Soft-Tissue Augmentation around Dental Implants with a Connective Tissue Graft (CTG) and Xenogeneic Collagen Matrix (CMX)-5-Year Follow-Up.

Proper horizontal and vertical thickness of the gingival connective tissue has been proven to be one of the success criteria in dental implant and reconstructive surgery. When thin tissue is found, gingiva augmentation methods can be used to increase the quality and volume of the tissue. Many methods have been described, among them pedicle soft-tissue flaps or autogenic tissue grafts. As an alternative to patients' own tissue, xenogenic materials can be used for grafting. The fundamental issue is to choose a material that will ensure the maximum therapeutic effect, while also minimizing the negative influence on the patient's health. The aim of this study was to compare gingival augmentation procedures using a palatal connective tissue graft (CTG) and an xenogenic soft-tissue substitute, Geistlich Mucograft (xenogeneic collagen matrix; CMX), and assess whether the timing of the graft surgery influences the clinical outcomes. The original study was a randomized control trial with a total of 75 implants placed. The patients received the soft-tissue thickening 3 months before the implant placement or 3 months after the implant placement (depending on the group). A connective tissue graft (CTG) or Geistlich Mucograft were used (depending on the group). For both the CTG and Geistlich Mucograft, better clinical outcomes were observed for maintaining the alveolar bone level and the thickness of the attached gingiva compared to the control group with no gingival augmentation. The Geistlich Mucograft showed good clinical performance in comparison to the control. Soft-tissue augmentation with the CTG before the implant placement was found to be most efficient method in terms of a stable increase of the tissue thickness since, throughout the entire observation period, the greatest increase of 1.035 mm (SD = 0.73 mm) in thickness was observed. Statistically important differences in the tissue thickness baseline compared after 5 years were observed for groups G1 vs. G2b (no augmentation vs. CTG before), G1 vs. G3b (no augmentation vs. CTG after) and for groups G2b vs. G3a (CTG before vs. CMX after).

Soft tissue augmentation around dental implants with connective tissue graft (CTG) and xenogenic collagen matrix (XCM). 1-year randomized control trail.

BACKGROUND: The anatomy of soft tissues around dental implants is extremely important to prevent inflammatory periimplant diseases and ensure healthy, stable and long-term survival of a dental implant. Various methods and materials for increasing the physiological thickness of tissues have been described including connective tissue graft (CTG) and xenogenic collagen matrix (XCM). While assessing various materials it is necessary to establish objective measurement method to determine the minimum amount of tissue thickness to maintain a stable level of bone around the implant. The aim of the study was to determine the effect of soft tissues in the implant area on the marginal bone level in the implant area and to define of the critical gingival thickness to minimize marginal bone level (MBL) loss. METHODS: 75 bone level implants (Conelog® Camlog, Switzerland) were inserted in the aesthetic area. Thickening of soft tissues was performed using CTG and XCM. 12 months after the loading with final restoration, the thickness of soft tissues in the implant area was examined with ultrasound USG device (Pirop®, Echoson, Poland), and each implant was subjected to RVG examination, where MBL loss was determined. RESULTS: A tendency to occur less MBL loss was found when thicker gingiva was present. The higher soft tissue thickness was, the lower MBL loss has occurred. A critical value for tissue thickness was determined as TKT ≤ 2.88. CONCLUSIONS: In case of thin biotype soft tissue augmentation is required when value of tissue thickness in ultrasound measure is less than 2.88 mm.

An evaluation of superhydrophilic surfaces of dental implants - a systematic review and meta-analysis.

BACKGROUND: The characteristics of a dental implant surface have a decisive influence on the process of osseointegration. According to the current state of knowledge, surface modification can not only affect the morphology of cells, and in this way have a positive impact on osseointegration. METHODS: The objective of this study was to compare survival rates and marginal bone loss as well as assess the degree of stability of Straumann SLAactive® and Thomenn Incell® implants with a superhydrophilic surface. Authors present review of data published between 01.01.2008 and 12.31.2016 that was found in PubMed/MEDLINE internet database, An Internet search of databases produced a total of 1230 studies, 20 publications were finally selected for the present study based on the established selection and exclusion criteria. RESULTS: The statistical analysis was performed. A Cumulative Implant Survival Rate (CSR%) was 98.5%, Marginal bone loss (MBL) after 6 months was M = 0.60 mm and 0.6 5 mm after 12 months and secondary stability in a group Thommen implants M = 71.3 ISQ and M = 75.2 ISQ in group of Straumann. CONCLUSION: Despite certain differences in the values of the studied parameters, both of the systems, i.e. Thommen Inicell and Straumann SLActive, demonstrated a high survival rate, a high level of implant stability and low marginal bone loss.

Ultrasound assessment of soft tissue augmentation around implants in the aesthetic zone using a connective tissue graft and xenogeneic collagen matrix - 1-year randomised follow-up.

PURPOSE: A comparative, ultrasound evaluation of the thickness of keratinized mucosa (TKT) around implants one year after gingival augmentation (GA) by means of a connective tissue graft (CTG) and the xenogeneic collagen matrix (CMX). MATERIALS AND METHODS: A total of 75 bone level tapered implants (Conelog® Camlog) were inserted in 57 patients in the aesthetic area of both jaws. The patients were divided into 3 groups: control group I- without GA; group II- GA 3 months before implantation, and group III- GA 3 months after implantation. Groups II and III were divided into two subgroups depends on type of material used for GA: (a) CMX (Mucograft®, Geistlich Pharma AG) and (b) CTG. The patients underwent a clinical and ultrasound examination before, then after 3 and 12 months following GA respectively to evaluate TKT at two points using ultrasound equipment (Pirop®, Echoson). Point 1 was considered to be in the middle of the line connecting the cemento-enamel junction (CEJ) to the adjacent teeth, and point 2 on the mucogingival junction (MGJ). RESULTS: Three months after GA, the highest increase in gingival thickness was noted in group IIIb (point 1 - 0.95mm, 2 - 1.01mm). However, 12 months after GA the highest gingival thickness was observed in group IIb (point 1 - 1.76mm, 2 - 1.36m) and next IIIb (point 1 - 1.52mm, 2 - 1.15mm). CONCLUSIONS: Both CTG and Geistlich Mucograft® increased TKT, but higher values were noted using CTG augmentation before implantation. An ultrasonic device can be used as a non-invasive, reliable, and reproducible method for evaluating TKT.

Radiographic evaluation of bone density around immediately loaded implants.

Understanding the changes in bone density after insertion of dental implants and their relation to immediate loading is essential to achieving improvements in their survival rate. Histological investigations of the bone bed in humans are limited, which in turn hampers opportunities to deepen knowledge about the remodelling process around dental implants. The aim of the present study was to follow the change in bone density by measuring the grey values of cone beam computed tomography (CBCT) at different periods subsequent to implant insertion. The CBCTs of 20 individual immediately loaded implants were evaluated at three time points: prior to surgery, one month following, and six months after the operation. The grey values were measured at different regions around the implants. Reduction in the grey values was observed with respect to the reference values after one month and six months from implant insertion in the apical, middle, and cervical regions. No correlation was detected either between the change in grey values and drilling method or with the measured primary and secondary stabilities by Osstell ISQ instrument. Cone beam computed tomography can be used as a qualitative method to support clinical follow up and monitor the changes in bone density around implants in critical cases.

Influence of semipermanent cement application used in immediately loaded, implant-supported restorations on crestal bone resorption.

INTRODUCTION: The paper presents clinical-radiological research on the impact of the new semi-cement luting agent in the immediately loaded implant-supported restoration on alveolar ridge resorption. MATERIAL AND METHODS: 25 patients with a partially edentulous alveolar ridge in the anterior section of the maxilla or mandible were included in the study. The implants were inserted with the application of traditional burs or with a Piezosurgery device supplied by Mectron. Taking into account the method of implant bed preparation, the scientific material was divided into two groups. The implants were loaded immediately with single crown restorations cemented with the Implantlink semi cement application. The following indices were taken into consideration: pocket depth around implant calculated at four measuring points, marginal alveolar bone loss measured using radio-visiography, the 3-degree Wachtel scale of healing of the soft tissue. In addition, the presence and possible width or height of any recession around the implants was measured. The success of the implant treatment was assessed according to the Albrektsson success criteria. The research results were subjected to statistical analysis. RESULTS: The results of our study revealed no influence of the Implant-link semi cement on the crestal bone level, regardless of the bone bed preparation technique.

Immediate loading of an implant with fine threaded neck-bone resorption and clinical outcome of single tooth restorations in the maxilla.

One of the conditions for ensuring success in implant surgery with an immediate loading (IL) protocol is to achieve maximum primary stability (PS) through the use of dental implants with the appropriate design and surface and a properly prepared osseous bed. The aim of this study was to assess the stability, degree of osseointegration, and success rate after inserting an implant with IL in an osseous bed prepared with burs or an ultrasonic device. Twenty-five patients requiring single tooth replacement (tioLogic; Dentaurum, Ispringen, Germany) in the aesthetic zone were divided randomly into the test (K0) and control (K1) groups. The following factors were investigated: primary (PS-ISQ) and secondary (SS-ISQ) stability- implant stability quotient (ISQ value) by Ostell Mentor, initial width of the alveolar ridge, marginal bone loss (MBL), and buccal bone thickness. The effectiveness of the implant treatment 1 year after the surgery was 100% for group K0 and 93.3% for group K1. A significant correlation was observed between PS and MBL after 1 month. No statistically significant differences were noted between the groups with regard to MBL after 6 months (K0 0.5±0.4 mm vs. K1 0.8±1.3 mm), PS-ISQ (K0 70±4 vs. K1 71±4), and SS-ISQ (K0 70±2 vs. K1 72±3). The average ISQ value of 70±4 is sufficient to allow for IL. A high level of PS results in lower MBL.