RESUMEN

BACKGROUND: Xenogenic collagen matrices (XCMs) are gaining popularity for soft tissue augmentation in dental implants; yet, gaps exist in our understanding of their comparative effectiveness. OBJECTIVE: This systematic review and meta-analysis focuses on studies that utilize soft tissue augmentation techniques for dental implants to improve keratinized mucosa width (KMW), soft tissue thickness (STT), and soft tissue volume (STV). We compared porcine collagen matrices with autogenous grafts when no bone grafts were utilized. MATERIALS AND METHODS: We searched databases such as PubMed, Scopus, and the Cochrane Central Register of Controlled Trials for randomized controlled trials and controlled clinical trials published between January 2013 and July 2023 that assessed the efficacy of XCM in peri-implant soft tissue augmentation. The primary outcome included KMW changes while the secondary outcome was STT/STV changes. Statistical analyses were conducted using a random- or fixed-effects model, and heterogeneity was assessed using I2 statistics. RESULTS: Nine studies were included in the qualitative analysis, and six were included in the meta-analysis. No significant intergroup differences were observed (p > 0.05), but a significant difference was observed in favor of KMW ≥ 2 mm. Heterogeneity among the studies varied at the 6- and 12-month follow-ups, with I2 values of 78% and 0%, respectively. The pooled mean difference between the XCM and autograft groups was -0.96 (-1.71 to -0.21), which shows that there was a larger increase in KMW in the autograft group compared with the XCM group (p < 0.05). CONCLUSIONS: Collagen matrices are less effective than autogenous grafts at increasing keratinized tissue and STT/STV, but the two techniques yield comparable aesthetic outcomes. Additional studies are necessary to better guide clinical practice and improve patient outcomes.

Asunto(s)

RESUMEN

Soft and hard tissue deficiencies around dental implants which can potentially compromise implant survival are commonly encountered. Complicated interventions are often required to address and resolve combinations of soft and hard tissue defects. This case report describes the management of peri-implant soft tissue fenestration accompanied by bony dehiscence associated with intrabony defect through soft tissue modification. A 51-year-old female was referred to the Periodontics and Oral Medicine Clinic with labial soft tissue fenestration at the maxillary left canine implant-supported crown. The patient complained of discomfort and malodor at the implant site. The implant showed mucosal fenestration and 6 mm probing depth (PD) with profuse bleeding at the distolabial site without mobility. A cone beam computed tomography (CBCT) demonstrated labial bony dehiscence associated with a 5.56-mm intrabony defect at mesial and distal surfaces. The implant was diagnosed as peri-implantitis with soft tissue deficiency. The treatment comprised oral hygiene instruction, debridement of the implant and all natural teeth, and mucogingival surgery with free connective tissue graft by the envelope technique. Two weeks after debridement, the mucosal margin of the implant disappeared, presenting soft tissue dehiscence of 4 × 4 mm. Mucogingival surgery was performed 3 weeks later. A 2-year follow-up revealed a stable mucosal margin with PD ranged 2-4 mm. In conclusion, modification of the soft tissue thickness around the implant together with excellent plaque control by the patient successfully maintained peri-implant health.

RESUMEN

This narrative review compares the peri-implant soft tissue responses around zirconia and titanium abutments in the aesthetic zone, emphasizing their mechanical, biological, and aesthetic properties. Titanium abutments, known for their excellent mechanical strength and fatigue resistance, have traditionally been the standard in dental restorations but face challenges in aesthetic integration due to their metallic appearance and potential for higher inflammatory responses. Zirconia abutments, emerging as a promising alternative, offer superior aesthetic outcomes, reduced plaque accumulation, and lower inflammatory responses, making them ideal for use in visible areas with thin soft tissue biotypes. However, zirconia's mechanical properties, such as lower fracture resistance, necessitate careful clinical application. The review also highlights rare instances of titanium allergies, underscoring the importance of individualized treatment planning and regular monitoring to ensure the longevity and success of implant restorations.

RESUMEN

AIMS: In the present case series, we performed implant surgery using a modified roll envelope technique and an apically repositioned flap (MRARF). To improve patients' peri-implant soft tissue phenotypes, they underwent dental implantation following the buccal contour concavities, inadequate keratinized tissue width, and soft tissue thickness simultaneously. MATERIALS AND METHODS: This case series includes four patients treated between July 2021 and February 2022 who received dental implants and GBR treatment six months earlier and were to be taken up for second-stage surgery. They were eligible for the MRARF technique if each implant site showed a labial and buccal deficiency and a reduced keratinized mucosa width than the adjacent teeth. Sutures were removed two weeks after surgery, and a provisional restoration was delivered. A final impression was taken at six weeks to produce the definitive implant-supported restoration. RESULTS: All surgery sites healed uneventfully, and no postoperative pain or excessive swelling was reported. The modified flap design allowed for increasing the width and thickness of keratinized mucosa with a minimally invasive technique. A harmonious color, texture, and mucogingival junction position that matched the surrounding tissue and adjacent teeth was achieved, and all patients were satisfied with the final results. CONCLUSIONS: MRARF at second-stage implant surgery could obtain satisfactory results regarding vertical and horizontal aesthetic gingival contours and an adequate width and thickness of keratinized mucosa around the implants.

RESUMEN

It has been said, 'Bone sets the tone, but tissue is the issue.' In the field of implantology, while significant breakthroughs have been achieved in hard tissue regeneration, clinicians find it more challenging to handle soft tissue complications around dental implants. Successfully managing soft tissue around dental implants requires clinicians to have comprehensive knowledge of proper implant placement, prosthetic design and tissue management, and a high level of surgical skills for soft tissue augmentation and grafting. Autogenous gingival grafts can be utilized in various clinical situations, providing surgeons with great potential and freedom to enhance the quality and quantity of peri-implant soft tissue. Emerging trends, such as digital tools for treatment planning, minimally invasive surgical approaches, and innovative biomaterials, can also contribute to a more pleasing outcome. By elucidating these multifaceted considerations, this review will serve as a valuable resource for clinicians aiming to achieve functional and aesthetic excellence in implant-based oral rehabilitation.

RESUMEN

Keratinized tissue augmentation around implants guarantees long-term success and maintenance of implant rehabilitations. Free gingival grafting is often described as the gold standard, especially when dealing with limited residual keratinized tissue height. Traditionally, an epithelio-conjunctive graft is harvested, either on the palate or the tuberosity, to reconstruct the missing keratinized soft tissues. This article introduces an innovative approach to increase keratinized tissue around implants, benefiting from second-intention gingival healing. This original surgical approach is interesting because it does not involve autogenous grafting or biomaterials. Its main goals are to enhance predictability while reducing the numerous per and post-operative risks related to autogenous harvesting. The success of this technique depends on the observance of fundamental principles: protection against bacterial contamination (immunocompetence of the patient), phenotypic induction (preoperative presence of keratinized tissue), space maintenance, and stabilization of flaps.

Asunto(s)

RESUMEN

PURPOSE: To investigate the effect of mid-buccal peri-implant keratinized mucosa width (KMW) ≥2 mm or peri-implant KMW >0 mm and <2 mm on the long-term outcomes of peri-implantitis reconstructive treatment. MATERIALS AND METHODS: Twenty-nine patients (40 implants; mean follow-up: 9.2 ± 1.4 years) with at least one implant affected by peri-implantitis and surgically treated through a reconstructive procedure followed by a submerged healing were included. Patients were categorized according to their initial KMW: Group 1 (KMW ≥2 mm) and Group 2 (KMW >0 mm and <2 mm). Peri-implant clinical and radiographic parameters and a dedicated composite outcome were assessed at different follow-up visits during supportive peri-implant therapy for up to 10 years. Regression analyses were utilized to identify possible risk/predictive indicators for probing pocket depth (PPD) change and treatment success at the latest follow-up. RESULTS: The mean PPD did not exhibit any statistical difference from the baseline to the latest follow-up between the groups at both patient and implant levels. Long-term treatment success was 46.6% (Group 1) and 42.6% (Group 2) at patient level, it was 42.8% (Group 1) and 33.3% (Group 2), respectively, at implant level (p > 0.05). Group 1 demonstrated significantly higher vertical defect depth reduction than Group 2 (p = 0.018). Presence of buccal bony wall and mean PPD at the baseline were found to be associated with mean PPD change, while KMW at 6 months following surgery was identified as the only significant indicator for treatment success (p < 0.05). CONCLUSION: Implants with KMW ≥2 mm did not present significantly better long-term clinical outcomes following reconstructive therapy than those exhibiting KMW >0 mm and <2 mm. However, KMW values at the end of healing phase following a submerged approach had a significant impact on long-term treatment success.

Asunto(s)

RESUMEN

This 10-year follow-up report describes the interdisciplinary comprehensive management of a patient with aneurysmal bone cyst of the maxilla in a 24-year-old patient. The treatment included resection and primary reconstruction with vascularized deep circumflex iliac artery-based composite free flap, implant placement, and peri-implant soft tissue management using denture-guided epithelial regeneration with interim dentures. Definitive management was done using implant-supported cast partial dentures, and the patient followed up for 10 years.

RESUMEN

PURPOSE: To evaluate the response of human peri-implant soft tissue (PIST) on different healing abutment materials 24 hours after positioning, by assessing the expression of genes related to the early connective tissue wound healing response. MATERIALS AND METHODS: Experimental abutments of 4 different materials (A): grade 4 titanium, (B) grade 5 titanium, (C) zirconia and (D) PEEK, were mounted on installed implants in 5 patients, four different abutments each. Before implant placement, a gingival biopsy (control-CT) was obtained using a 2 mm diameter punch (T0). After 24 hours (T24), PIST biopsies were collected using a specifically designed custom-made cutting device. Real-time PCR was performed to analyze the expression of the following genes: COL-I, COL-III, MMP-1, TIMP-1,TGF-b1, FN, ITGA4, ITGA5, ITGB1, RAC-1, COL-IV, aSMA, IL-6 and CXCL-1. RESULTS: Gene expression analysis showed some differences between CT and abutment of different materials, although no significant differences were detected comparing the experimental groups. COL-I was significantly down-regulated in groups A and C compared to CT. MMP-1 and TIMP-1 increased in all the experimental groups, although at a lower extent in group A. FN, RAC-1, COL-IV and aSMA were down-regulated, especially in group A, in which CXCL-1 and IL-6 showed the lowest expression. CONCLUSIONS: The results of grade 4 titanium and zirconia abutments seem to be promising, since a lower expression of genes related with inflammation, myofibroblasts activation and ECM remodeling was observed when compared with grade 5 titanium and PEEK, without triggering a pro-fibrotic response in the early phases of PIST repair.

RESUMEN

OBJECTIVE: The primary objective of this review is to compare autogenous soft tissue grafts (connective tissue graft - CTG and free gingival graft-FGG) with different type of matrices (acellular dermal matrix-ADM, xenograft collagen matrix-XCM, volume-stable collagen matrix-VCMX) used to increase peri-implant soft tissues. MATERIALS AND METHODS: A search on electronic databases was performed to identify randomized and non-randomized controlled trials (RCTs and CCTs, respectively) with either parallel or split-mouth design, and treating ≥ 10 patients. A network meta-analysis (NMA) was used to compare different matrices. Soft tissue thickness dimensional changes and keratinized width (KMW) changes were the primary outcome measures. The secondary outcomes were to evaluate: a) PROMs; b) volumetric changes; c) surgical operating time; and d) different periodontal measurements. RESULTS: A total of 23 studies were included in the qualitative analysis, and 16 studies (11 RCTs and 5 CCTs) in the quantitative analysis. A total of N = 573 sites were evaluated for NMA. CTG resulted the best material for increasing peri-implant soft tissue thickness, at 180 and 360 days after surgery. The use of an ADM showed good results for buccal thickness increase, primarily in the first three months after surgery. Vestibuloplasty + FGG resulted in the most effective technique for peri-implant KMW augmentation, after 180 days. CONCLUSIONS: While CTG demonstrated better performance in all the comparison and FGG showed to be the best graft to increase keratinized mucosa up to 90 days, ADM and VCMX may be used to increase soft tissue horizontal thickness with lower patients' morbidity. LIMITATIONS: The limits of this NMA are the following: a) limited number of included studies; b) high heterogeneity among them (number of patients, treatment sites, surgical techniques, outcome measures, and follow-ups). CLINICAL RELEVANCE: Many studies compared the efficacy of autogenous and non-autogenous grafts in terms of gingival thickness, volume, and keratinized width increase. However, there is still not clear overall evidence on this topic. This NMA helps clinicians to choose the right material in different peri-implant soft tissue procedures. Recommendations for future studies are mandatory.

Asunto(s)

RESUMEN

AIM: The aim of the present retrospective case series was to longitudinally assess soft tissue volume changes on the vestibular aspect of implants in relation to keratinized mucosa thickness (KMT) and width (KMW) after the application of the microsurgical envelope technique combined with a connective tissue graft (CTG). MATERIALS AND METHODS: A total of 12 healthy patients received 12 dental implants placed either in the posterior maxilla or mandible. The study involved the harvesting of 12 CTGs with a minimally invasive single-incision technique, grafted to the vestibular peri-implant soft tissue utilizing the envelope technique, followed by the insertion of 12 screw-retained IPS e.max crowns. RESULTS: The healing process was uneventful across all areas, and all patients were followed up for a period of 5 years. The evaluation of KMT showed the highest decrease in the first 6 weeks after surgery (5.5 ± 0.79 to 4.59 ± 0.62 mm), then dropped slightly to 4 ± 0.85 mm, after which it maintained at 4 ± 0.36 mm until the 2-year time point. Between the second and third years after surgery, a further decrease of 3.59 ± 0.42 mm was recorded for KMT, which then remained constant until the end of the 5-year research period. The observations regarding KMW were slightly different, with the measurements demonstrating the greatest decrease in first 6 weeks (from 2.5 ± 0.42 to 1.5 ± 0.42 mm), which was maintained until the 1-year time point. Between the first and second years after surgery, the KMW increased to 2 ± 0.60 mm and remained level for the next 3 years, at 2 ± 0.85 mm. CONCLUSIONS: The current research demonstrated the advantages of using a combination of a minimally invasively harvested CTG and the microsurgical envelope technique for a duration of 5 years.

Asunto(s)

RESUMEN

PURPOSE: The purpose of this cross-sectional clinical study was to determine and compare alveolar ridge mucosa thickness at crestal, buccal, and lingual locations of the maxillary and mandibular arches in completely edentulous patients using a dedicated, ultrasonic gingival scanner. MATERIALS AND METHODS: Thirty-eight completely edentulous subjects were included in the study. In each subject, soft tissue thickness was measured at 28 sites of the edentulous ridge by a single calibrated examiner. Intra-observer reliability was calculated with Intraclass Correlation Coefficients by measuring 10 subjects twice, after 1 week. Measurements (mm) were taken at the buccal, lingual, and crestal aspects of the ridge with a dedicated ultrasonic scanner. Repeated measures ANOVA and paired t-tests were used to compare the mean buccal, lingual, and crestal soft tissue thicknesses at each site. The Generalized Estimating Equations model was used to study the effects of age, sex, and race. Confidence level was set to 95%. RESULTS: Mean tissue thickness ranged from 0.96  to 1.98 mm with a mean of 1.63 ± 0.25 mm. Intraclass Correlation Coefficients were > 0.97. No significant differences between buccal, crestal, and lingual sites were noted for the mandibular arch as well as at 4 sites on the maxillary arch (maxillary right second molar, maxillary right canine, maxillary left first premolar, maxillary left second molar). However, significant differences in soft tissue thickness were noted for all remaining maxillary sites. Race was found to be positively correlated with tissue thickness, with Black individuals showing a significantly greater thickness than White individuals at 4 sites (maxillary right first molar, maxillary left canine, mandibular right second premolar, mandibular right first molar). Age was found to be positively correlated with tissue thickness at 4 sites (maxillary left central incisor, maxillary left first molar, maxillary left second molar, mandibular left second premolar) and negatively correlated at 2 sites (mandibular right canine, mandibular right second molar). Female sex was positively (maxillary left second premolar, maxillary left second molar) and negatively (mandibular right canine) correlated, respectively, with tissue thickness at 3 sites. When data for anterior and posterior sites were respectively pooled, tissue thickness was significantly less at anterior sextant lingual and crestal sites, while no difference was seen for buccal sites. CONCLUSION: Statistically significant differences for alveolar ridge mucosa thickness were found at several sites in the maxilla and between anterior and posterior sextants for lingual and crestal sites in the maxillary and mandibular arches. Tissue thickness differences were also noted for race with Black individuals showing greater tissue thickness at some sites. Age and sex did not show a clear effect on tissue thickness. Recorded differences in tissue thickness were however small and appear of uncertain clinical significance.

Asunto(s)

RESUMEN

INTRODUCTION: To evaluate the 10-year clinical outcomes following surgical treatment of shallow isolated peri-implant soft-tissue dehiscences (PSTD) at single tissue level dental implants. METHODS: The baseline population included 16 patients (16 implants) displaying an isolated peri-implant maxillary buccal soft-tissue dehiscence. The recipient bed was prepared with a minimally-invasive split-thickness flap limited to the buccal aspect to stabilize the tuberosity connective tissue graft (CTG) onto the periosteum. At the end of treatment, patients were enrolled in an individualized supportive peri-implant care (SPC) program. The aesthetic outcome was evaluated on photographs by three clinicians using a visual analog scale (VAS). RESULTS: SPC during the 10-years proceeded uneventfully in all patients. A total of 12 patients completed the 10-year examination, as 3 patients dropped-out and 1 implant was lost. Complete PSTD coverage was obtained at 7 implant sites (i.e., 58%) while the mean PSTD coverage amounted to 89.6% ± 17.1% without statistically significant differences between 1 and 10 years (p > 0.05). Stable peri-implant parameters (i.e., PD and BoP) and full-mouth scores (i.e., FMPS, FMBS) were recorded throughout the observation period (p > 0.05). The aesthetic improvements obtained in the short-term were maintained up to 10 years. CONCLUSION: Within their limits, the present results indicate that the proposed surgical technique is a simple and reliable treatment option for the treatment of single maxillary buccal PSTDs in selected cases with positive results up to 10 years in patients under regular SPC (NCT04983758-this clinical trial was not registered prior to participant recruitment).

Asunto(s)

RESUMEN

INTRODUCTION: Dental implants are frequently preferred method for oral rehabilitation all over the world. The incidence of various complications such as incorrect prosthesis, peri-implant mucositis, and peri-implantitis is high; premature loss of implants is encountered due to osteointegration process not being completed for some unexplained reasons. However, there is no study in the literature examining the nonfunctional period of implants. Closure screws of different implant companies have different designs like surface properties, and areas, where closure screws sit, are important reservoirs for microorganism colonization. Our study aims to evaluate the inflammatory response, epithelial maturation, and epithelial-connective tissue interaction around closure screws. METHODS: For this purpose, 52 implants belonging to five different implant companies were included in the study. Tissues removed over the cover screw during fitting of healing caps were used as biopsy material and for epithelial proliferation Ki-67, for epithelium-connective tissue interaction Syndecan-1, and for macrophage activation CD-68 expressions were evaluated by immunohistochemical analysis. Scanning electron microscopy (SEM) analyzes were performed to evaluate the presence of gap between the implant and the cover screw. RESULTS: As a result of our study, intensity of subepithelial inflammation between groups wasn't statistically different. Differences in CD-68 and Syndecan-1 levels were obtained at the lamina propria level. H score of CD-68 was statistically significantly different in epithelium (p = 0.032), and H score of Syndecan-1 was different in lamina propria (p = 0.022). There wasn't a statistically significant difference between the groups for Ki-67 (p = 0.151). CONCLUSION: Our study results indicate that in addition to the implant surface morphology, the design of the closure screws is important in the inflammatory response and epithelial maturation that develops during wound healing. Although the inflammatory response is required for healing, osteointegration, and implant survival, further investigation is needed to investigate the relationship between initial neck resorption and closure screws with radiographic and microbiological examinations.

Asunto(s)

RESUMEN

OBJECTIVES: The objective of this study, which included a 5-year follow-up, was to compare peri-implant soft tissue health, crestal bone loss (CBL), and buccal bone thickness (BBT) around triangular cross-section neck (TN) or round neck (RN) implants, using cone-beam computed tomography. MATERIALS AND METHODS: This study was initially designed as a prospective 1-year randomized controlled study and then extended with a 5-year retrospective evaluation of clinical and radiographic records. In the initial 1-year study, a total of 20edentulous patients receiving 40 implants with similar diameters were randomly assigned to the RN or TN groups using a split-mouth design. Pocket probing depths (PPD), plaque index (PI), and gingival index (GI) were recorded at postoperative month 12. CBL and BBT at three levels (0, -2, and -4 mm) were evaluated 1 year after insertion. Five years after insertion, PPD, PI, GI, CBL, and BBT were recorded as patients were recalled for clinical and radiographic monitoring. RESULTS: Nineteen patients completed the study. After 5 years, no significant differences in PPD, PI, and GI scores and BBT values between the two groups (p > .05). The mean ± SD CBL values at the final follow-up visit were -0.71 ± 0.69 mm for TN and -1.03 ± 0.86 mm for RN (p < .01). CONCLUSIONS: These results suggest better crestal bone preservation using implants with TN when compared to RN after a 5-year follow-up. However, TN showed similar results to RN regarding peri-implant soft tissue health and BBT.

Asunto(s)

RESUMEN

BACKGROUND: It is well established that nanotopography and wettability of implant surfaces contribute to osseointegration and long-term implant success. However, the effects of a hydrogenated surface with nanotubular and superhydrophilic properties on peri-implant soft tissue remain unclear. This study was designed to study the impact of a modified abutment surface on early soft tissue integration compared with a machined surface. METHODS: Thirty-six implants were placed at the bone level in the bilateral mandible of six beagles, followed by healing abutments belonging to the standard machined Ti-6Al-4V alloy abutments (TC4-M), anodized abutments with nanotubes (TC4-Nano), and hydrogenated abutments (TC4-H/Nano) groups, which were randomly screwed to the implants. After two and four weeks of wound healing, the animals were euthanized for histological evaluation. RESULTS: A superhydrophilic nanotubular surface developed on the hydrogenated abutment. Histological and histometric analyses revealed similar peri-implant soft tissue healing and dimensions for the three types of abutments at two and four weeks. Connective tissue (CT) length was longer around TC4-H/Nano abutments compared with standard abutments; however, the differences were not statistically significant. Moreover, collagen fibers in the TC4-H/Nano group extended and were attached perpendicularly to the superhydrophilic surface. CONCLUSIONS: Our results revealed that the soft tissue interface adjacent to the hydrogenated abutment is comparable to that of the machined abutment. A tendency of increased CT length and perpendicular collagen fibers was observed around the modified abutment. This study suggests that nanotubular/superhydrophilic surfaces could be a promising modification to enhance soft tissue sealing. However, comprehensive studies should be conducted to evaluate the peri-implant soft tissue around the modified abutment immunohistochemically, histopathologically, and clinically.

Asunto(s)

RESUMEN

OBJECTIVES: The aim of this study was to assess the following PIO question: In adult patients treated with an indication for single tooth extraction in the maxillary esthetic zone (15-25), what is the influence of an immediate implant placement and immediate loading protocol on the clinical performance (primary aim) and esthetic outcomes (secondary aim) focusing on investigations published after 2010. MATERIAL AND METHODS: An electronic search in Medline (PubMed), the Cochrane Central Register of Controlled Trials, and EMBASE databases up to April 2022 was performed to identify clinical studies investigating the outcome of single implants subjected to immediate placement with immediate restoration/loading (Type 1A). RESULTS: Sixty-three studies (10 randomized controlled trials, 28 prospective and 25 retrospective cohort studies) were included with a follow-up ranging from 12 to 96 months. One thousand nine hundred sixty-one implants reported survival rates of 99.2 (98.6-99.5) % at 1 year, 97.5 (95.9-98.4) % after 3 years, and 95.8 (93.3-97.4) % after 5 years; 1064 immediately loaded restorations presented survival rates of 98.9 (97.8-99.5) % after 1 year, 96.8 (93.6-98.4) % after 2 years, and 94.8 (89.6-97.4) % after 5 years. Comparing baseline to 12-month data using the Hedges' g effect size (95% CI), papilla height presented an overall effect size of -0.71 (-1.25, -0.1) mm, midfacial recession change of -0.15 (-0.66, 0.36) mm, and a 0.82 (0.37, 1.28) gain in PES. CONCLUSIONS: Immediate implant placement and immediate loading can be considered a predictable and safe treatment option for single maxillary anterior restorations with adequate survival rates and favorable esthetics outcomes for up to 5 years.

Asunto(s)

RESUMEN

The present pilot study was designed by hypothesizing a possible correlation between lack of accuracy in implant placement and peri-implant hard and soft tissue health. A total of five patients underwent computer-guided implant surgery and full-arch immediate loading between 2013 and 2014. They subsequently underwent postoperative cone-beam computed tomography (CBCT). After a follow-up of 5 years, all patients were recalled for a clinical-radiographic evaluation of peri-implant health status. The mean linear deviation was 0.5 ± 0.2 mm at the implant's head and 0.6 ± 0.2 mm at the implant's apex, while the mean angular deviation of the long axis was 2.8° ± 1.2°. A mean marginal bone loss (MBL) of 1.16 ± 0.94 mm and 2.01 ± 1.76 mm was observed after 1 and 5 years of follow-up, respectively. At 5 years, the mean peri-implant probing depth (PPD) was 4.09 ± 1.44 mm, 66.6% of the evaluated implants showed peri-implant bleeding on probing (BOP), keratinized mucosa (KM) was <2 mm in 48.4% of cases, and mucosal recession (REC) ≥ 1 mm was assessed in 45.4% of the included implants. A negative correlation was observed between bucco-palatal/lingual linear inaccuracy and MBL, PPD, BOP, and KM.

RESUMEN

Bone regenerative procedures have been widely proved to be a reliable treatment option to re-create the ideal pre-implant clinical conditions. Nevertheless, these techniques are not free from post-operative complications which might result in implant failure. Consequently, as demonstrated by the increasing recently published evidence, a careful pre- and intra-operative flap evaluation to ensure an ideal and hermetic tension-free wound closure is of paramount importance to successfully treat bony defects. In this respect, several surgical interventions mainly aimed to increase the amount of keratinized mucosa either to allow an optimal healing after a reconstructive procedure or to establish an optimal peri-implant soft tissue seal have been proposed. The present review summarizes the level of evidence on the surgical clinical aspects which have an impact on the soft tissue handling associated with bone reconstructive procedures and on the importance of soft tissue conditions to enhance and maintain peri-implant health in the long-term.

Asunto(s)

RESUMEN

PURPOSE: The aim of the present study was to evaluate the long-term effectiveness of a xenogeneic collagen matrix (CM) in pre-prosthetic augmentation of the keratinized mucosa width (KMW) at implant sites. METHODS: All of the patients with localized implant-supported rehabilitation previously treated with vestibuloplasty and KMW augmentation with a non-cross-linked porcine CM were recalled. KMW was measured clinically in an apico-coronal direction from the mucogingival junction to the mucosal margin at the prosthetic zenith of each crown. Measurements were performed clinically by means of a PCP-UNC15 periodontal probe and rounded to the nearest mm. KMW values recorded at 1 year, 5 and 10 years from the soft tissue augmentation procedure were compared using a one-way repeated-measures ANOVA with Bonferroni multiple comparison post-hoc analysis. The level of significance was set at 0.05. RESULTS: Measurements were conducted on 13 patients. All implants were in function with no signs of biological complications. All except one implant site showed KMW ≥ 2 mm. KMW decreased significantly from 1 year (3.33 ± 1.11 mm) to 5 years (2.77 ± 0.92 mm) (p = 0.001), and finally remained stable from 5 to 10 years (3.2 ± 0.99 mm) (p = 0.607). From a visual aspect, peri-implant soft tissues were characterized by a good texture and color blending compared to the adjacent teeth, highlighting good integration of the remodeled tissues and stability of the esthetic result. CONCLUSIONS: The use of a CM in pre-prosthetic soft tissue augmentation at implant sites has proven to be effective in obtaining and maintaining at least 2 mm of KMW around dental implants over a follow-up of 10 years.

Asunto(s)