International Journal of Oral Implantology, 03/2023

Purpose: This systematic review aimed to evaluate the medium-term (3-year) overall survival and success rates, marginal bone loss and different biological parameters displayed with one-piece zirconia implants. Materials and methods: Electronic searches were conducted of the MEDLINE (via PubMed), Scopus (Elsevier), Cochrane Library (Wiley) and Web of Science (Clarivate Analytics) databases and manual searching was also performed for relevant articles published up to 14 November 2022. The review included human studies with a minimum of 10 subjects and/or 20 implants and with a follow-up period of at least 3 years after implant placement. Results: Twelve studies met the inclusion criteria and were included for analysis, giving a total of 1,621 one-piece zirconia implants. Eleven studies were included to perform a meta-analysis of survival rates, and six for success rates and marginal bone loss. The survival and success rates at the 3-year follow-up were 94.4% (95% confidence interval 90.4%–98.4%; P < 0.001) and 91.6% (95% confidence interval 84.2%–98.9%; P < 0.001), respectively, and marginal bone loss was 0.231 mm (95% confidence interval 0.190–0.272; P < 0.001). Conclusions: One-piece zirconia implants appear to be a reliable option for restoring missing teeth, obtaining an implant survival rate of 94.4% and a success rate of 91.6% after a follow-up period of at least 3 years. Moreover, the results showed acceptable rates of marginal bone loss and adequate biological parameters. Keywords: clinical behaviour, dental implants, dental porcelain, success, survival The authors report no conflicts of interest related to this study.

Purpose: To determine the histological effects of ultraviolet light and cold atmospheric plasma treatment on the osseointegration of titanium implants in vivo. Materials and methods: Six juvenile pigs were divided into three groups of two animals each. A total of 54 titanium implants were placed randomly in the pigs’ calvarial bone (nine implants per pig). Of these, 18 implants served as untreated controls. The remaining 36 implants served as the experimental group and were treated with either ultraviolet light or argon plasma for 12 minutes each prior to insertion. Two pigs in each group were kept until 2, 4 and 8 weeks and then sacrificed. Resonance frequency analysis was conducted after implant placement and at the time of sacrifice. Osseointegration was evaluated using microcomputed tomography scans and histomorphometrical analysis. Results: After initial loss, all implants showed a constant increase in implant stability quotient values over time without significant differences between the groups. The bone–implant contact values increased steadily for all implants over 8 weeks of healing. Surface-treated implants showed significantly higher bone–implant contact values compared to untreated implants at each time point. Bone area fraction occupancy values were almost always higher following both treatment methods; however, differences were only significant after 4 and 8 weeks for the cold atmospheric plasma group and after 4 weeks for the ultraviolet light group. Conclusions: Ultraviolet light and cold atmospheric plasma may improve histomorphometrical osseointegration of titanium implants significantly. Keywords: dental implant, plasma gases, titanium, ultraviolet rays This research project was supported by a grant from the Oral Reconstruction Foundation (Basel, Switzerland), grant number CF11501. The funding source had no involvement in the study design, data collection, analysis and interpretation, writing of the study or the decision to submit the article for publication. The plasma and ultraviolet light devices and the titanium and zirconia samples were provided free of charge by Diener Electronic (Ebhausen, Germany) and Ushio (Tokyo, Japan). No advantages of any kind were received either directly or indirectly by the authors. The authors declare that there are no conflicts of interest relating to this article.

Purpose: To longitudinally assess the prevalence of peri-implant health, peri-implant mucositis and peri-implantitis in a cohort of patients with and without history of periodontitis over a 20-year period. Materials and methods: Eighty-four patients who attended a specialist private periodontal practice were evaluated prospectively 10 and 20 years after prosthesis delivery. Following successful completion of periodontal/implant therapy, patients (172 implants) were enrolled on an individualised supportive periodontal care programme. Clinical and radiographic parameters were collected to assess the prevalence of peri-implant health and diseases. Prevalence of peri-implantitis and peri-implant mucositis was calculated based on the case definition set out in 2018. A multilevel logistic regression analysis was conducted to assess potential risk or protective factors. Results: The analysis was performed on 22 periodontally healthy and 62 periodontally compromised patients rehabilitated with 39 and 130 implants, respectively. The 10-year prevalence of peri-implant health, peri-implant mucositis and peri-implantitis was 21.4%, 67.9% and 10.6%, respectively, whereas the 20-year prevalence was 29.8%, 47.6% and 33.3%, respectively. Non-compliant periodontally compromised patients showed a statistically significantly increased risk at 20 years of both peri-implant mucositis (odds ratio 11.1; 95% confidence interval 1.8–68.6) and peri-implantitis (bone loss and probing depth) (odds ratio 14.3; 95% confidence interval 1.8–32.9). High full-mouth plaque and bleeding scores were associated with higher odds of both peri-implant mucositis and peri-implantitis. Conclusions: Peri-implant diseases were prevalent in patients rehabilitated with dental implants and followed up for a period of 20 years. History of periodontal disease and a lack of compliance with a tailored supportive periodontal care programme were identified as risk factors for peri-implant diseases. Keywords: dental implants, peri-implantitis, periodontally compromised patients, periodontitis, supportive periodontal care The authors declare no potential conflict of interests with respect to this study. The study was self-funded; no external funding was available for this research.

Background: Studies on different surgical approaches have been published with excellent success rates for zygomatic implants. The same publications offer different results regarding the complications associated with the use of such implants. A consensus protocol on zygomatic implant interventions has yet to be documented. Purpose: To seek to establish a consensus at each step of treatment consisting of oral rehabilitation using zygomatic implant–anchored restorations, and to share the outcome of the process to serve as a basis for practitioners and researchers. Materials and methods: A wide variety of protocols were identified based on the results of a literature review conducted previously. All participants received the results of the systematic literature search. A modified Delphi process was used to establish a consensus protocol. Six sections were defined: Diagnosis and indications, Planning, Medication, Surgery, Prosthesis, and Follow-up. The first round of 17 open-ended questions was shared with 63 participants, all of whom were experts in zygomatic implant rehabilitation and part of the ZAGA Centers network. A total of 77 follow-up questions were then generated after analysis of the responses to the first 17 questions. Results: Of the 63 experts enrolled, 48 responded to both rounds of questions. Consensus was determined based on the percentage of agreement: < 70% was considered “no consensus” and ≥ 70% was considered “consensus”. A high level of consensus was reached. The sections with the lowest percentage of agreement were Medication and Surgery, where a consensus was reached for 67% of the questions. Of the questions included in the Follow-up section in both rounds, a consensus was reached for 80%. Overall, agreement was obtained on 71% of the topics. Conclusions: Use of the modified Delphi process led to the creation of the first consensus protocol for oral restorations anchored to zygomatic implants. Keywords: consensus, Delphi process, zygomatic implants, zygomatic process, zygomatic protocols The authors declare there are no conflicts of interest relating to this study.

Case presentation: Midfacial peri-implant soft tissue recession poses a significant challenge to achieving satisfactory aesthetic outcomes and requires a comprehensive, multidisciplinary approach. The present study describes two challenging cases in which implants were aesthetically compromised. A predictable technique was employed to manage these cases by using the implant itself as a tent to achieve 3D horizontal and vertical soft tissue building, which resulted in improved patient satisfaction. The first case involved a deep, severely buccally placed implant situated adjacent to compromised tooth structure. Horizontal and vertical soft tissue augmentation were carried out using a healing abutment to maintain the connective tissue coronal to the implant. The final fixed prosthesis was then delivered on top of the permanent submerged implant, with excellent soft tissue outcomes and a high level of patient satisfaction. The second case involved two compromised, deep, buccally placed implants that were managed by performing a permanent implant submergence technique on the maxillary left central incisor implant and augmenting the soft tissue vertically and horizontally. The final fixed prosthesis was delivered between the maxillary left lateral incisor implant and the previously prepared maxillary right central incisor, resulting in an acceptable aesthetic outcome. The technique presented managed the peri-implant soft tissue dehiscence effectively and restored the previously deficient peri-implant papillae. Conclusions: The key to treating challenging aesthetic complications encountered with implants is presurgical prosthetic preparation followed by use of a comprehensive surgical technique to optimise soft tissue thickness and height and address compromised aesthetics in a single surgical step. Use of a permanent implant submergence technique with remediation of associated defects may be a viable clinical approach that is not often explored for these types of defects. Keywords: aesthetics, connective tissue, dental implants, single-tooth The authors report no conflicts of interest relating to this study.

The following amendments are made to the published article: Int J Oral Implantol (Berl) 2023;16(2): 117–132; First published 9 May 2023