Peri-implant soft-tissue esthetic outcome after immediate implant placement in conjunction with xenogeneic acellular dermal matrix or connective tissue graft: A randomized controlled clinical study

Bone graft substitutes and dental implant stability in immediate implant surgery: a systematic review and meta-analysis

INTRODUCTION

Implant dentistry is currently being revolutionized by breakthroughs in techniques, technology, and material, there are few systematic reviews and meta-analyses that examine the effects of utilizing different bone graft substitutes in immediate implant placement surgeries.

AIM

The purpose of this research is to systematically review and meta-analyze the effect that different bone graft substitutes have on implant stability when concurrently utilized in patients undergoing immediate implant surgeries.

METHODOLOGY

The PICO criteria were used to construct the focused question, and the systematic review has been outlined as per the PRISMA guidelines. The revised Cochrane risk-of-bias method for randomized trials was used to assess the risk of bias for the selected articles. To derive estimates for the results, random effects meta-analysis was conducted on the selected articles.

RESULTS

The electronic databases were searched and a total of 1583 articles were identified. After title and abstract screening and due to problems in retrieval a further 1358 articles were eliminated. Fifteen articles were finally chosen to be qualified for review. Of which full text evaluation of 5 articles were found to meet the eligibility criteria and were therefore included in the systematic review.

CONCLUSION

This systematic review and meta-analysis on the stability of dental implants and bone graft substitutes in immediate implant surgery, was unable to draw any conclusions and established no statistically significant correlation between the different types of grafts used and implant stability.

Gingival color with implant-supported fixed prostheses (ISFP) and the impact on esthetic outcomes

OBJECTIVES

To: 1) analyze possible differences in the CIEDE2000 lightness, chroma and hue of the gingiva at the free gingival margin (FGM) and the middle zone of keratinized gingiva (MZ) between participants with an ISFP in the maxillary anterior region and participants with natural dentition and healthy gums; and 2) examine the perceptibility/acceptability of the differences in CIEDE2000 lightness, chroma and hue and in overall color, using the Euclidean and CIEDE2000 formulae.

METHODS

The L*, a* and b* color coordinates were measured in 60 adult participants (30 with an ISFP and 30 with healthy teeth and gums) using a Spectroshade™ Micro spectrophotometer. From these coordinates, the changes in lightness (ΔL'), chroma (ΔC') and hue (ΔH') CIEDE2000 between the participants with and without an ISFP were quantified. The one sample t-tests were used to test whether there were significant changes in lightness, chroma and hue between the participants with and without an ISFP, and effect size was assessed with Cohen's d. The authors examined the differences in CIEDE2000 lightness, chroma and hue, and the overall color differences between the participants in pairs (with ISFP-without ISFP), comparing results with the published perceptibility and acceptability thresholds.

RESULTS

Statistically significant differences were found (p < 0.05) between participants with and without an ISFP in all color attributes at both zones, with all color attributes observed to be lower in the gingiva of participants with an ISFP. In both gingival zones, the ISFP had a large effect on lightness (Cohen's d > 0.8) and a medium effect on hue (Cohen's d between 0.5 to 0.8). The mean gingival color difference of participants with and without an ISFP was 8.72 units in the MZ and 9.60 units at the FGM, using CIEDE2000.

CONCLUSIONS

CIEDE2000 lightness, chroma and hue are significantly lower in participants with an ISFP, both at the FGM and the MZ, with particularly marked differences in lightness. The average color difference between healthy gingiva next to natural teeth and the gingiva adjacent to an ISFP is clinically unacceptable.

CLINICAL RELEVANCE

Gingival color needs to be considered an indicator of success, given the potential unesthetic gray show-through of transmucosal abutments with ISFPs. Unacceptable color changes caused by poorly planned ISFPs can lead patients to demand treatment be repeated with more esthetic materials or mucogingival surgery to "camouflage" the discoloration.

Hard and soft tissue alterations after the application of different soft tissue grafting materials during immediate dental implant placement: a systematic review and Bayesian network meta-analysis

BACKGROUND

The aim of this review is to compare the clinical outcomes of different soft tissue grafting materials (connective tissue graft (CTG), platelet-rich fibrin (L-PRF), allogenic and xenogenic substitutes) applied in immediate implant placement with each other.

METHODS

Through an electronic search regarding the study's main question ("In patients with non-restorable teeth, who receive immediate dental implants (P), what is the best adjunctive soft tissue grafting approach among different autogenous, allogenous, and xenogenous grafts (I), to achieve the desired hard and soft tissue structure (O), compared to sites without grafting (C)?") in PubMed, Scopus, and ISI Web of Science, randomized controlled clinical trials (RCTs) using different soft tissue grafts were identified and analyzed using a Bayesian random-effect network meta-analysis framework. The pink esthetic score (PES), marginal interproximal bone level changes (MIBL), buccal bone thickness changes (BBT), keratinized tissue width changes (KTW), soft tissue thickness changes (STT), papilla height changes (PH), midfacial gingival margin level changes (MGML) were defined as desired outcomes of the study; except for the MIBL with 12 - 24 months of follow-up, 6 - 12 months is considered for other outcomes.

RESULTS

After duplication removal, 903 studies were identified through the electronic search; from which 21 RCTs were included in the review. Among all comparisons in different outcomes, only CTG demonstrated a significantly higher gain in STT compared to not placing soft tissue graft. However, CTG in MIBL, KTW, STT, PH, and MGML, and uni-layer xenogenic collagen matrix in PES were the superior treatments, according to the treatment ranking based on surface under cumulative ranking (SUCRA).

CONCLUSIONS

At the time of immediate implantation, there is no significant difference between different soft tissue grafts regarding the clinical outcomes of implants. However, the utilization of CTG can be suggested in cases with thin soft tissue. The acceptable efficacy of allogenic and xenogenic materials and the non-significant difference between them and CTG indicate supporting evidence for the application of these materials to specific clinical situations simultaneously with immediate implantation.

SYSTEMATIC REVIEW REGISTRATION

CRD42024568586.

Effect of different wound closure interventions on the clinical outcomes following immediate implant placement in the aesthetic area: A network meta-analysis based on thirty-four studies

OBJECTIVE

The purpose of this study was to systematically compare and assess the effect of various wound closure interventions on the clinical outcomes following immediate implant placement (IIP) in the esthetic zone.

DATA

Studies comparing the clinical effect of different interventions in the process of wound closure in IIP were included.

SOURCES

A systematic search was conducted in PubMed, EMBASE, Cochrane Library, Web of science, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang Database.

STUDY SELECTION

A total of 34 studies involving 1213 implants and eight interventions were included in the network meta-analysis (NMA). The agreement between reviewers reached a kappa value of 0.84. In terms of reducing marginal peri-implant recession (MPR), as the primary outcome, NMA showed that connective tissue graft (CTG) [MD = -0.44, 95 % CI (-0.56, -0.33)], collagen matrix (CM) [MD = -0.32, 95 % CI (-0.46, -0.17)] and CGF [MD = -0.11, 95 %CI (-0.16, -0.06)] showed significant less MPR than the control group, and CTG [MD = -0.33, 95 %CI (-0.46, -0.20)] and CM [MD = -0.20, 95 %CI (-0.36, -0.05)] were also associated with less MPR compared to concentrate growth factor (CGF). The optimal intervention to prevent MPR was CTG. Among the secondary outcomes, CTG was determined as the optimal intervention to increase gingival thickness (GT), CGF ranked as the promising intervention to reduce marginal bone loss (MBL) and improve pink aesthetic score (PES).

CONCLUSION

The use of CTF could enhance soft tissue stability by minimizing MPR and increasing GT in the process of wound closure in IIP, and CGF could better prevent MBL and improving PES. However, the findings related to CGF were based on a limited number of studies.

CLINICAL SIGNIFICANCE

CTG and CGF ought to be worthy of clinical promotion to intervene wound closure of IIP in esthetic area, with the ability of improving the peri-implant soft and hard tissues. However, clinicians should still consider the specific clinical situation when selecting the most appropriate intervention or alternative materials.

Aesthetic Clinical Case for Immediate Implant Therapy for Maxillary Central Incisor

This case report features a female patient with the chief complaint of needing to replace an anterior crown. After a comprehensive oral assessment and cone beam computed tomography (CBCT) radiographic examination, it was determined that the crown on Tooth #9 was subgingivally fractured. The procedure involved atraumatic extraction of Tooth #9, followed by immediate implant placement. Xenograft bone graft material was placed to complete the space between the buccal bone and the implant. A connective tissue graft (CTG), 1 mm thick and 5 mm wide, was harvested from the palate and placed. The final implant crown was restored using a prefabricated abutment with a titanium base and zirconia ceramic dental material. A well-planned combined treatment, including atraumatic tooth extractions for immediate implants and ideal contouring of soft tissues, can significantly impact the outcome of aesthetic restorations. A single immediate implant-supported crown in the aesthetic zone was able to fulfill the patient's aesthetic expectations at the 2-year follow-up.

Immediate Implant Placement with Soft Tissue Augmentation Using Acellular Dermal Matrix Versus Connective Tissue Graft: A Systematic Review and Meta-Analysis

This systematic review investigates the efficacy of using connective tissue grafting (CTG) versus an acellular dermal matrix (ADM) for soft tissue management in immediate implant placement (IIP). The study focuses on comparing the soft tissue thickness (STT) and keratinized tissue width (KTW) changes post-implantation. Adhering to the PRISMA guidelines, a comprehensive literature search was conducted, targeting randomized clinical trials and cohort studies involving soft tissue grafting in conjunction with IIP. Data extraction and analysis focused on STT and KTW measurements from baseline to follow-up intervals of at least 6 months. The statistical analyses included the weighted mean differences and heterogeneity assessments among the studies. The meta-analysis revealed no significant difference in the STT gain between CTG and ADM at 12 months, with the weighted mean differences favoring the control group but lacking statistical significance (CTG: 0.46 ± 0.53 mm, p = 0.338; ADM: 0.33 ± 0.44 mm, p = 0.459). The heterogeneity was high among the studies, with discrepancies notably influenced by individual study variations. Similarly, the changes in KTW were not significantly different between the two grafting materials. Conclusions: Both CTG and ADM are viable options for soft tissue management in IIP, with no significant difference in efficacy regarding the soft tissue thickness and keratinized tissue width outcomes. Future research should aim to minimize the heterogeneity and explore the long-term effects to better inform clinical decisions.

A Novel Prehydrated Porcine-Derived Acellular Dermal Matrix: A Histological and Clinical Evaluation

It is well known that soft tissue quality and quantity around dental implants is of paramount importance for later peri-implant health. For this purpose, the clinical and histological outcomes of the peri-implant mucosa, following soft tissue augmentation for soft tissue improvement with a novel prehydrated porcine acellular dermal matrix graft (PPADMG) in conjunction with simultaneous implant placement, were evaluated in this case series. Twenty-two patients were included in the study. They underwent a late implant placement protocol combined with PPADMG for soft tissue augmentation. A punch biopsy was taken at the time of uncovery of the submerged healed implant after a mean of 157 days healing time. Supracrestal soft tissue height (STH) was measured at the time of implant placement and uncovery. All sites showed a clinical increase in STH. The histological structure of the biopsies resembled a similar structure as found in the healthy oral mucosa. No unexpected tissue reactions could be found. Within the limits of this clinical and histological study, it may be concluded that STH improvement with this novel porcine-derived acellular dermal matrix, in combination with simultaneous implant placement, is a viable option to create a peri-implant tissue thickness and stability.

Tissue engineering innovations to enhance osseointegration in immediate dental implant loading: A narrative review

The demand for efficient and accelerated osseointegration in dental implantology has led to the exploration of innovative tissue engineering strategies. Immediate implant loading reduces treatment duration and necessitates robust osseointegration to ensure long-term implant success. This review article discusses the current studies of tissue engineering innovations for enhancing osseointegration in immediate dental implant loading in the recent decade. Keywords "tissue engineering," "osseointegration," "immediate implant loading," and related terms were systematically searched. The review highlights the potential of bioactive materials and growth factor delivery systems in promoting osteogenic activity and accelerating bone regeneration. The in vivo experiment demonstrates significantly improved osseointegration in the experimental group compared to traditional immediate loading techniques, as evidenced by histological analyses and biomechanical assessments. It is possible to revolutionize the treatment outcomes and patient satisfaction in dental implants by integrating bioactive materials and growth factors.

Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial

PURPOSE

This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates.

MATERIALS AND METHODS

Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test.

RESULTS

Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048).

CONCLUSIONS

Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome.

CLINICAL RELEVANCE

The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.