Inter-implant Papilla Changes Following Anterior Immediate Tooth Replacement with Socket Shields: A 1- to 10-Year Retrospective Study.

This retrospective study investigates the efficacy of the socket shield (SS) in preserving inter-implant papilla and bone in anterior adjacent implant sites. Clinical and radiographic records of 23 patients were evaluated. A total of 31 implants were placed immediately into extraction sockets with SS, resulting in 26 inter-implant sites, and 7 implants were placed without SS. After a mean follow-up of 41.5 months (range: 12 to 124 months), 30/31 (96.8%) implants with SS and 7/7 (100%) implants without SS were clinically successful. The mean changes in inter-implant papilla and bone heights were -0.40 mm and -0.46 mm, respectively. The effects of implant placement timing and the socket shield number, shape, and crestal level on inter-implant tissue height changes were found to be insignificant (P > .05). Supracrestal shield level (31.6% vs 16.6% in equicrestal), U-shape shield (41.2% vs 7.1% in C-shape), and shield-to-implant contact (40.0% vs 12.5% in no contact) were associated with increased occurrence of exposures. The application of SS in adjacent anterior implant situations is a viable treatment option for maintaining inter-implant papilla.

Facial Gingival Changes With and Without Socket Gap Grafting Following Single Maxillary Anterior Immediate Tooth Replacement: One-Year Results.

This 1-year prospective study evaluated horizontal and vertical facial gingival tissue changes after immediate implant placement and provisionalization (IIPP) with and without bone graft in the implant-socket gap (ISG). During IIPP, 10 patients received bone graft material in the ISG (G group), while the other 10 patients did not (NG group). The implants were evaluated for implant stability quotient (ISQ), modified plaque index (mPI), modified bleeding index (mBI), marginal bone level (MBL), facial gingival level (FGL), and facial gingival profile (FGP) changes. The mean ISQ value at 9-month follow-up was statistically significantly greater than on the day of implant surgery (P < .05). The mPI and mBI scores demonstrated that patients were able to maintain a good level of hygiene. There were no statistically significant differences in the mean MBL changes between the G and NG groups (P > .05). There were statistically significant differences in FGL changes between the G (-0.77 mm) and NG (-1.35 mm) groups (P = .035). There were no statistically significant differences in FGP changes between the G and NG groups (P > .05). However, statistically significant differences were noted in FGP change between the 3-12 and 0-12 month intervals in both groups (P < .05). Within the limitations of this study, although no significant differences were noted in FGP changes between groups, G group experienced significantly less FGL changes than NG group. Bone graft material placement into ISG seems to be advantageous for tissue preservation during IIPP. However, future long-term studies, with larger sample size, are needed to validate the efficacy of such procedure.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study.

PURPOSE: This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials. MATERIAL AND METHODS: Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05. RESULTS: A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction. CONCLUSION: Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

Histomorphometric Analysis of Maxillary Sinus Grafts: A Pilot Study.

PURPOSE: This pilot study evaluated and compared the degree of new bone formation following maxillary sinus graft (MSG) using three different bone graft materials. MATERIAL AND METHODS: Patients with an edentulous posterior maxilla (unilateral or bilateral) were included in this study and underwent a two-stage procedure. Each sinus was randomly assigned one of the three graft materials: anorganic bovine bone mineral (ABBM), anorganic equine bone mineral (AEBM), or mineralized cancellous bone allograft (MCBA). Bone core samples were obtained from the lateral wall of the grafted sites at least 8 months after MSG. Bone quality was evaluated during bone core retrieval. The samples were histomorphometrically analyzed using Kruskal-Wallis and Dunn-Bonferroni tests at the significance level of α = .05. RESULTS: A total of 28 sinuses (14 unilateral and 7 bilateral) from 21 subjects, with a mean age of 61.5 (range, 33-75) years, were included in the study. Twenty-eight bone cores (ABBM [n = 9], AEBM [n = 9], and MCBA [n = 10]) were obtained at a mean healing time of 9.1 (range, 8-12) months. Six maxillary sinus membrane perforations (≤ 5 mm) were noted and repaired during surgery (21.4%). Histomorphometric analysis of the harvested bone cores revealed statistically significant differences in the percentage of vital bone (VB%), residual bone materials (RBM%), and connective tissue/marrow (CT%) among the different graft materials (Kruskal-Wallis; P < .05). The VB% in the MCBA group (32.0% ± 12.4%) was significantly greater than those in the ABBM (10.9% ± 8.9%) and AEBM (9.1% ± 5.9%) groups (P < .05). The RBM% in the MCBA group (5.5% ± 5.7%) was, however, significantly less than those in the ABBM (34.3% ± 12.1%) and AEBM (38.9% ± 5.3%) groups (P < .05). There were no significant differences in VB% and RBM% between ABBM and AEBM (P = 1.0). Newly formed bone and residual graft materials were integrated into the surrounding tissue with no sign of inflammation or foreign-body reaction. CONCLUSION: Within the confines of the study, MCBA has significantly greater new bone formation than ABBM and AEBM. AEBM showed comparable histomorphometric results in all parameters (VB%, RBM%, CT%) to ABBM.

Adhesive residue on the CAD-CAM surgical guide sleeve: A technical report.

Computer-aided design and computer-aided manufacturing (CAD-CAM) surgical guides can be used by the clinician and dental technician to create a definitive cast before surgery, thereby allowing an indirect interim restoration to be fabricated. However, the accurate transfer of the interim restoration from the laboratory to the surgical site requires a precise interface between components. This article reports the prosthetic significance of adhesive residue on the intaglio surface of the CAD-CAM surgical guide sleeve, which can create errors in the implant analog position of the definitive cast. A technique for identifying the presence of residue and its careful removal are also introduced.

Residual root preparation for socket-shield procedures: a facial window approach.

Two common complications that occur following immediate implant placement and provisionalization procedures in the anterior maxilla are changes to the facial periimplant soft tissue levels and the facial contours. To counteract these changes, different techniques and treatments have been recommended. The recently introduced socket-shield technique (SST) appears to be a viable treatment option for stabilizing the facial osseous and gingival architecture; however, preparation of the root fragment can present challenges. This article describes a surgical approach designed to facilitate preparation of the facial root fragment.

Effects of implant morphology on rotational stability during immediate implant placement in the esthetic zone.

PURPOSE: Primary implant stability is critical to achieving implant success, especially in a situation with immediate implant placement and provisionalization (IIPP) when bone quality and quantity are compromised. The purpose of this study was to examine the effects of implant morphology (tapered vs cylindric) and the final drill-implant diameter discrepancy (FD-IDD) of six implant systems on the incidence of rotational instability during IIPP in the esthetic zone. MATERIALS AND METHODS: One hundred seventy-one implants in 112 patients were evaluated. Implants that exhibited inadequate resistance to the torque generated by the surgeon's hand during implant placement were classified as rotationally unstable. RESULTS: The overall incidence of rotational instability for the tapered implants (1.1%) was significantly lower than that exhibited by the cylindric (nontapered) implants (20.5%). Among the cylindric implants, those with < 0.5 mm FD-IDD experienced a significantly higher incidence of rotational instability (36.6%) than groups with ≥ 0.5 mm FD-IDD. The incidence of rotational instability of cylindric implants with ≥ 0.5 mm FD-IDD was significantly greater than that of the tapered implants with a comparable FD-IDD. CONCLUSION: Within the confines of this study, the use of a tapered implant with an FD-IDD of ≥ 0.5 mm minimized the incidence of rotational implant instability for the IIPP procedure.

Marginal bone response of implants with platform switching and non-platform switching abutments in posterior healed sites: a 1-year prospective study.

OBJECTIVES: This 1-year prospective study evaluated the implant success rate and marginal bone response of non-submerged implants with platform and non-platform switching abutments in posterior healed sites. MATERIAL AND METHODS: Nineteen patients (9 male, 10 female) with posterior partially edentulous spaces, between the ages of 23 and 76 (mean = 55.4 years), were included in this study. A total of 30 implants (15 implants restored with platform switching [PS] abutments [control] and 15 implants restored with non-platform switching [NPS] abutments [test]) were assigned between two groups using a randomization procedure. The definitive abutments with conical connections were placed at the time of surgery, and the definitive restorations were placed at 3 months. All patients were evaluated clinically and radiographically using standardized radiographs at time of implant placement (0), 3, 6 and 12 months after implant placement. Data were analyzed using Friedman test with post hoc pairwise comparisons, Mann-Whitney U-test, and Pearson's chi-square test at the significance level of α = 0.05. RESULTS: At 12 months, all 30 implants remained osseointegrated corresponding to a 100% success rate. The overall mean marginal bone level change at 12 months was -0.04 ± 0.08 mm for PS group and -0.19 ± 0.16 mm for NPS group. Statistically significant difference in the marginal bone level change was observed between groups at 0 to 12 months and 3 to 12 months (P < 0.05). CONCLUSIONS: This 1-year randomized control study suggests that when a conical implant-abutment connection is present, similar peri-implant tissue responses can be achieved with platform switching and non-platform switching abutments.

Effects of connective tissue grafting on the facial gingival level following single immediate implant placement and provisionalization in the esthetic zone: a 1-year randomized controlled prospective study.

PURPOSE: This 1-year randomized controlled prospective study evaluated the implant success rate and peri-implant tissue response following single immediate implant placement and provisionalization (IIPP) with and without subepithelial connective tissue graft (SCTG) in the esthetic zone. MATERIALS AND METHODS: Implants were placed either IIPP with SCTG (test group) or IIPP without SCTG (control group). The implants were evaluated both clinically and radiographically before surgery, immediately after implant placement, and 3, 6, and 12 months after implant placement. Data were analyzed using Friedman, Wilcoxon signed-rank, and Mann-Whitney U tests at the significance level of α = .05. RESULTS: Twenty implants (10 test, 10 control) were placed in 20 patients (7 men, 13 women) between the ages of 27 and 87 (mean age, 52.6 years). At 1 year, all implants remained osseointegrated, with overall mean marginal bone changes of -0.01 mm and -0.14 mm for the test and control groups, respectively. Mean facial gingival level change was significantly more pronounced in the control group (-0.70 mm) than in the test group (-0.25 mm). The modified Plaque Index scores showed that patients were able to maintain a good level of hygiene throughout the study. At 1 year, the Papilla Index indicated that more than 50% papilla fill was observed in 75% of the test sites and 80% of the control sites. CONCLUSIONS: Within the limitations of this study, SCTG was shown to be beneficial in maintaining facial gingival level when performed in conjunction with IIPP procedures.

Horizontal and vertical dimensional changes of peri-implant facial bone following immediate placement and provisionalization of maxillary anterior single implants: a 1-year cone beam computed tomography study.

PURPOSE: This cone beam computed tomography study (CBCT) evaluated horizontal and vertical dimensional changes to the facial bone following maxillary anterior single immediate implant placement and provisionalization. MATERIALS AND METHODS: CBCT scans taken immediately after (T1) and 1 year after surgery (T2) were evaluated. The midsagittal cut of each implant was identified, and measurements were made at predetermined levels. Horizontal facial bone thickness (HFBT) was measured at 0, 1, 2, 4, 6, 9, and 12 mm apical to the implant platform. Vertical facial bone level (VFBL) was the perpendicular distance from the implant platform (0) to the most coronal point of the facial bone. Measurements were recorded and changes between T1 and T2 were calculated. The data were analyzed statistically at a significance level of α = 0.05. RESULTS: CBCT scans of 21 patients were analyzed. At T2, the mean HFBT changes ranged from -1.23 to -0.08 mm at the seven different levels evaluated. The mean VFBL change was -0.82 mm. The HFBT changes at the 1- to 9-mm levels were not significantly different from one another, but they were significantly smaller than the change at the 0-mm level and significantly greater than the change at the 12-mm level. Significant positive correlations were observed only between horizontal and vertical changes and between horizontal change and initial VFBL at the implant platform. While the VFBL of eight implants (38%) was apical to the implant platform at T2, none was noted at T1. CONCLUSIONS: Dimensional changes to the peri-implant facial bone following maxillary anterior single immediate implant placement and provisionalization should be expected. The greatest HFBT change was noted at the implant platform level, in part because HFBT change is correlated to the initial VFBL and the change in VFBL at that level.

Immediate loading of maxillary and mandibular implant-supported fixed complete dentures: a 1- to 10-year retrospective study.

This study evaluated the success rates of 50 full-arch maxillary and/or mandibular implant-supported fixed complete dentures. After a mean follow-up time of 42.1 months, 269 implants remained in function, which corresponded to cumulative implant success rates of 85.2% and an absolute success rate of 90.6% (269/297 implants). This study suggested that higher implant failure rates might be associated with a dental history of bruxism (29.3%) vs no history of bruxism (4.6%) and surgeons with limited experience (≤5 years; 12.2%) vs surgeons with experience (2.4%).

Immediate loading of unsplinted implants in the anterior mandible for overdentures: 3-year results.

PURPOSE: This 3-year study evaluated the implant survival rate, peri-implant tissue response, prosthetic maintenance, and prosthetic complications in a series of patients who received two immediately loaded unsplinted threaded implants to retain a mandibular overdenture. MATERIALS AND METHODS: Eight completely edentulous patients were evaluated clinically and radiographically immediately after implant placement, at 3 months, and at 1, 2, and 3 years after implant placement. Data were analyzed using repeated-measures one-way analysis of variance and the Wilcoxon signed rank test at a significance level of α = .05. RESULTS: At 3 years, all implants remained osseointegrated (16/16), with an overall mean marginal bone change of -0.58 ± 0.39 mm and a mean Periotest value of -7.19 ± 0.54. The modified Plaque Index scores showed marked improvement in oral hygiene during the first year, but some relapse was observed thereafter. Prosthetic maintenance and complications included replacement of the attachment inserts, abutment loosening, dislodgement of the attachment housing, overdenture reline, denture tooth fracture, and overdenture base fracture. CONCLUSIONS: This 3-year study suggests that, despite less than ideal oral hygiene and a high incidence of complete/partial fracture of overdentures, favorable implant survival rate and peri-implant tissue responses can be achieved in mandibular overdentures retained with two immediately loaded unsplinted threaded implants.

Classification of sagittal root position in relation to the anterior maxillary osseous housing for immediate implant placement: a cone beam computed tomography study.

PURPOSE: The purpose of this study was to classify the relationship of the sagittal root positions of the maxillary anterior teeth to their respective osseous housings using cone beam computed tomography (CBCT). The frequency of each classification was also reported. MATERIALS AND METHODS: A retrospective review of CBCT images was conducted on 100 patients (40 men, 60 women; mean age, 53.1 years) who fulfilled the inclusion criteria. The CBCT images were evaluated and the relationship of the sagittal root position of the maxillary anterior teeth to its associated osseous housing was recorded as Class I, II, III, or IV. RESULTS: The frequency distribution of sagittal root position of maxillary anterior teeth indicated that, of the 600 samples, 81.1%, 6.5%, 0.7%, and 11.7% were classified as Class I, II, III, and IV, respectively. CONCLUSIONS: An understanding of the clinical relevance of sagittal root position will provide adjunct data for the treatment planning of immediate implant placement and provisionalization in the anterior maxilla. A classification system may lead to improved interdisciplinary communication in treatment planning for implant-based therapy in the anterior maxilla.

Peri-implant tissue response following connective tissue and bone grafting in conjunction with immediate single-tooth replacement in the esthetic zone: a case series.

PURPOSE: This case series evaluated the peri-implant tissue response following extraction and immediate placement and restoration of an implant in conjunction with subepithelial connective tissue grafting (SCTG) and bone grafting in the esthetic zone. Implant success rates and the peri-implant tissue response were also reported. METHODS AND MATERIALS: Ten patients (four men, six women) with a mean age of 48 years (range, 35 to 70) underwent extraction and immediate tooth replacement with SCTG and were evaluated clinically and radiographically presurgically (T0), immediately after immediate tooth replacement and SCTG (T1), and at 3 months (T2), 6 months (T3), and 12 months (T4) after surgery. Data was analyzed using Friedman and Wilcoxon signed-ranks tests at the significance level of a = .05. RESULTS: At 1 year, all implants remained osseointegrated, with an overall mean marginal bone change of +0.10 mm and a mean facial gingival level change of -0.05 mm. Modified Plaque Index scores showed that patients were able to maintain a good level of hygiene throughout the study. Papilla Index scores indicated that at T4, more than 50% papilla fill was observed in 80% of all sites. CONCLUSIONS: The results of this case series suggest that, in addition to a favorable implant success rate and peri-implant tissue response, the facial gingival level around single immediately placed implants can also be maintained following connective tissue grafting when proper three-dimensional implant positioning is achieved and bone is grafted into the implant-socket gap.

Retrieval of a fractured zirconia implant abutment using a modified crown and bridge remover: a clinical report.

This clinical report describes a novel method to retrieve the internal connection of a fractured zirconia abutment through modification of a crown and bridge remover. Furthermore, the strengths and limitations of using a zirconia implant abutment will be highlighted.

Immediate single tooth replacement with subepithelial connective tissue graft using platform switching implants: a case series.

This case series evaluated the facial gingival stability following single immediate tooth replacement in conjunction with subepithelial connective tissue graft (SCTG). Implant success rate and peri-implant tissue response were also reported. Ten patients (6 male, 4 female), with a mean age of 52.1 (range = 22.7 to 67.1) years, underwent immediate implant placement and provisionalization with SCTG and were evaluated clinically and radiographically at presurgery (T0), at the time of immediate tooth replacement and SCTG (T1), and 3 months (T2), 6 months (T3), and 12 months (T4) after surgery. Data were analyzed using the Friedman and Wilcoxon signed-ranks tests at the significance level of α = .05. At 1 year, 9 of 10 implants remained osseointegrated with the overall mean marginal bone change of -0.31 mm and a mean facial gingival level change of -0.05 mm. The modified plaque index scores showed that patients were able to maintain a good level of hygiene throughout the study. The papilla index score indicated that at T4, more than 50% of the papilla fill was observed in 89% of all sites. When proper 3-dimensional implant position is achieved and bone graft is placed into the implant-socket gap, favorable success rate and peri-implant tissue response of platform switching implants can be achieved following immediate tooth replacement in conjunction with subepithelial connective tissue graft.

Immediate loading of unsplinted implants in the anterior mandible for overdentures: a case series.

PURPOSE: This case series evaluated the implant success rate and peri-implant tissue response of immediately loaded unsplinted implants retaining a mandibular overdenture. MATERIALS AND METHODS: Eight completely edentulous patients (five men, three women) with a mean age of 69.1 years were included in the study. All participants received new maxillary and mandibular complete dentures prior to implant placement. Two 4.0- 3 13-mm threaded implants with a fluoride-modified microrough titanium surface were placed mesial to the mandibular canine position bilaterally. Individual stud attachments were connected and torqued to 25 Ncm and the overdenture was immediately attached. The patients were evaluated clinically and radiographically at implant placement and at 3, 6, and 12 months after implant placement. The data were analyzed using the paired-samples t test and the Wilcoxon signed-ranks test at a significance level of a = .05. RESULTS: At 12 months, all implants remained osseointegrated and showed an overall mean marginal bone change of -0.36 ± 0.29 mm and a mean Periotest value of -6.94 ± 0.73. The modified Plaque Index scores indicated improvements in oral hygiene over time. Surgical complications involved two episodes of implant rotational instability. Prosthetic complications were attributed to abutment loosening, the patients' inability to insert the prosthesis correctly, and soft tissue shrinkage. CONCLUSIONS: The results of this study suggest that favorable implant success rates and peri-implant tissue responses can be achieved with mandibular overdentures retained with two immediately loaded unsplinted threaded implants with a fluoride-modified microrough titanium surface.

Gingival biotype assessment in the esthetic zone: visual versus direct measurement.

This study evaluated the reliability of assessing visually the facial gingival biotype of maxillary anterior teeth with and without the use of a periodontal probe in comparison with direct measurements. Forty-eight patients (20 men, 28 women) with a single failing maxillary anterior tooth participated in this study. Three methods were used to evaluate the thickness of the gingival biotype of the failing tooth: visual, periodontal probing, and direct measurement. Prior to extraction, the gingival biotype was identified as either thick or thin via visual assessment and assessment with a periodontal probe. After tooth extraction, direct measurement of the gingival thickness was performed to the nearest 0.1 mm using a tension-free caliper. The gingival biotype was considered thin if the measurement was =or<1.0 mm and thick if it measured>1.0 mm. The assessment methods were compared using the McNemar test at a significance level of a=.05. The mean gingival thickness obtained from direct measurements was 1.06+/-0.27 mm, with an equal distribution (50%) of sites with gingival thicknesses of =or<1 mm and >1 mm. The McNemar test showed a statistically significant difference when comparing the visual assessment with assessment using a periodontal probe (P=.0117) and direct measurement (P=.0001). However, there was no statistically significant difference when comparing assessment with a periodontal probe and direct measurement (P=.146). Assessment with a periodontal probe is an adequately reliable and objective method in evaluating gingival biotype, whereas visual assessment of the gingival biotype by itself is not sufficiently reliable compared to direct measurement.