Clinical evaluation of the fit of lithium disilicate crowns fabricated with three different CAD-CAM systems.

STATEMENT OF PROBLEM: The fit and performance of prostheses fabricated using various computer-aided design and computer-aided manufacturing (CAD-CAM) systems have been evaluated. However, most studies were conducted in vitro, and relatively few have addressed gingival parameters and prosthesis fit under clinical conditions. PURPOSE: This clinical study aimed to compare the fit of lithium disilicate crowns produced using 3 CAD-CAM systems and evaluate clinical results up to 6 months after delivery. MATERIAL AND METHODS: Forty participants requiring a single crown were recruited. Three monolithic lithium disilicate crowns were fabricated per participant by using 3 different CAD-CAM systems (intraoral scanners, CAD software, and milling machines): CEREC group (CEREC Bluecam, CEREC AC, CEREC MC); EZIS group (EZIS PO, EZIS VR, EZIS HM); and TRIOS group (TRIOS 3, EXO-CAD, ARUM-4X). The fit of the prostheses was assessed via a silicone replica technique, and the most acceptable crown was delivered; 12 were selected from the CEREC group, 16 from the EZIS group, and 12 from the TRIOS group. Follow-up clinical examinations were performed at 1, 3, and 6 months after delivery. The Kruskal-Wallis test with the post hoc Mann-Whitney U test was conducted to analyze significant differences in crown fit and periodontal conditions among the groups (α=.05). RESULTS: The marginal gap of the CEREC group was significantly higher than that of the EZIS group, and the occlusal gap of the EZIS group was significantly lower than those of the CEREC and TRIOS groups (P<.05). Probing depth, bleeding index, and plaque index showed no intergroup differences at 6 months (P>.05). CONCLUSIONS: The lithium disilicate crowns of all groups showed clinically acceptable fit. No significant differences were found among the groups in terms of periodontal conditions after 6 months.

Comparison of the Microtensile Bond Strength of a Polyetherketoneketone (PEKK) Tooth Post Cemented with Various Surface Treatments and Various Resin Cements.

The aim of this in-vitro research was to evaluate the microtensile bond strength in the newly introduced PEKK tooth post with various surface treatments and resin cements. A fiberglass tooth post was included in order to compare it with PEKK as a possible post material. The microtensile bond strengths of the fiberglass post (FRC Postec Plus) and the PEKK post (Pekkton®) were tested using three kinds of self-adhesive resin cements (G-CEM LinkAce, Multilink Speed, and RelyX U200) and one self-etching resin cement (PANAVIA F2.0). The surface treatments of the fiberglass posts were processed according to the manufacturer's recommendations (F1, application of 37% phosphoric acid etching gel and silanization). For the PEKK post groups, various surface treatments were performed like no surface treatment (P1), sandblasting (P2), silica-coating and silanization (P3), and sandblasting with a composite primer (P4). In the surface treatment, PEKK posts with silica coating and silane treatment (P3) showed a significantly higher microtensile bond strength (mean MPa: 18.09, p < 0.05). The highest microtensile bond strength was shown when the PEKK posts were treated with a silica coating and silane treatment and cemented with RelyX U200 (mean MPa: 22.22). The PEKK posts with surface treatments of silica-coating and silanization or sandblasting displayed superior microtensile bond strengths (mean MPa: 18.09 and 16.25, respectively) compared to the conventional fiberglass posts (mean MPa: 14.93, p < 0.05).

Accuracy of several implant bite registration techniques: an in-vitro pilot study.

PURPOSE: This study evaluated the accuracies of different bite registration techniques for implant-fixed prostheses using three dimensional file analysis. MATERIALS AND METHODS: Implant fixtures were placed on the mandibular right second premolar, and the first and second molar in a polyurethane model. Aluwax (A), Pattern Resin (P), and Blu-Mousse (B) were used as the bite registration materials on the healing abutments (H) or temporary abutments (T). The groups were classified into HA, HP, HB, TA, TP, and TB according to each combination. The group using the bite impression coping was the BC group; impression taking and bite registration were performed simultaneously. After impression and bite taking, the scan bodies were connected to the lab analogs of the casts. These casts were scanned using a model scanner. The distances between two reference points in three-dimensional files were measured in each group. One-way ANOVA and Duncan's test were used at the 5% significance level. RESULTS: The smallest distance discrepancy was observed in the TB group using the temporary abutments. The Blu-Mousse and HP groups showed the largest distance discrepancy. The TB and BC groups showed a lower distance discrepancy than the HP group (P=.001), and there was no significant difference between the groups using the temporary abutments and healing abutments (P>.05). CONCLUSION: Although this study has limitations as an in-vitro investigation, the groups using the temporary abutments to hold the Blu-Mousse record and bite impression coping showed greater accuracy than the group using the healing abutments to hold the pattern resin record.

The Mechanical Properties and Biometrical Effect of 3D Preformed Titanium Membrane for Guided Bone Regeneration on Alveolar Bone Defect.

The purpose of this study is to evaluate the effect of three-dimensional preformed titanium membrane (3D-PFTM) to enhance mechanical properties and ability of bone regeneration on the peri-implant bone defect. 3D-PFTMs by new mechanically compressive molding technology and manually shaped- (MS-) PFTMs by hand manipulation were applied in artificial peri-implant bone defect model for static compressive load test and cyclic fatigue load test. In 12 implants installed in the mandibular of three beagle dogs, six 3D-PFTMs, and six collagen membranes (CM) randomly were applied to 2.5 mm peri-implant buccal bone defect with particulate bone graft materials for guided bone regeneration (GBR). The 3D-PFTM group showed about 7.4 times higher mechanical stiffness and 5 times higher fatigue resistance than the MS-PFTM group. The levels of the new bone area (NBA, %), the bone-to-implant contact (BIC, %), distance from the new bone to the old bone (NB-OB, %), and distance from the osseointegration to the old bone (OI-OB, %) were significantly higher in the 3D-PFTM group than the CM group (p < .001). It was verified that the 3D-PFTM increased mechanical properties which were effective in supporting the space maintenance ability and stabilizing the particulate bone grafts, which led to highly efficient bone regeneration.

The Effect of Thickness of Resorbable Bacterial Cellulose Membrane on Guided Bone Regeneration.

This study introduces the effect of the thickness of a bacterial cellulose membrane by comparing the bone regeneration effect on rat skulls when using a collagen membrane and different thicknesses of resorbable bacterial cellulose membranes for guided bone regeneration. Barrier membranes of 0.10 mm, 0.15 mm, and 0.20 mm in thickness were made using bacterial cellulose produced as microbial fermentation metabolites. Mechanical strength was investigated, and new bone formation was evaluated through animal experimental studies. Experimental animals were sacrificed after having 2 weeks and 8 weeks of recovery, and specimens were processed for histologic and histomorphometric analyses measuring the area of bone regeneration (%) using an image analysis program. In 2 weeks, bone-like materials and fibrous connective tissues were observed in histologic analysis. In 8 weeks, all experimental groups showed the arrangement of osteoblasts surrounding the supporting body on the margin and center of the bone defect region. However, the amount of new bone formation was significantly higher (p < 0.05) in bacterial cellulose membrane with 0.10 mm in thickness compared to the other experimental groups. Within the limitations of this study, a bacterial cellulose membrane with 0.10 mm thickness induced the most effective bone regeneration.

The Effect of Reduced Graphene Oxide-Coated Biphasic Calcium Phosphate Bone Graft Material on Osteogenesis.

This study was conducted to evaluate the effect of biphasic calcium phosphate (BCP) coated with reduced graphene oxide (rGO) as bone graft materials on bone regeneration. The rGO-coated BCP bone graft material was fabricatied by mixing rGO and BCP at various concentrations. The surface charge of rGO-coated BCP was measured to be -14.43 mV, which formed a static electrostatic interaction. Cell viabilities were significantly diminished at higher concentrations of ≥100 µg/mL. The calvarial defects of 48 rats were implanted rGO-coated BCPs at a weight ratio of 2:1000 (rGO2), 4:1000 (rGO4), and 10:1000 (rGO10), repectively. BCP was used as a control group. The micro-CT and histological analysis were performed to evaluate new bone formation at 2 and 8 weeks after surgery. The results showed that the new bone volume (mm³) was significantly higher in the experimental groups than in the control group. Histological analysis showed that new bone areas (%) were significantly higher in the rGO2 and rGO10 than in the control, and significantly higher in rGO4 than in the rGO2 and rGO10. Conclusively, the rGO-coated BCP was found to be effective on osteogenesis and the concentration of the composite was an important factor.

A Clinical Retrospective Study of Distal Extension Removable Partial Denture with Implant Surveyed Bridge or Stud Type Attachment.

This study was performed to make comparative analysis of the clinical findings between the two different types of the implant-assisted removable partial dentures: removable partial dentures using implant surveyed bridge as an abutment (ISBRPD) and overdenture type of removable partial denture using implant attachment (IARPD). Implant cumulative survival rate, marginal bone resorption, probing depth, peri-implant inflammation, bleeding, plaque, calculus, and complications were evaluated on 24 patients who were treated with implants in conjunction with removable partial denture and have used them for at least 1 year (ISCRPD: n = 12; IARPD: n = 12). There was no failed implant and all implants were functioning without clinical mobility. Marginal bone loss of ISCRPD (1.44 ± 0.57 mm) was significantly lower than that of IARPD (p < 0.05). There was no significant difference in probing depth, peri-implant inflammation, bleeding, and plaque between the two groups (p > 0.05), while the calculus was significantly more observed in ISCRPD group than in IARPD group (p < 0.05). The retention loss of IARPD was the most common complication. Within the limits of the present study, it was found that well-planned ISBRPD was clinically appropriate. Longitudinal and systematic clinical studies are necessary to confirm these results.

Comparison of the fit of cast gold crowns fabricated from the digital and the conventional impression techniques.

PURPOSE: The purpose of this study was to compare the fit of cast gold crowns fabricated from the conventional and the digital impression technique. MATERIALS AND METHODS: Artificial tooth in a master model and abutment teeth in ten patients were restored with cast gold crowns fabricated from the digital and the conventional impression technique. The forty silicone replicas were cut in three sections; each section was evaluated in nine points. The measurement was carried out by using a measuring microscope and I-Soultion. Data from the silicone replica were analyzed and all tests were performed with α-level of 0.05. RESULTS: 1. The average gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. 2. In marginal and internal axial gap of cast gold crowns, no statistical differences were found between the two impression techniques. 3. The internal occlusal gaps of cast gold crowns fabricated from the digital impression technique were larger than those of the conventional impression technique significantly. CONCLUSION: Both prostheses presented clinically acceptable results with comparing the fit. The prostheses fabricated from the digital impression technique showed more gaps, in respect of occlusal surface.

Clinical evaluation of mandibular implant overdentures via Locator implant attachment and Locator bar attachment.

PURPOSE: The aim of this study was to evaluate the clinical findings and patient satisfaction on implant overdenture designed with Locator implant attachment or Locator bar attachment in mandibular edentulous patients. MATERIALS AND METHODS: Implant survival rate, marginal bone loss, probing depth, peri-implant inflammation, bleeding, plaque, calculus, complications, and satisfaction were evaluated on sixteen patients who were treated with mandibular overdenture and have used it for at least 1 year (Locator implant attachment: n=8, Locator bar attachment: n=8). RESULTS: Marginal bone loss, probing depth, plaque index of the Locator bar attachment group were significantly lower than the Locator implant attachment group (P<.05). There was no significant difference on bleeding, peri-implant inflammation, and patient satisfaction between the two denture types (P>.05). The replacement of the attachment components was the most common complication in both groups. Although there was no correlation between marginal bone loss and plaque index, a significant correlation was found between marginal bone loss and probing depth. CONCLUSION: The Locator bar attachment group indicates lesser marginal bone loss and need for maintenance, as compared with the Locator implant attachment group. This may be due to the splinting effect among implants rather than the types of Locator attachment.

Comparison of changes in retentive force of three stud attachments for implant overdentures.

PURPOSE: The aim of this study was to compare the changes in retentive force of stud attachments for implant overdentures by in vitro 2-year-wear simulation. MATERIALS AND METHODS: Three commercially available attachment systems were investigated: Kerator blue, O-ring red, and EZ lock. Two implant fixtures were embedded in parallel in each custom base mounting. Five pairs of each attachment system were tested. A universal testing machine was used to measure the retentive force during 2500 insertion and removal cycles. Surface changes on the components were evaluated by scanning electron microscopy (SEM). A Kruskal-Wallis test, followed by Pairwise comparison, was used to compare the retentive force between the groups, and to determine groups that were significantly different (α<.05). RESULTS: A comparison of the initial retentive force revealed the highest value for Kerator, followed by the O-ring and EZ lock attachments. However, no significant difference was detected between Kerator and O-ring (P>.05). After 2500 insertion and removal cycles, the highest retention loss was recorded for O-ring, and no significant difference between Kerator and EZ lock (P>.05). Also, Kerator showed the highest retentive force, followed by EZ lock and O-ring, after 2500 cycles (P<.05). Based on SEM analysis, the polymeric components in O-ring and Kerator were observed to exhibit surface wear and deformation. CONCLUSION: After 2500 insertion and removal cycles, all attachments exhibited significant loss in retention. Mechanism of retention loss can only be partially explained by surface changes.

Enhancement of the killing effect of low-temperature plasma on Streptococcus mutans by combined treatment with gold nanoparticles.

BACKGROUND: Recently, non-thermal atmospheric pressure plasma sources have been used for biomedical applications such as sterilization, cancer treatment, blood coagulation, and wound healing. Gold nanoparticles (gNPs) have unique optical properties and are useful for biomedical applications. Although low-temperature plasma has been shown to be effective in killing oral bacteria on agar plates, its bactericidal effect is negligible on the tooth surface. Therefore, we used 30-nm gNPs to enhance the killing effect of low-temperature plasma on human teeth. RESULTS: We tested the sterilizing effect of low-temperature plasma on Streptococcus mutans (S. mutans) strains. The survival rate was assessed by bacterial viability stains and colony-forming unit counts. Low-temperature plasma treatment alone was effective in killing S. mutans on slide glasses, as shown by the 5-log decrease in viability. However, plasma treatment of bacteria spotted onto tooth surface exhibited a 3-log reduction in viability. After gNPs were added to S. mutans, plasma treatment caused a 5-log reduction in viability, while gNPs alone did not show any bactericidal effect. The morphological changes in S. mutans caused by plasma treatment were examined by transmission electron microscopy, which showed that plasma treatment only perforated the cell walls, while the combination treatment with plasma and gold nanoparticles caused significant cell rupture, causing loss of intracellular components from many cells. CONCLUSIONS: This study demonstrates that low-temperature plasma treatment is effective in killing S. mutans and that its killing effect is further enhanced when used in combination with gNPs.

Influence of the implant-abutment connection design and diameter on the screw joint stability.

PURPOSE: This study was conducted to evaluate the influence of the implant-abutment connection design and diameter on the screw joint stability. MATERIALS AND METHODS: Regular and wide-diameter implant systems with three different joint connection designs: an external butt joint, a one-stage internal cone, and a two-stage internal cone were divided into seven groups (n=5, in each group). The initial removal torque values of the abutment screw were measured with a digital torque gauge. The postload removal torque values were measured after 100,000 cycles of a 150 N and a 10 Hz cyclic load had been applied. Subsequently, the rates of the initial and postload removal torque losses were calculated to evaluate the effect of the joint connection design and diameter on the screw joint stability. Each group was compared using Kruskal-Wallis test and Mann-Whitney U test as post-hoc test (α=0.05). RESULTS: THE POSTLOAD REMOVAL TORQUE VALUE WAS HIGH IN THE FOLLOWING ORDER WITH REGARD TO MAGNITUDE: two-stage internal cone, one-stage internal cone, and external butt joint systems. In the regular-diameter group, the external butt joint and one-stage internal cone systems showed lower postload removal torque loss rates than the two-stage internal cone system. In the wide-diameter group, the external butt joint system showed a lower loss rate than the one-stage internal cone and two-stage internal cone systems. In the two-stage internal cone system, the wide-diameter group showed a significantly lower loss rate than the regular-diameter group (P<.05). CONCLUSION: The results of this study showed that the external butt joint was more advantageous than the internal cone in terms of the postload removal torque loss. For the difference in the implant diameter, a wide diameter was more advantageous in terms of the torque loss rate.

Comparison of the accuracy of digitally fabricated polyurethane model and conventional gypsum model.

PURPOSE: The accuracy of a gypsum model (GM), which was taken using a conventional silicone impression technique, was compared with that of a polyurethane model (PM), which was taken using an iTero™ digital impression system. MATERIALS AND METHODS: The maxillary first molar artificial tooth was selected as the reference tooth. The GMs were fabricated through a silicone impression of a reference tooth, and PMs were fabricated by a digital impression (n=9, in each group). The reference tooth and experimental models were scanned using a 3 shape convince™ scan system. Each GM and PM image was superimposed on the registered reference model (RM) and 2D images were obtained. The discrepancies of the points registered on the superimposed images were measured and defined as GM-RM group and PM-RM group. Statistical analysis was performed using a Student's T-test (α=0.05). RESULTS: A comparison of the absolute value of the discrepancy revealed a significant difference between the two groups only at the occlusal surface. The GM group showed a smaller mean discrepancy than the PM group. Significant differences in the GM-RM group and PM-RM group were observed in the margins (point a and f), mesial mid-axial wall (point b) and occlusal surfaces (point c and d). CONCLUSION: Under the conditions examined, the digitally fabricated polyurethane model showed a tendency for a reduced size in the margin than the reference tooth. The conventional gypsum model showed a smaller discrepancy on the occlusal surface than the polyurethane model.

High-efficiency tooth bleaching using non-thermal atmospheric pressure plasma with low concentration of hydrogen peroxide.

UNLABELLED: Light-activated tooth bleaching with a high hydrogen peroxide (HP; H2O2) concentration has risks and the actual role of the light source is doubtful. The use of conventional light might result in an increase in the temperature and cause thermal damage to the health of the tooth tissue. OBJECTIVE: This study investigated the efficacy of tooth bleaching using non-thermal atmospheric pressure plasma (NAPP) with 15% carbamide peroxide (CP; CH6N2O3) including 5.4% HP, as compared with conventional light sources. MATERIAL AND METHODS: Forty human teeth were randomly divided into four groups: Group I (CP+NAPP), Group II (CP+plasma arc lamp; PAC), Group III (CP+diode laser), and Group IV (CP alone). Color changes (∆E) of the tooth and tooth surface temperatures were measured. Data were evaluated by one-way analysis of variance (ANOVA) and post-hoc Tukey's tests. RESULTS: Group I showed the highest bleaching efficacy, with a ∆E value of 1.92-, 2.61 and 2.97-fold greater than those of Groups II, III and IV, respectively (P<0.05). The tooth surface temperature was maintained around 37°C in Group I, but it reached 43°C in Groups II and III. CONCLUSIONS: The NAPP has a greater capability for effective tooth bleaching than conventional light sources with a low concentration of HP without causing thermal damage. Tooth bleaching using NAPP can become a major technique for in-office bleaching in the near future.

Physical stability of arginine-glycine-aspartic acid peptide coated on anodized implants after installation.

PURPOSE: The aim of this study was to evaluate the stability of arginine-glycine-aspartic acid (RGD) peptide coatings on implants by measuring the amount of peptide remaining after installation. MATERIALS AND METHODS: Fluorescent isothiocyanate (FITC)-fixed RGD peptide was coated onto anodized titanium implants (width 4 mm, length 10 mm) using a physical adsorption method (P) or a chemical grafting method (C). Solid Rigid Polyurethane Foam (SRPF) was classified as either hard bone (H) or soft bone (S) according to its density. Two pieces of artificial bone were fixed in a customized jig, and coated implants were installed at the center of the boundary between two pieces of artificial bone. The test groups were classified as: P-H, P-S, C-H, or C-S. After each installation, implants were removed from the SRPF, and the residual amounts and rates of RGD peptide in implants were measured by fluorescence spectrometry. The Kruskal-Wallis test was used for the statistical analysis (α=0.05). RESULTS: Peptide-coating was identified by fluorescence microscopy and XPS. Total coating amount was higher for physical adsorption than chemical grafting. The residual rate of peptide was significantly larger in the P-S group than in the other three groups (P<.05). CONCLUSION: The result of this study suggests that coating doses depend on coating method. Residual amounts of RGD peptide were greater for the physical adsorption method than the chemical grafting method.

High-efficiency tooth bleaching using non-thermal atmospheric pressure plasma with low concentration of hydrogen peroxide

Light-activated tooth bleaching with a high hydrogen peroxide (HP; H2O2) concentration has risks and the actual role of the light source is doubtful. The use of conventional light might result in an increase in the temperature and cause thermal damage to the health of the tooth tissue. Objective This study investigated the efficacy of tooth bleaching using non-thermal atmospheric pressure plasma (NAPP) with 15% carbamide peroxide (CP; CH6N2O3) including 5.4% HP, as compared with conventional light sources. Material and Methods Forty human teeth were randomly divided into four groups: Group I (CP+NAPP), Group II (CP+plasma arc lamp; PAC), Group III (CP+diode laser), and Group IV (CP alone). Color changes (∆E) of the tooth and tooth surface temperatures were measured. Data were evaluated by one-way analysis of variance (ANOVA) and post-hoc Tukey's tests. Results Group I showed the highest bleaching efficacy, with a ∆E value of 1.92-, 2.61 and 2.97-fold greater than those of Groups II, III and IV, respectively (P<0.05). The tooth surface temperature was maintained around 37°C in Group I, but it reached 43°C in Groups II and III. Conclusions The NAPP has a greater capability for effective tooth bleaching than conventional light sources with a low concentration of HP without causing thermal damage. Tooth bleaching using NAPP can become a major technique for in-office bleaching in the near future. .

Sterilization effect of atmospheric pressure non-thermal air plasma on dental instruments.

PURPOSE: Autoclaves and UV sterilizers have been commonly used to prevent cross-infections between dental patients and dental instruments or materials contaminated by saliva and blood. To develop a dental sterilizer which can sterilize most materials, such as metals, rubbers, and plastics, the sterilization effect of an atmospheric pressure non-thermal air plasma device was evaluated. MATERIALS AND METHODS: After inoculating E. coli and B. subtilis the diamond burs and polyvinyl siloxane materials were sterilized by exposing them to the plasma for different lengths of time (30, 60, 90, 120, 180 and, 240 seconds). The diamond burs and polyvinyl siloxane materials were immersed in PBS solutions, cultured on agar plates and quantified by counting the colony forming units. The data were analyzed using one-way ANOVA and significance was assessed by the LSD post hoc test (α=0.05). RESULTS: The device was effective in killing E. coli contained in the plasma device compared with the UV sterilizer. The atmospheric pressure non-thermal air plasma device contributed greatly to the sterilization of diamond burs and polyvinyl siloxane materials inoculated with E. coli and B. subtilis. Diamond burs and polyvinyl siloxane materials inoculated with E. coli was effective after 60 and 90 seconds. The diamond burs and polyvinyl siloxane materials inoculated with B. subtilis was effective after 120 and 180 seconds. CONCLUSION: The atmospheric pressure non-thermal air plasma device was effective in killing both E. coli and B. subtilis, and was more effective in killing E. coli than the UV sterilizer.

Fabrication of blended polycaprolactone/poly(lactic-co-glycolic acid)/ß-tricalcium phosphate thin membrane using solid freeform fabrication technology for guided bone regeneration.

This study developed a bioabsorbable-guided bone regeneration membrane made of blended polycaprolactone (PCL), poly(lactic-co-glycolic acid) (PLGA), and beta-tricalcium phosphate (ß-TCP) using solid freeform fabrication (SFF) technology. The chemical and physical properties of the membrane were evaluated using field emission scanning electron microscopy, energy dispersive spectroscopy, and a tensile test. In vitro cell activity assays revealed that the adhesion, proliferation, and osteogenic differentiation of seeded adipose-derived stem cells (ADSCs) were significantly promoted by the PCL/PLGA/ß-TCP membranes compared with PCL/PLGA membranes. When the PCL/PLGA and PCL/PLGA/ß-TCP membranes were implanted on rabbit calvaria bone defects without ADSCs, microcomputed tomography and histological analyses confirmed that the SFF-based PCL/PLGA/ß-TCP membranes greatly increased bone formation without the need for bone substitute materials. Moreover, tight integration, which helps to prevent exposure of the membrane, between both membranes and the soft tissues was clearly observed histologically. The SFF-based PCL/PLGA and PCL/PLGA/ß-TCP membranes retained their mechanical stability for up to 8 weeks without significant collapse. Furthermore, PCL/PLGA/ß-TCP underwent adequate degradation without a significant immune response at 8 weeks.

Effect of the use of a ready-made plastic stent on the peri-implant soft tissue.

OBJECTIVE: This study compared the effect of the use of a ready-made plastic stent on the width of peri-implant keratinized mucosa with that of conventional methods and examined the effects of a plastic stent on peri-implant soft tissue. MATERIALS AND METHODS: Five young-adult beagle dogs were used. Forty titanium implants were placed in the mandibular alveolar ridge. Stage 2 surgery was performed 8 weeks after implant installation. Each dog received a full-thickness, apically positioned flap (fAPF) with a lingual crestal incision using a suture material in the control group (n = 20) and a ready-made plastic stent in the test group (n = 20). The keratinized mucosa width after stage 2 surgery was measured in each group. The pocket depth, length of connective-tissue contact and biological width were measured in the tissue samples. A student's t-test was used to test the differences between the groups (95% confidence level). RESULTS: The width of the keratinized mucosa was significantly higher and the distance from the top of the implant platform to the mucogingival junction was significantly longer in the test group than the control group. Histometric observations revealed the pocket depth and biological width to be significantly lower in the test group than the control group. CONCLUSION: The use of a fAPF with a lingual crestal incision using a ready-made plastic stent can effectively preserve or enhance the width of the keratinized mucosa and might restore a more optimal biological environment at the early soft-tissue healing stage.