Implant treatment in atrophic posterior mandibles: Vertical regeneration with block bone grafts versus implants with 5.5-mm intrabony length

Purpose: To retrospectively compare the outcomes of implants placed in posterior mandibles vertically regenerated with onlay autogenous block bone grafts and short dental implants. Materials and Methods: Consecutive patients with vertical bone atrophy in edentulous mandibular posterior regions (7 to 8 mm of bone above the inferior alveolar nerve) were treated with either implants placed in regenerated bone using autologous block bone grafts (group 1) or short implants (with 5.5-mm intrabony length) in native bone (group 2) between 2005 and 2010 and followed for 12 months after loading. The procedure used was the established treatment protocol for this type of patient at the Oral Surgery Uni…

Microbiological assessment of the implant-abutment interface in different connections: cross-sectional study after 5 years of functional loading.

Objective To evaluate the bacterial microflora present inside the implant connection and in the peri-implant sulcus fluid of healthy implants, and to analyze the relationships between these harboring sites for four different implant systems after at least 5 years of functional loading. Materials and methods A cross-sectional study was performed involving 40 patients treated with metal-ceramic cemented bridges supported by at least two healthy implants functionally loaded for 5 years. Four different implant-abutment connections were studied: external hexagon (control group), double internal hexagon (test group 1), internal hexagon with external collar (test group 2), and conical connection (…

Soft tissue integration of different abutment surfaces: An experimental study with histological analysis

OBJECTIVE To evaluate whether abutment surface and surface bio-activation have an effect on soft tissue morphogenesis. MATERIALS AND METHODS 36 patients (36 implants) were included. Abutments were randomly divided into 4 groups (n = 9): Smooth Surface-MAChined (MAC), Ultrathin Threaded Microsurface (UTM), MAC Plasma of Argon activated (Plasma-MAC), and UTM Plasma of Argon activated (Plasma-UTM). After 2 months of healing, soft tissue samples were collected and prepared for histological analysis. The margin of the peri-implant mucosa (PM), the apical extension of the barrier epithelium (aJE), and the apical location of the abutment (AM) were identified. Significances of differences among gro…

Association Between Clinical and Microbiologic Cluster Profiles and Peri-implantitis

Purpose: The correlation between associated local factors and peri-implantitis remains unknown. The aim of this study was to investigate the association between the clinical and microbiologic profiles and periimplantitis to eventually categorize different groups of this disease. Materials and Methods: Subjects with at least one implant presenting signs of peri-implantitis were selected. The clinical, radiographic, occlusal, and microbiologic profiles of these infected implants were collected. Cases were classified into five peri-implantitis groups according to potential disease-triggering factors: surgically, prosthetically, biomechanically, purely plaque-associated, and a combination of th…

Implant Abutment Cleaning by Plasma of Argon: 5-Year Follow-Up of a Randomized Controlled Trial.

Contamination of implant abutments could potentially influence the peri-implant tissue inflammatory response. The aim of the present study is to assess the radiographic bone changes around customized, platform-switched abutments placed according to the "one-abutment-one-time" protocol, with and without plasma of argon cleaning treatment.Thirty healthy patients with thin gingival biotype (1 mm) and history of periodontal disease received one maxillary implant each. Immediately before abutment connection, patients were randomly assigned to control group (cleaning protocol by steaming) or test group (plasma of argon treatment). Outcome measures were: 1) success rate of implants and prostheses;…

Delivery of the Definitive Abutment/Prosthesis: Biologics, Aesthetics, and Mechanical Considerations

The aim of implant therapy is integration, not only host tissue integration but also in the form of biology, esthetics, and mechanics, whereby the implant works as a system in harmony with the human body. Research inspired, this chapter will evaluate the fundamentals of soft tissue integration, the seal that protects the bone and acts as a barrier to the oral environment. Written by practicing clinicians, the goal is to provide information on how to optimize health through understanding handling, cleaning, aesthetics, and mechanics of the restorative componentry.

Influence of plasma cleaning procedure on the interaction between soft tissue and abutments: a randomized controlled histologic study

Introduction Plasma application can lead to an improved adhesion between soft tissue and abutments and promotes cell spreading. Objective A triple-blinded randomized controlled clinical trial was performed to in vivo test the effect of cleaning abutment titanium surfaces with plasma of argon on cell adhesion and collagen fiber orientation at an early healing time. Material and methods Thirty healthy patients with 30 submerged implants, at the second surgery, randomly received either a specially designed abutment with no additional treatment (as they come from industry; control group, G1) or cleaned by plasma of argon (test group, G2). Two weeks thereafter, a small biopsy including abutment …

Culturomic and quantitative real‐time ‐ polymerase chain reaction analyses for early contamination of abutments with different surfaces: A randomized clinical trial

Background Rough and/or plasma-activated abutments seem to be able to increase soft tissue adhesion and stability; however, limited evidence is available about bacterial contamination differences. Purpose The aim was to investigate the oral microbiota on four dental abutments with different surfaces by quantitative real-time polymerase chain reaction (qRT-PCR) and culturomic approach. Methods Forty patients needing a single implant rehabilitation were involved in the study. Forty healing abutments, especially designed for the study, were divided into four groups according to the surface topography (1. machined [MAC], 2. machined plasma of argon treated [plasmaMAC], 3. ultrathin threaded mic…

One abutment-one time approach to maximize peri-implant tissue expression in the aesthetic area

An up to 7-Year Retrospective Analysis of Biologic and Technical Complication With the All-on-4 Concept

The aim of this study was to evaluate retrospectively biologic and technical complications as well as clinical and radiographic outcomes of patients treated with 4 implants according to the All-on-4 protocol and followed up to 7 years of function. Data from 56 consecutive patients presenting complete edentulous jaw, aged 18 years or older, treated between January 2008 and December 2013, were evaluated. The outcomes were implant and prosthetic survival and success rates, any complications, and marginal bone loss (MBL). Two-hundred twenty-four implants were placed in 56 patients. During the entire follow-up, 1 maxillary implant but no prosthesis failed during the healing process. Fourteen pat…

Single-blind randomized clinical trial to evaluate clinical and radiological outcomes after one year of immediate versus delayed implant placement supporting full-arch prostheses

Purpose: To evaluate and compare peri-implant health, marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses. Material and Methods: The present study was a prospective, randomized, single-blind, clinical preliminary trial. Patients were randomized into two treatment groups. In Group A implants were placed immediately post-extraction and in Group B six months after extraction. The following control time-points were established: one week, six months and twelve months after loading. Measurements were taken of peri-implant crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified …

Marginal soft tissue stability around conical abutments inserted with the one abutment-one time protocol after 5 years of prosthetic loading

BACKGROUND Soft tissue stability is crucial to obtain and maintain optimal esthetic results. PURPOSE This study aimed to investigate, over 5 years, the soft tissue response using a conical abutment together with the "one-abutment one-time" (OA-OT) protocol in the restoration of implants inserted in the anterior esthetic area. MATERIAL AND METHODS From January 2011 to January 2012, all consecutive patients requiring an implant n the maxillary area between canines were enrolled. After submerged healing and osseointegration, a definitive abutment with a provisional crown was inserted. After 1 month, the definitive crown was delivered (Tdef). Analog impressions were taken before tooth extractio…

Bacterial inactivation/sterilization by argon plasma treatment on contaminated titanium implant surfaces: in vitro study

Background: Surface treatment by argon plasma is widely used as the last step of the manufacturing process of ti- tanium implant fixtures before their sterilization by gamma rays. The possibility of using such a technology in the daily clinical practice is particularly fascinating. The aim of the present study was to assess the effects of the argon plasma treatment on different titanium implant surfaces previously exposed in vitro to bacterial contamination. Material and Methods: Sterile c.p. titanium implant discs with turned (T, Sa: 0.8μm), sandblasted/acid-etched (SAE, Sa: 1.3μm) and titanium plasma sprayed (TPS, Sa: 3.0μm) surface were used in this study. A strain of Ag- gregatibacter a…

Soft Tissue Response to Titanium Abutments with Different Surface Treatment: Preliminary Histologic Report of a Randomized Controlled Trial

The aim of this preliminary prospective RCT was to histologically evaluate peri-implant soft tissues around titanium abutments treated using different cleaning methods. Sixteen patients were randomized into three groups: laboratory customized abutments underwent Plasma of Argon treatment (Plasma Group), laboratory customized abutments underwent cleaning by steam (Steam Group), and abutments were used as they came from industry (Control Group). Seven days after the second surgery, soft tissues around abutments were harvested. Samples were histologically analyzed. Soft tissues surrounding Plasma Group abutments predominantly showed diffuse chronic infiltrate, almost no acute infiltrate, with …

Systemic risk factors for peri-implant bone loss: a systematic review and meta-analysis

The aim of this study was to determine the influence of patient-related systemic risk factors (systemic disease, genetic traits, chronic drug or alcohol consumption, and smoking status) on peri-implant bone loss at least 1 year after implant installation and prosthetic loading. An electronic search was performed of MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials up to January 2012. One thousand seven hundred and sixty-three studies were identified. After applying a three-stage screening process, 17 articles were included in the qualitative analysis, but only 13 in the quantitative analysis, since smoking was a common exposure. The meta-analysis of these 13 studies (4…

Microbial Colonization of the Peri-Implant Sulcus and Implant Connection of Implants Restored With Cemented Versus Screw-Retained Superstructures: A Cross-Sectional Study.

The aim of this study is to investigate peri-implant and intraconnection microflora of healthy implants restored with cemented and screwed superstructures.Patients with two to three implants restored with cemented or screwed restorations and 5 years of follow-up were recruited. Samples were taken from peri-implant sulci, adjacent teeth, and the inner portion of connections. Prevalence of positive sites and bacterial loads for 10 microorganisms were obtained with quantitative real-time polymerase chain reaction. Implant connection permeability to the studied microorganisms was estimated using a standardized bacterial contamination index. Statistical analysis was performed using a generalized…

The predictive value of microbiological findings on teeth, internal and external implant portions in clinical decision making

International audience; Aim: The primary aim of this study was to evaluate 23 pathogens associated with peri-implantitis at inner part of implant connections, in peri-implant and periodontal pockets between patients suffering peri-implantitis and participants with healthy peri-implant tissues; the secondary aim was to estimate the predictive value of microbiological profile in patients wearing dental implants using data mining methods.Material and Methods: Fifty participants included in the present case─control study were scheduled for collection of plaque samples from the peri-implant pockets, internal connection, and periodontal pocket. Real-time polymerase chain reaction was performed to…

Soft tissue cell adhesion to titanium abutments after different cleaning procedures: preliminary results of a randomized clinical trial

Objectives: A randomized controlled trial was performed to assess soft tissue cell adhesion to implant titanium abutments subjected to different cleaning procedures and test if plasma cleaning can enhance cell adhesion at an early healing time. Study Design: Eighteen patients with osseointegrated and submerged implants were included. Before re-opening, 18 abutments were divided in 3 groups corresponding to different clinical conditions with different cleaning processes: no treatment (G1), laboratory customization and cleaning by steam (G2), cleaning by plasma of Argon (G3). Abutments were removed after 1 week and scanning electron microscopy was used to analyze cell adhesion to the abutment…

The influence of platform switching on the biomechanical aspects of the implant-abutment system. A three dimensional finite element study

Objective: To evaluate the biomechanical scenario of platform switching geometric implant-abutment configuration relative to standard configurations by means of finite element analysis.Study Design: A 3D Finite Element Analysis (FEA) was performed on 3 different implant-abutment configurations: a 3.8 mm implant with a matching diameter abutment (Standard Control Design, SCD), a 5.5 mm implant with matching diameter abutment (Wider Control Design, WCD), and a 5.5mm implant with a 3.8 mm abutment (Experimental Design, ED). All the different experimental groups were discretized to over 60000 elements and 100000 nodes, and 130N vertical (axial) and 90N horizontal loads were applied on the coron…

Measurement of gap between abutment and fixture in dental conical connection implants. A focused ion beam SEM observation

Background The aim of the authors was to examine the abutment-fixture interface in Morse-type conical implants in order to verify gaps at this level using a new microscopical approach. Material and Methods In this in vitro study, 20 abutment-fixture complexes were prepared by sectioning (longitudinal and cross-sectional to the long axis) with a microtome and then with a focused ion beam (FIB). This is a micrometric machine tool that uses gallium ions to abrade circumscribed areas to dig deeper into the cuts obtained with the microtome in order to eliminate cut-induced artifacts. This is because the FIB abrasion is practically free from artifacts, which are normally generated by the action o…

Clinical and microbiological findings in patients with peri-implantitis: a cross-sectional study

Objective The aim of this study was to analyze clinical and microbiological characters in subjects and implants affected and not affected by peri-implantitis. Additionally, same features were analyzed also intra-individually, comparing healthy and diseased implants within the same subject. Materials and methods A total of 534 patients who received at least 1 implant and coming to routine check-up or spontaneous visits at the University of Valencia were recruited. Clinical parameters including Bleeding on probing (BoP), Probing pocket depth (PPD), and Pi were screened. Samples for microbiological analysis were obtained from three locations: peri-implant sulci (PIS), inner parts of the implan…

Microbial Leakage at the Implant-Abutment Connection Due to Implant Insertion Maneuvers: Cross-Sectional Study 5 Years Postloading in Healthy Patients.

The aim of this study was to test if stress on the prosthetic connection during insertion maneuvers can induce micro-warping at the implant connection. From September 2011 to July 2013, patients with implants loaded for at least 5 years that were placed with 2 different insertion implant mounters—MP (conventional) and ME (mountless)—were selected from all of those who had received dental implant therapy in the past and were attending routine check-up or spontaneous visits during the study period. Samples were obtained from inside the connection and the abutment surface using absorbent sterile paper tips. Quantitative real-time polymerase chain reaction was performed for total bacterial coun…

Tilted implants for the restoration of posterior mandibles with horizontal atrophy: An alternative treatment

Purpose Horizontal atrophy in the posterior mandible presents serious limitations on conventional implant placement. The purpose of this study was to evaluate the use of tilted implants angled in a buccolingual direction for restoring atrophic posterior mandibular sectors. Materials and Methods A cohort study was performed of 25 patients who had partial prostheses supported by more than 1 implant (≥1 tilted and 1 axial implant) to restore molar areas in the mandible. When the bone thickness was at least 5 mm, axial implants were placed; when the alveolar ridge was narrower, the implant was placed with tilted angulation. The beds for these tilted implants were prepared using a lingual approa…

Impact of crestal and subcrestal implant placement upon changes in marginal peri-implant bone level. A systematic review.

Background To systematically assess studies analyzing peri-implant bone loss in implants placed in crestal and subcrestal position. Material and Methods Following the recommended methods for systematic reviews and meta-analyses (PRISMA), an electronic search was conducted in the PubMed (MEDLINE), EMBASE and LILACS databases to identify all relevant articles published up until April 2017. The search included human studies comparing marginal bone loss (MBL) between a control group and a study group with a minimum of 10 patients and a minimum follow-up of 6 months after prosthetic loading with rough neck implants. Two independent reviewers assessed the risk of bias in the selected studies base…

Implant Dentistry: New Materials and Technologies

Definitive Abutments Placed at Implant Insertion and Never Removed: Is It an Effective Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Purpose To assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing. Materials and Methods Electronic and manual searches were conducted for English-language articles published up to March 2017 that identified a relation between repeated disconnections of implant abutments (PA group) and prosthetic or implant failures, complications, marginal bone loss (MBL), soft tissue healing, and esthetic evaluation (pink esthetic score [PES]) after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement (DA group). Results Fourteen articles (535 patients with 994 impla…

Single-blind randomized clinical trial to evaluate clinical and radiological outcomes after one year of immediate versus delayed implant placement support

Purpose: To evaluate and compare peri-implant health, marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses. Material and Methods: The present study was a prospective, randomized, single-blind, clinical preliminary trial. Patients were randomized into two treatment groups. In Group A implants were placed immediately post-extrac - tion and in Group B six months after extraction. The following control time-points were established: one week, six months and twelve months after loading. Measurements were taken of peri-implant crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modifi…

Does Apico-Coronal Implant Position Influence Peri-Implant Marginal Bone Loss? A 36-Month Follow-Up Randomized Clinical Trial

Purpose Preserving peri-implant bone and reducing exposure of the rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiologic parameters after crestal and subcrestal dental implant placement at 36 months' follow-up. Materials and Methods We carried out a randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown. Patients were randomized according to the implant insertion depth: implants placed approximately 2 mm below the bone crest (test group) or implants placed at bone crest level (control group). They were e…

Dental Implants in the Third Millennium