Effect of different implant placement depths on crestal bone levels and soft tissue behavior: A 5â year randomized clinical trial

ObjectivesThis randomized clinical trial analyzed the longâ term (5â year) crestal bone changes and soft tissue dimensions surrounding implants with an internal tapered connection placed in the anterior mandibular region at different depths (equiâ and subcrestal).Materials and methodsEleven edentulous patients were randomly divided in a splitâ mouth design: 28 equicrestal implants (G1) and 27 subcrestal (1â 3 mm) implants (G2). Five implants were placed per patient. All implants were immediately loaded. Standardized intraoral radiographs were used to evaluate crestal bone (CB) changes. Patients were assessed immediately, 4, 8, and 60 months after implant placement. The correlation between vertical mucosal thickness (VMT) and soft tissue recession was analyzed. Subâ group analysis was also performed to evaluate the correlation between VMT and CB loss. Rankâ based ANOVA was used for comparison between groups (α = .05).ResultsFiftyâ five implants (G1 = 28 and G2 = 27) were assessed. Implant and prosthetic survival rate were 100%. Subcrestal positioning resulted in less CB loss (â 0.80 mm) when compared to equicrestal position (â 0.99 mm), although the difference was not statistically significant (p > .05). Significant CB loss was found within the G1 and G2 groups at two different measurement times (T4 and T60) (p  .05).ConclusionsThere was no statistically significant difference in CB changes between subcrestal and equicrestal implant positioning; however, subcrestal position resulted in higher bone levels. Neither mucosal recession nor vertical mucosa thickness was influenced by different implant placement depths.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154286/1/clr13569.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154286/2/clr13569_am.pd

Soft tissue stability at the facial aspect of gingivally converging abutments in the esthetic zone: A pilot clinical study

peer reviewedStatement of problem. The literature indicates that 0.5 to 1.5 mm of gingival recession most often occurs within the first months after implant placement or abutment connection. Purpose. The purpose of this pilot study was to evaluate the effect of a concave transmucosal profile on the vertical stability of soft tissues at the facial aspect of dental implants. Material and methods. Fifty-four implants were placed in esthetically demanding sites in 41 patients (17 women, 24 men; age range of 23 to 62 years, mean 40.3 years; 5 smokers), primarily following a 1-stage approach. Twenty-five implants were placed immediately after extraction. Experimental concave titanium (n=49) and zirconia abutments (n=5) were used, and a provisional crown was placed at the same session. Digital photographs were made perpendicularly to the facial aspect of the teeth at abutment placement, and at 1, 3, 6, 12, 18, and 24 months, and enlarged views were subsequently analyzed by an independent examiner. Vertical changes in soft tissue levels were measured, and the definitive esthetic result was evaluated subjectively (poor to excellent). Data were analyzed with descriptive statistics. Results. Twenty-four implants were evaluated at 24 months, 20 at 18 months, and 8 at 12 months. Vertical augmentation or no recession in soft tissue was observed in 87% of the situations, and in no situation was recession greater than 0.5 mm found. The gingival level remained stable at 12, 18, and 24 months. The average esthetic outcome was rated as 4.5 (very good to excellent) on a 0- to 5-point scale. Conclusions. The concave, gingivally converging abutments used in the study allowed for above-average soft tissue outcomes

Influence of implant scanbody material, position and operator on the accuracy of digital impression for complete-arch: a randomized in vitro trial

To evaluate the influence of implant scanbody (ISB) material, position and operator on the accuracy of a confocal microscopy intraoral scanning (IOS) for complete-arch implant impression

Parodontite chronique: pourquoi des recommandations cliniques en pratique générale et spécialisée sont-elles nécessaires en Belgique?

As the prevalence of periodontitis is more than 40 % in the adult Belgian population, periodontists are clearly understaffed to treat this disease in all patients. Therefore, it seems logic that mild forms of chronic periodontitis are treated by the general practitioner especially because Belgium lacks dental hygienists. Important prerequisites for organizing periodontal care as such relate to the general practitioner who should use the same techniques, have comparable communicative skills to motivate patients and create a similar amount of time for periodontal treatment as the specialist. After all, the patient has the right to qualitative treatment regardless of the level of education of the care provider. In order to guarantee this in general practice as much as possible, there is a need for clinical guidelines developed by specialists. These guidelines should not only support the general practitioner in treating disease; above all, they should assist the dentist in periodontal diagnosis. Hitherto, periodontal screening by general dentists seems to be infrequently performed even though reimbursement of the Dutch Periodontal Screening Index is implemented in the Belgian healthcare security system. In this manuscript possible explanations for this phenomenon are discussed. Apart from the need for guidelines in general practice, guidelines for surgical treatment seem compulsory to uniform treatment protocols in specialized practice. Extreme variation in the recommendation of surgery among Belgian specialists calls for consensus statements

The effect of a 2-mm inter-implant distance on esthetic outcomes in immediately non-occlusally loaded platform shifted implants in healed ridges: 12-month results of a randomized clinical trial

Background: Three millimeter is considered as the minimum distance to obtain soft and bone tissue stability in case of adjacent implants. The possibility to preserve peri-implant bone level using a platform switching connection has questioned this concept. Purpose: The study evaluates soft tissue maintenance and marginal bone stability around implants, placed at 2 or 3 mm of distance. Materials and methods: Thirty patients received two immediately loaded implants either at 2-mm (test) or at 3-mm (control) of distance in the premolar area. Soft tissue esthetics (papilla height and fill, keratinized tissue, recession) and radiographic peri-implant bone level changes were measured at 3, 6, and 12 months. Results: No significant differences between the two groups were detected neither for all soft tissue esthetic outcomes nor for bone level modifications up to 12 months. Conclusion: The results suggested that up to 12 months post-loading, both 2- and 3-mm inter-distance platform-switched implants in healed site, supported adequate esthetic outcomes and peri-implant bone stability

Accuracy, inter- and intrarater reliability, and user-experience of high tibial osteotomy angle measurements for preoperative planning: manual planning PACS versus semi-automatic software programs

PURPOSE: To compare the accuracy, inter- and intrarater reliability, and user-experience of manual and semi-automatic preoperative leg-alignment measurement planning software for high tibial osteotomy (HTO). METHODS: Thirty patients (31 lower limbs) who underwent a medial opening wedge HTO between 2017 and 2019 were retrospectively included. The mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and planned correction angle were measured on preoperative long-leg full weight-bearing radiographs utilising PACS Jivex Review® v5.2 manual and TraumaCad® v2.4 semi-automatic planning software. Independent measurements were performed by four raters. Two raters repeated the measurements. Accuracy in the standard error of measurement (SEM), inter- and intrarater reliability, and user-experience were analysed. Additionally, measurements errors of more than 3° were remeasured and reanalysed. RESULTS: The SEMs of all measured varus malalignment angles and planned correction angle were within 0.8° of accuracy for both software programs. Measurements utilising the manual software demonstrated moderate interrater intraclass correlation coefficient (ICC)-values for the mLDFA and mMPTA, and an excellent interrater ICC-value for the correction angle (0.810, 0.779, and 0.981, respectively). Measurements utilising the semi-automatic software indicated excellent interrater ICC-values for the mLDFA, mMPTA, and correction angle (0.980, 0.909, and 0.989, respectively). The intrarater reliability varied substantially per angle, presenting excellent intrarater agreements by both raters (ICC >  0.900) for the correction angle in each software program as well as poor-to-excellent ICC-values for the mLDFA (0.282-0.951 and 0.316-0.926) and mMPTA (0.893-0.934 and 0.594-0.941) in both the manual planning and semi-automatic software. Regarding user-experience, semi-automatic software was preferred by two raters, while the other two raters had no distinctive preference. After remeasurement of five outliers, excellent interrater ICC-values were found for the mLDFA (0.913) and mMPTA (0.957). CONCLUSIONS: Semi-automatic software outperforms the manual software when user-experience and outliers are considered. However, both software programs provide similar performance after remeasurement of the human-related erroneous outliers. For clinical practice, both programs can be utilised for HTO planning. LEVEL OF EVIDENCE: Diagnostic study, Level III