In young subjects, with no interdental attachment loss, toothbrushing or toothbrushing and adjunctive interdental cleaning devices such as dental floss, interdental brushes or interdental rubber picks can significantly reduce both plaque and gingival inflammation. Use of interdental brushes or rubber picks reduces more interdental plaque in comparison with toothbrushing alone.
The aim of the present retrospective study was to assess marginal bone changes around implants restored with different prosthetic emergence profile angles. Patients were treated with implants supporting fixed dentures and were followed for 3 years. Marginal bone levels (MBL) measured at the prosthesis installation (t0) and at the 3-year follow-up visit (t1) were considered. The MBL change from t0 to t1 was investigated. Two groups were considered: Group 1 for restorations with an angle between implant axis and prosthetic emergence profile >30°, and Group 2 for those with an angle ≤30°, respectively. Moreover, peri-implant soft tissue parameters, such as the modified bleeding index (MBI) and plaque index (PI) were assessed. Seventy-four patients were included in the analysis and a total of 312 implants were examined. The mean EA in groups 1 and 2 was 45 ± 4 and 22 ± 7 degrees, respectively. The mean marginal bone level change (MBL change) of 0.06 ± 0.09 mm and 0.06 ± 0.10 mm were, respectively, in groups 1 and 2. The difference in the MBL change between the two groups was not statistically significant (p = 0.969). The MBL change does not seem to be influenced by the emergence angle for implants with a stable internal conical connection and platform-switching of the abutment diameter.
Background: There is limited information on the effect of the connection between subcrestally placed implants and abutments on marginal bone levels. The aim of the present retrospective study was to evaluate marginal bone levels after definitive prosthesis delivery around implants with an internal 5° conical connection placed in a subcrestal position. Materials and methods: Patients treated with fixed prostheses supported by implants placed at a subcrestal level between 2012 and 2018 were recalled for a follow-up examination. All implants had 5° internal conical connection with platform switching. Radiographic marginal bone level (MBL) was measured. MBL change between prosthetic delivery (t0) and follow-up examination (t1) was calculated. A multiple regression model was performed to identify the most significant predictors on MBL change. Results: Ninety-three patients and 410 implants, with a mean follow-up of 2.72 ± 1.31 years, were examined. Mean MBL was −1.09 ± 0.65 mm and −1.00 ± 0.37 mm at t0 and t1, respectively, with a mean bone remodeling of 0.09 ± 0.68 mm. An implant’s vertical position in relation to the bone crest, the year of follow up and the presence of type-2 controlled diabetes were demonstrated to be influencing factors for MBL modifications. Conclusions: Subcrestally placed implants with platform switching and internal conical connection maintained stable bone levels over a mean follow-up of more than 2 years. How a tight internal conical connection between abutment and implant may contribute to this clinical evidence should be more deeply investigated. MBL variations seem to be mostly influenced by an implant’s vertical position and presence of type-2 controlled diabetes.
The aim of the present investigation is to evaluate the implant therapy outcomes over a period of 5 years and to analyze several patient risk factors influencing the stability of the peri-implant tissues. Seventy-eight patients were consecutively treated between 2009 and 2017 and restored with implant-supported fixed prostheses. The following inclusion criteria were considered: partial or complete edentulism; residual bone volume of at least 3.3 mm in diameter and 8 mm in length; a favorable relationship between maxilla and mandible; at least a minimum 5 year follow-up for each implant included in the statistical analysis. Intraoral radiographs were taken at implant loading and every 12 months during the follow-up visits. They were subsequently stored on a personal computer and analyzed to determine the changes in bone level. Seventy-eight patients receiving 209 implants completed a minimum follow-up period of 5 years. One-hundred dental implants were inserted in the maxilla while 109 were placed in the mandible. Eleven (14.1%) out of 78 treated patients who received 29 (13.9%) dental implants were considered as drop-outs. On the whole, peri-implantitis was diagnosed in three implants. The average final pocket probing depth at implant level was 2.5 ± 1.2 mm. The average final bone loss after 5 years was 0.3 ± 0.4 mm, both at the mesial and distal aspect of the implant. The effects of the prosthesis type, sex and implant site did not statistically influence the marginal bone loss; on the contrary, a statistically significant difference regarding marginal bone loss was detected between smoker and non-smoker patients (p = 0.021). Implants with internal-conical abutment connection showed stable peri-implant bone levels at the medium-term follow-up. Nevertheless, further prospective long-term clinical studies are necessary to confirm these data.
Computer-aided design and computer-aided manufacturing customized abutments are increasingly used in everyday clinical practice. Nevertheless, solid scientific evidence is currently lacking regarding their potential advantages in terms of soft tissue stability. The main aim of this systematic review and meta-analysis was to compare the soft tissue outcomes of prefabricated versus customized (CAD/CAM) abutments. The present review was registered with PROSPERO (CRD42020161875) and the protocol was developed according to the PRISMA statement. An electronic search was performed on three databases (PubMed, Embase and Cochrane Central) up to May 2023. Data extraction was followed by qualitative and quantitative analysis of the included studies. Three randomized controlled clinical trials and three controlled clinical trials (number of patients = 230; number of dental implants = 230) with a follow-up of between 12 and 36 months were included. No significant differences were observed between prefabricated versus customized (CAD/CAM) abutments regarding midfacial mucosal recession, interproximal papillae and pink aesthetic score (PES) after 12 months. Conclusion: The potential benefits of CAD/CAM abutments on soft tissues should be better clarified in future investigations. The usage of customized CAD/CAM abutments in everyday clinical practice should be based on a careful case-by-case evaluation (CRD42020161875).
Background: The aim of the present retrospective study was to assess peri-implant soft tissue health for implants restored with different prosthetic emergence profile angles. Methods: Patients were treated with implants supporting fixed dentures and were followed for 3 years. Buccal emergence angle (EA) measured at 3 years of follow-up visits (t1) were calculated for two different groups: Group 1 (153 implants) for restorations with angle between implant axis and prosthetic emergence angle from ≥30°, and Group 2 (67 implants) for those with angle ≤30°, respectively. Image J software was used for the measurements. Moreover, peri-implant soft tissue parameters such as pocket probing depth (PPD), plaque index (PI) and gingival index (GI) were assessed, respectively. Results: A total of 57 patients were included in the analysis and a total of 220 implants were examined. Mean (±SD) EA in Groups 1 and 2 was 46.4 ± 12.2 and 24.5 ± 4.7 degrees, respectively. After 3 years of follow-up, a PPD difference of 0.062 mm (CI95% −0.041 mm; 0.164 mm) was calculated between the two groups and was not statistically significant (p = 0.238). Similar results were found for PI (OR = 0.78, CI95% 0.31; 1.98, p = 0.599). Furthermore, GI scores of 2 and 3 were found for nine implants (5.9%) in Group 1, and for five implants in Group 2 (7.5%). A non-significant difference (p = 0.76) was found. Conclusions: Peri-implant soft-tissue health does not seem to be influenced by EA itself, when a proper emergence profile is provided for implant-supported reconstructions in anterior areas.
Background : The design and the location of the implant-abutment interface (IAI) has been deeply examined to minimize the early marginal bone resorption. It was observed that internal tapered IAI may provide better results in terms of stability, seal performance and better load distribution compared to butt-joint interfaces. Nevertheless, there is limited information on the medium-to long-term marginal bone maintenance around implants placed at subcrestal level. Aim/Hypothesis : The aim of the present retrospective study was to determine the radiographic marginal bone stability around implants placed at subcrestal level during a follow-up of 2 to 9 years, and to identify the risk factors for bone loss. Materials and Methods : All selected patients who gave their consent for the study, were recalled for a follow-up visit (t1) between September 2018 and February 2019. The following data were recorded: type of prosthesis, implant diameter and length, implant site, date of the prosthetic delivery, patient condition, including smoking habit (>10 cig/die), presence of type-2 diabetes. During the follow-up visit, an intraoral peri-apical radiograph and a clinical examination were performed. The radiographic images were then analyzed with a software program (Image J, NIH, Montgomery County, Maryland, USA). Marginal Bone Level (MBL) was measured for t0 and t1 as the following: the distance between the implant neck (bevel) and the first bone-to-implant contact. Measurements were taken for the mesial and the distal aspect of each implant. MBL change was calculated as the difference of MBL at the follow-up examination(t1) and MBL at baseline (t0). Results : According to the inclusion and exclusion criteria 93 patients were included. A total of 410 implants were positioned and the average follow-up period was 2.72 years. At the follow-up examination (t1), peri-implant mucositis was observed for 24 implants (prevalence: 5.9%) while peri-implantitis was observed for 16 implants (prevalence: 3.9%). The highest prevalence (16.7%) was observed at 7 years of follow up (2 implants out of 10). Mean MBL was-1.09 ± 0.65 mm and-1.00 ± 0.37 mm at t0 and t1, respectively. Furthermore, a mean MBL change of-0.09 ± 0.68 mm was calculated. The multiple regression analysis revealed that the combination of the time from prosthetic delivery (followup), the initial vertical position of the implant (MBL(t0)), and the presence of type-2 diabetes (Diabetes) provides the highest predictability of MBL change (adjusted R 2 : 0.213). Follow-up resulted to be the most significant predictor for MBL change (t = 8.165; P < 0.001), followed by the MBL(t0) and diabetes. Conclusions and Clinical Implications : Implants with internal conical connection and a platform switching of the abutment, placed at a subcrestal position of approximately 1 mm showed stable MBL with a low rate of peri-implant disease in a medium-to long-term follow-up. MBL change seems to be mostly influenced by the combination of time from prosthetic delivery, the initial vertical position ...
Background : The term 'platform switching' refers to the use of an abutment narrower than the corresponding implant ' s platform. Radiographic studies in 5.0 and 6.0 mm implants combined with 4.1 mm abutments in diameter have expectedly demonstrated smaller changes in terms of vertical marginal bone resorption than those occurring around implants with abutments of the same diameter. From the biomechanical standpoint, platform switching seems to create more favorable conditions for the distribution of the load. Aim/Hypothesis : The present study evaluated the implant therapy outcomes over a period of 5 years and analyzed patient risk factors influencing the peri-implant tissues stability. Materials and Methods : Seventy-eight patients were consecutively treated between 2009 and 2017 and restored with implant-supported fixed prostheses. Inclusion criteria were as follows: partial or complete edentulism; edentulous bone volume at least 3.3 mm in diameter and 8 mm in length; a favorable maxilla-mandibular relationship; a 5 years follow-up at least for every implant included in the measurements. Intraoral radiographs were taken at implant loading and every 12 months during the follow-up visits. They were subsequently stored on a personal computer and analyzed to determine bone level changes. Peri-implant bone resorption was assessed mesially and distally to the implants, respectively. Results : Seventy-eight patients received 209 implants and completed a 5 years minimum follow-up period. One-hundred maxillary and 109 mandibular implants were inserted. Out of 78 patients treated, 11 (14.1%) with 29 (13.9%) implants were considered as drop out. Periimplantitis was diagnosed in 3 implants. The average final pocket probing depth at implant level was 2.5 ± 1.2 mm. The average final bone loss after 5 years evaluation was 0.3 ± 0.4 mm both in the mesial either in the distal aspect of the implant. The effects of the prosthesis type, sex and implant site did not statistically influence the marginal bone loss; on the contrary, significantly different marginal bone was detected for smoker and NO-smoker patients (P = 0.021). Conclusions and Clinical Implications : Implants with stable implant to abutment connection could show stable peri-implant bone levels in a medium term follow-up. Nevertheless, additional prospective long-term data are expected. Different and more selective success criteria should be considered in reporting implants prognosis.
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