The Vertical Soft Tissue Thickness and Subcrestal Implant Placement as Factors for Peri-implant Crestal bone Stability

Aim The aim of this prospective study was to determine the influence of vertical soft tissue thickness on bone level changes in platform-switched implants placed eqicrestally or subcrestally and restored with screw-retained or cement-retained restorations. Methods Platform-switched bone-level implants were placed in a single stage manner in the posterior mandibular region. Implant sites were divided into thick (control) and thin (test) vertical soft tissue groups. The implants in the control group were placed equicrestally. The implant sites from the control group were randomly allocated to receive equicrestally or subcrestally placed implants. Bone remodeling/loss was radiographically measured at baseline, three months postoperatively and six months after delivery of final prosthetic restoration. Results The mean crestal bone loss values three months postoperatively and six months post prosthetic restoration were higher in sites with thin versus sites with thick gingiva. In implant sites with thin gingiva, subcrestally placed implants presented less bone loss than eqicrestally placed implants. Conclusion Platform switched implants are prone to more bone loss when they are placed in sites with thin soft tissue, regardless of the type of final restoration (screw-retained or cement-retained). Subcrestal placement of platform-switched implants can prevent crestal bone loss in sites with vertical soft tissue thickness < 3 mm.

Histologic and Histomorphometric Evaluation of a New Bioactive Liquid BBL on Implant Surface: A Preclinical Study in Foxhound Dogs

Background: Bioactive chemical surface modifications improve the wettability and osseointegration properties of titanium implants in both animals and humans. The objective of this animal study was to investigate and compare the bioreactivity characteristics of titanium implants (BLT) pre-treated with a novel bone bioactive liquid (BBL) and the commercially available BLT-SLA active. Methods: Forty BLT-SLA titanium implants were placed in in four foxhound dogs. Animals were divided into two groups (n = 20): test (BLT-SLA pre-treated with BBL) and control (BLT-SLA active) implants. The implants were inserted in the post extraction sockets. After 8 and 12 weeks, the animals were sacrificed, and mandibles were extracted, containing the implants and the surrounding soft and hard tissues. Bone-to-implant contact (BIC), inter-thread bone area percentage (ITBA), soft tissue, and crestal bone loss were evaluated by histology and histomorphometry. Results: All animals were healthy with no implant loss or inflammation symptoms. All implants were clinically and histologically osseo-integrated. Relative to control groups, test implants demonstrated a significant 1.5- and 1.7-fold increase in BIC and ITBA values, respectively, at both assessment intervals. Crestal bone loss was also significantly reduced in the test group, as compared with controls, at week 8 in both the buccal crests (0.47 ± 0.32 vs 0.98 ± 0.51 mm, p < 0.05) and lingual crests (0.39* ± 0.3 vs. 0.89 ± 0.41 mm, p < 0.05). At week 12, a pronounced crestal bone loss improvement was observed in the test group (buccal, 0.41 ± 0.29 mm and lingual, 0.54 ± 0.23 mm). Tissue thickness showed comparable values at both the buccal and lingual regions and was significantly improved in the studied groups (0.82–0.92 mm vs. 33–48 mm in the control group). Conclusions: Relative to the commercially available BLT-SLA active implants, BLT-SLA pre-treated with BBL showed improved histological and histomorphometric characteristics indicating a reduced titanium surface roughness and improved wettability, promoting healing and soft and hard tissue regeneration at the implant site.

The influence of laser-microgrooved implant and abutment surfaces on mean crestal bone levels and peri-implant soft tissue healing: a 3-year longitudinal randomized controlled clinical trial

Purpose The study aimed to compare clinical and radiographic parameters of peri-implant site of laser-microgrooved implants with either laser-microgrooved or regular machined prosthetic abutment post 3 years of early loading. Method Twenty edentulous sites of systemically and periodontally healthy individuals were allocated into two groups in this prospective, two-armed, randomized double-blinded clinical trial in 1:1 ratio, wherein each site received laser-microgrooved implants with either laser-microgrooved or machined prosthetic abutments. Outcome measures included full-mouth plaque (FMPS%) and bleeding score (FMBS%), site-specific plaque (SPS%) and bleeding score (SBS%), peri-implant sulcus depth (PISD mm), and mean crestal bone loss (MCBL mm) evaluated at baseline (6 weeks), 1 and 3 years post-early loading. Mean and standard deviation of all parameters were estimated, between groups and at different time points using independent and paired t-test, respectively, Normality was checked using Kolmogorov–Smirnov test and Shapiro–Wilk test, P value ≤ 0.05 was considered as statistically significant. Results Three-year follow-up of test group showed statistically significant reduction in SPS, SBS, PISD (P value ≤ 0.001). The MCBL reduced from 1.93 mm to 0.61 mm (P value ≤ 0.001); in other words, a bone gain of 0.15 mm was obtained in the test group. Conclusion Within the limitations of the present study, laser-microgrooved implants loaded with laser-microgrooved prosthetic abutments showed superior results clinically and radiographically when compared to loading with machined abutments.

ANTERIOR MAXILLARY IMMEDIATE IMPLANT AFTER EXTRACTION WITH CLOSE LOADING TEMPORARY CROWN

Immediate implant placement after extraction is a dental implant treatment procedure reported in several case studies with satisfactory results for patients and less crestal bone loss around the implant. This case report describes the method of immediate implant placement after extraction. It directs temporary crown placement in a female patient with failed post-endodontic treatment restoration on the maxillary incisor. The procedure was performed under local anesthesia, preceded by tooth extraction and socket cleaning post-extraction, followed by the implant and bone grafting procedure, then finalized by provisionalization. The immediate implant procedure is a simple and time-saving technique. No second surgery is required, such as delayed implant procedure, but the operator's good analytical, diagnostic, and planning skills in its implementation.

Ultrasonography for noninvasive and real-time evaluation of peri-implant soft and hard tissue: a case series

Background The diagnosis of soft and hard tissue at dental implants will be challenging in the future, as high prevalence of mucositis and peri-implantitis were described in the population. Ultrasonography is a promising non-invasive, inexpensive, painless, and radiation-free method for imaging hard and soft tissue at implants, especially an ultrasound device with a 25-MHz probe demonstrating a high correlation between ultrasound, clinical, and radiological measurements. Case presentation The following case series demonstrates the use of ultrasonography with high spatial resolution probe in patients with dental implants affected by soft tissue recession and/or crestal bone loss. Conclusion These ultrasound images can provide valuable additional information for the assessment of peri-implant soft and hard tissue.

Outcomes of implants placed after osteotome sinus floor elevation without bone grafts: a systematic review and meta-analysis of single-arm studies

Background The aim of this study is to evaluate the implant survival/success rate, gain in alveolar bone height, crestal bone loss, and complications associated with implants placed in the posterior maxilla after osteotome sinus floor elevation without bone substitutes. Methods The electronic databases, such as MEDLINE, EMBASE, CENTRAL, and SCOPUS were systematically and manually searched for publications in peer-reviewed journals. The included articles were subjected to qualitative and quantitative analyses, and the meta-analysis was carried out for single-arm studies. Methodological quality assessment was made for all the included studies. Results The included studies were of moderate quality, with the overall implant success and survival rates of 98.3% and 97.9% respectively. The most frequent intra-surgical complication was sinus membrane perforation, accounting for 3.08% of the total implants with reported perforations. The overall crestal bone loss in patients with immediate implants placed with OSFE after a 5-year follow-up was 0.957 mm 95%CI (0.538, 1.377). Conclusion Within the limitations of this review, it can be concluded that the survival and success rates of implants placed immediately along with OSFE without any bone substitutes are acceptable and show adequate implant stability with less crestal bone loss over 5 years.