Search

BACKGROUND AND OBJECTIVE: Few studies estimated the joint effect of implant design (length and diameter), peri-implant, and occlusal variables on early marginal bone loss. The monitoring of these factors during the first year after implant loading may be effective in preventing early implant failure. This prospective longitudinal study aimed to identify early-predictors of marginal bone loss around morse-tapered connection implants 12 months after implant loading.METHODS: Participants (n = 33) received 109 morse taper implants inserted subcrestally (diameter: 3.5 to 5 mm, length: 6 to 15 mm) loaded with single crowns. Implants were radiographically examined at the implant placement (baseline) and 12 months after prosthetic loading. Implant, peri-implant, and occlusal-related independent variables were analyzed by decision tree analysis. Mixed-effects multilevel analysis was used to estimate adjusted predictive values of marginal bone loss based on the early-predictors identified in decision tree analysis.RESULTS: Higher marginal bone loss was observed at mesial (mean of 0.87 mm; ranged from 0.5 to 1.19) than at distal sites (mean of 0.73 mm; ranged from 0.4 to 1.12 mm). The predictive model revealed of the largest marginal bone loss in association with cement-retained prostheses, a platform diameter of 3.5 mm, papilla sizes up to 2 mm, keratinized mucosa width inferior to 3 mm, implant lengths above 8.5 mm, inadequate occlusal relations, presence of bleeding on probing and deep peri-implant pocket.CONCLUSION: As implant dimensions, peri-implant and occlusal-related factors were associated with early marginal bone loss around morse taper implant, intervention in these factors might prevent early marginal bone loss.

Peri-implant keratinized mucosa (PI-KM) may support implant survival. Acellular collagen matrices (aCMs) have been widely used to facilitate soft tissue regeneration. The aim of this study was to investigate clinical outcomes obtained with the use of an aCM (mucoderm®) to enhance PI-KM. In this retrospective non-randomized case series, 27 restored implants in 14 patients (eight males and six females, mean age = 56 years) with a PI-KM width ≤ 1 mm were followed for 6 months. It was demonstrated that aCM grafts augmented PI-KM effectively (mean increase of 5.4 mm, &gt, 533%) without a significant change in bleeding on probing (BOP) from baseline. The mean aCM shrinkage was 3.9 mm (42%). Gender, area, arch, and BOP did not influence PI-KM augmentation or aCM shrinkage significantly. The present results demonstrated that the examined aCM was effective and predictable for attaining a band of keratinized tissue, while avoiding graft donor site harversting.

In maxillofacial reconstruction implant treatment, unsatisfactory soft tissue treatment of the area around the implant may lead to inflammation. As a result, appropriate soft tissue treatment is critical. To the best of our knowledge, there are no studies that compare the different tissue treatment methods available. Hence, in this study, we compare three soft tissue treatment methods around implants after mandibular reconstruction is achieved with a fibula-free flap. Out of 33 patients who underwent mandible reconstruction using fibula-free flaps between 2006 and 2015, 5 were selected for this study. A total of 17 implants were used for treatment by the final prosthetics of the five patients. Three soft tissue treatment methods with free gingival graft (FGG) were evaluated, namely, installing a splint in a modified abutment to protect the wounded area during a palatal mucosa transplant (method 1), installing a splint or dentures to a locator abutment (method 2), and the use of screw-in fixed dentures (method 3). The method that could guarantee the widest keratinized mucosa was the screw-in fixed denture method. The results of our study indicated that employing screw-in fixed dentures for FGG may be a useful soft tissue treatment for mandible reconstruction implants.

This study presents statistically processed morphometric data on maxillary and mandibular keratinised mucosa height and some clinical considerations. Measurements were performed at incisive, premolar and molar levels, in the maxillary and the mandibular jaws, in 31 patients (21 women and 10 men). The results obtained were centralised and the mean values of the keratinised mucosa height were determined, which were graphically presented. These results were then discussed by comparing with the findings in other studies.

BACKGROUND: This study aims to evaluate the use of the leukocyte- and platelet-rich fibrin (L-PRF) membranes in increasing the width of the keratinized mucosa (KM) around implants. MATERIAL AND METHODS: Eight patients in need for bilateral widening of the KM around implants in the lower jaw were recruited for a spit-mouth randomized controlled trial. At the control site, a free gingival graft (FGG) was used, whereas at the other side (test), L-PRF membranes were applied. The primary outcome was the increase in width of KM around the implants. As secondary outcomes, the postoperative pain and surgical time were assessed. The follow-up period was 6 weeks. RESULTS: A significant increase in the total bucco-lingual width of KM in both groups was observed, with 1.3 mm ± 0.9 extra gain (P

Background The aim of this cross-sectional study was (1) to determine the prevalence of peri-implant mucositis and peri-implantitis and (2) to reveal the risk indicators associated with peri-implant diseases. The second point was to investigate the role of keratinized mucosa on peri-implant health. Materials and methods Three hundred and eighty-two subjects who were treated with 1415 dental implants between 2011–2017 were clinically evaluated. Patients’ medical and dental history, as well as implant details, were recorded. Peri-implant examination included probing pocket depth (PPD), bleeding on probing (BoP), plaque index (PI), gingival index (GI), and keratinized tissue width. Furthermore, the patient (sex, age, and smoking) and implant/prosthesis-related factors (surface characteristic, time in function, design of prosthesis etc.) were evaluated. Implants were classified into three groups: healthy, peri-implant mucositis, and peri-implantitis. Uni- and multi-variate regression analyses were utilized for statistics. Results 41.1% (n = 157) and 36.9% (n = 84) of patients had mucositis and peri-implantitis, respectively. 53.6% (n = 758) of implants (95%CI 80.2–90.4) had mucositis, and 21.7% (n = 307) had peri-implantitis. Patients with a maintenance < 2/year (OR = 2.576), having periodontitis (OR = 3.342) and higher PI (OR = 3.046) had significant associations with the development of peri-implant mucositis. Significant ORs were determined for peri-implantitis with patients having maintenance < 2/year (OR = 2.048), having number of implants ≥ 4 (OR = 2.103), diagnosed with periodontitis (OR = 3.295), and higher PI (OR = 7.055). Keratinized tissue width < 2 mm (ORs = 5389/8.013), PPD (ORs = 1.570/8.338), PI (ORs = 6.726/5.205), and BoP (ORs = 3.645/4.353) independent variables were significantly associated with both peri-implant mucositis and peri-implantitis at implant level, respectively. Conclusions Within the limits of this study, the prevalence of mucositis and peri-implantitis was shown to be high in Turkish population. Furthermore, increased risk for peri-implantitis was identified in patients having maintenance < 2/year, presence of periodontitis, poor plaque control, and having number of implants ≥ 4. Less keratinized tissue (< 2 mm), PPD, and BoP were also risk indicators for peri-implantitis development.

Peri-implant soft tissues play a role of paramount importance, not only on the esthetic appearance, but also on the maintenance and long-term stability of implants. The present report presents the conclusions from the Consensus Conference of the South European North African Middle Eastern Implantology & Modern Dentistry Association (SENAME) (4–6 November 2016, Cairo, Egypt). The conference focused on the topic of the soft tissue around dental implants, and in particular, on the influence of implant configurations on the marginal soft tissues, soft tissue alterations after immediate, early or delayed implant placement and immediate loading, the long-term outcomes of soft tissue stability around dental implants, and soft tissue augmentation around dental implants. Thirty world experts in this field were invited to take part in this two-day event; however, only 29 experts were in the final consensus voting process.

In implant therapy, the adequate state of peri-implant tissue health and soft-tissue aesthetics is the essential criterion of restorative success. The need for keratinized mucosa for the maintenance of peri-implant health and soft-tissue integration remains a debated issue. The aim of this paper is to provide a narrative review of the current literature concerning the significance of keratinized mucosa with respect to the clinical parameters of monitoring oral hygiene practice and tissue status. The published studies revealed that there were conflicting results with regard to the influence of keratinized mucosa on plaque score and soft-tissue inflammation. Most studies showed that the amount of soft-tissue recession was significantly increased at implant sites with narrow keratinized mucosa, but the amount of keratinized mucosa had little effect on deepening of peri-implant pockets. The evidence related to the effect of keratinized mucosa on the changes of attachment or bone levels is limited, and conclusions could not be drawn at present. Further, this review found that a band of keratinized mucosa was not absolutely necessary for the maintenance of peri-implant tissue, whereas lack of adequate keratinized mucosa around the implant might impede proper oral hygiene performance and compromise the aesthetic results. In conclusion, because there is a wide variety of clinical features in patients pursuing implant therapy, individual consideration of treatment strategies for the patient with minimal keratinized mucosa is recommended.

Objective: The aim of this research was to investigate the clinical conditions around dental implants placed in the posterior mandible of healthy or moderately periodontally compromised patients, in relation to the presence or not of keratinized mucosa (KT). Materials and methods: One hundred and twenty-eight patients who needed an implant in the posterior mandible were consecutively enrolled in a private specialist practice. Only one implant per patient was examined originally placed either within KT or alveolar (AM) mucosa. At 10 years, clinical and radiographic measures were recorded by a calibrated operator. The number of sites treated according to therapy modalities C and D (antibiotics and/or surgery) during the 10 years was also registered. Results: Ninety-eight patients completed the 10-year study. The absence of KT was associated with higher plaque accumulation, greater soft-tissue recession (REC), and a higher number of sites that required additional surgical and/or antibiotic treatment. Patient-reported outcomes regarding maintenance procedures presented major differences between the groups. In 11 of the 35 AM cases, additional free gingival graft (FGG) was successfully employed to reduce discomfort and to facilitate optimal plaque control. Conclusion: Implants that are not surrounded by KT are more prone to plaque accumulation and REC, even in patients exercising sufficient oral hygiene and receiving adequate supporting periodontal therapy (SPT). In selected cases, particularly in the edentulous posterior mandible, where ridge resorption leads to reduced vestibular depth and lack of KT, additional FGG can be beneficial to facilitate proper oral hygiene procedures.

Objective The aim of this study was to analyze clinical and microbiological characters in subjects and implants affected and not affected by peri-implantitis. Additionally, same features were analyzed also intra-individually, comparing healthy and diseased implants within the same subject. Materials and methods A total of 534 patients who received at least 1 implant and coming to routine check-up or spontaneous visits at the University of Valencia were recruited. Clinical parameters including Bleeding on probing (BoP), Probing pocket depth (PPD), and Pi were screened. Samples for microbiological analysis were obtained from three locations: peri-implant sulci (PIS), inner parts of the implant connections (I), and gingival sulci of neighboring teeth (GS). Quantitative real-time PCR was performed for total counts of 10 microorganisms. Results A total of 534 patients with 1507 dental implants were analyzed. The prevalence of peri-implantitis was found 10.3% for patients and 7.3% for implants. Higher percentage of healthy periodontal subjects were found in the non-peri-implantitis group. The analysis within the 53 patients affected by peri-implantitis revealed that the implants affected by peri-implantitis presented a higher percentage of plaque, BoP, and number of implants presenting

The frenum exerts a pull upon the tissue and can lead to the continuation of the lesion, and the keratinized tissue provides increased resistance to the periodontium. Various techniques have been used to deepen the vestibule and increase the keratinized mucosa. However, there is no case report on correcting the frenal pull and increasing the keratinized mucosa around dental implant using denudation procedure. This article presents a case of frenal pull that was corrected with denudation procedure with the incision line within the keratinized tissue.

Background This retrospective study evaluated soft-tissue grafting as a surgical treatment option for peri-implantitis in case of unsuitable basic skeletal morphology of the alveolar bone and lack of keratinized mucosa. Methods Twenty-eight patients (21 females, 7 males, at a mean age 59.4 years) were included with a total of 54 implants. All implants showed peri-implantitis and attached keratinized buccal mucosa of ≤2 mm. A surgical procedure of soft-tissue grafting (STG) was made by inserting an inlay and inlay-onlay transplant. Clinical investigations were made prior to the STG (baseline) and after 9–180 months (Ø 43 months) including the following parameters: soft-tissue biotype, skeletal basic morphology of the alveolar bone, width of the peri-implant keratinized mucosa (KM), mobility of the KM, pocket probing depth (PPD), and bleeding on probing (BOP). Results Nearly all patients showed a thin soft-tissue biotype. The analysis of the skeletal basic morphology of the alveolar bone revealed a narrow apical base in 18 patients, middle base in 7 patients, and broad base in 3 patients. Width of the KM increased significantly (p

Aim The aim of this study was to evaluate the outcome of a soft tissue dehiscence coverage technique, at single non-submerged implant sites, presenting shallow isolated buccal mucosal recession. Material and Methods Sixteen patients were included in this prospective study. A connective tissue graft (CTG) was harvested from the maxillary tuberosity. The donor soft tissue was de-epithelialized and trimmed with a mucotome for an optimal adaptation to the collar of the implant. Results Surgery and healing proceeded with no complications and minimal post-operative discomfort. One-year follow-up demonstrated clinical and esthetic improvements. Treatment resulted in 89.6 ± 13.1% mean coverage, and complete implant soft tissue coverage was achieved in nine of 16 cases, corresponding to a 56.3%. The VAS esthetic analysis showed a significant improvement from 3.6 ± 0.2 to 8.5 ± 0.3. Conclusions These positive preliminary results suggest that, by means of the surgical technique presented, buccal soft tissue dehiscences around single implants can be successfully treated. Additional Randomized controlled trials (RCTs) should be encouraged to assess the most effective variation to the technique in the various clinical situations and around implants of different designs.

Made available in DSpace on 2016-01-28T16:53:47Z (GMT). No. of bitstreams: 0 Previous issue date: 2012. Added 1 bitstream(s) on 2016-01-28T17:00:54Z : No. of bitstreams: 1 ISSN1807-2577-2012-41-05-365-369.pdf: 12813904 bytes, checksum: 9cdd52b5d6a8c3c5411d5cb58eaa4f76 (MD5) Introdução: Estudos recentes são direcionados a explorar a relação da faixa da mucosa queratinizada com a saúde dos tecidos peri-implantares. Quando esta faixa não é suficiente, uma cirurgia para o aumento de mucosa queratinizada pode ser indicada, pois tem sido relatado que a presença ou a reconstrução de tecido queratinizado ao redor de implantes pode facilitar os procedimentos restauradores, promover a estética e ainda permitir a manutenção de uma higienização oral rotineira sem irritação ou desconforto ao paciente. Dentre os procedimentos cirúrgicos disponíveis, a técnica do enxerto gengival livre é consagrada na literatura periodontal para aumento da faixa de mucosa queratinizada. Objetivo: Este estudo relata um caso clínico em que foi realizada cirurgia de enxerto gengival livre com objetivo de aumentar a faixa da mucosa queratinizada na região de implantes previamente instalados na maxila, para suporte de prótese tipo protocolo. Relato do caso: Foi realizada a cirurgia de enxerto gengival livre na região anterior da maxila, obtido do palato, na qual haviam sido instalados implantes osseointegrados para suporte de prótese tipo protocolo e a mucosa peri-implantar apresentava-se sem tecido queratinizado e inflamada. Após dois meses de reparação da cirurgia mucogengival, foi possível observar que o enxerto gengival livre favoreceu a saúde peri-implantar e os procedimentos protéticos de moldagem. Conclusão: Diante dos resultados clínicos, pode-se concluir que o enxerto gengival livre é uma técnica previsível e de fácil realização para aumento da faixa de mucosa queratinizada em mucosa peri-implantar de prótese protocolo. Introduction: Recent studies have evaluated the relationship between the width of keratinized mucosa and peri-implant tissue health. Insufficiently wide keratinized tissue can be increased surgically, for example by free gingival grafting. The presence or reconstruction of keratinized tissue around the implant can facilitate restorative procedures, promote aesthetics and allow the maintenance of an oral hygiene routine without irritation or discomfort to the patient. Objective: To describe a patient who underwent free gingival graft surgery to increase the width of keratinized tissue in the region of previously implants to support a type of prosthetic protocol. Case report: A patient who had received dental implants to support a type of prosthetic protocol presented with inflamed peri-implant mucosa, but with no keratinized tissue. Free gingival tissue was obtained from the palate and grafted into the anterior maxilla. Sixty days after muco-gingival surgery, we observed that the free gingival graft favored peri-implant health and prosthetic casting. Conclusion: The free gingival graft technique is both easy to perform and effective in increasing the width of keratinized mucosa following implantation. Universidade do Oeste Paulista, Departamento de Periodontia, Faculdade de Odontologia Universidade Estadual Paulista, Departamento de Cirurgia e Clínica Integrada, Faculdade de Odontologia de Araçatuba

Purpose: To assess the long-term stability of gingival grafts placed around dental implants at the time of second surgery uncovering and to further investigate the association between mucosal thickness (MTh) by demographic variables and clinical investigation. Materials and Methods: Fourteen patients with submerged dental implants covered by inadequate keratinized mucosa were studied. The subjects underwent a periimplant plastic surgery (PPS) at the second-stage dental implant surgery and free gingival autograft orsubepithelial connective tissue graft were used according to the patients′ clinical situation. Clinical measurement of MTh was assessed by bone sounding with a periodontal probe using customized acrylic stents andthe values were recorded at baseline (day of graft) and at 0.5, 1.5, 4, 12, 24 and 36 months after grafting. Results: At 12 months postoperatively, the mean MTh was 2.89 mm, with a mean additional increase of 1.75 mm when compared with baseline (P=0.0001). No statistically significant differences in MTh were found between the 12- and the 36-month observations (P=0.09). In addition, at 36 months, a thin mucosa was associated with a greater increase in the MTh compared with a thick mucosa (2.14 and 0.64 mm, respectively, P=0.006). Similarly, the mandibular sites were associated with a greater increase in the MTh in comparison with the maxillary sites (2.17 and 0.81 mm, respectively; P=0.02). Conclusions: Within the limitations of this investigation, the data suggest that PPS at the second-stage dental implant surgery could results in additional increases in MTh, especially when it is performed in areas where the mucosa is of a thin biotype.

Background Long-term data concerning the impact of missing keratinized mucosa (KM) on periimplant tissue health are rare. The importance of KM for implant success remains unclear. Methods Two hundred eleven patients with 967 dental implants were analyzed up to 15 years after implant placement. Implants were divided into two groups: no keratinized mucosa (NKM) and KM. Evaluated parameters were plaque index (mAPI), bleeding index (mSBI), bleeding on probing (BOP), probing depth (PD), width of KM, and radiographic vertical bone level. Results mAPI, mSBI, and BOP were significantly higher for the NKM group. Implants of both groups showed no significant difference in PD and vertical bone level. Of the implants in the posterior regions (n = 261), 40.3% (regions 37 to 34, 44 to 47, 27 to 24, 17 to 14) showed NKM, whereas 30.4% of the implants in the anterior regions (regions 13 to 23; regions 33 to 43) presented NKM (n = 97). Conclusions Results indicate that the presence of KM has a positive effect on periimplant tissue health, but does not seem to have an influence on the periimplant bone level.