Clinical and radiographic evaluation of implant-supported single-unit crowns with cantilever extensions: A systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review and meta-analysis was to analyze the clinical and radiographic outcomes of patients rehabilitated using a single implant supporting a crown with a cantilever extension or two implants supporting two single crowns. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines, a systematic review of relevant literature published from 2000 was conducted in the Cochrane Library, Scopus, and MEDLINE databases. Moreover, a manual search was performed. A meta-analysis of the resulting data was carried out. Peri-implant marginal bone level, probing pocket depth, prevalence of technical and mechanical complications, implant survival rate, and prosthesis survival rate were assessed. RESULTS: The meta-analysis showed a non-statistically significant change in the peri-implant marginal bone level and probing pocket depth in the cantilever group and revealed a non-significant prevalence of technical complications, showing a 27% rate in the cantilever group. The analysis of the prosthesis survival rate in the cantilever group showed a mean survival rate of 99% while the comparison of the implant survival between the two groups revealed an odds ratio of 0.50. CONCLUSIONS: The use of a single implant supporting a crown with a cantilever extension does not result in lower implant survival rate if compared with two implants supporting two single crowns. Moreover, a high prosthesis survival rate was observed in the cantilever group even if the high prevalence of complications should be carefully considered by the clinician.

Development and validation of the Italian version of the Orofacial Esthetic Scale (OES-I).

OBJECTIVE: To develop an Italian version of the Orofacial Esthetic Scale (OES-I), validated in a prosthodontic and non-prosthodontic patients' cohort, for clinicians and researchers to use in their practice. MATERIALS AND METHODS: The OES-I was obtained with a process of translation and back translation from the English version of the questionnaire (OES-E). The psychometric properties of the obtained version were then observed in a group of 70 prosthodontic and 70 non-prosthodontic patients. Validity (discriminative and convergent) and reliability (internal and external) were measured. Also, CFA (confirmatory factor analysis) was run, and several models were obtained. RESULTS: The OES-I scores were much higher for patients who were not scheduled for an esthetic prosthodontic treatment (p < 0.05); similarly, the same analysis conducted by a clinicians provided similar results (Pearson's coefficient = 0.93, p < 0.05). Reliability results show that the different items of the questionnaire are consistent within the test (Cronbach alpha = 0.93) and that the obtained results are stable within a reasonable time period (test-retest reliability = 0.98). The Final CFA model showed that OES score can properly characterize orofacial esthetic. CONCLUSIONS: The OES-I is a reliable means both for clinicians and researchers to assess patients' self-perceived esthetic. CLINICAL RELEVANCE: The OES-I can be used effectively for measuring the self-perceived esthetic appearance in all areas of dental practice and research.

Patient preference and clinical working time between digital scanning and conventional impression making for implant-supported prostheses: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The technology behind optical scanners has greatly improved recently, making their dental application advantageous. While their accuracy is now comparable with that of conventional impression materials, whether these techniques have other advantages is unclear. PURPOSE: The purpose of this systematic review and meta-analysis was to determine whether digital scanning for implant-supported restorations is more time-efficient and convenient for the patient. MATERIAL AND METHODS: The study was conducted on September 23, 2020 using 4 different databases (Medline, Cochrane, Web of Science, Scopus) searching for clinical studies that compared the time needed and/or patient perceptions between those who had undergone the digital scanning procedure and those who had undergone conventional impression making. RESULTS: Twelve studies met the inclusion criteria for qualitative and quantitative analysis. Outcome variables were measured as standard mean differences (SMDs) by following a fixed-effects model or random-effects model (in the case of high heterogeneity). Digital scanning was more time-efficient and was preferred by patients for all 4 analyzed outcomes (comfort, anxiety, nausea, time perception). CONCLUSIONS: Digital scanning was found to be more time-efficient and convenient than conventional impression making for implant-supported restorations. Additional randomized controlled trials are needed to confirm the findings of this review.

Proximal Contact Loss in Implant-Supported Restorations: A Systematic Review and Meta-Analysis of Prevalence.

PURPOSE: This is a systematic review and meta-analysis to estimate the overall prevalence of proximal contact loss (PCL) and determine the distribution and clinical features of PCL. METHODS: This systematic review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As this was a systematic review of prevalence, the condition, context, and population framework was followed. The focus question was: What is the prevalence and distribution of PCL in implant-supported restorations? Two investigators independently examined the literature in four databases (Medline, Scopus, Web of Science, and Cochrane) for suitable articles published before November 11, 2020, with no start-date restriction; an additional search was conducted by hand. A standardized data extraction chart was utilized to extract the relevant information from the selected studies. RESULTS: Fifteen studies met the inclusion criteria. A total of 11,699 restorations were evaluated in the final sample. The overall prevalence was 20% at the implant restoration level (among 4984 implants) and 26.6% at the contact point level (among 2603 contact points). The frequency of PCL was higher on the mesial side, both at the implant restoration level (13.8%) and at the contact point level (21.9%), than on the distal side, where the prevalence was 3.3% and 11.0%, respectively. The event rate in the maxilla and in the mandible at the contact level was 21.4% and 21.9%, respectively. CONCLUSIONS: PCL is a frequent complication. Approximately 29% of contact points develop this condition, which may cause food impaction and damage to the interproximal tissues.

Hard and Soft Tissue Evaluation of Different Socket Preservation Procedures Using Leukocyte and Platelet-Rich Fibrin: A Retrospective Clinical and Volumetric Analysis.

PURPOSE: The extraction of a tooth is followed by hard and soft tissue changes that can compromise implant placement. The aim of the present retrospective study was to compare the clinical and radiographic outcomes of different ridge preservation procedures based on the use of leukocyte and platelet-rich fibrin (L-PRF). MATERIALS AND METHODS: The study population consisted of all patients who had undergone surgery from January 1, 2017 to January 1, 2018 for alveolar ridge preservation on single posterior teeth using 3 clinical protocols: L-PRF alone, L-PRF mixed with a bone xenograft, and bone xenograft alone. Clinical and radiographic measures were recorded preoperatively and at 6 months postoperatively to determine the horizontal and vertical ridge resorption. RESULTS: A total of 45 patients were included in the present study. All the surgeries were performed successfully, and no intraoperative complications developed. The L-PRF group experienced significantly greater horizontal and vertical bone resorption. The L-PRF plus bone xenograft group had less vertical and horizontal bone resorption than the bone xenograft alone group. Statistically significant differences in postoperative pain and wound healing were observed, with the bone xenograft alone group, in particular, having higher values for pain and experiencing delayed wound healing. CONCLUSIONS: Within the limitations of the present retrospective study, the use of a bone xenograft alone or L-PRF combined with a bone xenograft to perform alveolar ridge preservation procedures significantly limited bone resorption.

Management of Single Uncomplicated Dental Extractions and Postoperative Bleeding Evaluation in Patients With Factor V Deficiency: A Local Antihemorrhagic Approach.

PURPOSE: The aim of the present study was to analyze the management of single dental extractions and postoperative bleeding in patients with a diagnosis of factor V deficiency. A careful evaluation of each case will allow the team to categorize the risk and operate safely, minimizing the incidence of intraoperative and postoperative complications. If necessary, the oral-maxillofacial surgeon can choose to do so in collaboration with the hematologist on a case-by-case basis. PATIENTS AND METHODS: The present retrospective study included 5 patients with mild congenital factor V deficiency who had undergone at least 1 dental extraction. Mouth rinse with tranexamic acid, nonresorbable sutures, and gelatin sponge packed in the alveolar socket were used to obtain hemostasis. No systemic therapies, such as fresh frozen plasma, platelet concentrate, or recombinant activated factor VII, were administered. RESULTS: Twenty-five teeth were extracted. The factor V plasma levels ranged from 14.1 to 22.4%. Local antihemorrhagic treatments resulted in good hemostasis. No hemorrhagic complications or intraoperative or postoperative major bleeding was observed. CONCLUSIONS: Dental extractions appear to be safe procedures for patients with mild factor V deficiency when a bleeding risk assessment has been performed in conjunction with a hematologist and an appropriate treatment protocol is followed. Our treatment protocol was found to be effective and well tolerated by all the patients.

Latex immunotherapy: evidence of effectiveness.

INTRODUCTION: The only etiological and decisive therapy, able to influence the natural history of latex allergy is the specific desensitization. AIM: To verify the clinical efficacy and immunological changes determined by latex sublingual immunotherapy in allergic patients who underwent this treatment for at least 3 years. MATERIAL AND METHODS: We enrolled 76 patients (16 males and 60 females, mean age 34 years old) with evidence of a natural rubber latex allergy. To assess the effectiveness of the immunotherapy we performed a latex skin prick test, specific IgE and IgG4 and challenge tests before and after at least 3 years of desensitization. RESULTS: We observed a reduction in the mean diameter of the wheal area at the skin prick test and a decrease in latex specific IgE while no significant changes of latex IgG4 values were found. Moreover a reduction of symptoms and scores at the provocation tests were remarked. CONCLUSIONS: Although the primary prevention (which still remains the gold standard treatment for patients suffering from the latex allergy) sublingual immunotherapy can be offered with efficacy in addition to symptomatic treatment to selected patients.

Comparison of Aesthetic, Mechanical Outcome, and Bone Loss in Angulated Screw Channels (ASCs) and Cement-Retained Implant-Supported Prosthesis: A Case-Control Study.

Angulated-screw channels (ASCs) allow the clinician to employ screw-retained restorations in almost all cases, as the access hole can be moved away from the vestibular portion of the crown, where it would jeopardize the final esthetic result. The objective of this study was to compare screw-retained restorations employing ASCs with restorations cemented on angled abutments. In this study, 30 subjects, equally divided into two groups: group 1 (cemented restorations on angulated abutments) and group 2 (screw-retained restorations adopting ASCs), were treated and retrospectively compared after 2 years using the pink esthetic score (PES) and the white esthetic score (WES). All restorations were in use at the last follow-up, with a survival rate of 100%. Three mechanical complications were observed (2 chippings and 1 crown came loose), with a success rate of 93% in group 1 and 87% in group 2 (p > 0.05). No statistically significant differences were reported regarding the esthetic outcome; the marginal bone loss (MBL) showed better results for the screw-retained restorations, both at the distal aspect (group 1 = 0.98 mm ± 0.16; group 2 = 0.45 mm ± 0.06; p = 0.006) and at the mesial aspect (group 1 = 1.04 ± 0.27; group 2 = 0.45 ± 0.005; p < 0.001). From an esthetical perspective, screw-retained restorations with ASCs and cemented restorations on angulated abutments are both effective means of restoring implants; both have excellent esthetic outcomes, but screw-retained restorations have reduced bone loss when compared to cemented ones but are more prone to mechanical complications. Still, our results must be cautiously observed given the reduced dimension of our sample. Larger studies are needed to confirm our findings.

A Comparison of Guided Bone Regeneration vs. the Shell Technique Using Xenogeneic Bone Blocks in Horizontal Bone Defects: A Randomized Clinical Trial.

In cases of severe horizontal atrophy, implant placement requires bone reconstruction procedures. The aim of this randomized controlled trial is to compare the outcomes of bone augmentation with simultaneous implant placement using the shell technique to the outcomes of guided bone regeneration (GBR) in cases of severely horizontal bone atrophy. This study was designed as a monocentric, parallel-group, randomized controlled trial with a six-month follow-up. Among the primary outcomes of this study, peri-implant bone regeneration and peri-implant bone defect closure were selected. Forty-four patients were recruited and equally divided between two groups. In the GRB group, a horizontal regeneration of 2.31 ± 0.23 mm was observed opposed to a horizontal regeneration of 2.36 ± 0.17 mm in the shell group (p = 0.87). A volumetric increase was observed in both groups, with an increase of 0.30 ± 0.12 cm3 in the GBR group and an increase of 0.39 ± 0.09 cm3 in the shell group, highlighting a significant difference between the two groups (p = 0.02). In conclusion, bone augmentation with simultaneous implant placement using the shell technique or guided bone regeneration in horizontal bone atrophy are both predictable therapeutic options.

The Effects of a Mandibular Overdenture on Edentulous Patients' Quality of Life: A Clinical Study.

Edentulous patients' quality of life can be greatly diminished by the use of a badly fitting removable prosthesis, as many aspects of social life become notably impaired. The object of this study was to evaluate if treating these patients with a two implants mandibular overdenture could improve their quality of life as measured with the Italian version of the OHIP-14 (Oral Health Impact Profile). Edentulous patients, in good clinical condition, were selected. Two implants were placed following the recommended guidelines and three months after new mandibular dentures were manufactured, implants were uncovered and connected to the prosthesis using LOCATOR abutments. OHIP-14 was measured at baseline, one month after delivery and one year after delivery. An improvement was observed even after one month (with a mean reduction of 17 points in OHIP) and that improvement appeared to be stable at the one-year follow-up. Mandibular overdentures can improve a patient's quality of life when compared to a tissue-supported removable complete denture, as long as the patient is subjected to an appropriate follow-up as the retentive rings of the attachment can deteriorate even after two years and lose a great deal of retentive capabilities.

The Effect of Diabetes and Hyperglycemia on Horizontal Guided Bone Regeneration: A Clinical Prospective Analysis.

Guided bone regeneration (GBR) is a reconstructive procedure for treating atrophic alveolar ridges. This study aims to assess the correlation between different glycemic control levels and clinical findings in patients undergoing horizontal GBR before implant placement. The study population consisted of all patients requiring horizontal GBR. Patients were divided into three groups based on HbA1c levels: non-diabetic normoglycemic patients (HbA1c < 5.7%), non-diabetic hyperglycaemic patients (HbA1c < 6.5%), and patients with controlled diabetes (HbA1c < 7%). The primary outcomes were the horizontal (mm) and vertical (mm) dimensional changes of the alveolar ridge 6 months after the procedure. The study sample consisted of 54 patients. Sixty-eight implants (95.8%) were classified as "successful," meaning the possibility of inserting a standard-sized implant following the GBR (diameter ≥ 4 mm). There was a statistically significant difference between the three groups in terms of horizontal gain at 6 months: in particular, there was a statistically significant difference between group 1 and group 2 (p = 0.026) and between group 1 and group 3 (p = 0.030). The present investigation showed that patients with HbA1c levels below 7% could undergo GBR and obtain a statistically significant horizontal bone gain.

The Effect of Hyperlipidemia on Peri-implant Health: A Clinical and Radiographical Prospective Study.

High levels of cholesterol and triglycerides may have a negative effect on the immune system and bone health, leading to lower bone mineral density, an increased risk of osteoporosis, and bone fractures, and could therefore also be related to a significant worsening of peri-implant health. The purpose of the following study was to evaluate whether the altered lipid profile in patients who undergo implant insertion surgery represents a prognostic factor capable of influencing clinical outcomes. This prospective observational study was conducted on 93 subjects; patients were required to have taken blood tests to obtain triglycerides (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) levels prior to the surgical procedure to classify them according to current American Heart Association guidelines. The outcomes considered were marginal bone loss (MBL) 3 years after implant placement, full-mouth plaque score (FMPS), and full-mouth bleeding score (FMBS) 3 years after surgery. A statistically significant correlation was found between hypertriglyceridemia and MBL as well as between total cholesterol and MBL. There is no statistically significant correlation between the variables analyzed and the secondary outcomes 3 years after implant placement. Peri-implant marginal bone loss may be influenced by hyperlipidemia. However, further studies are needed, with larger samples and more extensive follow-ups, to confirm these results.

Hard and soft tissue evaluation of alveolar ridge preservation compared to spontaneous healing: a retrospective clinical and volumetric analysis.

PURPOSE: The remodeling process following tooth extraction can be observed as horizontal and vertical bone reduction of the alveolar ridge. Preservation procedures such as alveolar ridge preservation (ARP) aim to maintain the 3D volume of the extraction site. This retrospective study analyzed differences in the hard and soft tissue changes in patients treated with either spontaneous healing or ARP. METHODS: After tooth extraction, the patients were treated either by spontaneous socket healing (SH group) or with ARP using a xenograft and a resorbable membrane (ARP group). One week before and 6 months after extraction, the patients underwent cone beam computed tomography. A volumetric analysis was performed by superimposing the digital models of the two time points. Intraoral radiography was performed after implant placement, upon prosthesis delivery, and at 1-year post-treatment. An esthetic assessment was conducted using the Pink Esthetic Score (PES). The patients' overall satisfaction with the implant restoration was investigated at 12 months. RESULTS: Intragroup comparisons revealed significant differences between baseline and the 6-month follow-up in both groups at the measured locations (1 mm, 3 mm, and 5 mm below the most coronal aspect of the alveolar ridge) showing a reduction of the horizontal width (P < 0.05). Additionally, after treatment, the horizontal width at 1 mm was significantly different in the SH and ARP groups (P < 0.001), with mean changes of 2.03 ± 0.54 mm and 0.86 ± 0.49 mm, respectively. ARP was associated with an increased PES (11.6 ± 2.2) and a reduction in patients requiring additional grafting procedures in subsequent treatment phases (9% vs 26%; P = 0.11). CONCLUSIONS: In both groups, significant horizontal and vertical bone loss was observed after the extraction. ARP can reduce linear and volumetric shrinkage of the alveolar ridge, leading to improved outcomes. It can also simplify implant restoration.

Volumetric Evaluations of Full-Arch Implant Supported Restorations and Their Role on Patients' Quality of Life: A Mixed-Model Analysis.

Introduction: Full-arch, implant-supported hybrid restorations, employing tilted implants, can offer an efficient way of treating edentulous patients. Several factors, such as the timing of implant placement and the inclination of the fixture, can have a detrimental effect on their stability. This retrospective study is aimed at discerning the role played by those factors. Materials and Methods: Patients treated with full-arch, implant supported restorations were selected for this study; cone-beam computed tomography (CBCT) images, taken 3 months and 3 years after delivery of the final restoration, as well as peri-implant values, were obtained and compared; bone loss was measured on four sites for each implant and then averaged. These patients were recalled, and the OHIP-5 questionnaire was administered. Results: 21 patients, with a mean age of 53 years, were included in the present analysis. 108 implants were placed, and 25 Toronto prostheses were delivered. According to a mixed-model analysis, tilted implants (0.51, p < 0.001) had a higher rate of bone loss, while implants placed in a healed ridge suffered less bone loss than immediate implants (-0.21, p < 0.001). Patient-level variables have a significant effect on this variable, as implants coming from the same subject share a similar risk of bone loss. The mean response to the self-administered OHIP-5 questionnaire was 1.53 ± 0.29; other variables did not have a statistically significant effect on this outcome. Discussion/Conclusions. The results of the present study show that Toronto bridges prostheses are an efficient procedure for treating edentulous patients, as their oral-related quality of life is reported as satisfactory even 7 years after delivery of the restoration. Tilted and immediate implants are more at risk of bone loss. Implants coming from the same subject share a similar risk of bone loss.

Implant Placement with Simultaneous Guided Bone Regeneration Using Advanced Platelet-Rich Fibrin and a Deproteinized Bovine Bone Mineral: A 2-Year Retrospective and Comparative Study.

A lack of bone volume may compromise a correct three-dimensional implant placement. This study was designed to evaluate the clinical and radiographic outcomes of simultaneous horizontal guided bone regeneration (GBR) performed using autogenous bone or blood-derived products mixed with a bone xenograft. The study population consisted of patients operated on using one of two clinical protocols for GBR: group A, which used autogenous bone mixed with a bone xenograft, and group B, which used advanced platelet-rich fibrin (A-PRF) mixed with a bone xenograft. The primary outcome was the clinical gain in the peri-implant defect. The secondary outcomes included an analysis of the postoperative healing, periodontal parameters, marginal bone loss, and occurrence of adverse events. All of the surgeries were carried out successfully. One patient in each group experienced a case of early implant loss, and three patients (one in group A and two in group B) presented biologic complications. The mean peri-implant vertical defect heights at baseline in group A and group B were 3.6 ± 0.9 mm and 4 ± 1.5 mm, respectively (P = .382). No statistically significant differences in the mean residual defect heights (P = .521) or in the postoperative wound healing (P = .611) were observed. Stable peri-implant marginal bone levels were recorded after loading in both groups. The use of A-PRF combined with a particulate bone xenograft and covered with a fixed collagen membrane may provide clinical results similar to those obtained via autogenous bone mixed with bone xenograft.

Clinical Comparison of Diode Laser Assisted "v-Shape Frenectomy" and Conventional Surgical Method as Treatment of Ankyloglossia.

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow's classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.

The Effect of an Optimized Diet as an Adjunct to Non-Surgical Periodontal Therapy in Subjects with Periodontitis: A Prospective Study.

Diet and nutrition are generally categorized as modifiable lifestyle risk factors for the development of periodontal disease because diet may influence a person's inflammatory status. This study aimed to evaluate the efficacy of the application of a diet plan focused on reducing inflammation and oxidative stress in treating periodontitis. Subjects suffering from periodontitis were divided into two groups. Both groups underwent non-surgical periodontal therapy, and in the optimized diet (OD) group, this treatment was associated with a diet plan. The sample consisted of 60 subjects; 32 (53%) were treated in the non-optimized diet group (ND group) and 28 (47%) in the OD group. In both groups, the periodontal treatment significantly improved the recorded periodontal outcomes between T0 and T1 (FMPS, FMBS, CAL, PPD). Inter-group differences were not statistically significant (p < 0.05). The linear regression models showed that the optimized diet was associated with a higher reduction in PPD and FMBS after the treatment, while patients who had higher LDL levels (over 100 mg/mL) had a less favorable improvement of PPD. The application of an improved diet plan can increase the reduction in PPD and FMBS after non-surgical periodontal therapy when compared with periodontal treatment alone.

The Application of Angulated Screw-Channels in Metal-Free, Implant-Supported Restorations: A Retrospective Survival Analysis.

Angulated screw channels (ASC) allow the clinician to reposition the access hole of screw-retained restorations, improving the design of the rehabilitation and the esthetic outcome. Few clinical studies are available on the efficacy of these restorations, especially at longer follow-ups and with a large number of subjects. The objective of this study was therefore to retrospectively evaluate patients rehabilitated with screw-retained restorations using ASC. The time of delivery and their adherence to the maintenance program was obtained, as well as the characteristics of the restoration and of the patient's occlusion; a Kaplan-Meier survival curve was then built to investigate the success rate of these restorations and the effects of several variables were evaluated with a Cox model. A total of 105 subjects and 162 implants were enrolled in this study; after 42 months a success rate (92%) similar to what is reported for conventional screw-retained restorations was encountered. Monolithic zirconia restorations (n = 52) had a higher success rate (95%) when compared to partially veneered restorations (n = 53), which suffered a higher number of complications (90%). The other variables had no statistically significant effect. Implant supported prostheses adopting ASC provide a favorable outcome both in the posterior and anterior regions and can therefore be adopted to treat cases where the implant angulation is unfavorable for a conventional screw-retained prosthesis.

The effect of soft tissue augmentation on the clinical and radiographical outcomes following immediate implant placement and provisionalization: a systematic review and meta-analysis.

BACKGROUND: Nowadays, due to the esthetic and social demands of patients, conventional staged protocols seem to be increasingly replaced by faster, one-step protocols. The purpose of the present systematic review is to assess the peri-implant soft tissue changes after immediate implant placement and provisionalization (IIPP) comparing patients treated with or without a sub-epithelial connective tissue graft (SCTG) when replacing a single tooth in the esthetic region. METHODS: The present systematic review was written following the PRISMA checklist. Immediate implants placed with a connective tissue graft and without one were compared. The researched primary outcomes were the mid-buccal mucosa level (MBML) facial soft tissue thickness (FSTT) and marginal bone loss (MBL). The weighted mean differences (WMD) were estimated for all three outcomes. RESULTS: The change in the mid-buccal mucosa level in the intervention group was significantly higher (WMD 0.54; 95% CI 0.33-0.75), with no indication of heterogeneity (I2 = 16%). The facial soft tissue thickness increased significantly in the intervention group (WMD 0.79; 95% CI 0.37-1.22). The marginal bone loss was significantly higher in the control group (WMD 0.13; 95% CI 0.07-0.18), with no indication of heterogeneity (I2 = 0%). CONCLUSIONS: The results of the meta-analyses showed a statistically significant reduced change of the marginal bone loss and vestibular recession, as well as higher soft tissue thickness, when a graft was used. The included studies had a short observation time; therefore, studies with longer follow-ups are needed to confirm these findings.

Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.