International Journal of Periodontics & Restorative Dentistry, 05/2016

The aim of the present case series study was to evaluate the short- and longterm (3 years) soft tissue stability of a surgical technique combining transmucosal implant placement with submarginal connective tissue graft (CTG) in an area of shallow buccal bone dehiscence. A sample of 20 patients were treated by positioning a transmucosal implant in an intercalated edentulous area. A CTG sutured to the inner aspect of the buccal flap was used to cover the shallow buccal bone dehiscence. Clinical evaluations were made at 6 months (T1) and 1 (T2) and 3 (T3) years after the surgery. Statistically significant increases in buccal soft tissue thickness and improvement of vertical soft tissue level were achieved at the T1, T2, and T3 follow-ups. A significant increase in keratinized tissue height was also found at T3. No significant marginal bone loss was recorded. The submarginal CTG technique was able to provide simultaneous vertical and horizontal soft tissue increases around single implants with shallow buccal bone dehiscence and no buccal mucosal recession or clinical signs of mucositis or peri-implantitis at 1 and 3 years.

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.

The aim of the present study was the retrospective evaluation of the distance of the labial hard and soft tissue margins from the implant shoulder in 24 periodontally compromised sites that were restored by immediate implant restorations. Volumetric analysis was performed 5 years postoperatively using cone beam computed tomography with limited field of view. In all cases, a labial radiopaque plate component was apparent 5 years postoperatively coronal to the implant shoulder (3.1 ± 0.6 mm), supporting the soft tissue margin, which was extending above this level (5.2 ± 1.1 mm). In 12 of the sites, preoperative evaluation showed that this plate was missing at the time of implant placement.

This article discusses the clinical use of laser-microtextured abutments on dental implant restorations. Four cases are presented, each using one of the four commercially available laser-microtextured abutment styles. Numerous preclinical and clinical studies have shown the positive effects of laser microtexturing on the implant platform in limiting crestal bone loss and benefiting soft tissue stability. Other histologic studies of laser microtexturing on the implant abutment have demonstrated the ability of this specific feature to block epithelial downgrowth and provide a functional connective tissue attachment to the abutment surface. Other abutment designs, styles, and materials have only demonstrated a soft tissue seal with epithelial adhesion and a circular ring of connective tissue fibers around the abutment without direct contact. This article presents clinical and radiographic case examples from a private practice perspective on the longterm successful use of microtextured abutments with respect to crestal bone levels, exceptional soft tissue health, and stability with minimal sulcular depth.

Restoration of lost interdental papilla remains one of the most challenging goals for clinicians. When a single tooth is replaced with an implant, the papilla between the tooth and the implant can often be maintained or predictably reconstructed as long as the periodontal attachment and bone of the adjacent tooth is preserved. However, if the periodontal support is compromised on the neighboring natural tooth, the papilla will often be deficient or missing. This article presents a multidisciplinary treatment approach to regenerate the interdental papilla between an implant and a periodontally compromised tooth using surgical procedures and a customized abutment. Specifically, an abutment with modified subgingival contours is used to enhance support of the surgically reformed papilla.

This study describes the early soft tissue morphology around two different implant systems that received either smooth or laser-etched abutments in a beagle dog model. Implants were placed in the healed mandibular molar region of eight beagle dogs and allowed to heal for 7 weeks. When the most apical aspect of the junctional epithelium (JE) was above or within the upper half of the laser-etched region, fibers were oriented perpendicular to the abutment surface. In contrast, JE positioned within the lower half of the laser-etched region or within or below the implant-abutment gap level presented fibers oriented parallel to the abutment surface.

Buccopalatal collapse of the postextraction ridge is a significant challenge in restorative and implant dentistry. A variety of ridge preservation techniques using tissue and augmentative materials have been proposed in the literature. A slightly different approach is to use the tooth itself. Root submergence has been reported in the literature for more than 4 decades, and it has been demonstrated that the submerged tooth root retains the periodontal tissues and preserves the bone in pontic sites or below dentures to retain the ridge. The socket-shield technique entails preparing a tooth root section simultaneous to immediate implant placement and has demonstrated histologic and clinical results that are highly promising to esthetic implant treatment. The pontic shield technique preserves the alveolar ridge at sites intended for pontic development where the root submergence technique is not possible. The aforementioned techniques collectively may be termed partial extraction therapies (PET), a term newly introduced into the literature and clinical environment. This article is a review of these ridge preservation therapies, providing a classification and a guide to their application.

A sample of 24 patients with varied morphologic defects were treated with 34 titanium meshes and particulate bone and rehabilitated at least 8 to 9 months thereafter with the placement of 88 implants. Of the 34 meshes, 4 had to be removed before implant placement (11.76% total failure) and 20 were exposed due to soft tissue dehiscence (58.82% of complications): 4 (11.77%) prematurely (within 4 to 6 weeks) and 16 (47.05%) delayed (after 4 to 6 weeks), with no compromise in implant placement. None of the 88 implants was lost (100% implant survival), and 15 demonstrated increased bone loss, yielding a cumulative implant success rate of 82.9%. This technique appears useful in treating extended and morphologically varied alveolar defects.

Peri-implant bone levels are influenced by pathologic and nonpathologic conditions. The understanding of peri-implant disease has evolved over the past several decades, and the classification of peri-implantitis has been limited to descriptions of disease progression or those involving soft and/or hard tissues (peri-implant mucositis or peri-implantitis). However, no classification system has been established based on etiology. The objective of this study was to identify various etiologies for peri-implantitis and to establish a classification system based on the pathogenesis. The results indicate that the majority of bone loss was related to biofilm, followed by iatrogenic factors, exogenous irritants, absence of keratinized tissue, and extrinsic pathology. The proposed classification system will allow the clinician to properly diagnose peri-implant diseases in relation to etiology. These conditions may respond differently to applied therapies.

This is a case report of a custom titanium ridge augmentation matrix (CTRAM). Using cone beam computed tomography (CBCT), a custom titanium spacemaintaining device was developed. Alveolar ridges were virtually augmented, a matrix was virtually designed, and the CTRAM was additively manufactured with titanium (Ti6Al4V). Two cases are presented that resulted in sufficient increased horizontal bone volume with successful dental implant placement. The CTRAM design allows for preoperative planning for increasing alveolar ridge dimensions to support dental implants, reduces surgical time, and prevents the need for a second surgical site to gain sufficient alveolar ridge bone volume for dental implant therapy.

The application of laser as a monotherapy has been shown to reduce probing pocket depths and increase clinical attachment levels after treatment of patients suffering from chronic periodontitis. Its controversial use as an adjunct to scaling and root planing (SRP) is discussed. The present study aimed to evaluate the efficacy of adjunctive Er, Cr:YSGG laser application following conventional SRP. A total of 30 patients with chronic periodontitis were enrolled in the study. The quadrants of each patient were allocated to either SRP or SRP + laser. A total of 3,654 sites with pocket depths ≥ 4 mm were treated and evaluated at 6 weeks and 6 months postoperatively with respect to attachment gain. Both therapies resulted in improved probing pocket depths and clinical attachment levels. The adjunctive application of Er, Cr:YSGG laser following SRP did not improve probing pocket depth or attachment level compared with SRP alone.

The aim of this case report was to evaluate the histologic and radiographic new bone formation following maxillary sinus reentry surgery without a bone graft. A 61-year-old woman was referred with a failure of a sinus augmentation procedure. A reentry procedure was performed to retreat the sinus complication. The procedure involved removal of the bone graft plus debridement of the sinus. No additional bone graft material was used. A cone beam computed tomography scan was taken 6 months following the reentry procedure. During implant placement surgery, a core biopsy specimen was retrieved, stored, and prepared to obtain thin ground undecalcified sections. The histologic and radiographic analysis showed formation of new bone at the time of implant placement. At 18 months following implant placement, successful evidence of integration was determined by implant stability and radiographs. Space maintained by the previously elevated sinus membrane at the time of sinus reentry was sufficient to induce formation of bone without regrafting. However, more cases involving survival of implants placed in augmented sinuses without the use of bone grafts at the time of reentry are needed to confirm the results of this case report study.

The aim of this study was to analyze the primary stability of BoneTrust Sinus implants (BTSIs), which are intended to enable higher primary stability by their special design with reduced thread section in cases of reduced vertical bone availability, in comparison with standard BoneTrust implants (SBTIs) in vitro. A bone window 3 cm in length, 4 cm in width, and 3 cm in depth, resembling the maxillary bone window of the lateral sinus wall with 4 mm of residual bone height, was prepared at the dorsal side of freshly slaughtered bovine ribs. One single BTSI and a single SBTI with the same diameter (4 or 5 mm) were placed in each window. After implant placement, the implant stability quotient (ISQ) was measured by using resonance frequency analysis with an Osstell device. A total of 88 implants were placed. ISQ values varied between 63 and 84. Among the implants with 4-mm diameter, all BTSIs showed higher ISQ values compared with SBTIs. One-way analysis of variance showed a significant difference between BTSIs/SBTIs (P < .05). BTSIs with 4-mm diameter showed statistically higher values compared to BTSIs with 5-mm diameter (P < .05). Among the implants with 5-mm diameter, all SBTIs showed higher ISQ values compared to BTSIs but there was no significant difference. The use of 4-mm-diameter BTSIs could present higher ISQ values during simultaneous implant placement in conjunction with lateral sinus floor augmentation.

This case series aimed to investigate the initial-phase bone remodeling during implant wound healing and to discuss the possible contributing factors. A total of 11 implants with polished collars were placed in premaxillary regions via flapless approach with the aid of computer technology. After 15 months of follow-up, the results suggested that the presence of polished collars triggered bone resorption via a bone remodeling mechanism. The overall vertical crestal resorption was 0.78 ± 0.46 mm on average. This initial-phase bone remodeling primarily occurred within the first 3 months postoperatively. The slightly exposed polished collar may not worsen crestal bone level.

This study evaluated four implant surfaces in a minipig model: (1) Kohno Straight dual-engineered surface (DES) (Sweden & Martina); (2) SLActive (Straumann); (3) SM Biotite-H coated with Brushite (DIO); and (4) UF hybrid sandblasted and acid etched (HAS) (DIO). The surfaces presented different topographic features on the macro-, micro-, and nanoscales. After 12 weeks in vivo, significant differences were observed in bone-to-implant contact. UF HAS, presenting moderate microroughness and high nanoroughness, showed some advantage compared to nanorough SM Biotite-H and SLActive. A more pronounced difference was observed between UF HAS and Kohno Straight DES, characterized by a nanosmooth surface. Newly formed bone was observed around all surfaces.

This study evaluated color variability in the A hue between the VITA Classical (VITA Zahnfabrik) shade guide and four other VITA-coded ceramic shade guides using a Canon EOS 60D camera and software (Photoshop CC, Adobe). A total of 125 photographs were taken, 5 per shade tab for each of 5 shades (A1 to A4) from the following shade guides: Vita Classical (control), IPS e.max Ceram (Ivoclar Vivadent), IPS d.SIGN (Ivoclar Vivadent), Initial ZI (GC), and Creation CC (Creation Willi Geller). Photos were processed with Adobe Photoshop CC to allow standardized evaluation of hue, chroma, and value between shade tabs. None of the VITA-coded shade tabs fully matched the VITA Classical shade tab for hue, chroma, or value. The VITA-coded shade guides evaluated herein showed an overall unmatched shade in all tabs when compared with the control, suggesting that shade selection should be made using the guide produced by the manufacturer of the ceramic intended for the final restoration.

This study was designed to compare the combined effect of two different drilling techniques (conventional expansion and one-step) and four different implant geometries in a beagle dog model. The nondecalcified bone-implant samples underwent histologic/metric analysis at 2 and 6 weeks. Morphologic analysis showed similarities between different drilling technique groups and implant geometries. Histomorphometric parameters, bone-to-implant contact (BIC), and bone area fraction occupancy (BAFO) were analyzed, and no statistical difference between drilling groups and/or implant geometry was found. Time was the only variable that affected BIC and BAFO, suggesting that the two protocols are equally biocompatible and osseoconductive.