PC457: Widening of keratinized mucosa in posterior sites at implant placement with soft tissue substitutes

Guided implant dentistry using computed tomographic (CT) scans, virtual planning software and mucosa-supported surgical templates is an upcoming technology with the potential for more predictable and less invasive implant placement. While generally associated with a flapless approach, soft tissue punching and removal may not be indicated if available width of keratinized mucosa is limited prior to implant surgery. Two techniques to preserve keratinized peri-implant mucosa (Punch Reposition Technique and Topical Flap Technique) are presented and indications outlined. Appreciation of soft tissue conditions as well as functional and esthetic consequences of mucosal deficiencies (mucosal-driven approach) is recommended to supplement bone- and prosthetic-driven considerations in guided oral implant placement (Trinity Approach).

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Effect of free gingival graft before implant placement on peri-implant health and soft tissue changes: a randomized controlled trial

BMC Oral Health ◽

10.1186/s12903-021-01818-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chaoling Zheng ◽

Shimin Wang ◽

Hongqiang Ye ◽

Yunsong Liu ◽

Wenjie Hu ◽

...

Keyword(s):

Soft Tissue ◽

Control Group ◽

Free Gingival Graft ◽

Implant Placement ◽

Soft Tissue Thickness ◽

Significant Difference ◽

Tissue Changes ◽

Implant Restoration ◽

Soft Tissue Changes ◽

Keratinized Mucosa

Abstract Background To evaluate the clinical outcome and changes in posterior buccal soft tissue following implant restoration in groups with and without a free gingival graft (FGG) before implant placement. Methods Twenty-six individuals who required implant restoration and displayed lack of keratinized mucosa (KM) were recruited and assigned to the FGG group (with FGG before implant placement) or Control group (without FGG before implant placement) randomly. A screw-retained conventional implant restoration was performed for each patient. Peri-implant soft tissue was captured by an intraoral scanner and analyzed by an image processing software. Clinical parameters (plaque index, gingival index, probing depth, and bleeding on probing) were assessed at baseline and 1, 3, 6, and 12 months. Buccal soft tissue changes (mucosal margin, soft tissue thickness, and width of keratinized mucosa) on the buccal side of implant site were assessed at 1, 3, 6, and 12 months. Two-way ANOVA and Bonferroni test were used to analyze significant difference between groups at each time point (α = 0.05). Results The clinical parameters were lower in the FGG group than that in the Control group, although there were no significant differences between the two groups (P > 0.05). Peri-implant soft tissue collapsed and the changes (mucosal margin and soft tissue thickness) were significantly greater in the Control group than the FGG group (P < 0.05). Width of KM was larger in the FGG group than the Control group, although there was no significant difference between the two groups (P > 0.05). Conclusions Minimal peri-implant soft tissue changes occurred in two groups. Performing FGG before implant placement is a viable procedure to maintain peri-implant soft tissue but might not affect peri-implant health during 12 months follow-up. However, small sample size must be considered. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000037954; Date of registration: 6 September 2020).

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Immediate Loading of Single Post-Extractive Implants in the Anterior Maxilla: 12-Month Results From a Multicenter Clinical Study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-11-00058 ◽

2012 ◽

Vol 38 (S1) ◽

pp. 477-484 ◽

Cited By ~ 4

Author(s):

Tommaso Grandi ◽

Giovanna Garuti ◽

Rawad Samarani ◽

Paolo Guazzi ◽

Andrea Forabosco

Keyword(s):

Clinical Study ◽

Soft Tissue ◽

Bone Resorption ◽

Tooth Extraction ◽

Immediate Loading ◽

Insertion Torque ◽

Anterior Maxilla ◽

Implant Placement ◽

Implant Size ◽

Multicenter Clinical Study

The purpose of the study was to evaluate survival and peri-implant bone levels of single, immediately loaded post-extractive implants in the anterior maxilla 12 months after implant placement. Thirty-six consecutive patients from 3 study centers were included in the study. The concerned sites were upper premolars, canines, and incisors. For each patient the following data were recorded: reason for tooth extraction, bone quality, implant size, and final insertion torque. Implants were placed using a flapless technique and immediately loaded with a nonoccluding temporary restoration. Final restorations were provided 4 months later. Peri-implant bone resorption was evaluated radiographically after 6 and 12 months. The average final insertion torque was 70.55 Ncm. One implant inserted in D3 quality bone with a 35-Ncm seating torque was lost. All other implants had a final insertion torque ranging between 50 and 80 Ncm. The average peri-implant bone loss was 0.437 and 0.507 mm at 6 and 12 months, respectively. All the sites maintained excellent papillae and peri-implant soft-tissue conditions. The resulting 1-year success rate was 97.2%. Immediate nonfunctional loading of single post-extractive implants in the anterior maxilla is a predictable treatment. And it seems that achieving high insertion torques by placing self-tapping/self-condensing implants in an underprepared osteotomy is favorable.

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A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites

Scientific Reports ◽

10.1038/s41598-021-81402-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kwantae Noh ◽

Daniel S. Thoma ◽

Jung-Chul Park ◽

Dong-Woon Lee ◽

Seung-Yun Shin ◽

...

Keyword(s):

Soft Tissue ◽

Tooth Extraction ◽

Case Series ◽

Tissue Level ◽

Ridge Preservation ◽

Bone Augmentation ◽

Implant Placement ◽

Alveolar Ridge Preservation ◽

Tissue Changes ◽

Facial Area

AbstractInformation regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4–8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04–0.35 mm in group LP/ARP, 0.04–0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm3 in group LP/ARP, 0.96 mm3 in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.

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