Comparison of Bone-Level and Tissue-Level Implants: A Pilot Study with a Histologic Analysis and a 4-Year Follow-up.

This study clinically and histologically evaluated the performance of implants with different crestal morphologies: tissue-level implants and bone-level implants. Nine patients received at least two adjacent implants in an edentulous area: one bone-level implant (EO) and one tissue-level implant (TG) (total: 23 implants), placed beside each other using a single-stage delayed loading protocol. The implants were rehabilitated with screw-retained fixed partial dentures. Plaque Index (PI), bleeding on probing (BOP), probing depth (PD), and peri-implant bone level were recorded at various postsurgical follow-ups, including 2 and 6 months as well as 1 and 4 years. At 3 months postsurgery, soft tissue biopsy samples were taken from all implant sites and histologically analyzed. Longitudinal assessment of the results (TG vs EO implants) was performed using a linear mixed model with random intercept and by using Spearman correlation or chi-square after visual inspection of the probability distribution. Student t test was used to compare means, and chi-square test was used for dichotomic variables. P < .05 was considered statistically significant. All implants were functional at 4 years. Peri-implant bone resorption was limited, with means of 1.20 ± 0.71 mm and 1.24 ± 0.82 mm for TG and EO implants, respectively. No significant differences in clinical parameters were identified between EO and TG implants. Histologic analysis revealed normal peri-implant soft tissue healing with poor inflammatory infiltrate. Differences in the histologic appearance of soft tissues were more related to patients than implant type. Both implants appeared to be suitable for partial rehabilitation of edentulous arches without differences in the investigated clinical and histologic parameters. However, TG implants showed a greater risk of implant collar exposure.

MicroRNA in Implant Dentistry: From Basic Science to Clinical Application.

Specific microRNA (miRNA) expression profiles have been reported to be predictive of specific clinical outcomes of dental implants and might be used as biomarkers in implant dentistry with diagnostic and prognostic purposes. The aim of the present narrative review was to summarize current knowledge regarding the use of miRNAs in implant dentistry. The authors attempted to identify all available evidence on the topic and critically appraise it in order to lay the foundation for the development of further research oriented towards the clinical application of miRNAs in implant dentistry.

Angled implant brush for hygienic maintenance of full-arch fixed-implant rehabilitations: a pilot study.

PURPOSE: This pilot study was conducted to evaluate the cleaning efficacy of an angled implant brush for home oral hygiene of full-arch fixed-implant prostheses. METHODS: Forty-one patients treated with a full-arch implant rehabilitation in the maxilla or mandible (164 implants) for at least 4 months were enrolled. The screw-retained fixed prostheses were removed and baseline (T0) parameters were recorded, including plaque index (PI), probing depth (PD), and bleeding on probing (BOP). All patients completed a 5-item questionnaire on hygiene maintenance and received an implant brush for home hygiene. After 1 month (T1) PI, PD, and BOP were recorded again and patients completed a 7-item questionnaire to evaluate their satisfaction with the implant brush. One-way repeated-measures analysis of variance was conducted to evaluate the significance of changes in PI, PD, and BOP. A P value <0.05 was considered to indicate statistical significance. RESULTS: A statistically significant reduction of BOP (0.62±0.6 at T0 vs. 0.5±0.5 at T1; P=0.032) was found, while no statistically significant changes in PD (1.74±0.5 mm at T0 vs. 1.77±0.5 mm at T1; P=0.050) or PI (1.9±0.7 at T0 vs. 1.7±0.7 at T1; P=0.280) occurred. According to the 7-item questionnaire, patients reported no difficulty in using the angled brush (63.4%) and deemed it highly (46.3%) or very highly (4.8%) effective in improving their home oral hygiene. CONCLUSIONS: Within the limits of the present pilot study, the patients experienced a reduction of BOP 1 month after being instructed to use the angled implant brush. The angled implant brush appeared to be a well-accepted device for home-care hygiene of full-arch fixed-implant rehabilitations.

Oral Health-Related Quality of Life and Full-Arch Immediate Loading Rehabilitation: An Evaluation of Preoperative, Intermediate, and Posttreatment Assessments of Patients Using a Modification of the OHIP Questionnaire.

The aim of this study was to assess oral health-related quality of life (OHRQoL) of patients before, during, and after completion of implant-supported full-arch immediate loading rehabilitation according to the Columbus Bridge Protocol. Twenty-five patients with compromised dentition were rehabilitated according to the Columbus Bridge Protocol and were assessed for OHRQoL using 4 questionnaires specifically designed for this study and inspired by the Oral Health Impact Profile questionnaire. Patients assessed themselves before surgery, during the healing period (1 week and 2 months after surgery), and after definitive prosthodontic treatment (4 months after surgery). The questionnaires specifically investigated patients' pain, comfort, home oral hygiene habits, satisfaction related to esthetics, masticatory ability, phonetics and general satisfaction with the treatment. Patients reported an improvement of OHRQoL after full-arch immediate-loading rehabilitation. A statistically significant improvement in esthetics and chewing ability was found. After 4 months 92% of the patients did not feel tense about their smile, 96% did not indicate problems relating to other people or smiling, and 92% did not have difficulty eating some foods. Phonetics were a critical issue, especially in the intermediate phase of healing. One week after surgery, the percentage of patients who were very satisfied with phonetics slightly decreased from 48% to 36%. The assessment of patients' OHRQoL related to full-arch immediate-loading implant therapy exhibited a significant improvement in quality of life. The questionnaires herein presented could be an effective tool to evaluate patients' reaction to oral rehabilitation.

Comparison of biofilm removal using glycine air polishing versus sodium bicarbonate air polishing or hand instrumentation on full-arch fixed implant rehabilitations: a split-mouth study.

OBJECTIVES: To compare the cleaning efficacy of glycine air polishing against two different professional oral hygiene techniques on implants supporting full-arch fixed prostheses. METHOD AND MATERIALS: Thirty patients with a total of 32 implant fixed full-arch rehabilitations in the maxilla and/or mandible (134 implants) were included. After the removal of the screw-retained prostheses, baseline peri-implant spontaneous bleeding (SB), Plaque Index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded (T0). Three oral hygiene treatments were assigned randomly following a split-mouth method: all the patients received glycine air polishing (G) in one side of the arch (n = 32), and sodium bicarbonate air polishing (B) (n = 16) or manual scaling with carbon-fiber curette (C) (n = 16) was performed in the opposite side. After the hygiene procedures, PI and SB were recorded and patient's comfort degree towards the three techniques was analyzed by questionnaires using a rating scale from 1 to 5 (T1). RESULTS: PI reduction was significantly higher for G (T0, 2.88 ± 1.37; T1, 0.04 ± 0.21) and B (T0, 3.13 ± 1.34; T1, 0.0 ± 0.0) as compared with C (T0, 2.15 ± 1.46; T1, 0.44 ± 0.7) (P < .001). B reported the highest mean value of SB (T0, 0.0 ± 0.0; T1, 3.42 ± 0.75) compared with G (T0, 0.05 ± 0.21; T1, 1.60 ± 1.05) and C (T0, 0.07 ± 0.24; T1, 0.73 ± 0.91) (P < .001). A significant difference in comfort mean score was found between G (4.8 ± 0.5) and B (3.5 ± 1.7) (P = .014), no difference between G and C (4.7 ± 0.7) (P = .38). CONCLUSION: Professional oral hygiene on implants using glycine air polishing showed high levels of both cleaning efficacy and patients' acceptance.

A Luting Technique for Passive Fit of Implant-Supported Fixed Dentures.

Several factors contribute to distortion of implant prostheses during fabrication and could prevent passive, accurate adaptation between implants and implant frameworks. The misfit between implants and restorative components may be significant and possibly lead to biologic or mechanical complications. The aim of this article is to describe a laboratory luting technique used to lute implant cylinders to metal frameworks in implant prostheses. This technique provides accurate, passive fits. According to this technique, titanium implant cylinders provided with corresponding external castable cylinders are used. Implant cylinders are screwed into the analogs in the master cast while the castable cylinders on top are splinted together using castable resin to realize a castable resin pattern. After casting, the framework is adjusted and cemented to the titanium cylinders on the master cast. Due to its ease and quickness of use and clinical efficiencies, this technique is deemed particularly useful in immediate loading rehabilitations.

Influence of Different Surface Characteristics on Peri-implant Tissue Behavior: A Six-Year Prospective Report.

PURPOSE: The aim of this study was to evaluate the behavior of hard and soft tissue around implants with different surface treatments. MATERIALS AND METHODS: Eight patients were identified for this study. Each patient received at least 2 implants (1 control, 1 test) into an edentulous quadrant, for a total of 10 pairs of implants. Two types of implants were used: hybrid implants (control) with a dual acid-etched surface in their apical portion and a machined coronal part, and test implants with an acid-etched surface throughout their entire length. Standardized periapical radiographs were taken at baseline, 3 months, 6 months, and 1 year post implant placement and then annually until the 6-year follow-up. Bleeding on probing (BOP) and Plaque Index (PI) were recorded annually. Probing depth (PD) was recorded at the 6-year follow-up. RESULTS: Moderate crestal bone remodeling was observed during the 1-year postimplant placement evaluation (P=.001), and test implants revealed smaller marginal bone resorption (P=.030). No significant changes in bone level were observed between the 1-year and the 6-year follow-up appointments, and a significantly smaller bone resorption was found at test implants. No statistically significant differences in bone resorption were found between maxilla and mandible. No statistically significant differences were detected between test and control implants for BOP, PI, or PD. CONCLUSIONS: The preliminary results suggest that implant surface characteristics might affect the bone remodeling phase subsequent to the surgical trauma. However, once osseointegration was established, implant surfaces did not affect bone maintenance over time. Implant surfaces did not affect soft tissue behavior. The results of this pilot study need to be confirmed in a study with a larger sample size and over a longer time frame.

Morphological and chemical characteristics of different titanium surfaces treated by bicarbonate and glycine powder air abrasive systems.

OBJECTIVES: This in vitro study investigated possible morphological and chemical changes induced by glycine or sodium bicarbonate powder air polishing on machined and acid-etched titanium surfaces. MATERIALS AND METHODS: The glycine powder (granulometry <65 µm) and sodium bicarbonate powder (granulometry <150 µm) were applied on 2 machined healing abutments and on 2 acid-etched healing abutments. The samples were characterized by scanning electron microscopy coupled with energy dispersive x-ray spectroscopy. The analyses were performed at different steps: (1) as received, right after opening the abutment packaging; (2) after 20 minutes air exposure; (3) after aging in artificial saliva; (4) after glycine or sodium bicarbonate powder air polishing for 5 seconds; (5) after repetition of steps 3 and 4 with longer time of polishing (20 seconds). CONCLUSIONS: Air polishing using glycine and sodium bicarbonate powder seemed to be safe for professional oral hygiene of titanium dental implants, although acid-etched abutments and abutments treated with bicarbonate harbored more salts. This might indicate a greater plaque accumulation in a clinical situation. However, this result has to be investigated in vivo to understand its clinical relevance.