Passive Root Coverage Through Creeping Attachment of the Gingiva Before and After Scaling and Root Planning Therapy in the Mandibular Anterior Teeth: A Clinical Study.

Introduction Root coverage is one of the most imperative procedures in periodontal therapy. The demands from patients for aesthetics and sensitivity are some of the complaints in root exposure cases. Creeping attachment is a passive apical migration of the marginal gingiva and can be proposed as a noteworthy root coverage technique. The purpose of this study was to evaluate the position of the marginal gingiva and quantify the creeping attachment before and after the scaling and root planning (SRP) procedure. Materials and methods The present study was based on a single-centre clinical trial in which 30 sites from 10 patients were selected. Patients with Miller's class I gingival recession were selected. The plaque index, gingival biotype, and gingival margin position were measured at baseline and then at 10 and 21 days after SRP. The gingival biotype was measured with an endodontic file with a stopper and a digital vernier calliper. The gingival margin position was measured from the incisal surface of the tooth to the marginal gingiva with the help of a University of North Carolina (UNC) 15 periodontal probe. After recording the clinical parameters, a thorough SRP was performed using an ultrasonic scaler and manual instruments. Results The results were compared clinically at baseline and after 10 days and 21 days postoperatively. Statistical analysis was conducted for pre-SRP and post-SRP findings using the IBM SPSS Statistics for Windows, Version 19 (Released 2010; IBM Corp., Armonk, New York) software. A statistically significant improvement was seen in all the clinical parameters at baseline, at 10 days, and at 21 days postoperatively after the procedure (P < 0.01). Conclusion The position of the gingival margin was shifted towards the crown, and the creeping attachment was significantly observed from baseline to 10 and 21 days. Clinical significance Creeping attachment after the SRP procedure can be considered a significant root coverage technique. The genetic memory of the gingiva may play an important role in achieving root coverage. Once local irritants are removed, the gingiva attempts to regain its original position. In addition, the gingival phenotype plays an important role in gingival marginal positioning after basic therapy and root coverage procedures.

Accurate gingival recession quantification using 3D digital dental models.

OBJECTIVES: To develop and validate a method for accurate quantitative assessment of gingival recessions based on superimposition of serial 3D digital models. MATERIALS AND METHODS: Gingival recessions of mild (0.5-2 mm) and increased (3-7 mm) severity were simulated on stone casts and surface models were created. The outlines of the gingival margins of the mild (A) and severe recessions (B) were compared to the original gingival margins following 3D best fit superimposition through a gold standard technique (GS), which used intact adjacent structures, and the tested method (CC), which used single tooth crowns at the position of recessions, as superimposition reference. The primary outcome was the distance between the most apical point of each corresponding gingival margin along the respective tooth long axis. RESULTS: For mild recessions, the median difference of the test methods (CC_A) from the reference method (GS_A) was 0.008 mm (IQR: 0.093; range: - 0.143, 0.147). For severe recessions, the median difference of the test method (CC_B) from the reference method (GS_B) was 0.009 mm (IQR: 0.091; range: - 0.170, 0.198). The proposed method (CC) showed very high intra- and inter-operator reproducibility (median: 0.025 and 0.033 mm, respectively). CONCLUSIONS: The suggested method offers highly accurate monitoring of gingival margin changes and diagnosis of gingival recessions using 3D digital dental models. The method is applicable irrespective of changes in tooth position or form, allowing for assessments over any time span. CLINICAL RELEVANCE: The accurate detection and visualization of gingival margin changes in 3D will enhance diagnosis and patient-doctor communication.

The Effect of Laser Micro Grooved Platform Switched Implants and Abutments on Early Crestal Bone Levels and Peri-Implant Soft Tissues Post 1 Year Loading among Diabetic Patients-A Controlled Clinical Trial.

Background and Objectives: The study aimed to compare the mean crestal bone level (CBL) and peri-implant soft tissue parameters in laser micro-grooved (LMG) platform switched implants and abutments (I&A) post 1 year of functional loading among non-diabetic and type II diabetic individuals. Materials and methods: Patients with an edentulous site having minimum bone height and width of ≥13 mm and ≥6 mm, respectively, were divided into two groups: (i) Non-diabetic-8 (control) and (ii) diabetic-8 (test). LMG Implants were placed and loaded immediately with a provisional prosthesis. Mean crestal bone level (MCBL) was evaluated radiographically at baseline and at 1 year. Peri-implant attachment level (PIAL) and relative position of the gingival margin (R-PGM) were recorded. Implant stability quotient (ISQ) level and implant survival rate (ISR) were evaluated at 1 year. Results: Early MCBL within the groups 1 year postloading was similar both mesially and distally (control-0.00 to 0.16 mm and 0.00 to 0.17 mm, respectively; test-0.00 to 0.21 mm and 0.00 to 0.22 mm, respectively) with statistical significance (p ≤ 0.003, p ≤ 0.001 and p ≤ 0.001, p ≤ 0.001, respectively). However, intergroup comparison showed no significant difference statistically in the MCBL in 1 year post functional loading. The peri-implant soft tissue parameters showed no significant difference between the groups. ISQ level between both groups did not reveal any significant changes (p ≤ 0.92), and ISR was 100%. Conclusions: LMG Implants resulted in minimal and comparable early crestal bone loss and soft tissue changes post 1 year of functional loading in moderately controlled diabetic and non-diabetic individuals, suggesting that this could be a reliable system for use in systemically compromised individuals.

A novel computer-aided method for direct measurements and visualization of gingival margin changes.

AIM: To introduce and validate a computer-aided method for direct measurements and visualization of gingival margin (GM) changes. MATERIALS AND METHODS: The method consists of five main steps: digital model acquisition, superimposition, computer-aided GM detection, distance calculation between the GM curves, and visualization. The precision of the method was evaluated with repeatability and reproducibility analysis (n = 78 teeth). The method's repeatability was evaluated by repeating the algorithm on the same digital models by two operators. The reproducibility was evaluated by repeating the algorithm on two consecutive digital models obtained with a scan-rescan process at the same time point on the same patient. For demonstration, the proposed method for direct measurements of GM changes was performed on patients who had undergone root coverage procedures and treatment of periodontal disease. RESULTS: Excellent repeatability was found for both intra- and inter-operator variability, that is, 0.00 mm, regarding computer-aided GM detection. The reproducibility of computer-aided GM detection evaluated on scan-rescan models was 0.10 mm. CONCLUSIONS: The presented method enables the evaluation of GM changes in a simple, precise, and comprehensive manner through non-invasive acquisition and superimposition of digital models.

Biological Response Induced in Primary Human Gingival Fibroblasts upon Exposure to Various Types of Injectable Astringent Retraction Agents.

Traditional chemo-mechanical retraction/displacement materials can impact the gingival margin tissues. This study was undertaken to analyze biological responses induced in human gingival fibroblasts (HGFs) upon application of injectable astringent-based agents used in the cordless retraction technique. HGFs were exposed to hemostatic agents (five gels, three pastes, and one foam) based on aluminium chloride, aluminium sulphate and ferric sulphate. Changes in cell viability and proliferation were evaluated using an MTT assay and a BrdU assay. The cytoskeleton structure organization (zyxin and F-actin) was visualized by confocal laser scanning microscopy. Oxidative stress was determined using the Griess Reagent System. The RNA expression levels of antioxidant enzymes were quantified by real-time RT-PCR. The statistical significance was evaluated using Student's t-test and one-way ANOVA with post-hoc Tukey HSD test. The evaluated agents did not downregulate fibroblast viability or proliferation. No significant cytoskeleton reorganization was observed. Only one agent (Expasyl) induced oxidative stress, demonstrated by the increased level of nitrites. Incubation with the studied agents significantly increased the RNA expression of some antioxidant enzymes (SOD1, SOD3, GPX1). However, no significant influence on the expression of SOD2 and HMOX1 was detected. The injectable forms of chemical retraction agents revealed biocompatibility with HGFs, suggesting their potential clinical usefulness in gingival margin retraction.

Comparison of subgingival and gingival margin plaque microbiota from dogs with healthy gingiva and early periodontal disease.

The purpose of the investigation was to determine whether canine gingival margin (GM) plaque is a reliable surrogate for subgingival (SG) plaque from a microbial community (microbiota) perspective. SG and GM plaque samples were collected from 381 dogs visiting pet hospitals in the USA, China and Thailand. Dogs with clinically healthy gingivae through to early periodontitis were included in the study. The samples were subject to next generation Illumina sequence analysis to allow microbiota comparisons to be made between the two plaque sources. Overall, the SG and GM samples indicated commonality via the majority community that were shared between them; health associations led to the identification of some significant taxa-specific differences. GM microbiota exhibited lower variability and diversity and were shown to reflect a sub-population of those associated with SG plaque. Both plaque niches, however, demonstrated similar changes in microbial signatures with health and early periodontal disease and did not indicate divergent trends. The key, most abundant microbiota of GM plaque strongly reflect those observed with SG plaque across health and early periodontitis. Microbiota in plaque from above the gum line may therefore be employed as a biomarker of oral health. This opens up the potential to use plaque, sampled from conscious dogs, to define oral health status and improve the diagnosis, treatments and interventions for periodontal disease.

The Gingiva of Horses With Pituitary Pars Intermedia Dysfunction: A Macroscopic Anatomical Evaluation.

Pituitary pars intermedia dysfunction (PPID) is a common neurodegenerative disease mainly in horses older than 15 years. The domestic equine population is following the same demographic change as that seen in humans; it is aging and veterinarians are asked to attend to geriatric horses more frequently. Common problems seen regularly in older equines are dental disorders and especially periodontal disease. As a systemic and endocrine disease, associated with delayed wound healing and impaired immune function, PPID should be considered before major dental treatment in aged equines is started. Possible negative effects of PPID on epithelial tissues could also affect the periodontium. Therefore, the aim of the present study was to identify gross changes in the gingiva associated with PPID. Fourteen horses with clinical signs of PPID and adenoma in the pituitary pars intermedia and 13 controls showing neither clinical signs nor PPID-associated histological changes in the pituitary gland were included. PPID-affected horses (26.9 ± 0.73 years) were significantly older than controls (20.0 ± 1.24 years). In the PPID-affected group, significantly more often an irregular and bulky appearance of the gingival texture was observed, as well as an irregular shape of the gingival margin. Furthermore, the sulcus gingivalis of cheek teeth frequently was deeper than 1 mm. These findings indicate a possible association between age, soft tissue alterations, and PPID and suggest a potential predisposition of PPID-affected horses for periodontal diseases.

The Influence of Varying Gingival Display of Maxillary Anterior Teeth on the Perceptions of Smile Aesthetics.

OBJECTIVES: The aim of the study was to investigate the influence of gingival display on perceived smile aesthetics and to compare aesthetic gingival display preference amongst dental professionals and lay people. METHODS: This cross-sectional study was based on the analysis of quantitative data collected via questionnaires. Two sets of digitally altered smile images with variations of gingival amount and architecture displays were produced. Ranking order scale was used to record aesthetic preferences, from the most attractive to the least attractive. RESULTS: There were 124 respondents (60 lay people, 32 general dentists [GDPs] and 32 orthodontists). Average smile line, tangent to the zeniths of maxillary anterior teeth, was found to be the most attractive gingival amount (53.2%, χ2 = 144.15, p < 0.045) amongst lay people, GDPs and orthodontists. High smile line was ranked as the least attractive amount amongst all respondents (88.7%, χ2 = 359.37 p < 0.002). Class III gingival outline, where all gingival levels are symmetrical and in line, was found as the most attractive gingival architecture (65.3%, χ2 = 10.87 p < 0.001). CONCLUSION: No particular amount of gingival display is universally perceived as attractive although high smile lines are generally disliked. Class III gingival architecture is the most preferred gingival archetype when excessive amount of maxillary gingiva is exposed. CLINICAL SIGNIFICANCE: A general acceptance to smile line variations demonstrates that the harmony amongst all smile components is more important than merely focusing on a single ideal smile constituent. However, when designing the smile with an inherent high lip line, a Class III gingival architecture might be more preferable since it reduces the negative impact of excessive gingival display.

Effect of cervical margin relocation technique with composite resin on the marginal integrity of a ceramic onlay: a case report.

Treatment of a large proximal carious lesion that extends below the cementoenamel junction is challenging. Large defects usually require replacement with indirect restorations (inlays, onlays, or crowns). However, when the gingival cavity margins are deep, procedures such as isolation of the operative field, proper cavity preparation, successful impression-making, and adhesive luting may be hindered unless soft gingival or hard bony tissues are removed to expose the cavity margin. The present case report describes the clinical application of a conservative cervical margin relocation technique for treating deep cavity margins. A patient presented with large distal carious lesions and necrotic pulps in both the maxillary and mandibular right first molars, which were diagnosed with symptomatic apical periodontitis. After root canal treatment of both teeth, the maxillary molar underwent a crown-lengthening surgical procedure and subsequent placement of a zirconia crown. In the mandibular molar, the cervical margin was relocated by placing a composite resin base at the proximal gingival cavity margins under meticulous isolation of the operative field. The tooth was restored with a composite core build-up and bonded ceramic onlay. The satisfactory outcome suggested a promising prognosis for the oral health of the patient.

In vitro effects of vasoconstrictive retraction agents on primary human gingival fibroblasts.

The biological activity of chemical retraction/displacement agents in surrounding periodontal tissues is of unquestionable importance, but the activity of these agents has not been completely elucidated. In the present study, we aimed to evaluate the in vitro effects of vasoconstrictive retraction agents on primary human gingival fibroblasts (HGFs). A total of six commercial adrenergic solutions (0.05 and 0.01% HCl-epinephrine, two based on 0.05% HCl-tetrahydrozoline, 0.05% HCl-oxymetazoline, and 10% HCl-phenylephrine) and three experimental gel formulations (EG-1, EG-2, and EG-3) were used to treat primary HGFs. The biological effect of the retraction treatment on the expression of collagen types I and III was detected by performing immunocytochemical analysis. The generation of reactive oxygen species triggered by the retraction agents were evaluated by using the dichlorofluorescein (DCF) fluorescent probe. The effect of retraction agents on the expression of fibronectin was visualized by confocal laser scanning microscopy. According to the results, experimental retraction gels did not limit the expression of collagen types I and III. EG-3 even induced the synthesis of both types of collagen. The DCF assay indicated oxidative stress similar to the control cells for most of the selected retraction agents. Experimental gels did not cause degradation of the cellular shape and morphology of the primary HGFs. The proposed experimental retraction gels in the present study demonstrated higher biocompatibility with primary HGFs, suggesting their use as clinical vasoconstrictive agents for the application of gingival retraction with minimal damage to periodontal tissues.

The Equine Gingiva: A Gross Anatomical Evaluation.

Equine periodontal disease (ePD) usually starts with food impaction, formation of diastemata, gingival inflammation and formation of periodontal pockets. This process proceeds toward the dentoalveolar space, causing detachment of tooth supporting periodontal fibers. Although several therapeutical procedures have been proposed, ePD is often only diagnosed in advanced stages, requiring dental extraction. A similar dilemma has been observed in small animal medicine, but has been overcome by the introduction of reliable examination protocols for the early diagnosis of periodontal diseases (PD). These protocols are based on detailed anatomical descriptions of healthy gingiva, allowing for the determination of the pathognomonic signs of the onset of PD and providing a basis for grading systems and treatment plans. Consequently, proposals have also been made for periodontal examination protocols in horses. However, these protocols were widely adopted from small animal medicine assuming a similar anatomy of the equine and canine gingiva. To provide a solid anatomical basis for equine specific periodontal examinations, 20 equine heads were examined macroscopically, with special attention to the gingival sulcus, the gingival margin and the interdental papillae. Constant morphological patterns of the gingival margin and the interdental papillae were found for the vestibular and lingual/palatal aspects of the upper and lower cheek teeth arcades, as well as for the incisor arcades. A gingival sulcus measuring greater than 1 mm was present in only 6% of the investigated specimens. The inspection of the gingival margin and the interdental papillae, as well as the recognition of a gingival sulcus, may serve as criteria to establish equine specific periodontal investigation protocols.

Update on Perio-Prosthodontics.

Knowledge of the periodontal-restorative interface is critical in the fabrication of restorations that are functional and esthetic. Understanding biological principles allows the clinician to predict how the periodontium will respond to restorative therapy. Factors that influence the response to therapy in the periodontal-restorative interface are periodontal biotype, gingival architecture, alveolar crest position, gingival margin position, and gingival zenith.

Management of Cervically Fractured Central Incisors: A Multidisciplinary Approach.

INTRODUCTION: Fracture of tooth structure at or below the gingival margin compromises rehabilitation and hampers esthetics and function. MANAGEMENT: Management of such cases by a post-core and crown restoration, or periodontal surgery or orthodontic extrusion alone may not always suffice in attaining a good result. CASE REPORT: A multi-disciplinary approach which includes all of the above mentioned procedures helps in long term success. CONCLUSION: Careful case evaluation, treatment planning and meticulous attention to detail are the keys to the best treatment outcome.

The Setting Time of Polyether Impression Materials after Contact with Conventional and Experimental Gingival Margin Displacement Agents.

PURPOSE: The compatibility of chemical gingival margin displacement agents with polyether impression materials has not been determined. The aim of this study was to evaluate the setting time of polyether impression elastomers after contact with conventional and experimental gingival displacement agents. MATERIALS AND METHODS: The study compared the setting time of two polyether impression materials: medium body (Impregum Penta Soft) and light body (Impregum Garant L DuoSoft) after contact with 10 gingival displacement agents, including 5 conventional astringents (10%, 20%, and 25% aluminum chloride, 25% aluminum sulfate, and 15.5% ferric sulfate) and 5 experimental adrenergics (0.1% and 0.01% HCl-epinephrine, 0.05% HCl-tetrahydrozoline, 0.05% HCl-oxymetazoline, and 10% HCl-phenylephrine). As many as 120 specimens (60 light body and 60 medium body) were mixed with 20 µl of each of 10 gingival displacement agents, and the time to achieve maximum viscosity was measured with a viscometer. The setting times of these specimens were compared with the control group of 12 specimens, which were polymerized without contact with the displacement agents. The experiments were performed in two environments: 23°C and 37°C (± 0.1°C). Individual and average polymerization time compatibility indices (PTCI) were calculated. Data were analyzed by 2-way ANOVA (α = 0.05). RESULTS: The evaluated chemical displacement agents from both groups changed the setting time of light- and medium-body PE. The negative individual PTCI values achieved astringent (20% aluminum chloride) with two PE in both temperature environments. The average PTCI values of the experimental displacement agents at laboratory and intraoral temperatures were significantly higher than the conventional agents. CONCLUSIONS: The present findings suggest that experimental retraction agents can be recommended clinically as gingival margin displacement agents with minimal effects on the setting time of medium- and light-body polyether impression materials; however, direct contact of chemical displacement agents and polyether impression materials can be avoided.

Regenerative capacity of allogenic gingival margin- derived stem cells with fibrin glue on albino rats' partially dissected submandibular salivary glands.

OBJECTIVE: To evaluate the possible regenerative effect of allogenic gingival margin-derived stem cells (GMSCs) with or without autologous fibrin glue on partially dissected submandibular salivary glands of albino rats. METHODS: Forty rats were randomly divided into four equal groups. Group I, where no operation was performed, was considered the negative control. Group II rats were considered the positive control and were subjected to a rectangular cut on the outer surface of the center right of the submandibular salivary gland and received no other treatment. Groups III and IV rats were handled as those in group II, but the cut areas of group III were filled with fibrin glue and the cut borders of group IV were injected with 1×105cell/ml GMSCs and then glued with fibrin glue. Five animals from each group were euthanized at the end of the first postoperative week, while the remaining animals were euthanized at the end of the second postoperative week, i.e., end of the experiment. RESULTS: Regeneration of ductal, acinar, and myoepithelial cells was better in group IV. A two-way ANOVA for proliferating cell nuclear antigen and α-smooth muscle actin revealed an overall significant difference between the different groups (P<0.05). In addition, an LSD post hoc test for multiple comparisons revealed a significant difference between each two groups. An independent sample t-test revealed significant differences between time periods for groups II, III, and IV, but there were no significant differences between the time periods for group I. CONCLUSION: Injecting GMSCs at the cut borders and gluing the cut area with autologous fibrin glue ameliorates the regeneration of partially dissected submandibular salivary gland better than using fibrin glue alone.

Chemical Retraction Agents - in vivo and in vitro Studies into their Physico-Chemical Properties, Biocompatibility with Gingival Margin Tissues and Compatibility with Elastomer Impression Materials.

Gingival margin retraction/displacement (GMR/D) is a commonly accepted procedure in restorative dentistry. Of the various retraction methods, the chemo-mechanical approach with retraction media and chemical retraction agents (ChRAs) is mostly used. Different local and/or systemic side effects were observed after "chemical attacks" from these retraction agents. Moreover, no consensus exists as to the compatibility of chemical agents with different impression materials. This paper reports the findings of in vivo and in vitro studies and we discuss the physico-chemical properties of chemical retraction agents, their undesirable clinical side effects, biological activity and compatibility with selected groups of elastomer impression materials.

The esthetic prosthodontic treatments in maxillary anterior area, considering the gingival margin / 대한치과보철학회지

To enhance the esthetic appearance, the maxillary anterior area is important. It is possible to improve the esthetic appearance through the treatment of maxillary anterior area, which includes altering the color, form, and arrangement of teeth. When planning these treatments, clinicians should individualize personal demands, by using the information obtained from facial, dento-labial, dental, and gingival analysis. It is essential to properly prepare the gingival structure, which includes the height of gingival margin, the location of zenith, reconstruction of the interdental papillae, emergence profile, and symmetry. Clinicians often face unfavorable condition of the gingiva and the edentulous ridge, and appropriate management of the gingival structure is needed. In this case report, the patients were treated to improve the gingival conditions surrounding maxillary anterior teeth. By using conservative treatment without surgical intervention, such as application of pink porcelain, subgingival contour modelling and modification of pontic base, satisfactory esthetic results were gained.

A 12 Months Clinical and Radiographic Study to Assess the Efficacy of Open Flap Debridement and Subepithelial Connective Tissue Graft in Management of Supracrestal Defects.

BACKGROUND: An improvement in clinical parameters along with regeneration is the desired outcome of periodontal therapy. The aim of this study was to analyze and contrast the efficaciousness of combined open flap debridement (OFD) and subepithelial connective tissue graft (SECTG) to OFD in the management of periodontal supracrestal defects. MATERIALS AND METHODS: Totally, 20 paired sites exhibiting supracrestal defects were subjected to surgical treatment adopting the split mouth design. The defects were divided randomly for treatment with OFD and SECTG (test) or OFD alone (control). The clinical effectiveness of the two arms of treatment was evaluated at 6 months and 12 months post-operatively by assessing clinical and radiographic parameters. The measurements carried out included probing pocket depth (PPD), relative attachment level (RAL), gingival marginal level, radiographic bone level (BL). RESULTS: The mean reduction in PPD at 0-12 months was 3.20 ± 0.82 mm and RAL gain of 3.10 ± 1.51 mm was observed, the OFD and SECTG (test) group; corresponding observations for OFD (control) were 2.10 ± 0.63 mm and 1.90 ± 0.57 mm. However, BL changes did not follow the pattern of clinical improvement on the radiographic assessment of either treatment group. Post-operative evaluation was made. Improvement in different clinical parameters was statistically significant (P < 0.01). CONCLUSION: Treatment of supracrestal defects with a combination of OFD and SECTG led to significantly better clinical results compared to OFD alone.

The gingival Stillman's clefts: histopathology and cellular characteristics.

AIM OF THE STUDY: Stillman's cleft is a mucogingival triangular-shaped defect on the buccal surface of a root with unknown etiology and pathogenesis. The aim of this study is to examine the Stillman's cleft obtained from excision during root coverage surgical procedures at an histopathological level. MATERIALS AND METHOD: Harvesting of cleft was obtained from two periodontally healthy patients with a scalpel and a bevel incision and then placed in a test tube with buffered solution to be processed for light microscopy. RESULTS: Microscopic analysis has shown that Stillman's cleft presented a lichenoid hand-like inflammatory infiltration, while in the periodontal patient an inflammatory fibrous hyperplasia was identified. CONCLUSION: Stillman's cleft remains to be investigated as for the possible causes of such lesion of the gingival margin, although an inflammatory response seems to be evident and active from a strictly histopathological standpoint.

Fresh-Socket Implants of Different Collar Length: Clinical Evaluation in the Aesthetic Zone.

BACKGROUND: The aim of this clinical study was to compare clinical evaluations of implants in the aesthetic zone with smooth collars of different length. MATERIALS AND METHODS: Sixty-six patients requiring extractions of one, two, or three teeth in the aesthetic zone of the maxilla were enrolled in this study. Ninety-four implants were positioned and were loaded immediately after tooth extraction. Forty-seven implants with a short smooth collar of 0.5 mm (SCI) and 47 implants with a long smooth collar of 1.8 mm (LCI) were utilized in this study and were placed using a nonsubmerged approach. Clinical (gingival index, modified plaque index, modified bleeding index, probing depth, gingival recession) and intraoral digital radiographic parameters were measured at baseline and after 6, 12, 24, and 36 months of healing to evaluate crestal bone loss levels over time. RESULTS: After a follow-up period of 36 months, a survival rate of 100% was reported. The SCI group showed a mean bone loss of 1.07 ± 0.38 mm at 12 months and 1.09 ± 0.38 mm at 36 months. The LCI group showed a mean bone loss of 0.46 ± 0.14 mm at 12 months and 0.53 ± 0.12 mm at 36 months. After the 36-month follow-up period, both groups showed stable bone levels over time. Statistically significant differences were found between groups (p < .05). No statistically significant differences were found between SCI and LCI groups with regard to clinical parameters over time. CONCLUSIONS: This study revealed significant differences in radiographically observed marginal bone loss between the two types of implant with different smooth-collar lengths, but no differences in gingival vestibular margin outcome were observed.