Search Results (14)

Objectives: The presence of gingival buccal recession is a frequent problem especially in the canine area. The cortical buccal bone may be absent in presence of health normal lingual/palatal bone and of other periodontal pockets. The present case report describes a minimally invasive approach in a 76-year-old patient with previously endodontically treated lower canine affected by root fracture and by a serious chronic buccal recession. Methods: The tooth was characterized by a deep vestibular bone defect, lack of buccal bone and acute periapical lesion. After extraction, Maryland bridge was positioned on the edentulous area. A two-piece convergent neck transmucosal implant was inserted with a flapless approach after 6 months. Maryland bridge was left in place for additional 3 months. After this time, digital impressions were taken, and a customized abutment was positioned. A provisional crown was designed according to Biologically Oriented Preparation Technique (BOPT) concept and maintained for 6 months. A zirconia definitive crown was digitally designed and cemented with a polycarboxylate-based cement. The Pink Esthetic Score (PES) was used as an index to assess peri-implant soft tissue stability over time (preoperatively, at 9 months, at 12 months and 72 months). Results: The patient was followed for 6 years under a conventional hygienic recall program. No complications occurred, and the PES improved from 4 preoperatively to 8 at 9 months, 10 at 12 months and 13 at 72 months. Conclusions: The use of Maryland bridge prevented occlusal trauma on healing tissues and appeared to support bone and soft tissue healing for transmucosal implant placement. A stable aesthetic rehabilitation was achieved up to 6 years. Full article

Background/Objectives: The essential trace element zinc (Zn) has a pivotal role in wound healing and can show antibacterial activity, but its application in oral implant materials is underexplored. Customized healing abutments can modulate the peri-implant tissue health when appropriate bioactive materials promoting mucosal healing are used. The present study investigated a novel Zn-containing polymer for its potential in soft-tissue engineering applications. Methods: Four traditional materials—titanium, glass ionomer, a composite, and the novel Zn-containing polymer—were tested in vitro for bacterial growth using a multispecies oral bacterial model compared to hydroxyapatite. The biocompatibility of the materials was also evaluated by evaluating the adhesion, proliferation, and cytotoxicity of human oral keratinocytes (HOK-18A) onto these materials, compared to tissue culture plastic. Results: The Zn-containing polymer exhibited a significantly lower biofilm formation compared to conventional materials as it was composed of less pathogenic bacteria. The Zn-containing material also demonstrated a superior biocompatibility towards HOK-18A, approximating the adhesion and proliferation of the keratinocytes to optimal tissue culture conditions. Moreover, these properties did not seem to degrade and were maintained over a period of 31 days. The cytotoxicity assessment revealed no significant reduction in metabolic activity for any material. Conclusions: This study highlights the potential of the novel Zn-containing polymer in soft-tissue engineering, owing to its antimicrobial and biocompatible assets. These properties, combined with the ease of chairside modeling, position the material as a promising alternative for creating customized healing abutments. Further research is needed to explore its mechanism of wound healing modulation and its clinical performance. Full article

Background: This pilot study aimed to evaluate the effectiveness of digitally crafted customized healing abutments in stabilizing peri-implant soft tissues following tooth extraction and assess the preservation of peri-implant soft tissue architecture over 5 years. Material and Methods: Forty patients (age ≥ 25 years) were divided into test (n = 20) and control (n = 20) groups. The test group received dental implants with immediate loading after tooth extraction, along with customized healing abutments fabricated using CAD/CAM technology. The control group received dental implants with immediate loading without customized healing abutments. The primary outcome was the change in distance between the peri-implant soft tissue margin and implant fixture surface from baseline to 5 years post implantation. Results: In the test group, there was a significant decrease in the distance between the peri-implant soft tissue margin and fixture surface from baseline to 5 years (p < 0.001), with pairwise comparisons showing significant differences between multiple time points (p < 0.05). The control group showed less pronounced changes over time. Conclusions: Within the limitations of this pilot study, digitally fabricated customized healing abutments appear effective in stabilizing peri-implant soft tissues and preserving soft tissue architecture around dental implants over 5 years following immediate implant placement. Randomized controlled trials are needed to confirm these findings. Full article

Background: The objective of this study was to evaluate the pain and inflammatory response in soft tissues using healing and prosthetic abutments of different diameters and lengths. Methods: The study population was rehabilitated with Astra Tech EV single implants (Dentsply Sirona, Atlantis, Dentsply Sirona S.A., Barcelona, Spain) of 4.2 and 4.8 millimetres in diameter in the upper and lower maxilla and loaded with custom abutments digitally designed using Dentsply Sirona’s Virtual Atlantis Design software (Atlantis WebOrder, Dentsply Sirona S.A., Barcelona, Spain), version 4.6.5. The custom abutments had a larger diameter than the healing abutments to evaluate for biomarkers through ELISA. Results: Rehabilitations in the mandible and with healing abutments with diameters less than 4.29 mm and rehabilitators with diameters less than 2.18 mm elicited a higher pain and inflammatory response and, in turn, higher interleukin-1β values. Conclusions: Greater inflammation was evident in cases in which healing abutments with reduced diameter were used compared to the same subsequent rehabilitation with prosthetic abutments with larger diameters. Full article

This study aimed to evaluate the effect of customized healing abutments compared to prefabricated healing abutments in immediate implant sites. Twelve patients requiring single immediate implant placement were divided into two groups: a prefabricated group received prefabricated titanium healing abutments, and a customized group received a polyetheretherketone (PEEK) customized healing abutments fabricated based on the individuals’ digital impressions. Outcomes, including peri-implant horizontal and vertical soft tissue alteration, bone level change, volume change, pain score, and pink esthetic score (PES) change, were evaluated at the 1-, 4-, and 6-month follow-ups compared to pre-extraction teeth. At the 1- and 4-month follow-ups, the customized group had a significantly lower buccal volume variation (BVv). At the 6-month follow-up, neither group showed any significant difference in the marginal bone change; however, the customized group had a significantly lower PES change and a lower pain score. In the anterior and premolar regions, the customized group showed the preservation of peri-implant buccal horizontal soft tissue and buccal volume, while in the molar regions, the preservation of papilla height and midfacial height was observed. The morphology of the customized healing abutment demonstrated a better trend in preservation of peri-implant soft tissue, esthetic outcomes, and lower patient discomfort in immediate implant sites. Full article

The current scientific knowledge and guidelines in bone and soft tissue augmentation suggest the use of staged surgical workflows as the gold standard of regenerative procedures during implant therapy. In this context, the process is always the same, regardless of the techniques applied: an alternate series of surgical acts that follow one another after the completion of a specific period of osseointegration or graft maturation. As a result, the overall surgical treatment is often long and invasive and induces scar tissue formation. This article proposes a novel, fast, and less-invasive biphasic protocol with the use of a well-documented cortical barrier mounted on healing screws that are further replaced by customized abutments at an early second stage. Two cases are reported, one for an upper maxillary edentulous area and the other for a mandibular, with a total of four implants placed. The results at 4 months postop showed an optimal soft tissue configuration for both cases, with adequate cervical profile generation and a sufficient supracrestal complex height above the implant platforms. Significant bone gains were also recorded through CBCT data collection, either with alveolar width measurements on axial slices, the superposition of pre-op and post-op datasets, or 3D visualization after bone volume segmentation. Full article

Background: Alveolar socket preservation is a topic of serious interest, and researchers have investigated this problem quite extensively. In terms of aesthetics, it is very important to avoid bone resorption if the clinician decides to insert the implant immediately after the extraction. Recently, a new approach utilizing a barrier external to the socket has been developed, which has advanced the evolution of this technique. Immediate implants have also created some difficulty when re-evaluated in long-term follow-up, especially when an aesthetic result is part of the goal of the procedure. Methods: The modified periosteal inhibition (MPI) technique, which has shown interesting outcomes, is evaluated in this paper on a large group of patients. In this case series, among 14 patients, 11 received immediate implants using the MPI technique and immediate provisionalization, and 3 received immediate implants using the MPI technique and customized healing abutment. All patients showed ridge preservation to different degrees, ranging from 0.02 to 1.17 mm, with an average gain of 0.51 mm. Results: all of the 14 patients maintained the original ridge shape, and 1 showed an increase in bucco-lingual size. Conclusions: This case series confirms the promising information reported in earlier studies on this technique. Larger samples will be necessary to confirm the predictability of this new approach. Full article

Immediate dental implant placement with or without immediate loading is reported in daily dentistry and implantology, but these procedures are not common in the case of periradicular and periapical lesions around the tooth needed to be replaced. In the following retrospective evaluation, 10 cases with a 1-year follow-up were selected to propose the technique of an immediate provisional non-loading prosthesis being delivered on the same day of the post-extraction implant placement in multiradicular teeth affected by chronic periradicular and periapical lesions. Post-extractive sockets underwent immediate dental implant placement by filling the empty space with sterile, re-absorbable gelatin sponges. The widths of the alveolar ridge were measured on three-dimensional radiographs before and after the operation, 4 and 12 months later. Non-parametric statistics were performed to compare the outcomes over time with a level of significance of 0.05. Comparing the preoperative cross-sectional images of cone beam computerized tomography (CBCT) scans to the postoperative ones, it was noted that changes in the crestal ridge width, ΔCW, (compared to baseline) were negligible and not clinically appreciable. However, while ΔCW at 4 months appeared to be negative (−0.17 ± 045 mm), crestal width at 12 months was at the same level as the baseline (ΔCW = 0.02 ± 0.48 mm), with a significant difference between 4 and 12 months (p-value = 0.0494). Immediate implant placement with an immediate non-loading provisional customized healing abutment of polyether-ether-ketone placed into the post-extractive sockets with asymptomatic and large chronic periapical and periradicular lesions could represent a further treatment strategy for patients’ rehabilitation and soft tissue preservation to replace a hopeless tooth. Full article

Background: The present study aims to analyze the use of Laser-Lok microtextured neck implants placed with a transmucosal surgical approach. The marginal bone level (MBL) and periodontal parameters were evaluated in a cohort prospective 4-year clinical study. Methods: A total of 41 implants were placed in 36 healthy consecutive patients (16 males, 20 females, mean age 60 ± 9 years). Tapered tissue level implants, characterized by a 2.0 mm laser-microtextured neck, were used with a flapless approach. Customized abutments and provisional resin crowns were positioned. Definitive metal–ceramic crowns were cemented approximately 4 months after insertion. Periapical radiographs were taken after 1, 3, 6, 12, 36 and 48 months from implant placement to evaluate MBL. Gingival thickness (thin/thick), plaque score (PS) and bleeding on probing (BoP) were evaluated. Results: After 48 months, all implants were safe from complications. No complications, peri-implantitis, early implant failures or mucositis occurred. The survival rate was 100%. Mean MBL during the follow-up was −0.15 ± 0.18 at T1, −0.29 ± 0.29 at T3, −0.45 ± 0.37 at T6, −0.53 ± 0.45 at T12, −1.06 ± 1.13 at T 36 and −1.10 ± 0.89 at T 48. Implants placed 2–3 months after tooth extraction revealed lower MBL variation when compared to those placed immediately (in fresh extraction sockets) or in completely healed ridges (delayed group). Narrower diameter implants (3.8 mm) showed significantly higher MBL variation when compared to 4.6 diameter implants. Multilevel analysis at T48 revealed that among all the evaluated variables, implant diameter was the factor mostly associated with MBL modifications (p = 0.027). Conclusion: This 4-year clinical study supports the use of Laser-Lok implants placed at tissue level with a flapless approach. A limited bone loss during the 48-month follow-up was observed. Periodontal parameters were stable with no sign of inflammation or soft tissue alteration. The use of Laser-Lok implants with transmucosal surgery represents a suitable technique with a minimally invasive approach. Full article

Customized healing abutments have been introduced in clinical practice along with implant surgery to preserve or create natural-appearing hard and soft tissue around the implant. This provides the benefits of reducing the overall treatment time by eliminating the second stage and reducing the elapsed time of the fabrication of the final prostheses. This article aims to review the types and properties of materials used for the fabrication of customized healing abutments and their clinical applications. Articles published in English on customized healing abutments were searched in Google Scholar, PubMed/MEDLINE, ScienceDirect, and the Scopus databases up to August 2022. The relevant articles were selected and included in this literature review. Customized healing abutments can be fabricated from materials available for dental implants, including PEEK, PMMA, zirconia, resin composite, and titanium. All the materials can be used following both immediate and delayed implant placement. Each material provides different mechanical and biological properties that influence the peri-implant tissues. In conclusion, the studies have demonstrated promising outcomes for all the materials. However, further investigation comparing the effects of each material on peri-implant soft and hard tissues is required. Full article

Aim: To evaluate the effect of the resin-bonded prosthesis (Maryland bridge) on marginal bone remodeling of implants placed at the tissue level in the posterior region. Methods: Consecutive healthy patients (n = 46) were included in this clinical study. Flapless not-submerged implants were placed with cover screws exposed and positioned approximately 0.5 mm above tissue level. Patients received the implant and a temporary resin-bonded prosthesis (RBP) (n = 22) or only the implant (n = 24). The RBPs were kept in place for 3 months and removed before impressions. The implants received a custom-made abutment and provisional resin crowns followed by definitive cemented metal–ceramic crowns after 2–3 weeks. The marginal bone level (MBL) was evaluated in a single-blind condition on scanned periapical radiographs and assessed mesially and distally (MBL-M/MBL-D). The bone levels of adjacent teeth (CEJ-M/CEJ-D) and the modification of the area between the implant and the mesial/distal teeth (Area-M/Area-D) were measured. All measurements were made at 1, 3 (pre-loading time) and 12 months (post-loading time). Linear regression models were fitted to evaluate the existence of any significant difference. Results: A total of 44 patients (20 Female, 24 Male; Mean age: 53.9 ± 10.3) completed the study. Two patients were excluded for fractured RBP or de-bonding. The drop-out was of 4.3%. After 12 months, all implants were free from complications. No peri-implantitis or mucositis were observed. The RBP group showed the most stable MBL at 12 months (−0.07 ± 0.41), statistically different from the non-RBP group (−0.67 ± 0.52). CEJ-M and CEJ-D were stable in both groups. Conclusion: The proposed approach of the use of RBP creates a more stable marginal bone level around implants placed at the tissue level, resulting in a reliable technique to protect bone tissue from mechanical and occlusal trauma during the healing period and osteointegration. Full article

Introduction: Nowadays, the final success of implantation is not only based on obtaining osseointegration of the implant but is also determined by achieving a satisfactory aesthetic effect of the soft tissues surrounding the implant, which can be defined as an aesthetic integration. The process of obtaining this aesthetic integration already begins at the stage of placing the healing abutment, which allows us to obtain the emergence profile necessary for our prosthetic reconstruction. Materials and Methods: The study used cone-beam computer tomography (CBCT) scans of 51 patients. The measurements of the maxillary teeth (central incisor, lateral incisor, canine, first premolar, and first molar) were performed from cross-sections of the individual teeth at the transition zone to design a custom anatomic healing abutment milled from zirconium and luted to the non-index Ti-base. Results: The obtained results allowed to design and create the shape of the anatomic healing abutment. Conclusions: The use of laboratory-produced anatomical healing abutments is possible and may allow to obtain the desired and planned emergence profiles of prosthetic restorations. In addition, it might be a method of reducing work time at the dental chair but further clinical trials are necessary. Full article

Introduction: An optimal aesthetic implant restoration is a combination of a visually pleasing prosthesis and adequate surrounding peri-implant soft tissue architecture. This study describes a novel workflow for one-step formation of the supra-implant emergence profile. Materials and Methods: Two randomized groups were selected. Ten control group participants received standard healing screws at the surgical stage. Ten individualized healing abutments were Computer aided Design/Computer aided Manufacturing (CAD/CAM)-fabricated out of polyether ether ketone (PEEK) restoration material in a fully digital workflow and seated at the surgical stage in the test group. The modified healing abutment shape was extracted from a virtual library. The standard triangulation language (STL) files of a premolar and a molar were obtained considering the coronal anatomy up to the cement-enamel junction (CEJ). After a healing period ranging from 1 to 3 months depending on the location of the surgical site, namely, mandible or maxilla, a digital impression was taken. The functional implant prosthodontics score (FIPS) and the numerical rating scale (NRS) of pain were recorded and compared. Results: The mean FIPS value for the test group was 9.1 ± 0.9 while the control group mean value was 7.1 ± 0.9. In the test group, pain assessment at crown placement presented a mean value of 0.5 ± 0.7. On the contrary, the control group showed a mean value of 5.5 ± 1.6. Conclusions: Patients in the test group showed higher FIPS values and lower NRS scores during the early phases compared to the control group. Full article

This report describes the case of a patient who required rehabilitation of their maxillary anterior teeth following a traumatic injury through a physical altercation. The decision was made to extract the maxillary central incisors and maxillary right lateral incisor, perform immediate implantation on the maxillary right lateral incisor and left central incisor areas, and place a three-unit immediate provisional restoration. Predesigned virtual teeth enabled efficient fabrication of the immediate provisional restoration following the implant placement. After a sufficient healing period with periodic check-ups, final impressions were made using a digital approach, with meticulous care taken to preserve the gingival architecture around the sites of rehabilitation. Thus, the custom abutments and definitive restoration were placed without eliciting an uncomfortable feeling in the patient. Both esthetic and functional outcomes were satisfactory. Reduced soft tissue volume around the implant restoration was observed, primarily within the two months post-extraction/implantation, based on superimposition of the serial scan data. Soft tissue volume changes in the present case suggest the need for controlled clinical studies of three-dimensional changes of gingival contours after extraction and/or implantation. Full article