Esthetic and clinical outcomes after immediate placement and restoration: Comparison of two implant systems in the anterior maxilla-A cross-sectional study.

AIM: To assess the esthetic and clinical performance of a novel self-tapping implant system for single-tooth restorations in the esthetic zone after immediate placement and provisionalization. MATERIALS AND METHODS: This cross-sectional study included 52 patients contributing a total of 52 immediately placed and restored implants with ≥12 months after functional loading, comparing two different implant systems: Straumann® BLX (Institut Straumann AG, Basel, Switzerland; 25 patients) and Ankylos® (Dentsply Sirona, Hanau, Germany; 27 patients). As the primary outcome measure, peri-implant tissue esthetics were assessed by means of pink esthetics score (PES) rated by three independent clinicians. Moreover, as secondary outcome measures, the peri-implant tissue health was assessed by means of bleeding on probing, probing depth, and suppuration. Apart from that, the modified plaque index, keratinized mucosa width, and the presence of mucosal recessions were also assessed. When clinical signs suggested the possibility of peri-implantitis, radiographs were indicated to assess progressive bone loss. RESULTS: The mean PES ratings were 12.10 ± 1.10 for Ankylos versus 11.2 ± 1.86 for BLX, both achieving good esthetic results without significant differences (p = 0.143). There were no differences among most clinical parameters (plaque, bleeding on probing, probing depth, peri-implant mucosal recession), although peri-implant mucositis was present in one-third of the cases. The inter-rater agreement on esthetics was not significant (p < 0.250). CONCLUSION: Within the limitations of the present study, it was concluded that the use of either BLX or Ankylos implant systems was associated to comparable peri-implant health and good pink esthetic outcomes during immediate implantation and restoration protocols, for at least 12 months.

Clinical performance of a newly developed two-piece zirconia implant system in the maxilla: A prospective multicentre study.

PURPOSE: To assess the clinical performance of a two-piece zirconia implant system (PURE Ceramic Implants, Straumann, Basel, Switzerland) in the maxilla after a follow-up period of more than 1 year. MATERIALS AND METHODS: A total of 19 patients in three centres received 24 single-tooth implants in the maxilla. The implants were restored after a mean healing period of 7.1 ± 0.4 months (range 7 to 9 months). Implant survival, implant success, Plaque Index, probing pocket depth, bleeding on probing, mucosal recession/creeping attachment, width of keratinised mucosa, papilla index and pink aesthetic score were evaluated after prosthetic loading (T0), after 6 months (T1) and at the final follow-up (T2, mean 15.0 ± 2.1 months, range 12 to 19 months). RESULTS: All implants survived and were suitable for retaining prostheses. Low values were recorded for Plaque Index (0.38 ± 0.68) and probing pocket depth (2.49 ± 0.49 mm). Bleeding on probing increased significantly from T0 (21.7%) to T1 (50.0%) (P = 0.0342) and then remained stable (50.0% at T2). No recession was detected around any of the implants. A statistically significant increase in attachment level was observed from T0 to T2 (0.79 ± 0.88 mm; P = 0.0196). A papilla index of 2.27 ± 0.81 and pink aesthetic score of 11.67 ± 1.60 at T2 indicated a completely satisfying aesthetic result. CONCLUSION: Within the limitations of the present study, the two-piece zirconia implant system investigated achieved fully satisfying functional and aesthetic results.

Clinical and Esthetic Evaluation Following Immediate Implant Placement and Restoration with Platform- Switched Morse Taper Implants in the Esthetic Zone: A Cross-Sectional Study.

Immediate implant placement with immediate restoration in the esthetic zone is a standardized protocol that aims to satisfy the patient with an immediate, esthetic rehabilitation. This study evaluated clinical and esthetic outcomes following immediate implant placement and provisionalization over a medium- to long-term period. A total of 57 implants in 44 patients were included in the present cross-sectional study, with a follow-up period of 3.97 ± 2.03 years. Surgical and prosthetic treatments were performed according to a standardized protocol. Clinical outcomes (modified Plaque Index, bleeding on probing, probing depth [PD], keratinized mucosa, mucosal recession [MR], and pink esthetic score [PES]) were evaluated during follow-up. Peri-implant tissue health was assessed based on the established case definitions. The mean PES value at the final control examination (mean PES follow-up time: 3.79 ± 1.85 years) was 12.06, the mean PD was 2.52 ± 0.88 mm, and mean MR was 0.03 ± 0.13 mm. No suppuration, pain, or implant or prosthetic failures were reported. The prevalence rates of mucositis and peri-implantitis were 45.5% and 0%, respectively. Immediate implant placement and restoration was associated with peri-implant tissue stability and esthetics over medium- and long-term follow-up periods.

All-ceramic versus titanium-based implant supported restorations: Preliminary 12-months results from a randomized controlled trial.

PURPOSE: The aim of the present randomized controlled study was to compare prefabricated all-ceramic, anatomically shaped healing abutments followed by all-ceramic abutments and all-ceramic crowns and prefabricated standard-shaped (round-diameter) titanium healing abutments followed by final titanium abutments restored with porcelain-fused-to-metal (PFM) implant crowns in the premolar and molar regions. MATERIALS AND METHODS: Forty-two patients received single implants restored either by all-ceramic restorations (test group, healing abutment, final abutment, and crown all made of zirconia) or conventional titanium-based restorations. Immediately after prosthetic incorporation and after 12 months of loading, implant survival, technical complications, bone loss, sulcus fluid flow rate (SFFR) as well as plaque index (PI) and implant stability (Periotest) were analyzed clinically and radiologically. RESULTS: After 12 months of loading, an implant and prosthetic survival rate of 100% was observed. Minor prosthetic complications such as chipping of ceramic veneering occurred in both groups. No statistical significant differences were observed between both groups with only a minimum of bone loss, SFFR, and PI. CONCLUSION: All-ceramic implant prostheses including a prefabricated anatomically shaped healing abutment achieved comparable results to titanium-based restorations in the posterior region. However, observational results indicate a benefit as shaping the peri-implant soft-tissue with successive provisional devices and subsequent compression of the soft tissue can be avoided.

Screw-retained monolithic zirconia vs. cemented porcelain-fused-to-metal implant crowns: a prospective randomized clinical trial in split-mouth design.

OBJECTIVES: The objective of the present study was to compare the clinical performance of screw-retained, monolithic, zirconia, and cemented porcelain-fused-to-metal (PFM) implant crowns. MATERIALS AND METHODS: In a prospective, randomized, clinical, split-mouth trial, 22 patients' bilateral premolar or molar single-gap were restored with either screw-retained (test group) or cemented supraconstruction (control group). Clinical parameters, soft-tissue health, crestal bone-level changes, technical complications, and patient's subjective feelings were recorded during a follow-up period of 12 months. RESULTS: No implant was lost during the follow-up period. Of the crowns, 4.5% (test) and 9.1% (control) showed bleeding on probing (P = 1.000), and plaque was visible in 13.6% (test) and 27.3% (control) of the crowns (P = 0.240). Changes in bone crest level seemed to have no correlation with the restoration method (P = 0.77/0.79). Technical failures were observed in three restorations of the test and four of the control group. Evaluation of patients' satisfaction revealed high acceptance regarding fit, esthetics, and chewing effectiveness in both groups. CONCLUSION: Over a 12-month follow-up, screw-retained and cemented crowns could show comparable clinical and radiological results regarding soft tissue health, marginal bone level, and patient satisfaction. Duration of treatment alone was significantly shorter in screw-retained crowns. CLINICAL RELEVANCE: Prosthetic retention methods are related with the occurrence of complications, such as peri-implantitis. However, scientific valuable data that proof superiority of a specific retention technique are rare. In single-gap implants, screw retention and cementation seemed to achieved comparable results.

Prefabricated taper crowns for the retention of implant superstructures: Three-year results of a prospective clinical trial.

STATEMENT OF PROBLEM: Nonrigid retainer systems for removable implant superstructures are associated with negative effects such as rocking and increased load on the denture base. Rigid retainer systems such as telescopic crowns reduce these negative effects, but their fabrication demands highly skilled dental technicians and is therefore expensive. Whether a protocol with prefabricated retainers will reduce production time is unclear. PURPOSE: The purpose of this prospective clinical trial was to evaluate a prefabricated telescopic retainer and a treatment protocol including the intraoral luting of a framework. MATERIAL AND METHODS: A total of 23 participants (15 women and 8 men with a mean age of 61.6 ±2.9 years) were included. After 3 dropouts, 21 removable dentures (9 mandibular and 12 maxillary) retained by 91 delayed loaded Ankylos implants were investigated. All implants were restored with prefabricated conically shaped abutments (SynCone-abutment). The prefabricated corresponding cone matrix was assembled intraorally into a metal frame with autopolymerizing resin. After a loading period of 3 years, a follow-up examination investigated the fit of the framework, the prosthetic aftercare, the technical failures, and the retention force. A questionnaire was used to evaluate participant satisfaction. In addition, laboratory fabrication time and costs were compared with those of individually fabricated restorations. RESULTS: One mandibular implant was lost after 25 months (survival rate, 98.9%). The removable dentures showed no apparent rocking and minimal prosthetic maintenance during the 36-month trial. No dentures required relining. The retention force was scored as good in 17 participants and high (with 6 implants in the maxilla) and low (with 2 implants in the mandible) in 2 participants each. No technical failures occurred. An assessment of laboratory fabrication time and costs revealed reduced time and costs. Patient satisfaction was significantly increased (P<.001) over the entire observation time. CONCLUSIONS: The SynCone retainer presented a time- and cost-efficient treatment option with sufficient long-term retention for removable dentures and high patient satisfaction. Mandibular prostheses restored with 2 implants had limited success.

Autotransplantation of teeth.

Dental autotransplantation is the surgical transposition of a tooth from its original site to another site to replace a lost or compromised tooth in the same individual.1 It offers a method for replacing missing teeth or avulsed and traumatized teeth, particularly in children and adolescents. This surgical therapy is often overlooked as a treatment option by dentists and oral surgeons, who typically treat space closure by placing dental implants or bridges despite the fact that recent autotransplantation studies show high survival rates and success rates of 91.3%.2 Most tooth losses due to traumatic incidents occur in young patients, and implant placement is contraindicated until the completion of growth. In cases where there is no donor dilemma, and if a suitable graft is available, autotransplantation may be the therapy of choice.

Response of soft tissue to different abutment materials with different surface topographies: a review of the literature.

Soft tissue integration in the transmucosal zone of dental abutments supports the peri-implant tissues, improves esthetics, ensures soft tissue seal against microorganisms, and preserves crestal bone level. The aim of this literature review was to define the most favorable surface topography and macrodesign of the transmucosal zone of abutments to achieve optimal soft tissue seal. An electronic search of the PubMed/MEDLINE database was performed, seeking relevant English-language articles published between January 1, 2003, and October 11, 2014. The key terms implant abutment, surface topography, and soft tissue seal were used both singly and jointly with "AND" in this search. Additionally, a manual search was performed. Articles that did not distinguish between abutment and implant surfaces, investigated only 1-piece dental implants, or were systematic reviews were excluded, although 4 systematic reviews were studied to obtain background information. Out of a preliminary pool of 206 articles, 12 relevant articles were identified for final evaluation in addition to the 4 systematic reviews. These included 3 human studies, 3 animal studies, and 6 in vitro studies. The human histologic studies showed evidence of perpendicular insertion of human gingival fibroblasts into the treated abutment surface. Laser-ablated, hydrophilic, and oxidized titanium surfaces resulted in this type of attachment. Epithelial cells seem to slightly favor zirconia and polished titanium surfaces. Due to heterogeneity in the study designs, statistical methods, and reported results, meta-analysis of the data was not possible. Improvements in the surface topography and macrodesign of dental abutments might improve biocompatibility and adherence to soft tissue; however, manipulation of soft tissue and second-stage surgery could negate any advantages of the improved surfaces.

The influence of professional competence on the inter- and intra-individual esthetic evaluation of implant-supported crowns in the anterior maxilla.

OBJECTIVES: Evaluation of the influence of professional competence on esthetic predictability of implant-supported crowns in the anterior maxilla and identification of objective factors allowing predictable planning for esthetic results. MATERIALS AND METHODS: Sixty patients with 82 implants in the esthetic zone were included in this study. Width of keratinized mucosa, biotype, recessions, and papilla index according to Jemt as well as radiological bone loss were assessed. Study casts and photographs were obtained. Each patient as well as people with different level of expertise (laypersons, students and dentists) rated the esthetic satisfaction after final restoration on a scale (1-10). Correlations between esthetic assessments and previously documented clinical parameters were tested. RESULTS: The study failed to show a significant relationship between the raters' level of dental expertise and their subjective esthetic evaluation. However, patients rated themselves much more favorable than the three evaluator groups did. A comparison of the clinical parameters with the esthetic evaluation revealed significantly more favorable ratings by the lay group in the presence of a wide attached gingiva (P = 0.021) than by the other groups and by the laypersons (P = 0.002), the dentists (P = 0.003), and students (P = 0.009) in the absence of recessions. The ratio of the implant crown length to the length of the contralateral crown had a negative effect on ratings for all three groups ([laypersons P < 0.001], [students P < 0.001] and [dentists P = 0.001]). The papilla index of the mesial papilla correlated significantly with laypersons' ratings (P = 0.036). CONCLUSION: Earlier investigations are confirmed. Width of keratinized mucosa is a risk factor for esthetic predictability of implant-supported crowns in the anterior maxilla in laypersons' ratings. Furthermore, there is an association between the discrepancy of lengths of implant-supported single crowns to their contralateral natural teeth and esthetic satisfaction for all expertise levels.

Rationale for esthetic tissue preservation of a fresh extraction socket by an implant treatment concept simulating a tooth replantation.

In cases of an immediate insertion and loading of implants after a traumatic loss of the patient's own dentition or due to an inevitable extraction of an anterior tooth, it is essential to provide the patient with an adequate provisional crown. A soft-tissue recession must be avoided, whether it is due to a compression of the peri-implant soft-tissue caused by an over-dimensioned restoration in the cervical collar of the provisional crown or to a too small dimensioned sulcus former. A simulation of the exact dimension of the lost tooth - especially on the cervical part of the new provisional restoration - is expected to preserve all relevant information and allows the design of a naturally looking emergence profile. Based on theoretical considerations and a case report, the authors intend to demonstrate that a near-naturally dimensioned sealing of the dento-gingival soft-tissue collar may initiate a tissue-maintaining healing process, similar to a tooth replantation. The natural dental crown, connected to an implant instead of the root, is applied for a tight sealing of the wound. If due to traumatic impact the tooth is no longer available, a naturally dimensioned crown restoration will serve as an alternative wound sealant.