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Distraction osteogenesis (DO) is the latest addition to the variety of alveolar ridge augmentation procedures used to increase the volume of bone prior to implant placement. Thirty DO procedures were performed in 30 patients using 17 intraosseous and 13 extraosseous devices to augment deficient alveolar ridges. Fifty-five implants placed in the distracted bone were followed for a period of 34 to 60 months after loading. Five implants failed, for a 90.9% success rate. Vertical augmentation ranged from 3.5 to 13.0 mm (average, 7.8 mm). At least one complication was encountered, requiring additional hard or soft tissue surgery, in each of the 30 reported cases. This paper reviews complications encountered in the DO-treated patients, suggesting solutions and measures to prevent these problems. [ABSTRACT FROM AUTHOR]

The present study reports on the results of the use of a screw-retained narrow-diameter implant (NDI) system as an option for implant placement in areas of limited bone volume. This retrospective report followed 48 NDIs in 27 patients for 1 to 5 years postloading. No implant failures were reported, yielding a 100% survival rate. The screw-retained attribute of this system allows retrievability of the restorations, which may require replacement because of porcelain fracture, chipping, or a desire to change color. The three diameters available--1.8 mm, 2.2 mm, and 2.4 mm--allow flexibility for a variety of narrow edentulous spaces. These NDIs present a cost-effective alternative for restoring limited spaces with implant restorations, without the bone augmentation or orthodontic procedures required for conventional fixed restorations. The NDI system is approved by the U.S. Food and Drug Administration for long-term use. [ABSTRACT FROM AUTHOR]

PURPOSE: In this prospective multicenter clinical study, 1,179 3i standard threaded and self-tapping implants were followed for up to 6 years and monitored according to established success criteria. MATERIALS AND METHODS: A total of 493 patients (240 men and 253 women) with a mean age of 45.1 years at implant surgery were enrolled at 6 research centers after being screened for exclusion criteria. Implants were placed according to a 2-stage surgical protocol with a minimum of 4 months of submerged healing in the mandible and 6 months in the maxilla. Restorations included 633 prostheses, the majority of which were fixed partial dentures in the posterior mandible or maxilla or single-tooth replacements in the anterior maxilla. RESULTS: One hundred four implants (8.8%) did not meet success criteria and were designated as failures, and 222 implants (18.8%) were lost to follow-up. The cumulative success rate according to life table methods was 91.1% at 6 years. DISCUSSION: Sixty percent of the failed implants were short (< or = 10 mm long), and their cumulative success rate as a group at 6 years was 89.0%, compared to 93.1% for longer implants (P < .05). Thirty-three percent of all failures were implants placed in the posterior maxilla, for a 5-year cumulative success rate of 87.4%. CONCLUSION: It appears that limited bone dimensions and poor-quality bone have an impact on the performance of these machined-surface implants. [ABSTRACT FROM AUTHOR]

Peri-implant diseases affecting the surrounding structures of endosseous dental implants include peri-implant mucositis and peri-implantitis. The prevalence of peri-implantitis ranges between 15% and 20% after 10 y, highlighting the major challenge in clinical practice in the rehabilitation of dental implant patients. The widespread nature of peri-implant bone loss poses difficulties in the management of biological complications affecting the long-term success of osseointegrated implant reconstructions. Metal and titanium particles have been detected in peri-implant supporting tissues. However, it remains unclear what mechanisms could be responsible for the elicitation of particle and ion release and whether these released implant-associated materials have a local and/or systemic impact on the peri-implant soft and hard tissues. Metal particle release as a potential etiologic factor has been intensively studied in the field of orthopedics and is known to provoke aseptic loosening around arthroplasties and is associated with implant failures. In dental medicine, emerging information about metal/titanium particle release suggests that the potential impact of biomaterials at the abutment or bone interfaces may have an influence on the pathogenesis of peri-implant bone loss. This mini-review highlights current evidence of metal particle release around dental implants and future areas for research. [ABSTRACT FROM AUTHOR]

Background: The regeneration of gingival papillae after single-implant treatment is an area of current investigation. This study was designed to determine: 1) whether the distance from the base of the contact point to the crest of the bone would correlate with the presence or absence of interproximal papillae adjacent to single-tooth implants, and 2) whether the surgical technique at uncovering influences the outcome. Methods: A clinical and radiographic retrospective evaluation of the papilla level around single dental implants and their adjacent teeth was performed in the anterior maxilla in 26 patients restored with 27 implants. Six months after insertion, 17 implants were uncovered with a standard technique, while 10 implants were uncovered with a technique designed to generate papilla-like formation around dental implants. Fifty-two papillae were available for clinical and radiographic evaluation. The presence or absence of papillae was determined, and the effects of the following variables were analyzed: the influence of the 2 surgical techniques; the vertical relation between the papilla height and the crest of bone between the implant and adjacent teeth; the vertical relation between the papilla level and the contact point between the crowns of the teeth and the implant; and the distance from the contact point to the crest of bone. Results: When the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was > or = 6 mm, the papilla was present 50% of the time or less. The mean distance between the crest of bone and the most coronal papilla level (interproximal soft tissue height) was 3.85 mm (SD = 1.04). When comparing the conventional and modified surgical technique, the relation shifted from 3.77 mm (SD = 1.01) to 4.01 mm (SD = 1.10), respectively. Conclusions: These results clearly show the influence of the bone crest on the presence or absence of papillae between implants and adjacent teeth. The data also show a positive influence for the modified surgical technique, aimed at reconstructing papillae at the implant uncovering. [ABSTRACT FROM AUTHOR]

Background: The biologic width around implants has been well documented in the literature. Once an implant is uncovered, vertical bone loss of 1.5 to 2 mm is evidenced apical to the newly established implant-abutment interface. The purpose of this study was to evaluate the lateral dimension of the bone loss at the implant-abutment interface and to determine if this lateral dimension has an effect on the height of the crest of bone between adjacent implants separated by different distances. Methods: Radiographic measurements were taken in 36 patients who had 2 adjacent implants present. Lateral bone loss was measured from the crest of bone to the implant surface. In addition, the crestal bone loss was also measured from a line drawn between the tops of the adjacent implants. The data were divided into 2 groups, based on the inter-implant distance at the implant shoulder. Results: The results demonstrated that the lateral bone loss was 1.34 mm from the mesial implant shoulder and 1.40 mm from the distal implant shoulder between the adjacent implants. In addition, the crestal bone loss for implants with a greater than 3 mm distance between them was 0.45 mm, while the implants that had a distance of 3 mm or less between them had a crestal bone loss of 1.04 mm. Conclusions: This study demonstrates that there is a lateral component to the bone loss around implants in addition to the more commonly discussed vertical component. The clinical significance of this phenomenon is that the increased crestal bone loss would result in an increase in the distance between the base of the contact point of the adjacent crowns and the crest of bone. This could determine whether the papilla was present or absent between 2 implants as has previously been reported between 2 teeth. Selective utilization of implants with a smaller diameter at the implant-abutment interface may be beneficial when multiple implants are to be placed in the esthetic zone so that a minimum of 3 mm of bone can be retained between them at the implant-abutment level. [ABSTRACT FROM AUTHOR]

13 teeth in block were extracted from 2 patients. Their facial periodontal condition was essentially within normal clinical limits. Temporary crowns covering the bevel were placed below the, base, of the crevice 1 to 8 weeks prior to extraction. At time of extraction, all blocks were decalcified, the temporary crown dissolved, and the blocks prepared for histologic examinations using bucco-lingual cut, step serial sections. Histologic data revealed reformation of a new supracrestal attachment unit within 1 week following crown placement. The reformation of the gingival unit consisted of marginal recession with apical and lateral migration of the junctional epithelium to the level of remaining cementum inserted fibers. With gingival recession and migration of junctional epithelium, resorption of crestal portions of the facial plate occurred. However, periodontal fibers anchored into cementum opposite the resorbed bone were not lysed. Rather, the attached fibrillar ends appeared to interdigitate with fibers from the corium of the facial gingiva at this site, thereby forming a more apically located crestal attachment. This response may be one mechanism of reformation of the gingival attachment unit taking place following mechanical and/or surgical injury to this site and is completed often, within 2 weeks after injury. [ABSTRACT FROM AUTHOR]

A maxillary central incisor in a 55-year-old Caucasian female was extracted in modified block as part of a histologic study of gingival responses to subgingival crown placement. The facial portion of this block showed preclinical pocket depth of 1.0 mm with moderate gingival inflammation. The block was extracted 2 weeks after crown placement and prepared for histologic evaluation. Histologic responses to subgingival crown placement were, among others: gingival recession (1.0 mm), reformation of crevicular depth (0.7 mm) and remodelling of the gingival and periodontal attachment apparatus. Histologic evaluations of the gingival unit using cellular and connective tissue stains revealed an area of root resorption immediately apical to the junctional epithelium at a portion of the facial surface. Root resorption had progressed into dentin. Gingival connective tissue abutted the dentinal surface. Collagen stains showed the presence of tufts of collagen fibrils which appeared to arise from the dentin. These fibrillar elements seemed to splice with collagen fibrils found in the gingival connective tissue. The specimen thus suggests the possibility of a fiber linkage attachment involving exposed dentinal fibers as part of gingival repair following injury. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the repair response of bioactive glass synthetic bone graft particles and open debridement in the treatment of human periodontal osseous defects. Fifty-nine defects in 16 healthy adults were selected. Each patient had at least 2 sites with attachment loss of at least 6 mm with clinical and radiographic evidence of intrabony or furcation defects. One to 3 months after cause-related therapy (oral hygiene instructions, scaling and root planing), the following measurements were recorded prior to surgery: probing depths, clinical attachment level, and gingival recession. Each defect was surgically exposed and measurements made of the alveolar crest height and base of osseous defect. The test defects were implanted with bioactive glass. The other sites served as unimplanted controls. Flaps were sutured at or close to the presurgical level. Radiographs and soft tissue presurgical measurements were repeated at 6, 9, and 12 months. At 12 months all sites were surgically re-entered to record osseous measurements. At the 12-month evaluation, significantly greater mean probing depth reduction was noted in the bioactive glass group compared to the controls (4.26 mm versus 3.44 mm; P = 0.028). Clinical attachment level gain was significantly improved (P = 0.0004) in the bioactive glass sites (2.96 mm) compared to the control sites (1.54 mm). There was significantly less gingival recession in the bioactive glass sites (1.29 mm) compared to the control sites (1.87 mm). Defect fill was significantly greater in the bioactive glass sites (3.28 mm) compared to the control sites (1.45 mm). Defect depth reduction was significantly greater in the bioactive glass sites (4.36 mm) compared to the control sites (3.15 mm). In conclusion, bioactive glass showed significant improvement in clinical parameters compared to open flap debridement. [ABSTRACT FROM AUTHOR]

The author comments on increasing prevalence and management of peri-implantitis. Topics discussed include no perfection in restorations supported by dental implants, average amount of bone loss for implants that had peri-implantitis, tissue-level implant system would have less bone loss, and implants restored by general practitioners have a much higher rate of periimplantitis.

Purpose: To determine the effect of restorations with long contact areas for the management of interdental papilla deficiencies, in smile attractiveness among laypersons and dentists., Material and Methods: A full-portrait image was used to create a set of digitally modified images, simulating the management of various levels of interdental papilla loss. In a total of 48 modified images, single as well as multiple loss of interdental papilla among the anterior teeth, treated with a single or multiple restorations were simulated for unilateral and bilateral situations. Through a digital monitor 160 laypeople and dentists were asked to assess the attractiveness of each displayed image utilizing a visual-analog-scale. Multiple Wilcoxon-signed-rank tests followed by Mann-Whitney U tests were performed considering a significance level of 0.05., Results: The management of an open gingival embrasure due to interdental papilla loss, by simulating the restoration of both central incisors led to a significantly higher mean smile attractiveness compared to the restoration of a single central incisor. Among the investigated regions, the management of open gingival embrasure in the area of central incisors using a restorative approach was perceived as the least esthetic (p < 0.05)., Conclusions: Despite the restorative management of interdental papilla loss, with the establishment of longer contact areas for the reduction of open gingival embrasures, as the level of the interdental papilla loss is increased, facial esthetics are compromised. When a longer contact area is accomplished through a single restoration, asymmetry among the teeth can be induced, especially in the region of the central incisors., (© 2024 by the American College of Prosthodontists.)

Objectives: To investigate the influence of a single infrapositioned ankylosed tooth or implant supported restoration, in smile attractiveness., Material and Methods: A series of 48 digital modified images, simulating a varying degree of infraposition(from 0.25 to 2.0 mm, with a step of 0.25 mm), was created for each one of the maxillary anterior tooth, by altering the full-portrait image of a smiling male adult, in medium and high smile lines. For the model with the high smile line, also a series of 24 digital modified images simulating infraposition of a single anterior tooth with a restored incisal edge was created. Smile attractiveness for each one of the images was evaluated from 160 participants (80 dentists and 80 laypersons), implementing a visual analog scale., Results: For the images with the high smile line, an infraposition ≥ 0.25mm in central incisor's region and ≥ 0.5mm in the region of the lateral incisor or the canine, had a negative effect on the perceived smile attractiveness both for the dentists and the laypersons. Regarding the medium smile line, an infraposition ≥ 0.5mm in central and lateral incisor's region, had a negative effect on the perceived smile attractiveness for both groups of observers. In the area of the canine, infraposition ≥ 0.5mm for the dentists and ≥ 0.75mm for the laypersons, had a negative impact on the smile attractiveness., Conclusions: Even a minor infraposition of a single maxillary anterior ankylosed tooth or implant supported restoration, can reduce the perceived attractiveness of the face. Infraposition in canine's area can be better tolerated in a medium, compared to a high smile line. In patients with a high smile line prosthetic intervention in order to restore the incisal edge of an infrapositioned tooth, without to harmonize the gingival contour, can be beneficial for the lateral incisor, ineffective for the central incisor and unfavorable for the canine.

Objective: The purpose of this cone beam computed tomography (CBCT) study was to determine the frequency percentage of screw-retained crown using angulated screw channel (ASC) abutment for single immediate implant placement and provisionalization (IIPP) in the esthetic zone., Methods: The CBCT images of 200 patients without disease and without metal restorations in maxillary anterior teeth were evaluated. The mid-sagittal-sectional CBCT images of maxillary anterior teeth (#6-#11) were created in an implant planning software, screen-captured, and transferred to a presentation program. Template of tapered implants with diameter of 3.5 mm (for central and lateral incisors) and 4.3 mm (for central incisors and canines) and lengths of 13, 15, and 18 mm were applied to the sagittal images to identify the IIPP cases. To qualify for IIPP, the implant must engage >35% bone with at least 1 mm of surrounding bone and no perforations. The IIPP cases were further divided into straight screw channel (IIPPSSC) abutment or 25-degree angulated screw channel abutment (IIPPASC), based upon its restorability. The frequency percentages of possible IIPP, IIPPSSC, and IIPPASC were reported and compared among all maxillary anterior teeth., Results: A total of 1200 maxillary anterior teeth sagittal images from 200 patients (88 male and 112 female) with a mean age of 51.3 years (range 20-83 years) were evaluated in this study. The overall frequency percentages of IIPP, IIPPSSC, and IIPPASC possibility were 84% (74%-92%), 14% (10%-24%), and 75% (66%-87%), respectively., Conclusion: Within the limitations of this CBCT study, 90% of single IIPP in the esthetic zone can be restored with screw-retained crown when utilizing ASC. In addition, the possibility of using a screw-retained restoration following IIPP increases about five times with ASC abutment compared to the SSC abutment., (© 2023 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.)

Introduction: Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo- and dento-integration with partial preservation of the periodontal ligament (PDL) in humans. Strategic buccal root retention for PDL preservation is a biologically driven procedure that maintains alveolar ridge dimensions and esthetics, while allowing for implant placement. The aim of this study was to conduct a systematic review of longitudinal clinical outcomes of PDL-mediated ridge preservation in conjunction with implant placement in adults, compared with conventional immediate implant placement with total extractions. The primary outcome for this study was marginal bone level (MBL) changes after strategic buccal root retention implant placement techniques., Materials and Methods: To address a predefined PICOS question, a systematic search of randomized clinical trials and cohort studies with at least 10 participants per group and a minimum 12-month follow-up was conducted. A two-phase systematic selection strategy, data extraction, and risk of bias assessment, was performed independently and in duplicate. Randomized trials were quantitatively analyzed in a meta-analysis., Results: Ten human studies fulfilled the predefined criteria and were included; three clinical trials and seven cohort studies, for a total of 506 patients and 587 implants. PDL-mediated implant placement of single-rooted periodontally healthy teeth was found to reduce marginal peri-implant bone loss and buccal plate changes as compared to conventional immediate implants across studies, while implant survival and success rates were comparable between the two procedures. A meta-analysis found that bone changes were significantly less when retention of the buccal root section was performed as compared to total extractions (standardized mean difference: [-4.53, -0.11]); the three clinical trials were, however, largely heterogeneous (I 2 : 93.1%; Q = 28.98, p < 0.001)., Conclusion: Strategic retention of the buccal root section has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases of single-rooted teeth., (© 2022 Wiley Periodicals LLC.)

Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria's organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes.

Maxillary sinus elevation by the lateral window approach has been shown to be a highly predictable surgical procedure for increasing bone volume in the posterior maxilla. There are occasions, however, where this procedure may be difficult or impossible to perform in a highly predictable manner. There are many presurgical conditions and anatomical features that can make lateral window access difficult, leading to an increase in intraoperative complications and procedural failures. These complicating factors include complex internal sinus anatomy (multiple septa, anteroposterior septa), a narrow available window space, a thin or absent labial plate on adjacent teeth, and the presence of a root apex in the proposed window area, or it may be due to iatrogenically created defects, such as a previous failed sinus elevation, a healed oroantral fistula, or defects created by difficult extractions. While not frequently used or routinely reported in the literature, the palatal window approach may negate many of these obstacles. When it is reported, success rates are similar to those of lateral window procedures, and as an added advantage, postoperative morbidity is dramatically reduced, allowing the patient to wear a removable appliance immediately after surgery. There are, however, anatomical limitations that dictate when this procedure can be used. This case report is unique in that many of the lateral window complicating factors are present, and the palatal anatomy proved ideal for performing the technique.

Purpose: To search the literature and to critically evaluate the findings on the periodontal outcomes of restorations and tooth-supported fixed prostheses., Materials and Methods: PubMed was searched according to a systematic methodology, previously reported, but updated to include a larger database. Filters applied were: Case reports, clinical trial, review, guideline, randomized controlled trial, meta-analysis, systematic reviews, and English. A narrative review was then synthesized to discuss periodontal outcomes related to restorations and tooth-supported fixed prostheses. Relevant data was organized into four sections: Direct restorations, indirect restorations, biologic width or supracrestal tissue attachment and tooth preparation/finish line design., Results: While increased gingival index, bleeding on probing, probing depth and clinical attachment loss have been associated with subgingival restorations, intracrevicular margins do not cause periodontal diseases. Inflammation and bone loss occur, for both direct and indirect restorations, only with large overhangs. Different restorative materials are associated with different clinical responses when placed in the gingival sulcus or within the epithelial and connective tissue attachments. When the connective tissue attachment is removed, histological changes occur causing its apical shift and subsequent re-establishment. Gingival displacement during impression procedures can cause gingival recession. Emergence profile can have a range of values, not associated with periodontal diseases. Periodontal response appears to be clinically not different when compared among different finish line designs., Conclusions: Contemporary procedures and materials used for the placement and fabrication of tooth-supported restorations and fixed prostheses are compatible with periodontal health when adequate patient education and motivation in self-performed oral hygiene are present. Periodontal diagnostic criteria should be thoroughly reviewed before fixed restorative treatments are planned and executed., (© 2020 by the American College of Prosthodontists.)

There is a need to modify the definition of attached gingiva (AG) as it applies to healthy and diseased teeth and implants. There are two parts to this new definition: Part A is when the biologic width is supracrestal (epithelial attachment and gingival fibers) and is attached to a healthy tooth or tissue-level implant, and the zone of AG is measured from the base of the sulcus to the mucogingival junction (MGJ); Part B is when the biologic width is subcrestal-as with infrabony defects on periodontally involved teeth, periodontally involved tissue-level implants, and bone-level implants placed at or below the bone crest-and the zone of AG is measured from the bone crest (not the base of the sulcus) to the MGJ. Further, what the AG is actually attached to around teeth and different types of implants, and the clinical significance of these differences, are thoroughly discussed.

Introduction: This case report documents root coverage after using an acellular dermal matrix (ADM) combined with a tunneling procedure. The photographs and objective clinical measurements are presented to document a gain of new clinical attachment and subsequent creeping attachment., Case Presentation: A 50-year-old male who demonstrated around 6 mm of recessions on the direct facial of teeth #6 through #11 had a root coverage procedure using an ADM. After 24 months, >90% of the recession defects at all sites were eliminated. It was noted that creeping clinical attachment began to appear 6 months after initial therapy on teeth #7 through# 11., Conclusion: The delayed creeping attachment seems to be due to the time necessary to vascularize the ADM and the rate of vascularization may vary with different thicknesses of inserted ADM., (© 2019 American Academy of Periodontology.)

Objective: The aim of this clinical study was to retrospectively evaluate changes in bone following final abutment insertion and functional loading and to evaluate bone status relative to implant type, width, and length; placement into healed bone and extraction sockets; immediate provisionalization; abutment type (single-unit, multi-unit, cementable stock abutment, custom abutment, ti-base, UCLA); cementable restoration, screw-retained restoration, splinted restoration, and single-unit restoration., Materials and Methods: Fifty consecutive patients with 87 implants were evaluated radiographically following final abutment insertion and functional loading to their latest follow-up radiograph. Follow-up evaluation time from final abutment insertion ranged from 11 months (335 days) to 4 years (1,484 days), with an average of 831 days (2.3 years). Mesial and distal surfaces were examined and graded as bone improved, bone maintained, and bone decreased. A total of 174 surfaces were graded (87 implants)., Results: Thirty percent of implant surfaces showed bone improvement following restoration, 62% of implant surfaces showed bone maintenance, and 8% showed bone decrease (range 0.1 mm to 1 mm)., Conclusions: This retrospective study showed an unusual phenomenon of bone improvement following restoration for 30% of implant surfaces. Eight percent of the surfaces showed bone decrease but at a maximum of 1 mm. This places 100% of the followed implants well within established criteria for successful implant bone maintenance. There was no statistical difference among the groups in age, gender, implant diameter, implant length, implant location (maxilla versus mandible, anterior versus posterior), and prosthetic procedures. Additional highly controlled prospective studies are being planned to validate and further the authors' knowledge.

The decision to prescribe an adjunctive antibiotic when placing a dental implant in a systemically healthy patient who is not receiving a bone graft remains a controversial issue. In an effort to elucidate this enigma, the authors analyzed, from a statistical and clinical significance perspective, seven current systematic reviews that address this concern. Hypothesis testing often does not provide clear understanding regarding the efficacy of the administration of antibiotics in association with clinical implantations. Therefore, number needed to treat (NNT) calculations may be used to determine the effectiveness of antibiotics to reduce dental implant losses. The NNT indicates how many additional patients need to be treated with antibiotics to avoid an additional implant failure in another patient. This article addresses two questions: Do antibiotics help reduce implant loss, and if they do, what is the best drug dosage to use when placing dental implants? Based on NNT calculations, the data is interpreted to denote that adjunctive antibiotics help reduce early implant loss in systemically healthy patients who are not receiving bone grafts and that 2 gm of amoxicillin prior to implant placement in non-allergic patients appears to be a satisfactory drug dose that provides a clinically significant benefit.

Purpose: To compare the optical effects of an immediately placed anodized pink-neck implant and abutment vs a conventional gray implant and abutment in relation to soft tissue thickness 6 months after the restoration was completed., Materials and Methods: Forty patients with a hopeless maxillary anterior tooth received an immediate implant and an immediate provisional or custom healing abutment after flapless extraction. Participants were randomized to receive either a conventional titanium implant (control) or a pink-neck implant (test). All patients then received two identical CAD/CAM titanium abutments (one conventional gray, delivered first, and one anodized to appear pink, delivered 3 weeks after) and a zirconia crown. A spectrophotometer was used to record the color of the peri-implant mucosa and gingiva 3 weeks after delivery of each abutment and 6 months after the final restoration was delivered. The color difference between the two sites was calculated (ΔL*, Δa*, Δb*), and correlations with soft tissue thickness, change in ridge dimension, and implant position were assessed., Results: Irrespective of the randomization group, changing the abutments from gray to pink showed a change in color between the peri-implant mucosa and the natural gingiva. Patients with a thin gingival biotype showed a statistically significant color change (P = .00089) in the a* axis, meaning that the gingiva appeared more pink (Δa*). No significant correlation between the soft tissue color and buccolingual collapse, vertical recession, or implant position was observed in either group., Conclusion: The difference in color observed between the peri-implant mucosa and the gingiva was considerable in all groups. Anodized pink implants and abutments could reduce the difference in the red aspect (Δa*) of the peri-implant mucosa compared to the adjacent gingiva in patients with a thin biotype.

This prospective randomized controlled clinical trial aimed to compare changes in the horizontal and vertical soft tissue and the alveolar ridge dimension over the course of 12 months following immediate implant placement and temporization with or without simultaneous augmentation with a deproteinized bovine bone mineral with 10% collagen (DBBM-C). Thirty-two patients with a hopeless maxillary anterior tooth and fully intact sockets received an immediate implant and provisional or custom healing abutment after a flapless extraction. Patients were randomized to a control group (n = 16), which received no graft, or to a test group (n = 16), which received DBBM-C grafts. Horizontal and vertical soft tissue changes as well as soft tissue thickness were compared digitally between groups on casts obtained from impressions made at baseline and 3, 6, and 12 months. The test group showed less horizontal dimensional change than the control group; however, the change between the two groups was not statistically significant. Vertical dimensional soft tissue changes from baseline to 12 months showed a statistically significant difference at the distal papilla, favoring the test group. No statistically significant difference was observed for vertical changes between both groups at mesial papillae and midbuccal soft tissue; however, the test group showed lower values overall. No statistically significant differences in soft tissue thickness between groups were detected. Immediate implant placement and temporization with and without adding DBBM-C demonstrate favorable clinical outcomes regarding horizontal and vertical soft tissue changes. Both groups showed loss of tissue volume. Adding DBBM-C in the gap of immediately placed implants slightly lowered the change in tissue parameters, which was not statistically significant, for the first 12 months after implant placement.

Dental implantology is a discipline that merges knowledge regarding treatment planning, surgical procedures, and prosthetic endeavors. To attain optimal results many numbers pertaining to different facets of therapy are integrated into treating patients. This article outlines a wide range of digits that may assist clinicians in enhancing the performance of implant dentistry. Important integers are presented in three segments related to the sequence of therapy: pre-procedural assessments, surgical therapy, and postsurgical patient management.

Purpose: The aim of this study was to assess the visual effects of pink-neck implants and pink abutments with respect to the color of natural gingiva. The distribution pattern and magnitude of CIELAB color difference coordinates were studied., Materials and Methods: Forty subjects with a tooth in the maxillary esthetic zone deemed hopeless were recruited. Patients were randomized to either a conventional gray implant or a pink-neck implant. The hopeless tooth was removed and patients received an immediate implant along with an immediate customized provisional prosthesis. The provisional was maintained for 3 months to allow for complete healing of the implants. Two identical CAD/CAM titanium abutments only differing in color (gray and pink) were fabricated along with an all-ceramic zirconia crown. The gray abutment was delivered first with a zirconia crown, and it was replaced with the pink abutment 3 weeks later. Three weeks after insertion of each abutment with the zirconia crown, a spectrophotometer was used to collect the color of the peri-implant mucosa and natural gingiva, so the difference between the two sites could be calculated (ΔL* [difference in lightness], Δa* [difference in green-red axis], Δb* [difference in blue-yellow axis]). The natural gingiva measured was the gingiva of a contralateral or adjacent unrestored tooth. The effect of implant color and abutment on the color difference between peri-implant mucosa and natural gingiva was investigated with a linear regression model using a generalized estimating equation (GEE) approach., Results: Raw data demonstrated statistically insignificant smaller ΔL*, Δa*, Δb* between peri-implant soft tissue and natural gingiva when the implant was pink versus gray. Further, there were statistically insignificant smaller ΔL* and Δb* between peri-implant soft tissue and natural gingiva when the abutment was pink versus gray. Δa* between peri-implant soft tissue and natural gingiva was significantly smaller when using a pink abutment regardless of the implant type (P < .05)., Conclusion: Using an anodized pink abutment and/or a pink-neck implant minimizes the color difference observed between the peri-implant mucosa and the natural gingiva in the redness spectrum. These advances in technology assist in helping the peri-implant mucosa appear more natural by minimizing the color variance.

Purpose: This prospective, randomised, controlled clinical trial evaluated the relationship between alveolar ridge dimensional change and recession with the implant position (horizontal and vertical) and tissue phenotype in immediately placed and provisionalised implants without the use of bone grafting., Materials and Methods: Patients (n = 40) with a hopeless maxillary anterior tooth received an immediate implant and immediate provisional or customised healing abutment after flapless extraction. Implants were finally restored 3 months after placement and followed up for 6 months after delivery of the restoration. The alveolar ridge dimensional change and recession were measured using cone beam computed tomography (CBCT) scans and digitalised dental casts. Alveolar contour changes were correlated to implant position and tissue phenotype., Results: The tissue phenotype showed no significant correlation to the alveolar ridge dimensional change. At 6 months, the average alveolar ridge dimensional change was approximately 0.7 mm in the buccolingual dimension independent of tissue phenotype. A statistically significant difference was observed on the recession values comparing tissue phenotypes, with more recession observed in the thin phenotype (1.96 mm) than in the thick phenotype (1.18 mm). A significant correlation was observed between horizontal implant position and buccolingual alveolar ridge change. A positive correlation was observed between the horizontal implant position and the dimensional change measured in the casts at the level of the free gingival margin. A statistically significant negative correlation was observed between the horizontal implant position and the resorption measured by the CBCT scans., Conclusions: Patients with thin tissue phenotype had a more marked recession. The horizontal implant position showed a relationship to the alveolar ridge dimensional changes observed. The greater the buccal gap distance between the implant and the buccal plate, the lesser the radiographic changes observed in the alveolar bone, however, the greater the changes observed in the buccal aspect of the casts at the level of the free gingival margin., Competing Interests: Conflict of interest statement: This study was funded by Keystone Dental. Dr Tarnow is a consultant for Keystone Dental and Dr Bittner has lectured for Keystone Dental. The remaining authors have no financial interest in the companies whose materials were included in this article.

A postmortem evaluation of a 5-implant-supported mandibular fixed complete denture that had successfully opposed a maxillary conventional complete denture for 30 years was undertaken. Before embalming, radiographs, implant stability measurements, push-in failure load tests, and histomorphometric analyses were performed on the implants and the mandible. Evaluation of this cadaver suggests that an edentulous mandible restored with an implant-supported fixed prosthesis can function successfully for over 30 years with few complications., (Copyright © 2018 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

The aim of this prospective clinical study was to evaluate dimensional changes following immediate placement of a fixed ovate pontic provisional restoration into an intact extraction socket without grafting. The mean buccolingual dimensional change at 1 month was 0.51 ± 0.48 mm and 0.93 ± 0.55 mm at 3 months. The mean incisoapical dimensional change at 1 month was 0.68 mm ± 0.19 mm, and at 3 months, 1.64 ± 1.35 mm. The dental literature reports dimensional change of 3 to 5 mm in width and 1 to 4 mm in height for ridges with no treatment following extraction. This study provides validation for the use of ovate pontics in the preservation of tissue contour. Further research is needed to determine whether placing a graft into the socket with placement of an ovate pontic will decrease dimensional changes after extraction.

Objective: The objective of the present paper was to review factors and conditions that are associated with hard and soft-tissue deficiencies at implant sites., Importance: Hard- and soft-tissue deficiencies at dental implants are common clinical findings. They can lead to complications and compromise implant survival and, hence, may require therapeutic interventions. It is, therefore, important to understand the etiology of hard and soft-tissue deficiencies. Based on this understanding, strategies should be developed to correct hard and soft-tissue deficiencies with the aim of improving clinical outcomes of implant therapy., Findings: A large number of etiological factors have been identified that may lead to hard and soft-tissue deficiencies. These factors include: 1) systemic diseases and conditions of the patients; 2) systemic medications; 3) processes of tissue healing; 4) tissue turnover and tissue response to clinical interventions; 5) trauma to orofacial structures; 6) local diseases affecting the teeth, the periodontium, the bone and the mucosa; 7) biomechanical factors; 8) tissue morphology and tissue phenotype; and 9) iatrogenic factors. These factors may appear as an isolated cause of hard and soft-tissue defects or may appear in conjunction with other factors., Conclusions: Hard- and soft-tissue deficiencies at implant sites may result from a multitude of factors. They encompass natural resorption processes following tooth extraction, trauma, infectious diseases such as periodontitis, peri-implantitis, endodontic infections, growth and development, expansion of the sinus floor, anatomical preconditions, mechanical overload, thin soft tissues, lack of keratinized mucosa, malpositioning of implants, migration of teeth, lifelong growth, and systemic diseases. When more than one factor leading to hard and/or soft-tissue deficiencies appear together, the severity of the resulting condition may increase. Efforts should be made to better identify the relative importance of these etiological factors, and to develop strategies to counteract their negative effects on our patient's wellbeing., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)

A classification for peri-implant diseases and conditions was presented. Focused questions on the characteristics of peri-implant health, peri-implant mucositis, peri-implantitis, and soft- and hard-tissue deficiencies were addressed. Peri-implant health is characterized by the absence of erythema, bleeding on probing, swelling, and suppuration. It is not possible to define a range of probing depths compatible with health; Peri-implant health can exist around implants with reduced bone support. The main clinical characteristic of peri-implant mucositis is bleeding on gentle probing. Erythema, swelling, and/or suppuration may also be present. An increase in probing depth is often observed in the presence of peri-implant mucositis due to swelling or decrease in probing resistance. There is strong evidence from animal and human experimental studies that plaque is the etiological factor for peri-implant mucositis. Peri-implantitis is a plaque-associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri-implant mucosa and subsequent progressive loss of supporting bone. Peri-implantitis sites exhibit clinical signs of inflammation, bleeding on probing, and/or suppuration, increased probing depths and/or recession of the mucosal margin in addition to radiographic bone loss. The evidence is equivocal regarding the effect of keratinized mucosa on the long-term health of the peri-implant tissue. It appears, however, that keratinized mucosa may have advantages regarding patient comfort and ease of plaque removal. Case definitions in day-to-day clinical practice and in epidemiological or disease-surveillance studies for peri-implant health, peri-implant mucositis, and peri-implantitis were introduced. The proposed case definitions should be viewed within the context that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. It is recommended that the clinician obtain baseline radiographic and probing measurements following the completion of the implant-supported prosthesis., (© 2018 American Academy of Periodontology and European Federation of Periodontology.)

Objective: The purpose of this prospective, randomized, controlled, multicenter clinical study was to analyze the optical effects of an anodized pink colored implant shoulder/abutment system in the peri-implant mucosa of immediately placed dental implants., Materials and Method: Forty subjects with a restoratively hopeless tooth in the maxillary esthetic zone, were recruited and randomized to receive either a pink-neck implant, or a conventional gray implant. All patients received an immediate implant and immediate provisional and two identical CAD/CAM titanium abutments with different surface colors: pink and gray, and one zirconia all-ceramic crown. The color of the peri-implant mucosa was measured using a dental spectrophotometer and analyzed using CIELAB color system., Results: The overall color difference between the peri-implant mucosa with a pink abutment and a gray abutment was ΔE = 4.22. Patients with gray implants presented a color change of ΔE = 3.86-4.17 with this abutment change, while patients with pink implants had a color change of ΔE = 3.84-4.69. The peri-implant mucosa with a pink abutment was significantly more red when compared with a gray abutment (P ≤ .01)., Conclusions: When a pink abutment was used, there is a significant color change of the peri-implant mucosa that is above the detectable color threshold., Clinical Significance: Esthetic outcomes are important for the success of implant treatment of maxillary anterior implants. The phenomenon of the gray color of a dental implant and abutment shining through the peri-implant mucosa has been documented in the literature. The objective of this study was to assess the optical effect of an anodized pink-neck implant and a pink abutment on the color of peri-implant mucosa. This study demonstrates that using pink-neck implant and a pink abutment would contribute positively to the overall esthetic outcome for an anterior implant., (© 2017 Wiley Periodicals, Inc.)

Background: The aim of this animal study is to analyze bone remodeling around platform-switching (PS) implants with and without a machined (MACH) collar placed at different levels in relation to the crestal bone in a canine model., Methods: All mandibular premolars and first molars were extracted in five dogs. After 6 months, grit-blasted acid-etched (GBAE) PS implants with and without a MACH neck were randomly inserted in each hemimandible, positioning the implant-abutment interface in either a supracrestal (+1.5 mm), equicrestal, or subcrestal (-1.5 mm) position, and healing abutments were connected. Implant abutments were dis/reconnected at 12, 14, 16, and 18 weeks after implant placement. After 6 months of healing, animals were sacrificed. Clinical parameters and periapical radiographs were registered on the day of implant placement, at 2 months, at every abutment dis/reconnection, and at sacrifice. Crestal bone changes were calculated and defined as the primary outcome variable., Results: When crestal bone changes from implant placement to 6 months were compared between MACH and GBAE groups, no significant differences were encountered except for implants placed in an equicrestal position (P = 0.04). However, multivariable regression analysis revealed no significant differences between MACH and GBAE implants placed in a supracrestal (β = -0.08; P = 0.45), equicrestal (β = -0.05; P = 0.50), or subcrestal (β = -0.13; P = 0.19) position., Conclusion: Surface treatment of the implant neck had no significant influence on crestal bone changes around PS implants with and without a MACH collar.

Purpose and Objective: The aim of this in vitro study was to investigate the ability of epithelial cells to attach to or proliferate on various mechanical or chemical surface treatments of an implant provisional material., Materials and Methods: Polyethyl methacrylate discs 10 mm in diameter and ∼0.2 to 0.75 mm in width were used in the study. Experimental discs were treated with either a mechanical (pumice, varnish for shine, or high polishing) or a chemical agent (alcohol, chlorhexidine, or steam) to provide cleaning and/or polishing. Using primary human epidermal keratinocytes, experiments were performed to test the adhesion or proliferation of cells on the discs with various surface treatments., Results: Scanning electron microscope analysis, rhodamine staining, and cell counting using a hemocytometer corroborated all findings and illustrated that the highest cell adhesion was found to be in the smooth surface treatment groups and the poorest adhesion was found to be in the rough surface groups and chemical treatment group., Conclusion: Within the limitations of this study, the following clinical protocol is recommended for finishing, polishing, and disinfecting implant provisional restorations: coarse, medium, fine pumice → high polishing (if desired) → steam. It is recommended to avoid applying varnish in the perimucosal area near the epithelium. This study could establish the most appropriate way to handle provisional restorations in the peri-implant sulcus for improved soft tissue health, esthetics, and long-term stability.

A central dental implant success criterion is the marginal bone response as measured longitudinally. Factors that influence marginal bone changes include osseous and soft tissue architecture, occlusal loading factors, implant position, implant design, and inflammatory processes. The evolution of implant design is multifactorial and includes the implant-abutment interface geometries. The primary objective of this study was to compare the proximal marginal bone changes following placement and loading of internal conus design implants (ICI) and external hex design implants (EXI) used in the treatment of posterior partial edentulism. Among 45 enrolled participants, 39 were treated with 47 ICI or 46 EXI implants using a one-stage implant protocol. Prosthetic restoration was completed after 12 weeks using stock titanium abutments and all-ceramic crowns. Follow-up visits including clinical and radiographic examinations were performed 6 months after permanent restoration and then annually for 3 years. Marginal bone level changes, papilla index scores, condition of the peri-implant mucosa, presence of complications, and participant satisfaction were evaluated. The mean marginal bone level change from implant placement to 3 years was -0.25 ± 0.60 mm and -0.5 ± 0.93 mm for ICI and EXI implants, respectively. The change recorded from permanent restoration to 3 years was a gain of 0.31 ± 0.41 mm versus 0.04 ± 0.51 mm for ICI and EXI implants, respectively (P < .05). In the evaluation of interproximal soft tissue 3 years after permanent restoration, 80% of mandibular and 66% of maxillary interproximal ICI sites received papilla scores of 2 and 3, compared with 50% of mandibular and 60% of maxillary interproximal EXI sites. No significant differences in plaque or bleeding scores were recorded. Abutment/healing abutment complications were recorded for 11 EXI versus 1 ICI participant. The vast majority (> 90%) of participants stated they were satisfied or very satisfied with their implant prosthesis and rated function and esthetics highly for both implant types after 3 years in function. Modestly greater marginal bone loss occurred at EXI implants. Further, more positive papilla scores were found between adjacent ICI implants than between adjacent EXI implants. EXI implants displayed more abutment complications than the ICI implants. The implant-abutment interface design may contribute to therapeutic outcome differences. Replacement of missing posterior teeth with unsplinted implants was successful at the implant level and as reported by the participant.

Objectives: The aims of this study were to evaluate (i) the efficacy of ridge preservation and repair involving SocketKAP(™) and SocketKAGE(™) devices following tooth removal; and (ii) ridge contour changes at 6 months post-extraction in intact sockets and sockets with dehiscence defects., Material and Methods: Thirty-six patients required a total of 61 teeth to be extracted. Five cohorts were established with groups A-C involving intact sockets and groups D and E involving facial dehiscence: (A) Negative Control; (B) SocketKAP(™) alone; (C) Anorganic Bovine Bone Mineral (ABBM) + SocketKAP(™) ; (D) Negative Control; and (E) ABBM + SocketKAP(™)  + SocketKAGE(™) . Preoperative CBCT and laser-scanned casts were obtained. Teeth segmented from preoperative CBCT were merged with study cast images to allow for digital removal of teeth from the casts. Volumetric measurements of ridge contour were performed. Images of preoperative and 6 months post-operative casts were superimposed to measure ridge contour changes., Results: Post-extraction contour loss occurred in all sockets primarily in the crestal 3 mm but was also detected up to 6 mm from alveolar crest. For intact sockets, SocketKAP(™) or SocketKAP(™)  + ABBM interventions led to greater percentages of remaining ridge contour when compared to controls. A significant difference favoring SocketKAP(™)  + SocketKAGE(™)  + ABBM treatment was observed for sockets with facial dehiscence when compared to controls., Conclusion: SocketKAP(™) , with or without ABBM, significantly limited post-extraction ridge contour loss in intact sockets. In the absence of a group treated with only the SocketKAGE(™) , it is not possible to determine its efficacy, although the combination of SocketKAGE(™)  + SocketKAP(™)  + ABBM was effective in limiting post-extraction ridge contour loss in sockets with dehiscence defects., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)