Horizontal Bone Augmentation in the Anterior Esthetic Area of the Maxilla Using a Flap Design Adapted from Mucogingival Surgery in Association with PLA Membrane and ß-TCP.

Systematic reviews showed possible esthetic complications with the use of traditional flap designs after guided bone regeneration (GBR) procedures in the esthetic zone and the aim of this case series was to analyze hard and soft tissue changes over 18 months after these procedures. Healthy subjects requiring tooth extraction and single-implant placement in the anterior maxilla were enrolled in the study. Three months after tooth extraction and ridge preservation, a prosthetic-driven implant was placed. The horizontal bone deficiency was treated with a resorbable bone graft substitute (beta tricalcium phosphate [ß-TCP]) and a bioresorbable polylactic acid (PLA) membrane. Primary closure was obtained by a novel coronally advanced flap adapted from mucogingival techniques. Final metal-free implant restorations were delivered 4 months after placement. Clinical measurements, pictures, and radiographs were acquired after delivery of the final restoration (T1) and at the 18-month follow-up (T2). Digital impressions were taken at the time of tooth extraction (T-1) and implant insertion (baseline; T0) and at T2. Marginal bone level changes were assessed by radiographic analysis, while soft tissue changes were evaluated with ExoCad software. Student t test for paired data was used to detect differences between the different time points. Twelve subjects (7 men and 5 women; mean age: 63.7 ± 14 years) completed the study and received 15 implants. All implants healed uneventfully and were clinically osseointegrated and stable, showing no sign of infection. No GBR complications were noted. Statistically significant ridge-width changes were observed after extraction (T-1 vs T0 = -1.72 ± 0.30 mm; P = .00001) and after horizontal GBR (T0 vs T2 = 1.41 ± 0.64 mm; P = .00001). Radiographic bone levels after implant placement remained stable T0 to T2 (0.09 ± 0.08 mm). Periodontal parameters never exceeded physiologic levels. It can be concluded that GBR using a bioresorbable PLA membrane and resorbable ß-TCP bone graft in conjunction with a coronally advanced flap is a predictable procedure for horizontal bone augmentation with simultaneous implant placement in the esthetic area.

Marginal soft tissue stability around conical abutments inserted with the one abutment-one time protocol after 5 years of prosthetic loading.

BACKGROUND: Soft tissue stability is crucial to obtain and maintain optimal esthetic results. PURPOSE: This study aimed to investigate, over 5 years, the soft tissue response using a conical abutment together with the "one-abutment one-time" (OA-OT) protocol in the restoration of implants inserted in the anterior esthetic area. MATERIAL AND METHODS: From January 2011 to January 2012, all consecutive patients requiring an implant n the maxillary area between canines were enrolled. After submerged healing and osseointegration, a definitive abutment with a provisional crown was inserted. After 1 month, the definitive crown was delivered (Tdef). Analog impressions were taken before tooth extraction (T0), at implant insertion Timpl, and Tdef, and at 12 months (T1) and 60 months (T5). Casts were scanned and superimposed using a dedicated software. Differences in vertical height of soft tissue margins between the digitized model casts were calculated and paired sample t test was conducted to compare results. To detect the potential role of biotype, groups (thick vs. thin) were compared by analysis of variance with general linear model. RESULTS: Twenty-five patients were enrolled. Three patients dropped out. At the 60-month, 22 patients (12 men and 10 women with mean age of 68.3 ± 11 years) concluded the study follow-up. Horizontal changes demonstrated gain of 1.06 mm at Timpl, 0.94 mm at Tdef, 0.92 mm at T1 and 0.97 mm at T5 compared to T0. Vertical changes demonstrated gain of 0.84 mm at Timpl, 0.11 mm at Tdef, 0.29 mm at T1 and 0.59 mm at T5 compared to T0. The analysis of variance showed a significant better performance of thick biotype in soft tissue horizontal width (P = .022). No statistical differences were noticed for vertical width (P = .111). CONCLUSIONS: The use of a conical abutment together with the OA-OT approach allowed longitudinal stable soft tissue dimensions.