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Purpose: To evaluate the peri-implant soft and hard tissues of dental implants placed in vertically regenerated posterior mandibles with intraoral onlay block bone grafts and patient satisfaction at 3-year follow-up. Materials and Methods: A retrospective study of patients with dental implants placed in posterior mandibular sites vertically augmented with intraoral onlay block bone grafts was carried out between 2005 and 2009 at the University of Valencia. The outcomes assessed at the 3-year follow-up visit were the peri-implant soft tissues (Plaque Index and Bleeding Index, probing depth, keratinized mucosa width, and recession), implant survival and success rates, marginal bone loss, and patient satisfaction. Results: Sixteen patients with 36 implants were included. The mean Plaque Index and Bleeding Index scores were ≤ 0.4. The mean band of facial keratinized mucosa was ≥ 3 mm in 52.7% of implants; 38.8% of the implants showed facial recession. The mean midfacial recession was -0.31 ± 0.75 mm. Implant survival reached 100%, while the success rate was 85%, and the mean marginal bone loss was 1 ± 1.03 mm (range: 0.1 to 5.3). Good quality of life (9.19 ± 0.40) was reported for all patients, and the overall general satisfaction score was 8.07 ± 1.04 (mucosa esthetics: 7.71 ± 1.45; prosthesis esthetics: 8.42 ± 0.6; chewing: 8.68 ± 0.94; ease of cleaning: 8.01 ± 1.03). Conclusion: Considering the limitations of the study, implants in vertically augmented posterior mandibular areas with intraoral onlay block bone grafts showed good soft tissue levels and high patient satisfaction. No implants were lost at 3 years postloading, though one-fifth of the patients showed a statistically significant marginal bone loss. [ABSTRACT FROM AUTHOR]

Purpose: To correlate soft tissue thickness and peri-implant bone remodeling of platform-switching implants. Materials and Methods: This comparative prospective trial evaluated, for up to 3 years after implant loading, the influence of soft tissue thickness on changes in peri-implant marginal hard tissue levels. Any patient who was partially edentate in the mandible and required at least two adjacent implant-supported restorations was recruited at the University of Valencia in Spain. A 3-mm tissue punch biopsy, which corresponded to a diameter slightly smaller than the coronal diameter of the implants, was performed using a circular mucotome. Afterward, implants with a length of 10 to 13 mm and a diameter of 3.8 mm were inserted. Outcome measures were implant and prosthesis survival rates, marginal hard tissue changes, any complications, and results of morphologic and histomorphometric analyses. Correlation between mucosa width components (epithelium, connective tissue, and epithelium and connective tissue) and radiographic bone loss at 1 and 3 years after loading was performed at the patient level. Statistical significance was set at P ≤ .05. Results: A total of 26 samples in 26 patients with 68 implants were analyzed. The specimens were divided into two groups: group 1 (16 patients, 40 implants), with thin mucosa (≤ 2 mm), and group 2 (10 patients, 28 implants), with thick mucosa (> 2 mm). Two dropouts (two specimens) were recorded at the 3-year follow-up. None of the implants or definitive prostheses failed during the healing period, resulting in an overall implant and prosthesis cumulative survival rate of 100%. No major biologic or mechanical complications were recorded. The mean (standard deviation, SD) epithelium thickness was 430.33 (250.21) μm; the mean (SD) connective tissue thickness was 1,324.31 (653.46) μm, and the mean (SD) mucosa thickness was 1,751.29 (759.53) μm. Comparisons of radiographic bone loss between group 1 and group 2 failed to show any statistically significant differences at the 1-year (P = .290) or 3-year (P = .090) follow-up examinations. Conclusion: The initial mucosa thickness surrounding a bone-level platform-switching implant seems not to influence the pattern of physiologic marginal bone loss. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to investigate peri-implant and intraconnection microflora of healthy implants restored with cemented and screwed superstructures.Methods: Patients with two to three implants restored with cemented or screwed restorations and 5 years of follow-up were recruited. Samples were taken from peri-implant sulci, adjacent teeth, and the inner portion of connections. Prevalence of positive sites and bacterial loads for 10 microorganisms were obtained with quantitative real-time polymerase chain reaction. Implant connection permeability to the studied microorganisms was estimated using a standardized bacterial contamination index. Statistical analysis was performed using a generalized estimating equations model, Wald χ(2) test, and the least significant difference test.Results: The final sample consisted of 18 patients (55 implants) in the cemented group and 22 patients (46 implants) in the screw-retained group. Regarding prevalence of positive sites, significant differences between groups were only found for Tannerella forsythia, which was 8.7 times more frequent at peri-implant sulci of cemented than screw-retained prostheses. Bacterial loads of Porphyromonas gingivalis, T. forsythia, Parvimonas micra, and total bacterial load were significantly higher at peri-implant sulci for the cemented group; at the inner portion of connections, values were significantly higher for P. micra and Fusobacterium nucleatum for the screw-retained group. Contamination index values demonstrated higher permeability to most microbes in the cemented group.Conclusions: Internal implant surfaces were microbiologically contaminated for both cemented and screw-retained superstructures. Differences were found between the two methods of prosthetic retention: the cemented group presented significantly higher bacterial loads in the peri-implant sulcus but significantly lower bacterial loads at the inner portion of the implant connection. [ABSTRACT FROM AUTHOR]

Purpose: To report 20 cases with implant periapical pathology diagnosed during the osseointegration phase, evaluating retrospectively the efficacy of the treatment with implant periapical surgery., Materials and Methods: A retrospective chart review was conducted of all patients in whom implant periapical surgery was performed between 1996 and 2010. The criteria for diagnosing implant periapical pathology and, accordingly, performing implant periapical surgery were: (1) acute pain during the osseointegration period (8 weeks after implant placement) located in the area of the affected implant or presence of mucous fistula in relation with the implant apex; (2) absence of implant mobility; (3) non-dull percussion of nonsubmerged implants; and (4) presence or absence of implant periapical radiolucency., Results: Twenty-two implants were diagnosed with periapical pathology in 20 patients (13 women and 7 men) with a mean age of 54.3 years (range, 32 to 70 years) and were consecutively treated by a surgical approach. In 19 implants, the diagnosis was acute apical peri-implantitis (nonsuppurated in 7 cases and suppurated in 12), as based on the symptoms and radiographic sign, and in 3 cases it was subacute apical peri-implantitis, as based on the presence of a fistula. After a minimum follow-up of 1 year, 20 implants remained functional, with no clinical or radiologic alterations; the survival rate of the treated implants was 91%., Conclusion: The early diagnosis of inflammatory implant periapical lesions during the osseintegration phase, and their prompt surgical treatment, led to a survival rate of the treated implants of 91%.