Soft tissue conditions and marginal bone levels of implants with a laser-microtextured collar: a 5-year, retrospective, controlled study

Treatment of peri-implant mucositis using spermidine and calcium chloride as local adjunctive delivery to non-surgical mechanical debridement: a double-blind randomized controlled clinical trial

OBJECTIVES

To evaluate the effects of non-surgical mechanical debridement with or without adjunctive application of a gel with spermidine and sodium hyaluronate associated to a sealing gel (i.e. calcium chloride) in the treatment of peri-implant mucositis (PiM).

MATERIALS AND METHODS

Forty patients with one implant with PiM were randomly allocated in test and control groups. Test implants were treated with non-surgical mechanical debridement and local unique application of spermidine and calcium chloride gel while control implants were treated using non-surgical mechanical debridement alone. The primary outcome was BOP change. FMPS, FMBS and PD were also assessed. For an Implant the presence of a single bleeding spot (1 site/implant without a continuous line or profuse bleeding) was considered as complete disease resolution.

RESULTS

After 3 months, a statistically significant improvement of all parameters were recorded in each group (p < 0.05). However, no statistically significant differences were found between test and control procedures (p > 0.05). At 3 months, 85% of test implants and 70% of control implants resulted in disease resolution. Residual implants with PiM in control group displayed a greater number of BOP-positive sites when compared with those of test group (p < 0.05).

CONCLUSIONS

Whitin the limitations of the present study, results indicate that the clinical parameters improved following non-surgical mechanical debridement regardless the adjunct of spermidine and calcium chloride gel. Nevertheless complete resolution of PiM was not obtained in both experimental groups.

CLINICAL RELEVANCE

Although no statistically significant differences were found between test and control procedures, the adjunctive application of spermidine and calcium chloride gel to non-surgical mechanical debridement may be considered in order to reduce the number of sites with BOP-positive.

Influence of crestal and sub-crestal implant position on development of peri-implant diseases: a 5-year retrospective analysis

OBJECTIVES

The aim of the present study was to evaluate the influence of crestal and subcrestal implant position on development of peri-implant diseases.

MATERIALS AND METHODS

The study was designed as a retrospective clinical and radiographic analysis. Implant-supported fixed dental prostheses were allocated in two groups: with the shoulder (i) placed in sub-crestal level and (ii) placed at bone level. For each patient, the following clinical variables were assessed: FMPS, FMBS, PlI, BOP, and PD. After prothesis delivery, an intraoral radiograph was obtained; this exam was performed also at 5 years of observation period.

RESULTS

No statistically significant difference was found in terms of FMPS and FMBS at baseline and after 5 years follow-up (P < 0.05). A statistically significant difference was assessed between PD of control group and test group (P = 0.042). Patient-based analysis showed a 25.6% of peri-implant mucositis and 32.6% of peri-implantitis for implants placed with the shoulder in crestal position, while for implants inserted in sub-crestal position the percentage of peri-implant-mucositis and peri-implantitis were 19%; no statistically significant difference was found between groups after 5 years (P < 0.05).

CONCLUSIONS

Within the limitation of the present study, the clinical and radiographic outcomes showed that the percentage of peri-implant mucositis and peri-implantitis was not statistically significant for both groups after 5 years follow-up.

CLINICAL RELEVANCE

The outcomes of present study clinically demonstrated that a deep position of implant shoulder did not provide any benefits. On the contrary, it may be considered a possible risk indicator for implant diseases.

Influence of rough micro-threaded and laser micro-textured implant-neck on peri-implant tissues: A systematic review

Background and objective

This systematic review aimed to explore clinical outcomes of marginal or crestal bone level (MBL) and soft tissue status around implants, following the placement of rough micro-threaded/laser-microtextured surface (LMS) implants. These outcomes are compared with those following the placement of smooth machined-neck implants.

Materials and methods

Using EBSCO Information Services, we conducted a web-based search of databases such as the PubMed, Scopus, and EMBASE, for relevant English-language scientific papers published between January 2013 and August 2022. Prospective or retrospective controlled cohort studies and randomized controlled trials (RCTs) investigating the role of rough micro-threaded/LMS implant necks on MBL, sulcular probing depth (PD), and/or clinical attachment loss, were included in this review.

Results

From a comprehensive literature search of 247 articles, 6 RCTs, 5 prospective studies, and 4 retrospective studies (n = 15) fulfilled the eligibility criteria. MBL with rough micro-threaded implant necks ranged from 0.12 ± 0.17 mm to 3.25 ± 0.4 mm after loading. The smooth machined-neck implants without a micro-threaded neck had a loading MBL of 0.38 ± 0.51 mm to 3.75 ± 0.4 mm. Micro-threaded implant necks showed much lower MBL than machined-neck implants. LMS implant necks had a lower peri-implant PD than machined-neck implants after 3 years of early loading (2.3 ± 0.7 mm vs. 3.8 ± 0.8 mm). The experimental and control groups showed similar gingival recessions (1.08 ± 0.4 mm vs. 2.46 ± 0.3 mm). Meta-analysis was not feasible owing to heterogeneity of the studies.

Conclusion

Under functional loading, a roughened micro-threaded design for the implant neck could significantly lower MBL. Furthermore, PD and MBL were much lower around LMS neck implants than those around machined-neck or micro-threaded implants.

Resolution of peri-implant mucositis at tissue- and bone-level implants: A 6-month prospective controlled clinical trial

OBJECTIVE

The objective of the study was to compare resolution of inflammation of naturally occurring peri-implant mucositis (PM) at tissue-level (TL) and bone-level (BL) implants after non-surgical mechanical debridement.

MATERIALS AND METHODS

Fifty-four patients with 74 Implants with PM were allocated in two groups (39 TL and 35 BL implants) and treated by means of subgingival debridement using a sonic scaler with a plastic tip without adjunctive measures. At baseline and at 1, 3, 6 months, the full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), probing depth (PD), bleeding on probing (BOP), and modified plaque index (mPlI) were recorded. The primary outcome was BOP change.

RESULTS

After 6 months, the FMPS, FMBS, PD, and number of implants with plaque decreased statistically significantly in each group (p < .05); however, no statistically significant differences were found between TL and BL implants (p > .05). After 6 months, 17 (43.6%) TL and 14 (40%) BL implants showed a BOP change in (17.9%) and (11.4%), respectively. No statistical difference was recorded between groups.

CONCLUSIONS

Within the limitations of present study, the findings showed no statistically significant differences in terms of changes in clinical parameters following non-surgical mechanical treatment of PM at TL and BL implants. A complete resolution of PM (i.e., no BOP at all implant sites) was not achieved in both groups.

Interaction between Different Implant Surfaces and Liquid Fibrinogen: A Pilot In Vitro Experiment

Background

Platelet concentrates like leucocyte- and platelet-rich fibrin (L-PRF) have been widely evaluated in different oral surgical procedures to promote the healing process. However, liquid L-PRF products such as liquid fibrinogen have been poorly explored, especially in the biomimetic functionalization of dental implants. The aim of this in vitro study is to evaluate the interaction between 5 different dental implant surfaces and liquid fibrinogen.

Methods

Five commercially available dental implants with different surfaces (Osseospeed™, TiUnite™, SLActive®, Ossean®, and Plenum®) were immersed for 60 minutes in liquid fibrinogen obtained from healthy donors. After this period, the implants were removed and fixed for scanning electron microscopy (SEM).

Results

All dental implants were covered by a fibrin mesh. However, noticeable noncontact areas were observed for the Osseospeed™, TiUnite™, and SLActive® surfaces. On the other hand, Ossean® and Plenum® surfaces showed a dense and uniform layer of fibrin covering almost the entire implant surface. The Osseospeed™, TiUnite™, and SLActive® surfaces presented with lower blood cell numbers inside the fibrin mesh compared with the others. Moreover, at higher magnification, thicker fibrin fibers were observed in contact with Ossean® and Plenum® surfaces. The Plenum ®surface showed the thickest fibers which also inserted and interconnect to the microroughness.

Conclusion

The initial contact between an implant surface and the fibrin network differs significantly among different implant brands. Further studies are necessary to explore the clinical impact of these observations in the osseointegration process of dental implants.

The Use of Lasers in Dental Materials: A Review

Lasers have been well integrated in clinical dentistry for the last two decades, providing clinical alternatives in the management of both soft and hard tissues with an expanding use in the field of dental materials. One of their main advantages is that they can deliver very low to very high concentrated power at an exact point on any substrate by all possible means. The aim of this review is to thoroughly analyze the use of lasers in the processing of dental materials and to enlighten the new trends in laser technology focused on dental material management. New approaches for the elaboration of dental materials that require high energy levels and delicate processing, such as metals, ceramics, and resins are provided, while time consuming laboratory procedures, such as cutting restorative materials, welding, and sintering are facilitated. In addition, surface characteristics of titanium alloys and high strength ceramics can be altered. Finally, the potential of lasers to increase the adhesion of zirconia ceramics to different substrates has been tested for all laser devices, including a new ultrafast generation of lasers.

Cross-sectional evaluation of clinical and immunological parameters at partially microgrooved vs machined abutments in humans

OBJECTIVE

The objective of the present study was to examine the clinical and immunological parameters in samples collected from the peri-implant crevicular fluid (PICF) of machined titanium (M) abutments compared to titanium abutments with a laser-microtextured surface (LMS) on dental implants.

MATERIAL AND METHODS

A total of 40 patients with one titanium implant, half of them (n=20) provided with a M abutment (control group) and the other half (n=20) with LMS abutments (test group), were included in the study. Clinical parameters pocket probing depth (PD), full-mouth plaque score (FMPS), radiographic bone loss (RBL), clinical attachment level (CAL), mucosal recession (MR), bleeding on probing (BOP), and width of keratinized mucosa (KM) were evaluated. The peri-implant sulcus fluid was analyzed for cytokines IL-1α, IL-1β, IL-6, IL-8, and IL-10 via flow cytometry.

RESULTS

Clinical evaluation demonstrated no significant difference of PD (mean LMS = 3.50 mm/SD 0.95 mm vs mean M = 3.45 mm/SD 0.76 mm (p=0.855)), MR (mean LMS = 0.30 mm/SD 0.57 mm vs mean M = 0.35 mm/SD 0.67 mm (p=0.801)), CAL (mean LMS = 3.60 mm/SD 1.14 mm vs mean M = 3.55 mm/SD 0.89 mm (p=0.878)), and KM (mean LMS = 2.03 mm/SD 1.08 mm vs mean M = 2.13 mm/SD 0.92 mm (p=0.754)) between LMS and M abutments. LMS abutments showed less BOP than M abutments (26.7% vs 30.8%), but statistically not significant (p = 0.2235). Radiographic bone loss (mean LMS = 0.22 mm/SD 0.44 mm vs mean M = 0.59 mm/SD 0.49 mm) was reduced in the test group in comparison with the control group (p=0.016). In the collected PICF, the levels of pro-inflammatory cytokines IL-1α (median LMS = 180.8 pg/ml vs M = 200.9 pg/ml (p=0.968)) and IL-1β (median LMS = 60.43 pg/ml vs M = 83.11 pg/ml (p=0.4777)) were lower, and the levels of IL-6 (median LMS = 180.8 pg/ml vs M = 200.9 pg/ml (p<0.0001)) were significantly lower in the test group. In contrast, the levels of IL-8 (median LMS = 255.7 pg/ml vs M = 178.7 pg/ml (p=0.3306)) were higher in the test group, though not significantly. The levels of anti-inflammatory IL-10 were significantly increased in the test group (LMS median = 0.555 pg/ml vs M median = 0.465 pg/ml (p=0.0365)). IL-1β showed a significant correlation to radiologic bone loss (p=0.0024). The other variables IL-1α, IL-6, IL-8, and IL-10 had no significant correlation to radiological bone loss.

CONCLUSION

Within the limitations of this study, titanium implants provided with laser-microtextured surface abutments seem to demonstrate less pro-inflammatory and more anti-inflammatory activity and to show reduced radiographic bone loss compared to machined titanium abutments.

CLINICAL RELEVANCE

The use of laser-microtextured surface abutments might have the potential to support peri-implant tissue health.

In vitro study of surface alterations to polyetheretherketone and titanium and their effect upon human gingival fibroblasts

STATEMENT OF PROBLEM

Soft-tissue attachment to different surfaces may play a pivotal role in the long-term success of dental implants. However, studies on the issue, especially on newer materials, are sparse.

PURPOSE

The purpose of this in vitro study was to evaluate the viability and adhesion of human gingival fibroblasts (HGFs) on different implant abutment materials with specific surface modifications.

MATERIAL AND METHODS

One hundred and fifty specimens in 6 experimental groups were evaluated: smooth-machined titanium alloy (Ti), laser-modified titanium (TiL), smooth-machined polyetheretherketone (PEEK) (P), laser-modified PEEK (PL), plasma-treated PEEK (PP), laser- and plasma-treated PEEK (PLP). Machined Ti was considered as the control group. Surface roughness (S_a), water contact angle (WCA), and X-ray photoelectron spectroscopy (XPS) were measured. HGF attachment and proliferation were observed at 1, 3, and 7 days after cell seeding. Comparison of the means among the groups was performed with 1-way analysis of variance (ANOVA) with post hoc comparison using the Tukey test (α=.05).

RESULTS

S_a values of the laser modified groups were significantly higher than those of the nonmodified (smooth-machined) groups (P<.001). WCAs were significantly different among PEEK groups, and plasma-sprayed groups had the lowest WCAs. XPS analysis of both Ti and PEEK groups showed laser treatment did not have any significant effect on the surface composition of the PEEK as the same bonds with similar ratio/fraction were detected in the spectrum of the modified specimens. Scanning electron microscopy (SEM) revealed more functionally oriented HGF cells on the laser-grooved surfaces. On the first, third, and seventh day of proliferation, the titanium groups showed no significant differences (P>.05). On the first and third days of proliferation, the plasma sprayed groups (PP, PLP) showed significantly greater proliferation than all experimental groups (P<.001). On the seventh day of proliferation, statistically significant differences were observed between all PEEK groups and between all PEEK groups and the Ti group (P<.001), with the exception of the PL and P groups and the PLP and Ti groups (P>.05).

CONCLUSIONS

Laser-modified titanium and PEEK surfaces led to guided gingival fibroblast attachment. Plasma treatment of PEEK surfaces increased the wettability of this polymer and improved proliferation of HGF.

Modifications of Dental Implant Surfaces at the Micro- and Nano-Level for Enhanced Osseointegration

This review paper describes several recent modification methods for biocompatible titanium dental implant surfaces. The micro-roughened surfaces reviewed in the literature are sandblasted, large-grit, acid-etched, and anodically oxidized. These globally-used surfaces have been clinically investigated, showing survival rates higher than 95%. In the past, dental clinicians believed that eukaryotic cells for osteogenesis did not recognize the changes of the nanostructures of dental implant surfaces. However, research findings have recently shown that osteogenic cells respond to chemical and morphological changes at a nanoscale on the surfaces, including titanium dioxide nanotube arrangements, functional peptide coatings, fluoride treatments, calcium–phosphorus applications, and ultraviolet photofunctionalization. Some of the nano-level modifications have not yet been clinically evaluated. However, these modified dental implant surfaces at the nanoscale have shown excellent in vitro and in vivo results, and thus promising potential future clinical use.

Immediate implant placement in anterior teeth with grafting material of autogenous tooth bone vs xenogenic bone

Background

The aim of the study was to compare the efficacy of the autogenous tooth bone and xenogenic bone grafted in immediate implant placement with bone defect.

Methods

Thirty patients whose compromised anterior teeth need immediate implant placement were enrolled. Autogenous tooth bone made from the extracted teeth by chair-side or the xenogenic bone were used to repaired bone defect. Clinical examination, radiographic assessment about the horizontal bone change in the level of 0 mm, 3 mm and 6 mm below the implant neck and the marginal bone loss were made immediately, 6 and 12 months after implant placement. Questionnaire of the feelings about the surgery were made at the time of removing the sutures.

Results

All implants achieved the success criteria without any complications at the follow-up period. The percent of the horizontal bone change and the marginal bone loss at 6 and 12 months were almost the same between two groups (P > .05). The horizontal bone loss at the first or the latter 6 months was almost the same (P > .05). But the horizontal bone loss at the 6 mm level was less than the 0 mm and 3 mm levels at 6 and 12 months (P < .05). Meanwhile patients seem more satisfied with the autogenous tooth bone derived from the questionnaire.

Conclusion

The bone volume change in the facial part of the implant after immediate placement is almost the same between two groups. Providing clinical evidence that the autogenous tooth bone made from compromised tooth can be an acceptable bone graft material.

Short vs. Standard Laser-Microgrooved Implants Supporting Single and Splinted Crowns: A Prospective Study with 3 Years Follow-Up

PURPOSE

The aim of this study was to compare survival rates, marginal bone loss (MBL), and peri-implant soft tissue parameters between short and standard laser-microgrooved implants supporting single or splinted crowns 3 years after loading.

MATERIALS AND METHODS

30 subjects received 1 short ( ≤ 7 mm ) and 1 standard length ( ≥ 9 mm ) laser-microgrooved implant in adjacent sites of the premolar and molar regions of the mandible or maxilla. Peri-implant soft tissue parameters and intraoral radiographs were recorded at the delivery of definitive crowns (baseline) and 3 years later. Cumulative survival rate (CSR) and marginal bone loss (MBL) in relation to crown/implant (C/I) ratio, implant length, location, type of antagonist, and type of prosthetic design (single or splinted), were evaluated.

RESULTS

CSR of short implants was 98%, compared to 100% for standard implants, without significant statistical difference. MBL was not significantly different over the observation period, with an average of 0.23 ± 0.6 mm and 0.27 ± 0.3 mm for short and standard implants, respectively. No statistical differences were found between short and standard implants regarding plaque (14.7% vs. 15.7%), number of sites BOP (8.3% vs. 5.9%), probing depth (1.13 ± 0.6 mm vs. 1.04 ± 0.8 mm), and mean mucosal recession (0.18 ± 0.3 mm vs. 0.22 ± 0.3 mm). Analyzing MBL in relation to the C/I ratio, implant length, location, type of antagonist, and type of prosthetic design, no statistically significant differences were found.

CONCLUSION

Regardless of C/I ratio, implant length, location, type of antagonist, and type of prosthetic design, short and standard laser-microgrooved implants had similar survival rates, MBL, and peri-implant soft tissue conditions over the observation period of 3 years.

Influence of Laser-Microtextured Surface Collar on Marginal Bone Loss and Peri-Implant Soft Tissue Response: A Systematic Review and Meta-Analysis

BACKGROUND

A laser-microtextured surface (LMS) dental implant collar appears to promote a more tooth-like gingival collagen fiber attachment, which may help to stabilize peri-implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non-LMS collar on crestal bone level and peri-implant soft tissue response.

METHODS

Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri-implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non-LMS collars (e.g., roughened surface and machined surface).

RESULTS

Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined-surface collars (weighted mean difference [WMD]: -0.77; 95% CI: -1.01 to -0.52; I2 = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined-surface group (WMD: -1.34; 95% CI: -1.62 to -1.05; I2 = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened-surface groups (WMD: -0.04; 95% CI: -0.16 to 0.08; I2 = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non-LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I2 = 0.0%; P = 0.91).

CONCLUSIONS

Meta-analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined-surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.

Does the Laser-Microtextured Short Implant Collar Design Reduce Marginal Bone Loss in Comparison with a Machined Collar?

Purpose. To compare marginal bone loss between subgingivally placed short-collar implants with machined collars and those with machined and laser-microtextured collars. Materials and Methods. The investigators used a retrospective study design and included patients who needed missing posterior teeth replaced with implants. Short-collar implants with identical geometries were divided into two groups: an M group, machined collar; and an L group, machined and laser-microtextured collar. Implants were evaluated according to marginal bone loss, implant success, and probing depth (PD) at 3 years of follow-up. Results. Sixty-two patients received 103 implants (56 in the M group and 47 in the L group). The cumulative survival rate was 100%. All implants showed clinically acceptable marginal bone loss, although bone resorption was lower in the L group (0.49 mm) than in the M group (1.38 mm) at 3 years (p < 0.01). A significantly shallower PD was found for the implants in the L group during follow-up (p < 0.01). Conclusions. Our results suggest predictable outcomes with regard to bone loss for both groups; however, bone resorption was less in the L group than in the M group before and after loading. The laser-microtextured collar implant may provide a shallower PD than the machined collar implant.

Optimizing Connective Tissue Integration on Laser-Ablated Implant Abutments

Focused Clinical Question: The integration of connective tissue (CT) to a laser-ablated abutment with a microgrooved surface at the apical millimeter (LL) has been documented in both animal and human studies. How should the healing be influenced to optimize the CT integration on abutment surfaces? Summary: When smooth machined titanium (ST) abutments were placed, epithelial attachment was found on abutments, but no CT integration was noted. On LL abutments, a zone of epithelial attachment and CT integration was noted. When an ST abutment was switched for an LL abutment, the soft tissue was inconsistent; however, when an LL abutment was placed after the removal of a prior LL abutment, CT integration was observed. Conclusions: Consistent CT integration was observed on LL abutment surfaces after implant placement. Switching LL abutments with new LL abutments consistently led to CT integration. This was not consistent when an ST abutment was switched for an LL abutment. Plaque and gingival indices were comparable between teeth and abutments. Probing depth (PD) was lower around teeth. There was no difference in PD between abutments. CT integration on LL abutments was optimized by initial healing occurring on an LL abutment or by creation of a CT wound before insertion of the abutment.