Single implants in the aesthetic region preceded by local ridge augmentation; a 10-year randomized controlled trial.

OBJECTIVES: The aim of this randomized controlled trial was to assess the 10-year effects of three different augmentation techniques (augmentation with chin bone, augmentation with chin bone plus a membrane and augmentation with a bone substitute plus a membrane) for implant-supported restorations in the maxillary aesthetic region regarding clinical and radiographic parameters, and patient-centred outcomes. MATERIALS AND METHODS: Ninety-three patients requesting single tooth replacement and presenting with a horizontal bone deficiency were included. After augmentation, 93 implants were placed. Clinical variables, standardized radiographs and photographs and patient questionnaires were analysed to assess the impact of the various augmentation techniques 1 month (T1 ), 12 months (T12 ) and 120 months (T120 ) after final crown placement. RESULTS: 10-years implant survival was 95.7% and did not differ between the groups neither were significant differences observed in the other treatment outcomes assessed. Peri-implant bone loss was low, viz. 0.48 ± 1.19 mm (mesial) and 0.30 ± 1.24 mm (distal) at T120 . Loss of midbuccal marginal gingival level at T120 was 0.32 ± 0.83 mm. Mean overall satisfaction at T120 was 8.6 with 98.6% of the patients satisfied. CONCLUSIONS: Clinical, radiographic, aesthetic and patient centred outcomes were very favourable after 10 years and did not differ between the groups with different bone augmentation techniques.

Care and aftercare related to implant-retained dental crowns in the maxillary aesthetic region: a 5-year prospective randomized clinical trial.

AIM: To prospectively assess surgical and prosthetic care and aftercare related to the placement of implant-retained dental crowns after local bone augmentation in patients missing one tooth in the maxillary aesthetic region. METHODS: Ninety-three patients were randomly allocated to one of three local augmentation groups: (1) chin bone; (2) chin bone covered by a Bio-Gide® membrane (Geistlich, Wolhusen, Switzerland); and (3) Bio-Oss® covered by a Bio-Gide® membrane. After local augmentation, implant placement (ITI) and fabrication of an implant-retained dental crown (cemented metal-ceramic dental crown) was performed. Prosthetic and surgical care and aftercare was scored from the first visit until 5 years after the augmentation of the implant region. RESULTS: The need for care and aftercare was comparable between the local augmentation groups. Three implants were lost (5-year implant survival rate: 96.7%). Surgical aftercare was needed in 9% of patients and consisted of care related to peri-implant tissue problems. Prosthetic aftercare was needed more often: all patients needed periodic routine inspections; 63% needed supplemental oral hygiene support; and 16% needed additional prosthetic care, mainly consisting of fabricating new crowns (12%). CONCLUSION: Placing an implant in the maxillary esthetic region after local bone augmentation is a safe and reliable treatment option not needing much specific aftercare other than periodic preventive routine inspections, routine oral hygiene care, and fabrication of a new crown in one out of every eight to nine patients in 5 years. The method used for augmentation was irrespective of the patients' need for aftercare.

Microbiota around teeth and dental implants in periodontally healthy, partially edentulous patients: is pre-implant microbiological testing relevant?

This study aimed to assess the prevalence of seven periodontal marker pathogens, before implant placement and 1 yr after loading, in periodontally healthy individuals and to assess the long-term effectiveness of pre-implant reduction of pathogens to below threshold levels. In 93 individuals needing single tooth replacement, pooled subgingival microbiological samples from standard sites were cultured and analyzed before implant treatment and 1 yr after loading. Threshold levels commonly used in periodontology to predict periodontal breakdown were applied. Subjects with levels of pathogens above these thresholds received initial periodontal treatment including systemic antibiotics when indicated. At baseline, 49.5% of periodontally healthy subjects harboured one or more marker pathogens above threshold levels. Periodontal treatment reduced the pathogen levels below threshold values in 78.3% of these initially colonized subjects. In all cases Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were reduced to below threshold. At 1 yr after loading, periodontal pathogens were present above threshold levels in 74.1% of all subjects. It is concluded that in almost half of periodontal healthy individuals the subgingival biofilm harbours periodontal pathogens above threshold values. Long-term effectiveness of pre-implant reduction of the selected marker pathogens appeared limited in our patient population, making pre-implant reduction unpredictive for post-implant levels of these pathogens. Thus, considering the applied microbiological criteria, generalized pre-implant microbiological testing is not contributory in periodontally healthy subjects.

Evaluation of aesthetics of implant-supported single-tooth replacements using different bone augmentation procedures: a prospective randomized clinical study.

OBJECTIVES: The aim of this study was to evaluate the aesthetics of implant-supported single-tooth replacements using different augmentation procedures in a prospective study with the use of an objective rating index and with a subjective patient questionnaire, and to compare the results with each other. MATERIAL AND METHODS: Ninety-three patients with a single-tooth gap in the anterior zone of the maxilla were selected for the study. All patients had a local bone defect that needed augmentation before placement of an endosseous implant with sufficient initial stability. Aesthetics of the implant-supported crown and adjacent mucosa was rated by a prosthodontist 1 year after placement of the porcelain crown. Aesthetics was rated using the Implant Crown Aesthetic Index. A subjective appreciation of the final result was assessed with a patient questionnaire. RESULTS: The Implant Crown Aesthetic Index reveals a mean overall score of 4.8, with an acceptable result in 66% of the cases. Results of the satisfaction questionnaire reveal a mean overall score of 8.5 with an acceptable result in 100% of the cases. There is no correlation between results of the Index and the questionnaire for the overall and the crown score. The patients' opinion and the professionals' opinion about the peri-implant mucosa do show a significant correlation. CONCLUSIONS: The peri-implant mucosa is rated as less satisfactory than the implant-supported crown by both the dental professional and patients. The dental professional was less satisfied with respect to the total result and results of the crown than the patients.

Morbidity of mandibular bone harvesting: a comparative study.

PURPOSE: To assess the objective and subjective morbidity of mandibular bone harvesting. MATERIALS AND METHODS: Forty-five patients who had been subjected to mandibular bone harvesting from the chin region (group 1, n = 15), the retromolar region (group 2, n = 15), or the retromolar region after removal of the third molar (group 3, n = 15) participated in this study. Complications, postoperative morbidity, and patient acceptance of the procedure were evaluated by assessing the medical records and performing standardized routine clinical and radiographic examinations up to 12 months after the augmentation procedure. In addition, the patients were asked to complete a questionnaire on the subjective complaints related to the procedure. RESULTS: Analysis of the questionnaire revealed that there was no significant difference between patients of groups 1 and 2 regarding acceptance of the procedure (scores of 8.6 +/- 1.1 and 8.5 +/- 0.9 on a 10-point scale, respectively). Acceptance of the procedure was scored significantly higher by the patients of group 3 (9.3 +/- 0.7; Student t test, P < .05). Six patients of group 1 and 2 patients of groups 2 and 3 reported subjective sensory disturbances related to the donor site. With the exception of 2 patients in group 1, these subjective complaints disappeared within 2 months after surgery. In the 2 patients (group 1) who reported a persistent discrete sensibility disorder in the symphyseal region after 12 months, this disturbance could not be confirmed objectively. CONCLUSION: Mandibular bone harvesting for reconstructing local alveolar defects is a well-accepted procedure with low objective and subjective morbidity. Amongst the procedures evaluated, harvesting bone from the retromolar region combined with removal of the third molar was best accepted by the patients.

A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues--the Implant Crown Aesthetic Index.

OBJECTIVES: The important item of aesthetics is rarely included in evaluation studies. The aim of this study was to develop and validate an index for rating aesthetics of implant-supported single crowns and adjacent soft tissues. MATERIAL AND METHODS: Nine items were selected, which have an influence on the aesthetic result. The items are based on the anatomic form, colour and surface characteristics of the crown and on the anatomic form, colour and surface characteristics of the peri-implant soft tissues. Two oral-maxillofacial surgeons and two prosthodontists rated 24 implant-supported single-tooth restorations and adjacent soft tissues on a form with the nine items of the rating index. The rating was carried out twice by each of the examiners. Weighted Cohen's kappa was calculated to express the intra- and interobserver agreement. RESULTS: Intraobserver results indicated that the agreement between the first and second rating of both the prosthodontists was good (both 0.7) and that the agreement of the oral-maxillofacial surgeons was moderate (0.49 and 0.56). The best interobserver agreement was found between the two prosthodontists (0.61, good agreement). CONCLUSIONS: The Implant Crown Aesthetic Index is an objective tool in rating aesthetics of implant-supported single crowns and adjacent soft tissues. The rating is best be carried out by one prosthodontist to have the highest reliability.

A technique for standardized evaluation of soft and hard peri-implant tissues in partially edentulous patients.

BACKGROUND: There is a growing need to evaluate the esthetics of implant-supported crowns and bridges. An important tool for such an evaluation is standardized assessment of the soft and hard peri-implant tissue levels. METHODS: A simple acrylic device has been developed for reliable and reproducible assessment of soft and hard peri-implant tissues using standardized color slides and standardized dental x-rays. With this device, changes in both the soft and hard tissues around implant-supported crowns can be evaluated as a function of time. The reproducibility of the technique was tested on color slides as well as on dental x-rays in a series of implant-supported crowns and their neighboring teeth. RESULTS: The reproducibility of this technique was excellent. The measuring errors for repeated measurements of the soft and hard tissues were 0.14 +/- 0.02 mm and 0.13 +/- 0.01 mm, respectively. CONCLUSIONS: The device is a reliable tool to assess changes in both soft and hard tissues around crowns and implants over time. Likewise, it is suggested that this technique also can be used to objectively assess soft and hard tissue changes around natural teeth with or without prosthetic restorations.