Xanthan-based chlorhexidine gel effects in non-surgical periodontal therapy? A meta-analysis.

OBJECTIVE: To carry out a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) and controlled clinical trials (CCTs) comparing scaling and root planing (SRP) or placebo with subgingival application of xanthan-based CHX (chlorhexidine) gel as adjunct to SRP. MATERIALS AND METHODS: The literature search was carried out in PubMed/MEDLINE, EMBASE, and SCOPUS; primary outcomes were probing pocket depth (PPD) reduction and gain in clinical attachment level (CAL). RESULTS: Overall, 15 studies were included. Three studies were judged to be at moderate risk of bias while the remaining 12 were rated at high risk of bias. A significant improvement in PPD reduction (standardized mean difference, SMD, 0.87, 95% CI, 0.41-1.34) and CAL gain (SMD = 0.84, 95% CI, 0.36-1.33) emerged for the SRP + CXH gel compared to the SRP alone group, in the presence of significant high heterogeneity among the studies. CONCLUSIONS: Our systematic review and meta-analysis showed that xanthan-based chlorhexidine gel as adjunct to non-surgical periodontal therapy gives benefit in terms of PPD reduction and CAL gain as compared to non-surgical periodontal therapy only. Since there was high heterogeneity among studies and the quality of the evidence is low, further studies characterized by a better methodology, adequate sample size and longer follow-up are warranted in the next future. REGISTRATION: The protocol of this scoping review was registered in the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO) with ID: CRD42023391589.

Can transfer type and implant angulation affect impression accuracy? A 3D in vitro evaluation.

Impression accuracy is fundamental to achieve a passive fit between implants and the superstructure. Three transfer types were tested to evaluate the differences in impression accuracy and their efficiency in case of different implant angles. A master model with four implant analogues placed at 0°, 15° and 35° was used. 27 impressions were taken with three different types of impression coping: closed tray technique coping (CT), open tray technique coping (COT) and telescopic open tray coping (TOT). The impressions were poured. Analogues were matched with scan bodies to be scanned and exported in STL. An implant bar was designed from each STL and another one from the master model. A comparison between these bars was obtained. Linear and angular measurements for every type of coping were calculated for different angulations. The collected data were analyzed with ANOVA test (95% of confidence). Student's t test showed a significative discrepancy (p ≤ 0.001) on linear and angular measurements on Δx, Δy, Δz with different transfer types as well as diverse implant positioning angles (p ≤ 0.001). Within the limitations of this study, it can be concluded that the coping type and the implants divergence may be significant parameters influencing the impression accuracy.

Influence of abutment material on peri-implant soft tissues in anterior areas with thin gingival biotype: a multicentric prospective study.

PURPOSE: The aim of the present clinical trial was to analyze, through spectrophotometric digital technology, the influence of the abutment material on the color of the peri-implant soft tissue in patients with thin gingival biotype. MATERIAL AND METHODS: Thirty-seven patients received an endosseous dental implant in the anterior maxilla. At time of each definitive prosthesis delivery, an all-ceramic crown has been tried on gold, titanium and zirconia abutment. Peri-implant soft-tissue color has been measured through a spectrophotometer after the insertion of each single abutment. Also facial peri-implant soft-tissue thickness was measured at the level of the implant neck through a caliper. A specific software has been utilized to identify a standardized tissue area and to collect the data before the statistical analysis in Lab* color space. ΔE parameters of the selected abutments were tested for correlation with mucosal thickness. Pearson correlation test was used. RESULTS: Only 15 patients met the study inclusion criteria on peri-implant soft-tissue thickness. Peri-implant soft-tissue color was different from that around natural teeth, no matter which type of restorative material was selected. Measurements regarding all the abutments were above the critical threshold of ΔE 8.74 for intraoral color distinction by the naked eye. The ΔE mean values of gold and zirconium abutments were similar (11.43 and 11.37, respectively) and significantly lower (P = 0.03 and P = 0.04, respectively) than the titanium abutment (13.55). In patients with a facial soft-tissue thickness ≤2 mm, the ΔE mean value of gold and zirconia abutments was significantly lower than that of titanium abutments (P = 0.03 and P = 0.04, respectively) and much more close to the reference threshold of 8.74. CONCLUSIONS: For peri-implant soft tissue of ≤2 mm, gold or zirconia abutments could be selected in anterior areas treatment. Moreover, the thickness of the peri-implant soft tissue seemed to be a crucial factor in the abutment impact on the color of soft tissues with a thickness of ≤2 mm.

Microbial Leakage at Morse Taper Conometric Prosthetic Connection: An In Vitro Investigation.

OBJECTIVE: To evaluate in vitro the sealing capability at the prosthetic connection interface of 2 conometric systems. MATERIALS AND METHODS: Two conometric systems with the same design and different material were used, for a total of 24 samples. Each sample was assembled by a tapered abutment and respective coping. In group A, the copings were made of gold, whereas in group B they were made of PEEK. Three µL of mix bacterial suspension (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Fusobacterium nucleatum species) was inoculated into the abutment screw hole, and the coping was inserted on the abutment. Samples were immersed into culture tubes and incubated for 24, 48, and 72 hours into anaerobic conditions. Visual evaluation of turbidity was performed at each time point. Qualitative-quantitative assessment using real-time polymerase chain reaction was performed at 72 hours. Any difference between the groups was checked by means of Fisher exact test. RESULTS: Microbial leakage occurred in both groups, and there was no statistically significant difference between groups. Microbial concentration resulted in a presence inferior to 1 × 10 copies/µL in all positive assemblies. CONCLUSIONS: Because of the low bacterial count, it can be concluded that a minimal bacterial infiltration may be allowed by conometric interfaces for prosthetic connection.

Ridge Dimensions of the Edentulous Mandible in Posterior Sextants: An Observational Study on Cone Beam Computed Tomography Radiographs.

AIMS: To evaluate the ridge dimensions of posterior sextant in totally edentulous mandibles. MATERIAL AND METHODS: Cone beam computed tomography scans of 136 patients were retrospectively included for analysis. At sites corresponding to the second premolar (site a) and the mesial and distal root of first molar (sites b and c, respectively), bone height (BH) and bone width (BW) were measured. RESULTS: BH significantly decreased from site a (11.20 ± 4.03 mm) to site c (10.28 ± 3.33 mm). Males showed a significantly higher BH compared with females at all sites (P < 0.001), No significant impact of age on BH was found. BW increased from coronal to apical at all sites. At all height levels, BW increased from mesial to distal (BWc > BWb > BWa). CONCLUSIONS: BH decreased from mesial to distal, whereas BW showed an increase. Sex showed a significant impact on BH, with males having on average a 2.8 mm greater height than females, but not on BW. Age did not significantly influence the dimensions of the residual bone crest.

Simplified procedure for the immediate loading of a complete fixed prosthesis supported by four implants in the maxillary jaw: a 2-year prospective study.

PURPOSE: The aim of this study was to verify the reliability of a system for the fixed retention of complete maxillary prostheses supported by four implants with a follow-up of 2 years. MATERIAL AND METHODS: Patients were treated between September 2009 and December 2010 with four Straumann Bone Level SLActive implants supporting a complete prosthesis (CPs). The two distal implants were positioned mesially to the maxillary sinus and with a mesio-distal inclination ≤ 30° in order to reduce the distal prosthesis cantilever. An immediate loading surgical protocol was used. The CPs were planned to be fixed to multibase abutments to test their retention for a fixed rehabilitation. Clinical and radiographic parameters as probing pocket depth (PPD), bleeding score (mBI), plaque index (PI), and marginal bone loss (MBL) were assessed at a 1- and 2-year follow-up visits. Moreover, any biological and prosthodontic maintenance events were recorded. Clinical and radiographic parameters changes were analyzed. RESULTS: Twenty-one patients treated with a total of 84 implants completed the 2-year examination period. Four patients were lost to follow up. No technical complication was recorded. Also, no implant, reconstruction, or abutment failures were observed. Therefore, an implant and prosthetic survival rate of 100% were achieved after 2 years. The mean periodontal parameter scores after 2 years of function were 2.6 mm for PPD (SD 0.8 mm), 0.3 for mBI (SD 0.5 mm), and 1.2 for PI (SD 0.4 mm) indexes, respectively. In addition, the mean MBL score measured at the 2-year follow-up visit was -0.34 mm (SD of -0.45 mm). Furthermore, no peri-implant soft tissue inflammation or peri-implant infection was observed. CONCLUSIONS: It has been shown that immediate loading of four implants positioned anteriorly to the maxillary sinus could be a reliable treatment procedure to support fixed complete restorations.

Periodontal response to two different subgingival restorative margin designs: a 12-month randomized clinical trial.

OBJECTIVES: Subgingival margin placement is sometimes required due to different reasons and is often associated with adverse periodontal reactions. The purpose of this study was to determine if a single restoration with subgingival margin on a tooth, in the maxillary anterior zone, would affect its periodontal soft tissue parameters, and whether or not a deep chamfer preparation has a different influence in the periodontium when compared to a feather edge preparation. MATERIAL AND METHODS: Plaque and gingival indexes, periodontal probing depth, bleeding on probing, and patient's biotype were registered. One hundred six teeth were prepared with a deep chamfer, while 94 were prepared with a feather edge finishing line. Twelve months after the restoration delivery, the same parameters were evaluated. Repeated measure one-way analysis of variance (ANOVA) (α = 0.05) was used. RESULTS: A statistically significant difference between the baseline and the 12-month follow-up is present in regard to plaque index, gingival index, and periodontal probing depth, but no statistically significant difference between chamfer and feather edge finishing lines. There is a statistically significant difference between the baseline and the 12-month follow-up in regard to bleeding on probing. Feather edge preparation presents significantly more bleeding on probing and less gingival recession than the chamfer. CONCLUSIONS: Subgingival margins do influence the periodontal soft tissue response. Statistically significant difference exists between feather edge and chamfer finishing lines in regard to bleeding on probing and gingival recession. CLINICAL RELEVANCE: Subgingival margins should be carefully selected, especially when feather edge finishing line is utilized.

Patient morbidity and root coverage outcomes after the application of a subepithelial connective tissue graft in combination with a coronally advanced flap or via a tunneling technique: a randomized controlled clinical trial.

BACKGROUND AND OBJECTIVE: Subepithelial connective tissue grafts (SeCTG) in conjunction with a coronally advanced flap (CAF) or with tunneling technique (TT) are common periodontal procedures with similar indications for the treatment of a denuded root surface; however, it is unclear whether patient discomfort and postoperative morbidity are comparable in both approaches. The aim of this randomized controlled clinical trial was to compare the patient morbidity and root coverage outcomes of a SeCTG used in combination with a CAF or TT. MATERIALS AND METHODS: For this single-center, randomized, clinical trial, patients were randomly assigned to receive SeCTG + CAF (control group) or SeCTG + TT (test group). Postoperative questionnaires at 3 days post intervention were administered to evaluate postoperative discomfort, bleeding, and inability to masticate. Evaluation of patients' perception of pain was performed using a visual analog scale (VAS). Clinical outcomes including percentage of root coverage (RC) and complete root coverage (CRC) were recorded 12 months postoperatively. RESULTS: Fifty patients (25 SeCTG + CAF and 25 SeCTG + TT) completed the study. Healing was uneventful for all test and control patients. The SeCTG + TT group showed a longer chair time (33.6 (3.6) and 23.6 (4.2) min for the SeCTG + TT and the SeCTG + CAF, respectively), as well as more painkiller consumption: 2736 vs. 1536 mg (p < 0.001). At the same time, the SeCTG + CAF group reported less pain or discomfort in all four sections of the questionnaire: pain experienced within the mouth as a whole, pain experienced throughout the day, pain experienced at night, and edema experienced after the surgery (p = 0.002, p = 0.001, p = 0.001, and p = 0001, respectively). Both treatments showed clinical efficacy in terms of root coverage as no differences per group were observed in the percentage of root coverage (87 vs. 85 %, p = 704) or patients with complete root coverage (60 vs. 52 %, p = 0.569). CONCLUSIONS: SeCTG + TT is associated with a greater incidence of pain and discomfort compared to SeCTG + CAF in early postoperative periods, as well as a longer chair time. Both treatments showed similar clinical efficacy in terms of root coverage. CLINICAL RELEVANCE: The results of this study may influence the surgeon's choice on which root coverage procedure should be performed considering the need of more chair time and more painkiller assumption with the tunneling technique.

Reproducibility of Buccal Gingival Profile Using a Custom Pick-Up Impression Technique: A 2-Year Prospective Multicenter Study.

PURPOSE: The aim of this study was to transfer the provisional restoration emergence profile to the final implant-supported restoration and to buccal gingival margin (BGM) stability after 2 years of function. MATERIALS AND METHODS: A total of 33 patients were recruited for treatment of single gaps by means of 33 implant-supported restorations. Fixed provisional crowns were screwed to the fixture and adjusted until the complete peri-implant soft tissue maturation was achieved. After 12 weeks, a second fixture impression was taken by means of a pick-up customization technique in order to transfer the clinical aspect of the peri-implant soft tissues to the master cast. A definitive restoration was delivered. A standardized method from digital photographs was used to assess the gingival margin modification (BGM) from the provisional (P) to the definitive prosthesis installation at baseline (D0), and after 1 (D1) and 2 years (D2) of function. Also, marginal bone loss (MBL) was calculated after 1 (D1) and 2 years (D2) of definitive restoration function. RESULTS: The BGM index at the time of the final restoration installation (D0) was 0.12 ± 0.33 mm if compared with the BGM position of the provisional restoration (P); it was of 0.12 ± 0.46 mm after 1-year of follow-up (D1) and of 0.31 ± 0.21 after 2 years of function (D2). No significant difference was calculated between measurements in different follow-up visits (p > 0.05). No significant MBL was measured between the baseline (D0) and the 1-year follow-up (p = 0.816) with a mean MBL value of 0.2 ± 0.1 mm. Similar result was calculated after 2 years (p = 0.684) with a mean MBL value of 0.3 ± 0.2. CONCLUSION: A modified impression pick-up may be helpful to reproduce the gingival margin position from the provisional to the definitive restoration. Moreover, the gingival zenith position during the follow-up period seemed to be stable. CLINICAL SIGNIFICANCE: The modification of the standard impression pick-up technique may contribute to reproducing a natural emergence profile of esthetic implant prosthetic restorations (from the provisional to the definitive restoration.) With this technique, implant soft tissues stability around CAD-CAM (computer aided design-computer aided manufacturing) abutments can be easily obtained, and the customized abutment shape may better support the scalloped peri-implant soft tissues architecture, especially in anterior areas.

A prospective, randomized, controlled study using OsseoSpeed™ implants placed in maxillary fresh extraction socket: soft tissues response.

PURPOSE: The aim of this work was to study the peri-implant soft tissues response, by evaluating both the recession and the papilla indexes, of patients treated with implants with two different configurations. In addition, data were stratified by tooth category, smoking habit and thickness of buccal bone wall. MATERIALS AND METHODS: The clinical trial was designed as a prospective, randomized-controlled multicenter study. Adults in need of one or more implants replacing teeth to be removed in the maxilla within the region 15-25 were recruited. Following tooth extraction, the site was randomly allocated to receive either a cylindrical or conical/cylindrical implant. The following parameters were studied: (i) Soft tissue recession (REC) measured by comparing the gingival zenith (GZ) score at baseline (permanent restoration) with that of the yearly follow-up visits over a period of 3 years (V1, V2 and V3). (ii) Interdental Papilla Index (PI): PI measurements were performed at baseline and compared with that of the follow-up visits. In addition, data were stratified by different variables: tooth category: anterior (incisors and canine) and posterior (first and second premolar); smoking habit: patient smoker (habitual or occasional smoker at inclusion) or non-smoker (non-smoker or ex-smoker at inclusion) and thickness of buccal bone wall (TB): TB ≤ 1 mm (thin buccal wall) or TB > 1 mm (thick buccal wall). RESULTS: A total of 93 patients were treated with 93 implants. At the surgical re-entry one implant was mobile and then removed; moreover, one patient was lost to follow-up. Ninety-one patients were restored with 91 implant-supported permanent single crowns. After the 3-year follow-up, a mean gain of 0.23 mm of GZ was measured; moreover, 79% and 72% of mesial and distal papillae were classified as >50%/ complete, respectively. From the stratification analysis, not significant differences were found between the mean GZ scores of implants with TB ≤ 1 mm (thin buccal wall) and TB > 1 mm (thick buccal wall), respectively (P < 0.05, Mann-Whitney U-test) at baseline, at V1, V2 and V3 follow-up visits. Also, the other variables did not seem to influence GZ changes over the follow-up period. Moreover, a re-growth of the interproximal mesial and distal papillae was the general trend observed independently from the variables studied. CONCLUSIONS: Immediate single implant treatment may be considered a predictable option regarding soft tissue stability over a period of 3 years of follow-up. An overall buccal soft tissue stability was observed during the GZ changes from the baseline to the 3 years of follow-up with a mean GZ reduction of 0.23 mm. A nearly full papillary re-growth can be detectable over a minimum period of 2 years of follow-up for both cylindrical and conical/cylindrical implants. Both the interproximal papilla filling and the midfacial mucosa stability were not influenced by variables such as type of fixture configuration, tooth category, smoke habit, and thickness of buccal bone wall of ≤ 1 mm (thin buccal wall).

Soft tissues stability of cad-cam and stock abutments in anterior regions: 2-year prospective multicentric cohort study.

AIM: Aim of this study was to verify if the type of implant abutment manufacturing, stock or cad-cam, could influence the maintenance of stable gingival margins around single restorations in anterior areas. METHODS: After 16 weeks of healing, implants (Osseospeed, Astra Tech Dental Implant) were positioned. Depending on the different fixture inclination and the thickness of buccal peri-implant soft tissue, abutment selection resulted in four groups: Group 1 (patients with zirconia ZirDesign(®) stock abutments), Group 2 (titanium stock TiDesign(®) abutments), Group 3 (zirconia cad-cam abutments), and Group 4 (titanium cad-cam abutments). The following parameters were assessed: buccal gingival margin modification (BGM). The modification of the implant gingival margin was followed at 1 and 2 years of follow-up. A computerized analysis was performed for measurements. Differences between soft tissue margin at baseline and after 2 years measured the gingival margin recession. A general linear model was used to evaluate each group in relation to gingival recession after two years. Tukey's post hoc test was used to compare the mean REC indexes of each group of abutments. RESULTS: Seventy-two healthy patients (39 males and 33 females; mean age of 46 years) scheduled for single gap rehabilitation in anterior areas were enrolled. A 100% of implant survival rate was observed after 24 months of function. One failure occurred due to fracture of a Zirconia cad-cam abutment. Moreover, two abutment screw unscrewing were observed. Both for zirconia and titanium stock abutments (Group 1 and 2), the mean recession of implant buccal soft tissue was of 0.3 mm (SD of 0.3 and 0.4 mm, respectively). Soft tissue mean recession of zirconia and titanium cad-cam abutments (Group 3 and 4) was of 0.1 and -0.3 mm, respectively (SD of 0.3 and 0.4 mm, respectively). REC values of cad-cam titanium abutments (Group 4) were significantly lower than that of Group 1 (-0.57 mm), Group 2 (-0.61 mm), and Group 3 (-0.40 mm), respectively (Table 4). CONCLUSION: In the anterior area, the use of cad-cam abutments is related to a better soft tissue stability. Such a relationship is significant if cad-cam titanium abutments are compared to both titanium and zirconia stock abutments.

Conometric retention for complete fixed prosthesis supported by four implants: 2-years prospective study.

OBJECTIVE: The aim of this study was to verify the reliability of a conometric system for a fixed retention of complete prostheses (CPs) on four implants followed for 2 years. MATERIAL AND METHODS: Twenty-five patients received four implants and only one CPs for a total of 100 implants followed. Each prosthesis was supported by four implants. An immediate loading surgical protocol was used. The CPs were provided to be fixed to conometric abutments without prostheses removal by the patients, to test this retention for a fixed instead of a removable rehabilitation. Clinical and radiographical parameters were assessed at the yearly follow-up visit. A follow-up of 2 years was observed for each patient. Moreover, biological and technical complications were recorded. Changes overtime of clinical and radiographic parameters were analyzed as well as the satisfaction degree for each patient. RESULTS: No patient was classified as "dropout." The following results were observed after 2 years of follow-up: all the implants supporting the 25 CPs completed the follow-up examination. No implant, reconstruction, and abutment failure were recorded; therefore, the prosthetic survival was 100% for all the abutments and restorations. No significant differences in biological indexes were observed when compared with the baseline. No significant change of the mean marginal bone level (MBL) was found between the baseline and the last follow-up. No loss of retention was recorded for the CPs. No technical complications referred to abutments and frameworks were observed: a prosthetic survival rate of 100% can be recorded. Mucositis was recorded for two implants and successfully treated with interceptive supportive therapy. No significant differences (P < 0.05) were found between plaque index and MBi parameters at baseline and after 2 years of function. Similar results were recorded for the mean probing pocket depth Index at baseline (1.2 mm with SD of 0.3 mm) and after 2 years of function (1.2 mm with SD of 0.2 mm). CONCLUSIONS: The present implant-supported conometric retention system can be used to give a fixed retention to a CPs supported by four implants immediately loaded. Furthermore, costs reduction and simplified treatment procedures were provided by such a clinical approach.

Correlation between subjective and objective evaluation of peri-implant soft tissue color.

PURPOSE: While extensive references are present in the literature dealing with the correlation between subjective and objective evaluation of tooth shade, there is a lack of information on this correlation regarding the soft tissue color. The purpose of this experimental study was to verify whether a correlation between the objective and subjective evaluation exists in analyzing soft tissue color. MATERIAL AND METHODS: A total of 39 patients with at least one implant-supported restoration in the anterior maxilla were included in the study. The shade of the peri-implant mucosa was compared with the shade of the gingiva at the adjacent tooth in a subjective and in an objective manner. The subjective evaluation was performed by five dental professionals (prosthodontist, periodontist, general dentist, dental hygienist, and dental assistant) in a subjective scale (ranging from 1 to 4). The objective evaluation was obtained by means of a spectrophotometer in a CIELAB* Color Scale, and the differences were evaluated through formula ΔE=[(ΔL)²+(Δa)²+(Δb)²]¹/². To correlate the subjective and the objective evaluation, for each arithmetical median value of the subjective evaluation, a mean value of objective evaluation has been calculated, and the Spearman's rank correlation coefficient has been used. The differences have been also analyzed for thin and thick tissue biotypes. RESULTS: The mean ∆E value for the subjective evaluation between peri-implant soft tissue and adjacent tooth gingival tissue was ∆E = 9.74. Also, mean ∆E values of 10.35 and 7.54 have been reported for thin and thick biotypes, respectively. Mean values of ∆E = 6.63, 8.54, and 15.54 were presented by median values of 1 (perfect matching), 2 (good matching), and 3 (clinically distinguishable), respectively. The threshold for the distinction of differences of mucosal color by the human eyes between perfect or good matching and distinguishable values has been calculated in ∆E = 8.74. CONCLUSIONS: Within the limitation of this study, a correlation between the subjective and the objective evaluation of the peri-implant soft tissue exists and the threshold for the distinction of mucosal color differences between perfect or good matching and distinguishable subjective values has been calculated in ∆E = 8.74 in the objective evaluation.

Behaviour of soft tissues healing around single bone-level-implants placed immediately after tooth extraction A 1 year prospective cohort study.

AIM: The aim of this study was to verify if the three-dimensional implant position in fresh alveolar socket may influence the maintenance of stable gingival margins around single premolar restorations with immediate implant placement. METHODS: After 16 weeks of healing, implants were loaded with single crowns. Documentation consisted in peri-apical radiographs taken: before treatment; at the time of implant placement; at the time of prosthetic rehabilitation and 12 months after the start of prosthetic function. Parameters assessed were: the presence/absence of inter-proximal papilla; the inter-implant-tooth distance (ITD); the distance from the base of the crown contact-point to the inter-dental bone crest (CPB); and the buccal-gingival tissue modifications. ITD, CPB values and the modification of buccal-gingival tissue were determined using an image processing software. RESULTS: Twenty-one healthy patients with thick gingival biotype, with a total of 21 maxillary premolars scheduled for extractions were enrolled. Following extraction, implants were immediately positioned. A 100% of implant survival rate was observed after 12 months of function. The presence of the mesial papilla was significantly correlated with the mean mesial CPB value (P = 0.0519 by means of two-tailed Mann-Whitney U-test). No significant correlation was found between the mesial papilla presence and the mean mesial ITD score (P = 0.7722 by means of two-tailed Mann-Whitney U-test). Furthermore, the presence of the distal papilla was not significantly correlated with the mean distal ITD and CPB values: scores of 0.7195 and 0.8225 were calculated respectively. CONCLUSION: In the premolar area, the relationship between the presence of a complete inter-proximal papilla and ITD parameter was not significant (P > 0.05). The relationship between the presence of a complete inter-proximal papilla and CPB parameter still remain unclear. Nevertheless, a more large sample size is required to confirm this trend. Moreover, it was observed that the buccal-gingival tissue withdrew in the range 0-1 mm after 1 year of prosthetic function.

Managing the peri-implant mucosa: a clinically reliable method for optimizing soft tissue contours and emergence profile.

STATE OF THE PROBLEM: The proper representation of soft tissue contours for a natural aspect of the peri-implant mucosa and its mimesis with the adjacent teeth is a crucial aspect of the esthetic area restoration. PURPOSE: This paper describes a method for the easy transfer of the peri-implant tissue morphology onto impression material with a view to achieving an accurate, custom implant restoration. The procedure described is suitable both for single and multi-unit implant-supported prostheses. CLINICAL PROCEDURES: Once the peri-implant mucosa is sculpted by the provisional restoration, the emergence profile is duplicated. The implant analog is embedded into laboratory stone or plaster in a mixing cup and allowed to set. The provisional restoration is removed from the oral cavity and screwed to the implant analog; then, a polyether material is placed in the mixing cup so that the provisional restoration is put into impression material at the level of the prosthetic emergence profile. After the polyether polymerizing, the provisional prosthesis is unscrewed and replaced with the stock hexed transfer for the final impression. Next, cold self-curing resin is poured into this gap and left to set. A custom transfer for this single implant site is thus obtained. This modified transfer is then removed and screwed onto the implant in the oral cavity for the definitive impression. CONCLUSIONS: The technique described enables a faithful reproduction of the peri-implant soft tissues and emergence profile. CLINICAL SIGNIFICANCE: An emergence profile that mimics the natural tooth should be obtained by successful esthetic implant restoration. Moreover, it allows proper hygiene, which is fundamental for implant maintenance. The best way to achieve the correct emergence profile is to sculpture the peri-implant mucosa by means of a provisional prosthesis. Prefabricated provisional crowns cannot mimic the complexity and the variations of human soft tissue. Therefore, only a chair-side modification of the provisional restoration can accomplish the optimal result. Such a requirement can be satisfied by the clinical method described in the present report.

CAD/CAM Abutments in the Esthetic Zone: A Systematic Review and Meta-Analysis of Soft Tissue Stability.

Computer-aided design and computer-aided manufacturing customized abutments are increasingly used in everyday clinical practice. Nevertheless, solid scientific evidence is currently lacking regarding their potential advantages in terms of soft tissue stability. The main aim of this systematic review and meta-analysis was to compare the soft tissue outcomes of prefabricated versus customized (CAD/CAM) abutments. The present review was registered with PROSPERO (CRD42020161875) and the protocol was developed according to the PRISMA statement. An electronic search was performed on three databases (PubMed, Embase and Cochrane Central) up to May 2023. Data extraction was followed by qualitative and quantitative analysis of the included studies. Three randomized controlled clinical trials and three controlled clinical trials (number of patients = 230; number of dental implants = 230) with a follow-up of between 12 and 36 months were included. No significant differences were observed between prefabricated versus customized (CAD/CAM) abutments regarding midfacial mucosal recession, interproximal papillae and pink aesthetic score (PES) after 12 months. Conclusion: The potential benefits of CAD/CAM abutments on soft tissues should be better clarified in future investigations. The usage of customized CAD/CAM abutments in everyday clinical practice should be based on a careful case-by-case evaluation (CRD42020161875).

Esthetic management of space and soft tissue deficiencies in implant therapy: combined orthodontic-mucogingival approach.

The esthetic success of a case requiring implant therapy mainly depends on both the correct planning and the surgical-prosthetic execution. However, planning and surgical implementation according to prosthetically guided criteria are not always possible due to contingent anatomical limitations. When this is further complicated by the presence of mucogingival deficiencies in a highly visible esthetic area, the management of the case can become very complex. The present case report describes the presurgical and surgical management of a case of maxillary lateral incisor agenesis in the absence of sufficient vertical space. Through orthodontic therapy, the opening of the deep overbite and the alignment of the maxillary and mandibular arches were obtained, allowing for an implant positioning without compromises dictated by anatomical limitations. Finally, through mucogingival surgery and careful management of the provisional prosthetic phase, an optimal esthetic profile was achieved.

Marginal Bone Maintenance and Different Prosthetic Emergence Angles: A 3-Year Retrospective Study.

The aim of the present retrospective study was to assess marginal bone changes around implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Marginal bone levels (MBL) measured at the prosthesis installation (t0) and at the 3-year follow-up visit (t1) were considered. The MBL change from t0 to t1 was investigated. Two groups were considered: Group 1 for restorations with an angle between implant axis and prosthetic emergence profile >30°, and Group 2 for those with an angle ≤30°, respectively. Moreover, peri-implant soft tissue parameters, such as the modified bleeding index (MBI) and plaque index (PI) were assessed. Seventy-four patients were included in the analysis and a total of 312 implants were examined. The mean EA in groups 1 and 2 was 45 ± 4 and 22 ± 7 degrees, respectively. The mean marginal bone level change (MBL change) of 0.06 ± 0.09 mm and 0.06 ± 0.10 mm were, respectively, in groups 1 and 2. The difference in the MBL change between the two groups was not statistically significant (p = 0.969). The MBL change does not seem to be influenced by the emergence angle for implants with a stable internal conical connection and platform-switching of the abutment diameter.

Association between Peri-Implant Soft Tissue Health and Different Prosthetic Emergence Angles in Esthetic Areas: Digital Evaluation after 3 Years' Function.

BACKGROUND: The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. METHODS: Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. RESULTS: A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI95% -0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. CONCLUSIONS: Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.

Influence of abutment material on the gingival color of implant-supported all-ceramic restorations: a prospective multicenter study.

PURPOSE: The aim of this clinical research on implant-supported restorations is to analyze, through spectrophotometric digital technology, the influence of the abutment material on the color of the peri-implant soft tissue. MATERIAL AND METHODS: Twenty patients received an endosseous dental implant in the anterior maxilla. At the time of each definitive prosthesis delivery, an all-ceramic crown has been tried on gold, titanium and zirconia abutment. After the insertion of each single abutment, the peri-implant soft tissue color has been measured through a spectrophotometer. Also, the thickness of the facial peri-implant soft tissue was measured at the level of the implant neck through a caliper. A specific software has been utilized to identify a specific tissue area and to collect the data before the statistical analysis in Lab* color space. The normality of the quantitative variables was verified by means of the Shapiro-Wilk test. Simple linear correlation between quantitative variables was evaluated by using Pearson's coefficient. The results on the performance of the abutment materials with regard to the color measurements and the overall measurement ΔE were described by computing the least-square means. The significance of differences among types of abutment was verified by means of the Scheffe test for multiple comparisons. RESULTS: For all the abutments used, the color of the peri-implant soft tissue appeared to be significantly different from the one of the contra-lateral tooth (ΔE>8.5). Significantly higher (P<0.05) difference were present with the use of titanium abutments (11 ± 0.4) when compared with the results of gold (8.9 ± 0.4) and zirconia (8.5 ± 0.4) abutments. No correlation has been demonstrated between soft tissue thickness and degree of color difference (P>0.25). CONCLUSIONS: Within the limitation of the present study, the peri-implant soft tissue color appears to be different from the soft tissue color around natural teeth, no matter which type of restorative material is selected. When titanium abutment was selected, significantly higher differences were present than those obtained with gold or zirconia abutments. The thickness of the peri-implant soft tissue did not appear to be a crucial factor in the abutment impact on the soft tissue color.