The influence of connective tissue grafting on the reconstruction of a missing facial bone wall using immediate implant placement and simultaneous bone reconstruction: a retrospective long-term cohort study.

PURPOSE: This retrospective cohort study evaluates the influence of connective tissue grafts (CTG) on bone regeneration at implant sites with total loss of the buccal bone wall treated with flapless immediate implant placement (IIP) and reconstruction with autogenous bone chips (AB) within a follow-up of up to 13 years. METHODS: Sixty implants were inserted in 55 patients in sites with total loss of the buccal bone wall between 2008 and 2021. The implants were inserted and the buccal gaps were grafted by AB. A subgroup of 34 sites was grafted additionally with CTG using tunnel technique. Primary outcome was the vertical bone regeneration in height and thickness. Secondary outcome parameters were interproximal marginal bone level, recession, soft tissue esthetics (PES), width of keratinized mucosa (KMW) and probing depths (PPD). RESULTS: Mean follow-up period was 60.8 months. In 55 sites a complete vertical bone regeneration was documented. The mean buccal bone level increased by 10.6 mm significantly. The thickness of the buccal bone wall ranged between 1.7 and 1.9 mm, and was significantly thicker in sites without CTG. Interproximal marginal bone level was at implant shoulder level. The mean recession improved significantly by 1.2 mm. In sites with CTG, recessions and PES improved significantly more. CONCLUSIONS: Additional CTG in extraction sites with total buccal bone loss followed by IIP with simultaneous AB grafting led to improved PES and recession, but also to a thinner buccal bone wall compared to sites grafted just with AB.

Biomechanical analysis of the human derived soft tissue graft Epiflex for use in oral soft tissue augmentation.

PURPOSE: This study aimed to investigate the biomechanical properties, cell migration, and revascularization of the acellular dermal matrix Epiflex. As a decellularized, freeze-dried human skin graft, Epiflex has broad applications in medical fields, particularly in implantology and dentistry. Understanding its biomechanical characteristics is crucial for its clinical adoption as a novel soft tissue graft option. METHODS: Epiflex (n = 3) was evaluated in comparison to palatal tissue from body donors (n = 3). Key metrics, such as elongation and tear resistance, were quantified. Both graft types underwent histological analysis and scanning electron microscopy. Additionally, the healing properties of Epiflex were assessed using a Chorioallantoic Membrane (CAM) Assay. RESULTS: Biomechanically, Epiflex (mean = 116.01 N) demonstrated the ability to withstand greater forces (p = 0.013) than human palatal tissue (mean = 12.58 N). When comparing the elongation, no significant difference was measured (ASG mean = 9.93 mm, EF mean = 9.7 mm). Histologically, Epiflex exhibited a loosely connected network of collagen fibers with a dense upper layer. The CAM Assay indicated efficient revascularization. CONCLUSION: Epiflex appears to be a viable option for soft tissue augmentation, particularly appealing to patient groups who avoid all or specific animal-derived products due to ethical or religious reasons.

Bone regeneration as treatment of peri-implant disease: A narrative review.

INTRODUCTION: Analysis of the 3-dimensional implant position, the bone defect morphology, and the soft tissue situation guides the decision to preserve or to remove an implant with a severe peri-implantitis lesion. The aim of this narrative review was to analyze and to comprehensively illustrate the treatment options focusing on peri-implant bone regeneration in presence of severe peri-implant bone loss. METHODS: A database search was performed independently by the two reviewers to identify case reports, case series, cohort, retrospective, and prospective studies about peri-implant bone regeneration with a follow-up of at least 6 months. Of the 344 studies issued during the database analysis, 96 publications were selected by the authors for this review. RESULTS: Deproteinized bovine bone mineral remains the best documented material for defect regeneration in peri-implantitis in combination with or without a barrier membrane. While studies using autogenous bone in peri-implantitis therapy are rarely found, they do report favorable potential of vertical bone regeneration. Moreover, while membranes are an inherent part of the guided bone regeneration, a 5-year follow-up study demonstrated clinical and radiographic improvements with and without a membrane. The administration of systemic antibiotics is frequently performed in clinical studies observing regenerative surgical peri-implantitis therapy, but the analysis of the literature does not support a positive effect of this medication. Most studies for regenerative peri-implantitis surgery recommend the removal of the prosthetic rehabilitation and the use a marginal incision with a full-thickness access flap elevation. This allows for a good overview for regenerative procedures with a certain risk of wound dehiscences and incomplete regeneration. An alternative approach referring to the poncho technique may reduce the risk of dehiscence. The effectiveness of implant surface decontamination might have an impact on peri-implant bone regeneration without any clinical superiority of a certain technique. CONCLUSION: The available literature reveals that the success of peri-implantitis therapy is limited to the reduction of bleeding on probing, the improvement of the peri-implant probing depth and a small amount of vertical defect fill. On this basis, no specific recommendations for bone regeneration in surgical peri-implantitis therapy can be made. Innovative approaches for flap design, surface decontamination, bone defect grafting material, and soft tissue augmentation should be followed closely to find advanced techniques for favorable peri-implant bone augmentation.

Hard and soft tissue regeneration of severe peri-implantitis defects with the laser-assisted peri-implant defect regeneration technique: 3-year results.

PURPOSE: This retrospective cohort study evaluates the regeneration of severe peri-implantitis deficiencies treated with the laser-assisted peri-implant defect regeneration (LAPIDER) approach within a 3-year follow-up. METHODS: Twenty-four implants with severe peri-implantitis in 18 patients were treated according to the LAPIDER technique. In contrast to classic techniques for reconstructive peri-implantitis surgery with a marginal incision, a buccal split-flap preparation avoiding papillae separation was used. After a coronal flap elevation and a laser-assisted peri-implant defect cleaning, connective tissue and autogenous bone grafting was performed. Primary outcomes were the changes of the marginal bone levels (MBL) and the buccal bone thickness. Secondary outcomes included implant survival, peri-implant probing depths (PPD), bleeding on probing (BOP), recession, width of keratinized mucosa (KMW), thickness of keratinized mucosa (KMT), soft tissue esthetics (PES), and implant success. RESULTS: MBL improved interproximal by 3.10 ± 2.02 mm (p < 0.001), buccal by 3.49 ± 2.89 mm (p < 0.001), and lingual by 1.46 ± 1.98 mm (p = 0.003); buccal bone thickness by 0.55 ± 0.60 mm (p = 0.005), and 1.01 ± 1.25 mm (p = 0.001) at 1 and 3 mm below reference level. Two implants were removed; 22 implants were still in function at a mean follow-up of 36 months. PPD changed from 5.05 ± 1.39 to 3.08 ± 0.71 mm (p < 0.001); recession was reduced from 2.07 ± 1.70 to 0.91 ± 1.13 mm (p = 0.001); KMW increased from 2.91 ± 1.81 to 4.18 ± 1.67 mm (p = 0.006); KMT improved from 1.73 ± 0.50 to 2.44 ± 0.43 mm (p < 0.001); PES changed from 7.7 ± 2.8 to 10.7 ± 1.9 (p < 0.001). 45.8% to 54.2% of the implants met the criteria of implant success. CONCLUSIONS: The favorable results document the proof of principle for the regeneration of severe peri-implant hard and soft tissue deficiencies by the LAPIDER treatment approach.

Implants placed in an alveolar ridge with a sloped configuration. A 3-year prospective multicenter study.

AIM: The aim of the present study was to evaluate soft and hard tissue alterations around implants with a modified marginal portion placed in a healed, sloped ridge over 3 years of follow-up. MATERIAL AND METHODS: 65 patients with a single recipient implant site in an alveolar ridge with a lingual-buccal sloped configuration were recruited. Implants with a modified geometry in the marginal portion were installed in such a way that the sloped part of the device was located at the buccal and most apical position of the osteotomy preparation. Crowns were placed 21 weeks after implant placement. Radiologic examinations were performed at implant installation and at 1 and 3 years of follow-up. Bleeding on probing (BoP), probing pocket depth (PPD), and clinical attachment level (CAL; from the crown margin) were recorded at the insertion of the prosthesis and after 1 and 3 years. RESULTS: 57 patients with 57 implant-supported restorations attended the 3 years follow-up examination. The radiographic analysis revealed a mean marginal bone loss of 0.57 mm during the 3 years period. While the average bone loss between 1 and 3 years amounted to 0.30 mm, approximately 50% of the implants showed no bone loss during this period. The results from the clinical examinations showed a CAL gain of 0.11 ± 0.85 mm between baseline and 3 years of follow-up. About 65% of the implants showed no loss of attachment between 1 and 3 years. BoP and PPD ≥5 mm were identified at <10% of implants at the 3 years examination. CONCLUSION: Hard and soft tissues formed around dental implants that were designed to match the morphology of an alveolar ridge with a lingual-buccal sloped configuration remained stable over 3 years.

Marginal Bone and Keratinized Mucosa Alterations Around Sloped Implants Placed in Healed Sloped Crests: A Long-Term Cohort Study.

To improve the adaptation to bone level discrepancies of sloped alveolar crests, an implant with a sloped implant-abutment interface has been developed. In a previously reported international multicenter study, 65 sloped implants replaced single teeth with a buccolingual bone level discrepancy at least 3 months after tooth loss. The present study reports the long-term outcomes of one study center and also evaluates marginal bone and keratinized mucosa alterations around sloped implants in healed, sloped crests in a long-term follow-up. Implant survival, marginal bone levels, and buccal bone dimensions in relation to the implant shoulder level (assessed by periapical radiographs and CBCT), width of keratinized mucosa, and probing depths were observed. Two patients did not present for follow-up examinations. No implants were lost. The remaining 13 implants were followed for a mean period of 123 months. Mean marginal bone levels were maintained slightly coronal to implant shoulder level at the interproximal (0.13 mm) and the buccal aspects (0.57 mm). The width of keratinized mucosa improved significantly from delivery (1.85 mm) to the 1-year follow-up (3.39 mm) and was thereafter unchanged. Placing implants with a sloped shoulder in a healed crest with lingual-buccal bone level discrepancy resulted in circumferential marginal bone maintenance and improved width of the keratinized mucosa.

Peri-implant defect grafting with autogenous bone or bone graft material in immediate implant placement in molar extraction sites-1- to 3-year results of a prospective randomized study.

OBJECTIVES: To evaluate the survival rate, the orobuccal bone resorption and stability of peri-implant hard and soft tissues following immediate implant placement of wide diameter implants in molar extraction sites and peri-implant defect grafting with autogenous bone (AB) or biphasic bone graft material (BBGM) with 1- to 3-year follow-up examinations. MATERIAL AND METHODS: Fifty wide diameter implants were placed in 50 patients immediately into molar extraction sockets by a flapless approach. Peri-implant defect augmentation was performed randomized with either AB or BBGM. Primary outcome variable was implant survival. Marginal bone level changes, orobuccal width of the alveolar crest, probing depths, and implant success were considered as secondary parameters. RESULTS: One implant of the BBGM group was lost, 1 patient withdrew from the study (drop-out). The remaining 48 patients were still in function at a follow-up period up to 31 months after implant insertion. Interproximal marginal bone level regenerated from -7.5 mm to the level of the implant shoulder (AB + 0.38 mm, BBGM + 0.1 mm) at final follow-up. The width of the alveolar crest changed by -0.08 mm (AB) and +0.72 mm (BBGM) at 1 mm, -0.36 mm (AB) and +0.27 mm (BBGM) at 3 mm, -0.36 mm (AB) and +0.31 mm (BBGM) at 6 mm apical to implant shoulder level. Success rate was 87.5% in the AB and 56.3% in the BBGM group (p = .058). CONCLUSIONS: Medium-term results prove a high survival rate, a favorable amount of bone generation in both groups and a low amount of orobuccal resorption in immediate molar implant insertion.

A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects: laser-assisted periimplant defect regeneration (LAPIDER).

BACKGROUND: The main problem in periimplantitis is often the combination of severe periimplant bone loss with a contaminated implant surface and an insufficient soft tissue situation. Classic surgical concepts with crestal access to the bony defect and debridement of the surface most often lead to partial defect regeneration and a soft tissue recession. An incision directly above the pathologic bony lesion is contrary to general surgical treatment rules. AIM: To overcome this problem, a new surgical concept was developed which allows to clean the implant surface, reconstruct the bony defect, and improve soft tissue height and thickness without cutting the papilla complex. This publication presents the innovative regenerative treatment approach for severe periimplantitis defects. MATERIAL AND METHODS: After diagnosis and non-surgical pre-treatment of a severe periimplantitis lesion, the following treatment protocol was applied: horizontal mucosal incision 5 mm apical to marginal mucosa, supraperiosteal preparation in apical direction, cutting through periosteum at the level of the implant apex, subperiosteal coronal flap elevation, exploration and cleaning of the periimplant defect, thorough debridement of the implant surface with the Er:YAG laser, subperiosteal grafting with connective tissue, grafting of the bony defect with autogenous bone chips from the mandibular ramus, and bilayered suturing of periosteum and mucosa. Implant survival, marginal bone levels, periimplant probing depths, recession, and facial mucosa thickness (PIROP ultrasonic measurement) were evaluated in a pilot case at 1-year follow-up examination. RESULTS: Inter-proximal, oral, and buccal marginal bone levels increased significantly to the level of the implant shoulder from pre-operative to 1-year follow-up examination. No signs of suppuration or periimplant infection were present. Probing depths and recession decreased significantly, while the facial mucosa thickness improved from pre-operative to final examination. CONCLUSIONS: Marginal bone levels and soft tissue improvement suggest feasibility for the regeneration of severe periimplant hard and soft tissue deficiencies by this new treatment approach. With the use of this concept, the simultaneous implant surface cleansing and improvement of hard and soft tissue seem to be possible and unfavorable postoperative exposition of titanium surface might be prevented. Comparative studies are planned to quantify the effects of this new surgical protocol.

Retrospective cohort study of a tapered implant with high primary stability in patients with local and systemic risk factors-7-year data.

OBJECTIVES: This retrospective study examined the mid- to long-term clinical and radiographic performance of a tapered implant in various treatment protocols in patients with local and systemic risk factors (RFs). MATERIAL AND METHODS: Two hundred seven NobelActive implants were inserted in 98 patients in the period from 10/2008 to 02/2015. The subdivision of the cohort was defined by local (n = 40), systemic (n = 6), local and systemic (n = 8), or without any RFs (n = 44) to analyze implant survival and marginal bone levels. RESULTS: Fifteen implants failed within the follow-up period. The mean follow-up period of the remaining implants was 34 months (range 12 to 77 months). The cumulative survival rate according to Kaplan-Meier was 91.5%. The survival rate for 93 implants in 45 patients with no RFs was 94.8% whereas it was 94% for 83 implants in 48 patients with local RFs (p = 0.618), 81.3% for 14 implants in 6 patients with systemic RFs (p = 0.173), and 76.5% for 17 implants in 6 patients with local and systemic risk factors (p = 0.006). The interproximal marginal bone level was - 0.49 ± 0.83 mm at the mesial aspect and - 0.51 ± 0.82 mm at the distal aspect in relation to implant shoulder level and showed no relevant difference in the various risk factor groups. CONCLUSIONS: It can be assumed that the negative effects of the local or/and systemic risk factors were partially compensated by the primary stability and grade of osseointegration of the NobelActive implant. CLINICAL RELEVANCE: The use of this system in patients with risk factors and immediate loading procedures.

Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla.

BACKGROUND: Resorption of hard and soft tissues following immediate implant insertion is frequently reported. Data regarding the influencing factors on facial tissue thickness are rare. PURPOSE: This retrospective study investigated the impact of connective tissue grafting, the orofacial angulation and position of immediately inserted and provisionalized implants on the facial hard and soft tissue thickness in the anterior maxilla within a 1- to 5-year follow-up. MATERIAL AND METHODS: Implants with the prerequisite of having preoperative and postoperative cone beam computed tomography (CBCT) and a follow-up of 1 to 5 years were included. Facial bone deficiencies were grafted flaplessly with autogenous bone in all sites. In a subgroup of implants additional connective tissue grafting was performed, whereas the remaining implants were not grafted with soft tissue. The orofacial tooth and implant angulation, the change of horizontal position and the facial bone thickness were measured by CBCT, the facial mucosa thickness by an ultrasonic device. RESULTS: In total, 76 implants were placed in 55 patients. Sixty-nine sites showed a facial bone defect. Thirty-eight received a connective tissue graft additionally. All implants were still in function after a mean follow-up of 36 months. The mean thickness of the facial mucosa was 1.72 mm at 1 mm, 1.63 mm at 4 mm, 1.52 mm at 6 mm, and 1.66 mm at 9 mm apically to mucosal margin. The bone thickness was 0.02, 0.25, and 0.36 mm initially and 1.32, 1.26, and 1.11 mm finally at 1, 3, and 6 mm apically to implant shoulder level. Mixed model analysis revealed an impact of the preoperative bone status on the facial bone increase. The facial soft tissue thickness was significantly influenced by the gingival biotype. CONCLUSIONS: The results indicate that an initial severe hard tissue defect allows for significant bone regeneration. The facial soft tissue thickness is primarily influenced by the gingival biotype.

Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: A retrospective analysis with follow-up between 1 and 8 years.

BACKGROUND: Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare. PURPOSE: This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years. MATERIALS AND METHODS: Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a larger group of immediate implants only single tooth replacements with 1 to 3 mm recession and a pre- and post-op CB-CT were selected. Facial bone deficiencies were grafted flaplessly with autologous bone in all sites. In a group of 13 patients the recessions (mean 2.3 ± 0.7 mm, range 1.0-3.0 mm) were grafted additionally by connective tissue (ABG + CTG), in the remaining 13 patients no soft tissue grafting (mean recession 1.8 ± 0.6 mm, range 1.0-3.0 mm) was performed (ABG). The marginal hard and soft tissue level, the width of the keratinized mucosa, the PES, and implant success were evaluated. RESULTS: After a mean follow-up period of 45 months the recessions were significantly reduced in the ABG group from 1.8 to 0.9 mm. The improvement was even more pronounced in the ABG + CTG group (from 2.3 to 0.5 mm). The PES improved significantly in both groups. At final examination all implants were still in function. Within the observational period, in 5 of 13 implants a marginal bone loss of more than 1 mm was noticed in the ABG, but in none of the ABG + CTG group. CONCLUSIONS: These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.

Immediate and flapless implant insertion and provisionalization using autogenous bone grafts in the esthetic zone: 5-year results.

OBJECTIVES: As the 2-year results for immediately inserted and provisionalized implants have been reported, it remained an open issue, whether the initially high success rates and the esthetic outcome remain stable for longer observation periods. Therefore, this prospective study examines the 5-year hard and soft tissue changes at implants placed in the anterior maxilla. MATERIAL AND METHODS: Meanwhile, 37 microthreaded implants were placed in 21 patients into extraction sockets with and without facial bone deficiencies by a flapless approach. Facial gaps and bony defects were grafted with autogenous bone chips. The implants were immediately provisionalized. The primary outcome parameters were the interproximal marginal bone level and the thickness of the facial bony wall. Implant success and Pink Esthetic Score (PES) were considered as secondary outcome parameters. RESULTS: Two patients with four implants withdrew from the study (dropouts), and the remaining 33 implants were still in function at a follow-up period of 68 months. Marginal bone height averaged 0.04 mm coronal to the implant shoulder. The thickness of the facial bony lamellae increased significantly between pre-op examination and 1-year follow-up (p = .002) and thereafter remained stable. Within 5 years of follow-up, 24 of 33 implants were clinically stable, free of signs and symptoms, and showed bone loss less than 1 mm. The mean PES ratings improved slightly from 10.7 pre-operatively to 11.7 at the last follow-up (p = .02). CONCLUSIONS: Interproximal marginal bone levels, survival rates, and esthetic results remain stable at the 5-year follow-up in implants used in an immediate insertion, reconstruction, and provisionalization concept. Facial marginal bone levels decreased slightly; however, this reduction did not affect the PES so far.

Immediately provisionalized OsseoSpeed(™) Profile implants inserted into extraction sockets: 3-year results.

OBJECTIVES: A sloped shoulder might improve the congruence between extraction socket and dental implant and may add to a better circumferential support of the peri-implant structures. Therefore, this study evaluates the 3-year clinical outcome (survival and success rates, marginal bone levels, and Pink Esthetic Score (PES)) of immediately inserted and provisionalized OsseoSpeed(™) Profile implants in the anterior maxilla. MATERIAL AND METHODS: Twenty-one implants were inserted in 16 patients. All implants were immediately placed into extraction sites with and without facial bone deficiencies. A flapless procedure was utilized, and the implants were provisionalized immediately. Facial gaps were grafted with autogenous bone chips from the mandibular ramus. Implant survival and success, the interproximal bone levels, the thickness of the facial bony wall, and the PES were evaluated. RESULTS: After a mean follow-up period of 43 months, 19 implants were still in function. One patient with 1 implant did not follow the study protocol (dropout) and 1 implant was lost at 10 weeks. Interproximal marginal bone levels measured -0.2 ± 0.4 mm (range, -1.0-0.4 mm) apical to the implant shoulder. The mean PES ratings were 11.9 ± 1.4 (range, 8-14) at the final examination. CONCLUSIONS: Clinical and radiographic results provide evidence that sloped implants can preserve the marginal bone circumferentially and are able to maintain soft tissue esthetics when inserted and provisionalized immediately, even in the presence of facial bony wall defects.

Immediate nonfunctional loading of NobelPerfect implants in the anterior dental arch in private practice--5-year data.

BACKGROUND: The concept of scalloped implants to maintain the natural contour of the alveolar ridge has been a source of controversy for many years. PURPOSE: This study examined the long-term clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate loading in the esthetic zone). MATERIALS AND METHODS: In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants in a private practice and followed for up to 78 months. Twenty-one implants were placed immediately after extraction, seven implants were placed after osseous consolidation of the extraction sockets, and three implants were placed secondary to extended alveolar ridge augmentation procedures. All implants were provisionalized on the day of implant placement and adjusted to clear all contacts in centric occlusion and during eccentric movements. Outcome variables were success rates, marginal bone levels, and pink esthetic score (PES) assessed per implant. RESULTS: One implant failed after 1.4 months. Five patients with six implants in total were scored in the 5-year follow-up as dropouts. Mean follow-up period of remaining 24 implants was 65 months (range, 55-78 months). Cumulative success rates according to the criteria specified by Smith and Zarb were 96.8%. Marginal bone levels averaged 1.1 mm above the first thread. Mean PES ratings were 10.5 (range, 3-13). CONCLUSIONS: Survival rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of the interproximal bony lamella with a scalloped implant design in long-term data.

Maintenance of marginal bone support and soft tissue esthetics at immediately provisionalized OsseoSpeed implants placed into extraction sites: 2-year results.

BACKGROUND: Placement of implants into extraction sockets targets the maintenance of peri-implant hard and soft tissue structures and the support of a natural and esthetic contour. The main advantages of immediate implant insertion in comparison with delayed implant placement protocols are as follows: a reduced treatment time, less number of sessions, and, thus, the less invasive procedure. This study examines the clinical performance (survival rate, marginal bone levels and Pink Esthetic Score [PES]) of OsseoSpeed implants placed into extraction sockets with immediate provisionalization in the anterior maxilla after a follow-up of at least 12 months. METHODS: Twenty patients received a total number of 37 OsseoSpeed implants which were immediately inserted into extraction sockets with or without facial bone deficiencies of various dimensions. A flapless procedure was applied, and the implants were immediately provisionalized with temporary crowns without occlusal contacts. Facial gaps between implant surface and facial bone or the previous contour of the alveolar process were grafted with autogenous bone chips. Implants in diameters 3.5, 4.0, 4.5, and 5.0 with lengths of 11-17 mm were used in the study. During the course of the study, interproximal marginal bone levels, the thickness of the facial bony wall, implant success rate according to the criteria established by Buser, and the PES were assessed per implant. RESULTS: One patient with three implants did not continue the study after prosthesis delivery, the remaining 34 implants were still in function at the final follow-up (survival rate: 100%). The mean follow-up period was 27 months (range, 12-40 months). Marginal bone height at the level of the implant shoulder averaged -0.1 ± 0.55 mm (range, -1.25 to 1.47 mm) at the final follow-up. The mean PES ratings were 11.3 ± 1.8 (range, 6-14) at the final follow-up. In 78% of the patients, the PES was preserved or even improved. CONCLUSIONS: Success rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of marginal bone height at immediately placed and provisionalized OsseoSpeed implants after a follow-up of at least 12 months. Even implant sites with facial bony deficiencies can be successfully treated with a favorable esthetic outcome using the immediate implant insertion, immediate reconstruction, and immediate provisionalization technique.

Soft and hard tissue alterations around implants placed in an alveolar ridge with a sloped configuration.

AIM: The aim of this study was to evaluate soft and hard tissue alterations around implants placed in healed, sloped ridge sites. MATERIALS AND METHODS: In this prospective multi-center study, 65 patients between 20 and 74 years of age and with a need for a single tooth replacement were included. All patients presented with a recipient implant site demonstrating a lingual-buccal bone height discrepancy of 2.0-5.0 mm and with a neighboring tooth on its mesial aspect. Implant placement (OsseoSpeed™ Profile implants; Astra Tech AB, Mölndal, Sweden) was performed using a non-submerged installation procedure. The implants were placed in such a way that the sloped part of the device was located at the buccal and most apical position of the osteotomy preparation. As the buccal rim of the implant was positioned at the crestal bone level, the lingual rim became situated either below or at the level of the lingual bone crest. Clinical assessments of bone levels at the buccal and lingual aspects of the implant were carried out immediately after implant installation and at a surgical re-entry procedure performed 16 weeks later. Crowns were placed at 21 weeks after implant placement. Radiographs were obtained immediately after implant placement, at 16 and 21 weeks and at the 1-year re-examination. Clinical assessment of probing pocket depth and clinical attachment levels were carried out at 21 weeks and at 1 year of follow-up. RESULTS: The alterations of the bone levels that occurred between implant placement and the 16-week surgical re-entry were -0.02 mm (lingual) and -0.30 mm (buccal). The average change in interproximal bone levels between implant placement and the 1-year re-examination was 0.54 mm. Clinical attachment level changes between the 21 week and the 1-year examinations varied between 0.1 mm gain and 0.1 mm loss. CONCLUSION: Implant placement in an alveolar ridge with a sloped marginal configuration resulted in minor remodeling with preserved discrepancies between buccal and lingual bone levels.

Does thread design influence relative bone-to-implant contact rate of palatal implants?

AIM: To determine histologically whether (a) changing the thread design between first- and second-generation palatal implants (Straumann, Basel, Switzerland) influences the bone-to-implant contact (BIC) rate of palatal implants subjected to conventional loading, and (b) whether histological evidence of peri-implantitis appears in this setting. PATIENTS AND METHODS: Patients who had received an orthodontic palatal implant for skeletal anchorage between January 1998 and December 2007 were examined. First-generation palatal implants (Straumann, Basel, Switzerland) 3.3 mm in diameter and 6 mm or 4 mm long were used, as were second-generation implants 4.1 mm in diameter and 4.2 mm long. After completion of active orthodontic treatment, the implants were removed and prepared for histological investigation. This study was designed as a comparative analysis of a series of two cases: 28 explanted first-generation (n = 14) and second-generation (n = 14) palatal implants were analyzed. RESULTS: Bone healing was achieved with all implants. Both types of implants revealed a mean bone-to-implant contact (BIC) rate that was nearly equal: 80.7% (SD 10.7%) for the first-generation and 81% (SD 13.1%) for the second-generation implants. Bone resorption was only observed in 5 palatal implants (3/14 of the first, and 2/14 of the second generation). CONCLUSION: Despite differing thread designs, second-generation palatal implants revealed similar bone-to-implant contact rates as did those of the first generation. Few patients presented bone resorption in the peri-implant bone.

Immediate implant placement and provisionalization after long-axis root fracture and complete loss of the facial bony lamella.

The aim of this research was to explore the performance of a flapless surgical approach for immediate implant placement, simultaneous alveolar ridge augmentation, and immediate provisionalization in patients with complete loss of the facial bony lamella resulting from long-axis root fracture. Eighteen NobelPerfect implants were placed in 16 patients (follow-up, 13 to 36 months) who had sustained complete loss of the facial bony lamellae. Implants were inserted simultaneous to subperiostal bone augmentation with autogenous bone chips and underwent immediate provisionalization. Outcome variables included implant success, marginal bone levels, and pink esthetic score (PES). All implants achieved excellent primary stability. There were no implant losses. On average, interproximal marginal bone levels stabilized at 1.0 to 1.3 mm above the first thread. Postoperative cone beam computed tomography scans were available for 16 implant sites and confirmed restoration of the facial lamella in the vast majority of patients. Marginal esthetics, as assessed by the PES, was by and large preserved (mean postoperative PES, 12.5). Oral hygiene was highly predictive for the esthetic result. Survival rates, marginal bone levels, and esthetic results suggest a proof-of-principle for the new flapless immediate implant placement technique in patients with complete loss of the facial bony lamella. Oral hygiene status may be considered as a negative prognostic factor for the esthetic outcome.

Immediate function with NobelPerfect implants in the anterior dental arch.

This study examined the clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate provisionalization in the esthetic zone). In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants and followed for up to 27 months. Outcome variables were success rates, marginal bone levels, and Pink Esthetic Score (PES) assessed per implant. One implant failed (success rate: 96.8%). Marginal bone levels averaged 1.7 mm above the first thread and remained stable during the observation period. Mean PES ratings were 11.3 (range, 8 to 14). Survival rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of the interproximal bony lamella with a scalloped implant design.