Long-term stability of soft tissues following alveolar ridge preservation: 10-year results of a prospective study around nonsubmerged implants.

The purpose of this study was to evaluate the long-term clinical outcomes around implants placed in sites previously augmented with demineralized bovine bone mineral with 10% collagen (Bio-Oss Collagen, Geistlich). In this prospective study, 36 consecutive, healthy patients, in need of a single-tooth extraction (incisors, canines, and premolars) and implant replacement, were included. After tooth extraction, Bio-Oss Collagen was inserted in the socket and covered either with a double layer of collagen membrane (test) or with a few drops of a flowable polylactide polymer (control). Following a healing period of 4 to 6 months, a single nonsubmerged implant surgery was performed. After cementation of a single ceramic crown, patients were asked to follow an individualized supportive periodontal therapy program. Clinical and radiographic data were obtained after prosthesis delivery (baseline) and at the 10-year follow-up visit. At the 10-year examination, two patients were lost to follow-up. All implants demonstrated healthy peri-implant soft tissues as documented by standard parameters (full-mouth plaque score, full-mouth bleeding score, local bleeding on probing) in both groups. Mean soft tissue recession (REC) was 0.39 ± 0.54 mm for the test group and 0.50 ± 0.33 mm for the control, with no significant difference between the two groups. The results of this prospective study confirmed the long-term stability of the peri-implant marginal soft tissues supported by regenerated bone by means of the described technique using Bio-Oss Collagen. If the patient is properly followed throughout time, the risk for mucosal recession is low, with < 1 mm of mean REC after 10 years.

Surgical treatment of buccal soft tissue recessions around single implants: 1-year results from a prospective pilot study.

AIM: The aim of this study was to evaluate the outcome of a soft tissue dehiscence coverage technique, at single non-submerged implant sites, presenting shallow isolated buccal mucosal recession. MATERIAL AND METHODS: Sixteen patients were included in this prospective study. A connective tissue graft (CTG) was harvested from the maxillary tuberosity. The donor soft tissue was de-epithelialized and trimmed with a mucotome for an optimal adaptation to the collar of the implant. RESULTS: Surgery and healing proceeded with no complications and minimal post-operative discomfort. One-year follow-up demonstrated clinical and esthetic improvements. Treatment resulted in 89.6 ± 13.1% mean coverage, and complete implant soft tissue coverage was achieved in nine of 16 cases, corresponding to a 56.3%. The VAS esthetic analysis showed a significant improvement from 3.6 ± 0.2 to 8.5 ± 0.3. CONCLUSIONS: These positive preliminary results suggest that, by means of the surgical technique presented, buccal soft tissue dehiscences around single implants can be successfully treated. Additional Randomized controlled trials (RCTs) should be encouraged to assess the most effective variation to the technique in the various clinical situations and around implants of different designs.

Early loading of sandblasted and acid-etched implants: a randomized-controlled double-blind split-mouth study. Five-year results.

OBJECTIVES: The aim of the present split-mouth study is to assess the peri-implant conditions around early-loaded sandblasted and acid-etched (SLA) implants, 5 years after abutment connection and to compare, in the same patients, the results obtained with a standard protocol using identical implants with a TPS surface. MATERIAL AND METHODS: Surgical procedure was performed by the same operator and was identical at test (SLA) and control (TPS) sites, in 32 healthy patients. Abutment connection was carried out at 35 N cm 6 weeks postsurgery for test sites and 12 weeks for the controls. Patients were seen regularly, for control and professional cleaning. At 60 months, clinical measures and radiographic bone changes were recorded by the same operator, blind to the type of surface of the implant, on 27 patients, as five patients were lost to follow-up. RESULTS: A total number of 106 implants were examined. No implant was lost. No significant differences were found with respect to the presence of plaque [modified plaque index (mPI) 0.27+/-0.56 vs. 0.32+/-0.54], bleeding on probing (29% vs. 32%), mean pocket depth (3.2+/-1 vs. 3.2+/-1 mm) or mean marginal bone loss (0.32+/-1.04 vs. 0.44+/-1.12 mm) between test and control. Four implants that presented 'spinning' at the time of abutment connection presented no significant differences from the rest of the test sites. CONCLUSION: The results of this prospective study confirm that SLA implants, under defined conditions, are suitable for early loading at 6 weeks in both the mandible and the maxilla. Limited implant spinning, occasionally found at abutment connection, produces no detrimental effect on the clinical outcome when properly handled.

Autogenous bone graft alone or associated with titanium mesh for vertical alveolar ridge augmentation: a controlled clinical trial.

OBJECTIVES: The aim of this controlled clinical trial is to evaluate alveolar ridge augmentation using an autogenous onlay bone graft alone or associated with a titanium mesh (Ti-Mesh). MATERIAL AND METHODS: A group of 23 partially edentulous patients, presenting the need for vertical bone augmentation of at least 4 mm, were treated before implant placement. Surgical procedure was performed by the same operator and was identical at 12 test (bone graft+Ti-Mesh) and 12 control (bone graft alone) sites. During the first surgery, an autogenous bone graft was harvested from the mandibular ramus and secured by means of titanium screws. Particulate bone was added. In patients assigned to the test group only, a Ti-Mesh was used to stabilize and protect the graft. RESULTS: No major complications were recorded at recipient or donor sites. After a mean interval of 4.6 (SD 0.7) months, the mean vertical augmentation obtained was 5 mm (range 4-7 mm) for the test group and 3.4 mm (range 3-6 mm) for the control. The sites with Ti-Mesh coverage underwent bone resorption of 13.5%, while the sites with no coverage showed a corresponding value of 34.5%. The differences between the two groups were statistically significant. Implants were placed at all grafted sites. CONCLUSION: The results of this study suggest that an onlay osseous graft protected by a Ti-Mesh demonstrated significantly less bone resorption when compared with an onlay bone graft alone. This benefit was reduced in case of short-term mesh exposure, with limited drawbacks.

Periodontal plastic surgery for treatment of localized gingival recessions: a systematic review.

BACKGROUND: The evidence for the efficacy of periodontal plastic surgery (PPS) in the treatment of recession defects has not yet been systematically evaluated. The objective of this review was to systematically review the efficacy of PPS in achieving root coverage in the treatment of localized gingival recession. The following surgical procedures have been considered in this review: guided tissue regeneration (GTR), free gingival graft (FGG), connective tissue graft (CTG), and coronally advanced flap (CAF). METHODS: Randomized and controlled trials, as well as case series of at least 6 months' follow-up, were searched. Data sources included electronic databases and hand-searched journals. Screening, data abstraction and quality assessment were conducted independently and in duplicate. RESULTS: Regarding recession reduction, a limited but statistically significant greater benefit was found for CTG compared with GTR (weighted mean difference: 0.43 mm, 95% CI: 0.62-0.23). No differences were found comparing either GTR with CAF or resorbable versus non-resorbable GTR barriers. Gain in attachment was also similar for each of the three comparisons. Analysis of single arms of trials and case series demonstrated that PPS can have a marked improvement on clinical parameters but heterogeneity was often high and only partly explained by initial defect depth. CONCLUSIONS: Overall, PPS was effective in reducing gingival recessions with a concomitant improvement in attachment levels. Even though no single treatment can be considered superior to all the others, CTG was statistically significantly more effective than GTR in recession reduction. Further research is needed to identify the factors most associated with successful outcomes.