdentures retained by solitary attachments in terms of improved masticatory functioning and denture satisfaction. However, they have relatively high risk of implant loss. TRIAL REGISTRATION: UMCG Trial Register (RR201900060), registered 22 January 2019.

Maxillary bar overdentures on four or six posterior implants: 10-year results from a randomized clinical trial.

OBJECTIVE: To compare clinical and patient-reported outcomes when providing maxillary overdentures on four and six splinted implants placed in the posterior region during a 10-year follow-up period. MATERIALS AND METHODS: Sixty-six edentulous participants with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a bone augmentation procedure. After healing, participants were randomized to receive either four or six implants in the posterior maxilla. After 3 months of osseointegration, a bar overdenture was constructed. Implant survival, overdenture survival, clinical scores, peri-implant bone height changes, and patient satisfaction were assessed. RESULTS: Forty-six participants completed the 10-year follow-up. Implant survival was 100% in the 4-implant group and 96.7% in the 6-implant group. Seven new overdentures were made in the 4-implant group and 12 new overdentures were made in the 6-implant group due to excessive wear of the denture base and teeth. Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.41 ± 0.37 mm in the 4-implant group and 0.70 ± 1.07 mm in the 6-implant group. Overall, patient satisfaction improved significantly, but did not differ between groups. CONCLUSION: From this 10-year follow-up trial, it was concluded that bar maxillary overdentures on four or six implants in the posterior region of an augmented maxilla resulted in a comparable treatment outcome with high implant survival, limited loss of peri-implant marginal bone, and high patients' satisfaction. (Clinical trial registration number: NTR9729).

Digital Workflow for Immediate Implant Placement and Chairside Provisionalization in the Esthetic Zone.

Introduction: Immediate implant placement and immediate chairside provisionalization in the esthetic zone require meticulous treatment planning. A digital workflow that combines intraoral scans and a cone beam computed tomography scan can be used to visualize the surgical and restorative aspects of the treatment and to plan a prosthetically driven implant position. A digital workflow in implant dentistry enables the prefabrication of an individualized CAD/CAM temporary restoration, based on the planned implant position. This could be a predictable method to deliver a screw-retained temporary restoration, directly after static computer-assisted immediate implant surgery. Interventions. Three patients with a failing tooth in the maxillary esthetic zone were treated with immediate implant placement and chairside provisionalization using this digital workflow. After 3 months, a final restoration was placed. Clinical, radiographic, and patient-reported outcome measures were collected prior to implant treatment, 6 weeks after placing the temporary restoration and then 1 month and 1 year after placing the final restoration. Outcomes. At the 1-year follow-up, healthy soft tissues were observed, and peri-implant bone levels were stable. Patient satisfaction after the treatment was high. Conclusion: The three reported cases demonstrate the potential for predictable immediate implant placement and chairside provisionalization using a digital workflow.

Three-unit fixed dental prostheses supported by either two abutment implants or two abutment teeth: A comparative retrospective cohort study.

OBJECTIVES: In general, similar restorative constructions are made on natural teeth and on dental implants. The assumption is made that implants and their restoration perform the same as natural roots and their prosthetic restoration. Evaluating cohorts of three-unit bridges on teeth and on implants, this retrospective clinical study aimed to compare implants and teeth as supporting units, including the reconstructions, in terms of survival, success, clinical, radiographic, and patient-reported outcomes. MATERIAL AND METHODS: From an 8-year period, all patients treated with a posterior three-unit fixed reconstruction on either implants or teeth, with a follow-up of at least 2 years, were identified. For each implant-supported reconstruction, a comparable tooth-supported reconstruction was selected, based on the length of follow-up, the material of the reconstruction, and the location in either the maxilla or mandible. RESULTS: For the Implant-group, 24 patients could be matched with 24 best matching patients with tooth-supported fixed dental prostheses (FPDs). Supporting implants and implant-supported reconstructions were all in function with a mean follow-up of 52 ± 23 months. Two tooth-supported reconstructions had been replaced (91.7% survival) (mean follow-up: 52 ± 19 months). Radiographic bone levels and soft tissue conditions were favorable in both groups with minor differences. There was no significant difference in overall patient satisfaction. The modified USPHS-score revealed an 87.5% overall success in the Implant-group and 91.7% in the Tooth-group. CONCLUSIONS: Implant-supported three-unit FDPs are a reliable treatment option with survival and success rates not significantly different from the results of tooth-supported three-unit FDPs.

Incidence of peri-implant mucositis and peri-implantitis in patients with a maxillary overdenture: A sub-analysis of two prospective studies with a 10-year follow-up period.

BACKGROUND: Though studies on maxillary overdentures show satisfying results on implant survival, patient-related outcomes and prosthetic complications, the epidemiology of peri-implant diseases in this specific group of patients has hardly been reported. While the general patient-level prevalence of peri-implant mucositis and peri-implantitis are estimated at ~45% and ~20%, respectively, the risk of developing these diseases within a specific period is less clear. To fully appreciate the epidemiology of peri-implant diseases, more long-term data on incidence of peri-implant diseases are needed. PURPOSE: The purpose of this sub-analysis of two prospective studies was to assess the incidence of peri-implant mucositis and peri-implantitis in fully edentulous patients with implant-retained maxillary overdentures during a 10-year follow-up period. MATERIALS AND METHODS: One hundred and sixteen patients treated with implant-supported maxillary overdentures were available from two clinical trials. Data on biological complications, clinical and radiographical parameters were collected for 106 patients at 5-year, for 82 patients at 10-year follow-up. The incidence was calculated following the consensus of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Extent and severity then were calculated to enable an appropriate epidemiological description of peri-implantitis. RESULTS: The patient-level incidence of peri-implant mucositis was 37.7% after 5 years and 64.6% after 10 years whereas the patient-level incidence of peri-implantitis was 10.4% after 5 years and 19.5% after 10 years. After 10 years, the extent of peri-implant mucositis and peri-implantitis is 52.8% and 43.8%, respectively. In terms of severity, 26.5% of all affected implants suffered from >3 mm bone loss and 17.6% of all affected implants was lost. CONCLUSION: Three of five fully edentulous patients with implant-supported maxillary overdentures experience peri-implant mucositis after 10 years. Peri-implantitis occurs in one of five patients after 10 years. In spite of these incidence rates, implant survival remains high.

Monolithic zirconia single tooth implant-supported restorations with CAD/CAM titanium abutments in the posterior region: A 1-year prospective case series study.

PURPOSE: To assess the clinical, radiographic, and patient-reported outcome measures, including the success of screw-retained monolithic zirconia implant-supported restorations with CAD/CAM titanium abutments in the posterior region during a 1-year follow-up. METHODS: In a prospective case series, 50 molar sites in the posterior region of 46 patients with a minimum age of 18 years and sufficient bone volume and anatomical conditions for placing an implant (≥8 mm) and an anatomical restoration were included. Parallel-walled implants with a conical connection were inserted in a two-stage surgical procedure. Implant uncovering and healing abutment placement occurred 12 weeks after insertion. Two weeks after mucosa healing, a screw-retained monolithic zirconia restoration with a CAD/CAM titanium abutment was placed. Clinical, radiographic, and patient-reported outcome measures were collected at baseline before implant placement and then during the 1 month and 1 year follow-ups. RESULTS: At the 1 year follow-up, 49 restorations could be evaluated. The plaque accumulation, presence of calculus, bleeding tendency and peri-implant inflammation indices were low, representing healthy peri-implant conditions. The mean marginal bone level change between the 1 month and the 1 year follow-up was -0.17 ± 0.46 mm. The mean patient satisfaction was high. The restoration success was, according to the modified USPHS criteria, 95.9%. CONCLUSION: Monolithic zirconia implant-supported restorations with CAD/CAM titanium abutments have very good clinical, radiographic and patient-reported outcomes after 1 year in function.

Erythritol air polishing in the surgical treatment of peri-implantitis: A randomized controlled trial.

OBJECTIVES: To compare erythritol air polishing with implant surface cleansing using saline during the surgical treatment of peri-implantitis. MATERIAL AND METHODS: During a resective surgical intervention, implant surfaces were randomly treated with either air polishing (test group n = 26 patients/53 implants) or saline-soaked cotton gauzes (control group n = 31 patients/ 40 implants). Primary outcome was change in mean bleeding on probing (BoP) from baseline to 12 months follow-up. Secondary outcomes were changes in mean suppuration on probing (SoP), plaque score (Plq), probing pocket depth (PPD), marginal bone loss (MBL), periodontal full-mouth scores (PFMS), and levels of 8 classical periodontal pathogens. Clinical and radiographical parameters were analyzed using multilevel regression analyses. Microbiological outcomes were analyzed using the Mann-Whitney U test. RESULTS: No differences between the test and control group were found for BoP over 12 months of follow-up, nor for the secondary parameters Plq, PPD, and MBL. Between both groups, a significant difference was found for the levels of SoP (p = 0.035). No significant effect on microbiological levels was found. A total number of 6 implants were lost in the test group and 10 in the control group. At 1-year follow-up, a successful treatment outcome (PPD<5 mm, max 1 out of 6 sites BoP, no suppuration and no progressive bone loss >0.5 mm) was achieved for a total of 18 implants (19.2%). CONCLUSIONS: Erythritol air polishing as implant surface cleansing method was not more effective than saline during resective surgical treatment of peri-implantitis in terms of clinical, radiographical, and microbiological parameters. Both therapies resulted in low treatment success. TRIAL REGISTRY: https://www.trialregister.nl/ Identifier: NL8621.

Linear and profilometric changes of the mucosa following soft tissue augmentation in the zone of aesthetic priority: A systematic review and meta-analysis.

OBJECTIVES: To assess the outcomes of soft tissue augmentation, in terms of change in level and thickness of mid-buccal mucosa, at implants sites in the zone of the aesthetic priority. MATERIAL AND METHODS: MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials databases were searched (last search on 1 June 2020). Inclusion criteria were studies reporting outcomes of different materials and timing of grafting in patients undergoing soft tissue augmentation at implant sites in the aesthetic zone with a follow-up of ≥1 year after implant placement. Outcome measures assessed included changes in level and thickness of mid-buccal mucosa, implant survival, peri-implant health and patients' satisfaction. RESULTS: Eighteen out of 2,185 articles fulfilled the inclusion criteria. Meta-analysis revealed a significant difference in vertical mid-buccal soft tissue change (0.34 mm, 95% CI: 0.13-0.56, p = .002) and mid-buccal mucosa thickness (0.66 mm, 95% CI: 0.35-0.97, p < .001) following immediate implant placement in favour of the use of a graft versus no graft. Mean difference in mid-buccal mucosa level following delayed implant placement (0.17 mm, 95% CI: 0.01-0.34, p = .042) was also in favour of the use of a graft versus no graft. With regard to mucosa thickness, the use of a graft was not in favour compared with no graft following delayed implant placement (0.22 mm, 95% CI: -0.04-0.47, p = .095). Observed changes remained stable in the medium term. CONCLUSION: Soft tissue augmentation in the zone of the aesthetic priority results in less recession and a thicker mid-buccal mucosa following immediate implant placement and less recession in mid-buccal mucosa following delayed implant placement compared with no graft.

Single implant-supported two-unit cantilever fixed partial dentures in the posterior region: a retrospective case series with a mean follow-up of 6.5 years.

BACKGROUND: The aim of this retrospective study was to evaluate the implant survival, clinical and radiographic outcomes, and patient satisfaction of single implant-supported two-unit cantilever fixed partial dentures in the posterior region. METHODS: Patients who received a single implant-supported fixed partial denture with a cantilever in the posterior region between January 2004 and February 2018 were included. Survival rate of the implants and the fixed partial dentures and data regarding the marginal bone level, presence of plaque, calculus, bleeding on probing, mucosa health, pocket probing depth, and patient satisfaction were collected during an evaluation visit. Complications were recorded from the medical records. RESULTS: Twenty-three patients (mean age 64 ± 13 years) with 28 implants could be included in the study. The mean follow-up period was 6.5 ± 4.8 years at the time of data collection. The survival rate of the implants and fixed partial dentures was 100%. Mean marginal bone loss for the mesial and distal side of the implants was 0.41 mm (SD 1.18 mm) and 0.63 mm (SD 0.98 mm) respectively. A high prevalence of peri-implant-mucositis (89.3%) and peri-implantitis (17.9%) was observed as well as a limited number of technical complications. Patients were quite satisfied, as reflected by a mean VAS score of 94.0 ± 7.2 points (range 0-100) and a OHIP-NL49 score of 10.8 (range 0-196). CONCLUSIONS: Single implant-supported fixed partial dentures with a mesial or distal cantilever can be a predictable treatment option in the posterior region, with stable peri-implant bone levels, minor technical complications, and very content patients. However, the prevalence of peri-implant mucositis and peri-implantitis was high. TRIAL REGISTRATION: ISRCTN, ISRCTN79055740 , Registered on March 14, 2021 - -Retrospectively registered.

The effect of implant-abutment connections on peri-implant bone levels around single implants in the aesthetic zone: A systematic review and a meta-analysis.

OBJECTIVE: To systematically review literature about the effect of different implant-abutment interface designs on peri-implant bone level changes, implant loss and mid-buccal mucosa changes around single implants in the anterior maxilla. Reviewing three connection configurations: Platform switched conical (PS-conical); Platform switched parallel (PS-parallel); Platform matched parallel (PM-parallel). METHODS: A detailed search was carried out in Pubmed, EMBASE, Cochrane, Scopus, Open Gray and African journals Online (until December 1, 2020) and was restricted to clinical prospective studies of at least 1 year and with at least 10 human participants. A meta regression analysis was carried out primarily on the pooled peri-implant bone level changes followed by implant loss and mid-buccal mucosa level change. Risk of bias was assessed with RoB 2.0 and ROBINS-I. The manuscript complied with the PRISMA guidelines and was registered in the PROSPERO database (ID: 225092). RESULTS: A total of 5513 hits gave 44 eligible articles for the analyses. Bone level change did not differ significantly between the two platform switched connections; their bone loss scores were significantly lower than PM-connection. The PS-conical connections have significantly lower implant losses than the PM connection. Mid-buccal mucosa level change was comparable between the three connection configurations. Moderate to high risk of bias was detected in the included studies. CONCLUSIONS: The performance of PS-conical and PS-parallel connection configurations both favored bone loss scores compared to the PM-parallel connection configuration. All three demonstrated mid-buccal mucosa changes that were small and did not differ significantly amongst the groups.