Association between dental implants in the posterior region and traumatic occlusion in the adjacent premolars: a long-term follow-up clinical and radiographic analysis

PURPOSE: The aim of this retrospective study was to determine the association between dental implants in the posterior region and traumatic occlusion in the adjacent premolars, using data collected during from 2002 to 2015. METHODS: Traumatic occlusion in the adjacent premolars was assessed by examining clinical parameters (bleeding on probing, probing pocket depth, fremitus, and tooth mobility) and radiographic parameters (loss of supporting bone and widening of the periodontal ligament space) over a mean follow-up of 5 years. Clinical factors (gender, age, implant type, maxillary or mandibular position, opposing teeth, and duration of functional loading) were evaluated statistically in order to characterize the relationship between implants in the posterior region and traumatic occlusion in the adjacent premolars. RESULTS: The study inclusion criteria were met by 283 patients, who had received 347 implants in the posterior region. The incidence of traumatic occlusion in the adjacent premolars was significantly higher for splinted implants (P=0.004), implants in the maxillary region (P<0.001), and when implants were present in the opposing teeth (P<0.001). The other clinical factors of gender, age, and duration of functional loading were not significantly associated with traumatic occlusion. CONCLUSIONS: This study found that the risk of traumatic occlusion in the adjacent premolars increased when splinted implants were placed in the maxillary molar region and when the teeth opposing an implant also contained implants.

Comportamento dos tecidos peri-implantares no implante imediato com provisionalização: revisão de literatura / Behavior of peri-implant tissues inimmediate implant with provisionalization:A literature review

Introdução: a Implantodontia alcançou um patamar onde apenas a osseointegração já não é o bastante para se considerar sucesso o resultado do tratamento. Hoje, além de devolver função, o implante deve estar associado a restaurações estéticas similares à dentição natural, harmoniosas com os dentes vizinhos e com as outras estruturas peri-implantares. O processo cicatricial, após a perda dentária, é desfavorável aos tecidos moles, que acompanham a remodelação óssea comprometendo a estética. A utilização de implantes imediatos e provisionalização possibilita uma abordagem de tratamento que visa a manutenção dos tecidos peri-implantares, em substituição ao tratamento das sequelas da atrofia pós-extração. Objetivo: identificar e discutir os determinantes do comportamento morfo-estético-funcional do tecido peri-implantar no procedimento de implante imediato com provisionalização. Métodos: utilizou-se como fonte de pesquisa a base de dados do PubMed no período de 2003 a 2012. Resultados: dentro dos limites dessa revisão, foi possível concluir que o resultado estético na terapia com implantes sofre influência do biótipo tecidual, especialmente nos níveis da mucosa peri-implantar vestibular. O biótipo fino apresentou maior suscetibilidade a recessão gengival. Por outro lado, o biótipo tecidual demonstrou pouca influência na altura da papila interproximal. O preenchimento do gap com um substituto ósseo ou enxerto autógeno contribuiu para a manutenção das estruturas ao redor do implante, mas não se pode afirmar a existência de superioridade entre os materiais de enxerto. Conclusão: o enxerto de tecido conjuntivo subepitelial parece beneficiar o nível da mucosa marginal vestibular.

Introduction: Implantodontics has reached a level in which osseointegration alone is no longer enough for treatmentsuccess. Today, in addition to recovering function, the implant must be associated with esthetic restorations that aresimilar to natural dentition, in harmony with surrounding teeth and with other peri-implant structures. The healingprocess after tooth loss is unfavorable to soft tissues that follow bone remodeling, compromising esthetics. The use ofimmediate implants and provisionalization enables a treatment approach that aims at maintaining peri-implant tissues,replacing treatment of atrophy sequelae after extraction. Objective: The aim of this paper is to conduct a literaturereview in order to identify and discuss the determinants of morpho-esthetic-functional tissue peri-implant behavior inimmediate implant placement with provisionalization. Methods: PubMed database was used as a research resourceconsidering the period between 2003 and 2012. Results: Within the limits of this review, it was reasonable to concludethat the esthetic results in implant therapy are influenced by tissue biotype, especially in the peri-implant mucosa.The thin biotype revealed higher susceptibility to gingival recession. Conversely, tissue biotype revealed little influenceover the height of the interproximal papilla. Filling the gap with autogenous bone graft contributed to the maintenanceof the structures around the implant, but we can not affirm the existence of superiority between different graft materials.Conclusion: Subepithelial connective tissue graft seems to positively influence the level of marginal mucosa.

Esthetic evaluation of maxillary single-tooth implants in the esthetic zone

PURPOSE: The aim of this study is to assess the influence exerted by the observer's dental specialization and compare patients' opinion with observers' opinion of the esthetics of maxillary single-tooth implants in the esthetic zone. METHODS: Forty-one adult patients, who were treated with a single implant in the esthetic zone, were enrolled in this study. Eight observers (2 periodontists, 2 prosthodontists, 2 orthodontists and 2 senior dental students) applied the pink esthetic score (PES)/white esthetic score (WES) to 41 implant-supported single restorations twice with an interval of 4 weeks. We used a visual analog scale (VAS) to assess the patient's satisfaction with the treatment outcome from an esthetic point of view. RESULTS: In the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. The mean total PES/WES was 11.19 +/- 3.59. The mean PES was 5.17 +/- 2.29 and mean WES was 6.02 +/- 1.96. In the total PES/WES, the difference between the groups was not significant. However, in the WES, the difference between the groups was significant and prosthodontists were found to have assigned poorer ratings than the other groups. Periodontists gave higher ratings than prosthodontists and senior dental students. Orthodontists were clearly more critical than the other observers. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. However, the correlation between the total PES/WES and the VAS score for the first premolar was not statistically significant. CONCLUSIONS: The PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.