The effect of antiresorptive therapy on the prevalence and severity of oral lichen planus: a retrospective study.

BACKGROUND: Antiresorptive therapy (AR) disrupts osseous homeostasis and can induce direct irritation over the gastrointestinal mucosa; however, its possible erosive effects on the oral epithelium have not been totally described. Among the most frequent oral erosive lesions, oral lichen planus (OLP) frequently presents as painful mucosal ulcerations, arising from basal membrane inflammatory damage. Thus, the aim of this retrospective study was to describe the association between AR and the incidence of OLP. METHODS: This case-control study included data from 148 patients (17 patients undergoing AR therapy (AR group) / 131 without AR therapy (Control group)). Each patient record was systematically processed and the association between AR drugs and OLP clinical characteristics within both groups was assessed. RESULTS: The erosive form of OLP was significantly more frequent in the AR group than in the Control group (p = 0.029). Indeed, the AR treatment using alendronic acid (41.2%) was the most frequently reported. Additionally, the erosive form of OLP showed the strongest association with pain and burning sensation among the OLP types (p < 0.050). However, disease worsening and AR consumption were not significantly associated (p = 0.150). CONCLUSIONS: Patients under AR therapy show more clinical symptoms associated to the erosive type of OLP. Regardless of the AR therapy, the erosive type of OLP is associated with more severe symptoms.

Influence of loading and grafting on hard- and soft-tissue healing at immediately placed implants: An experimental study in minipigs.

AIM: To histologically evaluate the influence of (1) loading and (2) grafting on osseointegration and peri-implant soft-tissue healing at immediately placed, self-cutting progressive tissue-level implants (TLX) in a minipig model. MATERIALS AND METHODS: TLX implants (n = 56) were immediately placed following the extraction of the mandibular first and second premolars, bilaterally, in a total of n = 14 minipigs. In each animal, the implant sites were allocated to the following four groups: (1) unloaded with simultaneous grafting using a bovine bone mineral; (2) unloaded without grafting; (3) loaded with simultaneous grafting; and (4) loaded without grafting. Histomorphometric assessments at 4 and 12 weeks (n = 7 animals each) included primary (i.e., bone-to-implant contact [BIC]) and secondary outcome measures (e.g., first BIC [fBIC], junctional epithelium length [JE], connective tissue contact length [CTC], biological width [BW = JE + CTC]). RESULTS: At 4 weeks, mean BIC values ranged from 74.5 ± 11.6% in Group 2 to 83.8 ± 13.3% in Group 1, and, at 12 weeks, from 75.5% ± 7.9% in Group 2 to 79.9 ± 8.6% in Group 1. Multivariate linear mixed regression did not reveal any associations between BIC and implant loading or grafting at 4 and 12 weeks. At 12 weeks, significantly higher fBIC values were noted in Group 2 when compared with Group 1. All groups showed comparable JE, CTC, and BW values. CONCLUSIONS: Implant loading and grafting had no major effects on osseointegration and peri-implant soft tissue healing at TLX implants.

Efficacy of autogenous tooth roots for a combined vertical and horizontal alveolar ridge augmentation and staged implant placement. A prospective controlled clinical study.

OBJECTIVES: To assess and compare the efficacy and safety of autogenous tooth roots (TRs) and autogenous bone blocks (ABs) for combined vertical and horizontal alveolar ridge augmentation and two-stage implant placement. MATERIALS AND METHODS: A total of 28 patients in need of implant therapy and vertical ridge augmentation were allocated to parallel groups receiving either healthy autogenous tooth roots (e.g., retained wisdom teeth) (n = 14, n = 15 defects) or cortical autogenous bone blocks harvested from the retromolar area (n = 14, n = 17 defects). After 26 weeks of submerged healing, the clinical reduction in ridge height (RH) deficiency was defined as the primary outcome. RESULTS: Both surgical procedures were associated with a similar mean reduction in RH deficiency values, amounting to 4.48 ± 2.42 mm (median: 4.25; 95% CI: 3.08-5.88) in the TR group and 4.46 ± 3.31 mm (median: 3.00; 95% CI: 2.54-6.38) in the AB group (p = .60, Mann-Whitney U-test). In all patients investigated, the reduction in RH deficiency values allowed for an adequate implant placement at the respective sites. The frequency of complications (e.g., soft tissue dehiscences) was low (TR: n = 4; AB: n = 0). CONCLUSIONS: Up to staged-implant placement, both TR and AB grafts appeared to be associated with comparable efficacy and safety for combined vertical and horizontal alveolar ridge augmentation.

Lateral alveolar ridge augmentation using an equine-derived collagen-containing bone block: A prospective case series.

OBJECTIVES: To assess the clinical performance of an equine-derived collagen-containing bone block (CXBB) for lateral alveolar ridge augmentation and staged implant placement. MATERIAL AND METHODS: A total of n = 16 patients (16 implants) had received a modified surgical protocol for lateral ridge augmentation using a size-adapted rigidly fixed CXBB and contour augmentation. After 26 weeks of submerged healing, the primary endpoint was defined as the final ridge width (RW26) sufficient to place an adequately dimensioned titanium implant at the respective sites. Secondary outcomes included the gain in ridge width (RWg) and the need for secondary grafting. Clinical outcomes (bleeding on probing-BOP, probing depth-PD, and mucosal recession-MR) were assessed at implant loading and after a median observation period of 12.3 months. RESULTS: In all patients (n = 16) investigated, RW26 allowed for a successful placement of an adequately dimensioned titanium implant at respective sites exhibiting mean RWg values of 5.09 ± 1.07 mm. A soft tissue dehiscence was noted in one patient (6.3%), and a secondary grafting was needed in two patients (12.5%) The changes in mean BOP, PD, and MR values at V9 amounted to 10.23 ± 30.11%, 0.14 ± 0.80 mm, and -0.01 ± 0.04 mm, respectively. CONCLUSIONS: CXBB may represent a feasible approach for lateral alveolar ridge augmentation and two-stage implant placement.

The prevalence of peri-implant diseases around subcrestally placed implants: A cross-sectional study.

OBJECTIVES: To evaluate the prevalence of peri-implant health, peri-implant mucositis or periimplantitis for subcrestally placed implants (1-3 mm) on the short-, medium- and long term. MATERIAL AND METHODS: Two hundred patients were enrolled in this cross-sectional study that were treated and screened during regular maintenance visits at one university center. A total of 657 implants were evaluated. Peri-implant health and diseases were assessed according to predefined case definitions. Binary logistic regression was used to assess the correlation with local and systemic factors. RESULTS: After a median function time of 9.36 ± 6.44 years (range: 1-26 years), the prevalence of peri-implant mucositis and peri-implantitis was 66.5% and 15.0%, at the patient level, corresponding to 62.6% and 7.5%, at the implant level, respectively. Peri-implantitis was significantly associated with patients' history of periodontitis (odds ratio, OR 5.33). CONCLUSION: Peri-implant diseases were a common finding around subcrestally placed implants.

Short-term outcomes of lateral extraction socket augmentation using autogenous tooth roots: A prospective observational study.

OBJECTIVES: To assess the short-term clinical outcomes of lateral augmentation of deficient extraction sockets and two-stage implant placement using autogenous tooth roots (TR). MATERIAL AND METHODS: A total of n = 13 patients (13 implants) were available for the analysis. At the time of tooth extraction, each subject had received lateral augmentation using the respective non-retainable but non-infected tooth root where the thickness of the buccal bone was <0.5 mm or where a buccal dehiscence-type defect was present. Titanium implants were placed after a submerged healing period of 6 months and loaded after 20 ± 2 weeks (V8). Clinical parameters (e.g., bleeding on probing-BOP, probing pocket depth-PD, mucosal recession-MR, clinical attachment level-CAL) were recorded at V8 and after 26 ± 4 weeks (V9) of implant loading. RESULTS: At V9, all patients investigated revealed non-significant changes in mean BOP (-19.23 ± 35.32%), PD (0.24 ± 0.49 mm), MR (0.0 ± 0.0 mm) and CAL (0.24 ± 0.49 mm) values, respectively. There was no significant correlation between the initial gain in ridge width and changes in BOP and PD values. CONCLUSIONS: The surgical procedure was associated with stable peri-implant tissues on the short-term.

Histomorphometrical assessment of vertical alveolar ridge augmentation using extracted tooth roots in the canine.

OBJECTIVES: To histomorphometrically evaluate the influence of autoclavation on the efficacy of extracted tooth roots (TR) used for vertical alveolar ridge augmentation. MATERIALS AND METHODS: Upper premolars were randomly assigned to either autoclavation (TR-A) or an untreated control group (TR-C) and used as block grafts for vertical alveolar ridge augmentation in both lower quadrants (n = 4 beagle dogs). Tissue biopsies were obtained after 15 weeks of submerged healing. Histological analyses considered gain in ridge height (GRH), augmented area (AA), and the proportion of mineralized (MT) and non-mineralized tissue (NMT). RESULTS: TR-C and TR-A grafts were commonly associated with a complete replacement resorption and a marked gain in ridge height. Significant differences between groups were noted for mean GRH [TR-C: 2.35 ± 0.55 vs. TR-A: 2.46 ± 0.21 mm] and AA [TR-C: 11.88 ± 4.31 vs. TR-A: 8.65 ± 1.59 mm2] values. Within AA, both groups revealed a comparable distribution of mean MT and NMT values. The linear regression analysis pointed to a significant correlation between NMT and AA values. CONCLUSIONS: Both TR-C and TR-A grafts supported vertical alveolar ridge augmentation; however, GRH was improved in the TR-A group. CLINICAL RELEVANCE: TR grafts may serve as a potential alternative for vertical alveolar ridge augmentation.

Influence of autoclavation on the efficacy of extracted tooth roots used for vertical alveolar ridge augmentation.

OBJECTIVES: To assess the influence of autoclavation on the efficacy of extracted tooth roots (TR) used for vertical alveolar ridge augmentation and two-stage osseointegration. MATERIAL AND METHODS: Maxillary premolars were randomly assigned to either autoclavation (TR-A) or were left untreated (TR-C) and used as block grafts for vertical alveolar ridge augmentation in both lower quadrants (n = 4 beagle dogs). At 12 weeks, titanium implants were inserted and left to heal for 3 weeks. Histological analyses considered vertical bone gain (BD-BC), augmented area (AA) and bone-to-implant contact (BIC) at vestibular (v) and oral (o) aspects. RESULTS: Both TR-C and TR-A (exposures n = 3) grafts were associated with a replacement resorption and marked vertical bone gain. Median BD-BC (TR-C: 1.45 [v] to 1.62 mm [o] versus TR-A: 0.97 [v] to 1.79 mm [o]) and AA (TR-C: 0.64 [v] to 2.36 mm2 [o] versus TR-A: 0.22 [v] to 2.36 mm2 [o]) values were comparable in both groups. V BIC (TR-C: 49.32 [v] to 52.97% [o] versus TR-A: 25.34 [v] to 46.11% [o]) values were significantly higher in the TR-C group. CONCLUSIONS: Both TR-C and TR-A grafts equally supported vertical alveolar ridge augmentation; however, osseointegration was partially facilitated in the TR-C group.

Short-term outcomes of staged lateral alveolar ridge augmentation using autogenous tooth roots. A prospective controlled clinical study.

OBJECTIVES: To assess the short-term clinical outcomes of lateral alveolar ridge augmentation using autogenous tooth roots (TR) and autogenous bone blocks (AB). MATERIAL AND METHODS: A total of n = 23 patients (23 implants) were available for the analysis. Each subject was allocated to lateral ridge augmentation using either (a) healthy autogenous tooth roots (e.g., retained wisdom or impacted teeth; n = 13) or (b) cortical autogenous bone blocks harvested from the retromolar area (n = 10). Clinical parameters (e.g., bleeding on probing-BOP, probing pocket depth-PD, mucosal recession-MR, clinical attachment level-CAL) were recorded at (V8) and after 26 ± 4 weeks (V9) of implant loading. RESULTS: TR and AB groups were associated with comparable (p > 0.05) changes in mean BOP (-23.0 ± 34.3%; -11.75 ± 24.9%), PD (-0.03 ± 0.14 mm; -0.1 ± 0.29 mm), MR (0.0 ± 0.0 mm; 0.0 ± 0.0 mm) and CAL (-0.03 ± 0.14 mm; -0.1 ± 0.29 mm) values. The regression analysis failed to reveal any significant correlations between changes in BOP and PD values and the initial as well as the ridge width measured at 26 weeks. CONCLUSIONS: TR and AB were associated with comparable clinical short-term outcomes.

Discomfort/pain due to periodontal and peri-implant probing with/without platform switching.

OBJECTIVE: To compare discomfort/pain following periodontal probing around teeth and peri-implant probing around implants with or without platform switching. METHODS: Two dentists recruited and examined 65 patients, each of them exhibiting a dental implant with a contralateral tooth. Only two types of implants were included: one with and one without platform switching. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether implant or tooth was measured first was randomly assigned. Immediately after probing, patients scored discomfort/pain using a visual analogue scale (VAS). The emergence profiles of implant crowns were assessed as angles between interproximal surfaces on radiographs. RESULTS: Sixty-five patients (age 69; 63/76 years [median; lower/upper quartile]; 38 females, 11 smokers) were examined. With the exception of mean PPD and PAL (p < .05) clinical parameters (PPD, PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 10; 0.75/16.25) caused significantly (p < .001) more discomfort/pain than periodontal probing (4; 0/10). Logistic regression analysis identified a larger difference between discomfort/pain for peri-implant and periodontal probing in the maxilla than the mandible (p = .003). Comparing discomfort/pain between implants maxilla (p = .006) and emergence profile (p = .015) were associated with discomfort/pain. Type of implant (with/without platform switching) had no significant effect on discomfort/pain. CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Implant design with/without platform switching failed to have a significant effect on discomfort/pain.

Discomfort/pain due to periodontal and peri-implant probing: Implant type and age.

AIM: There is evidence that patients experience more discomfort/pain after peri-implant probing than periodontal probing. However, there are several plausible factors to additionally influence this observation: e.g., implant type, age, smoking. Thus, this study was designed to compare discomfort/pain after periodontal and peri-implant probing in different implant types. METHODS: Two dentists recruited and examined 80 patients, each of them exhibiting a dental implant with a contralateral natural tooth. Only two types of implants were included. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether implant or tooth were measured first was randomly assigned. Immediately after probing patients scored discomfort/pain using a visual analogue scale (VAS). RESULTS: Eighty patients (median; lower/upper quartile: age 57; 47.5/65.5 years; 40 females, 11 smokers) were examined. With the exception of PPD and PAL at the deepest site as well as mean PPD (p < .05) clinical parameters (PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 9.0; 5.0/17.0) caused significantly (p = .038) more discomfort/pain than periodontal probing (5.5; 2.0/13.5). This was confirmed by repeated measures analysis of variance adjusting for several factors (p = .011). CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing.

Discomfort/pain due to pocket probing at teeth and endosseous implants: a cross-sectional study.

AIM: Patients seem to feel more discomfort/pain after peri-implant probing than after periodontal probing. However, there is not one single study to address this clinical observation. Thus, this study was designed to compare discomfort/pain after peri-implant and periodontal probing. METHODS: Each of three dentists recruited and examined 20 patients each contributing one pair of one dental implant and a contralateral natural tooth. Periodontal and peri-implant probing depths (PPD) and probing attachment level (PAL) were assessed. Whether the implant or the tooth was measured first was randomly assigned. Immediately after probing, the patients scored discomfort/pain using a visual analogue scale (VAS). RESULTS: A total of 60 patients (median; lower/upper quartile: age 62.5; 47.5/69.0 years; 35 females, five smokers) were examined. With the exception of PPD at the deepest site (implants: 4.0; 3.0/5.5 mm; teeth: 3.0; 3.0/4.0 mm; P = 0.032), clinical parameters (PPD, PAL, bleeding on probing, suppuration) were well balanced between implants and teeth. Peri-implant probing (VAS: 16.4; 8.7/28.2) caused significantly (P = 0.011) more discomfort/pain than periodontal probing (9.1; 4.6/18.2). Repeated-measures analysis identified peri-implant probing causing more discomfort than periodontal probing related to the examiner (P = 0.046). CONCLUSIONS: On average, peri-implant probing caused significantly more discomfort/pain than periodontal probing.

Traumatic dental injuries over an 8-year period at a German dental center: a retrospective overview and cross-sectional analysis.

BACKGROUND/AIM: The aim of this study was to analyze a population of patients who had suffered from traumatic dental injuries (TDIs) by using different patient-, trauma- and treatment-related parameters. MATERIAL AND METHODS: All dental records of patients ≥ 3 years old who had presented at the dental emergency service between Jan 1, 2009 and Dec 31, 2016 for the treatment of dental trauma were analyzed. A total of 2758 patients were invited for a recall examination at the Department for Dental Surgery and Implantology, ZZMK Carolinum, Goethe University Frankfurt, Germany; of these, 269 patients attended their recall appointments. RESULTS: The enrolled patient population consisted of 1718 males and 1040 females, with a mean age of 19.63 years (median 12.00 ± 17.354 years). A total of 4909 injured teeth were assessed, with a mean of 1.78 injured teeth per patient (median 2.00 ± 1.279). Males were found to be more frequently affected by TDIs compared to females (1.65:1). The majority of these injuries occurred in the first two decades of life (66.1%; n = 1824). The majority of the patients presented for initial treatment within 24 h of their accident (95.7%). The most frequent TDIs were isolated luxation injuries 49.4% (n = 2426) and isolated crown fractures 30% (n = 1472). Combination injuries were diagnosed in 20.6% of the cases (n = 1011). CONCLUSIONS: Based on the findings of the present analysis, it can be concluded that males were more frequently affected by TDIs than females. Most patients had suffered from TDI before they had turned 10 years of age. Overall, the enamel-dentin fracture was found to be the most frequent injury, followed by concussions and lateral luxations.

Esthetic and clinical outcomes after immediate placement and restoration: Comparison of two implant systems in the anterior maxilla-A cross-sectional study.

AIM: To assess the esthetic and clinical performance of a novel self-tapping implant system for single-tooth restorations in the esthetic zone after immediate placement and provisionalization. MATERIALS AND METHODS: This cross-sectional study included 52 patients contributing a total of 52 immediately placed and restored implants with ≥12 months after functional loading, comparing two different implant systems: Straumann® BLX (Institut Straumann AG, Basel, Switzerland; 25 patients) and Ankylos® (Dentsply Sirona, Hanau, Germany; 27 patients). As the primary outcome measure, peri-implant tissue esthetics were assessed by means of pink esthetics score (PES) rated by three independent clinicians. Moreover, as secondary outcome measures, the peri-implant tissue health was assessed by means of bleeding on probing, probing depth, and suppuration. Apart from that, the modified plaque index, keratinized mucosa width, and the presence of mucosal recessions were also assessed. When clinical signs suggested the possibility of peri-implantitis, radiographs were indicated to assess progressive bone loss. RESULTS: The mean PES ratings were 12.10 ± 1.10 for Ankylos versus 11.2 ± 1.86 for BLX, both achieving good esthetic results without significant differences (p = 0.143). There were no differences among most clinical parameters (plaque, bleeding on probing, probing depth, peri-implant mucosal recession), although peri-implant mucositis was present in one-third of the cases. The inter-rater agreement on esthetics was not significant (p < 0.250). CONCLUSION: Within the limitations of the present study, it was concluded that the use of either BLX or Ankylos implant systems was associated to comparable peri-implant health and good pink esthetic outcomes during immediate implantation and restoration protocols, for at least 12 months.

Three-dimensional changes of a porcine collagen matrix and free gingival grafts for soft tissue augmentation to increase the width of keratinized tissue around dental implants: a randomized controlled clinical study.

BACKGROUND: Emerging clinical data points to the relevance of the presence of keratinized tissue (KT). Although apically positioned flap/vestibuloplasty along with free gingival graft (FGG) is considered as a standard intervention for augmenting KT, substitute materials appear to be a viable treatment alternative. So far, there is a lack of data investigating the dimensional changes at implant sites treated with soft-tissue substitutes or FGG. AIM: The present study aimed at comparing three-dimensional changes of a porcine derived collagen matrix (CM) and FGG for increasing KT at dental implants over a 6-month follow-up period. MATERIALS AND METHODS: The study enrolled 32 patients exhibiting deficient KT width (i.e., < 2 mm) at the vestibular aspect who underwent soft tissue augmentation using either CM (15 patients/23 implants) or FGG (17 patients/31 implants). The primary outcome was defined as tissue thickness change (mm) at treated implant sites between 1- (S0), 3- (S1), and 6-months (S2). Secondary outcomes considered changes of KT width over a 6-month follow-up period, surgical treatment time, and patient-reported outcomes. RESULTS: Dimensional analyses from S0 to S1 and from S0 to S2 revealed a mean decrease in tissue thickness of - 0.14 ± 0.27 mm and - 0.04 ± 0.40 mm in the CM group, and - 0.08 ± 0.29 mm and - 0.13 ± 0.23 mm in the FGG group, with no significant differences noted between the groups (3 months: p = 0.542, 6 months: p = 0.659). Likewise, a comparable tissue thickness decrease was observed from S1 to S2 in both groups (CM: - 0.03 ± 0.22 mm, FGG: - 0.06 ± 0.14 mm; p = 0.467). The FGG group exhibited a significantly greater KT gain after 1, 3 and 6 months compared to the CM group (1 month: CM: 3.66 ± 1.67 mm, FGG: 5.90 ± 1.58 mm; p = 0.002; 3 months: CM: 2.22 ± 1.44; FGG: 4.91 ± 1.55; p = 0.0457; 6 months: CM: 1.45 ± 1.13 mm, FGG: 4.52 ± 1.40 mm; p < 0.1). Surgery time (CM: 23.33 ± 7.04 min.; FGG: 39.25 ± 10.64 min.; p = 0.001) and postoperative intake of analgesics were significantly lower in the CM group (CM: 1.2 ± 1.08 tablets; FGG: 5.64 ± 6.39 tablets; p = 0.001). CONCLUSIONS: CM and FGG were associated with comparable three-dimensional thickness changes between 1 and 6 months. While a wider KT band could be established with FGG, the use of CM significantly reduced surgical time and patients´ intake of analgesics.

Clinical and Esthetic Evaluation Following Immediate Implant Placement and Restoration with Platform- Switched Morse Taper Implants in the Esthetic Zone: A Cross-Sectional Study.

Immediate implant placement with immediate restoration in the esthetic zone is a standardized protocol that aims to satisfy the patient with an immediate, esthetic rehabilitation. This study evaluated clinical and esthetic outcomes following immediate implant placement and provisionalization over a medium- to long-term period. A total of 57 implants in 44 patients were included in the present cross-sectional study, with a follow-up period of 3.97 ± 2.03 years. Surgical and prosthetic treatments were performed according to a standardized protocol. Clinical outcomes (modified Plaque Index, bleeding on probing, probing depth [PD], keratinized mucosa, mucosal recession [MR], and pink esthetic score [PES]) were evaluated during follow-up. Peri-implant tissue health was assessed based on the established case definitions. The mean PES value at the final control examination (mean PES follow-up time: 3.79 ± 1.85 years) was 12.06, the mean PD was 2.52 ± 0.88 mm, and mean MR was 0.03 ± 0.13 mm. No suppuration, pain, or implant or prosthetic failures were reported. The prevalence rates of mucositis and peri-implantitis were 45.5% and 0%, respectively. Immediate implant placement and restoration was associated with peri-implant tissue stability and esthetics over medium- and long-term follow-up periods.

Immediate versus delayed implant placement in the esthetic zone: a prospective 3D volumetric assessment of peri-implant tissue stability.

PURPOSE: To evaluate the volumetric stability of peri-implant soft and hard tissue prospectively, this study compared immediate versus delayed implants placed in the anterior esthetic region. METHODS: This non-randomized controlled clinical study included 25 patients, who received an immediate (type 1) or a delayed (type 4) implant placement for the replacement of a single anterior tooth. The anterior maxillae were intraorally scanned at three timepoints: before surgery (S0), 6 months (S1), and 12 months (S2) after surgery. A specific region of interest (ROI), divided into marginal and apical regions, was determined and superimposed for volumetric changes analysis. At 6 and 12 months, the probing depth (PD), bleeding/suppuration on probing (BOP/SUP), modified plaque index (PI), keratinized mucosa (KM) width, mucosal recession (MR), and implant stability (PTV) by means of periotest were recorded. RESULTS: Between S0-S2, tissue surrounding immediate implants was reduced in 0.37 ± 0.31 mm, whereas delayed implants gained 0.84 ± 0.57 mm mean tissue volume. Peri-implant tissue loss at type 1 implants occurred primarily in the marginal section of the ROI (0.42 ± 0.31 mm), whereas tissue gain at type 4 implants occurred mainly in the apical section (0.83 ± 0.51 mm). These values were significantly different between both groups for the entire ROI (p = 0.0452) and the marginal region (p = 0.0274). In addition, the mean buccal KM width around type 1 implants was significantly wider in comparison with the type 4 implants group after 12 months (p = 0.046). There were no significant differences between groups regarding PD, BOP/SUP, or PTV. CONCLUSIONS: The results suggest that type 1 implants placed in the esthetic region experience more tissue loss than type 4 implants, thus marginal tissue remodeling should be considered for planning immediate implants placement in the anterior maxillae.

Clinical performance of a newly developed two-piece zirconia implant system in the maxilla: A prospective multicentre study.

PURPOSE: To assess the clinical performance of a two-piece zirconia implant system (PURE Ceramic Implants, Straumann, Basel, Switzerland) in the maxilla after a follow-up period of more than 1 year. MATERIALS AND METHODS: A total of 19 patients in three centres received 24 single-tooth implants in the maxilla. The implants were restored after a mean healing period of 7.1 ± 0.4 months (range 7 to 9 months). Implant survival, implant success, Plaque Index, probing pocket depth, bleeding on probing, mucosal recession/creeping attachment, width of keratinised mucosa, papilla index and pink aesthetic score were evaluated after prosthetic loading (T0), after 6 months (T1) and at the final follow-up (T2, mean 15.0 ± 2.1 months, range 12 to 19 months). RESULTS: All implants survived and were suitable for retaining prostheses. Low values were recorded for Plaque Index (0.38 ± 0.68) and probing pocket depth (2.49 ± 0.49 mm). Bleeding on probing increased significantly from T0 (21.7%) to T1 (50.0%) (P = 0.0342) and then remained stable (50.0% at T2). No recession was detected around any of the implants. A statistically significant increase in attachment level was observed from T0 to T2 (0.79 ± 0.88 mm; P = 0.0196). A papilla index of 2.27 ± 0.81 and pink aesthetic score of 11.67 ± 1.60 at T2 indicated a completely satisfying aesthetic result. CONCLUSION: Within the limitations of the present study, the two-piece zirconia implant system investigated achieved fully satisfying functional and aesthetic results.

The influence of soft-tissue volume grafting on the maintenance of peri-implant tissue health and stability.

BACKGROUND: To investigate the influence of soft-tissue volume grafting employing autogenous connective tissue graft (CTG) simultaneous to implant placement on peri-implant tissue health and stability. MATERIAL AND METHODS: This cross-sectional observational study enrolled 19 patients (n = 29 implants) having dental implants placed with simultaneous soft-tissue volume grafting using CTG (test), and 36 selected controls (n = 55 implants) matched for age and years in function, who underwent conventional implant therapy (i.e., without soft-tissue volume grafting). Clinical outcomes (i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and mucosal recession (MR)) and frequency of peri-implant diseases were evaluated in both groups after a mean follow-up period of 6.15 ± 4.63 years. RESULTS: Significant differences between test and control groups at the patient level were noted for median BOP (0.0 vs. 25.0%; p = 0.023) and PD scores (2.33 vs. 2.83 mm; p = 0.001), respectively. The prevalence of peri-implant mucositis and peri-implantitis amounted to 42.1% and 5.3% in the test and to 52.8% and 13.9% in the control group, respectively. CONCLUSION: Simultaneous soft-tissue grafting using CTG had a beneficial effect on the maintenance of peri-implant health.

Prospective study assessing three-dimensional changes of mucosal healing following soft tissue augmentation using free gingival grafts.

BACKGROUND: The present study aimed to assess the three-dimensional changes following soft tissue augmentation using free gingival grafts (FGG) at implant sites over a 3-month follow-up period. METHODS: This study included 12 patients exhibiting deficient keratinized tissue (KT) width (i.e., <2 mm) at the vestibular aspect of 19 implants who underwent soft tissue augmentation using FGG at second stage surgery following implant placement. Twelve implants were considered for the statistical analysis (n = 12). The region of interest (ROI) was intraorally scanned before surgery (S0), immediately post-surgery (S1), 30 (S2) and 90 (S3) days after augmentation. Digital scanned files were used for quantification of FGG surface area (SA) and converted to standard tessellation language (STL) format for superimposition and evaluation of thickness changes between the corresponding time points. FGG shrinkage (%) in terms of SA and thickness was calculated between the assessed time points. RESULTS: Mean FGG SA amounted to 91 (95% CI: 63 to 119), 76.2 (95% CI: 45 to 106), and 61.3 (95% CI: 41 to 81) mm2 at S1, S2, and S3, respectively. Mean FGG SA shrinkage rate was 16.3% (95% CI: 3 to 29) from S1 to S2 and 33% (95% CI: 19 to 46) from S1 to S3. Mean thickness gain from baseline (S0) to S1, S2, and S3 was 1.31 (95% CI: 1.2 to 1.4), 0.82 (95% CI: 0.5 to 1.12), and 0.37 (0.21 to 0.5) mm, respectively. FGG thickness shrinkage was of 38% (95% CI: 17.6 to 58) from S1 to S2 and 71.8% (95% CI: 60 to 84) from S1 to S3. Dimensional changes from S1 to S3 were statistically significant, P <0.017. Soft tissue healing was uneventful in all patients. CONCLUSIONS: The present three-dimensional assessment suggests that FGG undergo significant dimensional changes in SA and thickness over a 3-month healing period.