Do soft tissue augmentation techniques provide stable and favorable peri-implant conditions in the medium and long term? A systematic review

To review the available literature on the medium- and long-term effects of soft tissue augmentation (STA) at implant sites and to explore the effects of the different approaches on clinical-, patient-reported, and health-related parameters. Materials and Methods A comprehensive electronic and manual search was performed to identify prospective clinical studies that assessed the medium- and long-term (≥36 months) outcomes following STA, including number of sites maintaining peri-implant health and number of sites developing peri-implant disease, incidence of complications, stability of the clinical, volumetric, and radiographic parameters, and patient-reported outcome measures (PROMs). Results Fifteen studies were included in the qualitative analysis. STA was performed with either a bilaminar- or an apically positioned flap (APF) approach, in combination with autogenous grafts (free gingival graft [FGG] and connective tissue graft [CTG]) or substitutes (acellular dermal matrix [ADM] and xenogeneic cross-linked collagen matrix [CCM]). An overall high survival rate was observed. Most of the augmented implant sites maintained peri-implant health in the medium and long term, with the incidence of peri-implant mucositis and peri-implantitis ranging from 0% to 50% and from 0% to 7.14%, respectively. The position of the soft tissue margin following APF + FGG and bilaminar approaches involving CTG or CCM was found to be stable over time. No substantial changes were reported for plaque score/index, bleeding on probing/bleeding index, and probing depth between early time points and following visits. CTG-based STA procedures resulted in a stable or increased dimension of keratinized mucosa width (KMW) and mucosal thickness (MT)/volumetric outcomes over time, when compared with early follow-ups. Most of the included studies described stable marginal bone levels at the grafted implant sites over time. No substantial changes for patient-reported outcomes and professionally assessed esthetic results were reported at different time points.Conclusions Implants that received STA showed overall high survival rate and relatively low incidence of peri-implantitis in the medium and long term. Augmented sites seem to maintain the level of soft tissue margin and marginal bone over time, while non-augmented implants may exhibit apical shift of the soft tissue margin. The overall favorable early outcomes obtained with STA are maintained in the medium and long term, with an increase in KMW and MT that may be expected over time at CTG-augmented sites

The Impact of Repeated Abutment Changes on Peri-implant Tissue Stability: Five-year Post-loading Results From a Multicentre Randomised Controlled Trial

PURPOSE. To evaluate the impact of at least three abutment disconnections on hard and soft tissues around conventionally loaded implants versus definitive immediately non-oc-clusally loaded abutments in implants. A secondary aim was to evaluate whether the presence of less than 2 mm of keratinised mucosa is associated with increased soft tissue recession and/or peri-implant marginal bone loss. MATERIALS AND METHODS. Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implant placement at greater than 35 Ncm, according to a parallel-group design to receive either definitive immediately loaded abutments (definitive abutment or immediate loading group) or transmucosal abutments which were loaded after a delay of 3 months and removed at least three times. Patients were treated in four centres, and each patient contributed to the study with only one prosthesis, which was followed up for 5 years after initial loading. Outcome measures were: prosthesis failures, implant failures, complica-tions, pink aesthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone-level changes and height of the keratinised mucosa. RESULTS. Forty patients were randomly allocated to each group according to a paral-lel-group design. Seven patients from the definitive abutment group versus six from the repeated disconnection group dropped out or died. No patient from the definitive group had implant failures versus three patients who lost five implants in the repeated disconnection group (difference = 9.1%; CI95%:-0.7% to 18.9% to; P = 0.227). Nine patients from the repeated disconnection group lost or had to have their prosthesis remade (four provisional and five definitive prostheses) versus one provisional prosthesis failure in the definitive abutment group; this difference was statistically significant (difference = 23.5%; CI95%: 7.6% to 39.4%; P = 0.017), but was due to the erroneous use of non-indexed abutments in indexed implants in patients from the repeated disconnection group alone. Seven patients from the definitive abutment group versus nine patients from the repeated disconnection group were affected by complications (difference =-5.9%; CI95%:-26.0% to 14.2%; P = 0.775), the difference being not statistically significant. PES scores assessed at 5 years post-loading were 12.1±1.8 for the definitive abutment group and 11.9±1.7 for the repeated abutment changes group (difference = 0.2; CI95%:-0.7 to 1.1; P = 0.615); however, there was a statistically significant difference of 0.20 out of a maximum score of 2 in favour of the definitive abutment group for soft tissue contour alone (P = 0.045). Buccal recessions at 5 years post-loading amounted to-0.19±0.77 mm for the definitive abutment group and-0.07±1.24 mm for the repeated abutment changes group (difference = 0.12 mm CI95%:-0.42 to 0.66; P = 0.662). All patients declared being very satisfied or sati-sfied with the function and aesthetics of their prosthesis and would undergo the same procedure again. Mean peri-implant marginal bone loss 5 years after loading was 0.11±0.30 mm for the definitive abutment group and 0.48±0.73 mm for the repeated abutment change group (difference =-0.37 [SE=0.14] mm; CI95%:-0.66 to-0.09; P = 0.012), the difference being statistically significant. The height of keratinised mucosa at 5 years post-loading was 2.81±1.46 mm in the definitive abutment group and 2.83±1.84 mm in the repeated abutment change group (difference =-0.02 mm; CI95%:-0.85 to 0.80; P = 0.956), and there were no significant differences in marginal bone loss (difference = 0.00 mm; CI95%:-0.32 to 0.32, P = 0.990) or buccal recession (difference = 0.05 mm, CI95%:-0.43 to 0.54, P = 0.826) at implants having less than 2 mm of keratinised mucosa at loading compared to those having more than 2 mm of keratinised mucosa. CONCLUSIONS. Five-year post-loading data show that at least three repeated abutment disconnections significantly increased bone loss by 0.37 mm when compared to no di-sconnection, but this difference may not be clinically significant. While it might be advi-sable to avoid unnecessary abutment disconnection whenever possible, if disconnections are required, no clinically significant side effects may be expected. Immediately non-oc-clusally loaded dental implants are a viable alternative to conventional loading, and no increased bone loss or buccal recessions were noted even at implants with less than 2 mm of keratinised mucosa

Safety and effectiveness of early loaded maxillary titanium implants with a novel nanostructured calcium-incorporated surface (Xpeed): 3-year results from a pilot multicenter randomised controlled trial

Purpose: To evaluate clinical safety and effectiveness of a novel calcium-incorporated titanium implant surface (Xpeed, MegaGen Implant Co., Gyeongbuk, South Korea). Materials and methods: Sixty patients were randomised to receive one to six implants in the maxilla with either calcium-incorporated (Xpeed) or control resorbable blasted media (RBM) surfaces, according to a parallel group design at two centres. Implants were submerged and exposed at three different endpoints in equal groups of 20 patients, each at 12, 10 and 8 weeks, respectively. Within 2 weeks, implants were functionally loaded with provisional or definitive prostheses. Outcome measures were prosthesis failures, implant failures, any complications and peri-implant marginal bone level changes. Results: Thirty patients received 45 calcium-incorporated implants and 30 patients received 42 control titanium implants. Three years after loading four patients dropped-out from the Xpeed group and one from the RBM group. No prosthesis or implant failures occurred. There were no statistically significant differences between the groups for complications (P = 0.91; difference in proportions = 0.79 %; 95% CI -0.71 to 2.29) and mean marginal bone level changes (P = 0.88; mean difference = -0.02 mm; 95% CI -0.26 to 0.22). Conclusions: Both implant surfaces provided good clinical results and no significant difference was found when comparing titanium implants with a nanostructured calcium-incorporated surface versus implants with RBM surfaces. Conflict-of-interest statement: MegaGen partially supported this trial and donated the implants and prosthetic components. The study design was negotiated with MegaGen Implant Co. (Gyeongbuk, South Korea), however, data property belonged to the authors and by no means did MegaGen interfere with the conduct of the trial or the publication of its results

The effectiveness of adjunctive light-activated disinfection (LAD) in the treatment of periimplantitis: 4-month results from a multicentre pragmatic randomised controlled trial

Objectives: To evaluate possible benefits of the adjunctive use of light-activated disinfection (LAD) in the treatment of peri-implantitis. Materials and methods: Eighty patients with at least one implant affected by peri-implantitis defined as at least 3 mm of bone loss from the baseline radiographs in the presence of signs of infection (pus exudation and/or soft tissue swelling and/or soft tissue redness) were nonsurgically or surgically treated. A total of 50% were randomly allocated to receive an additional treatment of LAD (FotoSan) according to a parallel group design at four different centres. Only one implant per patient was considered. Outcome measures recorded up to 4 months after treatment were implant failures, complications, probing pocket depth (PPD) changes and number of re-treatment sessions recorded by blinded assessors. Patients were followed for 4 months after treatment. Results: Five treated patients did not fit the original inclusion criteria, 4 because they were not affected by peri-implantitis (as defined in the present study) and one because the patient was treated with antibiotics, however they were included according to an intention-to-treat analysis concept. Nine patients of the LAD group were treated surgically versus 10 control patients. After 4 months, 1 patient dropped out from the LAD group and no implant failed. Fifteen implants had to be re-treated in the LAD group versus 16 implants in the control group, the difference was not significant. Three minor complications occurred: 2 in the LAD group and 1 in the control group. PPD significantly decreased in both groups, and at 4 months there was no significant differences between groups (difference -0.12 mm, 95% CI of difference -0.94 to 0.69, P = 0.77). There were significant differences between centres for number of re-treatments needed, PPD changes, plaque and marginal bleeding 4 months after treatment. The results did not change when removing the 5 patients who did not match the present inclusion criteria. Conclusions: The use of adjunctive LAD therapy with mechanical cleaning of implants affected by peri-implantitis did not improve any clinical outcomes up to 4 months after treatment, however longer follow-ups are needed to evaluate the possible effect of repeated LAD therapy over time. Conflict-of-interest statement: CMS Dental A/S, the manufacturer of FotoSan, the LAD device tested in this investigation, partially supported this trial. However, the data belonged to the authors and by no means did FotoSan interfere with the conduct of the trial or the publication of the results