Multicentre Withinperson Randomised Controlled Trial of 0.5 Mm Versus 1.5 Mm Subcrestal Placement of Dental Implants With Internal Conical Connection: Five-year Post-loading Results

PURPOSE. To assess whether there are any clinical benefits to placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests. MATERIALS AND METHODS. Sixty partially edentulous patients at six centres requiring two single implant-supported crowns had both sites randomly allocated according to a split-mouth design to either 0.5 mm or 1.5 mm subcrestal implant placement; implants in aesthetic areas were submerged for 3 months while those in non-aesthetic areas were not. Provisional acrylic crowns were fitted and replaced with definitive metal-ceramic crowns after 2 months. Patients were followed up to 5 years after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, and patient prefe-rence, recorded by blinded assessors. RESULTS. Two patients dropped out. There were no statistically significant differences in failure rate (out of 58 patients, four implants failed in the 0.5 mm group versus one in the 1.5 mm group; difference =-5.17%; 95% CI-10.87% to 0.53%; P = 0.250) or complications (out of 58 patients eight complications occurred in eight patients from the 0.5 mm group versus five complications in five patients from the 1.5 mm group (difference =-5.17%; 95% CI-14.01% to 3.67%; P = 0.453) between groups. At 5 years after loading, the mean pink aesthetic scores were 10.89 ± 2.30 and 10.79 ± 2.41 in the 0.5 and 1.5 mm groups, respecti-vely, a difference that was not statistically significant (P = 0.943). Patients from the 0.5 mm group lost on average 0.53 ± 1.43 mm peri-implant marginal bone, and those in the 1.5 mm group lost 0.31 ± 0.98 mm, a statistically significant difference (0.26 mm; 95% CI 0.05 to 0.47; P = 0.016). Patients did not prefer any depth of implant placement over the other. There were no differences in outcomes between centres. CONCLUSIONS. No clinically appreciable differences were noted when placing implants surrounded by at least 1 mm of bone 0.5 mm or 1.5 mm subcrestally. Clinicians are therefore free to choose which strategy they prefer

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

Traps of multi-level governance. Lessons from the implementation of the Water Framework Directive in Italy

During recent decades, different patterns of multi-level governance (MLG) have spread across Europe as a consequence of Europeanisation of public policies, which have increasingly adopted decentralized and participatory procedures conceived as a tool of more effective and accountable policy-making. It appears, however, that the implementation of operational designs based on MLG may be rather problematic and it does not necessarily bring to the expected performance improvements. Referring to the case of the EU Water Framework Directive (2000/60/EC), which conceives the creation of new multi-level institutional settings as a key tool for enacting a new holistic approach to water management and protection, this article explores the difficulties that the implementation of such settings has brought in Italy, despite some favorable pre-conditions existing in the country. Evidence is provided that along with institutional and agency variables, the implementation effectiveness of MLG arrangements promoted by the EU can be challenged by their inherent characteristics

Photodynamic therapy to treat periimplantitis

Aim:Periimplantitis is a bacterial complication after dental implants implantation. Photodynamic therapy (PDT) implies the use of low-power laser in combination with appropriate photosensitizer to increase the detoxification of the implant surfaces. Little information exists about PDT in the treatment of periimplantitis. A randomized comparative case-control study has been conducted with 20 patients and 20 controls to compare the efficacy of antimicrobial PDT versus surgical therapy in patients with periimplantitis, who have received dental implants with rough surfaces. Materials and Methods:In the surgery group, mucoperiosteal flap surgery was used with scaling on implant surfaces and debridement of granulation tissue. Microbiologic testing was evaluated before and after intervention treatment, at 12 and 24 weeks in the study subjects. Discussion:Total anaerobic counts of bacteria did not differ significantly between patients assigned to receive PDT and those assigned to receive surgical therapy (mean, 95.2% and 80.85%, respectively). PDT was associated with a significant decrease in bleeding scores (P = 0.02) as well as inflammatory exudation (P = 0.001). Conclusion:Treatment with PDT in patients with periimplantitis was not associated with major reduction of total anaerobic bacteria on the rough surfaces of dental implants as compared with surgical therapy. A significantly lower proinflammatory index of periimplantitis was observed in the PDT group at 24 weeks of follow-up