Non-invasive assessment of peri-implant mucosal thickness: A cross-sectional study

Characterization of the anterior maxillary region for immediate implant placement: A radiographic cross-sectional study

STATEMENT OF PROBLEM

Information regarding the influence of local phenotypical features in the context of immediate implant placement (IIP) in the anterior maxillary region is sparse.

PURPOSE

The purpose of this clinical study was to characterize key phenotypical and anatomical characteristics of the anterior maxilla related to the feasibility of virtual IIP.

MATERIAL AND METHODS

Cone beam computed tomography (CBCT) scans acquired from adult participants were used for virtual implant placement and to measure periodontal phenotypical dimensions (buccal and palatal gingival (GT) and bone thickness (BT)), the buccal gap (BG) at different apico-coronal levels, and anatomical variables nasopalatine canal and ramifications, nasal cavity, maxillary sinus). The study sample was comprised of 330 maxillary anterior teeth. Two different immediate implant modalities were examined: cingulum emergence plan (CEP) and incisal edge emergence plan (IEP).

RESULTS

A total of 660 implants were virtually placed. The mean periodontal phenotypical dimensions showed variability between and within individuals depending on the apico-coronal level, tooth type, and implant placement modality. Immediate implant feasibility was 90.1% and 93.6% for the CEP and IEP groups, respectively, and was influenced by tooth type and anatomical variables. BG distance was generally greater at the coronal aspect and in the CEP. Thick bone and gingiva (≥1 mm) were observed in 15.2% and 89.3% of the sites, respectively. A minimum of 2 mm of apical bone availability to achieve primary stability was observed in 88.8% and 91.2% of the sites in the CEP and IEP groups, respectively.

CONCLUSIONS

This study highlights the variability in periodontal phenotypical and local anatomical features at anterior maxillary sites. These observations underscore the importance of recognizing such variations that should be identified and considered during the planning and execution of therapy.

Patient-Reported Outcome Measures Following Implant Placement With Simultaneous Horizontal Bone Augmentation

OBJECTIVES

This study aimed to evaluate the impact of implant placement with simultaneous bone augmentation on patients' willingness to repeat the procedure. Secondary outcomes included assessing patient-reported outcome measures, clinical- and surgical-related factors affecting treatment outcomes.

METHODS

Subjects who were currently undergoing or have undergone implant placement with simultaneous bone augmentation in the esthetic region (maxillary second premolar to second premolar) were assigned to three groups: Group A (short-term), Group B (1-5 years post-surgery), and Group C (> 5 years post-surgery). Clinical assessments, dichotomous questions, and visual analogue scales were used to evaluate therapeutic outcomes according to the group of interest.

RESULTS

One hundred and fifty patients completed the study (n = 50 per group). In Group A, 16% experienced wound dehiscence (membrane exposure < 3 mm), and 2% had postoperative bleeding, infection, swelling, or abscess. Flaps extending beyond three teeth significantly increased early membrane exposure (p = 0.04). Patient-reported postoperative discomfort (p < 0.001) and wound healing scores (p < 0.04) decreased over time. Willingness to repeat the procedure was 100%, 88%, and 98% in Groups A, B, and C, respectively, with satisfaction rates of 98.2 ± 7.5, 91.2 ± 10.6, and 95.2 ± 10.9. No significant differences were found between Groups B and C for functional or esthetic satisfaction. However, Group C reported higher satisfaction and comfort (p < 0.001). Younger adults and women reported greater postoperative discomfort than older adults and men.

CONCLUSIONS

Implant placement with simultaneous horizontal bone augmentation in esthetic areas shows a high willingness of patients to repeat the procedure in the short-, mid-, and long-term. Additionally, this therapeutic approach yields low rates of postoperative complications and discomfort, along with high patient satisfaction related to functional performance, esthetics, and overall comfort.

Reproducibility and Reliability of Intraoral Scanners for Evaluating Peri-Implant Tissues and Implant-Supported Prostheses: A Cross-Sectional Study

OBJECTIVE

To assess the reproducibility and reliability of the pink (PES) and white esthetic scores (WES) using digital images and the intra- and inter-examiner agreement among different clinical backgrounds and assessment methods.

MATERIAL AND METHODS

Standardized intraoral images were obtained from adult subjects with an implant-supported single-tooth fixed dental prosthesis located in the maxillary esthetic zone using a digital camera and a true-color intraoral scanner. According to the PES and WES criteria, the images were evaluated by 20 calibrated evaluators, 5 prosthodontists, 5 periodontists, 5 undergraduates, and 5 oral surgeons.

RESULTS

The total number of individual PES and WES was 12600 and 9000, respectively. Similar PES and WES values were obtained with the intraoral scanner compared to the digital camera. Intra- and inter-rater variations were observed between and within evaluators' clinical backgrounds, with periodontists showing consistently lower mean PES and WES. The intraclass correlation coefficient ranges between 0.41 to 0.61 for the PES and 0.42 to 0.69 for the WES, resulting in fair to good agreement in both digital methods.

CONCLUSION

The digital assessment of the peri-implant tissues and implant-supported prostheses utilizing images provided by an intraoral scanner offers a reproducible and reliable digital method comparable with the digital camera.

CLINICAL SIGNIFICANCE

This study highlights the reliability and reproducibility of using intraoral scanners for evaluating peri-implant tissues and implant-supported prostheses. The findings suggest that intraoral scanners are a viable digital alternative to traditional digital imaging for these assessments. However, the observed intra- and inter-rater variations in pink and white esthetic scores, according to the clinical background of evaluators, emphasize the need for caution when interpreting these values in clinical decision-making and research.

Methods for 3D evaluation and quantification of gingival recessions and gingival margin changes: Advancements from conventional techniques

In an era of increasing life expectancy and growing patient demands towards lifelong natural tooth retention, accurate assessment of gingival recessions is crucial for diagnosing periodontal diseases, planning preventive or restorative interventions, and evaluating their outcomes. The traditional two-dimensional (2D) methods, while useful, often fall short in capturing the complex topography of gingival tissue margins and their changes over time. By examining relevant published studies, this review highlights the transition from 2D to 3D techniques, analyzing the limitations of widely used 2D approaches, while emphasizing the potential of novel 3D tools and techniques. It discusses their comparative effectiveness, accuracy, and application challenges in clinical and research settings. Advancements in three-dimensional (3D) imaging regarding methodologies for the precise evaluation and quantification of free gingival margin changes and gingival recessions are explored and critically evaluated. The review underscores the potential for these technologies to enhance patient outcomes through more precise diagnosis and data generation. It also identifies gaps in current research and suggests directions for future investigation. Overall, this review provides a comprehensive overview of the state of the art in 3D evaluation methods for gingival recessions and gingival margin changes, offering valuable insights for clinicians and researchers.

[Measuring methods of volumetric changes of soft tissues at dental implants site and tooth recessions site]

The article is a review of literature on various methods for measuring gingival thickness at implant site and tooth recession. The purpose of the study was to analyze existing methods for assessing volumetric changes in soft tissues based on literature data and give recommendations on the choice of methods. The authors analyzed available methods and identified limitations and recommendations for the use of different methods. The literature review is also helpful to identify promising methods for assessing changes in soft tissue volume, which may help authors of future studies with method selection.