A 4-year prospective study to assess peri-implant hard and soft tissues adjacent to titanium versus gold-alloy abutments in cemented single implant crowns. Biological width formation to immediate implants placed at different level in relation to the crestal bone: an experimental study in dogs. Periimplant soft tissue barrier at experimental one-piece mini-implants with different surface topography in humans: A light-microscopic overview and histometric analysis. Cemented versus screw-retained implant-supported single-tooth crowns: a 4-year prospective clinical study. Five-year results of fixed implant-supported rehabilitations with distal cantilevers for the edentulous mandible. Peri-implant conditions around sintered porous-surfaced (SPS) implants. A 36-month prospective cohort study. Cemented versus screw-retained implant-supported single-tooth crowns: a 10-year randomised controlled trial. Immediate loading of implants with 3-unit fixed partial dentures: a 12-month clinical study. Influence of abutment material on the gingival color of implant-supported all-ceramic restorations: a prospective multicenter study. A systematic review of marginal soft tissue at implants subjected to immediate loading or immediate restoration. Comparison of two different abutment designs on marginal bone loss and soft tissue development. Five-year evaluation of the influence of keratinized mucosa on peri-implant soft-tissue health and stability around implants supporting full-arch mandibular fixed prostheses. Clinical and radiographic evaluation of soft and hard tissue changes around implants: a pilot study. Experimental custom-made zirconia abutments for narrow implants in esthetically demanding regions: a 5-year follow-up. Effect of different prosthetic abutments on peri-implant soft tissue. A randomized controlled clinical trial. Early loading of non-submerged titanium implants with a sandblasted and acid-etched surface. 5-year results of a prospective study in partially edentulous patients. A 5-year longitudinal study of the clinical effectiveness of ITI solid-screw implants in the treatment of mandibular edentulism. Early loading of nonsubmerged titanium implants with a sandblasted and acid-etched (SLA) surface: 3-year results of a prospective study in partially edentulous patients. Impact of implant diameter on bone level changes around platform switched implants: preliminary results of 18 months follow-up a prospective randomized match-paired controlled trial. Soft and hard tissue assessment of immediate implant placement: a case series. Buccal bone deficiency in fresh extraction sockets: a prospective single cohort study. Influence of frequent clinical probing during the healing phase on healthy peri-implant soft tissue formed at different titanium implant surfaces: a histomorphometrical study in dogs. Single crowns in the resorbed posterior maxilla supported by either 6-mm implants or by 11-mm implants combined with sinus floor elevation surgery: a 1-year randomised controlled trial.
PURPOSE The purpose of this prospect i ve clinical study was to compare titanium and gold-alloy abutments when used with cemented , implant-supported single-tooth crowns . For 4 years following prosthodontic rehabilitation , these abutments were evaluated with respect to peri-implant marginal bone levels and peri-implant soft tissue parameters . MATERIAL S AND METHODS During the years 1998 to 2000 , 20 patients were selected from a patient population receiving treatment in the Implantology Department at the University of Padova , Italy . They all presented with single-tooth bilateral edentulous sites in the premolar/molar region with adequate bone width , similar bone height on each side , and an occlusal scheme that allowed for the establishment of identical occlusal cusp/fossa contacts on each side . Each subject received two identical implants ( one in each edentulous site ) . One was r and omly selected to be restored with a titanium abutment and a cemented implant-supported single-tooth crown , and the other was restored with a gold-alloy abutment and a cemented implant-supported single tooth crown . Data on peri-implant marginal bone levels and soft tissue parameters were collected for 4 years after abutment and crown insertion placement and analyzed to determine whether there was a significant ( p < .001 ) difference with respect to the type of abutments ( titanium vs. gold alloy ) used . RESULTS All subjects completed the study . All 40 implants survived , result ing in a cumulative implant success rate of 100 % . Statistical analysis revealed no significant differences between the two groups with respect to peri-implant marginal bone levels and soft tissue parameters . CONCLUSIONS Within the limitations of this study , the results indicate that there was no evidence of different response with the peri-implant marginal bone and soft tissue when titanium or gold-alloy abutments were used in conjunction with the cemented , single-tooth implant restorations provided for this limited patient population . There was no evidence of different behavior of peri-implant marginal bone and of peri-implant soft tissue when titanium abutments or gold-alloy abutments were used for cemented single-tooth implant restorations in this limited patient population PURPOSE / AIM Evaluate differences in bone remodeling , soft tissue reactions and biological width formation around immediate implants placed at different level in relation to the crestal bone in beagle dogs . MATERIAL AND METHODS The m and ibular second , third and fourth premolars of six beagle dogs were extracted , and three implants were placed in the right side of each dog . Healing abutments were adjusted ( n = 18 ) . After 4 weeks , the procedure was repeated on the left side of the m and ible ( n = 18 ) . R and omly , three implants were placed at crestal level ( control group ) , and three implants were placed 2 mm subcrestally ( test group ) in relation to the crestal bone in each animal . The dogs were sacrificed after 8 weeks from the first surgical procedure , and biopsies were obtained . Sample s were processed for ground sectioning . Histometric analysis was carried out to compare buccal and lingual bone resorption , soft tissue behavior and biological width formation in both groups . RESULTS Crestal bone resorption was higher in the test group when considering the difference of 2 mms ( IS-B = 2.05 ± 0.36 mm , control ; 1.75 ( + 2 ) ± 0.38 mm , test ) . However , the dimensions of the biological width were similar for both groups ( PM-C = 3.34 ± 0.53 mm , control ; 3.13 ± 0.55 mm , test ) . CONCLUSIONS The alterations that occurred in the peri-implant soft tissues may be related to the hard tissue remodeling , showing similar quantitative findings in the biological width formation in both groups . Even though the subcrestal placement might reduce the distance from the implant shoulder to the first bone-to-implant contact and reestablish the biological width dimension in a most coronal position , it might not have any effect on minimizing the marginal bone loss BACKGROUND Following connection to the oral cavity , osseointegrated dental implants and surrounding tissues are exposed to microbiologic and biomechanical challenges . The establishment of a firm functional periimplant soft tissue barrier ( PSTB ) is considered to be important to protect the implant 's interface from invasion of bacteria . The current knowledge on the histologic architecture of the PSTB is mainly based on animal experiments . PURPOSE The aim of this study was to histologically characterize the PSTB formed in humans around experimental one-piece mini-implants with different surface topography . MATERIAL S AND METHODS Five patients received a total of 12 experimental titanium , one-piece mini-implants with an oxidized ( n = 4 ) , an acid-etched ( n = 4 ) , or a machined ( n = 4 ) surface distal to therapeutic implants . Following transmucosal healing of 8 weeks and at abutment connection of the regular implants , the mini-implants were harvested with a layer of surrounding hard and soft tissue . The specimens were fixed and processed for histologic sectioning according to st and ard procedures . The most central bucco-oral section cut in the long axis was used for morphologic analyses of the PSTB . The vertical soft tissue morphology was quantified using histometric measurements . RESULTS The overall height of the soft tissue , that is , the biologic width , was around 4 to 4.5 mm and consisted of an epithelial and a supracrestal connective tissue barrier . The junctional epithelium established the attachment to the implant surface , whereas the collagen fibers and fibroblasts of the connective tissue seal were oriented parallel to the implant . The epithelial attachment was shorter at the oxidized and acid-etched surfaces compared with the machined surfaces . Accordingly , the oxidized and acid-etched mini-implants exhibited a longer zone of connective tissue seal . CONCLUSION The periimplant soft tissue formed at the experimental one-piece mini-implants in humans was of a character similar to that described in animal studies . The oxidized and acid-etched implants revealed less epithelial downgrowth and longer connective tissue seal than machined implants PURPOSE The purpose of this controlled prospect i ve clinical study was to compare cemented and screw-retained implant-supported single-tooth crowns followed for 4 years following prosthetic rehabilitation with respect to peri-implant marginal bone levels , peri-implant soft tissue parameters , and prosthetic complications . MATERIAL S AND METHODS Twelve consecutive patients were selected from a patient population attending the Implantology Department at the University of Padova . They all presented with single-tooth bilateral edentulous sites in the canine/premolar/molar region with adequate bone width , similar bone height at the implant sites , and an occlusal scheme that allowed for the establishment of identical occlusal cusp/fossa contacts . Each patient received 2 identical implants ( 1 in each edentulous site ) . One was r and omly selected to be restored with a cemented implant-supported single-tooth crown , and the other was restored with a screw-retained implant-supported single-tooth crown . Data on peri-implant marginal bone levels and on soft tissue parameters were collected 4 years after implant placement and analyzed to determine whether there was a significant difference with respect to the method of retention ( cemented versus screw-retained ) . RESULTS All patients completed the study . All 24 implants survived , result ing in a cumulative implant success rate of 100 % . Statistical analysis revealed no significant differences between the 2 groups with respect to peri-implant marginal bone levels and soft tissue parameters . DISCUSSION The data obtained with this study suggested that the choice of cementation versus screw retention for single-tooth implant restorations is likely not based on clinical results but seems to be based primarily on the clinician 's preference . CONCLUSIONS Within the limitations of this study , the results indicate that there was no evidence of different behavior of the peri-implant marginal bone and of the peri-implant soft tissue when cemented or screw-retained single-tooth implant restorations were provided for this patient population OBJECTIVES The purpose of this study was to evaluate the survival rate , success rate and primary complications associated with m and ibular fixed implant-supported rehabilitations with distal cantilevers over 5 years of function . MATERIAL AND METHODS In this prospect i ve multi-center trial , 45 fully edentulous patients were treated with implant-supported m and ibular hybrid prostheses with distal extension cantilevers . Data were collected at numerous time points , including but not limited to : implant placement , abutment placement , final prosthesis delivery , 3 months and 5 years post-loading . Biological , implant and prosthetic parameters defining survival and success were evaluated for each implant including : sulcus bleeding ndex ( SBI ) at four sites per implant , width of facial and lingual keratinized gingiva ( mm ) , peri-implant mucosal level ( mid-facial from the top of the implant collar , measured in mm ) , modified plaque index ( MPI ) at four sites per implant , mobility and peri-implant radiolucency . Survival was defined as implants or prostheses that did not need to be replaced . Success rate was defined as meeting well-established criteria that were chosen to indicate healthy peri-implant mucosa osseointegration , prostheses success and complications . RESULTS A total of 237 implants in 45 completely edentulous patients were included in the study . In each patient , four to six implants were placed to support hybrid prostheses with distal cantilevers . Cantilevers ranged in length from 6 to 21 mm , with an average length of 15.6 mm . The ages of the patients ranged from 34 to 78 with a mean age of 59.5 years . The survival rate of implants was 100 % ( 237/237 ) and for prostheses 95.5 % ( 43/45 ) . The overall treatment success rate was calculated as 86.7 % ( 39/45 ) . Of the six patients that have not met the criteria for success , two patients required replacement of the entire prosthesis and four patients presented > four complications events . CONCLUSION Fixed implant-supported rehabilitation with distal cantilever result ed in a reliable treatment modality over the 5-year observation period . Although biological parameters of MPI , SBI , keratinized tissue and peri-implant mucosal levels showed statistically significant differences over time , the mean values for each patient remained within the normal limits of oral health . Complications were categorized as biological or technical . The majority of complications were technical complications ( 54/79 ) and of these most involved fracture of the acrylic teeth and base ( 20/54 ) . While the survival rate was 100 % for implants and 95.5 % for prostheses , the application of strict criteria for treatment success result ed in an overall treatment success rate of 86.7 % OBJECTIVES The specific aim of this study was to assess sintered porous-surfaced ( SPS ) implant system from a biological point of view , through a prospect i ve study of the health status and the evolution of the peri-implant tissues over time and analysis of the changes observed in the various peri-implant parameters . MATERIAL AND METHODS Hundred and fifty-one patients were treated consecutively from 2005 to 2007 using 280 SPS implants , which were restored with a single crown or a partial fixed denture . To accurately monitor the health and biological evolution of peri-implant soft and hard tissues , a number of clinical parameters were adopted , such as the modified Plaque Index ( mPI ) , the modified sulcus Bleeding Index ( mBI ) , Peri-implant Probing Depth ( PPD ) , and Crestal Bone Level ( CBL ) . Clinical and radiographic examinations were scheduled over a 36-month follow-up of functional loading according to a well-established protocol generally applied to determine implant success rates and Peri-implant Bone Loss ( PBL ) . Statistical analysis was used to determine any significant differences or correlations ( P = 0.05 ) . RESULTS A total of 259 SPS implants in 136 patients were followed up for 36 months . According to Buser 's success criteria , the overall implant-based success rate was 98.1 % and the mean PBL was 0.48 ± 0.29 mm . MBI and mPI mean values showed statistically significant differences between baseline and follow-up analyses ( P < 0.001 ) . No statistically significant differences in mean PPD values were found between baseline and control analyses ( P = 0.060 ) . CONCLUSION This prospect i ve cohort study revealed that the biological behavior of SPS implant system was characterized by high tissue stability during the observation period , both as regards soft and hard tissues . In particular , the crestal bone remodeling pattern was very similar to that reported in other studies , confirming that the bone loss around SPS implants , at least at 36 months , seems to be predictable PURPOSE The purpose of this r and omised controlled trial was to compare the long-term clinical outcome of cemented and screw-retained implant-supported single-tooth crowns .  MATERIAL S AND METHODS Eighteen consecutive patients presenting with single-tooth bilateral edentulous sites in the canine/molar region with adequate bone width , similar bone height at the implant sites , and an occlusal scheme that allowed for the establishment of identical occlusal cusp/fossa contacts were treated . Each patient received two identical implants according to a split-mouth design . One side was r and omly selected to be restored with a cemented implant-supported single crown , and the other was restored with a screw-retained implant-supported single crown . Outcome measures were implant success , complications , marginal bone levels and peri-implant soft tissue health . RESULTS Ten years after initial loading , 2 patients moved away and were lost to follow-up . Two implants placed in the same patient failed 5 years after their insertion ; the remaining 30 implants survived , result ing in a cumulative implant success rate of 93.7 % . No complication occurred . The mean marginal bone resorption at 10 years after implant placement , measured on intraoral radiographs , was 1.1 ± 0.2 mm for both types of restorations . There were no statistically significant differences between the two groups with respect to peri-implant marginal bone level at the 10-year follow-up appointment ( T2 ) ( P = 0.58 ) ; at the 4-year follow-up appointment ( T1 ) a statistically significant difference was observed ( P = 0.01 ) , but this was not considered clinical ly relevant ( mean difference : -0.06 mm ) . The status of the soft tissue around the implants remained stable over the evaluation period . No statistically significant difference was identified for the facial keratinised gingiva between the two groups at T1 ( P = 0.10 ) or at T2 ( P = 0.07 ) . CONCLUSIONS Within the limitations of this study , the results indicate that there was no evidence of a significant difference in the clinical behaviour of the peri-implant marginal bone or of the peri-implant soft tissues when cemented or screw-retained single-tooth implant restorations were provided PURPOSE The aim of the present clinical trial was to evaluate the 12-month success rate of titanium dental implants placed in the posterior m and ible and immediately loaded with 3-unit fixed partial dentures . MATERIAL S AND METHODS Patients with missing m and ibular premolars and molars were enrolled in this study . To be included in the study , the implants had to show good primary stability . Implant stability was measured with resonance frequency analysis using the Osstell device ( Integration Diagnostics ) . Implants were included in the study when the stability quotient ( ISQ ) exceeded 62 . Clinical measurements , such as width of keratinized tissue , ISQ , and radiographic assessment of peri-implant bone crest levels , were performed at baseline and at the 12-month follow-up . The comparison between the baseline and the 12-month visits was performed with the Student t test for paired data ( statistically significant at a level of alpha = 0.05 ) . RESULTS Forty implants with a s and blasted , large grit , acid-etched ( SLA ) surface ( Straumann ) were placed in 20 patients . At 12 months , only 1 implant had been lost because of an acute infection . The remaining 39 implants were successful , result ing in a 1-year success rate of 97.5 % . Neither peri-implant bone levels , measured radiographically , nor implant stability changed significantly from baseline to the 12-month follow-up ( P > .05 ) . DISCUSSION The immediate functional loading of implants placed in this case series study result ed in a satisfactory success rate . CONCLUSION The findings from this clinical study showed that the placement of SLA transmucosal implants in the m and ibular area and their immediate loading with 3-unit fixed partial dentures may be a safe and successful procedure PURPOSE The aim of this clinical research on implant-supported restorations is to analyze , through spectrophotometric digital technology , the influence of the abutment material on the color of the peri-implant soft tissue . MATERIAL AND METHODS Twenty patients received an endosseous dental implant in the anterior maxilla . At the time of each definitive prosthesis delivery , an all-ceramic crown has been tried on gold , titanium and zirconia abutment . After the insertion of each single abutment , the peri-implant soft tissue color has been measured through a spectrophotometer . Also , the thickness of the facial peri-implant soft tissue was measured at the level of the implant neck through a caliper . A specific software has been utilized to identify a specific tissue area and to collect the data before the statistical analysis in Lab * color space . The normality of the quantitative variables was verified by means of the Shapiro-Wilk test . Simple linear correlation between quantitative variables was evaluated by using Pearson 's coefficient . The results on the performance of the abutment material s with regard to the color measurements and the overall measurement ΔE were described by computing the least-square means . The significance of differences among types of abutment was verified by means of the Scheffe test for multiple comparisons . RESULTS For all the abutments used , the color of the peri-implant soft tissue appeared to be significantly different from the one of the contra-lateral tooth ( ΔE>8.5 ) . Significantly higher ( P<0.05 ) difference were present with the use of titanium abutments ( 11 ± 0.4 ) when compared with the results of gold ( 8.9 ± 0.4 ) and zirconia ( 8.5 ± 0.4 ) abutments . No correlation has been demonstrated between soft tissue thickness and degree of color difference ( P>0.25 ) . CONCLUSIONS Within the limitation of the present study , the peri-implant soft tissue color appears to be different from the soft tissue color around natural teeth , no matter which type of restorative material is selected . When titanium abutment was selected , significantly higher differences were present than those obtained with gold or zirconia abutments . The thickness of the peri-implant soft tissue did not appear to be a crucial factor in the abutment impact on the soft tissue color OBJECTIVES The objective of this systematic review was to critically evaluate marginal soft-tissue aspects at implants subjected to immediate loading or immediate restoration . METHODS An electronic Medline search from 1966 up to August 2005 was conducted to identify prospect i ve and retrospective studies on immediate implant loading . The search strategy was complemented by h and search ing in peer- review ed journals . Studies reporting on soft-tissue aspects at implants subjected to immediate loading or immediate restoration and with a follow-up time of at least 1 year were included . Assessment of identified studies and data extraction was performed independently by two review ers . An attempt was made to isolate and categorize studies with similar protocol s in order to identify trends and relevant factors . Variables that were considered included marginal and interproximal soft-tissue stability , marginal plaque accumulation , probing depth , bleeding on probing , peri-implant mucositis and peri-implantitis . RESULTS From an initial yield of 581 titles , 240 articles were selected for text analysis , finally result ing in 17 studies that met the inclusion criteria . Six studies on immediate implant loading or restoration were controlled studies , whereas the remainder was prospect i ve case series . Seven studies reported on a 1-year data , and the longest follow-up within the included studies was 4 years . The total number of patients treated within the 17 studies was 432 including a total 706 implants studied . Overall , the articles reported on many different procedures and follow-up times , time points and evaluated soft-tissue parameters varied considerably between the different articles . CONCLUSION Within the limits of the evaluated data it can be cautiously concluded that once immediately loaded or restored implants integrate successfully , they appear to show a soft-tissue reaction with regard to periodontal as well as morphologic aspects comparable with those of conventionally loaded implants . However , follow-up periods are generally short , number of patients and /or implants per study are few , and most studies present only limited data on peri-implant soft-tissue evaluation . More accurate long-term studies with a stronger study design ( i.e. , RCT ) reporting more detailed on treatment and follow-up protocol s are required to allow for proper comparisons and conclusions PURPOSE To assess the response of soft tissues around two different abutment design s in healed sites in the esthetic zone . MATERIAL S AND METHODS Twenty-six subjects received two endosseous implants in healed , bilateral implant sites in the esthetic zone in the maxilla or the m and ible . After 17 to 19 weeks and left/right r and omization , the implants were restored with either a conventional ( control ) or curved ( experimental ) titanium abutment and a provisional crown . Eight weeks after abutment placement , definitive crowns were cemented ( T0 ) . Soft tissue development was assessed based on peri-implant bone loss , Pink Esthetic Score ( PES ) , and probing depths immediately after placement of the definitive crown and after 1 year ( T12 ) and compared between sites . Possible confounding variables ( abutment angle , plaque presence , gingival bleeding , width of attached mucosa ) were also documented at T0 and T12 . RESULTS The mean peri-implant marginal bone loss from T0 to T12 was 0.00 ± 0.37 mm in the experimental group and 0.12 ± 0.27 mm in the control group . Differences were not statistically significant ( P = .25 ) . At T12 , the curved abutment scored a mean PES of 10 ± 2.3 and the straight abutment scored 9.7 ± 2.3 . The difference was not significant ( P = .46 ) ) . Probing depths were also not significantly different between the two groups ( P = .85 ) . Correlation and regression analysis showed no hints of predictive behavior for the possible confounding variables . CONCLUSION A titanium abutment with a circumferential curved design is of no additional benefit to soft tissue development and preservation of marginal bone compared to a conventional straight abutment design for the restoration of single-tooth implants in the esthetic zone BACKGROUND The question of the importance of keratinized mucosa around dental implants for the prevention of peri-implant disease could not be answered in the relevant literature so far . OBJECTIVE To investigate the influence of peri-implant keratinized mucosa on long-term peri-implant soft-tissue health and stability over a period of 5 years . MATERIAL AND METHODS A total of 386 m and ibular dental implants were placed in 73 completely edentulous patients , and subsequently restored with fixed full-arch prostheses . At prosthesis delivery ( baseline ) and after 3 , 6 , 12 , 18 , 24 , 36 , 48 and 60 months , modified plaque index ( mPlI ) , modified sulcus bleeding index ( mBI ) , distance between implant shoulder and mucosal margin ( DIM ) and width of peri-implant keratinized mucosa ( KM ) were recorded . Statistical analysis included multivariate logistic regression , multivariate ordinal logistic regression , generalized estimating equations and Bonferroni 's correction . RESULTS Fifty-eight patients with 307 implants completed the 5-year study . Statistically significantly higher plaque accumulation on lingual sites ( mean mPlI 0.67 , SD 0.85 ) , bleeding tendencies on lingual sites ( mean mBI 0.22 , SD 0.53 ) and larger soft-tissue recession on buccal sites ( mean DIM -0.69 mm , SD 1.11 mm ) were found when the width of KM was < 2 mm , compared to sites with > or=2 mm of KM ( mean mPlI 0.40 , SD 0.68 , P=0.001 ; mean mBI 0.13 , SD 0.41 , P<0.01 ; mean DIM -0.08 mm , SD 0.86 mm , P<0.001 ) . The width of keratinized mucosa had no effect on bleeding tendency or plaque accumulation on buccal sites ( P>0.05 ) . CONCLUSION In patients exercising good oral hygiene and receiving regular implant maintenance therapy , implants with a reduced width of < 2 mm of peri-implant keratinized mucosa were more prone to lingual plaque accumulation and bleeding as well as buccal soft-tissue recession over a period of 5 years BACKGROUND The aim of this study was to evaluate the clinical and radiographic changes in the peri-implant tissues around  one-stage implants  with different smooth neck portion lengths before and after functional prosthetic loading . METHODS Twelve one-stage implants were placed in adult patients with bilateral edentulous posterior m and ibular ridges . The sites were r and omly assigned into two groups of six each : group 1 : 2.8 mm neck implants and group 2 : neck implants . The parameters plaque index ( PI ) , gingival index ( GI ) , probing depth ( PD ) , gingival margin level ( GML ) , relative clinical attachment level ( r-CAL ) , and optical density ( OD ) were measured at loading ( 4 months ) and 12 months after implant placement . The radiographic parameter osseous level ( OL ) was measured at implant placement , loading , and at 12 months . Analysis of variance and the paired Student t test were used to detect difference over time and between groups . RESULTS The results showed significant differences ( P<0.05 ) for both groups for PD , r-CAL , and OL for intragroup comparisons over time . However , no significant differences were found for PI , GI , PD , GML , OD , and OL for between-group comparisons . CONCLUSION Bony loss occurred before loading , supporting the soft tissues and maintaining the biologic width irrespective of the smooth portion length PURPOSE This prospect i ve clinical study evaluated an experimental custom-made zirconia abutment with respect to peri-implant hard and soft tissue reaction in narrow implants . MATERIAL S AND METHODS Patients were treated with prefabricated titanium implants and custom-made zirconia abutments . All-ceramic crowns were fabricated and cemented with resin cement . Clinical parameters such as Plaque Index , Sulcus Bleeding Index , peri-implant probing depth , and radiographic marginal bone loss levels were recorded , along with any biologic and mechanical complications , at baseline and up to 5 years . RESULTS Twelve patients with missing maxillary lateral incisors treated with a total of 23 implants were evaluated . Thirteen Straumann Narrow Neck Solid Screw implants  with a diameter of 3.3 mm and 10 Astra MicroThread implants with a diameter of 3.5 mm were used . Six patients with 11 implants were treated with custom-made zirconia abutments and prefabricated metal abutments were used in the control group . Implant and abutment success at 5 years was 100 % . No abutment fractures occurred . Abutment screw loosening was reported for one restoration at the 1-year recall . Mean marginal bone loss measured 0.21 mm after 5 years of functional loading . CONCLUSION Custom-made zirconia abutments offered sufficient stability to support all-ceramic restorations over narrow implants in anterior regions over a 5-year period . The soft and hard tissue reactions to zirconia were favorable PURPOSE This r and omized clinical trial assessed the effect of three different prosthetic abutments ( titanium , gold-hue titanium and zirconia ) on peri-implant soft tissue 2 years after treatment in partially edentulous subjects . METHODS Baseline data concerning ( 1 ) thickness of the buccal peri-implant soft tissue , ( 2 ) soft tissue thickness above the bone crest , ( 3 ) depth/length of transmucosal pathway , and ( 4 ) periodontal biotype at adjacent teeth were collected . The final sample consisted of 47 subjects ( 21 males , 26 females ) with a total of 97 implants . A two-level ( patient , implant ) statistical model was applied . RESULTS At the 2-year clinical observation , recession of the gingival margin was observed only at 13 % of implants irrespective of the type of abutment . No significant correlation between periodontal biotype at adjacent teeth and peri-implant biotype was observed . Furthermore , none of the investigated variables at patient level ( age , gender , implant type , periodontal biotype ) or at implant level ( keratinized tissue thickness , probing depth , soft tissue thickness ) was identified as a significant predictor of recession . In conclusion , this study pointed out that ( 1 ) abutment type was not able to influence peri-implant variables after 2 years , and ( 2 ) caution should be used in considering periodontal biotype at patient level as a possible indicator of the future peri-implant biotype OBJECTIVES The aim of this prospect i ve cohort study was to evaluate the success rate of titanium screw-type implants with the s and blasted and acid-etched ( SLA ) surface loaded early , after 6 weeks of healing . MATERIAL AND METHODS A total of 104 implants were inserted into posterior sites of 51 partially edentulous patients exhibiting bone densities of class I-III . After a healing period of 6 weeks , all implants were functionally loaded with cemented crowns or fixed partial dentures . The patients were recalled at 3 , 12 , 24 , 36 , 48 and 60 months for clinical and radiographic examination . RESULTS One implant failed to integrate during healing , and three implants were lost to follow-up and were considered drop-outs . The remaining 100 implants showed favorable clinical and radiographic findings at the 5-year examination . The peri-implant soft tissues were stable over time ; the mean probing depths and mean attachment levels did not change during the follow-up period . None of the radiographs exhibited signs of continuous peri-implant radiolucency , which confirmed ankylotic stability for all 100 implants . The measurement of the bone crest levels ( DIB values ) indicated stability as well . Based on strict success criteria , all 100 implants were considered successfully integrated , result ing in a 5-year success rate of 99 % . CONCLUSION This prospect i ve study using an early loading protocol with 6 weeks of healing demonstrated that titanium implants with the SLA surface can achieve and maintain successful tissue integration with high predictability for at least 5 years of follow-up in selected patients and sites PURPOSE The aim of this longitudinal study was to gain 5-year clinical documentation of the 1-stage surgical technique in connection with ITI solid-screw implants used in the edentulous m and ible . MATERIAL S AND METHODS One hundred patients with totally edentulous m and ibles were treated with bar-retained overdentures supported by a total of 340 consecutively placed ITI solid-screw implants . The patients were followed at annual intervals for at least 5 years to evaluate implant success , longitudinal reactions of the peri-implant hard and soft tissues , and incidences of biologic and mechanical complications . RESULTS During the trial period , a total of 4 implants failed , all prior to loading , and 51 implants were lost to follow-up , result ing in a cumulative survival rate of 98.8 % after 5 years of functional service . The success analysis included additional strictly defined events ( either " first occurrence of marginal bone loss > or = 4 mm " or " first occurrence of pocket depth > or = 4 mm " and " first occurrence of crevicular fluid flow rate > or = 2.5 mm ) and result ed in a cumulative 5-year success rate of 95.7 % . The median marginal bone loss experienced between implant placement and prosthetic treatment was 0.5 mm , followed by an annual bone level change of 0.1 mm for the functional period of 5 years . The increasing incidence of remarkable plaque deposits from 19 % to 50 % represented the difficulties of the patients in maintaining a high level of oral hygiene , particularly for the lingual surfaces . Sulcus Bleeding Index , probing depth , attachment level , and crevicular fluid flow rate were used to describe the health of the peri-implant soft tissues and remained almost within acceptable st and ards . DISCUSSION Survival and success rates of implants , amount of marginal bone loss , and periodontal indices of peri-implant soft tissues were consistent with those reported in the literature regarding implants with the submerged healing concept . CONCLUSION With a cumulative survival rate of 98.8 % , a cumulative success rate of 95.7 % , and a median marginal bone loss of 0.5 mm during the healing period , followed by an annual rate of 0.1 mm after loading , non-submerged ITI solid-screw implants confirm the good clinical outcome of implant-supported treatment concepts for the rehabilitation of totally edentulous patients in a medium-term perspective PURPOSE The aim of this study was to evaluate the success rate of ITI implants with the SLA surface that were loaded after 6 weeks of healing . MATERIAL S AND METHODS In this prospect i ve cohort study , a total of 104 implants were placed in posterior sites of 51 partially edentulous patients exhibiting bone densities of Class 1 , 2 , or 3 . After a healing period of 6 weeks , all implants were functionally loaded with cemented crowns or fixed partial dentures . The patients were recalled at 3 , 12 , 24 , and 36 months for clinical and radiographic examination . RESULTS One implant failed to integrate during healing , and 1 implant was lost to follow-up and considered a dropout . The remaining 102 implants showed favorable clinical and radiographic findings and were considered successfully integrated at the 3-year examination . This result ed in a 3-year success rate of 99.03 % . DISCUSSION The peri-implant soft tissues were stable over time , as evidence d by no changes in the mean probing depths and the mean attachment levels during the follow-up period . None of the radiographs exhibited signs of continuous peri-implant radiolucency , which confirmed ankylotic stability of all 102 implants . The radiographic evaluation of the bone level at the implant indicated stability of the bone crest levels . CONCLUSION The results of this prospect i ve study demonstrated that early loading of ITI implants with the SLA surface after an unloaded healing period of 6 weeks provided successful tissue integration with high predictability , and that successful tissue integration was well maintained up to 3 years of follow-up in this study population OBJECTIVE This prospect i ve r and omized match-paired controlled trial aim ed to evaluate the impact of implant platform diameter on marginal bone level around implants restored according to the platform switching ( PS ) concept . MATERIAL AND METHODS A total of 24 implants were examined in 12 patients . All patients received two adjacent implants inserted at the crestal level : 4.3 mm ( control group ) and 4.8 mm ( test group ) in diameter . Mesio-distal implant position was r and omly performed . According to the PS concept , for restoration , a 3.8 and 4.3 mm diameter abutment was used , respectively in the control and test groups , result ing , in both groups , with 0.25 mm of implant/abutment mismatching . Implant restorations were splinted . Eighteen months after final restoration , periapical st and ardized digital radiographs were taken to evaluate marginal bone level alterations after loading . The Wilcoxon Signed-Rank Test was selected to identify differences between groups . RESULTS At the last follow-up , control implants exhibited a mean bone loss value of 1.10 mm ( SD : 0.47 mm ) ; the test group showed a mean value of 1.09 mm ( SD : 0.08 mm ) . No statistically significant differences were found between test and control groups . CONCLUSIONS Within the limits of this study , the present results suggest that bone resorption is mostly related to biologic ( biologic width re-establishment ) rather than to biomechanical factors ( implant platform diameter ) . Furthermore long-term studies with a wider sample size are needed to confirm the platform diameter influence on hard tissue response around implants restored according to the PS concept OBJECTIVES The aim of this prospect i ve study was to evaluate clinical ly and radiographically the success and esthetic result of immediate implant placement at the time of extraction . MATERIAL AND METHODS Twelve patients with 14 titanium screw-shaped implants ( 13 - 16 mm length and 4.3 or 5 mm diameters ) were placed in the extraction sockets . Defects after implant placement were recorded , and then filled up with deproteinized bovine bone mineral , bioabsorbable collagen membrane , and absorbable pins . The defect was again re-evaluated at second-stage surgery . Clinical and radiographic parameters of the peri-implant conditions were assessed at the moment of prosthesis placement and at 1-year follow-up . RESULTS The cumulative implant survival and success rate was 100 % after a 1-year observation period . Analysis of the esthetic result showed that the mean pink esthetic score ( PES ) was 11.1 ( SD 1.35 ) at 1-year follow-up . At 1 year , 64.3 % papillae had a score of 2 and the remaining 35.7 % score 3 according to the Jemt ( 1997 ) papillary index . Optimal value of width of the keratinized mucosa was recorded in 13 ( 92.9 % ) implant cases in both periods of follow-up . At 1-year follow-up , the linear distance between implant-shoulder to the bone peaks remains stable with a mean of 2.62+/-0.2 mm at the mesial and 2.9+/-0.58 mm at the distal aspect . CONCLUSION Careful evaluation of potential extraction sites before immediate implant installation promotes optimal implant esthetics OBJECTIVE The purpose of this prospect i ve single cohort study was to evaluate the use of xenograft and collagen membranes in treating full or partial buccal bone defects of fresh extraction sockets in the esthetic zone . MATERIAL S AND METHODS Thirty-three patients requiring tooth extraction in the anterior maxillary area and showing a complete or partial buccal bone plate deficiency ( more than 2 mm ) were consecutively enrolled and treated . Corticocancellous porcine bone and platelet-rich fibrin ( PRF ) with a collagen membrane were used to graft the extraction sockets , and the membranes were left exposed to the oral cavity with a secondary soft tissue healing . The outcome variables were as follows : width of keratinized mucosa , facial soft tissue levels , clinical bone changes ( measured with a clinical splint ) , implant and prosthesis failures , and peri-implant marginal bone changes . RESULTS All treated sites allowed the placement of implants ; the width of keratinized mucosa at the mid-facial aspect showed an increase of 2.3 mm 5 months after the grafting procedure , and its value was 3.2 ± 0.6 mm at 1-year follow-up . The mean values of the facial soft tissue level indicated an increase over time . The bone level showed an improvement of 0.8 ± 0.1 mm and 0.7 ± 0.1 mm at mesial and distal sites , respectively , when compared to the baseline measurements . Finally , in the palatal area , no bone changes were observed . No implant failed during the entire observation period . CONCLUSIONS Findings from this study showed that xenograft and PRF , used for ridge preservation of the extraction sockets with buccal bone plate dehiscence in the esthetic zone , can be considered effective in repairing bone defects before implant placement . The secondary soft tissue healing over the grafted sockets did not compromise bone formation ; moreover , the soft tissue level and the width of keratinized gingiva showed a significant improvement over time OBJECTIVES To investigate ( i ) the impact of different  titanium implant surfaces  on soft tissue integration over 6 months , and ( ii ) the influence of frequent clinical probing during the healing phase on the established mucosal seal . MATERIAL AND METHODS St and ardized clinical probing was r and omly performed ( 12 dogs , probing versus control ) at different transmucosal surfaces [ machined ( M ) , s and -blasted/acid-etched ( SLA ) , and chemically modified acid-etched ( modA ) , modSLA ] at 2 , 4 , 8 , and 12 weeks ( i.e. 1 x , 2 x , 3 x , and 4 x ) . Histomorphometrical analysis ( e.g. mucosal margin ( PM ) - apical extension of the junctional epithelium ( aJE ) , PM - coronal level of bone-to-implant contact ( CBI ) was performed at 4 , 8 , 12 , and 24 weeks . RESULTS While M and SLA groups revealed a split formation , epithelial cells and connective tissue were in close contact to modA and modSLA surfaces . Frequent clinical probing ( i.e. 3 x and 4 x ) increased mean pocket depths , PM-aJE , and aJE-CBI values in all groups and markedly disrupted the epithelial and connective tissue attachment . CONCLUSIONS It was concluded that irrespective of the surface characteristics , a frequent clinical probing at short intervals during the healing phase was associated with dimensional and structural changes of the mucosal seal PURPOSE The aim of this r and omised controlled trial was to assess the clinical performance of  single crowns in the posterior maxilla supported by either 6-mm or 11-mm implants combined with maxillary sinus floor elevation . MATERIAL S AND METHODS 41 consecutive patients with one missing premolar or molar in the posterior maxilla and with an estimated bone height of 6 to 8 mm in that area were included . Each patient was r and omly allocated to one of the two treatment groups , namely to receive an 11-mm implant ( Osseo Speed 4.0 S , Dentsply Implants , Mölndal , Sweden ) in combination with maxillary sinus floor elevation surgery or to receive a 6-mm implant ( Osseo Speed 4.0 S ) without any grafting . After a 3-month osseointegration period , all implants were restored with custom-made titanium abutments and cemented zirconia-based porcelain crowns . Outcome measures were : implant survival ; radiographic bone changes ; plaque accumulation ; bleeding tendency ; peri-implant inflammation ; presence of dental calculus ; biological and technical complications ; and patients ' satisfaction . Clinical and radiographic examinations were performed at placement of the crown and 12 months thereafter . Patients ' satisfaction was scored before treatment and after 12 months of functioning of the crown . RESULTS One patient of the 11 mm implant group died during the follow-up . No implant failed and no biological or technical complications occurred . From loading to the 12 months follow-up , no difference was found in mean marginal bone changes between the groups ( bone resorption in both groups 0.1 ± 0.3 mm ) . Clinical items revealed very healthy peri-implant soft tissues in both groups . Patients ' satisfaction scores were high in both groups . CONCLUSIONS 6-mm implants and 11-mm implants combined with sinus floor elevation surgery are equally successful to support a single crown in the resorbed posterior maxilla after 1-year follow-up
Evidence analysis shows that the present knowledge about biologic width around implants is mainly derived from animal studies and that clinical controlled human studies are insufficient
PURPOSE The concept of biologic width forms a basis for successful peri-implant soft tissue integration around titanium implants .
Therefore , the objectives of this review are to determine and critically evaluate the present knowledge about biologic width around implants and to establish future research trends .