Effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures: Consensus report of group 2 of the SEPA/DGI/OF workshop.

OBJECTIVES: The aim of this study was to comprehensively assess the literature in terms of the effect of peri-implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures to increase the mucosal thickness with autogenous grafts or soft tissue substitutes. MATERIAL AND METHODS: Two systematic reviews (SR) were performed prior to the consensus meeting to assess the following questions. Review 1, focused question: In systemically healthy patients with an implant-supported fixed prosthesis, what is the influence of thin as compared to thick peri-implant mucosa on esthetic outcomes? Review 2, focused question 1: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of connective tissue graft (CTG), as compared to absence of a soft tissue grafting procedure, in terms of gain in peri-implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? Review 2, focused question 2: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri-implant STT reported by RCTs or CCTs? The outcomes of the two SRs, the consensus statements, the clinical implications, and the research recommendations were discussed and subsequently approved at the consensus meeting during the group and plenary sessions. CONCLUSIONS: There was a tendency of superior esthetic outcomes in the presence of a thick mucosa. The connective tissue graft remains the standard of care in terms of increasing mucosa thickness.

The gingival biotype: measurement of soft and hard tissue dimensions - a radiographic morphometric study.

BACKGROUND: Gingival biotypes have been reported to influence the outcome of restorative therapies. The aim of this study was to evaluate the correlation of different morphometric parameters with the thickness of the buccal gingiva and alveolar bone at different apico-coronal levels. METHODS: In 60 periodontally healthy subjects, the central maxillary incisor was examined. Clinical parameters included the crown width/crown length ratio (CW/CL), gingival width (GW), gingival scallop (SC) and transparency of the periodontal probe through the gingival sulcus (TRAN). Gingival and alveolar bone dimensions were assessed on parallel profile radiographs. RESULTS: Crown width/crown length ratio was positively correlated with the thickness of the gingiva at the cementoenamel junction (G3) (r = 0.47) and to the thickness of the alveolar crest (A1) (r = 0.46); whereas SC had a weak negative and GW had a moderate positive correlation with all radiographic measurements. TRAN had a stronger negative relation to the thickness at the free gingiva (r = -0.42) than to other tissue thicknesses. All gingival thickness values were correlated with A1 value. Multivariate models identified CW/CL and GW as significant predictors for G3 value, whereas CW/CL was a significant predictor for A1 value. CONCLUSION: Crown width/crown length ratio and GW could represent surrogate parameters to anticipate the gingival thickness at the cementoenamel junction, whereas CW/CL might also be an indicator for alveolar bone crest thickness. Periodontal probing has a limited prognostic value for these tissue dimensions.

Telescopic Crowns On Implants And Teeth: Evaluation Of A Clinical Study After 8 to 12 Years.

PURPOSE: To evaluate the outcome of a clinical study on telescopic-crown-retained removable dental prostheses (TCR-RDPs) on implants or implants and teeth after 8 to 12 years. MATERIALS AND METHODS: Between 1999 and 2002, 39 (41 jaws) patients received implant- or combined tooth-implant-supported TCR-RDPs in the maxilla and/or mandible. One-stage surgery was performed, and after a conventional healing period, TCR-RDPs were inserted. Thirty-one patients (33 prostheses) were available for annual follow-up investigations with a standardized protocol from 2010 until 2013. Cumulative survival and success of the abutments was estimated using the Kaplan-Meier method, and a Cox regression model was used to identify potential predictors for abutment complications. Patients' oral health-related quality of life (OHRQoL) was measured by means of the Oral Health Impact Profile (OHIP). RESULTS: After a mean observation period of 11.3 ± 1.1 years, all restorations were still functioning successfully. Two implants and 10 abutment teeth were lost, leading to significantly different implant and tooth survival rates of 97.6% (SE ± 1.7%) and 81.8% (SE 5.3%; P = .007). Implants placed in the mandible, and those in the group with a higher number of abutments (5 to 6 vs 2 to 4) showed higher success rates. The success rates of abutment teeth were not influenced by location (mandible vs maxilla) or number of abutments (5 to 6 vs 2 to 4). CONCLUSION: Implant- or combined tooth-implant-supported TCR-RDPs provided a satisfying treatment option for patients with severely reduced dentition in the long term. Due to the small sample size, the results presented should be interpreted with caution.

Combination of ultrasonic decontamination, soft tissue curettage, and submucosal air polishing with povidone-iodine application for non-surgical therapy of peri-implantitis: 12 Month clinical outcomes.

BACKGROUND: The aim of this study is to evaluate clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant povidone-iodine application with and without systemic antibiotics. METHODS: Forty-five patients with chronic periodontitis and a total of 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of > 2 mm, probing depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP), and a repeated submucosal application of povidone-iodine. Teeth with PD > 4 mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (n = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days. RESULTS: After 12 months, implants treated without AM showed significant reductions (P < 0.05) of mean PD (1.4 ± 0.7 mm), clinical attachment level (CAL) (1.3 ± 0.8 mm), and BOP (33.4% ± 17.2%). In deep pockets (PD > 6 mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm), and BOP (44.0% ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes in these parameters. However, the reduction of implant sites with PD > 4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8% ± 12.6% versus 20.8% ± 14.7%; P < 0.05). CONCLUSIONS: The combination of ultrasonic debridement, STC, and GPAP with adjuvant povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.

Combination of Ultrasonic Decontamination, Soft Tissue Curettage and Submucosal Air Polishing With Povidone-Iodine Application for Non-Surgical Therapy of Peri-Implantitis: 12 Months Clinical Outcomes.

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of a concept for non-surgical peri-implantitis combining stepwise mechanical debridement measures with adjuvant Povidone-iodine application with and without systemic antibiotics. METHODS: 45 patients with chronic periodontitis comprising 164 screw-typed implants with peri-implantitis were included. Peri-implantitis was defined as radiographic bone loss of >2 mm, probing pocket depth (PD) ≥5 mm with bleeding on probing (BOP). Stepwise treatment of implants was performed with ultrasonic debridement, soft tissue curettage (STC), glycine powder air polishing (GPAP) and a repeated submucosal application of Povidone-iodine. Teeth with PD >4mm were treated simultaneously according to the same concept except STC. In cases with severe periodontitis (N = 24), amoxicillin and metronidazole (AM) were prescribed for 7 days. RESULTS: After 12 months, implants treated without AM showed significant reductions (p<0.05) of mean PD (1.4 ± 0.7 mm), CAL (1.3 ± 0.8 mm) and BOP (33.4 ± 17.2%). In deep pockets (PD >6mm) changes of mean PD (2.3 ± 1.3 mm), CAL (2.0 ± 1.6 mm) and BOP (44.0 ± 41.7%) were more pronounced. Intake of AM did not significantly influence the changes of these parameters. However, the reduction of implant sites with PD >4 mm and BOP was significantly higher in patients with AM than in those without AM (31.8 ± 12.6% vs. 20.8 ± 14.7%; p<0.05). CONCLUSIONS: The combination of ultrasonic debridement, STC and GPAP with adjuvant Povidone-iodine led to significant clinical improvements at implants. Systemic antibiotics had limited effects on the reduction of persisting implant sites with treatment need.

Postextraction Socket Seal Surgery with an Epithelized Connective Tissue Graft Using a Subpapillar Tunneling Procedure.

Ridge preservation in the esthetic area is still a challenging procedure. The aim of the present case series was to introduce a technique for postextraction socket seal surgery using an epithelized connective tissue graft and socket filling with a xenogeneic biomaterial. Using a tunneling approach, the buccal gingiva and interdental papillae are undermined and augmented with the soft tissue graft. This method was applied and evaluated in 16 sites in 13 patients with need for extraction of at least one maxillary anterior tooth. Five months postoperative, the mean reduction of the horizontal width of the alveolar ridge was 0.5 mm, while the height of the mesial and distal papillae were reduced by 0.2 mm and 0.4 mm, respectively. The buccogingival margin of the alveolar ridge showed a vertical gain of 0.5 mm. Therefore, the presented technique seems appropriate for preservation of the alveolar ridge in esthetically relevant areas.

Definition, etiology, prevention and treatment of peri-implantitis--a review.

Peri-implant inflammations represent serious diseases after dental implant treatment, which affect both the surrounding hard and soft tissue. Due to prevalence rates up to 56%, peri-implantitis can lead to the loss of the implant without multilateral prevention and therapy concepts. Specific continuous check-ups with evaluation and elimination of risk factors (e.g. smoking, systemic diseases and periodontitis) are effective precautions. In addition to aspects of osseointegration, type and structure of the implant surface are of importance. For the treatment of peri-implant disease various conservative and surgical approaches are available. Mucositis and moderate forms of peri-implantitis can obviously be treated effectively using conservative methods. These include the utilization of different manual ablations, laser-supported systems as well as photodynamic therapy, which may be extended by local or systemic antibiotics. It is possible to regain osseointegration. In cases with advanced peri-implantitis surgical therapies are more effective than conservative approaches. Depending on the configuration of the defects, resective surgery can be carried out for elimination of peri-implant lesions, whereas regenerative therapies may be applicable for defect filling. The cumulative interceptive supportive therapy (CIST) protocol serves as guidance for the treatment of the peri-implantitis. The aim of this review is to provide an overview about current data and to give advices regarding diagnosis, prevention and treatment of peri-implant disease for practitioners.