Peri‐implant soft tissue phenotype modification and its impact on peri‐implant health: A systematic review and network meta‐analysis

et al. 2021

J Esthet Restor Dent

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Objective To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri‐implant referred to as the peri‐implant phenotype), in the context of peri‐implant esthetic complications. Overview The individual components of the peri‐implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri‐implant buccal bone) have been linked to different aspects of implant esthetics, as well as health‐related aspects. At the time of implant therapy, respecting the biology of the peri‐implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. Conclusions While the current literature may not allow for a point‐by‐point evidence based‐recommendation for the required amount of each peri‐implant structure, bearing in mind the proposed values for the components of the peri‐implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. Clinical Significance Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

Section: The Peri‐implant Phenotypementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The peri‐implant phenotype and implant esthetic complications. Contemporary overview

Wang

et al. 2021

J Esthet Restor Dent

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“…We emphasize that all the treated cases had been performed by an expert clinician and involved the use of a CTG. While the importance of an experienced surgeon in treatment of PTSDs cannot be overstated, with regard to the use of a CTG, indeed its properties of enhancing blood clot, flap stability, increasing keratinized tissue width/soft tissue thickness, and the possibility of creeping attachment (Tavelli et al., 2019, 2020) have rendered it the gold standard for root coverage (Barootchi et al., 2019, 2020; Mazzotti et al., 2018; Zucchelli et al., 2019). Therefore, future studies are needed for further validation of IDES, including different flap designs (e.g., the tunnel approach; Aroca et al., 2013; Tavelli et al., 2018; Zuhr et al., 2014) and grafting materials (e.g., acellular dermal or collagen matrices; Barootchi, Tavelli, Gianfilippo, et al., 2020; Stefanini, Mounssif, et al., 2020), as well as execution by less proficient clinicians.…”

Section: Discussionmentioning

confidence: 99%

“…Peri‐implant soft tissue dehiscence/deficiencies (PSTD) have become an emerging concern in the last decade. While this condition had already been observed in the early 1990s and in the beginning of the 2000s (Bengazi et al., 1996; Small et al., 2001), it is recently patients’ esthetic demands have increased such that even a minimal appearance of the grayish color of the implant component or an implant‐supported crown that is longer than its homologous contralateral tooth can be considered unacceptable, especially when it comes to the esthetic region (Roccuzzo et al., 2014; Tavelli et al., 2020; Zucchelli et al., 2019). The relatively high and heterogenous incidence of PSTD, ranging from 9% to 64% (Chen & Buser, 2014; Cosyn et al., 2012; Khzam et al., 2015; Mazzotti et al., 2018), is likely due to the large variety of factors that have been suggested to be associated with this condition (Mazzotti et al., 2018; Zucchelli et al., 2019).…”

Section: Introductionmentioning

confidence: 99%

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within‐ and between‐rater analysis of consistency in objective and subjective scores

Zucchelli

Clinical Oral Implants Res

et al. 2021

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Objectives To introduce an esthetic index for assessing the outcomes of peri‐implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within‐ and between‐reviewer reliability. Materials and Methods Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post‐treatment level of the soft tissue margin, peri‐implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables. Results Regression models showed reproducible esthetic evaluation among the examiners (inter‐reliability) and negligible intra‐reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters’ IDES values, and their subjective esthetic response, by the same raters. Conclusion The IDES showed persistent judgment among the 4 reviewers, and only a slight intra‐reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.

“…Nowadays, transgingival probing is one of the most common methods for assessing soft tissue thickness, as typically measured 1–3 mm apical to the soft tissue margin (Barootchi, Tavelli, Gianfilippo, et al, 2020; Barootchi, Tavelli, Zucchelli, et al, 2020; Tavelli, Barootchi, et al, 2020). However, this measurement does not represent the overall volumetric changes, but the variation in MT at a specific reference point (plane), which may not be representative of the overall volume gain/loss after a treatment.…”

Section: Discussionmentioning

confidence: 99%

Volumetric changes at implant sites: A systematic appraisal of traditional methods and optical scanning‐based digital technologies

J Clinic Periodontology

Majzoub

et al. 2020

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AimTo evaluate techniques for assessing soft tissue alterations at implant sites and compare the traditionally utilized methods to the newer three‐dimensional technologies emerging in the literature.Materials and MethodsA comprehensive search was performed to identify interventional studies reporting on volumetric changes at implant sites following different treatments.ResultsSeventy‐five articles were included the following: 30 used transgingival piercing alone, one utilized calliper, six with ultrasonography, six on cone‐beam computed tomography, and 32 utilized optical scanning and digital technologies. Optical scanning‐based digital technologies were the only approach that provided ‘volumetric changes,’ reported as volumetric variation in mm3, or the mean distance between the surfaces/mean thickness of the reconstructed volume. High variability in the digital analysis and definition of the region of interest was observed. All the other methods reported volume variation as linear dimensional changes at different apico‐coronal levels. No studies compared volumetric changes with different approaches.ConclusionsDespite the emergence of optical scanning‐based digital technologies for evaluating volumetric changes, a high degree of variation exists in the executed workflow, which renders the comparison of study results not feasible. Establishment of universal guidelines could allow for volumetric comparisons among different studies and treatments.