Objectives
The purpose of this study was to evaluate crestal bone stability around sloped implants using the flapless procedure and compare it with conventional implants placed axially.
Materials and methods
A total of 40 bone‐level implants with platform switching were used for this study for 10 patients (4 males and 6 females) in edentulous mandible. Twenty mesial conventional implants were placed in upright position and 20 distal 30° sloped implants tilted 30°. Bone loss was estimated using radiographic imaging after a 6‐ and a 12‐month follow‐up period. Comparison of the bone loss in the distal and mesial region at both implantation angles were conducted to understand the nature and progression of crestal bone loss.
Results
Crestal bone loss around the sloped implants was 0.29 mm (SD = 0.292) on average, while around conventional implants it was 0.22 mm (SD = 0.202) after one‐year follow‐up. However, there was no significant difference in the average of crestal bone loss between two trial groups after 6 months (p < 0.243) and one‐year (p < 0.614) follow‐up. The results indicated a 100% implant survival rate after one‐year follow‐up. Additionally, three fixed prostheses needed realignment after fracturing during the follow‐up time.
Conclusion
Considering the limitations of this study, it can be presumed that sloped and conventional implants with platform switching and conical connection have the same potential for minimal crestal bone loss.
Objectives: It was shown, that Connective Tissue Grafts (CTG) retrieved from the tuberosity tends to determine hyperplastic responses and may induce a beneficial overkeratinization of non-keratinized mucosa. Clinically evaluate and compare CTG from tuberosity ability to increase soft tissue thickness and the keratinization potential after recipient area is either prepared using split or full thickness flap in edentulous mandible.Materials and methods: Fourty implants were placed in 10 edentulous patients with atrophied mandible (Class IV of Misch) presenting less than 1.0 mm of keratinized tissue using a flapless approach and immediately restored with acrylic temporary bridge on multi-unit abutments. The surgical sites were split-mouth randomized and prepared as CTG recipients by a tunneling procedure. Twenty benefited of a partial thickness approach and 20 of a full thickness one. The CTG was placed buccally using partial thickness or full thickness flap according to the randomization schedule. The width of keratinized tissue (KT), the horizontal soft tissue thickness (STT), the marginal hard and soft tissue levels as well as the implant success parameters were collected and analyzed.Results: After a 3 year follow-up period the increase of KT was statistically significantly (p < 0.001) larger in the partial thickness group from 0.6(0.6) to 5.1(0.72) mm, while full thickness group showed very little improvement from 0.5(0.51) to 1(0.57) mm (p < 0.001). STT was significantly increased in both groups over time: from 2.4 (0.88) to 5.4(0.68) mm in full thickness group and from 2.5(0.51) to 5.8(0.41) mm in partial thickness group without any significant difference between the groups.
Conclusion:The increase of soft tissue thickness by using CTG from tuberosity was found in both groups, while keratinization of non-keratinized mucosa appeared more in the partial thickness group.
Objective
To evaluate the amount of residual cement after cementation of implant crown abutments with rubber dam and retraction cord with copy abutments techniques.
Material and Methods
Thirty single posterior metal‐ceramic implant‐supported restorations were delivered to 20 patients. The crowns were fabricated with occlusal openings obturated with composite, and then luted with resin‐reinforced glass‐ionomer cement on customised standard abutments. The cementation procedure was performed twice in the same specimens using rubber dam (group 1) and retraction cord with copy abutment (group 2). If no cement remnants were seen on periapical radiographs after cleaning, the crown‐abutment unit was dismounted. All quadrants of the specimens were photographed to calculate the percentage proportions of residual cement area. Mann–Whitney and Kruskal–Wallis tests were used for statistical analysis.
Results
In each group, 120 measurements were performed (30 implants, 4 surfaces each). The median percentage ratio with interquartile range (IQR) between the cement remnant area and total specimen area was 1.39% (IQR 0.77%–2.29%) and 0.58% (IQR 0.31%–1.33%) in groups 1 and 2, respectively. Lesser cement remnants were found in group 2 with a statistically significant difference (p < .001). The comparison of the mesial, distal, buccal, and lingual surfaces in each group showed no statistically significant differences between them (group 1, p = .482; group 2, p = .330).
Conclusions
The retraction cord and copy abutment reduced the excess cement more efficiently than the rubber dam did. Notwithstanding, undetected cement remnants were observed with both methods, and neither should be considered reliable in clinical applications.
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