Feasibility of Immediate, Early and Delayed Implant Placement for Single Tooth Replacement in the Premaxilla: A Retrospective Cone-Beam Computed Tomography Study of 100 Cases.

AIM: To assess the feasibility of immediate (IIP), early (EIP) and delayed implant placement (DIP) for single tooth replacement in the premaxilla on the basis of the complete indication area of each approach in routine practice. MATERIALS AND METHODS: Data from 100 patients (59 women, 41 men, all Caucasians) aged between 19 and 81 years old (mean age 51.71) who had been consecutively treated with a single implant in the premaxilla (13-23) in one private periodontal practice were retrospectively collected. Demographic data, diagnostic information and linear measurements were extracted from patient files and CBCTs. The feasibility of IIP, EIP and DIP was assessed for all cases by both authors, based on the following criteria: availability of apical bone, position of the tooth in relation to the morphology of the alveolar process, buccal bone morphology and presence of midfacial recession. The reasons for not being able to perform an approach, and the viable alternatives for each approach were secondary outcomes. DIP was considered to have been preceded by alveolar ridge preservation (ARP). RESULTS: Ninety-two patients could be treated by means of IIP, EIP or DIP. In eight patients none of these approaches were possible as they required bone augmentation prior to implant placement. Fifty-two patients (95% CI: 42%-62%) could by treated with IIP, 58 (95% CI: 48%-67%) with EIP and 88 (95% CI: 80%-93%) with DIP. The feasibility proportions of IIP and EIP were significantly lower than the one of DIP (p < 0.001). All patients who could be treated with IIP could also be treated with EIP or DIP. Lack of apical bone for implant anchorage was the main reason for not being able to perform IIP and EIP. Complete loss of the buccal bone wall and the need for bone augmentation prior to implant placement were the reasons for not being able to perform DIP. CONCLUSION: From the results of this retrospective CBCT analysis, DIP is nearly always possible in contrast to IIP and EIP. Therefore, and since it is much easier than IIP and EIP, inexperienced clinicians should mainly focus on ARP and DIP in clinical practice deferring IIP and EIP until more surgical skills have been acquired.

Prognosis of Single Implant-Supported Prosthesis in Patients With Primary Sjögren's Syndrome: A Five-Year Prospective Clinical Study.

BACKGROUND: Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease characterized by hyposalivation. Currently, there is limited evidence for the prognosis of dental implant treatment in Sjögren's syndrome. AIM/HYPOTHESIS: We hypothesized comparable clinical outcomes of implant-supported restorations in pSS-patients and control subjects, and improvement in oral health-related quality of life 5 years after restoration. MATERIAL AND METHODS: Patients with pSS and matched (age, gender, and tooth region) control group were recruited between June 2016 and March 2020. The clinical and radiological examination were performed, and patient-reported oral health impact profile (OHIP-49) questionnaire was used 2 months (baseline), 1, 3, and 5 years after prosthetic treatment. RESULTS: We included 23 patients with pSS and 24 matched control subjects (all women, mean age: 57.1 years). The overall DMFT (decayed-missed-filled-tooth) was significantly higher (p = 0.008), symptoms of dry mouth were more severe (p = 0.001), and unstimulated and chewing-stimulated saliva flow rates were significantly lower (p < 0.001) in pSS than in control group. All implants survived with no implant mobility. At implant sites, the plaque index and probing depths did not differ (p = 0.301 and 0.446, respectively), but the gingival index was significantly higher (p = 0.003) in pSS than control group. The mean marginal bone loss, prosthetic complications, and clinician-reported aesthetic outcomes were similar in both groups after 5 years. The OHIP scores were significantly higher in the pSS than control group (p < 0.001) but reduced significantly in both groups (p = 0.026). CONCLUSION: Replacement of missing single teeth with dental implants was successful in patients with pSS 5 years after restoration.

A Randomized Controlled Trial on the Timing of Soft-Tissue Augmentation in Immediate Implant Placement: Hard-Tissue Changes and Clinical Outcome.

AIM: To assess the impact of the timing of soft-tissue augmentation (STA) on mean buccal bone changes following immediate implant placement (IPP) in the anterior maxilla. MATERIALS AND METHODS: Patients with a failing tooth and intact buccal bone wall in the anterior maxilla (15-25) were enrolled in this randomized controlled trial. Following single IIP and socket grafting, they were randomly allocated to the control group (immediate STA performed during the same surgical procedure) or the test group (delayed STA performed 3 months later). Implants were placed with a surgical guide and immediately restored with an implant-supported provisional crown. Changes in bone dimensions were assessed using superimposed CBCT images taken prior to surgery and at 1-year follow-up. Clinical outcomes were registered at 1-year follow-up. RESULTS: Twenty patients were randomized to each group (control: 16 females, 4 males, mean age 57.6; test: 9 females, 11 males, mean age 54.2). Ten patients in the control group and 13 patients in the test group had a thick bone wall phenotype. Estimated marginal mean horizontal buccal bone loss at 1 mm below the implant shoulder was -0.553 and -0.898 mm for the control and test group, respectively. The estimated mean difference of 0.344 mm in favour of the control group was not significant (95% CI: -0.415 to 1.104; p = 0.363). Also at all other horizontal and vertical levels, no significant differences could be observed between the groups. The combination of socket grafting and STA enabled counteraction of any buccal soft-tissue loss (≥ 0 mm) at 1 mm below the implant shoulder in 82% of the patients in the control group and in 75% of the patients in the test group (p = 1.000). The clinical outcome was favourable in both groups, yet implants in the control group demonstrated slightly less marginal bone loss (median difference 0.20 mm; 95% CI: 0.00-0.44; p = 0.028). CONCLUSION: In patients with an intact and mainly thick buccal bone wall in the anterior maxilla, the timing of STA following IIP had no significant impact on mean buccal bone loss. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05537545.

Effectiveness of using implant fixture as a ridge expander.

OBJECTIVES: Adequate bone thickness around dental implants is vital for their stability and to reduce resorption. This study evaluated the ability of implant fixtures to serve as ridge expanders by measuring width changes pre- and post-implantation. MATERIALS AND METHODS: Measurements including initial alveolar bone width, post-osteotomy width, post-expansion width, and buccal bone thickness were recorded for patients undergoing implant placement. Bone quality was assessed using established criteria. RESULTS: Of the 102 subjects (52% male, 48% female), significant ridge width increases at 0 mm and 2 mm levels were noted (p < 0.05). Larger implant diameters resulted in greater ridge expansion. Absence of prior augmentation was linked to higher bone quality (B = -1.684, p = 0.001), explaining 15% of bone quality variance. Ridge expansion effects also correlated with the site, implant diameter, and design. CONCLUSIONS: Dental implant fixtures can effectively expand the ridge, with expansion influenced by implant diameter, anatomical location, prior augmentation, and implant design. These factors must be considered for tailored treatment planning in implant dentistry. CLINICAL RELEVANCE: This study's clinical relevance lies in its exploration of the potential benefits of dental implant fixtures can effectively to expand the ridge taking into consideration implant diameter, anatomical location, prior augmentation, and implant design.

Deciduous Mandibular First Molar with Single Root and Single Canal: An Astounding Occurrence.

Having just one root canal in a primary mandibular first molar is an extremely unusual congenital defect. One possible cause of this odd root shape is the invagination of Hertwig's epithelial root sheath (HERS) failing. A pediatric dentist may successfully provide root canal therapy by drawing on extensive knowledge of root canal evaluation, morphological and anatomical differences of primary teeth, and other relevant topics. Herein, we detail the treatment of a singular root, single canal primary mandibular first molar that presented with a unique morphology. The patient underwent pulpectomy, obturation, and restoration. How to cite this article: Prakash S, Sharma V, Khan W, et al. Deciduous Mandibular First Molar with Single Root and Single Canal: An Astounding Occurrence. Int J Clin Pediatr Dent 2024;17(2):198-201.

Collagen Matrix for Increasing Peri-implant Mucosal Thickness in Smokers: A Prospective Case Series.

This prospective case series aimed to evaluate the feasibility of using a volume collagen matrix for soft tissue augmentation to increase mucosal thickness in single implants in smokers who consume more than 10 cigarettes per day. Participants had single submerged implants necessitating soft tissue thickening. Soft tissue augmentation was done using a collagen matrix in the second-stage surgery. The primary outcome was soft tissue thickness at 90 days post-surgery. Secondary outcomes included median thickness at 30 and 60 days, changes in buccal soft tissue profile (digital measurements) at 30, 60, and 90 days, and oral health-related quality of life using OHIP-14 up to 90 days post-surgery. Pain levels via VAS scale and adverse effects were also assessed. Ten participants (4 men, 6 women) aged 45.2 ± 13.18 years initially smoked 10-20 cigarettes daily (average: 14.70 ± 3.47 cigarettes/day). After 90 days, median soft tissue thickness increased to 3.00 (2.00;3.00) mm. Buccal soft tissue profile (median change in ROI) increased by 0.40 (0.25;0.62) mm at 90 days. Pain levels decreased, and oral health-related quality of life improved significantly. No complications were reported. The collagen matrix significantly augmented buccal soft tissue thickness at implant sites in smokers (>10 cigarettes/day), with favorable outcomes and no complications.

The distally anchored connective tissue graft platform for papilla enhancement: A case report.

BACKGROUND: As the need for using dental implants to replace single missing teeth grows, so does the demand for greater esthetic results. However, achieving complete interproximal papillae fill in single-tooth implant restorations remains a challenge. The distally anchored connective tissue platform is a novel soft tissue augmentation technique that consists of harvesting an autogenous connective tissue graft from the palate, folding it, and positioning it at the level of the distal occlusal and buccal surfaces with the help of a distal sling suture to the adjacent distal tooth. METHODS: This case report describes how a maxillary central incisor with compromised hard and soft tissues were replaced using a comprehensive treatment plan. RESULTS: The clinical outcomes showed stable mucosal margin levels and complete papillae fill. The patient expressed satisfaction with the achieved results. CONCLUSIONS: The distally anchored connective tissue graft platform performed at the time of implant placement emerges as a viable and effective soft tissue augmentation technique that yields highly esthetic results. KEY POINTS: Why is this case new information? To the best of our knowledge, this is the first case report in the literature using the distally anchored connective tissue platform. What are the keys to successful management of this case? Adequate diagnosis and decision-making, resulting in a treatment plan focused on reconstructing both soft and hard tissues in a single-tooth implant within the esthetic area, yield favorable clinical, radiological, and patient-reported outcomes. What are the primary limitations to success in this case? The primary limitation of this study is its reliance on a single case report.

Association of Connective Tissue Grafts in Immediate Implants: Systematic Review and Meta-Analysis.

BACKGROUND: The increase in soft tissue (ST) around implants can benefit peri-implant health and aesthetic results. The objective was to compare the gingival and esthetic health benefits of immediate implant placement (IIP) with simultaneous or delayed connective tissue graft (CTG) compared to IIP without CTG. METHODS: A systematic review was carried out by two reviewers in Medline-Pubmed, Scopus, and Cochrane. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were considered. Randomized Clinical Trials (RCTs) that were published between April 2017 and February 2024 were used. Studies that analyzed the performance of a simultaneous or deferred CTG after the placement of an implant in the aesthetic zone, with or without immediate provisionalization, without previous regeneration, with a follow-up of 6 months, and that were performed in humans were included. RESULTS: Quantitative analysis was performed using data provided by the RCTs. The five RCTs that were selected analyzed a total "n" of 245 subjects who met the inclusion criteria and focused on the subject of the study. In the quantitative analysis, four RCTs were included. The studies evaluated buccal gingiva levels when placing the IIP with and without CTG, obtaining a mean buccal gingiva level difference of 0.09 mm (95% CI: -0.54 to 0.72, p = 0.05), statistically not significant, but with a favorable trend. CONCLUSIONS: The use of CTG associated with the II can maintain the gum level but not increase the volume. CTG is favorable for achieving successful esthetic results when immediate placement of an implant with a provisional prosthesis is planned.

Single-piece zirconia versus single-piece titanium, narrow-diameter dental implants in the anterior maxilla: 5-year post-loading results of a randomized clinical trial.

OBJECTIVES: The aim of this study was to evaluate esthetic parameters in the anterior maxillary region by comparing single-piece zirconia versus titanium narrow-diameter implants. Additionally, clinical, radiological and patient-reported outcome measures (PROMs) were analyzed. MATERIALS AND METHODS: Thirty implants (tissue level implant) were placed in 30 patients in the maxillary esthetic sector. Depending on randomization, a zirconia (test) or titanium implant (control) was placed. Esthetic, clinical, and radiological parameters, including the implant crown esthetic index (ICAI), pink esthetic score (PES), probing pocket depth, bleeding on probing, plaque index, and marginal bone levels, were evaluated at 12, 36 and 60 months after loading. RESULTS: Sixty months after crown placement, no significant differences were found between groups. The ICAI values were 5.25 ± 4.21 and 4.50 ± 2.98 for the test and control groups, respectively. The corresponding PES values were 7.44 ± 1.93 and 7.43 ± 1.74 for the test and control groups, respectively. There were no significant intergroup differences for the rest of the parameters evaluated. CONCLUSION: It can be suggested that monotype zirconia implants may serve as a potential alternative to titanium implants in selected clinical scenarios. While the results demonstrated comparable esthetic, clinical, and radiological aspects for zirconia implants as compared to titanium implants after a 5-year follow-up period, further research with larger sample sizes and longer-term follow-up is recommended.

Accuracy of immediately placed implants using surgical guides from different 3-dimensional printers: An in vitro study.

AIM: The aim of this study was to evaluate the accuracy of 3-dimensional (3D)-printed surgical guides for fully guided immediate implants from different manufacturers. METHODS: Eighteen 3D printed fully guided surgical guides (split into 3 groups [n = 6] according to their manufacturer: Company, Desktop, or Lab), were used to place 72 implants (n = 24) in identical maxillary models. After placement, the mean global, angular, mesiodistal, buccopalatal, and vertical deviation at the platform and apex of the placed implants, relative to their preoperatively planned positions, was calculated. RESULTS: Significant differences in global apex deviation, angular deviation, mesiodistal apex deviation, and vertical platform and apex deviation were found between the Lab and Desktop groups (p ≤ 0.007). Significant differences in mesiodistal platform and apex deviation and buccopalatal apex deviation were also found between the Company and Desktop groups (p ≤ 0.005). Finally, significant differences in buccopalatal apex deviation, and vertical platform and apex deviation were found between the Company and Lab groups (p ≤ 0.003). Mean differences between guide groups across all parameters never exceeded 0.5 mm or 1°. CONCLUSIONS: The choice of 3D printer has a significant effect on the accuracy of fully guided immediate implants. However, the clinical relevance of these differences may be considered limited.

Somatosensory alterations after single-unit dental implant immediate loading: A 1-year follow-up study.

OBJECTIVE: This cohort study aimed to assess the incidence of somatosensory alterations after implant surgery using standardized quantitative and qualitative sensory testing. METHODS: 33 participants with single-tooth loss, undergoing immediate implant loading were included. Quantitative Sensory Testing (QST) and Qualitative Sensory Testing (QualST) were conducted at eight time points over a year (baseline to 1 year). Two-Way Repeated Measures ANOVA and post hoc Tukey test were used on QST values and Cochran Q test on QualST. RESULTS: The study revealed significant increase in thermal thresholds overtime. At the operated side, overall Cold Pain Threshold (extraoral: p = 0.030; intraoral: p < 0.001), and Cold Detection Threshold (intraoral: p < 0.001) increased overtime. In contralateral region, maxilla Cold Detection Threshold (extraoral: p = 0.024; intraoral: p = 0.031), Warm Detection Threshold (extraoral: p = 0.026; intraoral: p = 0.047) and overall Cold Pain Threshold (extraoral and intraoral: p < 0.001) also increased. QualST showed extraoral pinprick (p = 0.032) and intraoral pinprick (p = 0.000), cold (p = 0.000) and touch (p = 0.002) stimuli abnormalities overtime. CONCLUSIONS: Somatosensory alterations after implant surgery were detected in both quantitative and qualitative sensory assessments, but rapidly decreased during the first follow-ups, and then continuously until 1-year. CLINICAL SIGNIFICANCE: This study provides clinical and controlled evidence on the real effect of the somatosensory alterations overtime, leading to a better understanding of neurosensory behaviour after single-tooth dental implant rehabilitation.

Morphometric Comparison of Two Implants with Different Macroscopy Placed Immediate in the Anterior Region of the Maxilla - A Randomized Clinical Trial with 6-Month of Follow Up.

Purpose - Compare the morphometric results of immediate implants (Type 1C) with a cylindrical (conventional) or triangular neck, in the anterior region of the maxilla, during 6 months of osseointegration. Materials and Methods - Prospective randomized clinical trial with a sample of 20 individuals randomly assigned to each group (10 triangular neck implants and 10 cylindrical neck implants). Consecutively direct measurements were performed: before (T-1) and after tooth extraction (T0), after implant placement (T1), after 1 month of the submerged implant healing (T2), when placing the healing abutment (T3), after placing the definitive crown (T3), and after 6 months of osseointegration (T4). Results - A significant difference between T1 and T3 in the buccal cortical thickness was identified (0.49Å}0.86mm). Although there was a significant increase in the buccal cortical thickness in both implants, this increase was greater for the triangular neck implants (cylindrical shape: 0.08Å}0.59 vs. triangular neck 0.90Å}0.91mm). It was also observed that implants placed below the buccal bone crest (í-1mm) promote less vertical buccal bone loss than implants placed Ñ-1mm at crest level (-0.65Å}0.52mm vs. -1.42Å}0.86mm). This observation needs to be further investigated in additional studies. Conclusions - The triangular neck implants present an increase in the cortical buccal thickness compared to the cylindrical implants. However, this increase does not fully compensate the remodulation after tooth loss.

SURVIVAL RATE OF IMPLANT-SUPPORTED, SINGLE-TOOTH RESTORATIONS BASED ON ZIRCONIA OR METAL ABUTMENT IN PATIENTS WITH TOOTH AGENESIS: A 5-YEARS PROSPECTIVE CLINICAL STUDY.

OBJECTIVES: The primary aim was to investigate survival rate of zirconia versus metal abutments, and the secondary aim was clinical outcomes of all-ceramic versus metal-ceramic crowns on single-tooth implants. METHODS: Patients with tooth-agenesis participated to previously published prospective clinical study with 3-year follow-up were recalled after 5 years. Biological variables included survival and success rate of implants, marginal bone level, modified Plaque and Sulcus Bleeding Index and biological complications. Technical variables included restoration survival rate, marginal adaptation and technical complications. The aesthetic outcome of crowns and peri-implant mucosa in addition to patient-reported outcome were recorded. Descriptive analysis, linear mixed model for quantitative data, or generalized linear mixed model for ordinal categorical data were applied; significance was set to 0.05. RESULTS: Fifty-three patients (mean age: 32.4 years), with 89 implants participated to the 5-years examination. The implants supported 50 zirconia abutments with 50 all-ceramic (AC) crown and 39 metal abutments with 29 metal-ceramic (MC) and 10 AC crowns. The Implant and restoration survival rate was 100% and 96%, respectively. No clinically relevant biological difference between implants supporting metal or zirconia abutments was registered. The technical complications were veneering fracture of AC-crowns (n = 3), crown loosening of MC-crowns (n = 4) and one abutment screw loosening (MC-crown on metal abutment). MC-crowns had significantly better marginal adaptation than AC-crowns (p = .01). AC-crowns had significantly better color and morphology than MC-crowns (p = .01). CONCLUSIONS: Zirconia-based single-tooth restorations are reliable alternative materials to metal-based restorations with favorable biological and aesthetic outcome, and few technical complications.

Immediate implant placement in a dialysis patient. A case report.

Implant-supported rehabilitation in high-risk patients poses significant challenges for the dental team. The presence of comorbidities and increased infection risk can, for example, lead to a higher risk of implant loss. For the therapy to be completed with as few complications as possible, special anamnesis, detailed diagnostics, and a risk analysis based on those findings are indispensable. The aim of all considerations is to keep the risk of infection for the patient with a disease history to a minimum and to strive for an appropriate functional and esthetic therapeutic success. Particularly in the esthetic zone, in addition to the general health risks of the surgical procedure, esthetic aspects are increasingly taken into account in planning. The present article describes the implant-prosthetic replacement of a single anterior tooth in a dialysis patient. Several aspects (regular dialysis, missing buccal lamella, high smile line, functional risk) increased the risk of complications in this case.

A comparative finite element analysis of titanium, poly-ether-etherketone, and zirconia abutment on stress distribution around maxillary anterior implants.

Background: The aim of this study was to investigate the influence of abutment material, alveolar bone density, and occlusal forces on stress distribution around maxillary anterior implants. Materials and Methods: An in-vitro study was conducted. The maxillary anterior implant was modeled using a three-dimensional finite element model in D2 and D3 bones with three different abutment materials: titanium, zirconia, and poly-ether-ether ketone (PEEK). Von Mises stress was evaluated after the application of vertical and oblique loads of 100 N, 175 N, and 250 N. Statistical analysis was done by Friedman-Wilcoxon signed-rank test, Mann-Whitney U test, and Kruskal-Wallis test. The probability value <0.05 is considered a significant level. Results: Stress distribution around D3 bone was higher than D2 bone in all the abutment materials with greater values seen in oblique load than vertical load with insignificant difference (P > 0.05). Statistically insignificant stress values were seen greater in PEEK than titanium or zirconia abutment (P > 0.05). A statistically significant difference was observed between 100 N and 175 N of load (P < 0.05). Conclusion: PEEK, zirconia, and titanium as abutment material in the anterior region showed similar properties. The stress on the bone was proportionately increased during the vertical and oblique loads suggesting the influence of mechanical load in crestal bone loss rather than the type of abutment material.

Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial.

OBJECTIVES: The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla. MATERIALS AND METHODS: Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12). RESULTS: No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups. CONCLUSION: Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters. CLINICAL RELEVANCE: There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.

Immediate versus early implant placement for single tooth replacement in the aesthetic area: A systematic review and meta-analysis.

OBJECTIVES: To compare immediate implant placement (IIP) with early implant placement (EIP) for single tooth replacement in the aesthetic area in terms of aesthetic, clinical, and patient-reported outcomes. MATERIALS AND METHODS: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to February 2023. Randomized Controlled Trials (RCTs) comparing IIP with EIP were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue change. Secondary outcomes were horizontal midfacial soft tissue change, vertical papillary change, pink esthetic score (PES), implant survival, buccal bone thickness, marginal bone level change, patient discomfort, chair time, and patient satisfaction. RESULTS: Out of 1185 records, 6 RCTs were selected, reporting on 222 patients who received 222 single implants (IIP: 112 implants in 112 patients; EIP: 110 implants in 110 patients) in the anterior maxilla or mandible. Patients had a mean age ranging from 35.6 to 52.6 years and were followed between 8 and 24 months. Two RCTs showed some concerns, and four showed a high risk of bias. Four studies could be included in a meta-analysis on the primary outcome and three only considered cases with an intact buccal bone wall. Meta-analysis failed to demonstrate a significant difference in terms of vertical midfacial soft tissue change between IIP and EIP (mean difference: 0.31 mm, 95% CI [-0.23; 0.86], p = .260; I2 = 83%, p < .001). No significant differences were found for PES (standardized mean difference: 0.92, 95% CI [-0.23; 2.07], p = .120; I2 = 89%, p < .001), implant survival (RR: 0.98, 95% CI [0.93, 1.03], p = .480; I2 = 0%, p = .980), and marginal bone level change (mean difference: 0.03 mm, 95% CI [-0.12, 0.17], p = .700; I2 = 0%, p = .470). Insufficient data were available for meta-analyses of other secondary outcomes. CONCLUSION: In low-risk patients with an intact buccal bone wall, there seems to be no difference between IIP and EIP in terms of aesthetic and clinical outcomes. The strength of this conclusion is rated as low since studies showed an unclear or high risk of bias. In addition, state-of-the-art therapy was only delivered in a minority of studies. Future RCTs should also provide data on patient-reported outcomes since these have been underreported.

Establishing Clinically Acceptable PES/WES Threshold for Single- Tooth Implant Restoration.

PURPOSE: Determining the esthetic success of single-tooth implant restorations (STIR) requires an objective tool such as one devised by Belser et al., 2009 - pink esthetic scores and white esthetic scores (PES/WES). This study aimed to utilized PES/WES to establish threshold scores based on (1) detectability and (2) acceptability of a STIR by lay person perception, (3) to study the difference in the ability of laypeople and dentists in detecting the presence of STIR, and (4) to study the pink and white deficiencies in relation to the detectability of the presence of STIR. MATERIALS AND METHODS: A total of 38 calibrated photographs of STIR in the anterior region were scored with PES/WES by 3 prosthodontists. Next, 100 laypeople and 60 dentists were instructed to identify the STIR among the anterior teeth and provide reasoning behind the identification (based on pink and white esthetic criteria). The acceptance of the STIR was recorded. Receiver Operating Characteristics (ROC) analysis was utilized to determine the threshold scores. RESULTS: At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3,800 occasions, laypeople correctly identified the STIR 1,770 (46.58%) of those occasions. Among the correctly identified STIR, 751 (42.43%) of those occasions were identified with pink deficiencies and 1019 (57.57%) of those occasions were with white deficiencies. Out of 2,280 occasions, dentists correctly identified STIR 1869 (81.98%) of those occasions. CONCLUSIONS: The PES/WES score of 12 indicates the clinically acceptable threshold, while the score of 17 indicates the detectable threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the most focused criteria of PES/WES, followed by overall white deficiencies that remain influential. Compared to laypeople, dentists tend to have a higher ability to detect STIR.

Preload and Removal Torque of Two Different Prosthetic Screw Coatings-A Laboratory Study.

This study aimed to evaluate the effect of two coating materials, a silicone sealing gel and a polytetrafluoroethylene (PTFE) tape, on the screw preload and removal torque value (RTV) to develop strategies to prevent prosthetic screw loosening. We examined 45 complexes comprising an implant, abutment, and prosthetic screw, of which 15 samples were uncoated, 15 were coated with GapSeal® (Hager & Werken GmbH & Co., Duisburg, Germany), and 15 were coated with PTFE tape (MIARCO®, Valencia, Spain). The screws were tightened to register the preload and then untightened to register the RTV. The preload values showed a statistically significant difference only in the PTFE group, suggesting that this lubricant negatively affects the preload. The RTVs showed statistically significant differences among all groups, with the GapSeal® group and PTFE group showing the highest and lowest values, respectively. It can be concluded that the application of the PTFE tape on the screw significantly reduced the preload and RTV. The silicone sealing gel did not affect the preload but increased the RTV. Therefore, the use of GapSeal® should be considered to prevent prosthetic screw loosening, while the use of PTFE tape should be avoided.

Clinical analysis of the tooth-implant papilla for two narrow-diameter titanium-zirconium implants in the anterior area: prospective controlled clinical study.

BACKGROUND: Rehabilitation of the anterior area when the mesio-distal space is reduced is a challenge for the clinician, due to the patient's anatomical limitations and aesthetic requirements. Narrow Diameter Implants (NDI) are an option of treatment when the standard diameter implant is not possible, but the evidence is scarce. This prospective clinical study aims to analyze the formation of the tooth-implant papilla between the implant and the adjacent natural tooth in the maxillary lateral incisors and mandibular incisors. METHODS: A total of 40 patients treated with NDI, of titanium-zirconium (Ti-Zr) alloy i.e., 2.9 mm Test Group (TG) and 3.3 mm Control Group (CG), were included. The mesiodistal distance between the adjacent natural teeth was used for implant selection, maintaining 1.5 mm between the fixation and the adjacent tooth. Clinical assessment was performed by a clinical examiner at 6 and 12 months after the final prosthesis. The primary variable was the Jemt Papillary Index. Also, implant survival rate (SR), complications, Implant Stability Quotient (ISQ), and patient-reported outcomes measures (PROMs) such as aesthetics, chewing, phonation, comfort, and self-esteem were analyzed. RESULTS: A significant amount of papilla filling was observed concerning the baseline, with a trend towards more formation of the papilla in the TG, with a JPI score of 3. No significant differences were observed between the two groups regarding implant SR, clinical parameters, and complications. In terms of PROMs, a higher satisfaction in the TG was observed, with significant intergroup differences for aesthetics, comfort, self-esteem, and primary stability ISQ (TG: 59.05 (SD: 5.4) vs. CG: 51.55 (SD: 5.7)). CONCLUSIONS: The 2.9 mm diameter Ti-Zr implants achieved a formation of papilla similar to 3.3 mm implants in the anterior region at 12 months of follow-up after the final prosthetic restoration. The use of Ti-Zr implants with a diameter of 2.9 mm to rehabilitate single teeth in areas of the anterior region, where the mesiodistal distance is limited, showed favorable clinical results and a high degree of satisfaction during 1 year of observation similar to 3.3 mm dental implants. TRIAL REGISTRATION: This study was retrospectively registered in ClinicalTrials.gov with the number NCT05642520, dated 18/11/2022.