Ridge augmentation planning, wound healing evaluation, and peri-implant tissue phenotype assessment with ultrasonography: A case report.

BACKGROUND: Ridge regeneration for implant therapy requires comprehensive site evaluation and wound healing monitoring. This case report aimed to demonstrate ultrasound (US) can image soft and hard tissues for surgical planning and assess longitudinal outcomes. METHODS AND RESULTS: US was used in a patient planned for ridge augmentation to evaluate soft tissue thickness, location of muscle attachment, and hard tissue defect features presurgically. US were obtained at 1, 2.5, and 5 months afterward to assess tissue healing. Preoperatively, US showed ∼2.5 mm and ∼0.8 mm soft tissue thickness on the facial and lingual sides, respectively. The crestal bone width was ∼2 mm, with severe facial bone deficiency and high muscle attachment. US showed wound approximation and ridge width gain to 4.5 and 4.0 mm at 1 and 5 months, respectively. US tissue perfusion increased to ∼two-fold and ∼4-fold at 1 and 2.5 months and reduced below the baseline at 5 months. An implant with simultaneous bone augmentation was performed accordingly. Tissue phenotype around the implant was measured on US images at 1-year visit. CONCLUSIONS: This case report demonstrated that US parameters could be valuable for planning and wound healing outcome assessment of ridge augmentation in clinical as well as research settings. KEY POINTS: Why is this case new information? Novel high-resolution, chairside ultrasound was proposed to facilitate treatment planning and wound healing outcome assessment of ridge augmentation in clinical as well as research settings. What are the keys to successful use of this technology? Proper training in imaging acquisition and interpretation Adhere to high-level disinfection protocol Patient education and explanation What are the primary limitations to success in using this technology? Investment in this technology Learning curve in imaging acquisition and reading Insurance reimbursement strategy.

Ultrasonography-Derived Elasticity Estimation of Live Porcine Oral Mucosa.

OBJECTIVES: To investigate the biomechanical properties of porcine oral tissues with in vivo ultrasonography and to compare the difference between oral alveolar mucosa and gingival tissue concerning compressional and tensile mechanical strain. MATERIALS AND METHODS: Sinclair minipigs (6 females and 4 males, 6 to 18 months of age) were anesthetized for ultrasonography. In vivo high-frequency tissue harmonic ultrasound (12/24 MHz) cine-loops were obtained while inducing mechanical tissue stress (0 to 1 N). Post-processing strain analysis was performed in a cardiac speckle tracking software (EchoInsight®). Region of interest (ROI) was placed for gingival and alveolar mucosa tissues for longitudinal (compressional) and tensile strain analyses. A calibrated gel pad was employed to determine the absolute force (pressure) for the measured tissue strain response function. The resulting elasticity data was statistically analyzed using custom Matlab scripts. RESULTS: In total, 38 sonography cine-loops around the third premolars were included in the investigation. The longitudinal strain of alveolar mucosa ε AM L was found to be significantly (P < .05) larger than that of gingiva ε G L . Across the measured force range, ε AM L ~ 1.7 × Îµ G L . Significant differences between alveolar mucosa and gingiva tissues were found for all forces. The tensile strain of the alveolar mucosa ε AM T was found to be ~2 × Îµ G T (on the epithelial surface of the gingiva). Both were statistically significantly different for forces exceeding ~0.08 N. At depth, that is, 500 and 1000 µm below the epithelial surface, the gingiva was found to have less ability to stretch contrary to the alveolar mucosa. Gingival tissue at 500 µm depth has significantly less tensile strain than at its surface and more than at 1000 µm depth. In contrast, the tensile strain of alveolar mucosa is largely independent of depth. CONCLUSION: Ultrasonography can reveal significant differences in oral alveolar mucosal and gingival elastic properties, such as compressional and tensile strain. Under minute forces equivalent to 10 to 40 g, these differences can be observed. As dental ultrasound is a chairside, and noninvasive modality, obtaining real-time images might soon find clinical utility as a new diagnostic tool for the objective and quantitative assessment of periodontal and peri-implant soft tissues in clinical and research realms. As ultrasound is a safe modality with no known bioeffects, longitudinal monitoring of areas of concern would be particularly attractive.

Diabetes self-management education on the sustainability of metabolic control in type 2 diabetes patients: Diabetes share care program in Taiwan.

BACKGROUND: Diabetes self-management education (DSME) improves glycemic and metabolic control. However, the frequency, duration and sustainability of DSME for improving metabolic control have not been well studied. METHODS: The Diabetes Share Care Program (DSCP) stage 1 provided DSME every 3 months. If participants entering DSCP stage 1 ≥ 2 years and HbA1c < 7%, they can be transferred to stage 2 (DSME frequency: once a year). Three-to-one matching between DSCP stage 1 and stage 2 groups based on the propensity score method to match the two groups in terms of HbA1c and diabetes duration. We identified 311 people living with type 2 diabetes in DSCP stage 1 and 86 in stage 2 and evaluated their metabolic control and healthy behaviors annually for 5 years. RESULTS: In the first year, HbA1c in the DSCP stage 2 group was significantly lower than that in the stage 1 group. In the first and the fifth years, the percentage of patients achieving HbA1c < 7% was significantly higher in the DSCP stage 2 group than the stage 1 group. There was no significant difference in other metabolic parameters between the two groups during the 5-year follow-up. Self-monitoring of blood glucose (SMBG) frequency was associated with a reduced HbA1c after 5 years (95% CI: -0.0665 to -0.0004). CONCLUSION: We demonstrated sustainable effects of at least 2-year DSME on achieving better glycemic control for at least 1 year. SMBG contributed to improved glycemic control. The results may be applied to the reimbursement strategy in diabetes education.

Therapeutic Effects of Perilla Phenols in Oral Squamous Cell Carcinoma.

The herbal medicine perilla leaf extract (PLE) exhibits various pharmacological properties. We showed that PLE inhibits the viability of oral squamous cell carcinoma (OSCC) cells. HPLC analysis revealed that caffeic acid (CA) and rosmarinic acid (RA) are the two main phenols in PLE, and reduced OSCC cell viability in a dose-dependent manner. The optimal CA/RA combination ratio was 1:2 at concentrations of 300-500 µM but had no synergistic inhibitory effect on the viability of OSCC cells. CA, RA, or their combination effectively suppressed interleukin (IL)-1ß secretion by OSCC OC3 cells. Long-term treatment with CA and CA/RA mixtures, respectively, induced EGFR activation, which might cause OC3 cells to become EGFR-dependent and consequently increased the sensitivity of OC3 cells to a low dose (5 µM) of the EGFR tyrosine kinase inhibitor gefitinib. Chronic treatment with CA, RA, or their combination exhibited an inhibitory effect more potent than that of low-dose (1 µM) cisplatin on the colony formation ability of OSCC cells; this may be attributed to the induction of apoptosis by these treatments. These findings suggest that perilla phenols, particularly CA and RA, can be used as adjuvant therapies to improve the efficacy of chemotherapy and EGFR-targeted therapy in OSCC.

The Role of SCL Isoforms in Embryonic Hematopoiesis.

Three waves of hematopoiesis occur in the mouse embryo. The primitive hematopoiesis appears as blood islands in the extra embryonic yolk sac at E7.5. The extra embryonic pro-definitive hematopoiesis launches in late E8 and the embryonic definitive one turns on at E10.5 indicated by the emergence of hemogenic endothelial cells on the inner wall of the extra embryonic arteries and the embryonic aorta. To study the roles of SCL protein isoforms in murine hematopoiesis, the SCL-large (SCL-L) isoform was selectively destroyed with the remaining SCL-small (SCL-S) isoform intact. It was demonstrated that SCL-S was specifically expressed in the hemogenic endothelial cells (HECs) and SCL-L was only detected in the dispersed cells after budding from HECs. The SCLΔ/Δ homozygous mutant embryos only survived to E10.5 with normal extra embryonic vessels and red blood cells. In wild-type mouse embryos, a layer of neatly aligned CD34+ and CD43+ cells appeared on the endothelial wall of the aorta of the E10.5 fetus. However, the cells at the same site expressed CD31 rather than CD34 and/or CD43 in the E10.5 SCLΔ/Δ embryo, indicating that only the endothelial lineage was developed. These results reveal that the SCL-S is sufficient to sustain the primitive hematopoiesis and SCL-L is necessary to launch the definitive hematopoiesis.

The Effect of Limosilactobacillus reuteri on Social Behavior Is Independent of the Adaptive Immune System.

Gut microbes can modulate almost all aspects of host physiology throughout life. As a result, specific microbial interventions are attracting considerable attention as potential therapeutic strategies for treating a variety of conditions. Nonetheless, little is known about the mechanisms through which many of these microbes work. Recently, we and others have found that the commensal bacterium Limosilactobacillus reuteri (formerly Lactobacillus reuteri) reverses social deficits in several mouse models (genetic, environmental, and idiopathic) for neurodevelopmental disorders in a vagus nerve-, oxytocin-, and biopterin-dependent manner. Given that gut microbes can signal to the brain through the immune system and L. reuteri promotes wound healing via the adaptive immune response, we sought to determine whether the prosocial effect mediated by L. reuteri also depends on adaptive immunity. Here, we found that the effects of L. reuteri on social behavior and related changes in synaptic function are independent of the mature adaptive immune system. Interestingly, these findings indicate that the same microbe (L. reuteri) can affect different host phenotypes through distinct mechanisms. IMPORTANCE Because preclinical animal studies support the idea that gut microbes could represent novel therapeutics for brain disorders, it is essential to fully understand the mechanisms by which gut microbes affect their host's physiology. Previously, we discovered that treatment with Limosilactobacillus reuteri selectively improves social behavior in different mouse models for autism spectrum disorder through the vagus nerve, oxytocin reward signaling in the brain, and biopterin metabolites (BH4) in the gut. However, given that (i) the immune system remains a key pathway for host-microbe interactions and that (ii) L. reuteri has been shown to facilitate wound healing through the adaptive immune system, we examined here whether the prosocial effects of L. reuteri require immune signaling. Unexpectedly, we found that the mature adaptive immune system (i.e., conventional B and T cells) is not required for L. reuteri to reverse social deficits and related changes in synaptic function. Overall, these findings add new insight into the mechanism through which L. reuteri modulates brain function and behavior. More importantly, they highlight that a given bacterial species can modulate different phenotypes (e.g., wound healing versus social behavior) through separate mechanisms.

Periosteum Classification and Flap Advancement Techniques Around the Mental Foramen.

Various surgical flap advancement techniques for bone regeneration have been described in the literature; however, the clinical challenges of managing tissue that contains scars or embedded foreign materials have not been thoroughly described, especially around metal foramen. Fibrotic and thickened scar periosteum as well as mental foramen restrict the tissue from responding in the same way as native tissue. Therefore, additional considerations and approaches must be considered to achieve tension-free flap closure. This article presents a flap advancement classification that describes three common clinical scenarios based on the periosteum and soft tissue quality and provides surgical approaches for tissue management in each classification, with a focus on flap advancement around the mental foramen.

Retrospective Outcomes of Horizontal Guided Bone Regeneration at Partially Edentulous Sites with a Facially Oriented Crestal Incision (FOCIS) Design.

This retrospective study aimed to describe the facially oriented crestal incision (FOCIS) and assess the incidence of flap dehiscence and its efficacy in simultaneous and staged guided bone regeneration (GBR) procedures. The data of 41 patients treated with FOCIS GBR were analyzed. The primary outcome analyzed was the rate of initial wound closure. Secondary outcomes were related clinical parameters, including mean resolution of dehiscences and fenestrations, crestal buccal bone thickness (BBT), and bone width (BW) increase. A total of 53 implants were placed. The initial wound closure rate was 92.7% (38/41) and 94.3% (50/53) at the patient and implant levels, respectively. The complete dehiscence resolution rate was 79.31%, and the mean dehiscence reduction was 3.12 ± 2.46 mm (95% CI: 2.19 to 4.06 mm). BBT had a mean increase of 1.22 ± 1.07 mm (95% CI: 0.86 to 1.59 mm), and the final BBT was an average of 1.56 ± 0.79 mm (95% CI: 1.32 to 1.80 mm). Lastly, BW increase averaged 3.38 ± 1.49 mm (95% CI: 2.58 to 4.17 mm) for the staged cases. Utilizing FOCIS at partially edentulous sites can help achieve and maintain wound closure in horizontal GBR procedures.

Comparative Assessment of Flap-Advancing Techniques in an Ex Vivo Cadaverous Porcine Model.

PURPOSE: Since flap advancement is a prerequisite for tension-free primary closure and successful regenerative procedures, the aim of this study was to test the efficacy of six surgical approaches for flap advancement in an ex vivo porcine model. MATERIALS AND METHODS: A total of 60 fresh mandibles from pigs were randomized into one of six groups: (1) trapezoidal full-thickness flap design with two vertical releasing incisions (control), (2) trapezoidal flap with linear periosteal scoring, (3) mucosal detachment technique, (4) mucosal detachment with horizontal extension, (5) mucosal detachment with horizontal and vertical extension, and (6) mucosal detachment with horizontal vertical and cutback extension. Coronal advancement of the flap was recorded as the primary variable; the surface area of exposed mucosa and the tear strength were recorded as secondary variables. RESULTS: Homogeneity existed among groups for preoperative keratinized tissue width and tissue thickness. Mucosal detachment with horizontal, vertical, and, cutback extensions achieved the highest amount of advancement. All remaining groups achieved a statistically higher advancement compared with the trapezoidal full-thickness flap (control). Pairwise comparison demonstrated statistical significance between any two groups (P < .001). A positive correlation was noted between exposed mucosa and flap advancement; the advancement increased 0.62 mm for each 10 mm2 of increase in the exposed mucosal surface. Strength at tear stress was the highest in the trapezoidal full-thickness flap (control) and mucosal detachment with horizontal-vertical-cutback incisions (P < .001). CONCLUSION: Coronal flap advancement was maximized in the mucosal detachment techniques and positively correlated with the area of exposed mucosa.

The Buccally Displaced Palatal (BDP) Flap to Increase Quantity and Thickness of Peri-implant Soft Tissue.

Common challenges encountered for atrophic maxilla rehabilitation are the inadequate width and height of attached keratinized mucosa (AKM) and shallow vestibular depth. This study presents a buccally displaced palatal (BDP) flap technique to increase the tissue thickness and AKM width at the second-stage surgery and reestablish the correct fornix depth. The peri-implant pocket depths, modified Plaque Index score, modified sulcus Bleeding Index score, and soft tissue recession were evaluated 6 and 12 months after prostheses loading. A total of 52 implants were placed and analyzed, and no implant failures were found. No significant changes in peri-implant parameters were observed between 6 and 12 months, and mean recession was less than 0.2 mm after 12 months. Though this change was statistically significant, it was clinically irrelevant. The results demonstrate that adequately healthy peri-implant soft tissues and substantial dimensional stability of vestibular soft tissues at the 1-year follow-up were achieved with the BDP flap technique. The BDP flap could represent a viable option for increasing the width and the height of AKM and establishing the correct maxillary fornix depth.

Association between peri-implantitis and cardiovascular diseases: A case-control study.

BACKGROUND: This study assesses the association between peri-implantitis and cardiovascular diseases (CVD). METHODS: One hundred and twenty-eight patients with dental implants were recruited to evaluate the prevalence of peri-implantitis in patients with or without CVD (CVD group, n = 82, control group, n = 46, respectively). Diagnosis of peri-implantitis followed the 2017 World Workshop guidelines and the severity was defined as mild, moderate, and severe form when the radiographic bone loss (RBL) was <2, 2 to 4, and >4 mm. Multivariable logistic regression was performed to test the association between two diseases. RESULTS: A trend of higher prevalence of peri-implantitis defined by detectable RBL beyond the physiologic bone remodeling was found in the CVD group (64.6%) when compared with the controls (56.5%). A significant higher prevalence (48.8%) of moderate to severe peri-implantitis was identified in CVD compared with controls(30.4%) with a significant crude association between moderate to severe peri-implantitis and CVD (odds ratio = 2.18, 95% CI, 1.02 to 4.67; P = 0.04). The CVD group had a trend of higher prevalence of deep pockets (≥7 mm) and higher numbers of sites with bleeding on probing  (>66%) when compared with controls (P > 0.05). However, after controlling for multiple confounders including age, hypertension, smoking, family history of heart attack, and periodontitis, the significant association was not found. CONCLUSIONS: CVD group had significantly higher prevalence of moderate to severe peri-implantitis (RBL ≥2 mm). The association between the two diseases did not exist after controlling multiple confounders for CVD. Future studies with a larger sample size controlling for the patient- and implant-related confounders are needed to better understand the link between peri-implantitis and CVD.

Pro-inflammatory profiles in cardiovascular disease patients with peri-implantitis.

BACKGROUND: To investigate the pro-inflammatory cytokine profiles in patients with or without cardiovascular disease (CVD) and with or without peri-implantitis. METHODS: Serum, peri-implant crevicular fluid (PICF), and gingival crevicular fluid (GCF) were collected from patients with (n = 82) or without CVD (n = 46) at the most severe peri-implantitis site including sites with periodontitis. A panel of proinflammatory molecules including high-sensitivity C-reactive protein (hsCRP), fibrinogen, interleukin-1 beta (IL-1ß), IL-6, plasma tumor necrosis factor-alpha (TNF-α), matrix metallo-proteinase-8 (MMP-8), osteoprotegerin (OPG), vascular endothelial growth factor (VEGF), IL-17, IL-8, tissue inhibitor of metalloproteinase-2 (TIMP-2), myeloperoxidase (MPO), and prostaglandin E2 (PGE2 ) were analyzed using human custom Quantibody arrays. Krunskal-Wallis test was used to compare groups. The diagnostic ability of each biomarker was assessed using chi-square test and ROC analysis. RESULTS: Serum IL-1ß, TNF-α and fibrinogen were significantly higher in CVD patients than those without. Serum fibrinogen displayed a trend of higher concentration in patients with radiographic bone loss (RBL) ≥2 mm (P = 0.08). PICF TNF-α exhibited a significantly higher detection level in the CVD patients that is coincided with the local peri-implant inflammation. In addition, PICF MMP-8 was significantly higher in the RBL ≥2 mm sites than the healthy implants; whereas IL-1ß, IL-8, MMP-8, and TIMP-2 proved to be the significant predictors for peri-implant disease. GCF TNF-α collected from patients with periodontitis was significantly associated with CVD cases. CONCLUSION: The augmented expression of local and systemic pro-inflammatory cytokines found in the current study supports the weak association between the chronic peri-implantitis with increasing severity and CVD.

Elp1 facilitates RAD51-mediated homologous recombination repair via translational regulation.

BACKGROUND: RAD51-dependent homologous recombination (HR) is one of the most important pathways for repairing DNA double-strand breaks (DSBs), and its regulation is crucial to maintain genome integrity. Elp1 gene encodes IKAP/ELP1, a core subunit of the Elongator complex, which has been implicated in translational regulation. However, how ELP1 contributes to genome maintenance is unclear. METHODS: To investigate the function of Elp1, Elp1-deficient mouse embryonic fibroblasts (MEFs) were generated. Metaphase chromosome spreading, immunofluorescence, and comet assays were used to access chromosome abnormalities and DSB formation. Functional roles of Elp1 in MEFs were evaluated by cell viability, colony forming capacity, and apoptosis assays. HR-dependent DNA repair was assessed by reporter assay, immunofluorescence, and western blot. Polysome profiling was used to evaluate translational efficiency. Differentially expressed proteins and signaling pathways were identified using a label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS) proteomics approach. RESULTS: Here, we report that Elp1 depletion enhanced genomic instability, manifested as chromosome breakage and genotoxic stress-induced genomic DNA fragmentation upon ionizing radiation (IR) exposure. Elp1-deficient cells were hypersensitive to DNA damage and exhibited impaired cell proliferation and defective HR repair. Moreover, Elp1 depletion reduced the formation of IR-induced RAD51 foci and decreased RAD51 protein levels. Polysome profiling analysis revealed that ELP1 regulated RAD51 expression by promoting its translation in response to DNA damage. Notably, the requirement for ELP1 in DSB repair could be partially rescued in Elp1-deficient cells by reintroducing RAD51, suggesting that Elp1-mediated HR-directed repair of DSBs is RAD51-dependent. Finally, using proteome analyses, we identified several proteins involved in cancer pathways and DNA damage responses as being differentially expressed upon Elp1 depletion. CONCLUSIONS: Our study uncovered a molecular mechanism underlying Elp1-mediated regulation of HR activity and provides a novel link between translational regulation and genome stability.

FOXM1 is required for small cell lung cancer tumorigenesis and associated with poor clinical prognosis.

Small cell lung cancer (SCLC) continues to cause poor clinical outcomes due to limited advances in sustained treatments for rapid cancer cell proliferation and progression. The transcriptional factor Forkhead Box M1 (FOXM1) regulates cell proliferation, tumor initiation, and progression in multiple cancer types. However, its biological function and clinical significance in SCLC remain unestablished. Analysis of the Cancer Cell Line Encyclopedia and SCLC datasets in the present study disclosed significant upregulation of FOXM1 mRNA in SCLC cell lines and tissues. Gene set enrichment analysis (GSEA) revealed that FOXM1 is positively correlated with pathways regulating cell proliferation and DNA damage repair, as evident from sensitization of FOXM1-depleted SCLC cells to chemotherapy. Furthermore, Foxm1 knockout inhibited SCLC formation in the Rb1fl/flTrp53fl/flMycLSL/LSL (RPM) mouse model associated with increased levels of neuroendocrine markers, Ascl1 and Cgrp, and decrease in Yap1. Consistently, FOXM1 depletion in NCI-H1688 SCLC cells reduced migration and enhanced apoptosis and sensitivity to cisplatin and etoposide. SCLC with high FOXM1 expression (N = 30, 57.7%) was significantly correlated with advanced clinical stage, extrathoracic metastases, and decrease in overall survival (OS), compared with the low-FOXM1 group (7.90 vs. 12.46 months). Moreover, the high-FOXM1 group showed shorter progression-free survival after standard chemotherapy, compared with the low-FOXM1 group (3.90 vs. 8.69 months). Our collective findings support the utility of FOXM1 as a prognostic biomarker and potential molecular target for SCLC.

Efficacy of microsurgery and comparison to macrosurgery for gingival recession treatment: a systematic review with meta-analysis.

OBJECTIVES: Microsurgical principles, techniques, and armamentarium have made significant contributions to the periodontal plastic surgery. The present meta-analysis aimed to investigate the overall efficacy of microsurgery on root coverage, and its clinical outcomes when compared to traditional macrosurgery. MATERIAL AND METHODS: Electronic searches on PubMed, Embase, and CINAHL were used to retrieve prospective clinical trials. Primary outcomes were the mean root coverage (mRC) and probability of achieving complete root coverage (cRC), with secondary outcomes as other periodontal parameters and patient-reported outcome measures (PROMs). RESULTS: Nineteen studies were included in the quantitative analysis. Microsurgery was estimated to achieve 83.3% mRC and 69.3% cRC. From a subgroup of 9 comparative studies, it was estimated microsurgery increased mRC by 6.6% (p<0.001) and cRC by 27.9% (p<0.01) compared to macrosurgical control treatments. Operating microscope (OM) yielded a significantly 6.7% higher mRC than the control group (p=0.002), while using loupes showed 6.16% increase in mRC with a borderline significance (p=0.09). OM and loupes-only had a 31.05% (p=0.001) and 25.54% (p=0.001) increases in achieving cRC compared to control, respectively. As for PROMs, microsurgery reduced postoperative pain (p<0.001) and enhanced esthetics (p= 0.05). CONCLUSIONS: Microsurgery significantly improved mean root coverage, probability of achieving complete root coverage, esthetics, and post-surgical recovery. Microsurgery enhances not only subclinical healing but also clinical outcomes, possibly owing to its minimally invasive approach and surgical precision. CLINICAL RELEVANCE: Periodontal plastic microsurgery is minimally invasive, inducing less surgical trauma and ultimately resulting in improved clinical outcomes, patient's satisfaction, and quality of life.

Facial mucosal level of single immediately placed implants with either immediate provisionalization or delayed restoration: An intermediate-term study.

BACKGROUND: Immediately placed single implants with either immediate provisionalization (test) or delayed restoration (control) were followed for up to 1 year in our previous randomized clinical trial. Peri-implant tissues continue to remodel after implants are in function. Therefore, the primary aim of this study was to evaluate the facial mucosal level changes in the intermediate term between the two groups and to study potential factors influencing the mucosal level change. METHODS: Patients who had already completed the previous clinical trial by receiving a single immediately placed implant were re-invited to this study. The facial mucosal level as well as the other peri-implant hard and soft tissue dimensions and conditions were measured clinically, radiographically and with ultrasound. These data were compared between the test and control implants. The mucosal level change as the function of the final crown contour, measured as the abutment-crown angle (ACA), was estimated with a linear regression model. RESULTS: Twenty-eight patients (n of test/control = 16/12) with a mean 30-month follow-up were recruited. The mean mucosal level change was -0.38 mm (control) and 0.06 mm (test), without statistical difference between the two groups. The other clinical, radiographic, and ultrasound parameters were not statistically different. ACA was statistically significant associated with the recession (P = 0.02). The estimate effect was 0.25 mm per 10° increase (adjusted R2  = 0.18; 95% CI, 0.02 to 0.49 mm). After adjusting for vertical implant position, implant abutment angle and the group, the effect became borderline significant (P = 0.09). CONCLUSIONS: Peri-implant tissues, including the mucosal level change of immediately placed implants with either immediate provisionalization or delayed restoration remained stable and did not differ between the groups in the intermediate term. The final crown angle, influenced by implant position and abutment angle, might be associated with mucosal margin level change.

The peri-implant phenotype and implant esthetic complications. Contemporary overview.

OBJECTIVE: To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. OVERVIEW: The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. CONCLUSIONS: While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. CLINICAL SIGNIFICANCE: Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

Effect of Implant Vertical Position, Design, and Surgical Characteristics on Mucosal Vertical Dimension: A Meta-Analysis of Animal Studies.

PURPOSE: The aim of this study was to investigate the effect of implant and surgical characteristics on the mucosal vertical dimension components. Mucosal vertical dimension consists of the sulcular epithelium and the supracrestal tissue attachment, which can be clinically measured from the gingival margin to the bone-to-implant contact. Connective tissue attachment is measured from the apical border of attached epithelium to the first bone-to-implant contact, while epithelial vertical dimension is measured from the mucosal margin to the apical border of attached epithelium. MATERIALS AND METHODS: An electronic and manual search for relevant articles published from January 1980 to May 2019 was performed. Animal studies of ≥ 10 implants followed by histometric analysis were included. Quality assessment was performed using the ARRIVE guidelines, and risk of bias assessment was performed using SYRCLE guidelines. Subgroup meta-analysis was performed to analyze the influence of different surgical approaches and implant design. RESULTS: A total of 38 articles were included. The mean value and corresponding standard error of mucosal vertical dimension, supracrestal tissue attachment, connective tissue attachment, and epithelial vertical dimension were 3.39 ± 0.07 mm, 2.9 ± 0.12 mm, 1.35 ± 0.04 mm, and 2.0 ± 0.06 mm, respectively. Supracrestal and subcrestal bone-level implants had significantly higher mucosal vertical dimension than equicrestal bone-level implants. Platform-switching implants demonstrated significantly lower mucosal vertical dimension compared with non-platform-switching implants. CONCLUSION: Within its limitations, this review showed that equicrestal implants had a smaller mucosal vertical dimension than subcrestal and supracrestal implants, and platform-switching implants possessed a smaller mucosal vertical dimension.