Esthetic And Functional Integration Of Soft Tissue Around Dental Implants: Thickness, Width, Stability.

The long-term Functional success of the implant treatment depends on the stability of the crestal bone tissue around the implant platform. The Esthetic result is achieved by an adequate soft tissue in the peri-implant zone. Furthermore, the soft tissue creates the buffer area that ensures the mechanical and biological protection of the underlying bone. Therefore, it is necessary to maintain for a long term, not only the implant osseointegration but also the integration of the soft tissue around the Sub and Supra-structure of the restoration. In order to create the protective soft tissue area, it is necessary to ensure three criteria. This treatment approach will be defined as the TWS – Soft Tissue Management : T for Thickness , W for Width, and S for Stability . The purpose of this article is to present with clinical cases, the detailed description of each criteria. There are many ways to achieve the two first criteria and they are well described in the literature. Achieving the third criteria of the Stability become possible only in the last years since the development of the digital technology and its implementation into the dental practice. A one time abutment and the creation of peri- implant mucosal thickness with an optimal amount of the attached keratinized gingiva above and around the implant platform, for muco-gingival integration of the system, are therefore a prerequisite for functional and esthetic result. The article presents the possibility for the clinicians to use in their daily practice this new clinical approach of TWS - Soft Tissue Management.

Palatal mucosa thickness and palatal neurovascular bundle position evaluation by cone-beam computed tomography—retrospective study on relationships with palatal vault anatomy

Background Measuring the thickness of the palatal mucosa at the planning of the surgical procedure is an important step in order to obtain the maximum width and thickness of the graft from the appropriate area. The aim of this study is to determine whether there is a relationship between palatal angle (PA) or palatal depth (PD) and palatal mucosa thickness (PMT) or palatal neurovascular bundle distance (PNBD). Methods PMT, PNBD, PD and PA were measured on cone-beam computed tomography (CBCT) images of maxillary posterior region of 200 male and 200 female patients. The mean of all parameters according to gender was compared and the significance of the difference detected between groups was evaluated. Potential relationship between PMT or PNBD and PA or PD was also evaluated. Results In females, the palatal mucosa was significantly thinner at all tooth regions (p < 0.005), and PNBD was lower only at the level of the second molar (p < 0.001). In addition, it was found that there was a significant inverse correlation between the palatal depth value and the palatal mucosal thickness, and palatal depth was correlated with the palatal neurovascular bundle distance (p ≤ 0.001). Discussion Consistent with previous studies, it was observed that the thickest mucosa in the palatal region was located in the region of the premolar teeth, and women had thinner palatal mucosa. In addition, in patients with a deeper palate vault, the palatal mucosa was thinner, but the palatal neurovascular bundle was more distant from the cemento-enamel junction.

Effects of Supplementation with a Quebracho Tannin Product as an Alternative to Antibiotics on Growth Performance, Diarrhea, and Overall Health in Early-Weaned Piglets

This study assessed the feasibility of using a vegetable extract, MGM-P (quebracho tannin product), as an alternative to antibiotics for weaned piglets; it investigated MGM-P effects on growth performance, diarrhea, and overall health in early-weaned piglets. In total, 24 piglets were allocated to three treatment groups fed basal diets supplemented with 0, 0.2%, or 0.3% MGM-P for 20 days. The addition of 0.3% MGM-P to the diet of early-weaned piglets improved diarrhea incidence, hematological parameters, and intestinal mucosa structure. Furthermore, the addition of 0.2% or 0.3% MGM-P to the diet of early-weaned piglets did not affect their overall health. Importantly, MGM-P had no effects on average daily gain (ADG), average daily feed intake (ADFI), or feed conversion ratio (FCR). Gut morphology analysis showed that treatment with 0.3% MGM-P enhanced the jejunal villus height (p < 0.05) while reducing the ileal crypt depth (p < 0.05) and colon mucosal thickness (p < 0.05). Collectively, the findings suggested that the use of MGM-P as an alternative to dietary antibiotics could improve diarrhea incidence in early-weaned piglets without negative effects on growth performance or overall health.

Effects of autolyzed yeast on performance, blood parameters, intestinal morphometry, immunohistochemistry and microbiological parameters of weaned piglets in a tropical humid climate

This study aimed to evaluate the effects of dietary supplementation of autolyzed yeast (AY) from fermentation of sugarcane on performance, blood parameters, intestinal morphometry, immunohistochemistry and microbiological parameters of weaned piglets of different weight categories. A total of 480 piglets were distributed in a 3 x 2 factorial design study, with three inclusion levels of AY (0, 4 and 8 g/kg) and two weight categories (light and heavy, 5.71 ± 0.21 kg and 6.99 ± 0.25 kg, respectively), i.e., 6 treatments with 8 replicates pen each. There was no significant interaction between weight category and linear or quadratic effect of AY levels on performance, blood parameters, intestinal morphometry, immunohistochemistry and microbiological parameters (P > 0.05). The dietary supply of AY for nursery piglets linearly decreased the monocytes concentration of the piglets at 63 days of age (P < 0.05). AY levels linearly increased the villus height, mucosal thickness, absorptive area and number of mitotic cells of the duodenum, as well as the villus height:crypt depth ratio, mucosal thickness and number of mitotic cells of the jejunum (P < 0.05). Heavy piglets had higher ADFI in all evaluated periods, as well as higher values of villus height in the duodenum, and mucosal thickness in the duodenum and jejunum than light animals (P < 0.05). Dietary supplementation of autolyzed yeast positively influences health status, intestinal morphometry and immunohistochemistry of nursery piglets. Heavy weaned piglets have higher feed intake and greater intestinal morfometry than light animals.

Evaluation of the effect of periapical lesions and other odontogenic conditions on maxillary sinus mucosal thickness characteristics and mucosal appearance: A CBCT study

Background. This retrospective study aimed to investigate the effect of various dental and maxillary sinus variables on maxillary sinus mucosal thickness (MT). The variables included periodontal bone loss (PBL), periapical status, dental restorations of posterior maxillary teeth, and the distance from the root apices to the sinus mucosa. Methods. Cone-beam computed tomography (CBCT) images of the maxillary sinuses (n=600) in 300 patients were examined. The sinus MT and the distance of the roots from maxillary sinuses were measured. Apical lesions of the roots, PBL, and situations of adjacent teeth were recorded. The relationships between these conditions and MT and characterization of MT were evaluated. The Kruskal–Wallis H test was used to compare groups due to the non-normal distribution of the data. The relationship between categorical variables was analyzed using chi-squared test. Results. There was a significant correlation between maxillary sinus MT and periapical lesions, PBL, and restorations (P<0.05). MT increased as the apical lesions of premolar teeth enlarged (P<0.05, P=0.022). MT increased in cases of mild PBL of molar teeth (P=0.041). Conclusion. In this retrospective study, the MT significantly increased in patients with periapical lesions, inadequate endodontic treatment, increased PBL, and inadequate dental restorations.

assessment of periimplant soft tissue condition with morse taper abutment connection

Aim: This study aims to evaluate the clinical assessment results of periimplant soft tissue with morse taper (internal abutment connection). Methods: The study was conducted using a rapid review by searching the articles from PubMed NCBI and Cochrane by using keywords. All articles were selected by the year, duplication, title, abstract, full-text, and finally, all selected articles were processed for final review. Following clinical parameters were included; Periimplant Probing Pocket Depth (PPD), Plaque Score (PS), modified Plaque Index (mPI), Mucosal Thickness (MTh), Gingival Height (GH), periimplant mucosal zenith, Pink Esthetic Score (PES), Bleeding On Probing (BOP), Sulcus Bleeding Index (SBI), and modified Gingival Index (mGI). Results: 9 selected articles were obtained from the initial literature searching count of 70 articles. The overall samples included 326 morse taper implants. Based on the evaluation, 3 out of 4 articles reported pocket depth < 4 mm, no bleeding was reported in 2 out of 4 articles. 4 out of 4 articles reported low plaque accumulation, low soft tissue recession was reported in 3 out of 3 articles, and 4 out of 4 articles reported acceptable PES values. Conclusion: The evaluations indicate that the morse taper (internal abutment connection) has favorable assessment results based on various clinical parameters.

Variations in vertical mucosal thickness at edentulous ridge according to site and gender measured by cone-beam computed tomography

Background The vertical thickness of the peri-implant mucosa is associated with the amount of post treatment marginal bone loss. However, the variations in mucosal thickness at the different edentulous sites have been sparsely documented. The purpose of the study was to conduct a survey of the frequency distribution of variations in mucosal thickness at the different sites of the edentulous alveolar ridge and to compare them according to gender. Our study included 125 partially edentulous patients having a total of 296 implant sites. Cone-beam computed tomography (CBCT) scans were obtained by placing a diagnostic template with a radiopaque crown indicator on the ridge to determine the mucosal thickness at the crest of the alveolar ridge. Results The mucosal thickness was 3.0±1.3 mm in the maxilla, which was significantly greater than the mucosal thickness of 2.0±1.0 mm in the mandible (p<0.001). In both the maxilla and the mandible, the mucosa was the thickest in the anterior region, followed by the premolar and molar regions. Sites were further classified into two groups based on whether the mucosal thickness was greater than 2 mm. In the mandible, more than half of the sites showed a mucosal thickness of 2 mm or less. Conclusions Although this study was a limited preoperative study, the vertical mucosal thickness at the edentulous ridge differed between the maxillary and mandibular regions. The majority of sites in the mandibular molar region had a mucosal thickness of less than 2 mm. Practitioners might be able to develop an optimal dental implant treatment plan for long-term biologic and esthetic stability by considering these factors.

Influence of the Periapical Status of the Posterior Maxillary Teeth on the Width of the Schneiderian Membrane of the Maxillary Sinus Mucosa

Background: Various parameters are known to affect the amount and type of mucosal thickening. The aim of this retrospective study was to investigate these effects through a survey of cone-beam computed tomography (CBCT) images. CBCT scans of 150 patients, which included the area of the MS and maxillary teeth (canine, first premolar, second premolar, first molar, second molar, and third molar), were evaluated retrospectively for the presence of sinus mucosal thickening. The parameters evaluated as possible causes of mucosal thickening were age, sex, tooth type, proximity to the maxillary sinus, endodontic treatment, and periapical lesion. Descriptive statistics and multiple logistic regression were used to analyze the data. A total of 28% of the teeth presented with mucosal thickening, which was associated with periapical lesions in 57.1% of 77 cases. The size of the lesion was the only parameter that was found to be significantly connected to the presence of mucosal thickness. More than 50% of teeth with periapical lesions in the posterior maxilla exhibited mucosal thickening. Other parameters such as age, sex, and the position of the root tips in relation to the MS floor did not influence the probability of developing mucosal thickening.