The effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis: A retrospective study.

PURPOSE: The objective of this retrospective study was to evaluate the effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis. MATERIAL AND METHODS: Records of 96 patients and 148 external hexagon (EH) implants with time in function ranging from 1 to 17 years were included in the study. The most recent clinical and radiographic data were collected from records and the prevalence of peri-implantitis was defined according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Marginal bone level (MBL), emergence angle (EA), emergence profile (EP), and crown/implant platform horizontal ratio (CIHR) were obtained from periapical radiographs. Dichotomous variables at the patient- and implant level were compared with association tests. Mann-Whitney U-Test was performed to compare continuous quantitative values between the studied groups. Binomial logistic regression was conducted to identify risk indicators associated with the peri-implantitis event at the patient- and implant level, with the significance level set at 5% for all tests. RESULTS: Nineteen patients (19.2%) and 24 implants (16.2%) with a mean time in function of 5.0 ± 4.7 years were classified as having peri-implantitis. No statistically significant differences concerning gender, mean age, implant location in the jaw, or time in function were observed between patients with or without peri-implantitis (p > 0.05). Of 24 implants with peri-implantitis 10 (41.7%) displayed EA ≤ 30° (16.4%) while 14 (58.3%) presented EA > 30° with no statistical difference between the groups (p > 0.05). No statistically significant associations were identified between EA, EP, or CIHR and the prevalence of peri-implantitis. CONCLUSION: The findings seem to indicate that the EA, EP, and CIHR of single restorations over external hexagon implants are not associated with the presence of peri-implantitis. However, prospective studies with larger samples are required to better ascertain such an association in the long term.

Influence of residual pockets on periodontal tooth loss: a retrospective analysis.

BACKGROUND: Individuals enrolled in supportive periodontal therapy (SPT) can still present with tooth loss due to periodontitis (TLP). There is limited evidence on the influence of residual pockets (RPc) and a defined "threshold" at which a patient's profile is set to be at high risk for TLP in the literature. Therefore, this study aimed to assess the influence of RPc on TLP and determine the prognostic performance of RPc compared to the staging and grading of periodontitis on TLP risk. METHODS: Clinical data from 168 patients (3869 teeth) treated for periodontitis and receiving SPT for at least 10 years were evaluated in this retrospective study. TLP and the percentage of sites with RPc ≥ 5 mm or ≥6 mm per patient were collected. The prognostic performance of RPc was compared to the staging and grading of the disease on TLP using a multilevel Cox proportional hazard regression model. RESULTS: Over a median follow-up of 25 years, 13.7% of teeth were lost, 4.6% of which were due to periodontitis. Most patients with TLP had ≥1 site with RPc ≥5 mm (90.8%) or ≥6 mm (77.6%). Multivariate multilevel Cox regression revealed that patients with >15% of sites with RPc ≥5 mm had a hazard ratio of 2.34, and grade C had a hazard ratio of 4.6 for TLP compared to RPc ≤4 mm/grade A. Grading exhibited the best discrimination and model fit. CONCLUSION: Patients with RPc ≥5 mm at >15% of the sites are at risk for tooth loss. Grading and RPc ≥5 mm displayed very good predictive capability of TLP.

Four single implant-supported crowns replacing the maxillary incisors: A retrospective report of 10 cases with 2-9 years of follow-up.

OBJECTIVE: This retrospective case series aimed to assess the stability of the papilla around four single crowns supported by narrow-diameter implants replacing all maxillary incisors. Secondary objectives included assessment of marginal bone level stability, incidence of technical and biological complications, and patient satisfaction. MATERIALS AND METHODS: Individuals with four adjacent implants in maxillary incisor sites, placed with a 3 mm inter-implant distance and rehabilitated with single crowns were included. Retrospective data were obtained from photographs and radiographs taken at the delivery of the prosthesis (baseline-T0). Patients were then recalled (≥2 years after T0) for clinical and radiographic examination (follow-up-T1). Photographs were obtained and patient satisfaction was assessed using a visual analogue scale. Papilla height and marginal bone level were compared over time. RESULTS: Data from 10 patients with medium-low smile lines and rehabilitated with 40 implants, in function for 5.4 ± 1.9 years, were analyzed. The papilla height between implants (T0: 2.3 ± 0.9 mm; T1: 2.6 ± 0.7 mm; p = .011) and between tooth and implant (T0: 3.4 ± 0.9 mm; T1: 3.8 ± 0.8 mm; p = .025) increased significantly over the years. The marginal bone level remained stable over time (T0: 0.88 ± 0.57 mm; T1: 0.71 ± 0.67 mm; p = .007). Patients were highly satisfied (97.7 ± 0.3%) with the treatment outcome. CONCLUSION: Within its limitations, this study demonstrated that four single implant-supported crowns placed at maxillary incisor sites may exhibit soft tissue and marginal bone stability over a long period of time. This treatment approach, however, should be restricted to few patients as it requires a proper case selection and skillful execution of all surgical and prosthetic steps.

Anatomical characteristics of the alveolar process and basal bone that have an effect on socket healing.

Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing.

Periodontal regeneration risk assessment in the treatment of intrabony defects.

BACKGROUND: Regenerative approaches performed in periodontics seems to be efficient in treating intrabony defects. There are, however, many factors that may affect the predictability of the regenerative procedures. The present article aimed to propose a new risk assessment tool for treating periodontal intrabony defects by regenerative therapy. METHODS: Different variables that could affect the success of a regenerative procedure were considered based on their impact on (i) the wound healing potential, promoting wound stability, cells, and angiogenesis, or (ii) the ability to clean the root surface and maintain an optimal plaque control or (iii) aesthetics (risk for gingival recession). RESULTS: The risk assessment variables were divided into a patient, tooth, defect, and operator level. Patient-related factors included medical conditions such as diabetes, smoking habit, plaque control, compliance with supportive care, and expectations. Tooth-related factors included prognosis, traumatic occlusal forces or mobility, endodontic status, root surface topography, soft tissue anatomy, and gingival phenotype. Defect-associated factors included local anatomy (number of residual bone walls, width, and depth), furcation involvement, cleansability, and number of sides of the root involved. Operator-related factors should not be neglected and included the clinician's level of experience, the presence of environmental stress factors, and the use of checklists in the daily routine. CONCLUSIONS: Using a risk assessment comprised of patient-, tooth-, defect- and operator-level factors can aid the clinician in identifying challenging characteristics and in the treatment decision process.

7 Keys for Treatment of Periodontal Intrabony Defects.

Although technique-sensitive, periodontal regeneration seems efficient in treating intrabony defects; nonetheless, complete success can be difficult to attain. Seven keys for successful periodontal regeneration of intrabony defects, presented herein, encapsulate an evidence-based treatment planning and surgical protocol for achieving predictable outcomes. Utilizing a step-by-step approach, the seven keys offer periodontists a checklist for treating intrabony defects and include protocols for the planning, surgical, and postoperative phases of the treatment. This article describes the use of the seven keys checklist to achieve predictable regenerative outcomes at short-term and long-term follow-ups. A case report demonstrates the application of these seven keys.

Translating Clinical Outcomes to Patient Value Through Use of the Periodontal Risk Score: An Evidence-Based Treatment Approach.

Periodontitis is a chronic, multifactorial inflammatory disease characterized by progressive destruction of the tooth-supporting apparatus. Determining tooth prognosis is of central importance in clinical practice to help both the clinician and patient understand the risks and benefits of treatment while shedding light on the patient's long-term periodontal prognosis and aiding in the development of an individualized treatment plan. Several indexing-type systems have been proposed for determining the prognosis of periodontally involved teeth. The periodontal risk score (PRS) is a simple, evidence-based, motivational tool that can be used in daily clinical practice in both healthy and periodontally involved patients. The PRS incorporates systemic and lifestyle prognostic factors to achieve superior predictive accuracy. With the PRS, patients are encouraged to achieve a target score (representing an "excellent" prognosis) that can be realistically attained through compliance with a periodontal maintenance plan. The purpose of this article is to present to clinicians how to implement this evidence-based tool into their daily practices and thus help patients improve their long-term periodontal prognosis.

Minimal invasiveness in the alveolar ridge preservation, with or without concomitant implant placement.

The aim of this systematic review was to evaluate the benefit of ridge preservation (RP) with minimally invasive (MI) approaches with or without concomitant implant placement on morbidity, esthetics, and patient-related outcomes. Three Internet sources were used to search for appropriate papers. The search strategy was designed to include any clinical study published on RP with MI approaches such as flapless surgery, socket shield and socket sealing techniques and, use of biological agents. Characteristics of the individual studies, regarding methodological aspects, quantitative and qualitative data were extracted. The potential risk of bias was estimated, and the acquired evidence was graded. Independent screening of 860 reports resulted in 26 included original articles. Nine publications evaluated MI approaches for RP without concomitant implant placement. Eleven studies evaluated interventions for RP with immediate implant placement (IIP). Six studies compared RP with IIP vs RP without IIP. This systematic review found that MI approaches in most of the studies failed to improve clinical variables regarding morbidity, esthetics, and patient-related outcomes. Based on the limited number of studies analyzed and the methodological discrepancies observed, it is not possible to confirm that MI approaches promote a significant benefit when applied to RP procedures.

Flap versus flapless alveolar ridge preservation: A clinical and histological single-blinded, randomized controlled trial.

BACKGROUND: The aim of this randomized clinical trial was to compare a flapless technique of alveolar ridge preservation (ARP) to a flap technique to determine if preserving the periosteal blood supply would limit loss of crestal ridge width and height. METHODS: Twenty-four patients were randomly assigned to receive ARP using either a flapless or flap technique. Sockets were grafted with demineralized bone matrix and mineralized particulate allograft then covered with a barrier in both groups. Re-entry was performed at 4 months to obtain samples for histological analysis and subsequent implant placement. RESULTS: Ridge width of the flapless group at the crest decreased from 8.3 ± 1.3 mm to 7.0 ± 1.9 mm for a mean loss of 1.3 ± 0.9 mm (p < 0.05), whereas the flap group decreased from 8.5 ± 1.5 mm to 7.5 ± 1.5 mm for a mean loss of 1.0 ± 1.1 mm (p < 0.05). The mean midbuccal vertical change for the flap group was a loss of 0.9 ± 1.3 mm (p < 0.05) versus 0.5 ± 0.9 mm (p < 0.05) for the flapless group. There was no statistically significant difference between the groups. Histologically, flapless ARP revealed more vital mineralized tissue (44 ± 10%) compared to the flap group (p>0.05). In the flapless group, the occlusal soft tissue was significantly thicker than in the flap group at the 4-month re-entry (p< 0.05). CONCLUSIONS: Crestal ridge width, height, and percentage of vital mineralized bone following treatment with a flapless ARP technique, was not significantly different from a flap technique.

Identification of thin and thick gingival phenotypes by two transparency methods: A diagnostic accuracy study.

BACKGROUND: There is limited information on the diagnostic accuracy of the transparency method to diagnose gingival phenotypes taking into consideration not only the gingival thickness (GT) but also the keratinized tissue width (KTW). Thus, the aim of the present study was to compare the diagnostic accuracy of two transparency methods using a conventional steel probe (SP) and a plastic color-coded probe (CCP) to identify thin and thick gingival phenotypes. METHODS: Maxillary anterior teeth (n = 300) of 50 individuals were included in this study. The GT was measured via transgingival assessment at 2 mm apical to the gingival margin. Tooth sites were subdivided into thin or thick phenotypes according to the corresponding GT, respectively, ≤1 mm and >1 mm. SP and CCP were used to determine the gingival phenotype by the transparency method. The KTW was also evaluated. The diagnostic accuracy of the experimental periodontal probes to identify the thin and thick gingival phenotypes were compared. RESULTS: Of 300 gingival sites evaluated, 57% (n = 172) were identified as thin (GT: 0.82 ± 0.12 mm, KTW: 4 ± 1.2 mm) and 43% (n = 128) as thick phenotypes (GT: 1.16 ± 0.12 mm, KTW: 4.3 ± 1.3 mm) by the transgingival method. The SP and CCP were very sensitive (>0.94) to identify the thin phenotype, however, less specific (0.35-0.39) to diagnose thick phenotype. The diagnostic accuracy for the SP and CCP was similar, 0.69 and 0.70, respectively. CONCLUSION: The steel and color-coded plastic probe were equally effective in identifying thin gingival phenotype at maxillary anterior tooth sites.

A Prospective, Randomized, Controlled, Multicenter Evaluation of Extraction Socket Management Comparing a Wound Dressing and a Soft Tissue Substitute.

Postextraction bone grafting and implant placement help preserve alveolar bone volume. Collagen wound dressings and soft tissue graft substitutes may help protect extraction socket bone grafts and provide better gingival contours. This randomized, controlled, multicenter, and double-blinded study was conducted to compare a control (wound dressing) and a test (soft tissue graft) substitute in nearly intact extraction sockets. Both test and control sockets were grafted with a xenogeneic bone graft. Graft containment, extraction socket soft tissue gap closure, gingival contour, and gingival thickness were examined over 16 weeks, at which time implants were placed. Healing was uneventful for both groups, and there was no significant difference (P < .05) between the times required to close the extraction socket soft tissue gap (~80% of sites closed by 8 weeks). Bone grafts were covered and contained longer in the test group (~4 weeks vs ~2 weeks), with less contour disruption out to 4 weeks; however, at implant placement, soft tissue contours in both groups were comparable, and soft tissue thicknesses were not significantly different.

The effect of brushing discomfort on peri-implant health in sites exhibiting inadequate keratinized mucosa width: A cross-sectional study.

OBJECTIVES: The aim of this cross-sectional study was to evaluate the effect of brushing discomfort (BD) on peri-implant health in sites exhibiting inadequate keratinized mucosa (KM) width. MATERIAL AND METHODS: Patients presenting with at least one implant exhibiting KM <2 mm and in function for ≥1 year were eligible for inclusion. BD was assessed with the visual analogue scale (VAS), and implants were classified into two groups: Absence (aBD; VAS = 0) or Presence (pBD; VAS > 0) of BD. Bleeding on probing (BoP), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), suppuration (Sup), and marginal bone level (MBL) were recorded. Mann-Whitney, chi-square test, and a multilevel model were used for analysis. RESULTS: Fifty-nine patients with 155 dental implants were analyzed, of which 60 presented no BD, and 95 presented some level of BD. BoP, PD, CAL, and MBL were significantly higher in the pBD than in the aBD group (p < .05). The prevalence of peri-implant diseases at implant level was also higher in the pBD group than in the aBD group. However, after controlling for confounding factors, only mPI showed an effect on BoP. In addition, difficulty to perform oral hygiene was statistically higher in the pBD group. CONCLUSIONS: The findings of the present study suggest that although BD around implants exhibiting KM <2 mm did not influence tissue inflammation, it could represent a symptom of peri-implant diseases. Further clinical trials assessing the long-term effect of BD must be considered to better ascertain its effects on peri-implant health.

Effect of Connective Tissue Graft Following Immediate Implant Placement on Esthetic Outcomes at Maxillary Central Incisor Sites: A Long-Term Cohort Study.

The aim of this cohort study was to assess the effect of connective tissue graft (CTG) following immediate implant placement (IIP) at maxillary central incisors on esthetic outcomes, buccal bone thickness, soft tissue dimensional alterations, and patient-centered outcomes. Twenty-eight patients treated with IIP at maxillary central incisor sites with approximately 6 ± 4 years in function were divided according to the use of CTG (n = 17) or no CTG (n = 11). The primary variable of the study was the Pink and White Esthetic Score (PES/WES), evaluated in photographs taken before and after implant placement. The thickness of the buccal bone, midbuccal mucosal level (MBML) changes, and patient satisfaction were assessed and compared between the two groups. The results showed similar PES/WES before IIP between the CTG and no-CTG groups (13.5 ± 3.7 and 12.6 ± 3.2, respectively). After IIP, the PES/WES value in the CTG group was significantly higher (15 ± 2.5) than in the no-CTG group (12.1 ± 3.1) (P = .012). No significant differences in the buccal bone thickness, MBML, or patient satisfaction were observed in CTG and no-CTG groups. This study found that CTG following IIP and socket grafting promoted better esthetic outcomes.

Effect of the buccal gap width following immediate implant placement on the buccal bone wall: A retrospective cone-beam computed tomography analysis.

BACKGROUND: The effect of the buccal gap width on the clinical outcome of socket graft and immediate implant placement (IIP) at maxillary central incisor sites has not been investigated. Thus, the aim of the present study was to evaluate the effect of the width of the buccal gap on the thickness of the newly formed buccal wall. METHODS: Forty-two patients and 51 maxillary central incisor sites treated with IIP and ridge preservation by means of graft of the buccal gap at the maxillary central incisor region were included in the study. The width of the buccal gap was measured and filled with deproteinized bovine bone mineral. Implant sites were divided into two groups: wide gap (WG, >2 mm; n = 34) and narrow gap (NG, ≤2 mm; n = 17). After at least 1 year in function (5 ± 4), CBCT scans were obtained and assessed by a calibrated examiner. The thickness of the buccal and palatal bone walls, the percentage of the implant height covered by bone in the buccal and palatal aspects and the position of the buccal and palatal crests were compared between the two groups. A linear regression model was performed to assess predictors of the thickness of the buccal bone. RESULTS: The buccal bone was significantly thicker in the WG group than the NG group at all levels observed (overall 1.9 ± 0.9 mm and 0.5 ± 0.6 mm, respectively). The thickness of the palatal bone was similar between both groups (>2 mm). The percentage of the implant height covered by bone at the buccal aspect was significantly higher in the WG group (95 ± 16.6%) than in the NG group (59.4 ± 42.3%). The position of the buccal crest in relation to the implant shoulder was significantly more coronal (0.3 ± 2.2 mm) in the WG group than in the NG group (-4.7 ± 5.6 mm). The regression analysis model indicated that the width of the buccal gap was the only predictor of the thickness of the newly formed buccal bone wall (p < 0.001). CONCLUSION: Grafting of >2 mm-wide buccal gaps following IIP promoted a thicker buccal bone wall.

Application of the 10 Keys for Replacement of Multiple Teeth in the Esthetic Zone.

Ten keys for successful esthetic-zone single immediate implants encapsulate in an evidence-based manner the treatment planning and replacement of single hopeless teeth in the maxillary anterior sextant. These include two treatment-planning, five surgical, and three prosthetic keys, which, collectively, aim to minimize soft- and hard-tissue complications for an optimal esthetic implant restoration. The Straightforward, Advanced, and Complex (SAC) classification is designed to aid clinicians in the treatment planning of dental implant cases. As per this classification, cases are stratified by the degree of surgical and restorative risk and complexity for both the surgical and prosthetic phases of treatment. A technique-sensitive and skill-demanding task, the replacement of multiple adjacent teeth in the esthetic zone poses significant challenges for clinicians and is considered a complex SAC procedure surgically and restoratively. This article presents a case report on the replacement of multiple adjacent teeth in the esthetic zone, demonstrating the use of 10 key principles to achieve an optimal esthetic outcome.

The Basal Bone and Alveolar Process in the Maxillary Anterior Region in Humans: A Cone Beam Computed Tomographic Study.

The aim of this study was to describe the basal bone and alveolar process in the maxillary anterior region by assessing patient CBCT scans. Parasagittal reconstructions were made to quantify basal bone and alveolar process dimensions and inclination of teeth in the maxillary anterior region. The CBCT scans of 87 patients and 522 tooth sites were included in this study. The results showed that the surface areas of the basal bone, alveolar process, and palatal triangle varied from 22.1 to 54.1 mm2, 87.8 to 144.0 mm2, and 37.1 to 66.0 mm2, respectively. The basal bone in the canine region had a significantly smaller cross-sectional area than in the incisor region. The alveolar process in the canine region was markedly larger than those of the central and lateral incisor regions. The mean overall thickness of the alveolar facial bone at 3, 5, and 7 mm above the CEJ were 0.6 ± 0.5 mm, 0.9 ± 0.5 mm, and 0.7 ± 0.6 mm, respectively. Additionally, the findings demonstrated that the cross-sectional area of the alveolar process and palatal triangle were greater among men than women. The study identified significant anatomical differences among various tooth regions in the anterior maxilla. The results also demonstrated that the tooth type, but not the tooth inclination or apex location, correlates with the size of the alveolar process.

The effect of inadequate access to peri-implant hygiene on marginal bone level. A 4-year cohort prospective study.

OBJECTIVE: The objective of this four-year cohort prospective study was to evaluate the effect of inadequate access to peri-implant hygiene on marginal bone level (MBL). MATERIAL AND METHODS: Forty-one partially edentulous patients (16 males and 25 females, aged 49.8 ± 11.9 years) who had implants with at least one year in function were selected. Patients were clinically and radiographically evaluated at three different times: baseline (T0), 2-year (T1), and 4-year (T2) follow-up intervals. At baseline, implants were classified and allocated into two groups: those presenting adequate access (ACC) and inadequate access (no-ACC) to peri-implant hygiene. A linear mixed-effects model for clustered longitudinal data was used to analyze MBL, probing depth (PD), plaque index (PI), and bleeding on probing (BoP). RESULTS: Of 131 implants, 74 were considered as having ACC, and 57 as having no-ACC at T0. Implants in the no-ACC group presented a statistically greater mean MBL measurement at T2 than implants in the ACC group (p = .011). In the no-ACC group, a significant reduction in PD from T0 to T1 (p = .019) and from T0 to T2 (p = .010) was observed. Regardless of the group, PI significantly increased at both T1 (p = .00001) and T2 (p = .00004). Regardless of time, the prevalence of BoP was significantly higher in the no-ACC group than in the ACC group (p = .012). CONCLUSION: Inadequate access to peri-implant hygiene frequently resulted in more peri-implant inflammation and MBL over time. Proper accessibility to peri-implant hygiene should be carefully considered during planning of implant restoration, and patients properly motivated into maintenance care.

Accuracy of High-resolution Small-volume Cone-Beam Computed Tomography in the Diagnosis of Vertical Root Fracture: An In Vivo Analysis.

INTRODUCTION: The purpose of this in vivo study was to evaluate the accuracy of small-volume cone-beam computed tomographic (CBCT) imaging compared with conventional periapical radiography (CPR) in the diagnosis of vertical root fractures (VRFs) using exploratory surgery as the reference standard. METHODS: Eighty-two dental records of 85 teeth with suspected VRFs that underwent CPR, CBCT imaging, and exploratory surgery were included. Two observers assessed CPR and CBCT images independently for the presence or absence of root fractures, and findings from the exploratory surgery were considered the reference standard. Diagnostic sensitivity, specificity, accuracy, and the receiver operating characteristic curve values were obtained. The effect of single- and multirooted teeth on diagnostic accuracy as well as the association between clinical symptoms and the presence of VRFs were also assessed. RESULTS: VRFs were surgically detected in 64 of the 85 teeth (75.3%), of which 62.5% were multirooted and 76.6% had intracanal posts. CBCT imaging was more sensitive and accurate (65.6% and 64%) than CPR (27.3% and 40.5%). Both CPR and CBCT diagnostic accuracies were higher in single- than multirooted teeth. Pain on percussion, a localized periodontal pocket, and tooth mobility were associated with the presence of VRFs (P < .05; odds ratio = 4.15, 13.5 and 4.1, respectively). CONCLUSIONS: The accuracy of CBCT imaging for the diagnosis of VRFs was poor, although it was higher than with CPR. Multirooted teeth in the presence of intracanal posts may limit its diagnostic value.

Excessive occlusal load on chemically modified and moderately rough titanium implants restored with cantilever reconstructions. An experimental study in dogs.

OBJECTIVE: To evaluate the outcomes of excessively loaded implants. MATERIAL AND METHODS: In five dogs, all mandibular premolars were extracted. After 3 months, six implants (three SLA® and three SLActive®) were placed (S). After 4 weeks, implants were restored: one single crown with stable occlusal contacts (SC), one crown and a cantilever unit with excessive occlusal contacts (OL), and a non-loaded implant (NL). Bleeding-on-probing (BoP), attachment level (AL), mucosal margin (GM) were assessed. Resonance frequency analysis (RFA) was assessed weekly. Standardized X-rays were taken at S, 4 and 24 weeks. RESULTS: Similar findings were observed for SLA® and SLActive® implants regarding PlI, GI, GM, AL, and BL. No significant differences were detected between baseline and 24-weeks or between treatment modalities for all clinical parameters (p > .05). Six months after loading, RFA values were significantly greater than at implant placement. No significant differences between treatment modalities were found. Linear radiographic measurements yielded similar results between SLA® and SLActive® implants. SLA® OL implants yielded a statistically significant gain on peri-implant bone density over all other groups (p = .012). Radiographic results were confirmed by descriptive histology. Technically, loosened occlusal screws occurred in 13.3% (SC = 3.3%; OL = 10%), while abutment fractures totalized 23.3% (SC = 6.6%; OL = 16.6%). CONCLUSIONS: Excessive occlusal load applied to implants (SLA® or SLActive®) restored with cantilevers did not cause loss of osseointegration or significant changes in their clinical, radiographic, or histologic outcomes. Early excessive occlusal load on SLA® implants promoted a gain in peri-implant bone density. Excessively loaded implants showed more technical complications.

Socket healing with and without immediate implant placement.

The aim of the present review was to describe the studies produced in Latin America that contributed to the elucidation of the effect of tooth extraction with and without immediate implant installation. An electronic search was conducted in MEDLINE (PubMed), Scopus, Scielo, Lilacs, and Embase to include clinical and experimental (animal) studies on immediate implants. The studies selected had to fulfill the following inclusion criteria: (i) to present clinical and/or histological data on socket healing with or without immediate implant installation; (ii) to be approved by a Latin American Ethic Committee or comparable; and (iii) to include at least one author from a Latin American institution or to be conducted in a Latin America institution. Latin American studies that fulfilled these criteria demonstrated that immediate implant installation was conducive for predictable osseointegration and high survival rates but failed to prevent bone modeling and dimensional reduction of the alveolar ridge. In addition, it was also shown that regenerative approaches, including hard and soft tissue grafts at the time of immediate implant placement, may be beneficial to compensate for the alveolar ridge reduction. Regenerative approaches immediately after tooth extraction may decrease the amount of dimension reduction of the alveolar ridge.