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Bienz SP, Pirc M, Papageorgiou SN, Jung RE, Thoma DS. The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis. Clin Oral Implants Res 2022; 33 Suppl 23:56-71. [PMID: 35763024 PMCID: PMC9543651 DOI: 10.1111/clr.13789] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023]
Abstract
Objectives In systematically healthy patients with an implant‐supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri‐implant soft tissues on aesthetic outcomes (O)? Methods Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant‐supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random‐effects meta‐analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence. Results Thirty‐four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross‐sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow‐up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = −0.24, 0.53]; p = .46). PES changes during the follow‐up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, −0.62 mm (4 studies; [95% CI = −1.06, −0.18]; p = .006). Patient‐reported outcome measures (patient satisfaction) were in favour of thick soft tissues −2.33 (6 studies; [95% CI = −4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non‐randomized studies, high risk of bias and residual confounding. Conclusion Within the limitations of the present study (weak study designs and various soft tissue measurements or time‐points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes.
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Affiliation(s)
- Stefan P Bienz
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Miha Pirc
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland.,Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Ceruso FM, Ieria I, Martelli M, Lumbau AI, Xhanari E, Gargari M. New Generation of Fixture-Abutment Connection Combining Soft Tissue Design and Vertical Screw-Retained Restoration: 1-Year Clinical, Aesthetics and Radiographic Preliminary Evaluation. Dent J (Basel) 2021; 9:35. [PMID: 33804864 DOI: 10.3390/dj9040035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/03/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
Implant design factors and the abutment connection are correlated with crestal bone stability. The aim of the present study was to evaluate a new type of screw-retained prostheses delivered on tissue-level implants with conical external vertical seal and internal hexagon connection. Implants 4.25 mm in diameter and 10 mm in length (Prama, Sweden and Martina) were placed in partially edentulous patients needing at least one implant in the healed site, having sufficient bone volume. The implant neck was positioned above the bone crest. A healing abutment was placed according to a one-stage approach. Outcome measures were implant and prosthesis survival rate, any complications, marginal bone loss (MBL), periodontal parameters, and pink esthetic score (PES). Overall, 13 patients (4 women and 9 men; mean age 50 ± 22 years) with the same number of implants were treated and followed for one year after loading. At the 12-month follow up, no implant and no prosthesis failed, and no complications were experienced. The mean MBL experienced at the one year follow-up was 0.65 ± 0.48 mm. One year after loading, 2 out of 13 implants present bleeding on probing (15.4%), 4 out of 13 patients presented with plaque at the one year of follow-up (30.8%) and the PES was 10.5 ± 2.3 mm. Within the limitations of the present study, the analyzed implants seem to be a viable treatment option for the rehabilitation of a single tooth gap.
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Lin G, Curtis DA, Kapila Y, Velasquez D, Kan JY, Tahir P, Avila‐Ortiz G, Kao RT. 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] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Guo‐Hao Lin
- Department of Orofacial Sciences School of Dentistry University of California San Francisco San Francisco CA
| | - Donald A. Curtis
- Department of Preventive and Restorative Dental Sciences School of Dentistry University of California San Francisco San Francisco CA
| | - Yvonne Kapila
- Department of Orofacial Sciences School of Dentistry University of California San Francisco San Francisco CA
| | - Diego Velasquez
- Graduate Periodontics Department of Periodontics & Oral Medicine School of Dentistry University of Michigan Ann Arbor MI
| | - Joseph Y.K. Kan
- Department of Restorative Dentistry School of Dentistry Loma Linda University Loma Linda CA
| | - Peggy Tahir
- University of California San Francisco Library CA
| | - Gustavo Avila‐Ortiz
- Department of Periodontics College of Dentistry University of Iowa Iowa City IA
| | - Richard T. Kao
- Department of Orofacial Sciences School of Dentistry University of California San Francisco San Francisco CA
- Private Practice Cupertino CA
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Canullo L, Di Domenico A, Marinotti F, Menini M, Pesce P. Soft Tissue Contour Impression with Analogic or Digital Work Flow: A Case Report. Int J Environ Res Public Health 2018; 15:ijerph15122623. [PMID: 30477091 PMCID: PMC6313340 DOI: 10.3390/ijerph15122623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/19/2018] [Accepted: 11/20/2018] [Indexed: 11/16/2022]
Abstract
Purpose: Transferring precise information to the dental laboratory is one of the key factors to achieving clinical success. The aim of the present study was to describe classical and digital work-flows used to rehabilitate an implant with a convergent collar in the aesthetic zone following the BOPT (biologically oriented preparation technique) approach and to report the three years follow-up outcomes of two patients rehabilitated following such procedures. Materials and methods: Two central incisors of two different patients were rehabilitated with a tissue-level implant with a convergent collar and, after a provisional and healing phase, one implant was “impressed” using a classical workflow and one using a digital one. The primary outcome measured was the mean bone loss. An intraoral radiograph was taken at crown delivery and at the three years follow-up visit. Secondary Esthetic outcomes pre-op and post-op were evaluated using the PES (pink esthetic score). Results: At the three years follow-up visit, radiographic analysis showed no signs of bone resorption. For the analogic procedure, the pre-and post-op PES scores were 8, whereas for the digital procedure the pre-op PES score was 4 and a post-op score of 9 was obtained. Conclusions: classical and digital work flows succeeded in giving precise and complete anatomical information of implant position, including the soft tissue contour. Minimum bone loss and an esthetic success were obtained in both procedures.
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Affiliation(s)
| | | | | | - Maria Menini
- Department of Surgical Sciences (DISC), Implant and Prosthetic Dentistry Unit, University of Genoa, Ospedale S. Martino (Pad. 4), L. Rosanna Benzi 10, 16132 Genoa, Italy.
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), Implant and Prosthetic Dentistry Unit, University of Genoa, Ospedale S. Martino (Pad. 4), L. Rosanna Benzi 10, 16132 Genoa, Italy.
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Eghbali A, Seyssens L, De Bruyckere T, Younes F, Cleymaet R, Cosyn J. A 5‐year prospective study on the clinical and aesthetic outcomes of alveolar ridge preservation and connective tissue graft at the buccal aspect of single implants. J Clin Periodontol 2018; 45:1475-1484. [DOI: 10.1111/jcpe.13018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 09/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Aryan Eghbali
- Faculty of Medicine and PharmacyOral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health SciencesDental SchoolGhent University Ghent Belgium
| | - Lorenz Seyssens
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health SciencesDental SchoolGhent University Ghent Belgium
| | - Thomas De Bruyckere
- Faculty of Medicine and PharmacyOral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health SciencesDental SchoolGhent University Ghent Belgium
| | - Faris Younes
- Faculty of Medicine and PharmacyOral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Roberto Cleymaet
- Faculty of Medicine and PharmacyOral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
| | - Jan Cosyn
- Faculty of Medicine and PharmacyOral Health Research Group (ORHE)Vrije Universiteit Brussel (VUB) Brussels Belgium
- Department of Periodontology and Oral ImplantologyFaculty of Medicine and Health SciencesDental SchoolGhent University Ghent Belgium
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Schmidt A, Häussling T, Rehmann P, Schaaf H, Wöstmann B. Accuracy of various impression materials and methods for two implant systems: An effect size study. J Prosthodont Res 2018; 62:245-251. [DOI: 10.1016/j.jpor.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/08/2017] [Accepted: 10/18/2017] [Indexed: 11/25/2022]
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Irinakis T, Aldahlawi S. The dome technique: a new surgical technique to enhance soft-tissue margins and emergence profiles around implants placed in the esthetic zone. Clin Cosmet Investig Dent 2018; 10:1-7. [PMID: 29491722 PMCID: PMC5817416 DOI: 10.2147/ccide.s154152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Achieving symmetry of the soft-tissue margins between anterior maxillary dental-implant restorations and adjacent teeth is a therapeutic challenge for both the implant surgeon and the restorative dentist. This article describes a modified procedure utilizing autogenous connective-tissue grafts to improve primarily buccal soft-tissue margins and secondarily inter-proximal tissues around tooth-bound single dental implants. This technique has the advantage of allowing for coronal augmentation of the peri-implant soft tissue while maximizing the blood supply to the area by using tunneling-technique principles. A detailed description of the technique and a case with a stable result over 24 months after crown placement is presented.
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Affiliation(s)
- Tassos Irinakis
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Salwa Aldahlawi
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada.,Faculty of Dentistry, Umm Al-Qura University, Mecca, Saudi Arabia
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Shi JY, Jie-Ni, Zhuang LF, Zhang XM, Fan LF, Lai HC. Peri-implant conditions and marginal bone loss around cemented and screw-retained single implant crowns in posterior regions: A retrospective cohort study with up to 4 years follow-up. PLoS One 2018; 13:e0191717. [PMID: 29401469 DOI: 10.1371/journal.pone.0191717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/23/2017] [Indexed: 12/05/2022] Open
Abstract
The aim of the present study was to identify the peri-implant conditions (bleeding on probing (BOP), pocket probing depth (PPD), modified plaque index (mPI)) and marginal bone loss (MBL, marginal bone level change between follow-up and occlusal loading) around cemented and screw-retained posterior single crowns on tissue-level implants. The study was a retrospective cohort study with up to 4 years (mean 2.5 years) follow-up. Patients with either cemented or screw-retained crowns in posterior regions were included. Implant survival, technical complications, BOP, PPD, mPI, MBL, biologic complications (peri-implant mocositis and peri-implantitis) were evaluated. Mann-Whitney U test was used to test the difference between the screw-retained group (SG) and cemented group (CG). 176 patients (SG: 94, CG: 82) were included. The implant survival rates were 100% in SG and 98.8% in CG. Prosthetic screw loosening was found in 8 restorations (8.7%) at follow-up visit. Peri-implant mucositis rate was significantly higher in the SG group (42.1%) than that in the CG group (32.2%) (P = 0.04). Six patients (6.38%) in the screw-retained group and 5 patients (6.10%) in the cemented group were diagnosed with peri-implantitis, the difference did not reach statistical significance (P>0.05). No significant difference of PPD, mPI and MBL were found between two groups (P = 0.11, 0.13 and 0.08, respectively). High implant survival rates were achieved in both groups. Cemented single crowns on tissue-level implants showed comparable peri-implant conditions in comparison with two-piece screw-retained crowns. Well-designed prospective cohort or randomized controlled clinical trials with longer follow-up are needed to confirm the result.
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Doornewaard R, Christiaens V, De Bruyn H, Jacobsson M, Cosyn J, Vervaeke S, Jacquet W. Long-Term Effect of Surface Roughness and Patients' Factors on Crestal Bone Loss at Dental Implants. A Systematic Review and Meta-Analysis. Clin Implant Dent Relat Res 2016; 19:372-399. [PMID: 27860171 DOI: 10.1111/cid.12457] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Publications from 2011 to 2015 were selected to evaluate effect of implant surface roughness on long-term bone loss as surrogate for peri-implantitis risk. 87 out of 2,566 papers reported the mean bone loss after at least 5 years of function. Estimation of the proportion of implants with bone loss above 1, 2, and 3 mm as well as analysis the effect of implant surface roughness, smoking, and history of periodontitis was performed. By means of the provided statistical information of bone loss (mean and standard deviation) the prevalence of implants with bone loss ranging from 1 to 3 mm was estimated. The bone loss was used as a surrogate parameter for "peri-implantitis" given the fact that "peri-implantitis" prevalence was not reported in most studies or when reported, the diagnostic criteria were unclear or of dubious quality. The outcome of this review suggests that peri-implant bone loss around minimally rough implant systems was statistically significant less in comparison to the moderately rough and rough implant systems. No statistically significant difference was observed between moderately rough and rough implant systems. The studies that compared implants with comparable design and different surface roughness, showed less average peri-implant bone loss around the less rough surfaces in the meta-analysis. However, due to the heterogeneity of the papers and the multifactorial cause for bone loss, the impact of surface roughness alone seems rather limited and of minimal clinical importance. Irrespective of surface topography or implant brand, the average weighted implant survival rate was 97.3% after 5 years or more of loading. If considering 3 mm bone loss after at least 5 years to represent the presence of "peri-implantitis," less than 5% of the implants were affected. The meta-analysis indicated that periodontal history and smoking habits yielded more bone loss.
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Affiliation(s)
- Ron Doornewaard
- Specialist in training, Master student Periodontology, Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium
| | - Véronique Christiaens
- PhD student, Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium
| | - Hugo De Bruyn
- full professor and chairman, Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium, visiting professor, Department of Prosthodontics, Malmö University, Sweden
| | - Magnus Jacobsson
- adjunct professor, Department of Prosthodontics, Malmö University, Sweden
| | - Jan Cosyn
- professor, Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium, professor, Faculty of Medicine and Health Sciences, Oral Health Research Group ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stijn Vervaeke
- assistant professor, Department Periodontology & Oral Implantology, Dental School, Faculty Medicine and Health Sciences, Ghent University Belgium
| | - Wolfgang Jacquet
- professor, Faculty of Medicine and Pharmacy, Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium, professor, Faculty of Medicine and Health Sciences, Oral Health Research Group ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Mangano FG, Mastrangelo P, Luongo F, Blay A, Tunchel S, Mangano C. Aesthetic outcome of immediately restored single implants placed in extraction sockets and healed sites of the anterior maxilla: a retrospective study on 103 patients with 3 years of follow-up. Clin Oral Implants Res 2016; 28:272-282. [PMID: 26913807 DOI: 10.1111/clr.12795] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare the aesthetic outcome of single implants in extraction sockets and healed ridges of the anterior maxilla by means of the pink aesthetic score/white aesthetic score (PES/WES) index. MATERIALS AND METHODS This retrospective study was based on data from 103 patients (43 males, 60 females) aged 24-65 years (mean age 41.4 ± 13.8 years) who had been successfully treated with a single implant in the anterior maxilla, in four different clinical centres. Forty-two patients (mean age 46.5 ± 15.1 years) were treated with a single implant in a fresh post-extraction socket (immediate implant treatment, IIT), while 61 patients (mean age 38.0 ± 11.8 years) were treated with a single implant in a healed site (conventional implant treatment, CIT). Two independent calibrated examiners applied the PES/WES index to the 103 single-tooth restorations, respectively 3 months and 3 years after implant placement. RESULTS A few biological (4.8%) and prosthetic (8.7%) complications were reported. Both IIT and CIT yielded satisfactory aesthetic outcomes. At the delivery of the final restoration, a PES/WES score of 16.6 ± 2.6 and 15.7 ± 3.0 was reported for IIT and CIT, respectively: this difference was not statistically significant. A higher decrease in the PES/WES score was observed with CIT over time. At 3 years, a PES/WES score of 16.4 ± 2.8 and 15.2 ± 3.3 was reported for IIT and CIT, respectively: this difference was statistically significant. IIT seemed to yield better aesthetic outcomes in young patients (≤30 years), with implants placed in central incisor/cuspid areas, in the presence of bone contouring. CONCLUSIONS Both immediate and conventional single-implant treatment in the anterior maxilla can yield satisfactory aesthetic outcomes, when performed by experienced clinicians in well-selected cases. Further studies are needed to confirm these results.
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Affiliation(s)
- Francesco Guido Mangano
- Department of Surgical and Morphological Sciences, Dental School, University of Varese, Varese, Italy
| | | | | | | | | | - Carlo Mangano
- Department of Medical, Oral and Biotechnological Sciences, Dental School, University of Chieti-Pescara, Chieti, Italy
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