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OBJECTIVES: The objective of this long-term retrospective study was to evaluate the fracture rate and the risk factors associated with the fracture of 3.3 mm narrow diameter implants (NDIs). MATERIALS AND METHODS: A total of 524 records of patients rehabilitated with 3.3 mm NDIs between 1997 and 2015 were assessed. Data on patients, implants, and prostheses were collected, and descriptive analysis of the variables was performed. NDIs were separated into 2 groups: "fractured" and "non-fractured", and a multilevel logistic regression model was applied to identify the risk factors associated with NDI fracture. RESULTS: Eighty-four patients were removed from the analysis for interrupting follow-up or presenting failures other than fractures. Of the 440 patients included (64.66 ± 13.4 years), 272 were females (61.8%), and 168 males (38.2%), and mean follow-up time was 129 ± 47.1 months. Of the 1428 NDIs, 15 (1.05%) in 9 patients (2.04%) fractured during the studied period. Ten fractures (66.66%) happened in 6 patients (66.66%) showing signs of parafunction. NDI with modified sandblasted, large grit, acid-etched surface was the only implant variable to show a protective statistical significance (p = .0439). CONCLUSIONS: NDI fracture was a rare event in the studied sample. NDIs manufactured with modified sandblasted, large grit, acid-etched surface may provide extra protection against NDI fracture. Patient-specific factors and implant characteristics should be carefully considered to limit the risk of fracture of 3.3 mm NDIs.

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OBJECTIVES: To investigate long-term alveolar ridge bone changes in patients treated with the split-crest technique (SCT) with simultaneous implant placement. MATERIALS AND METHODS: Alveolar ridge width (ARW) was measured with a caliper immediately before (ARW1) and after SCT (ARW2) with a caliper. Existing CBCT scans taken at least 5 years postoperatively were used to assess the healed ARW (ARWF), buccal bone thickness (BBT), and lingual/palatal bone thickness (L/PBT) at 0, 3, and 5 mm apically from implant platform level (IPL). The distance between IPL and buccal bone crest (IPL-BBC) was also measured. Findings were compared with Wilcoxon and Student's t tests (p < .05). RESULTS: Records of thirty patients with 85 implants were included. Eleven patients (31 implants) presented CBCT scans taken in two separate occasions, resulting in 116 measurements. Tomographic follow-up ranged from 5 to 18 years (11.5 ± 4.18 years). Mean ARW increased from 3.2 ± 0.6 to 6.6 ± 0.48 mm after SCT, but significantly reduced overtime to 4.46 ± 0.83 mm (ARWF) (p < .0001). Mean BBT was 0.5 ± 0.9, 1.3 ± 0.9, and 2.0 ± 1.2 mm, while mean L/PBT was 0.9 ± 0.7, 1.6 ± 0.9, and 2.1 ± 1.0 mm at 0, 3, and 5 mm from IPL, respectively. IPL-BBC distance varied up to 8.7 mm (1.4 ± 2.0 mm), with 56/116 measurements (51/85 implants) showing IPL-BBC = 0 mm. CONCLUSION: Although SCT with simultaneous implant placement can predictably increase ARW postoperatively, ARW tended to significantly reduce over time, due to reductions in BBT and L/PBT, especially coronally. Nonetheless, 60% of the implants still presented some buccal bone at IPL.

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This article forms part of the themed issue on dental implants, with the general dentist being the main intended reader and with particular relevance to primary care dental professionals. It aims to describe the various characteristics of the implant in health, address contemporary developments in implant dentistry and offer some novel insights on the prevention of peri-implant diseases. A healthy implant exhibits specific histological, clinical and radiographic characteristics. Understanding such aspects leads to proper diagnosis and measures to maintain tissue integrity and prevent the development and progression of peri-implant diseases. Moreover, internationally and widely accepted definitions and recommendations based on expert consensus have been put forward to guide day-to-day clinical practice. This information should provide general practitioners with the means necessary to achieve the best possible outcome for their patients.

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Water is a scarce, strategic resource and the most important input for economic development, especially in agricultural countries such as Brazil. Cocoa production is directly related to water availability, and, as climate changes, selecting drought-tolerant genotypes is vital to keep cacao crops sustainable. Here, we evaluated cacao genotypes under irrigated and water-stressed conditions and selected drought-tolerant ones based on nutritional and physiological traits. Thirty-nine genotypes were monitored for three years for agronomic traits and higher fruit yield. After this evaluation, the 18 most promising genotypes were evaluated in a randomized block design, under a 2 (with and without irrigation)  ×  18 (genotypes) factorial arrangement, with three replicates and five plants per plot. We evaluated seven physiological and 11 nutritional traits, selecting genotypes based on the Genotype-by-Trait Biplot approach. Significant effects (p < 0.05) were observed for the nutritional traits N, P, Mg, S, Zn, Cu, Mn and for the physiological traits CO2 assimilation rate (A), stomatal conductance (gs), transpiration (E), intercellular and atmospheric CO2 concentrations (Ci/Ca), intrinsic water use efficiency (A/gs), instantaneous water use efficiency (A/E), and instantaneous carboxylation efficiency (A/Ci), as determined by analysis of variance. The genotype  ×  irrigation treatment interaction was significant (p < 0.05) for the traits A, gs, and E. Genotypes CP 41, CP 43, and CCN 51 exhibited superior performance for both nutritional and physiological traits (A, gs, and E). In the irrigated environment, CP 41 showed superiority in traits such as P, A/E, A/gs, Mn, S, and Zn. Conversely, under non-irrigated conditions, CP 43 exhibited better performance in nutritional properties, specifically Mn, Mg, and Zn. Notably, in both irrigated and non-irrigated environments, CCN 51 excelled in key physiological traits, including A/Ci, A/E, and A/gs. This robust performance across diverse conditions suggests that these three genotypes possess physiological mechanisms to endure water-stressed conditions. Our research can generate valuable insights into these genotypes informing suitable choices for cocoa cultivation, especially in the context of global climate change.

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PURPOSE: The objective of this retrospective study was to evaluate the effect of the interproximal contour of single external hexagon implant restorations on the prevalence of peri-implantitis. MATERIAL AND METHODS: Records of 96 patients and 148 external hexagon (EH) implants with time in function ranging from 1 to 17 years were included in the study. The most recent clinical and radiographic data were collected from records and the prevalence of peri-implantitis was defined according to the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Marginal bone level (MBL), emergence angle (EA), emergence profile (EP), and crown/implant platform horizontal ratio (CIHR) were obtained from periapical radiographs. Dichotomous variables at the patient- and implant level were compared with association tests. Mann-Whitney U-Test was performed to compare continuous quantitative values between the studied groups. Binomial logistic regression was conducted to identify risk indicators associated with the peri-implantitis event at the patient- and implant level, with the significance level set at 5% for all tests. RESULTS: Nineteen patients (19.2%) and 24 implants (16.2%) with a mean time in function of 5.0 ± 4.7 years were classified as having peri-implantitis. No statistically significant differences concerning gender, mean age, implant location in the jaw, or time in function were observed between patients with or without peri-implantitis (p > 0.05). Of 24 implants with peri-implantitis 10 (41.7%) displayed EA ≤ 30° (16.4%) while 14 (58.3%) presented EA > 30° with no statistical difference between the groups (p > 0.05). No statistically significant associations were identified between EA, EP, or CIHR and the prevalence of peri-implantitis. CONCLUSION: The findings seem to indicate that the EA, EP, and CIHR of single restorations over external hexagon implants are not associated with the presence of peri-implantitis. However, prospective studies with larger samples are required to better ascertain such an association in the long term.

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KEY MESSAGE: We propose an "enviromics" prediction model for recommending cultivars based on thematic maps aimed at decision-makers. Parsimonious methods that capture genotype-by-environment interaction (GEI) in multi-environment trials (MET) are important in breeding programs. Understanding the causes and factors of GEI allows the utilization of genotype adaptations in the target population of environments through environmental features and factor-analytic (FA) models. Here, we present a novel predictive breeding approach called GIS-FA, which integrates geographic information systems (GIS) techniques, FA models, partial least squares (PLS) regression, and enviromics to predict phenotypic performance in untested environments. The GIS-FA approach enables: (i) the prediction of the phenotypic performance of tested genotypes in untested environments, (ii) the selection of the best-ranking genotypes based on their overall performance and stability using the FA selection tools, and (iii) the creation of thematic maps showing overall or pairwise performance and stability for decision-making. We exemplify the usage of the GIS-FA approach using two datasets of rice [Oryza sativa (L.)] and soybean [Glycine max (L.) Merr.] in MET spread over tropical areas. In summary, our novel predictive method allows the identification of new breeding scenarios by pinpointing groups of environments where genotypes demonstrate superior predicted performance. It also facilitates and optimizes cultivar recommendations by utilizing thematic maps.

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OBJECTIVE: This retrospective case series aimed to assess the stability of the papilla around four single crowns supported by narrow-diameter implants replacing all maxillary incisors. Secondary objectives included assessment of marginal bone level stability, incidence of technical and biological complications, and patient satisfaction. MATERIALS AND METHODS: Individuals with four adjacent implants in maxillary incisor sites, placed with a 3 mm inter-implant distance and rehabilitated with single crowns were included. Retrospective data were obtained from photographs and radiographs taken at the delivery of the prosthesis (baseline-T0). Patients were then recalled (≥2 years after T0) for clinical and radiographic examination (follow-up-T1). Photographs were obtained and patient satisfaction was assessed using a visual analogue scale. Papilla height and marginal bone level were compared over time. RESULTS: Data from 10 patients with medium-low smile lines and rehabilitated with 40 implants, in function for 5.4 ± 1.9 years, were analyzed. The papilla height between implants (T0: 2.3 ± 0.9 mm; T1: 2.6 ± 0.7 mm; p = .011) and between tooth and implant (T0: 3.4 ± 0.9 mm; T1: 3.8 ± 0.8 mm; p = .025) increased significantly over the years. The marginal bone level remained stable over time (T0: 0.88 ± 0.57 mm; T1: 0.71 ± 0.67 mm; p = .007). Patients were highly satisfied (97.7 ± 0.3%) with the treatment outcome. CONCLUSION: Within its limitations, this study demonstrated that four single implant-supported crowns placed at maxillary incisor sites may exhibit soft tissue and marginal bone stability over a long period of time. This treatment approach, however, should be restricted to few patients as it requires a proper case selection and skillful execution of all surgical and prosthetic steps.

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Following tooth extraction, a sequence of events takes place in order to close the wound and restore tissue homeostasis, a process called socket healing. The outcome of socket healing includes a marked reduction of the ridge dimensions. The amount of tissue loss that occurs during healing is influenced by several local and systemic factors. Thus, the aim of the present review was to describe the effect of anatomical characteristics of the alveolar process and basal bone on the socket healing outcome. The studies included showed that the quantity (number) and quality (composition) of socket walls exhibited a significant influence on the ridge diminution. A damaged socket (3 walls or less), as well as a thin buccal bone wall, which quickly resorbs negatively affected the healing outcome. Periodontally compromised sockets appeared to promote more extensive dimensional changes. Angulation between tooth and basal bone in addition to basal bone dimensions may also have altered the wound environment and influenced socket healing. The findings from the present review suggest that some anatomical characteristics of the alveolar process and basal bone have an effect on socket healing.

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BACKGROUND: There is limited information on the diagnostic accuracy of the transparency method to diagnose gingival phenotypes taking into consideration not only the gingival thickness (GT) but also the keratinized tissue width (KTW). Thus, the aim of the present study was to compare the diagnostic accuracy of two transparency methods using a conventional steel probe (SP) and a plastic color-coded probe (CCP) to identify thin and thick gingival phenotypes. METHODS: Maxillary anterior teeth (n = 300) of 50 individuals were included in this study. The GT was measured via transgingival assessment at 2 mm apical to the gingival margin. Tooth sites were subdivided into thin or thick phenotypes according to the corresponding GT, respectively, ≤1 mm and >1 mm. SP and CCP were used to determine the gingival phenotype by the transparency method. The KTW was also evaluated. The diagnostic accuracy of the experimental periodontal probes to identify the thin and thick gingival phenotypes were compared. RESULTS: Of 300 gingival sites evaluated, 57% (n = 172) were identified as thin (GT: 0.82 ± 0.12 mm, KTW: 4 ± 1.2 mm) and 43% (n = 128) as thick phenotypes (GT: 1.16 ± 0.12 mm, KTW: 4.3 ± 1.3 mm) by the transgingival method. The SP and CCP were very sensitive (>0.94) to identify the thin phenotype, however, less specific (0.35-0.39) to diagnose thick phenotype. The diagnostic accuracy for the SP and CCP was similar, 0.69 and 0.70, respectively. CONCLUSION: The steel and color-coded plastic probe were equally effective in identifying thin gingival phenotype at maxillary anterior tooth sites.

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The aim of this systematic review was to evaluate the benefit of ridge preservation (RP) with minimally invasive (MI) approaches with or without concomitant implant placement on morbidity, esthetics, and patient-related outcomes. Three Internet sources were used to search for appropriate papers. The search strategy was designed to include any clinical study published on RP with MI approaches such as flapless surgery, socket shield and socket sealing techniques and, use of biological agents. Characteristics of the individual studies, regarding methodological aspects, quantitative and qualitative data were extracted. The potential risk of bias was estimated, and the acquired evidence was graded. Independent screening of 860 reports resulted in 26 included original articles. Nine publications evaluated MI approaches for RP without concomitant implant placement. Eleven studies evaluated interventions for RP with immediate implant placement (IIP). Six studies compared RP with IIP vs RP without IIP. This systematic review found that MI approaches in most of the studies failed to improve clinical variables regarding morbidity, esthetics, and patient-related outcomes. Based on the limited number of studies analyzed and the methodological discrepancies observed, it is not possible to confirm that MI approaches promote a significant benefit when applied to RP procedures.

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Cowpea is a widely cultivated crop in the world. Biofortification strategies aim to reduce mineral and protein deficiencies, especially among the poorest people. The aim of this study was to estimate adaptability and stability of cowpea genotypes for iron, zinc and protein contents, through GGE biplot analysis. Twenty cowpea genotypes were evaluated in the municipalities of Piauí Monsenhor Hipólito, Pio IX and São Miguel do Tapuio, under rainfed conditions. The experimental design was a randomized block design with four replications. The traits evaluated were grain yield, iron, zinc and protein contents in dry grains. Iron (Fe) and zinc (Zn) were determined by flame atomic absorption spectrophotometer, and protein contents by Kjeldahl methods. Adaptability and stability were evaluated by GGE biplot analyses. The means of the experiments were 1,209.1 kg ha-1, 51.1 mg kg-1, 46.8 mg kg-1 and 24.3% for grain yield, Fe, Zn and protein contents, respectively. The joint analysis of variance showed significant difference (p < 0.05) for the effect of interaction genotypes by environments for Fe, Zn and protein contents. The lines G6 and G8 were the most promising for grain yield, mineral and protein content through adaptability and stability by GGE biplot approach.

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OBJECTIVES: The aim of this cross-sectional study was to evaluate the effect of brushing discomfort (BD) on peri-implant health in sites exhibiting inadequate keratinized mucosa (KM) width. MATERIAL AND METHODS: Patients presenting with at least one implant exhibiting KM <2 mm and in function for ≥1 year were eligible for inclusion. BD was assessed with the visual analogue scale (VAS), and implants were classified into two groups: Absence (aBD; VAS = 0) or Presence (pBD; VAS > 0) of BD. Bleeding on probing (BoP), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), suppuration (Sup), and marginal bone level (MBL) were recorded. Mann-Whitney, chi-square test, and a multilevel model were used for analysis. RESULTS: Fifty-nine patients with 155 dental implants were analyzed, of which 60 presented no BD, and 95 presented some level of BD. BoP, PD, CAL, and MBL were significantly higher in the pBD than in the aBD group (p < .05). The prevalence of peri-implant diseases at implant level was also higher in the pBD group than in the aBD group. However, after controlling for confounding factors, only mPI showed an effect on BoP. In addition, difficulty to perform oral hygiene was statistically higher in the pBD group. CONCLUSIONS: The findings of the present study suggest that although BD around implants exhibiting KM <2 mm did not influence tissue inflammation, it could represent a symptom of peri-implant diseases. Further clinical trials assessing the long-term effect of BD must be considered to better ascertain its effects on peri-implant health.

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OBJECTIVE: The objective of this four-year cohort prospective study was to evaluate the effect of inadequate access to peri-implant hygiene on marginal bone level (MBL). MATERIAL AND METHODS: Forty-one partially edentulous patients (16 males and 25 females, aged 49.8 ± 11.9 years) who had implants with at least one year in function were selected. Patients were clinically and radiographically evaluated at three different times: baseline (T0), 2-year (T1), and 4-year (T2) follow-up intervals. At baseline, implants were classified and allocated into two groups: those presenting adequate access (ACC) and inadequate access (no-ACC) to peri-implant hygiene. A linear mixed-effects model for clustered longitudinal data was used to analyze MBL, probing depth (PD), plaque index (PI), and bleeding on probing (BoP). RESULTS: Of 131 implants, 74 were considered as having ACC, and 57 as having no-ACC at T0. Implants in the no-ACC group presented a statistically greater mean MBL measurement at T2 than implants in the ACC group (p = .011). In the no-ACC group, a significant reduction in PD from T0 to T1 (p = .019) and from T0 to T2 (p = .010) was observed. Regardless of the group, PI significantly increased at both T1 (p = .00001) and T2 (p = .00004). Regardless of time, the prevalence of BoP was significantly higher in the no-ACC group than in the ACC group (p = .012). CONCLUSION: Inadequate access to peri-implant hygiene frequently resulted in more peri-implant inflammation and MBL over time. Proper accessibility to peri-implant hygiene should be carefully considered during planning of implant restoration, and patients properly motivated into maintenance care.

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BACKGROUND: The triclosan-containing dentifrices are effective in controlling biofilm formation and maintaining gingival health; however, there is limited information on their effects during the periodontal maintenance phase. Therefore, the aim of this study was to evaluate the clinical effects of a toothpaste containing 0.3% triclosan on the periodontal parameters of subjects that have been treated for peri-implantitis and were enrolled in a regular maintenance program. METHODS: Subjects presenting at least one implant with peri-implantitis and received surgical anti-infective therapy were selected. Sixty days post-surgery (baseline), subjects were randomized into two groups: (1) toothpaste containing 0.3% triclosan + 2.0% PVM/MA copolymer + 1450 ppm fluoride (test) or (2) toothpaste containing 1450 ppm fluoride (control), and were instructed to brush with the assigned toothpaste twice/day for 2 years. They received clinical monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months. RESULTS: Eighty-eight subjects with natural teeth were enrolled in the study (Test, n = 39; Control, n = 49). The test group showed a greater reduction in the percentage of sites exhibiting bleeding on probing (primary outcome) and lower levels of plaque in comparison with the control group after 24 months (P < 0.05). The mean percentage of sites with probing depth ≥5 mm was reduced over the course of the study only in the test group (P < 0.05). CONCLUSION: A toothpaste containing 0.3% triclosan was more effective than a regular fluoride toothpaste in improving the periodontal clinical condition around natural teeth of periodontally healthy subjects enrolled in a regular maintenance program for 2 years.

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OBJECTIVE: To evaluate the outcomes of excessively loaded implants. MATERIAL AND METHODS: In five dogs, all mandibular premolars were extracted. After 3 months, six implants (three SLA® and three SLActive®) were placed (S). After 4 weeks, implants were restored: one single crown with stable occlusal contacts (SC), one crown and a cantilever unit with excessive occlusal contacts (OL), and a non-loaded implant (NL). Bleeding-on-probing (BoP), attachment level (AL), mucosal margin (GM) were assessed. Resonance frequency analysis (RFA) was assessed weekly. Standardized X-rays were taken at S, 4 and 24 weeks. RESULTS: Similar findings were observed for SLA® and SLActive® implants regarding PlI, GI, GM, AL, and BL. No significant differences were detected between baseline and 24-weeks or between treatment modalities for all clinical parameters (p > .05). Six months after loading, RFA values were significantly greater than at implant placement. No significant differences between treatment modalities were found. Linear radiographic measurements yielded similar results between SLA® and SLActive® implants. SLA® OL implants yielded a statistically significant gain on peri-implant bone density over all other groups (p = .012). Radiographic results were confirmed by descriptive histology. Technically, loosened occlusal screws occurred in 13.3% (SC = 3.3%; OL = 10%), while abutment fractures totalized 23.3% (SC = 6.6%; OL = 16.6%). CONCLUSIONS: Excessive occlusal load applied to implants (SLA® or SLActive®) restored with cantilevers did not cause loss of osseointegration or significant changes in their clinical, radiographic, or histologic outcomes. Early excessive occlusal load on SLA® implants promoted a gain in peri-implant bone density. Excessively loaded implants showed more technical complications.

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Objective: This study aimed to characterize the prognostic factors of breast cancer among women with this pathology treated by the Brazilian Unified Health System in the Municipality of Bagé, Rio Grande do Sul, which comprises the municipalities of the 7th Regional Health Coordination. Methods: This study was documentary, retrospective and quantitative in nature and based on the analysis of the medical records of patients undergoing cancer treatment who were attended at the oncological treatment unit in Bagé, from December 2010 to June 2017. Results: The results showed a total of 349 patients with breast cancer in the analyzed period, and their age ranged from 24 to 90 years, with the highest frequency presenting in white women in the left breast (42%). Most of the cancers were smaller than 2 cm (53.9%), with no lymph node involvement (57%) and without distant metastases (93.4%), and the majority of patients were diagnosed in the early stages, I (36.4% %) and II (32.4%). Regarding the anatomopathological and immunohistochemical characteristics, invasive ductal carcinoma was the most common type (79.7%), the histological grade II was present in more than half of cases (56.5%), and 78.8% of the patients presented with the expression of hormone receptors, whereas 16% had HER2 overexpression; the luminal subtype B was present in 64.8% of the patients. Conclusion: Thus, it is noted that most patients are diagnosed in the early stages. Nonetheless, it is still necessary to adopt measures that guarantee diagnosis in pre-invasive phases.

Objetivo: Este estudo objetivou caracterizar os fatores prognósticos do câncer de mama entre mulheres portadoras dessa patologia atendidas pelo Sistema Único de Saúde no município de Bagé, Rio Grande do Sul, o qual abrange os municípios da 7ª Coordenadoria Regional da Saúde. Método: Este estudo foi do tipo documental, retrospectivo e quantitativo a partir da análise dos prontuários médicos das pacientes em tratamento de câncer atendidas na unidade de tratamento oncológico em Bagé, de dezembro de 2010 a junho de 2017. Resultados: Os resultados demonstraram um total de 349 pacientes com câncer de mama no período analisado; a faixa etária variou dos 24 aos 90 anos, sendo a maior frequência em mulheres brancas, na mama esquerda (42%). A maior parte dos carcinomas possuía tamanho inferior a 2 cm (53,9%), sem comprometimento linfonodal (57%) e sem metástases a distância (93,4%), e as pacientes são diagnosticadas particularmente em estádios iniciais ­ I (36,4%) e II (32,4%). Com relação às características anatomopatológicas e imuno-histoquímicas, o carcinoma ductal infiltrante foi o tipo mais presente (79,7%), e o grau histológico GII esteve presente em mais da metade dos casos (56,5%). Quanto à expressão dos receptores hormonais, 84,7% das pacientes a apresentavam, e 12,5% possuíam superexpressão do fator de crescimento humano epidérmico receptor-2 (HER2); o subtipo Luminal B esteve presente em 64,8% das pacientes. Conclusão: Dessa forma, verificamos que a maior parte das pacientes é diagnosticada em estádios iniciais. Entretanto, ainda é necessária a adoção de medidas que garantam o diagnóstico em fases pré-invasivas.

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The aim of the present review was to describe the studies produced in Latin America that contributed to the elucidation of the effect of tooth extraction with and without immediate implant installation. An electronic search was conducted in MEDLINE (PubMed), Scopus, Scielo, Lilacs, and Embase to include clinical and experimental (animal) studies on immediate implants. The studies selected had to fulfill the following inclusion criteria: (i) to present clinical and/or histological data on socket healing with or without immediate implant installation; (ii) to be approved by a Latin American Ethic Committee or comparable; and (iii) to include at least one author from a Latin American institution or to be conducted in a Latin America institution. Latin American studies that fulfilled these criteria demonstrated that immediate implant installation was conducive for predictable osseointegration and high survival rates but failed to prevent bone modeling and dimensional reduction of the alveolar ridge. In addition, it was also shown that regenerative approaches, including hard and soft tissue grafts at the time of immediate implant placement, may be beneficial to compensate for the alveolar ridge reduction. Regenerative approaches immediately after tooth extraction may decrease the amount of dimension reduction of the alveolar ridge.

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OBJECTIVE: The purpose of the present prospective follow-up study was to evaluate the long-term influence of the peri-implant keratinized mucosa (KM) on marginal bone level (MBL), peri-implant tissues health, and brushing discomfort. MATERIAL AND METHODS: Eighty patients were initially recruited during their maintenance visit from January to October 2013 and allocated in two groups according to KM width around implants: Wide Group (KM ≥ 2 mm) and Narrow Group (KM < 2 mm). In the four-year follow-up examination (T4), marginal bone level (MBL), modified plaque index (mPI), probing depth (PD), clinical attachment level (CAL), bleeding on probing (BoP), and brushing discomfort (BD) were reassessed and compared to the initial assessments (T0). Mann-Whitney, Wilcoxon signed-rank test, and a multilevel model were used for the statistical analysis. RESULTS: Fifty-four patients with 202 implants returned at T4. Mean mPI (0.91 ± 0.60), BoP (0.67 ± 0.21), and BD (12.28 ± 17.59) were higher in the Narrow Group than in the Wide Group (0.54 ± 0.48, 0.56 ± 0.26, and 4.25 ± 8.39, respectively). Marginal bone loss was higher in the Narrow Group (0.26 ± 0.71) than in the Wide Group (0.06 ± 0.48). Multilevel analysis suggested that KM width and time in function had a statistically significant effect on MBL. CONCLUSIONS: The findings of the present study indicate that KM width had an effect on MBL, plaque accumulation, tissue inflammation, and brushing discomfort over the studied period. Thus, the presence of a KM ≥ 2 mm around implants appears to have a protective effect on peri-implant tissues.

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OBJECTIVE: To evaluate the effects of a toothpaste containing 0.3% triclosan in volunteers that have been treated for peri-implantitis and were enrolled in a maintenance program. MATERIAL AND METHODS: Subjects presenting at least one implant with peri-implantitis were selected. They received anti-infective surgical therapy, and sixty days post-surgery (baseline) were randomized into two groups, brushing twice/day for 2 years (a) with a toothpaste containing 0.3% triclosan+2.0% PVM/MA copolymer (GantrezTM )+1,450 ppm fluoride (test) or (b) with a toothpaste containing 1,450 ppm fluoride (control). They received clinical and microbiological monitoring at baseline, 3, 6, 12, 18, and 24 months, and professional maintenance every 3 months. RESULTS: A total of 102 subjects were enrolled (test: 48; control: 54). The control group showed loss of clinical attachment (CA) around treated implants over the course of the study (p < 0.05), while the test group was stable for this parameter. The difference between groups (0.55 mm) for CA change between baseline and 24 months (primary outcome variable) was statistically significant (p < 0.05). Red complex pathogens were only reduced in the test group at 24 months. The implants with no history of peri-implantitis in the test group had a significant reduction in the percentage of sites with bleeding on probing and in mean probing depth, throughout the study (p < 0.05). This improvement was not observed in the control group. CONCLUSION: A toothpaste containing 0.3% triclosan was more effective than a toothpaste without triclosan in maintaining a healthy peri-implant environment around treated implants and implants with no history of peri-implantitis during a 2-year maintenance program (ClinicalTrials.govNCT03191721).

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OBJECTIVE: The aim is to define clinical and histologic characteristics of peri-implant tissues in health and describe the mucosa-implant interface. IMPORTANCE: An understanding of the characteristics of healthy peri-implant tissues facilitates the recognition of disease (i.e., departure from health). FINDINGS: The healthy peri-implant mucosa is, at the microscopic level, comprised of a core of connective tissue covered by either a keratinized (masticatory mucosa) or non-keratinized epithelium (lining mucosa). The peri-implant mucosa averages about 3 to 4 mm high, and presents with an epithelium (about 2 mm long) facing the implant surface. Small clusters of inflammatory cells are usually present in the connective tissue lateral to the barrier epithelium. Most of the intrabony part of the implant appears to be in contact with mineralized bone (about 60%), while the remaining portion faces bone marrow, vascular structures, or fibrous tissue. During healing following implant installation, bone modeling occurs that may result in some reduction of the marginal bone level. CONCLUSIONS: The characteristics of the peri-implant tissues in health are properly identified in the literature, including tissue dimensions and composition. Deviation from the features of health may be used by the clinician (and researcher) to identify disease, including peri-implant mucositis and peri-implantitis.

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