The effect of triangular cross-section neck design on crestal bone stability in the anterior mandible: A retrospective study with a 5-year follow-up.

OBJECTIVES: The objective of this study, which included a 5-year follow-up, was to compare peri-implant soft tissue health, crestal bone loss (CBL), and buccal bone thickness (BBT) around triangular cross-section neck (TN) or round neck (RN) implants, using cone-beam computed tomography. MATERIALS AND METHODS: This study was initially designed as a prospective 1-year randomized controlled study and then extended with a 5-year retrospective evaluation of clinical and radiographic records. In the initial 1-year study, a total of 20edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN or TN groups using a split-mouth design. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were recorded at postoperative month 12. CBL and BBT at three levels (0, -2, and -4 mm) were evaluated 1 year after insertion. Five years after insertion, PPD, PI, GI, CBL, and BBT were recorded as patients were recalled for clinical and radiographic monitoring. RESULTS: Nineteen patients completed the study. After 5 years, no significant differences in PPD, PI, and GI scores and BBT values between the two groups (p > .05). The mean ± SD CBL values at the final follow-up visit were -0.71 ± 0.69 mm for TN and -1.03 ± 0.86 mm for RN (p < .01). CONCLUSIONS: These results suggest better crestal bone preservation using implants with TN when compared to RN after a 5-year follow-up. However, TN showed similar results to RN regarding peri-implant soft tissue health and BBT.

Crestal bone loss and implant failure of prefabricated versus customized abutments: a 10-year retrospective radiological study.

OBJECTIVES: There is no information today about the impact of abutment type on the crestal bone stability. This retrospective study was aimed to evaluate the crestal bone levels (CBL) and failures of implants with prefabricated and customized abutments after the long term. MATERIALS AND METHODS: The mesial and distal CBL around dental implants with prefabricated and custom abutments were recorded. Measures were completed at 5- and 10-year endpoints. RESULTS: Sixty-three patients with 249 implants were included. One hundred twenty-seven implants (51%) were restored with prefabricated and 122 implants (49%) with customized abutments. All the patients received fixed restorations. The results showed that the CBL was higher in patients with custom abutments than the CBL of patients with prefabricated abutments. The mean bone loss around implants with prefabricated abutments was 0.29 mm mesial/0.45 mm distal after 10 years. Meanwhile, the mean bone loss at implants with custom abutments was 1.19 mm mesial/1.27 mm distal (p < 0.05) after 10 years. None of the implants with prefabricated abutments failed up to 10-year follow-up, whereas 4.1% of implants with customized abutments failed. CONCLUSION: Implants with prefabricated abutments present less crestal bone loss compared to customized abutments. CLINICAL RELEVANCE: The selection of abutment type is associated with the crestal bone stability or marginal bone loss.

Influence of Glycemic Control on the Survival of Implants Placed in the Zygomatic Bone of Edentulous Patients With and Without Type 2 Diabetes Mellitus: 10-Year Follow-Up Results.

It is hypothesized that under optimal glycemic control (GC), there is no difference in the survival of implants placed in the zygomatic bone of edentulous patient with and without type 2 diabetes mellitus (T2DM). The aim was to assess the influence of GC on survival of implants placed in the zygomatic bone of an edentulous patient with and without T2DM at the 10-year follow-up. Twenty patients with T2DM (10 with poorly controlled T2DM and 10 with well-controlled T2DM) and 12 patients without T2DM were included. Hemoglobin A1c (HbA1c) levels were recorded, and demographic data were collected from all participants. Peri-implant inflammatory parameters (plaque index [PI], probing depth [PD], crestal bone loss [BL], and gingival index [GI]) were measured in all patients. Group comparisons were done, and P values, which were less than .01, were indicative of statistical significance. Twenty and 12 male patients with and without T2DM, respectively, were included. Among patients with T2DM, 10 and 10 individuals had poorly and well-controlled T2DM, respectively. The mean HbA1c levels were significantly higher in patients with poorly controlled T2DM (9.2 ± 0.7%) compared with well-controlled T2DM (4.8 ± 0.3%; P < .01) and nondiabetic individuals (4.6 ± 0.3%; P < .01). The crestal BL on the mesial (P < .01) and distal (P < .01) surfaces, PD (P < .01), PI (P < .01), and GI (P < .01) were significantly higher around all zygoma implants placed in patients with poorly controlled T2DM compared with patients with well-controlled T2DM and patients without T2DM. These clinicoradiographic parameters were comparable around zygoma implants placed in patient with well-controlled T2DM and in subjects without T2DM. Optimal GC is essential for the long-term stability of zygomatic plants in patients with T2DM.

Efficacy of Antibiotic Versus Probiotics As Adjuncts to Mechanical Debridement for the Treatment of Peri-Implant Mucositis.

The objective was to compare the efficiency of probiotic therapy (PT) vs antibiotic therapy (AT) as adjuvants to nonsurgical-mechanical debridement (NSMD) for the treatment of peri-implant mucositis (Pi-M). Volunteers with Pi-M were encompassed. Therapeutically, patients were randomly divided into 3 groups: (a) Group 1: NSMD + PT; (b) Group 2: NSMD + AT; and (c) Group 3: NSMD alone. Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD), and crestal bone loss (CBL) were recorded at baseline and at 3 and 6 months follow-up. P < .05 was selected as the indicator of statistical significance. Forty-two male individuals (14, 14, and 14 in Groups 1, 2, and 3, respectively) were included. At 3 and 6 months of follow-up, PI (P < .01), BOP (P < .01), and PD (P < .01) were higher in Group 2 than Group 1. At 3 months of follow-up, PI (P < .01), BOP (P < .01), and PD (P < .01) were higher in Group 3 than Group 2. At 6 months of follow-up, PI, BOP, and PD were comparable in Groups 2 and 3. In Group 3, PI, BOP, and PD were comparable with the respective baseline values at 6 months of follow-up. The CBL in all groups remained unchanged up to 6 months of follow-up. The NSMD with adjuvant PT is more effective than adjunct AT for the treatment of Pi-M for up to 3 months.

Comparison of Crestal Bone Loss and Osteocalcin Release Kinetics in Immediately and Delayed Loaded Implants: A Randomized Controlled Trial.

PURPOSE: To compare concentration and release kinetics of osteocalcin and crestal bone loss under immediate and delayed loading conditions during osseointegration. MATERIALS AND METHODS: Forty-one patients who were indicated for rehabilitation with dental implants randomly received either implant with placement of permanent prosthesis after 3 months (delayed loading) or implant with placement of permanent prosthesis within 7 days (immediate loading). Radiographic assessment of crestal bone loss at the mesial and distal surface was done at 3, 6, and 12 months after implant placement. Peri-implant sulcular fluid was collected immediately from the buccal surface at two sites after implant insertion and also, at 7, 15, 30, and 90 days after surgery. The level of osteocalcin was evaluated using ELISA and data were compared using two sample t-test. Differences between two groups were analyzed by unpaired Student's t test. Intragroup comparison was done by repeated measures ANOVA. RESULTS: Mean crestal bone loss was lower in the immediate loading group compared to the delayed loading group at 3, 6, and 12 months (p < 0.001). Intragroup comparison revealed a statistically significant increase in osteocalcin levels in both group I (delayed loading) (F = 26712.2) and group II (immediate loading) (F = 10497.2) at the predetermined time intervals. CONCLUSIONS: Less crestal bone loss and early release of osteocalcin was found in the immediately loaded group than in the delayed loaded group. The study substantiates that immediately loaded implants show less crestal bone as well as early release of osteocalcin facilitating upregulation of bone metabolism, improving long term health of bone and prognosis of implants. Immediately loaded implants can be a better treatment protocol provided there is adequate bone and primary stability.

Clinical Evaluation of Short Tuberosity Implants among Type 2 Diabetic and Non-Diabetic Patients: A 5 Year Follow-Up.

Aim: To assess clinical and radiographic parameters including bleeding on probing (BoP); probing depth (PD), plaque index (PI) and crestal bone loss (CBL) around short tuberosity implants (STI) supporting fixed partial dentures in patients with Type 2 diabetes mellitus (T2DM) and non-diabetics. Material and Methods: Participants with T2DM and without T2DM with at least one STI (6 mm) posteriorly restored with a fixed partial denture splinting premolar implant were included. A questionnaire collected demographic details including gender, age, duration of diabetes, habits of brushing, the total number of dental implants and location, implant loading after placement, restoration type, and family history of DM. Clinical and radiographic assessment of peri-implant parameters, i.e., bleeding on probing (BoP), probing depth (PD), plaque index (PI), and crestal bone loss (CBL) was performed. The restorative success of STI was determined by no sensation of the foreign body, lack of pain and dysesthesia, lack of infection, no radiolucency around the implant, and no mobility. The Kruskal-Wallis test was used for statistical analysis. A p-value of less than 0.05 was considered statistically significant. Results: Twenty-five T2DM (19 males and 6 females) and 25 non-diabetic (18 males and 7 females) participants were included. The number of STIs in T2DM was 41, whereas in non-diabetic it was 38. At 1 year follow-up, mean PI% in T2DM participants was 18.9% (19.2-21.4%) and in non-diabetics it was 17.6% (16.3-18.5%). The mean PD was recorded in diabetics (1.3 ± 5.0 mm) and non-diabetics (1.1 ± 3.2 mm). The BoP value in diabetics was 44.9% (39.8-46.4%) and 28.2% in non-diabetics (17.2-24.6%). At 5 years of follow-up, the mean PI% range in T2DM participants was 26.18% (25.4-29.1%) and 24.42% in non-diabetic (20.1-25.5%). The mean PD in millimeters around STI in T2DM was observed to be 2.3 ± 4.8 mm and 1.4 ± 3.4 mm in non-diabetics. In addition, BoP in diabetic participants was 39.54% (27.7-42.1%) and 24.42% in non-diabetics (20.1-25.5%). A total of six STIs failed, i.e., two in the non-diabetic and four in the T2DM group. Conclusions: Patients with T2DM have poor periodontal (BoP, PD, CBL) and restorative peri-implant parameters around STIs when compared to healthy (non-diabetic) participants at five years of follow-up. For long-term stability, glycemic control is pivotal along with following good plaque control.

Evaluation of Crestal Bone Loss in Flap vs Flapless Implant Placement Technique: An In Vivo Comparative Study.

AIMS: The aims of the study were to assess the technique with-flap and flapless implant placement and to compare crestal bone heights around the implant in flapless and conventional flap technique using digital radiovisiograph, in 3 and 6 months after the surgery. MATERIALS AND METHODS: A total of 20 implants were placed by flap and flapless implant technique; each patient received two implants, except for two patients who received four implants. A radiovisiograph was taken at implant placement, as well as 3- and 6-month intervals. Crestal bone level was compared between flapless and flap during these intervals and compared between intervals for each group. RESULTS: On evaluating the distribution, it was found to be asymmetric and hence lacked normality (K-S = 0.382; p <0.001). On mesial side, bone loss values in group I ranged from 0.40 to 1.10 units with a mean value of 0.71 and a standard deviation of 0.26 units. The median value was 0.70. On evaluating the data for normality, it was found to be symmetric and normal (K-S = 0.166; p = 0.200). CONCLUSION: This study concluded that there are not any significant differences in the crestal bone with both flap and flapless techniques. Comparatively, the flapless approach showed a lesser crestal bone height reduction, which was statistically significant. CLINICAL SIGNIFICANCE: Implant dentistry is nonetheless behind when advances are concerned, we have seen the inclination toward minimal invasive implant techniques to yield better esthetic as well as improved results, thus taking care of patients' discomfort.

Comparative Study of the Crestal vs Subcrestal Placement of Dental Implants via Radiographic and Clinical Evaluation.

AIM: The study aims at using the level/depth of implant placement (equicrestal or cretsal) as the key parameter in measuring the vertical crestal bone loss (CBL) mesially and distally, using periapical radiographs (IOPARs) taken at 1-, 3-, and 6-months interval, postprosthetic loading. MATERIALS AND METHODS: Patients (n = 40; 18-65 years), with edentulous space anteriorly or posteriorly, were randomly divided into two groups, namely, group I (equicrestal) and group II (subcrestal) with 20 patients in each group. Implants were placed at an edentulous site (delayed implants), after obtaining cone-beam computed tomography (CBCT) scans. Prosthetic loading (following osseointegration) was done within 3 months of implant placement. The patients were followed up and IOPAR were taken to measure CBL at 1-, 3-, and 6-months interval, postloading. The CBL between the two groups was compared using IOPARs. The data obtained was compiled and unpaired Student's t-test was done for statistical analysis. RESULTS: After the statistical analysis of the data obtained during follow-up, CBL was measured radiographically. Mesial and distal vertical bone loss was charted and compared between the two groups. The mean bone loss on the mesial aspect for group I implants is 0.39 mm and for group II implants, it is 0.27 mm, 6 months postloading, determined radiographically. CONCLUSION: Subcrestally placed implants are conducive to the overall oral rehabilitation, as it has been seen to preserve marginal peri-implant bone for longer durations than their equicrestally placed counterparts, within the limitations of the current study. CLINICAL SIGNIFICANCE: The study prospectively relates the level of implant shoulder with respect to alveolar crestal bone, postloading. Following radiographic comparison between the two groups, significant clinical findings indicated that better esthetics and stability were seen in the subcrestally placed implants. This proves that implant placement level directly influences crestal bone levels; hence, indirectly affects esthetics and function.

The effect of triangular cross-section neck design on crestal bone stability in the anterior mandible: A randomized, controlled, split-mouth clinical trial.

OBJECTIVES: This randomized controlled trial aimed to compare crestal bone loss (CBL) and buccal bone thickness (BBT) around triangular cross-section neck (TN) to round neck (RN) implants retaining mandibular overdentures one year after loading, using cone beam computed tomography (CBCT). MATERIAL AND METHODS: Twenty edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN and TN groups. Clinical buccal bone thickness (CBBT) around the implants was measured with a caliper at baseline. A resonance frequency analyzer was used to measure the implant stability quotient (ISQ) at the baseline and two months after insertion. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were also recorded at postoperative months 2, 6, and 12. CBCT was used to evaluate proximal CBL and BBT at three levels (0, -2, and -4 mm) one year after loading. RESULTS: No implant loss was observed during the follow-up period. No significant differences in CBBT, ISQ values, and scores for PPD, PI, and GI between the two groups were observed at any time (p > .05). BBT was also comparable one year after loading (p > .05). The mean ± SD proximal CBL one year after loading was 0.58 ± 0.36 mm for TN and 0.91 ± 0.59 mm for RN (p < .01). CONCLUSIONS: This study found better crestal bone preservation in the implants with the novel neck design than conventional neck design in the anterior mandible after a follow-up of one year. However, it may not be clinically noticeable.

Clinical, radiographic and restorative parameters for short tuberosity implants placed in smokers: a retrospective study with 5 year follow-up.

This study aimed to estimate and compare the clinical, radiographic, and restorative parameters around short tuberosity implants (STIs) placed in cigarette smokers (CS) and never smokers (NS). In this 60-month follow-up retrospective study, a total of 50 (37 males + 13 females) individuals who had received 82 dental implants were included. These participants were categorized into two groups as follows: (i) Group-1: 25 self-reported systemically healthy CS with 43 STIs; and (ii) Group-2: 25 self-reported systemically healthy NS with 39 STIs. In both groups, peri-implant plaque index (PI), probing depth (PD), bleeding on probing (BOP), and crestal bone loss (CBL) and restorative parameters were measured at 12 and 60 months of follow-up. Group comparisons were performed utilizing the Kruskal-Wallis test. The significance level was set at p < 0.05. In CS and NS, the mean age of participants was 58.5 and 60.7 years, respectively. No statistically significant differences were observed in the overall mean levels of PD and CBL around STIs among CS and NS. However, a statistically significant increase was observed in the mean scores of BOP and PI around STIs in the NS and CS at 12 and 60 months follow-up, respectively. In both groups, the loosening of the implant was the most frequently encountered type of STI failure. The outcomes of the present study suggest that STIs placed in maxillary tuberosity can show reliable clinical, radiographic, and restorative stability among cigarettes smokers and non-smokers. However, the role of smoking status and oral hygiene cannot be disregarded in this scenario.

Implant-prosthetic Rehabilitation with and without Platform Switching: A Retrospective Clinical Cohort Study.

AIM: The study aimed to retrospectively compare peri-implant bone loss, prosthetic complications, and patient-reported outcome measures (PROMs) after implant-prosthetic treatment on abutments with platform switch or platform match. MATERIALS AND METHODS: Records of patients, who received implant-prosthetic treatment on abutments with/without platform switch in a single dental clinic between November 2015 and November 2018, were retrospectively analyzed. Analysis was restricted to the following patient selection criteria: no need for any bone grafting procedures before/during implant placement, and no serious systemic disease. Implants were conventionally loaded with screwed prosthetic restorations after a healing period of 3 months. Crestal bone loss was measured by digital radiography at implant placement and after at least 2 years under functional implant loading conditions. Patient satisfaction was recorded with the visual analogue scale (VAS) at the time of the follow-up examination. RESULTS: Clinical records of 59 patients were available for analysis. Patients of the study cohort received in total 128 implants with different lengths and diameters according to the manufacturer's specifications. Prosthetic restorations were fixed either on abutments with platform switch (BEGO PS-UNI: n = 74; 57.8%) or platform match (BEGO SUB-TEC Universal: n = 54; 42.2%). No implant was lost and no failure of prosthetic restoration was recorded during follow-up, except for prosthetic screw loosening in 32 implants (25.0%). Abutment type and location (maxilla vs mandible) had a significant impact on peri-implant bone loss (OR = 3.4; 2.8). A significant reduced rate of bone loss was observed at implant sites, provided with abutments according to the platform switch concept (35.1 vs 64.8%). No significant correlation was recorded between less bone loss and a higher patient satisfaction, while loosening of the prosthetic screw was significantly associated with lower satisfaction scores. CONCLUSION: BEGO PS-UNI abutments with a platform switch design revealed significant less crestal bone loss after a mean observation period of 20.8 months. CLINICAL SIGNIFICANCE: Abutments with a platform switch design may lead to less peri-implant bone loss. In order to maintain a higher patient satisfaction, clinicians should focus on the quality of the implant-prosthetic connection in screwed restorations.

Crestal Bone Changes and Patient Satisfaction with Single Implant-Retained Mandibular Overdentures with Dalla Bona and Locator Attachments with Immediate Loading Protocols. A Randomized Controlled Clinical Study.

PURPOSE: There is no enough evidence present on the success of single implant-retained mandibular overdentures (SIMO) with Dalla Bona and Locator attachments. This study aims to compare crestal bone loss and patient satisfaction with SIMO with Dalla Bona and Locator attachment following immediate loading protocols. MATERIAL AND METHODS: Twelve patients included in Group 1 received immediate SIMO with Dalla Bona attachments, and another twelve patients in Group 2 received immediate SIMO with Locator attachments in the mid symphyseal region. The follow-up was scheduled at 6 and 12 months after implant placement. The patient satisfaction with the denture was evaluated with the visual analog scale (VAS) score. The data obtained were statistically analyzed with the independent student t-test for intergroup comparison and repeated measures of ANOVA followed by Bonferroni's Post hoc analysis for intragroup comparison of mean crestal bone loss at a different time interval. RESULTS: Ten patients each in both the groups were available for follow-up. Crestal bone loss at 6 months follow-up for Dalla Bona group was 0.42 ± 0.10 mm on the mesial side and 0.43 ± 0.14 mm on the distal side and at 1 year 1.54 ± 0.16 mm on the mesial side and 1.66 ± 0.13 mm on the distal side. The mean crestal bone loss at 6 months follow-up for Locator group was 0.48 ± 0.16 mm on the mesial side and 0.45 ± 0.11 mm on the distal side and at 1 year was 1.71 ± 0.22 mm on mesial side and 1.74 ± 0.28 mm on the distal side. There was difference in bone loss at 6 months (mesial: 0.06 mm, p = 0.327; distal:0.02 mm; p = 0.726) and at 1 year (mesial: 0.17 mm, p = 0.063; distal: 0.08 mm; p = 0.423) in between two groups but the difference was statistically insignificant. There was a significant difference found in the VAS score for patient satisfaction with SIMO with Dalla Bona attachments and Locator attachments at 6 months (54.2 vs. 51.8, p = 0.005) and 1 year (60.6 vs. 55.2, p = 0.005). CONCLUSIONS: Patient satisfaction with SIMO with Dalla Bona attachments was higher during the follow-up. SIMO with Dalla Bona attachments had less crestal bone loss and less prosthetic complications when compared to Locator attachments, although the difference in the bone loss was statistically insignificant.

Comparative evaluation of crestal bone levels around endosseous implants as influenced by conventional and diode laser during second-stage surgery in mandibular implant-supported overdenture: An in vivo study.

AIM: This study aims to evaluate and compare the crestal bone levels around implants as influenced by conventional and diode laser during second-stage surgery in an edentulous mandible using cone beam computed tomography (CBCT) and digital radiography (DR). SETTINGS AND DESIGN: A split-mouth in vivo prospective study on edentulous patients involving placement of two implants in mandible followed by the comparison of two different techniques for second-stage surgery. MATERIALS AND METHODS: The study was undertaken to evaluate the crestal bone change around 16 implant sites distributed in two groups (eight implants each) following two methods during second-stage surgery, i.e., Group 1 - Conventional second stage and Group 2 - Diode laser. Measurements were made on two sides (mesial and distal) using intraoral periapical and four sides (labial, lingual, mesial, and distal) using CBCT scans for both groups. These measurements were conducted at two time intervals for both, i.e., immediately after implant loading and twenty 4 weeks after implant loading. The values obtained were subjected to statistical analysis. STATISTICAL ANALYSIS USED: The normality of data was checked by Shapiro-Wilk's test. Intragroup comparison was compared using independent t-test by post hoc comparison by Bonferroni method (P < 0.05). RESULTS: Crestal bone loss at the time of loading for Group 1 evaluated by CBCT was 0.950 ± 0.988 while after 24 weeks of loading, it was 1.388 ± 0.576. For Group 2, mean crestal bone loss was 1.200 ± 0.925 at the time of loading, and after 24 weeks, it was 1.512 ± 0.674. Crestal bone loss at the time of loading for Group 1 evaluated by DR was 1.075 ± 0.849 while after 24 weeks of loading, it was 1.562 ± 0.480. For Group 2, mean crestal bone loss was 1.162 ± 0.833 at the time of loading and after 24 weeks, it was 1.700 ± 0.498. CONCLUSIONS: In the present study, no statistically significant difference was observed in crestal bone loss between conventional and diode laser technique.

Hard and soft-tissue evaluation of bar-clip, ball-socket, and kerator attachments in mandibular implant overdenture treatment: An in vivo study.

AIM: The aim of this in vivo study was to evaluate and compare the soft and hard tissue changes in implant supported mandibular overdenture with three different attachment system. SETTINGS AND DESIGN: In vivo - observation study. MATERIALS AND METHODS: After evaluation of prosthetic space, fifteen edentulous subjects received two implants in the inter-foramina region of the mandible and were divided into 3 groups with 5 subjects each, delayed loading protocol was followed in all the patients. The crestal bone loss, modified sulcular bleeding index, plaque index values were evaluate with the attachments at baseline and after 6 months was measured in a standardised way. STATISTICAL ANALYSIS USED: Oneway ANOVA test and post hoc Bonferroni multiple test. RESULTS: At the end of six months modified sulcular bleeding index and plaque index values was higher in Group 2 (bar and clip attachment) as compared to Group 1 (ball and socket attachment) and Group 3 (Kerator attachment) and crestal bone loss was equal in groups 1, 2 and 3. Analysis of variance with repeated measures showed significant differences in modified sulcular bleeding index and plaque index among the three attachment types. CONCLUSION: (1) Group 2 (bar-and-clip attachment) exhibited higher Modified Sulcular Bleeding Index and Plaque Index values than Group 1 (ball-and-socket attachment) and Group 3 (kerator attachment). (2) Crestal bone loss was equal in Group 1 (ball-and-socket attachment), Group 2 (bar-and-clip attachment), and Group 3 (kerator attachment).

Influence of titanium base, lithium disilicate restoration and vertical soft tissue thickness on bone stability around triangular-shaped implants: A prospective clinical trial.

OBJECTIVE: To evaluate how vertical mucosal tissue thickness affects crestal bone stability around triangular-shaped bone-level implants, restored with low profile titanium bases and monolithic lithium disilicate restorations. MATERIAL AND METHODS: Fifty-five bone-level implants of 4.3 mm diameter were evaluated in 55 patients (22 males and 34 females, mean age 48.3 ± 3.4 years) in prospective cohort study. According to vertical mucosal thickness, patients were assigned into three groups: 1 (thin, 2 mm or less), 2 (medium, 2.5 mm) and 3 (thick, 3 mm and more). Implants were placed in posterior mandible and maxilla in one-stage approach and, after integration, were restored with single screw-retained monolithic lithium disilicate crowns, using low gingival profile titanium bases. Radiographic examination was performed after implant placement and after 1-year follow-up. Crestal bone loss was registered mesially and distally, and mean value was calculated. One-way ANOVA and Tukey's HSD tests were applied; significance was set to 0.05. RESULTS: Mean vertical tissue thickness in 1 group was 1.76 ± 0.26 mm, 2 group-2.5 mm and 3.91 ± 0.59 mm in group 3, with statistically significant difference between all groups (p < 0.001). After 1-year follow-up, implants in group 1 (thin) had 1.25 ± 0.8 mm bone loss. Implants in group 2 (medium) had 0.98 ± 0.06, while implants in group 3 (thick) lost 0.43 ± 0.37 mm of crestal bone. Tukey's HSD test showed that differences between 1/3 and 2/3 were statistically significant (p < 0.001 and p = 0.0014, respectively), while between 1 and 2 was not significant (p = 0.310). CONCLUSIONS: Significantly less bone loss occurs around triangular-shaped bone-level implants in thick mucosal tissues (≥3 mm), compared to medium or thin tissue biotype. Crestal bone loss did not differ between medium and thin tissues.

Crestal Bone Loss under Delayed Loading of Full Thickness Versus Flapless Surgically Placed Dental Implants in Controlled Type 2 Diabetic Patients: A Parallel Group Randomized Clinical Trial.

PURPOSE: To compare crestal bone loss around dental implants using a delayed loading protocol. Bone loss was compared in patients following conventional full thickness flap and flapless surgery in controlled type 2 diabetic patients. MATERIALS AND METHODS: Eighty-eight type 2 diabetic patients satisfying predetermined inclusion and exclusion criteria were selected for this single center, parallel group study after obtaining institutional review board approval and informed consent. These patients were randomly divided into two groups. Group I consisted of patients undergoing full thickness flap surgery for implant placement, and group II consisted of patients undergoing flapless surgery for implant placement. The mean age, duration of diabetes, glycosylated hemoglobin levels, and male-to-female ratio in both groups were matched and compared statistically. Dental implants were placed followed by delayed loading (4 months) in both groups. Crestal bone loss was assessed with intraoral periapical radiographs with the help of computer software (DBSWIN viewer). Actual implant length acted as the radiographic index, and implant-abutment junctions were used as a reference point for all measurements. Mesial and distal bone levels at baseline, 6, and 12 months post implant placement of the two groups were determined. Mesial and distal crestal bone loss from baseline to 6 and 12 months were calculated and compared with Tukey test using SPSS v15.0 statistical analysis software. RESULTS: Tukey test revealed similar (not statistically different) mean mesial crestal bone loss between the two groups after 6 months (0.47 ± 0.08 mm vs. 0.36 ± 0.13 mm, p = 0.576) and after 12 months (1.56 ± 0.25 mm vs. 1.50 ± 0.22 mm, p = 0.891). The mean distal bone loss resulting between the two groups was not statistically different at 6 months (0.44 ± 0.08 mm vs. 0.35 ± 0.12 mm, p = 0.687) and at 12 months (1.57 ± 0.23 mm vs. 1.61 ± 0.22 mm, p = 0.947). CONCLUSIONS: The results of this clinical randomized control trial indicated that in controlled type 2 diabetic patients, levels of crestal bone loss around dental implants placed following conventional full thickness flap surgery was comparable to crestal bone loss around dental implants placed with the flapless surgical technique. More clinical studies are required regarding controlled type 2 diabetics with larger sample sizes, for long time periods to obtain more predictable results.

Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters around Crestally and Subcrestally Placed Dental Implants: 5-Year Retrospective Results.

PURPOSE: To compare changes in clinical (bleeding on probing [BOP] and probing pocket depth [PPD]), radiographic (crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1ß] and matrix metalloproteinase-9 [MMP-9]) parameters around crestally and subcrestally placed dental implants 5 years after implant placement. MATERIALS AND METHODS: Fifty-two patients were divided into 2 groups: group 1 (n = 27): patients with single implants placed approximately 2 mm below the alveolar crest; group 2 (n = 25): patients with single implants placed at bone level. In both groups, peri-implant BOP, PPD, and CBL were measured, and levels of IL-1ß and MMP-9 were determined in duplicates using enzyme-linked immunosorbent assay. Full-mouth debridement was performed biannually in both groups. Statistical analysis was performed using the Mann-Whitney U test (significance set at p < 0.05). RESULTS: All measurements in groups 1 and 2 were performed 5.3 ± 0.2 and 5.2 ± 0.1 years after implant placement, respectively. The mean CBL was 1.2 ± 0.2 mm and 1.4 ± 0.2 mm in groups 1 and 2, respectively. There was no significant difference in mean BOP, PPD, CBL and in levels of IL-1ß, and MMP-9 among implants in both groups. CONCLUSION: Clinical, radiographic, and immunologic inflammatory parameters are comparable around crestally and subcrestally placed single dental implants up to 5 years after placement. The depth of implant placement appears to have no effect on clinical status and performance of single dental implants.

Comparison of clinical and radiographic parameters around short (6 to 8 mm in length) and long (11 mm in length) dental implants placed in patients with and without type 2 diabetes mellitus: 3-year follow-up results.

OBJECTIVE: To compare the clinical and radiographic parameters around short (6 to 8 mm in length) and long (11 mm in length) dental implants placed in patients with and without type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: Forty-five male patients with T2DM (Group-1) and 42 male non-diabetic controls (Group-2) who had undergone implant therapy in the posterior mandible were included. Depending upon the length of the implant, patients were divided into two subgroups: (a) patients with short implants (6-8 mm long) and (b) patients with long implants (11 mm long). Peri-implant plaque index (PI), bleeding on probing (BOP), probing depth (PD) and crestal bone loss (CBL) were measured at 18 and 36 months of follow-up in both groups. Hemoglobin A1c (HbA1c) levels were measured at baseline and after 18 and 36 months of follow-up in both groups. P-values less than 0.05 were considered statistically significant. RESULTS: The mean age of patients in groups 1 and 2 was 42.5 and 40.6 years, respectively. The mean HbA1c levels at baseline among patients in groups 1 and 2 were 7.7% and 4.5%, respectively. At 18 and 36 months of follow-up, the mean HbA1c levels among patients in groups 1 and 2 were 6.6% and 4.5% and 6.5% and 4.4%, respectively. The mean duration of T2DM among patients that received short and long implants was 4.3 years and 4.1 years, respectively. There was no significant difference in PI, BOP, PD and CBL around implants placed in both groups at 18 and 36 months of follow-up. Success rate of short and long dental implants was 100% in both groups. CONCLUSION: Short implants can demonstrate clinical and radiographic stability in a manner similar to conventional long implants in patients with and without T2DM. The role of oral hygiene and glycemic maintenance in this scenario cannot be disregarded.

Short implants placed with or without grafting into atrophic sinuses: the 5-year results of a prospective randomized controlled study.

OBJECTIVES: Over 5 years, (i) to evaluate the clinical efficiency of 8-mm implants placed with osteotome sinus floor elevation (OSFE) in extremely atrophic maxillae and (ii) to compare bone levels around implants placed with and without grafting. MATERIAL AND METHODS: TE® SLActive® implants (Institut Straumann AG, Basel, Switzerland) were placed in sites with a residual bone height (RBH) of ≤4 mm. Before surgery, sinuses were randomized to receive anorganic bovine bone (control) or no graft (test). After 10 weeks of healing, implants were functionally loaded with single crowns. Bone levels were measured from standardized peri-apical radiographs. RESULTS: Thirty-seven (17 test, 20 control) implants were placed in 12 patients (RBH: 2.4 ± 0.9 mm). Two early and one late failures occurred. The success rate was 91.9% (94.1% test, 90.0% control). All implants gained endo-sinus bone (3.8 ± 1.0 mm test, 4.8 ± 1.2 mm control; P = 0.004). Mean crestal bone loss (CBL) was 0.6 ± 1.1 mm, without a significant difference between the groups (P = 0.527). Mean bone gain and CBL did not change significantly between 1 and 5 years (P = 0.249 and P = 0.293, respectively). CONCLUSIONS: Atrophic posterior maxillae can be predictably rehabilitated using OSFE with a simultaneous implant placement. The new bone formed around implants after 1 year was stable after 5 years, irrespective of the presence or the absence of graft. Grafting was unnecessary to achieve an average bone augmentation of 3.8 mm, but more bone was gained with grafting.

Comparison of clinical and radiographic status around immediately loaded versus conventional loaded implants placed in patients with type 2 diabetes: 12- and 24-month follow-up results.

There are no studies that have compared the clinical and radiographic status around immediately loaded (IL) and conventional loaded (CL) implants placed in patients with type 2 diabetes mellitus (T2DM). The aim was to compare the clinical and radiographic status around IL and CL implants placed in T2DM patients. One hundred and eight diabetic patients [55 with IL implants (Group 1) and 53 with CL implants (Group 2)] were included in this cross-sectional study. All implants were placed in healed sites in the maxillary and mandibular premolar and molar regions and supported single restorations. All patients underwent full mouth mechanical debridement biannually. Haemoglobin A1c (HbA1c) levels, clinical [bleeding on probing (BOP) and probing depth (PD) ≥ 4 mm] and radiographic [crestal bone loss (CBL)] peri-implant parameters were measured for both groups at 12- and 24-month follow-up. Group comparisons were performed using the Mann-Whitney U-test (P < 0·05). The mean age and duration of T2DM in groups 1 and 2 were 50·6 ± 2·2 and 51·8 ± 1·7 years, and 9·2 ± 2·4 and 8·5 ± 0·4 years, respectively. At 12- and 24-month follow-up, the mean HbA1c levels in groups 1 and 2 were 5·4% (4·8-5·5%) and 5·1% (4·7-5·4%) and 5·1% (4·7-5·2%) and 4·9% (4·5-5·2%), respectively. At 12- and 24-month follow-up, there was no statistically significant difference in peri-implant BOP, PD and CBL in both groups. It was concluded that clinical and radiographic status is comparable around IL and CL implants placed in patients with T2DM. The contribution of careful case selection, oral hygiene maintenance and glycaemic control is emphasised.