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Gingival zenith level, position, and symmetry: A systematic review and meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00225-7. [PMID: 38704322 DOI: 10.1016/j.prosdent.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 05/06/2024]
Abstract
STATEMENT OF PROBLEM The gingival zenith (GZ) influences the line angle position in the emergence profile and the axial inclination of the crown. Irregularities in GZ symmetry and contour have a negative impact on dental esthetics. GZ location is not consistently distal to the crown's long axis; instead, it tends to be more distal in anterior teeth. The GZ levelling of the lateral incisor is often described as either level with or slightly above the zenith line connecting the central incisor and canine teeth, but there are also reports of GZ being aligned apically to the zenith line. Controversial reports persist regarding GZ positioning, magnitude, and location, potentially leading to inadequate positioning and levelling of the GZ in esthetic restorative therapy. PURPOSE The purpose of this systematic review and meta-analysis was to assess the scientific evidence related to GZ level, position, and symmetry in maxillary incisors and canines. MATERIAL AND METHODS This study adhered to the population, variable, outcome (PVO) criteria and the preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist. Cross-sectional studies involving healthy adults with complete dentition of the maxillary anterior sextant were subjected to prevalence analysis and quantitative measurement to assess the gingival zenith level and position. Data were extracted, and methodological quality was appraised using the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Certainty of evidence was evaluated through the grading of recommendations, assessment, development, and evaluation (GRADE) system. RESULTS The GZs were distally positioned, coinciding with the tooth axis or mesially positioned in, respectively, 96%, 3%, and 1% on central incisors; 84%, 14%, and 1% on lateral incisors; and 43%, 44%, and 5% on canines. GZ distal positioning was greater in central incisors, followed by lateral incisors and canines. In lateral incisors, the GZ was levelled coronally in 82% of the population. Contralateral symmetry was observed for GZ levelling and positioning. The certainty of the evidence was very low for all comparisons. CONCLUSIONS The frequency and magnitude of the distal position of the GZ increased the more anterior the tooth. Axially, the GZ was frequently levelled coronally to the zenith line. The contralateral positioning and levelling of the GZ was symmetrical.
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Impact of immediate interim restoration on peri-implant tissues around immediately placed single dental implants in the esthetic region: A systematic review and meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00045-3. [PMID: 38355364 DOI: 10.1016/j.prosdent.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
STATEMENT OF PROBLEM Immediate implant placement with an immediate interim restoration is a well-established protocol. Nevertheless, a consensus regarding the impact of immediate interim restoration on peri-implant tissues around single dental implants is lacking. PURPOSE The purpose of this systematic review and meta-analysis was to address the research question: "Does the placement of an immediate interim restoration influence the mid-facial mucosal (MFM) marginal and interdental papilla (IDP) levels around single dental implants placed in the anterior esthetic region by using an immediate implant placement protocol?" MATERIAL AND METHODS A comprehensive literature search was made in the Medline/PubMed, Scopus, Cochrane, and Science Direct electronic databases for articles published in English evaluating the impact of immediate interim restoration on peri-implant tissues around single dental implants in the anterior esthetic region. The primary outcomes assessed were changes in the MFM marginal and IDP levels. Additional outcomes were marginal bone (MB) loss, esthetic outcomes involving the pink and white esthetic scores (PES and WES), implant survival rates, and patient reported outcome measures (PROMs). The risk of bias assessment was performed by using the RoB 2 tool for randomized trials and the Newcastle-Ottawa scale for nonrandomized studies. Meta-analysis was performed by using random and fixed effects model (α=.05) in the RevMan software program. RESULTS Sixteen studies were included that analyzed 836 single dental implants involving 823 patients. The meta-analysis showed no significant differences in implants with and without interim restoration in terms of MFM marginal level (MD=0.01; 95% CI=-1.23 to 1.25; P=.98), mesial IDP level (MD=0.12; 95% CI=-0.23 to 0.47; P=.50), distal IDP level (MD=0.20; 95% CI=-0.40 to 0.79; P=.52), and MB loss (MD=0.01; 95% CI=-0.42 to 0.43; P=.97). The systematic analysis for survival rates determined no notable difference in implants with or without an interim restoration. However, the esthetic outcomes and PROMs substantially improved with immediate interim restorations. The RoB 2 tool showed a moderate to low risk of bias, and the Newcastle-Ottawa scale indicated high-quality studies. CONCLUSIONS After a 12-month follow-up, immediate interim restoration had no significant impact on peri-implant soft (MFM marginal and IDP levels) and hard tissues (MB loss) around immediately placed single dental implants. Nevertheless, additional well-designed and well-implemented clinical trials with long-term follow-up periods are needed to provide more precise evidence-based recommendations.
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Association between Gingival Biotype and Crestal Bone Loss in Implants Placed in Anterior Maxilla. J Long Term Eff Med Implants 2024; 34:71-78. [PMID: 37938208 DOI: 10.1615/jlongtermeffmedimplants.2023045450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND When bone loss occurs around an implant, it can cause esthetic compromise, which might affect the tissue level design. Thus, bone level design implants are usually preferred if a natural emergence profile is important. The gingival biotype had been identified as a significant factor in the stability of crestal bone. AIM The aim of the current study is to analyze the gingival biotype and crestal bone in implants placed in anterior maxilla. MATERIALS AND METHODS retrospective study was conducted using the case records of patients in University Hospital. Data on the gingival biotype and crestal bone loss in implants placed in anterior maxilla were collected (sample size = 96 patients) and analyzed for association with age and gender by descriptive statistics and chi-square association. RESULTS In thick gingival biotype 59.3% of the cases showed no crestal bone loss and 5.2% of the patients showed only 1 mm of bone loss, but in case of thin gingival biotype, 16.6% of patients had 1 mm of bone loss, 5.2% of them has 2 mm of bone loss, and 1% of them had bone loss of 3 mm and above, with a significant p value of 0.02 (less than 0.05) showing a strong association between gingival biotype and crestal bone loss around implants. CONCLUSION It can be concluded that there exists a significant association between gingival biotype and crestal bone loss around implants placed in anterior maxilla.
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Current landmarks for gingival thickness evaluation in maxillary anterior teeth: a systematic review. Clin Oral Investig 2023; 27:1363-1389. [PMID: 36786957 DOI: 10.1007/s00784-023-04898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES To identify and report the current landmarks used for measuring gingival thickness (GT) in healthy maxillary anterior teeth. MATERIAL AND METHODS The protocol of this Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) 2020-compliant systematic review was registered in PROSPERO. A literature search was conducted to identify articles that met the eligibility criteria published up to 2022. The methods of assessing gingival thickness and the landmarks adopted on the studies were described. Primary outcomes were identified, and the frequency of reporting in the selected articles was calculated. Additionally, risk-of-bias assessments were performed for individual articles. RESULTS Fifty-eight articles (34 with low risk of bias and 24 with medium risk of bias) were selected. A total of 3638 individuals had their gingival thickness measured. Thirty-nine different landmarks were adopted in the studies. Fifty-six articles with 22 landmarks were included in the meta-analysis. A higher heterogeneity was found between the studies (GT ranged from 0.48 to 2.59 mm, mean GT 1.074; 95% CI: 1.024-1.104). The 3 most used landmarks were 2 mm from gingival margin (10 studies, mean GT 1.170 mm, 95% CI: 1.085-1.254), bone crest (9 studies, mean GT 1.01 mm; 95% CI: 0.937-1.083), and cemento-enamel junction (7 studies, mean GT 1.172 mm; 95% CI: 1.105, 1.239). CONCLUSIONS Within the limits of this study, a large heterogeneity in GT was found, and there was no consensus on the ideal landmark for GT measurement. CLINICAL RELEVANCE The landmark 2 mm from gingival margin, located at attached gingiva, can be used for GT measurement by clinical and image-based devices. This is an important step for a quantitative instead of a qualitative evaluation of phenotypes.
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Accuracy of cone-beam computed tomography in determining gingival thickness: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:1801-1814. [PMID: 36757462 DOI: 10.1007/s00784-023-04905-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 02/03/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE To assess the accuracy of cone-beam computed tomography (CBCT) for determining gingival thickness. MATERIAL AND METHODS Searches were undertaken in PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, and gray literature (Google Scholar and ProQuest) for studies considered eligible according to the following criteria: cross-sectional observational studies, which compared CBCT accuracy with that of transgingival probing when determining gingival thickness, in adult patients with good periodontal health. No language or time restrictions were applied in this systematic review. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional studies. RESULTS Six articles were included for qualitative synthesis, involving a pooled sample of 132 patients with a mean age of 29 years (18-51 years). Of these 6 studies, 5 were eligible for quantitative analysis. The meta-analysis showed no statistically significant difference between CBCT and transgingival probing measures of gingival tissue (mean difference of 0.10 (95% CI-0.17-0.38). No significant level of heterogeneity was detected (Tau2-P = 0.0662; I2 = 0%; H2-P = 1.000; Q-P = 1.134). According to the GRADE criterion, confidence in the cumulative evidence was considered low. CONCLUSIONS CBCT is an accurate method for determining gingival tissue thickness, comparable to the reference standard (transgingival probing). CLINICAL RELEVANCE CBCT could be considered for gingival thickness measurement when bone thickness is also needed, and thereby aid in the assessment of gingival biotype without the discomfort and anesthesia needed in transgingival probing. TRIAL REGISTRATION This protocol was registered at the PROSPERO database (International Prospective Register of Systematic Review) under registration number CRD42022326970. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022326970 .
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Gingival landmarks and cutting points for gingival phenotype determination: A clinical and tomographic cross-sectional study. J Periodontol 2022; 93:1916-1928. [PMID: 35451505 DOI: 10.1002/jper.21-0615] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/20/2022] [Accepted: 03/23/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND This cross-sectional study assessed the role of gingival landmarks (GLs) and cutting points (CPs) for gingival phenotype (GP) determination. METHODS Six maxillary anterior teeth (70 subjects) were evaluated using soft tissue cone-beam computed tomography (ST-CBCT). Gingival thickness was measured at different GLs: 1) tissue zone (gingival margin [GM], 1 and 2 mm apical to GM, cemento-enamel junction, above the bone crest); 2) bone zone (buccal bone crest [BBC], 1, 2, and 3 mm apical to BBC). CPs of 0.6, 0.8, 1.0, 1.2, and 1.5 mm were used to discriminate between thin and thick GP. The clinical determination of GP was made based on transparency of the periodontal probe (TRAN). RESULTS The prevalence of thin and thick GP depended on the GL and CP. Considering the CP (1 mm), thin GP at the tissue zone ranged from 99% at the GM to 10.2% above the bone crest. In the bone zone, thick GP ranged from 28% at the BBC to 6% at 3 mm apical to the BBC. The predictability of a correct assessment of GP by TRAN compared with ST-CBCT was influenced by the GLs and CPs. A slight agreement (kappa <0.2) and low accuracy (area under the curve <0.7) were found between methods. CONCLUSIONS The determination of thin and thick GPs is related to the gingival landmarks and CPs. Further studies are required for a well-defined treatment protocol considering different gingival landmarks in tissue and bone zones. An ST-CBCT may be useful for this purpose.
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Applications of maxillary tuberosity block autograft. J ESTHET RESTOR DENT 2022; 34:1015-1028. [PMID: 35384291 PMCID: PMC9790261 DOI: 10.1111/jerd.12911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Autogenous bone grafts are considered the gold standard due to their compatibility and osteogenic potential to induce new bone formation through osteogenesis, osteoinduction, and osteoconduction. The aim of this paper was to describe clinical applications of the maxillary tuberosity block autograft in small and moderate localized defects of the alveolar process around implants and teeth. CLINICAL CONSIDERATIONS Maxillary tuberosity is often used as a particulate graft for augmentation of deficient alveolar ridge or maxillary sinus prior to or simultaneously with implant insertion, but not as a bone block graft. The maxillary tuberosity block autograft may also provide a valuable bone source for challenging situations such as immediate implant placement into types II and III extraction sockets, treatment of horizontal and vertical bone defects with simultaneous implantation, reconstruction of circumferential defects around implants, and preservation of alveolar ridge. CONCLUSIONS The advantages of the maxillary tuberosity include intraoral corticocancellous autogenous graft with fewer intraoperative difficulties, no need for donor site restoration, less morbidity, and an excellent correction of localized alveolar ridge defects. CLINICAL SIGNIFICANCE Within the limitations of the presented case reports, the use of maxillary tuberosity block autograft has shown to be successful in alveolar ridges augmentation that lack both width and height.
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Abstract
With the evolution of CAD/CAM technology, custom titanium and/or zirconia abutments are increasingly being used, leading to several comparisons in the literature, both mechanical and aesthetic, to evaluate performance differences between these two types of abutments. Therefore, the aim of this comprehensive review is to present the most recent data on the latest comparisons between CAD/CAM and stock abutment applications. The PICO model was used to perform this review, through a literature search of the PubMed (MEDLINE) and Scopus electronic databases. CAD/CAM abutments allow individualization of abutment parameters with respect to soft tissue, allow increased fracture toughness, predict the failure mode, show no change in the fracture toughness over time, reduce the prosthetic steps, and reduce the functional implant prosthesis score and pain perceived by patients in the early stages. The advantages associated with the use of stock abutments mainly concern the risk of corrosion, time spent, cost, and fit, evaluated in vitro, in the implant–abutment connection. Equal conditions are present regarding the mechanical characteristics during dynamic cycles, screw loss, radiographic fit, and degree of micromotion. Further randomized controlled clinical trials should be conducted to evaluate the advantages reported to date, following in vitro studies about titanium and/or zirconia stock abutments.
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Clinical evaluation of the buccal aspect around immediate implant using dual zone therapeutic concept versus buccal gap fill to bone level: A randomized controlled clinical trial. Clin Implant Dent Relat Res 2022; 24:307-319. [PMID: 35507735 DOI: 10.1111/cid.13091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Soft tissue esthetics for immediate implant is considered challenging when restoring a tooth in an esthetic zone. This study aimed to evaluate the buccal aspect after immediate implant using the dual-zone therapeutic concept compared to grafting the buccal gap to the bone crest. MATERIALS AND METHODS Twenty-four patients were randomly assigned into either immediate implant with the dual-zone therapeutic concept (DZ, test group) or with bone grafting till buccal bone crest with immediate temporization (BCG, control group). Pink esthetic score (PES), buccal bone loss (BBL), mid-facial recession (MFR), soft tissue thickness (STT), keratinized tissue width (KTW), post-operative swelling (POS), and patient satisfaction (PS) were evaluated for 1 year. RESULTS At 12 months the PES in the test group was 11.36 ± 1.69, and 10.80 ± 1.55 in the control group, with no statistically significant difference (p = 0.45). MFR in the DZ and BCG groups was 0.27 ± 0.34 and 0.45 ± 0.44 after 12 months with no statistical significance difference (p = 0.195). The STT assessment showed a statistically significant increase in both groups, however the intergroup comparison was statistically not significant (p = 0.23). The mean KTW in the DZ and BCG groups was 4.55 ± 1.08 and 4.20 ± 0.82 mm, respectively with no statistical significance (p = 0.42). There was no statistical significant difference in patient satisfaction between the two groups except in question number 10 concerning the post-operative swelling which was higher in the DZ group (p = 0.009). CONCLUSIONS Both treatment modalities are considered reliable methods to achieve good soft tissue esthetics. However, both treatment modalities were not effective in preventing facial bone resorption despite the use of bone graft.
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Does simultaneous soft tissue augmentation around immediate or delayed dental implant placement using sub-epithelial connective tissue graft provide better outcomes compared to other treatment options? A systematic review and meta-analysis. PLoS One 2022; 17:e0261513. [PMID: 35143503 PMCID: PMC8830641 DOI: 10.1371/journal.pone.0261513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 12/03/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The clinical benefits of simultaneous implant placement and soft tissue augmentation using different treatment modalities are unclear. The current meta-analysis aimed to compare the effect of simultaneous soft tissue augmentation using subepithelial connective tissue graft (SCTG) around immediate or delayed dental implant placement with other treatment modalities on the peri-implant tissue health and esthetic. METHODS Up to May 2021, four databases (PubMed, EMBASE, Cochrane Central, and Google Scholar) were searched. Randomized control trials with follow-up >3 months, evaluating simultaneous implant placement (immediate or delayed) and soft tissue augmentation using SCTG compared with other treatment modalities were included. The predictor variables were SCTG versus no augmentation with/without guided bone regeneration (GBR) or other augmentation techniques (Acellular dermal matrix (ADM), Xenogeneic collagen matrix (XCM). The outcome variables were buccal tissue thickness (BTT), mid-buccal gingival level (MGL), marginal bone loss (MBL), and pink esthetic scores (PES). Cumulative mean differences (MD) and 95% confidence interval (CI) were estimated. RESULTS Twelve studies were included. SCTG along with immediate implant placement (IIP) or delayed implant placement (DIP) showed a statistically significant improvement in BTT (Fixed; MD, 0.74; 95% CI, 0.51; 0.97), MGL (Fixed; MD, 0.5; 95% CI, 0.21; 0.80), PES (Fixed; MD, 0.79; 95% CI, 0.29; 1.29), and less MBL (Fixed; MD, -0.11; 95% CI, -0.14; -0.08) compared to no graft (P<0.05). A statistically insignificant differences in BTT (Random; MD, 0.62; 95% CI, -0.41; 1.65), MGL (Fixed; MD, -0.06; 95% CI, -0.23; 0.11), MBL (Fixed; MD, 0.36; 95% CI, -0.05; 0.77) and PES (Fixed; MD, 0.28; 95% CI, -0.10; 0.67) was observed when SCTG along with DIP was compared with no augmentation plus GBR. Similarly, no statistically significant difference was observed when comparing SCTG along with DIP with acellular dermal matrix (ADM) concerning BTT (MD:0.71, P = 0.18) and KMW (MD: 0.6, P = 0.19). CONCLUSION There is a very low quality of evidence to provide recommendations on whether simultaneous dental implant placement (IIP or DIP) and soft tissue augmentation using SCTG is superior to no augmentation or is comparable to the other tissue augmentation materials in improving the quality and quantity of peri-implant tissues. Therefore, further, well-designed RCTs with larger sample sizes and long follow-up times are still needed.
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Does initial buccal crest thickness affect final buccal crest thickness after flapless immediate implant placement and provisionalization: A prospective cone beam computed tomogram cohort study. Clin Implant Dent Relat Res 2022; 24:24-33. [PMID: 34981616 PMCID: PMC9306851 DOI: 10.1111/cid.13060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Flapless immediate implant placement and provisionalization (FIIPP) in the aesthetic zone is still controversial. Especially, an initial buccal crest thickness (BCT) of ≤1 mm is thought to be disruptive for the final buccal crest stability jeopardizing the aesthetic outcome. PURPOSE To radiographically assess the BCT and buccal crest height (BCH) after 1 year and to calculate the correlation between initial and final achieved BCT. MATERIALS AND METHODS The study was designed as a prospective study on FIIPP. Only patients were included in whom one maxillary incisor was considered as lost. In six centers, 100 consecutive patients received FIIPP. Implants were placed in a maximal palatal position of the socket, thereby creating a buccal space of at least 2 mm, which was subsequently filled with a bovine bone substitute. Files of preoperative (T0), peroperative (T1) and 1-year postoperative (T3) cone beam computed tomogram (CBCT) scans were imported into the Maxillim™ software to analyze the changes in BCT-BCH over time. RESULTS Preoperatively, 85% of the cases showed a BCT ≤1 mm, in 25% of the patients also a small buccal defect (≤5 mm) was present. Mean BCT at the level of the implant-shoulder increased from 0.6 mm at baseline to 3.3 mm immediate postoperatively and compacted to 2.4 mm after 1 year. Mean BCH improved from 0.7 to 3.1 mm peroperatively, and resorbed to 1.7 mm after 1 year. The Pearson correlation of 0.38 between initial and final BCT was significant (p = 0.01) and therefore is valued as moderate. If only patients (75%) with an intact alveolus were included in the analysis, still a "moderate correlation" of 0.32 (p = 0.01) was calculated. CONCLUSIONS A "moderate correlation" was shown for the hypothesis that "thinner preoperative BCT's deliver thinner BCT's" 1 year after performing FIIPP.
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Zirconium dioxide implants as an alternative to titanium: A systematic review. J Clin Exp Dent 2021; 13:e511-e519. [PMID: 33981400 PMCID: PMC8106941 DOI: 10.4317/jced.58063] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/26/2020] [Indexed: 01/11/2023] Open
Abstract
Background This systematic review evaluates the available scientific literature to demonstrate the aesthetic and clinical benefits and to determine the survival and the success of zirconium dioxide implants concerning titanium implants.
Material and Methods The electronic databases were searched until January 2020. Outcome measures were pink aesthetic score (PAS), white aesthetic score (WAS), bleeding on probing (BOP) and probing depth (PD). The addressed PICO question was: In partially edentulous patients in the upper-anterior sector, do zirconium dioxide implants provide aesthetic benefits over conventional titanium implants?
Results In the 15 articles included after the screening were evaluated respectively, the pink aesthetic score, white aesthetics score, the peri-implant, and crown index, bleeding on probing, plaque index, probing pocket depth, radiographic bone loss, papilla height, and survival and success rate. The results show how the aesthetic and clinical benefits and the survival and success rate of zirconium dioxide implants are, in general, better than titanium implants.
Conclusions Despite the optimal aesthetics, clinical and survival results obtained in the review, more studies are needed to confirm these data. Key words:Ceramic dental implants, zirconia implants, esthetics, zirconium dioxide and zirconia.
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Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8822804. [PMID: 33490278 PMCID: PMC7803424 DOI: 10.1155/2021/8822804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/02/2020] [Accepted: 12/26/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.
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Predicting bone and soft tissue alterations of immediate implant sites in the esthetic zone using clinical parameters. Clin Implant Dent Relat Res 2020; 22:325-332. [DOI: 10.1111/cid.12910] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 03/01/2020] [Accepted: 03/29/2020] [Indexed: 11/26/2022]
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The significance of surgically modifying soft tissue phenotype around fixed dental prostheses: An American Academy of Periodontology best evidence review. J Periodontol 2019; 91:339-351. [DOI: 10.1002/jper.19-0310] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/19/2022]
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Esthetic, clinical, and radiographic outcomes of two surgical approaches for single implant in the esthetic area: 1‐year results of a randomized controlled trial with parallel design. Clin Oral Implants Res 2019; 30:745-759. [DOI: 10.1111/clr.13458] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 05/18/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
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Soft tissue augmentation at immediate implants using a novel xenogeneic collagen matrix in conjunction with immediate provisional restorations: A prospective case series. Clin Implant Dent Relat Res 2018; 21:145-153. [DOI: 10.1111/cid.12696] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 09/20/2018] [Accepted: 10/10/2018] [Indexed: 11/28/2022]
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Influence of different implant operative procedures on morphologic changes in peri-implant alveolar bone and soft tissue: a one-year prospective clinical study. J Prosthodont Res 2018; 62:490-496. [DOI: 10.1016/j.jpor.2018.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 06/30/2018] [Accepted: 07/06/2018] [Indexed: 11/28/2022]
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Implant placement post extraction in esthetic single tooth sites: when immediate, when early, when late? Periodontol 2000 2018; 73:84-102. [PMID: 28000278 DOI: 10.1111/prd.12170] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Implant placement in post-extraction sites of single teeth in the esthetic zone has been a topic of great interest in the field of implant dentistry since 1990. Triggered by the development of guided bone regeneration, the concept of immediate implant placement became quite popular in the 1990s. In the past 12 years, however, the dental community has begun to focus increasingly on the esthetic outcomes of post-extraction implant placement and several studies indicated a significant risk for the development of mucosal recessions with immediate implants. Parallel with this, significant progress has been made in the understanding of tissue biology in terms of hard and soft tissue alterations post extraction, based on preclinical, clinical and radiological studies. This knowledge has helped better to understand the etiology of these esthetic complications with immediate implant placement. The present review first analyzes the various phases of the development of therapeutic strategies over the years for post-extraction implant placement in single tooth sites in the esthetic zone. It presents the current knowledge concerning the terminology with immediate, early and late implant placement, the risk factors for the development of esthetic complications, and the selection criteria for the various treatment options. In the second part, clinical recommendations are given, since a clinician active in this field of implant therapy can use all treatment options depending on the preoperative analysis including a 3D cone beam computed tomography. The selection criteria for all four treatment options are presented and documented with typical case reports to illustrate the current treatment approaches applied in daily practice.
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Influence of implant location on the clinical outcomes of implant abutments: a systematic review and meta-analysis. Clin Cosmet Investig Dent 2018. [PMID: 29520162 PMCID: PMC5834166 DOI: 10.2147/ccide.s143910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To compare the failure events and incidence of complications of different abutment materials in anterior and posterior regions. Failure was defined as complete loss of the abutment requiring replacement by a new abutment. Materials and methods Electronic searches using PubMed/Medline and Google Scholar complemented with manual searches were performed with specific search terms. Searches were restricted to publications in English between January 2006 and March 2016. Results A total of 863 and 1,264 implants were inserted in the anterior and posterior regions, respectively, in a total of 1,529 patients. No titanium abutments failed in anterior or posterior regions. On the other hand, 1.6% of zirconia abutments failed in the anterior region and 1.5% failed in the posterior region. Technical complications occurred mostly in the posterior region and mostly involved zirconia abutment. Meta-analysis was possible only for zirconia-abutment failure, due to considerable heterogeneity of studies and outcome variables. No significant difference in failure rate was found between anterior and posterior zirconia abutments (risk ratio 1.53, 95% CI 0.49–4.77; P=0.47). Conclusion This systematic review and meta-analysis showed similar outcomes of different abutment materials when used in anterior and posterior regions in terms of failure events and biological and aesthetic complications. The only significant finding was the increased incidence of technical complications in the posterior region, mostly involving zirconia abutments. Abutment-screw loosening was the most common technical complication.
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Papilla-Crown Height Dimensions around Zirconium Dioxide Implants in the Esthetic Area: A 3-Year Follow-Up Study. J Prosthodont 2018; 28:e694-e698. [DOI: 10.1111/jopr.12766] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2017] [Indexed: 11/26/2022] Open
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Effect of connective tissue grafting on peri-implant tissue in single immediate implant sites: A RCT. J Clin Periodontol 2017; 45:253-264. [PMID: 28941303 DOI: 10.1111/jcpe.12820] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 11/30/2022]
Abstract
AIM To assess the effect of connective tissue grafting on the mid-buccal mucosal level (MBML) of immediately placed and provisionalized single implants in the maxillofacial aesthetic zone. MATERIALS AND METHODS Sixty patients with a failing tooth were provided with an immediately placed and provisionalized implant. During implant placement, patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). Follow-up visits were at one (T1 ) and twelve months (T12 ) after final crown placement. The primary outcome measure was any change in MBML compared to the pre-operative situation. In addition, gingival biotype, aesthetics (using the Pink Esthetic Score-White Esthetic Score), marginal bone level, soft tissue peri-implant parameters and patient satisfaction were assessed. RESULTS The mean MBML change at T12 was -0.5 ± 1.1 mm in the control group and 0.1 ± 0.8 mm in the test group (p = .03). No significant differences regarding other outcome variables were observed, neither was gingival biotype associated with a gain or loss in MBML. CONCLUSIONS This one-year study shows that connective tissue grafting in single, immediately placed and provisionalized implants leads to less recession of the peri-implant soft tissue at the mid-buccal aspect, irrespective of the gingival biotype (www.trialregister.nl: TC3815).
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Papilla and alveolar crest levels in immediate versus delayed single-tooth zirconia implants. Int J Oral Maxillofac Surg 2017; 46:1039-1044. [DOI: 10.1016/j.ijom.2017.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 02/08/2017] [Indexed: 11/15/2022]
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Periodontics, Implantology, and Prosthodontics Integrated: The Zenith-Driven Rehabilitation. Case Rep Dent 2017; 2017:1070292. [PMID: 28713600 PMCID: PMC5496111 DOI: 10.1155/2017/1070292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 05/14/2017] [Indexed: 11/17/2022] Open
Abstract
A customized treatment plan is important to reach results that will satisfy the patient providing esthetics, function, and long-term stability. This type of oral rehabilitation requires professionals from different dental specialties where communication is a major key point. Digital Smile Design allows the practitioners to plan and discuss the patient's condition to establish the proper treatment plan, which must be driven by the desired zenith position. The ideal gingival position will guide the professionals and determine the need to perform surgical procedures or orthodontic movement before placing the final restorations. In this article, the zenith-driven concept is discussed and a challenging case is presented with 4-year follow-up where tooth extraction, immediate implant placement, bone regeneration, and a connective tissue graft were performed.
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Immediate definitive individualized abutments reduce peri-implant bone loss: a randomized controlled split-mouth study on 16 patients. Clin Oral Investig 2017; 22:475-486. [DOI: 10.1007/s00784-017-2136-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 05/22/2017] [Indexed: 01/05/2023]
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Evaluation of the papilla level adjacent to implants placed in fresh, healing or healed sites: A systematic review. Int J Oral Maxillofac Surg 2017; 46:1437-1445. [PMID: 28521965 DOI: 10.1016/j.ijom.2017.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/03/2017] [Accepted: 04/20/2017] [Indexed: 11/23/2022]
Abstract
A better understanding of factors that can lead to papilla formation or recession, such as the type of site where the implant was placed, is of fundamental importance to the aesthetic success of the rehabilitation. The aim of this study was to perform a systematic review of the literature regarding the formation or recession of papilla adjacent to implants placed in fresh, healing or healed sites. The protocol for this study was registered in the PROSPERO database (registration number CRD 42016033784). An electronic search was performed by two independent reviewers who applied the inclusion and exclusion criteria on the PubMed/MEDLINE, Scopus, and Embase databases from January 2005 up to February 2016. The initial screening yielded 1,065 articles, from which 15 were selected for a systematic review after applying the inclusion and exclusion criteria. Nine studies compared fresh and healed sites, four studies compared healing and healed sites, one study compared fresh and healing sites, and one study analysed all three sites. The majority of studies identified by this systematic review showed no difference between groups after the longer follow-up period. The sites where the implants were placed did not have a long-term influence on papilla formation or recession.
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Immediate implant placement and restoration in the anterior maxilla: Tissue dimensional changes after 2-5 year follow up. Clin Implant Dent Relat Res 2017; 19:694-702. [PMID: 28429394 DOI: 10.1111/cid.12487] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/19/2017] [Accepted: 04/03/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Immediate implant placement followed by an immediate restoration has proven to be a viable technique in the anterior maxillary region. PURPOSE This prospective study evaluated the mid-long term (2-5 years) tissue changes around immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous hard tissue augmentation. MATERIALS AND METHODS Thirty AstraTech implants were immediately placed in 30 patients, followed by the delivery of an immediate provisional restoration on the same day. All participating 30 patients underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth, immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft, followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic Score (PES). RESULTS All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15 months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae, respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES 10.27) (P = .001). CONCLUSIONS In addition to a favorable implant success rate and peri-implant bony response, the soft tissue levels and overall aesthetics around single immediately placed and restored implants can also be maintained in the mid-long term.
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Influence of lip retraction on the cone beam computed tomography assessment of bone and gingival tissues of the anterior maxilla. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:714-720. [PMID: 28411007 DOI: 10.1016/j.oooo.2017.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/20/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the influence of lip retraction on cone beam computed tomography (CBCT) assessment of bone and gingival tissues on the labial surface of the anterior maxilla. STUDY DESIGN A retrospective study was conducted using measurements of bone and gingival tissues collected from 120 maxillary incisors. The thicknesses of the bone and gingival tissues of different regions were measured on CBCT images, with and without a lip retractor. The thicknesses of the gingival tissues obtained from CBCT were correlated with measurements performed by clinical probing. RESULTS The thickness of bone in the more cervical region presented a higher mean value for exams performed with a lip retractor (P = .021). The thickness of bone found a significant correlation with the thickness of the gingiva (P ≤ .020) with a lip retractor in CBCT exams. The thickness of the gingival tissue obtained from CBCT scans with lip retraction found significant correlations with those obtained clinically (P ≤ .001). CONCLUSIONS The use of lip retractors is a simple and reliable practice that allows the measurement of gingival tissues on CBCT images. This practice can exempt a patient from an invasive clinical procedure for measuring the thickness of the gingival tissue for implant cases of the anterior segment.
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Authors' response. Am J Orthod Dentofacial Orthop 2017; 151:237-238. [PMID: 28153147 DOI: 10.1016/j.ajodo.2016.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/28/2022]
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Evolution of loading protocols in implant dentistry for partially dentate arches. Periodontol 2000 2016; 73:152-177. [DOI: 10.1111/prd.12171] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Long-Term Outcomes of Immediate Implant Placement Into Infected Sockets in Association With Immediate Loading: A Retrospective Cohort Study. J Periodontol 2016; 87:1135-40. [DOI: 10.1902/jop.2016.160104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bioactivity and Osseointegration of PEEK Are Inferior to Those of Titanium: A Systematic Review. J ORAL IMPLANTOL 2016; 42:512-516. [PMID: 27560166 DOI: 10.1563/aaid-joi-d-16-00072] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Polyetheretherketone (PEEK) has been suggested as an alternative to replace titanium as a dental implant material. However, PEEK's bioactivity and osseointegration are debatable. This review has systematically analyzed studies that have compared PEEK (or PEEK-based) implants with titanium implants so that its feasibility as a possible replacement for titanium can be determined. The focused question was: "Are the bioactivity and osseointegration of PEEK implants comparable to or better than titanium implants?" Using the key words "dental implant," "implant," "polyetheretherketone," "PEEK," and "titanium" in various combinations, the following databases were searched electronically: PubMED/MEDLINE, Embase, Google Scholar, ISI Web of Knowledge, and Cochrane Database. 5 in vitro and 4 animal studies were included in the review. In 4 out of 5 in vitro studies, titanium exhibited more cellular proliferation, angiogenesis, osteoblast maturation, and osteogenesis compared to PEEK; one in vitro study observed comparable outcomes regardless of the implant material. In all animal studies, uncoated and coated titanium exhibited a more osteogenic behavior than did uncoated PEEK, while comparable bone-implant contact was observed in HA-coated PEEK and coated titanium implants. Unmodified PEEK is less osseoconductive and bioactive than titanium. Furthermore, the majority of studies had multiple sources of bias; hence, in its unmodified form, PEEK is unsuitable to be used as dental implant. Significantly more research and long-term trials must focus on improving the bioactivity of PEEK before it can be used as dental implant. More comparative animal and clinical studies are warranted to ascertain the potential of PEEK as a viable alternative to titanium.
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Correlation between horizontal mucosal thickness and probing depths at healthy and diseased implant sites. Clin Oral Implants Res 2016; 28:1158-1163. [DOI: 10.1111/clr.12932] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 12/01/2022]
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A Combination of Buccal Plate Preservation and Dual Zone Therapeutic Technique in Immediate Implants: A One-Year Follow-Up. J ORAL IMPLANTOL 2016; 42:484-489. [PMID: 27267169 DOI: 10.1563/aaid-joi-d-16-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Immediate Restoration of Immediate Implants in the Esthetic Zone of the Maxilla Via the Copy-Abutment Technique: 5-Year Follow-Up of Pink Esthetic Scores. Clin Implant Dent Relat Res 2016; 19:28-37. [DOI: 10.1111/cid.12423] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/27/2016] [Indexed: 12/27/2022]
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Clinical Outcomes of Implants Placed in Extraction Sockets and Immediately Restored: A 7-Year Single-Cohort Prospective Study. Clin Implant Dent Relat Res 2016; 18:1103-1112. [PMID: 26888632 DOI: 10.1111/cid.12393] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The placement of implants immediately after tooth extraction has proven to be a predictable treatment strategy with a very high success rate. PURPOSE The aim of the present 7-year prospective single cohort study was to evaluate the success rate, marginal bone level (MBL), soft tissue stability of implants placed in fresh extraction sockets and immediately restored. MATERIAL AND METHODS This prospective cohort study included 37 implants in 32 patients (19 females and 13 males) with an average age of 40.1 ± 13.3 (range: 21-63 years) who received immediate implants and immediate single unit restorations. Outcome evaluations were: implant failures, complications, MBL, width of keratinized gingiva, facial soft tissue (FST) levels, modified Plaque Index and modified Bleeding Index. RESULTS AND CONCLUSIONS The cumulative survival rate was of 94.6% at 7-year visit. The mean MBL was -0.6 ± 0.49 mm at baseline and 1 ± 0.2 mm after 7 years. The FST Level was 0.4 ± 0.69 mm at baseline and 0.02 ± 0.70 mm at the 7-year follow-up. The Width of Keratinazed Gingiva was 3.8 ± 0.47 mm at baseline and 3.1 ± 0.42 mm at 7-year follow-up. Implants placed immediately after tooth extraction and immediately restored showed predictable clinical outcomes in this prospective study.
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Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla. J Periodontol 2015; 86:1321-30. [DOI: 10.1902/jop.2015.150287] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Reproducibility of Buccal Gingival Profile Using a Custom Pick-Up Impression Technique: A 2-Year Prospective Multicenter Study. J ESTHET RESTOR DENT 2015; 28:43-55. [DOI: 10.1111/jerd.12171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Treatment of a Central Incisor Crown-Root Fracture With Buccal Wall Reconstruction and Immediately Loaded Titanium Implant. J Craniofac Surg 2015; 26:980-2. [DOI: 10.1097/scs.0000000000001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
The definition of failure for dental implants has evolved from lack of osseointegration to increased concern for other aspects, such as esthetics. However, esthetic failure in implant dentistry has not been well defined. Although multiple esthetic indices have been validated for objectively evaluating clinical outcomes, including failure of an implant-supported crown, only one author has determined a failure threshold. On the basis of objective indices, esthetic failures in implant dentistry can be categorized as pink-tissue failures and white-tissue failures. This article discusses esthetic failures, the factors involved in these failures, and their prevention and treatment.
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Soft tissues stability of cad-cam and stock abutments in anterior regions: 2-year prospective multicentric cohort study. Clin Oral Implants Res 2014; 26:1436-42. [PMID: 25196805 DOI: 10.1111/clr.12479] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 12/27/2022]
Abstract
AIM Aim of this study was to verify if the type of implant abutment manufacturing, stock or cad-cam, could influence the maintenance of stable gingival margins around single restorations in anterior areas. METHODS After 16 weeks of healing, implants (Osseospeed, Astra Tech Dental Implant) were positioned. Depending on the different fixture inclination and the thickness of buccal peri-implant soft tissue, abutment selection resulted in four groups: Group 1 (patients with zirconia ZirDesign(®) stock abutments), Group 2 (titanium stock TiDesign(®) abutments), Group 3 (zirconia cad-cam abutments), and Group 4 (titanium cad-cam abutments). The following parameters were assessed: buccal gingival margin modification (BGM). The modification of the implant gingival margin was followed at 1 and 2 years of follow-up. A computerized analysis was performed for measurements. Differences between soft tissue margin at baseline and after 2 years measured the gingival margin recession. A general linear model was used to evaluate each group in relation to gingival recession after two years. Tukey's post hoc test was used to compare the mean REC indexes of each group of abutments. RESULTS Seventy-two healthy patients (39 males and 33 females; mean age of 46 years) scheduled for single gap rehabilitation in anterior areas were enrolled. A 100% of implant survival rate was observed after 24 months of function. One failure occurred due to fracture of a Zirconia cad-cam abutment. Moreover, two abutment screw unscrewing were observed. Both for zirconia and titanium stock abutments (Group 1 and 2), the mean recession of implant buccal soft tissue was of 0.3 mm (SD of 0.3 and 0.4 mm, respectively). Soft tissue mean recession of zirconia and titanium cad-cam abutments (Group 3 and 4) was of 0.1 and -0.3 mm, respectively (SD of 0.3 and 0.4 mm, respectively). REC values of cad-cam titanium abutments (Group 4) were significantly lower than that of Group 1 (-0.57 mm), Group 2 (-0.61 mm), and Group 3 (-0.40 mm), respectively (Table 4). CONCLUSION In the anterior area, the use of cad-cam abutments is related to a better soft tissue stability. Such a relationship is significant if cad-cam titanium abutments are compared to both titanium and zirconia stock abutments.
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Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis. J Periodontol 2014; 85:e241-50. [DOI: 10.1902/jop.2014.130632] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The Clinical Outcomes of Immediate Versus Delayed Restoration Procedures on Immediate Implants: A Comparative Cohort Study for Single-Tooth Replacement. Clin Implant Dent Relat Res 2014; 17:1114-26. [PMID: 24852761 DOI: 10.1111/cid.12225] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immediate implant placement into fresh extraction sockets is generally considered a reliable procedure that offers several clinical advantages. PURPOSE The primary aim of this study was to evaluate and compare the overall clinical outcomes of immediate and delayed restoration procedures for implants placed in fresh extraction sockets by means of a flapless technique and resorbable membrane stabilizing a xenograft. Total costs and operating times were also compared. MATERIALS AND METHODS In this prospective cohort study, changes of marginal bone level, facial soft tissue (ΔFST), and width of keratinized gingiva (ΔWKG), in addition to the papilla index, underwent a pairwise comparison; correlations with pristine buccal bone thickness were also investigated. RESULTS Although similar results were recorded for the two procedures, with a bone loss of -1.0 ± 0.5 mm and -0.9 ± 0.7 mm, respectively, for immediate and delayed restoration, negative remodeling in the delayed restoration procedure was seen to occur from 4 to 12 months after implant placement. No significant differences were recorded between the two procedures in terms of ΔFST and ΔWKG. A loss of the papillary soft tissues before restoration, followed by a reestablishment after restoration, seemed to be verified for the delayed group, for which the papilla index went from the minimum of 0 at 4 months to a value of 2 at 24 months. Moreover, the immediate restoration procedure seemed to be more promising in terms of healing times and costs. CONCLUSION Immediate restoration of implants installed in fresh extraction sockets was at least as effective and safe as delayed restoration.
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Esthetic outcome and alterations of soft tissue around single implant crowns: a 2-year prospective study. Clin Oral Implants Res 2014; 26:909-914. [PMID: 24750306 DOI: 10.1111/clr.12408] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 11/29/2022]
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Esthetic outcome of single implant crowns following type 1 and type 3 implant placement: a systematic review. Clin Oral Implants Res 2014; 26:768-74. [PMID: 24450873 DOI: 10.1111/clr.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2013] [Indexed: 02/04/2023]
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Effects of Currently Available Surgical and Restorative Interventions on Reducing Midfacial Mucosal Recession of Immediately Placed Single-Tooth Implants: A Systematic Review. J Periodontol 2014; 85:92-102. [DOI: 10.1902/jop.2013.130064] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Clinical Outcomes of Implant Abutments in the Anterior Region: A Systematic Review. J ESTHET RESTOR DENT 2013; 25:159-76. [DOI: 10.1111/jerd.12031] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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