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The mucosa height has always been of interest in modern implant dentistry to obtain biomimetic results. Papilla height, mucosa scalloping, and free mucosal margin level are crucial to achieve "pink aesthetics". The aim of this study was to investigate the vertical increase in the peri-implant soft tissues with a porcine cross-linked collagen matrix (Geistlich Fibro-Gide®). Methods: A total of 60 patients were divided into the following three groups: Group 1—patients who received porcine cross-linked collagen matrix for vertical soft tissue augmentation and a cover screw combined with a coronally advanced flap (CAF); Group 2—patients who received the collagen matrix combined with a healing abutment and CAF; Group 3 (control group)—patients who received a traditional surgical approach based on crestal incision and no collagen matrix as well as no CAF. Results: The average horizontal tissue thickness growth after 3 months was more effective for Group 1 (1.35 ± 1.23 mm) compared to Group 2 (0.85 ± 0.67 mm) and the control group (0.20 ± 0.41 mm). The average tissue height growth was 1.05 ± 1.39 mm for Group 1, 0.32 ± 1.28 mm for Group 2, and −0.05 ± 0.39 mm for the control group. Finally, the average increase in the band of keratinized mucosa was 0.60 ± 1.23 mm for Group 1, −0.60 ± 0.94 mm for Group 2, and 0.45 ± 0.60 mm for the control group. Conclusions: The combination of the CAF, porcine cross-linked collagen matrix, and cover screw resulted in better clinical results compared to Group 2 and 3. [ABSTRACT FROM AUTHOR]

In our previous article, we observed and measured a spontaneous growth in the coronal direction of the keratinized tissues present around implants. This growth involved both free margins and interdental papillae, and we indicated our hypothesis on the probable cause of this still-unexplained phenomenon. The growth of oral soft tissues involves several other structures, such as the linea alba and tongue indentation. Our idea holds that growth of these tissues is generated by the negative intraoral pressure created in the oral phase of swallowing and the subsequent resting position, which through the resulting suction causes a shift of these soft structures in the gaps around the dental crowns. Other hypotheses have been suggested in the past to understand this phenomenon of soft tissue growth, which still lacks data supporting etiological evidence. The purpose of this article is to thoroughly analyze and verify our model by comparing the clinical observations with citations and examples from the literature, combined with notions of physiology, biology, and physics that help in clarifying these events. To better explain the mechanisms of oral soft tissue growth, photographs of clinical cases paradigmatic of the phenomenon are shown. [ABSTRACT FROM AUTHOR]

Peri-implant soft tissue deficiency (PSTD) is a significant factor impacting aesthetics, particularly in the anterior zone, where labial bone resorption and thin peri-implant phenotypes are common. The occurrence of a gray color around the implant fixture due to PSTD can be aesthetically concerning in the esthetic zone. In cases involving natural teeth, autogenous soft tissue grafts such as subepithelial connective tissue grafts (SCTGs), free gingival grafts (FGGs), and coronally advanced flaps (CAFs) are commonly utilized. However, there are limited reports of using bone grafts in conjunction with these techniques for modifying the gingival phenotype around both teeth and implants. In the presented cases where PSTD resulted in visible gray coloration of the implant fixture in the esthetic zone, mechanical and chemical decontamination of the exposed implant surface was performed using a titanium brush and tetracycline (Tc) HCl. Subsequently, to enhance peri-implant mucosa thickness and mask the titanium color, simultaneous SCTG and bone grafting procedures were conducted. Within the limitations of these case reports, successful esthetic outcomes were achieved and maintained without recurrence for 3–6 years following the simultaneous subepithelial connective tissue graft and bone graft procedures. These findings suggest the potential efficacy of this combined approach in addressing PSTD and enhancing aesthetic results around dental implants, though further studies are needed to validate these outcomes. [ABSTRACT FROM AUTHOR]

Immediate tooth-replacement therapy can be a predictable method for treating anterior hopeless teeth. Preserving and augmenting both hard and soft tissues is critical for the physiologic and esthetic success of therapy. Utilizing a combined hard and soft tissue augmentation approach improves outcomes. Reducing morbidity associated with procuring autogenous grafts can be efficacious regarding short and long-term outcomes. The Dermal Apron Technique uses both bone and soft tissue allografts to increase soft tissue thickness around immediately placed and provisionalized implants. Studies demonstrate the increased soft tissue thickness produced by the technique. This article demonstrates the technique and discusses the clinical research supporting the use of this method for successful immediate tooth-replacement therapy.

The peri‑implant mucosa (PIM) is formed during the wound healing process that follows implant and abutment placement. The PIM is known to play crucial roles in function; acting as a biologic barrier for bacterial infiltration and maintaining the mucosal health of the implant, and for implant esthetics. This narrative review presents:• Differences between periodontal soft tissue attachment and peri‑implant mucosal tissue attachment• Development of the osseointegration and its effect on PIM• Different Implant – abutment interface configurations including one– VS two-piece implants, bone-level VS tissue-level implants, and PIM in different implant collars• Engineering in surface characteristics

The mucosa height has always been of interest in modern implant dentistry to obtain biomimetic results. Papilla height, mucosa scalloping, and free mucosal margin level are crucial to achieve “pink aesthetics”. The aim of this study was to investigate the vertical increase in the peri-implant soft tissues with a porcine cross-linked collagen matrix (Geistlich Fibro-Gide®). Methods: A total of 60 patients were divided into the following three groups: Group 1—patients who received porcine cross-linked collagen matrix for vertical soft tissue augmentation and a cover screw combined with a coronally advanced flap (CAF); Group 2—patients who received the collagen matrix combined with a healing abutment and CAF; Group 3 (control group)—patients who received a traditional surgical approach based on crestal incision and no collagen matrix as well as no CAF. Results: The average horizontal tissue thickness growth after 3 months was more effective for Group 1 (1.35 ± 1.23 mm) compared to Group 2 (0.85 ± 0.67 mm) and the control group (0.20 ± 0.41 mm). The average tissue height growth was 1.05 ± 1.39 mm for Group 1, 0.32 ± 1.28 mm for Group 2, and −0.05 ± 0.39 mm for the control group. Finally, the average increase in the band of keratinized mucosa was 0.60 ± 1.23 mm for Group 1, −0.60 ± 0.94 mm for Group 2, and 0.45 ± 0.60 mm for the control group. Conclusions: The combination of the CAF, porcine cross-linked collagen matrix, and cover screw resulted in better clinical results compared to Group 2 and 3.

Enhanced mucosal sealing around titanium implants can reduce complications such as peri‐implantitis. The present study aims to investigate the mucosal healing at the early stage around the protease activated receptor 4‐agonist peptide (PAR4‐AP)‐ or perpendicularly protruded type I collagen (pCol)‐treated titanium implants. A total of 72 implants were placed in 36 rats in the study. Following extractions, two tissue‐level implants among the following three different surfaces, PAR4‐AP‐coated (PAR4 group, n = 24), pCol‐treated (pCol group, n = 24) and non‐treated (control group, n = 24) ones, were placed in the maxillae of each rat based on a split‐mouth design. The specimens retrieved at 8 h (n = 8 per group), 3 days (n = 8 per group), and 2 weeks (n = 8 per group), were immunostained and tissue‐cleared, and the signals of laminin‐5 and collagen fibers were observed under multiphoton microscopy. Statistical analyses were performed using linear mixed model with post hoc tests to compare differences between the groups. While there was no intergroup difference at 8 h, the laminin‐5 at 3 days was more abundant near the PAR4‐group‐surface, and its area was significantly larger in the PAR4 group (0.0204 ± 0.0194 mm2) than the control (0.0019 ± 0.0025 mm2, p =.001) and pCol (0.0023 ± 0.0022 mm2, p <.001) groups. The pCol group showed a significantly larger area of collagen fibers (0.0230 ± 0.0148 mm2) compared to the control (0.0035 ± 0.0051 mm2, p =.002) and PAR4 (0.0031 ± 0.0057 mm2, p <.001) groups at 3 days. At 3 days and 2 weeks, the collagen fiber orientation of the pCol group showed a more perpendicular manner compared to the control and PAR4 groups. The signal of basal lamina and collagen fibers were stronger around the PAR4‐AP‐ and pCol‐treated titanium surfaces, respectively during the early healing stage. This could have implications for improved mucosal sealing around dental implants, potentially reducing complications such as peri‐implantitis. [ABSTRACT FROM AUTHOR]

Aim: To investigate the healing after heterotopic mucosa transpositioning at dental implants and teeth. Materials and Methods: One hemimandible per dog (n = 4) was allocated to receive 3 implants (test), whereby 3 premolars on the contralateral side served as controls. After osseointegration, a Z‐plasty was performed on the buccal aspect of the test and control sites to heterotopically move the zone of keratinized tissue (KT) into a region with non‐keratinized tissue (nKT) and vice versa. Clinical measurements were performed before (T0) and at 12 weeks following heterotopic transposition (T1). Thereafter, specimens were processed for histological analysis. Results: Clinical measurements revealed that at T1, a band of KT was reestablished at teeth (mean: 2.944 ± 1.866 mm), whereas at implants, the transpositioned nKT resulted in a mucosa without any signs of keratinization (mean: 0 mm; p <.0001). At implant sites, the probing attachment level loss was more pronounced compared to tooth sites (−1.667 ± 1.195 mm and −1.028 ± 0.878 mm, respectively; p =.0076). Histologically, the transpositioned nKT, was accompanied by the formation of KT at the tooth but not at implant sites. The supracrestal soft tissues were statistically significantly higher at tooth compared to implant sites (2.978 ± 0.483 mm and 2.497 ± 0.455 mm, p =.0083). The transpositioned KT remained mostly unaltered in its morphological characteristics. Conclusions: The findings of this study indicate that: (a) transpositioned KT may retain its morphological characteristics; and (b) transpositioned nKM was accompanied by the formation of KT at the tooth but not at implant sites. [ABSTRACT FROM AUTHOR]

In our previous article, we observed and measured a spontaneous growth in the coronal direction of the keratinized tissues present around implants. This growth involved both free margins and interdental papillae, and we indicated our hypothesis on the probable cause of this still-unexplained phenomenon. The growth of oral soft tissues involves several other structures, such as the linea alba and tongue indentation. Our idea holds that growth of these tissues is generated by the negative intraoral pressure created in the oral phase of swallowing and the subsequent resting position, which through the resulting suction causes a shift of these soft structures in the gaps around the dental crowns. Other hypotheses have been suggested in the past to understand this phenomenon of soft tissue growth, which still lacks data supporting etiological evidence. The purpose of this article is to thoroughly analyze and verify our model by comparing the clinical observations with citations and examples from the literature, combined with notions of physiology, biology, and physics that help in clarifying these events. To better explain the mechanisms of oral soft tissue growth, photographs of clinical cases paradigmatic of the phenomenon are shown.

Purpose: The objective of this investigation was to assess the extent of mucosal discoloration caused by different CAD/CAM abutment materials and to determine the influence of mucosa thickness on the subsequent color, with a particular focus on titanium nitride. Materials and Methods: In a pig maxilla, a trapdoor-shaped mucosa flap was prepared unilaterally. Several CAD/CAM abutment materials were used to assess a number of clinical scenarios. Varying mucosa thicknesses were simulated by connective tissue grafts harvested at the contralateral side of the palate, resulting in layer thicknesses of 1.5, 2, and 3 mm. Titanium (Ti), zirconia (ZrO2), and titanium nitride (TiN) served as test specimens with and without ceramic veneering. Color differences (ΔE) and deviations in brightness (L), chroma (C), and hue (H) were determined spectrophotometrically, comparing the measured value of the native tissue and the results obtained with different materials at varying mucosa thicknesses. Results: All tested specimens caused a mucosa discoloration in comparison to the native tissue, diminishing with increasing mucosa thickness. The use of TiN demonstrated the least mucosa discoloration in thin soft tissue of 1.5 mm, with a mean ΔE value of 1.93 (P = .004). While ZrO2 revealed a comparable ΔE value of 2.13 (P = .022) at a tissue thickness of 1.5 mm, Ti showed the highest mucosa discoloration above the visibility threshold of ΔE = 3.1, with a mean ΔE value of 4.07 (P = .002). Ceramic veneering of the Ti samples led to a considerable reduction in soft tissue discoloration, with a resulting ΔE value of 2.2. The veneering of TiN and ZrO2 samples with porcelain, on the other hand, had no noticeable effect on the mucosa color. Conclusion: CAD/CAM abutment materials cause an adverse soft tissue color shift that decreases with increasing mucosa thickness. In thin peri-implant mucosa, titanium nitride and zirconia lead to the least discoloration. Due to their positive optical properties and mechanical superiority compared with ceramic abutments, gold-hue titanium nitride-coated CAD/CAM abutments could be a clinical alternative in cases of thin peri-implant mucosa. [ABSTRACT FROM AUTHOR]

Abstract Background The morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics. Purpose To evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth. Method Digital impressions using the intraoral scanner (MEDIT i500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test. Results Customized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months. Conclusions Immediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management.

Purpose: This study sought to define the tissue responses at different implant-abutment interfaces by studying bone and peri-implant mucosal changes using a 5-year prospective randomized clinical trial design study. The conus interface was compared with the flat-to-flat interface and platform-switched implant-abutment systems. Materials and Methods: One hundred forty-one subjects were recruited and randomized to the three treatment groups according to defined inclusion and exclusion criteria. Following implant placement and immediate provisionalization in healed alveolar ridges, clinical, photographic, and radiographic parameters were measured at 6 months and annually for 5 years. The calculated changes in marginal bone levels, peri-implant mucosal zenith location, papillae lengths, and peri-implant Plaque Index and bleeding on probing were statistically compared. Results: Forty-eight conus interface implants, 49 flat-to-flat interface implants, and 44 platform-switched implants were placed in 141 subjects. Six platform-switched interface and eight flat-to-flat interface implants failed, most of them within 3 months. After 5 years, 33 conical interface, 28 flat-to-flat interface, and 27 platform-switched interface implants remained for evaluation. Calculation of marginal bone level change showed a mean marginal bone loss of -0.16 ± 0.45 (-1.55 to 0.65), -0.92 ± 0.70 (-2.90 to 0.20), and -0.81 ± 1.06 (-3.35 to 1.35) mm for conical interface, flat-to-flat interface, and platform-switched interface implants, respectively (P < .0005). The peri-implant mucosal zenith changes were minimal for all three interface designs (0.10 mm and +0.08 mm, P > .60). Only 16% to 19% of the surfaces had presence of bleeding on probing, with no significant differences (P > .81) between groups. Interproximal tissue changes were positive and similar among the implant interface designs. Conclusion: Over 5 years, the immediate provisionalization protocol resulted in stable peri-implant mucosal responses for all three interfaces. Compared with the flat-to-flat and platform-switched interfaces, the conical interface implants demonstrated significantly less early marginal bone loss. The relationship of marginal bone responses and mucosal responses requires further experimental consideration. [ABSTRACT FROM AUTHOR]

Abstract Purpose The aim of the present study was to evaluate the long-term effectiveness of a xenogeneic collagen matrix (CM) in pre-prosthetic augmentation of the keratinized mucosa width (KMW) at implant sites. Methods All of the patients with localized implant-supported rehabilitation previously treated with vestibuloplasty and KMW augmentation with a non-cross-linked porcine CM were recalled. KMW was measured clinically in an apico-coronal direction from the mucogingival junction to the mucosal margin at the prosthetic zenith of each crown. Measurements were performed clinically by means of a PCP-UNC15 periodontal probe and rounded to the nearest mm. KMW values recorded at 1 year, 5 and 10 years from the soft tissue augmentation procedure were compared using a one-way repeated-measures ANOVA with Bonferroni multiple comparison post-hoc analysis. The level of significance was set at 0.05. Results Measurements were conducted on 13 patients. All implants were in function with no signs of biological complications. All except one implant site showed KMW ≥ 2 mm. KMW decreased significantly from 1 year (3.33 ± 1.11 mm) to 5 years (2.77 ± 0.92 mm) (p = 0.001), and finally remained stable from 5 to 10 years (3.2 ± 0.99 mm) (p = 0.607). From a visual aspect, peri-implant soft tissues were characterized by a good texture and color blending compared to the adjacent teeth, highlighting good integration of the remodeled tissues and stability of the esthetic result. Conclusions The use of a CM in pre-prosthetic soft tissue augmentation at implant sites has proven to be effective in obtaining and maintaining at least 2 mm of KMW around dental implants over a follow-up of 10 years.

Peri-implant soft tissue deficiency (PSTD) is a significant factor impacting aesthetics, particularly in the anterior zone, where labial bone resorption and thin peri-implant phenotypes are common. The occurrence of a gray color around the implant fixture due to PSTD can be aesthetically concerning in the esthetic zone. In cases involving natural teeth, autogenous soft tissue grafts such as subepithelial connective tissue grafts (SCTGs), free gingival grafts (FGGs), and coronally advanced flaps (CAFs) are commonly utilized. However, there are limited reports of using bone grafts in conjunction with these techniques for modifying the gingival phenotype around both teeth and implants. In the presented cases where PSTD resulted in visible gray coloration of the implant fixture in the esthetic zone, mechanical and chemical decontamination of the exposed implant surface was performed using a titanium brush and tetracycline (Tc) HCl. Subsequently, to enhance peri-implant mucosa thickness and mask the titanium color, simultaneous SCTG and bone grafting procedures were conducted. Within the limitations of these case reports, successful esthetic outcomes were achieved and maintained without recurrence for 3–6 years following the simultaneous subepithelial connective tissue graft and bone graft procedures. These findings suggest the potential efficacy of this combined approach in addressing PSTD and enhancing aesthetic results around dental implants, though further studies are needed to validate these outcomes.

Background: The morphologic and dimensional alveolar bone is significant for resorption in the first 3 months after tooth removal because they restrict treatment outcomes with respect to function and esthetic. Following teeth extraction, the width and height of the alveolar ridge contour are reduced in both the horizontal and vertical dimensions. Following implant placement, the gingival morphology should be changed minimally compared to pre-extraction. Surrounding natural-like tissue is also an ultimate goal of the dental implant treatment, which is correlated with the cervical third contour on the anatomical tooth, for comfortable cleansing, food impaction avoidance, and esthetics. Purpose: To evaluate the peri-implant soft tissue changes after immediate implant placement (IIP) with the use of a customized titanium healing abutment in the posterior teeth. Method: Digital impressions using the intraoral scanner (MEDIT i500) were taken from 30 patients. Customized titanium healing abutments were designed and milled before extraction. Flapless extractions were done using surgical guides, 32 immediate implants placement were done in posterior areas, and healing abutments were placed. Soft tissues were scanned during pre-operation, and post-surgery during the 1st, 3rd, and 6th months. A 3D analysis program (Final Surface) evaluated the gingival margin distance, height, contour width, and volume in each period. SPSS was used to analyze the data with a p-value = 0.05. The between-time interval comparisons were done and the analysis was done using a Multivariate test. Results: Customized titanium healing abutments used in immediate implantation maintained optimal peri-implant mucosa. In intermittent periods, there was no significant reduction in all aspects of the margin distances and heights. During the entire period, the margin height reduction on the buccal, lingual, mesial, and distal was 0.63 mm, 0.93 mm, 0.08 mm, and 0.24 mm, respectively, and contour width reduction on the buccal, lingual, and buccolingual was 0.59 mm, 0.43 mm, and 1.03 mm, respectively. There was a significant reduction in the total buccolingual contour width in the 1st month and total volume in the 3rd to 6th months. Conclusions: Immediate implant placement with customized titanium healing abutment can achieve the optimal peri-implant mucosa and this protocol is an alternative for soft tissue management. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance of the indirect technique in peri‐implant soft tissue contour duplication after the delivery procedure in the anterior maxilla. Materials and Methods: Patients with single implant‐supported fixed restorations in the anterior maxilla were recruited. For the impression procedure, an intraoral scan was acquired by both the direct and the indirect techniques. For the delivery procedure, implants were randomly allocated into one of the two groups according to the approaches of digital impression preceding definite crown fabrication (A—direct technique; B—indirect technique) and were scanned again after the definite crown delivery. The stereolithography files were superimposed to analyze changes in peri‐implant soft tissue contour after the delivery procedure. The main outcomes were dimensional deviations of peri‐implant mucosa, and the secondary outcome was differences in the pink esthetic score (PES). Results: A total of 20 implants that underwent the complete workflow were included. After the delivery procedure, significant deviations in palatal tissue thickness between the provisional and definite crowns were observed in Group A but these were absent in Group B. Additionally, deviations in labial thickness (0.27 ± 0.12 mm vs. 0.08 ± 0.09 mm) and palatal thickness (0.17 ± 0.15 mm vs. 0.03 ± 0.08 mm), and labial volume of soft tissue (1.87 ± 0.94 mm3 vs. 0.75 ± 0.74 mm3) in Group A were significantly higher than those in Group B. No significant differences in PES were found. Conclusion: The indirect technique of scanning the provisional crown can more accurately duplicate the peri‐implant soft tissue contour than the direct technique, resulting in a smaller deviation of the soft tissue in the delivery procedure. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to evaluate the long-term effectiveness of a xenogeneic collagen matrix (CM) in pre-prosthetic augmentation of the keratinized mucosa width (KMW) at implant sites. Methods: All of the patients with localized implant-supported rehabilitation previously treated with vestibuloplasty and KMW augmentation with a non-cross-linked porcine CM were recalled. KMW was measured clinically in an apico-coronal direction from the mucogingival junction to the mucosal margin at the prosthetic zenith of each crown. Measurements were performed clinically by means of a PCP-UNC15 periodontal probe and rounded to the nearest mm. KMW values recorded at 1 year, 5 and 10 years from the soft tissue augmentation procedure were compared using a one-way repeated-measures ANOVA with Bonferroni multiple comparison post-hoc analysis. The level of significance was set at 0.05. Results: Measurements were conducted on 13 patients. All implants were in function with no signs of biological complications. All except one implant site showed KMW ≥ 2 mm. KMW decreased significantly from 1 year (3.33 ± 1.11 mm) to 5 years (2.77 ± 0.92 mm) (p = 0.001), and finally remained stable from 5 to 10 years (3.2 ± 0.99 mm) (p = 0.607). From a visual aspect, peri-implant soft tissues were characterized by a good texture and color blending compared to the adjacent teeth, highlighting good integration of the remodeled tissues and stability of the esthetic result. Conclusions: The use of a CM in pre-prosthetic soft tissue augmentation at implant sites has proven to be effective in obtaining and maintaining at least 2 mm of KMW around dental implants over a follow-up of 10 years. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the peri-implant tissue response and marginal bone levels of immediately loaded narrow diameter dental implants. In this study, 10 patients with single maxillary anterior edentulous space were included. Implants were placed and immediate provisional crown was given without any centric or eccentric contacts. After three months, a definitive restoration was placed. All the clinical and radiographical parameters were evaluated.

Purpose: The goal of this investigation was to define time-dependent peri-implant tissue changes at implants with different abutment interface designs. Materials and Methods: Participants requiring replacement of single maxillary anterior and first premolar teeth were recruited and treated under an institutional review board (IRB)-approved protocol. Implants, titanium abutments, and provisional crowns were placed in healed ridges 5 months following preservation after tooth extraction with recombinant human bone morphogenetic protein-2 (rhBMP-2). Twelve weeks later, permanent crowns were placed on patient-specific abutments and evaluated at 6, 12, and 36 months following implant placement. Clinical and radiographic assessments of abutments and crowns, peri-implant mucosa, and marginal bone levels were recorded. Results: The 3-year assessment included 45 conical interface (CI), 34 flat-to-flat interface (FI), and 32 platform-switched interface (PS) implants in 111 participants. At 3 years, the mean marginal bone level (MBL) change at CI, FI, and PS implants was -0.12, -1.02, and -1.04 mm, respectively (P = .014). "Zero" MBL loss or gain was measured over the 3-year period at 72.1% CI, 3.0% FI, and 16.6% PS implants. There was a minor change (0.0 to 0.3 mm) in peri-implant mucosal zenith positions over time and between groups. Eighty percent of CI implants, 61% of FI implants, and 84% of PS implants were observed to have a clinically stable periimplant mucosal zenith position with less than 0.5 mm of measured recession. Over the 36-month period, there were no significant changes in the location of mesial or distal papilla in any group. Conclusion: Significant differences in MBLs were observed at different implant interfaces. Conical implant interfaces, but not flat-to-flat or platform-switched implant interfaces, were associated with no MBL changes over 3 years. Peri-implant mucosal stability was generally observed. The relationship of marginal bone responses and peri-implant mucosal stability requires further evaluation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence that three different implant-abutment interface designs had on periimplant mucosal outcomes as assessed by the pink esthetic score (PES) 3 years after delayed implant placement and immediate provisionalization. Materials and Methods: Adult subjects (n = 141) requiring replacement of a bounded single tooth in the anterior maxilla as well as first premolar sites were randomized to receive one of three unique implant-abutment interface designs (conical interface [CI]; flat-to-flat interface [FI]; or platform-switch interface [PS]). Treatment included immediate provisionalization with prefabricated titanium abutments, followed by custom computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia abutments and cement-retained, all-ceramic crowns delivered after 12 weeks. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, 12, 24, and 36 months post-implant placement. Five calibrated faculty evaluators who previously scored the 1-year PES image dataset scored the 24- and 36-month photographs using a digital, cloud-based tablet interface. Results: Six hundred ten clinical photographs were evaluated, resulting in a total of 3,050 sum PES values and 21,350 individual PES values. Faculty evaluator intrarater and interrater reliability were found to be "substantial," with intraclass correlation coefficient (ICC) values of 0.76 and 0.77, respectively. All three implant-abutment interface groups demonstrated acceptable esthetics at 3 years (mean sum PES = 10.1 ± 1.9, 4.0 to 13.2), with no single group demonstrating significantly greater mean sum PES values than another at the 3-year follow-up or at any recall interval in between. Conclusion: No significant differences were observed in mean sum PES scores for subjects randomized to one of three different implant-abutment interface geometries. Within the limitations of this study thus far, the first 6 months following definitive prosthesis delivery appear to still be the most significant with regard to improvement in PES outcomes for all three treatment groups. [ABSTRACT FROM AUTHOR]

Aim: The aetiology and pathogenesis of peri‐implantitis are currently under active research. This study aimed to dissect the pathogenesis of murine experimental peri‐implantitis and assess Resolvin D2 (RvD2) as a new treatment modality. Materials and Methods: Four weeks following titanium implant insertion, mice were infected with Porphyromonas gingivalis using single or multiple oral lavages. RvD2 was administrated following infection, and tissues were analysed using flow cytometry, quantitative RT‐PCR, taxonomic profiling, and micro‐computed tomography. Results: Repeated infections with Pg resulted in microbial dysbiosis and a higher influx of innate and adaptive leukocytes to the peri‐implant mucosa (PIM) than to gingiva surrounding the teeth. This was accompanied by increased expression levels of IFN‐α, IL‐1β, and RANKL\OPG ratio. Interestingly, whereas repetitive infections resulted in bone loss around implants and teeth, a single infection induced bone loss only around implants, suggesting a higher susceptibility of the implants to infection. Treatment with RvD2 prevented Pg‐driven bone loss and reduced leukocyte infiltration to the PIM. Conclusions: Murine dental implants are associated with dysregulated local immunity and increase susceptibility to pathogen‐induced peri‐implantitis. However, the disease can be prevented by RvD2 treatment, highlighting the promising therapeutic potential of this treatment modality. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the tissue morphology around implant‐supported prostheses by digital technology and to evaluate the effect of prosthetic contours on the changes in tissues following the free gingiva graft procedure. Material and methods: A total of 53 implants in 32 patients receiving free gingiva grafts were selected. These had previously presented insufficient keratinized mucosa width (KMW). At the follow‐up visits (mean: 16.66 ± 9.97 months), the implant position and tissue condition were documented with an oral scanner. Vertical soft tissue thickness (VT), measured from the implant‐abutment connection to the marginal tissues, and horizontal soft tissue thickness (HT), at the level of the platform, were calculated. The VT, HT, and emergence angle (EA) of prostheses were assessed by 3Shape analyzing software. The final KMW was measured by clinical assessment. Marginal bone loss (MBL) was calculated in the follow‐up bitewing radiographs. Results: The mean VT in the study was 2.65 ± 0.75 mm at the mid‐buccal sites, 3.74 ± 1.22 mm at the mesial, 3.16 ± 1.08 mm at the distal, and 2.53 ± 0.92 at the mid‐lingual aspects. The mid‐buccal HT was 1.45 ± 0.53 mm while the mid‐lingual was 1.05 ± 0.43 mm (p = 0.008). Interestingly, prostheses with mid‐buccal EA>$\; > \;$30° exhibited slightly lower VT, but higher HT, than the ones with EA≤$\; \le \;$30°. Prostheses with proximal EA > 30° displayed slightly more MBL, compared to prostheses with EA≤$\; \le \;$30°. The mean KMW was 4.08 ± 1.10 mm. Conclusions: Free gingival grafting is a predictable treatment approach to augmenting soft tissue 3‐dimensionally. Prostheses with EA≤$\; \le \;$30° were preferable for preserving the maximal VT and maintaining crestal bone stability. [ABSTRACT FROM AUTHOR]

The stability of peri-implant soft tissues is essential for long-term success. Integrins play a vital role in biological processes through developing and maintaining cell interactions; however, few studies have evaluated the effects of modifications to abutment surfaces on cell adhesion across integrin expression. Therefore, this pilot study assessed the influence of different surface topographies of titanium healing abutments prepared by additive manufacturing (AM) on the gene expression levels of the integrin subunits α2, β1, αv, and β6 in the human peri-implant mucosa. Thirteen healthy adults were included. Depending on the number of required implants, the subjects were distributed in different groups as a function of healing abutment topography: group 1 (fully rough surface); group 2 (upper machined + lower rough); group 3 (rough upper surface + lower machined); group 4 (fully machined). A total of 40 samples (n = 10/group) of the peri-implant mucosa around the abutments were collected 30 days after implant placement, and subsequently, the gene expression levels were evaluated using real-time PCR. The levels of gene expression of β1-subunit integrin were upregulated for individuals receiving fully rough surface abutments compared with the other surface topographies (p < 0.05). However, the healing abutment topography did not affect the gene expression levels of the α2, αv, and β6 integrin subunits in the human peri-implant mucosa (p > 0.05). This preliminary study suggested that controlled modifications of the surface topography of titanium healing abutments produced by AM may influence the quality of the peri-implant mucosa in the early stages of the soft tissue healing process. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to comprehensively assess the literature in terms of the effect of peri‐implant mucosal thickness on esthetic outcomes and the efficacy of soft tissue augmentation procedures to increase the mucosal thickness with autogenous grafts or soft tissue substitutes. Material and methods: Two systematic reviews (SR) were performed prior to the consensus meeting to assess the following questions. Review 1, focused question: In systemically healthy patients with an implant‐supported fixed prosthesis, what is the influence of thin as compared to thick peri‐implant mucosa on esthetic outcomes? Review 2, focused question 1: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of connective tissue graft (CTG), as compared to absence of a soft tissue grafting procedure, in terms of gain in peri‐implant soft tissue thickness (STT) reported by randomized controlled clinical trials (RCTs) or controlled clinical trials (CCTs)? Review 2, focused question 2: In systemically healthy humans with at least one dental implant (immediate or staged implant), what is the efficacy of CTG, as compared to soft tissue substitutes, in terms of gain in peri‐implant STT reported by RCTs or CCTs? The outcomes of the two SRs, the consensus statements, the clinical implications, and the research recommendations were discussed and subsequently approved at the consensus meeting during the group and plenary sessions. Conclusions: There was a tendency of superior esthetic outcomes in the presence of a thick mucosa. The connective tissue graft remains the standard of care in terms of increasing mucosa thickness. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of the present retrospective study was to evaluate papillae filling rate and buccal margins coronal growth in implant‐supported prostheses which were over‐contoured at the apical buccal third to form a rearmost collar zone, thus mimicking a false root. Material and methods The influence of adjacent elements, teeth, implants, or pontics was examined. One‐hundred and three crowns have been assessed in photographs taken on 61 patients after prosthesis delivering and at last follow‐up (mean 2.8 years). The Jemt index was adopted to evaluate papillae growth at the baseline and follow‐up as follows: 0, absence of papilla; 1, less than half of interdental embrasure height; 2, more than half of interdental embrasure height; 3, fully papilla filled interdental embrasure. Index score 4, papilla hyperplasia was not included. Moreover, the coronal growth (or recession) of buccal mucosa in implant‐supported crowns was assessed. Results At baseline, a total of 29 papillae had a 0 score, while only two scored 3 with complete papilla formation. On follow‐up, only one papilla scored 0, while 46 scored 3 with complete interdental embrasures filling. The highest papilla score was registered from first year crown insertion and likewise in interdental embrasures located between two implants or implants and pontics. Moreover, the buccal margin growth was observed in almost 80% of crowns. Such findings seem to indicate that buccal margin and papilla around implant‐supported crowns presented a coronal growth over time, especially during its first year. The average papilla growth between two implants was no lower than that observed in papilla present between implants and natural teeth. Conclusions Recessed areas at collar of implant‐supported prostheses appear to positively influence papillae and buccal margin growth, especially in its first year. Papilla growth between two implants was similar to that observed between implants and natural teeth.

Abstract Background The vertical thickness of the peri-implant mucosa is associated with the amount of post treatment marginal bone loss. However, the variations in mucosal thickness at the different edentulous sites have been sparsely documented. The purpose of the study was to conduct a survey of the frequency distribution of variations in mucosal thickness at the different sites of the edentulous alveolar ridge and to compare them according to gender. Our study included 125 partially edentulous patients having a total of 296 implant sites. Cone-beam computed tomography (CBCT) scans were obtained by placing a diagnostic template with a radiopaque crown indicator on the ridge to determine the mucosal thickness at the crest of the alveolar ridge. Results The mucosal thickness was 3.0±1.3 mm in the maxilla, which was significantly greater than the mucosal thickness of 2.0±1.0 mm in the mandible (p

Aims: The objective of the present case series is to report on the rationale, surgical technique and outcome of a protocol for peri‐implant mucosal phenotype modification therapy, referred to as "fibrin immobilization vestibular extension (FIVE)". Material and Methods: The protocol utilized entailed apical positioning and stabilization of peri‐implant flap with modular screws. The screws were also used for the immobilization of solid matrix platelet‐rich fibrin to fill the gap created between apically positioned flap and the crestal margin of the flap. Results: A total of 30 patients (12 male, 18 females) with 93 implants were treated with FIVE protocol for various indications, including for vestibular extension following alveolar ridge augmentation (N = 6), preprosthetic (N = 9), postprosthetic (N = 2), and peri‐implantitis (N = 13). The keratinized mucosal width preoperatively was 1.67 mm with 95% confidence interval [CI] (1.46, 1.88). Immediately following FIVE surgery, the vestibule was extended to 9.10 with 95% CI (8.44, 9.76). At 3 months, 4.9 mm (95% CI: 4.5–5.2 mm) of peri‐implant keratinized mucosal width was present. The keratinized mucosal width remained relatively stable thereafter and was 4.0 mm (95% CI: 3.5–4.5 mm) at 3 years post‐FIVE surgery. When overall group means across all time points were analyzed, maxilla had mean of 6.1 mm (95% CI: 5.8–6.5) versus mandible exhibited mean of 5.1 mm (95% CI: 4.6–5.6 mm). The mean of maxilla was significantly higher than that of the mandible (p < 0.0001) across all time points. Treatment of peri‐implantitis with FIVE lead to significant pocket reduction and wide band of keratinized mucosa. Seven of 38 implants in 3 of 13 peri‐implantitis patients were removed due to advanced peri‐implantitis. Discussion The present case series provides proof‐of‐principle data for efficacy of FIVE for peri‐implant phenotype modification therapy that generated attached keratinized mucosa in a variety of applications. This protocol provides an alternative to procedures involving harvesting of autogenous mucosal graft. [ABSTRACT FROM AUTHOR]

Introduction: A special interest has been raised regarding the role of the peri‐implant mucosa as a critical factor for long‐term maintenance of the artificial fixtures as well as the final esthetic outcome that may significantly affect patient satisfaction. It is then imperative to develop minimally invasive and easy‐to‐apply plastic surgical methods to increase the volume of the peri‐implant mucosa. Case Presentation: The limited scientific evidence regarding possible techniques to treat esthetic soft tissue defects around endosseous implants is encouraging a preventive soft tissue augmentation of mucosa deficiencies and thin phenotypes. Several techniques have been proposed to augment the volume of the mucosa to achieve the so‐called pink esthetics. Among these the buccal pedicle flap seems to be less invasive in terms of morbidity since it does not necessitate any soft tissue harvesting. Its low morbidity allows it to treat patients without the need of postoperative medications since it reduces pain, the risk of infections, alteration of the sensitivity of the donor site and significantly reduces the period of healing which is generally longer when associated with connective tissue grafts. A modified surgical approach is based on the combination of the buccal pedicle flap with a stable collagen matrix to boost a biomimetic peri‐implant mucosa and generate a convex pink interface with the final restoration. Conclusion: The proposed modified buccal pedicle flap seems to be promising in terms of decreased morbidity and maintenance of the blood supply, and conducive to an increased patient acceptance rate. [ABSTRACT FROM AUTHOR]

The management and prevention of soft tissue complications is of key importance in modern implant dentistry and influences biologic and esthetic outcomes. The assessment of the soft tissue conditions from a quantitative and qualitative perspective should, therefore, be part of the overall treatment plan. Such an assessment dictates a potential indication as well as an ideal time point for additional soft tissue management. A proper risk assessment and management of the soft tissues at the planned implant site are of key importance prior to any implant-related surgery. Cases with peri-implant soft tissue complications generally involve: (a) a lack of attached and keratinized mucosa; (b) insufficient volume; (c) development of mucosal dehiscences; or (d) a combination of (a), (b), and (c). In case of soft tissue deficiencies, these should be addressed as early as possible to increase the predictability of the surgical interventions. This article reviews the main causes for peri-implant soft tissue complications and presents different therapeutic options for the management of various clinical scenarios. [ABSTRACT FROM AUTHOR]

Purpose: The implant-abutment interface may affect peri-implant mucosal architecture, and influence health and esthetics. The goal of this 1-year follow-up report of a 5-year clinical investigation was to examine the peri-implant mucosal tissue responses to different implant-abutment interface designs. Materials and Methods: Subjects requiring an anterior maxillary implant were recruited. Tooth extractions, with or without preservation or ridge augmentation procedures, were performed as required. After 5 months of healing, one of three different implant-abutment combinations (conical interface [CI] n = 48); flat-to-flat interface [FI] n = 49); or platform switch interface [PS] n = 44) was placed and provisionalized. Twelve weeks later, permanent crowns were placed and data gathered throughout the first year. Peri-implant mucosal architecture and bone levels were evaluated clinically, photographically, and radiographically. Results: At 1 year, seven FI and six PS implants failed and two FI and two PS implant participants were lost to follow-up, resulting in survival rates of 100% (CI), 85.7% (FI), and 86.4% (PS) (90.8% overall). Marginal bone level changes were -0.22 mm (CI, P < .05), -1.2 mm (FI, P < .05), and -1.32 mm (PS, P < .05) after 1 year. Marginal bone level stability (< 0.5-mm bone loss or gain) was recorded for 87% (CI), 8% (FI), and 27% (PS) of implants. Measurement of midbuccal mucosal zenith and papilla positions revealed no change in the mucosal positions and 0.2 to 0.3 mm of gain in papilla dimensions in all groups. Conclusion: Significant differences in marginal bone loss were observed among the three implant-abutment interfaces. At 1 year follow-up, changes in the buccal mucosal zenith position or papilla dimensions were not discernable. A continued longitudinal evaluation of peri-implant bone and mucosal changes around these different interfaces is ongoing. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present retrospective study was to evaluate papillae filling rate and buccal margins coronal growth in implant‐supported prostheses which were over‐contoured at the apical buccal third to form a rearmost collar zone, thus mimicking a false root. Material and methods: The influence of adjacent elements, teeth, implants, or pontics was examined. One‐hundred and three crowns have been assessed in photographs taken on 61 patients after prosthesis delivering and at last follow‐up (mean 2.8 years). The Jemt index was adopted to evaluate papillae growth at the baseline and follow‐up as follows: 0, absence of papilla; 1, less than half of interdental embrasure height; 2, more than half of interdental embrasure height; 3, fully papilla filled interdental embrasure. Index score 4, papilla hyperplasia was not included. Moreover, the coronal growth (or recession) of buccal mucosa in implant‐supported crowns was assessed. Results: At baseline, a total of 29 papillae had a 0 score, while only two scored 3 with complete papilla formation. On follow‐up, only one papilla scored 0, while 46 scored 3 with complete interdental embrasures filling. The highest papilla score was registered from first year crown insertion and likewise in interdental embrasures located between two implants or implants and pontics. Moreover, the buccal margin growth was observed in almost 80% of crowns. Such findings seem to indicate that buccal margin and papilla around implant‐supported crowns presented a coronal growth over time, especially during its first year. The average papilla growth between two implants was no lower than that observed in papilla present between implants and natural teeth. Conclusions: Recessed areas at collar of implant‐supported prostheses appear to positively influence papillae and buccal margin growth, especially in its first year. Papilla growth between two implants was similar to that observed between implants and natural teeth. [ABSTRACT FROM AUTHOR]

The stability of peri-implant soft tissues is essential for long-term success. Integrins play a vital role in biological processes through developing and maintaining cell interactions; however, few studies have evaluated the effects of modifications to abutment surfaces on cell adhesion across integrin expression. Therefore, this pilot study assessed the influence of different surface topographies of titanium healing abutments prepared by additive manufacturing (AM) on the gene expression levels of the integrin subunits α2, β1, αv, and β6 in the human peri-implant mucosa. Thirteen healthy adults were included. Depending on the number of required implants, the subjects were distributed in different groups as a function of healing abutment topography: group 1 (fully rough surface); group 2 (upper machined + lower rough); group 3 (rough upper surface + lower machined); group 4 (fully machined). A total of 40 samples (n = 10/group) of the peri-implant mucosa around the abutments were collected 30 days after implant placement, and subsequently, the gene expression levels were evaluated using real-time PCR. The levels of gene expression of β1-subunit integrin were upregulated for individuals receiving fully rough surface abutments compared with the other surface topographies (p < 0.05). However, the healing abutment topography did not affect the gene expression levels of the α2, αv, and β6 integrin subunits in the human peri-implant mucosa (p > 0.05). This preliminary study suggested that controlled modifications of the surface topography of titanium healing abutments produced by AM may influence the quality of the peri-implant mucosa in the early stages of the soft tissue healing process.

Background: The vertical thickness of the peri-implant mucosa is associated with the amount of post treatment marginal bone loss. However, the variations in mucosal thickness at the different edentulous sites have been sparsely documented. The purpose of the study was to conduct a survey of the frequency distribution of variations in mucosal thickness at the different sites of the edentulous alveolar ridge and to compare them according to gender. Our study included 125 partially edentulous patients having a total of 296 implant sites. Cone-beam computed tomography (CBCT) scans were obtained by placing a diagnostic template with a radiopaque crown indicator on the ridge to determine the mucosal thickness at the crest of the alveolar ridge. Results: The mucosal thickness was 3.0±1.3 mm in the maxilla, which was significantly greater than the mucosal thickness of 2.0±1.0 mm in the mandible (p<0.001). In both the maxilla and the mandible, the mucosa was the thickest in the anterior region, followed by the premolar and molar regions. Sites were further classified into two groups based on whether the mucosal thickness was greater than 2 mm. In the mandible, more than half of the sites showed a mucosal thickness of 2 mm or less. Conclusions: Although this study was a limited preoperative study, the vertical mucosal thickness at the edentulous ridge differed between the maxillary and mandibular regions. The majority of sites in the mandibular molar region had a mucosal thickness of less than 2 mm. Practitioners might be able to develop an optimal dental implant treatment plan for long-term biologic and esthetic stability by considering these factors. [ABSTRACT FROM AUTHOR]

Purpose: To retrospectively evaluate the clinical performance of zirconia endosseous implants. Materials and Methods: Partially edentulous patients with adequate bone volume to fit yttria tetragonal zirconia polycrystal (Y-TZP) implants at least 3.5 mm wide and 8.0 mm long were included. Full-mouth probing pocket depth (PPDs) and percentage bleeding on probing (BOP) scores around teeth and implant(s) were assessed and compared. Marginal bone loss/gain relative to baseline was measured on intraoral radiographs, and the prevalence and quantities of seven periodontal bacteria were assessed around implants and teeth in the same patient. Results: Seventy-four consecutively treated patients with 121 zirconia implants (66 two-piece implants and 55 one-piece implants) were clinically evaluated after a mean observation period of 18 months. Three implants had failed and had been removed, for a cumulative implant survival rate of 96.5% (± 2.0%) after 3 years. The 118 surviving implants demonstrated healthy mucosal conditions, with low mean PPDs (1.8 ± 0.4 mm) and mean BOP scores (4.1% ± 4.2%). PPD and BOP were statistically significantly lower around implants than around teeth. BOP and PPD around implants and teeth were significantly correlated. Stable marginal bone levels were observed (mean bone loss of 0.1 ± 0.6 mm after 3 years). The frequency of isolation of all marker bacteria was similar at tooth and implant sites. Conclusion: Zirconia endosseous implants can achieve a 3-year implant survival rate in partially edentulous patients, similar to that of titanium implants, with healthy and stable soft and hard tissues. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review was performed to address the focus question: “In adult patients with soft tissue deficiencies around maxillary anterior implants, what is the effect on esthetic outcomes when a soft tissue procedure is performed?” In addition, this paper reviews the importance of presurgical esthetic risk assessment (ERA) starting with comprehensive team case planning prior to surgical intervention and a restorative-driven approach. Materials and Methods: A thorough Medline database search performed on related MeSH terms yielded 1,532 titles and selected abstracts that were independently screened. Out of the 351 abstracts selected, 123 full-text articles were obtained for further evaluation. At each level, any disagreements were discussed until a consensus was reached. Results: A total of 18 studies were included in this systematic review of esthetic outcomes following soft tissue procedures around implants with soft tissue deficiencies. A preliminary analysis of the included studies showed that the vast majority were case series studies with most not providing objective outcomes of their results. Moreover, only one randomized controlled trial was identified. Therefore, quantitative data analysis and subsequent meta-analysis could not be performed. The included studies were grouped according to the intervention on the peri-implant soft tissue performed and six groups were identified. The periodontal procedures performed around dental implants gave initial good results from the inflammation involved in wound healing, but in virtually all cases significant recession occurred as healing resolved and the tissues matured. Conclusions: Although success of implant therapy is similar in the anterior maxilla and other areas of the mouth, the majority of studies evaluating this therapy in the esthetic zone are lacking literature support, few in number, devoid of long-term follow-up and number of patients, and are subject to inclusion bias. The use of the ERA tool for all esthetic zone cases can benefit both the clinician and the patient to avoid any miscommunication and problems of expectation upon completion. All the available knowledge on this topic, including the approaches described in this paper, is based on a very limited literature support and thus should be addressed with caution. These concerns should encourage long-term good clinical trials for better assessment of those issues. [ABSTRACT FROM AUTHOR]

Purpose: The host response to infection differs between peri-implantitis and periodontitis, but the mechanisms underlying these differences are not understood. In this study, the distribution of dendritic cell subpopulations in healthy peri-implant mucosa (HPIM) was compared to that of healthy gingiva (HG). Materials and Methods: HPIM and HG specimens were obtained from nonsmoking, systemically healthy subjects. Immunohistochemistry was used to quantify the number of Langerhans cells (LCs) (CD1a+) and interstitial dendritic cells (IDCs) (factor XIIIa+) in the oral epithelium, sulcular/junctional epithelia, and lamina propria without inflammatory infiltration and with inflammatory infiltration. Results: Fourteen HPIM and 13 HG specimens were obtained from subjects aged 29 to 55 years. The lamina propria of the HPIM had fewer LCs than that of the HG (HPIM: 7.99 ± 10.76, HG: 25.68 ± 16.98; P = .003). There was no significant difference in the number of CD1a+ cells in the oral epithelium or the sulcular/junctional epithelia between the HPIM and the HG (P ≥ .23). A greater number of IDCs was observed in the lamina propria with inflammatory infiltration of the HPIM compared to the HG (HPIM: 57.02 ± 35.70, HG: 33.89 ± 26.98; P = .06). Conclusions: In the lamina propria of HPIM, fewer LCs and more IDCs were observed. These differences may be associated with reduced stimulation of the innate and acquired immune responses initiated by LCs and the greater matrix remodeling of peri-implant tissue associated with IDCs. [ABSTRACT FROM AUTHOR]

Background. The effect of keratinized tissue width on the peri-implant health has not been well elucidated. The results of previous studies on this topic are controversial and the role of keratinized tissue width in the long-term success of dental implants has not been confirmed. This cross-sectional study aimed to assess the correlation of keratinized tissue width with periodontal indices around implant-supported fixed partial dentures (FPDs). Methods. This cross-sectional study evaluated 73 implants. Patients underwent periodontal examinations, including measurement of plaque index (PI), gingival index (GI), clinical probing depth (PD), bleeding on probing (BOP), marginal gingival recession, keratinized mucosa width and radiographic marginal bone level. Data were analyzed using SPSS. Results. The mean GI, PI and marginal gingival recession around implants with 0.05). No significant differences were noted in PD and radiographic marginal bone level between the two implant groups with keratinized tissue width

Background: Peri- implant diseases are mainly caused by the formation of a Biofilm on the surface of the implant. This deposition of the biofilm causes an inflammation and hence destruction of the implant supporting tissues. Though the response of the host is different in peri-implanttitis and periodontitis, the exact mechanism of the difference in the host response is not very clear till date. In the present study, the distribution of langerhans cells in healthy peri-implant mucosa (HPIM) was compared with healthy mucosa (HM). Materials and methods: In the present study, 15 subjects who were non-smokers were selected. Before placing the implant the first sample of healthy mucosa was obtained and this was marked as Group I. The second sample consisted of peri-implant mucosa which was obtained while the gingival former was placed and this was considered as Group II. In order to quantitatively identify the Langerhans cells in the sample, Immunochemistry was used. To compare the distribution of cells in epithelium and lamina propria, Wilcoxon matched paired test was utilized. Results: Mean number of CD1a (Langerhans cells) in epithelium and lamina propria of Group I and Group II were 25.2 ± 6.41 and 27.47 ± 10.26 and 19.27 ± 7.27 and 12.46 ± 3.04 respectively. Statistically significant difference in the number of cells in epithelium and lamina propria of Group I and Group II was noted. (P=0.001) Conclusion: In the lamina propria of HPIM, a lesser number of CD1a+ (Langerhans cells) were noticed compared to HM. [ABSTRACT FROM AUTHOR]

Oral mucosal homeostasis is achieved by complex immunologic mechanisms, orchestrating host immunity to adapt to the physiologic functions of the various specialized niches in the oral cavity. Dental implants introduce a novel mucosal niche to the immune system to deal with. Nevertheless, the immune mechanisms engaged toward implants and whether they have broader effects are not well defined. Using a murine model, we found an accumulation of neutrophils and RANKL-expressing T and B lymphocytes in the implant-surrounding mucosa, accompanied by local bone loss. Surprisingly, the presence of implants had an impact on remote periodontal sites, as elevated inflammation and accelerated bone loss were detected in intact distant teeth. This was due to microbial dysbiosis induced by the implants, since antibiotic treatment prevented bone loss around teeth. However, antibiotic treatment failed to prevent the loss of implant-supporting bone, highlighting the distinct mechanisms mediating bone loss at each site. Further analysis revealed that implants induced chronic lymphocyte activation and increased mRNA expression of IFN-α and accumulation of IFN-α-producing plasmacytoid dendritic cells, which we previously reported as bone-destructive immune responses. Collectively, this study demonstrates that implants have a strong and broad impact on oral mucosal homeostasis, inducing periodontal bone loss in a niche-specific manner that is both microbiota dependent and independent. [ABSTRACT FROM AUTHOR]

Implant dentistry has come a long way since 1981, with great improvements made to achieve primary implant stability and improve bone-to-implant contact. The focus has since shifted toward creating an esthetic restoration that is indistinguishable from natural teeth and is stable over time. This paper proposes a management triad that enhances soft tissue thickness around implant-supported restorations while discussing distinct differences between thin and thick tissue biotypes. In addition, the effect of tissue biotype on implant esthetics is highlighted. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cohort study was to evaluate the safety and the acceptability of an electric toothbrush used on the peri-implant mucosa of implants placed in the aesthetic area. Methods: One hundred consecutive patients rehabilitated with implants positioned in the maxillary aesthetic area were recruited. Implants had to be restored at least 6 months prior to baseline. At baseline, subjects were provided with Oral-B Professional Care 7000 and received appropriate instructions to brush twice a day over a 12-month period. Papillary bleeding index, recession and probing depth were measured at baseline and at 3, 6, and 12 months. Results: Ninety-eight (98) patients completed the study. There was an overall reduction of recession (mean 0.2 mm) of borderline statistical significance. All of the changes occurred at the first follow-up visit (P=0.09) and persisted thereafter. The statistical analyses regarding the probing depth found a highly significant decrease over time (mean 0.3 mm). The bleeding score showed a gradual decrease over time, with a reduction at 12 months by more than half (0.65) in comparison with the baseline (1.50) and was shown to be highly significant (Wilcoxon sign-rank test: P<0.001). No patient showed adverse effects such as ulcerations or desquamation. A high score of satisfaction by the patients using the electric toothbrush was reported (94% would continue to use it). Conclusion: The electric toothbrush Oral B Professional Care 7000 appears to be safe for patients with fixed prosthesis on implants in aesthetic areas. Successive randomised clinical trials are needed to compare this instrument with other therapeutic devices for mechanical plaque control. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the ultrastructural and immunohistochemical organization of the main collagenous components of healthy human keratinized mucosa surrounding endosseous implants. Eight patients with completely edentulous mandibles were selected. Four endosseous implants were placed in the mandible of each patient, connected with a bar to support a complete overdenture, and loaded 4 months later. Two years after placement, biopsies of surrounding soft tissue, including the sulcular and junctional epithelium with the underlying and supracrestal connective tissue, were routinely prepared for standard electron microscopy and for ultrastructural immunolabeling of Types I, III, and IV collagen. The connective tissue located under the junctional epithelium comprised Types I and III collagen, whereas the supracrestal connective tissue was composed mainly of Type I collagen. Type IV collagen was located exclusively in the basement membrane of the junctional epithelium. [ABSTRACT FROM AUTHOR]

Objective: To histologically and radiographically evaluate soft (primary outcome) and hard tissue integration of two‐piece titanium and zirconia dental implants with/without buccal dehiscence defects. Materials & methods: In six dogs, five implants were randomly placed on both sides of the mandible: (a) Z1: a zirconia implant (modified surface) within the bony housing, (b) Z2: a zirconia implant (standard surface) within the bony housing, (c) T: a titanium implant within the bony housing, (d) Z1_D: a Z1 implant placed with a buccal bone dehiscence (3 mm in height, identical width to implant body), and (e) T_D: a titanium implant placed with a buccal bone dehiscence. Two weeks of healing and 6 months of loading were applied on each hemi‐mandible, respectively. Results: The median level of the margo mucosae shifted more apically over time in all groups (borderline statistical significance in groups Z1_D: −0.52 mm and T_D: −1.26 mm). The median height of the peri‐implant mucosa in groups Z1_D and T_D was greatest at 2 weeks and 6 months, but the linear change in the peri‐implant mucosa was statistically significant only for group T_D over time (−1.45 mm). Z1 demonstrated a higher bone‐to‐implant contact compared to Z2 and T. Minimal change of radiographic marginal bone levels in all groups was observed (<1 mm). Conclusion: When buccal dehiscence was presented, titanium implants presented significant loss of peri‐implant mucosal height compared to zirconia implants with a modified surface, due to greater apical shift of the margo mucosae. A modified zirconia surface enhanced osseointegration. [ABSTRACT FROM AUTHOR]

A 3-year multicenter study on 63 maxillary and 10 mandibular fixed prostheses in 71 patients is reported. Angulated abutments or a combination of angulated and standard abutments were used to support prostheses; all components were from the Brånemark System. Of 425 implants initially placed, 4 were lost before abutment connection. Of the remaining 421 implants, 209 angulated (test) abutments and 212 standard (control) abutments were placed to support fixed prostheses. The prosthesis success rates were 96.8% for maxillae and 100% for mandibles. A total of 5.3% of the loaded test implants and 7.5% of the loaded control implants failed. The survival rates after 3 years were 91.3% for maxillary control implants, 94.8% for maxillary test implants, 97.4% for mandibular control implants, and 94.1% for mandibular test implants. The findings in this study pointed out that angulated abutments will not necessarily promote peri-implant mucosal problems. The study indicated that angulated abutments on Brånemark System implants have exhibited good preliminary results and should be comparable to the standard abutment as a predictable modality in prosthetic rehabilitation. [ABSTRACT FROM AUTHOR]

Human gingival epithelial cells (HGEps) and fibroblasts (HGFs) are the main cell types in peri-implant soft tissue. HGEps are constantly exposed to bacteria, but HGFs are protected by connective tissue as long as the mucosa–implant seal is intact. Streptococcus oralis is one of the commensal bacteria, is highly abundant at healthy implant sites, and might modulate soft tissue cells—as has been described for other streptococci. We have therefore investigated the effects of the S. oralis biofilm on HGEps and HGFs. HGEps or HGFs were grown separately on titanium disks and responded to challenge with S. oralis biofilm. HGFs were severely damaged after 4 h, exhibiting transcriptional inflammatory and stress responses. In contrast, challenge with S. oralis only induced a mild transcriptional inflammatory response in HGEps, without cellular damage. HGFs were more susceptible to the S. oralis biofilm than HGEps. The pro-inflammatory interleukin 6 (IL-6) was attenuated in HGFs, as was interleukin 8 (CXCL8) in HGEps. This indicates that S. oralis can actively protect tissue. In conclusion, commensal biofilms can promote homeostatic tissue protection, but only if the implant–mucosa interface is intact and HGFs are not directly exposed.

Background: The peri-implant mucosa undergoes surgical and bacterial assaults in various stages of implant therapy, however, the literature on changes occurring in the peri-implant mucosa is minimal. This study was thus conducted to evaluate the change in the peri-implant mucosal thickness and its effect on the marginal bone levels around dental implants treated in a conventional two-stage implant therapy. Materials and Methods: A total of 36 implants were placed in 22 subjects. Two subjects dropped out. Thirty-three implants in 20 subjects were then evaluated. Initial mucosal thickness, marginal bone levels on radiographs, pain, and exudation were evaluated. All these parameters were recorded at the time of implant placement, at the time of cementation of final restoration, 6 months and 12 months post cementation/restoration. Results: The peri-implant mucosal thickness reduced from implant placement to second stage and till restorations and was statistically significant, in both the thick and thin biotypes, however, at 12 months there was a rebound of the tissue thickness, which was more in the thick biotype (P < 0.05). At 1-year follow-up, there was a reduction in the marginal bone levels, which was more in the thick biotype as compared to the thin biotype (P < 0.05). Conclusion: The mucosa at implant sites undergoes a reduction in thickness from the time of implant placement till the placement of final restorations. The placement of the final restorations and then end of active therapy leads to a rebound of the tissue thickness. Sites with thicker tissues preoperatively have a lesser bone loss and better rebound as compared to thinner tissues.

Background. The effect of keratinized tissue width on the peri-implant health has not been well elucidated. The results of previous studies on this topic are controversial and the role of keratinized tissue width in the long-term success of dental implants has not been confirmed. This cross-sectional study aimed to assess the correlation of keratinized tissue width with periodontal indices around implant-supported fixed partial dentures (FPDs). Methods. This cross-sectional study evaluated 73 implants. Patients underwent periodontal examinations, including measurement of plaque index (PI), gingival index (GI), clinical probing depth (PD), bleeding on probing (BOP), marginal gingival recession, keratinized mucosa width and radiographic marginal bone level. Data were analyzed using SPSS. Results. The mean GI, PI and marginal gingival recession around implants with <2 mm width of keratinized gingiva were greater than the corresponding values around implants with keratinized tissue width of ≥2 mm. However, this difference was not statistically significant (P>0.05). No significant differences were noted in PD and radiographic marginal bone level between the two implant groups with keratinized tissue width <2 mm and ≥2 mm. Thus, no correlation was found between the keratinized tissue width and the measured indices. Conclusion. Although this study did not show a significant correlation between the keratinized tissue width and peri-implant tissue health and consequently the implant success rate, long-term interventional studies are required to make a final judgment in this respect. [ABSTRACT FROM AUTHOR]