Classification of facial periâ implant soft tissue dehiscence/deficiencies at single implant sites in the esthetic zone

BackgroundThe incidence of a periâ implant soft tissue dehiscence/deficiency (PSTD) is not a rare finding. Despite multiple previous attempts aimed at correcting the PSTDs, a classification of these conditions has not yet been proposed. This lack in the literature may also lead to discrepancies in the reported treatment outcomes and thus misinform the clinician or the readers. The aim of the present article was therefore to present a classification of periâ implant PSTD at a single implant site.MethodsFour classes of PSTDs were discussed based on the position of the gingival margin of the implantâ supported crown in relation to the homologous natural tooth. In addition, the buccoâ lingual position of the implant head was also taken into consideration. Each class was further subdivided based on the height of the anatomical papillae.ResultsSubsequently, for each respective category a surgical approach (including bilaminar techniques, the combined prostheticâ surgical approach or soft tissue augmentation with a submerged healing) was also suggested.ConclusionThis paper provides a new classification system for describing PSTDs at single implant sites, with the appropriate recommended treatment protocol.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151905/1/jper10351_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151905/2/jper10351.pd

Soft tissue management at implants: Summary and consensus statements of group 2. The 6th EAO Consensus Conference 2021

OBJECTIVES The task of working Group 2 at the 6th Consensus Meeting of the European Association for Osseointegration was to comprehensively assess the effects of soft tissue augmentation procedures at dental implant sites on clinical, radiographic and patient-reported outcome measures (PROMs) including an overview on available outcome measures and methods of assessment. MATERIALS AND METHODS Three systematic reviews and one critical review were performed in advance on (i) the effects of soft tissue augmentation procedures on clinical, radiographic and aesthetic outcomes, (ii) reliability and validity of outcome measures and methods of assessment and (iii) PROMs applied in clinical studies for soft tissue augmentation procedures at dental implant sites. Major findings, consensus statements, clinical recommendations and implications for future research were discussed in the group and approved during the plenary sessions. RESULTS The four reviews predominantly revealed: Soft tissue augmentation procedures in conjunction with immediate and delayed implant placement result in superior aesthetic outcomes compared to no soft tissue augmentation in the zone of aesthetic priority. Soft tissue augmentation procedures have a limited effect on marginal bone level changes compared to implant sites without soft tissue augmentation. Clinically relevant parameters (gingival index, mucosal recession) and plaque control improve at implant sites when the width of keratinised mucosa is increased. A variety of aesthetic indices have been described with good reliability. Pink Esthetic Score and Complex Esthetic Index are the most validated aesthetic indices for single implants, though. Superimposed digital surface scans are most accurate to assess profilometric tissue changes. PROMs following soft tissue augmentation procedures have been assessed using various forms of questionnaires. Soft tissue augmentation had a limited effect on PROMs. CONCLUSIONS Soft tissue augmentation procedures are widely applied in conjunction with implant therapy. Depending on the indication of these interventions, clinical, radiographic and aesthetic outcomes may improve, whereas the effect on PROMs is limited

Consensus Report of Working Group 2:Soft Tissue Management

OBJECTIVES: The task of working Group 2 at the 6th Consensus Meeting of the European Association for Osseointegration was to comprehensively assess the effects of soft tissue augmentation procedures at dental implant sites on clinical, radiographic and patient‐reported outcome measures (PROMs) including an overview on available outcome measures and methods of assessment. MATERIALS AND METHODS: Three systematic reviews and one critical review were performed in advance on (i) the effects of soft tissue augmentation procedures on clinical, radiographic and aesthetic outcomes, (ii) reliability and validity of outcome measures and methods of assessment and (iii) PROMs applied in clinical studies for soft tissue augmentation procedures at dental implant sites. Major findings, consensus statements, clinical recommendations and implications for future research were discussed in the group and approved during the plenary sessions. RESULTS: The four reviews predominantly revealed: Soft tissue augmentation procedures in conjunction with immediate and delayed implant placement result in superior aesthetic outcomes compared to no soft tissue augmentation in the zone of aesthetic priority. Soft tissue augmentation procedures have a limited effect on marginal bone level changes compared to implant sites without soft tissue augmentation. Clinically relevant parameters (gingival index, mucosal recession) and plaque control improve at implant sites when the width of keratinised mucosa is increased. A variety of aesthetic indices have been described with good reliability. Pink Esthetic Score and Complex Esthetic Index are the most validated aesthetic indices for single implants, though. Superimposed digital surface scans are most accurate to assess profilometric tissue changes. PROMs following soft tissue augmentation procedures have been assessed using various forms of questionnaires. Soft tissue augmentation had a limited effect on PROMs. CONCLUSIONS: Soft tissue augmentation procedures are widely applied in conjunction with implant therapy. Depending on the indication of these interventions, clinical, radiographic and aesthetic outcomes may improve, whereas the effect on PROMs is limited

Gingival biotype revisited-novel classification and assessment tool.

OBJECTIVES: To evaluate the relationship between gingival biotypes and gingival thickness based on probe transparency through the gingival margin and to assess the sensitivity of a novel classification method. MATERIAL AND METHODS: Sixty adult Caucasian subjects were stratified by their gingival biotype (GB) as defined by the transparency of a prototype double-ended periodontal probe through the buccal gingival margin into "thin" (30 subjects), "moderate" (15 subjects), and "thick" (15 subjects) GB. Three additional parameters were also assessed: gingival thickness (GT), probing depth (PD), and gingival width (GW). RESULTS: Median GT was 0.43 mm (P 25% 0.32; P 75% 0.58) for thin, 0.74 mm (P 25% 0.58; P 75% 0.81) for moderate, and 0.83 mm (P 25% 0.74; P 75% 0.95) for thick GB, respectively. GT was statistically significant different for thin versus moderate and thin versus thick, respectively (Kruskal-Wallis test, p < 0.05; Dunn's test, thin versus moderate: p = 0.002; thin versus thick: p < 0.001; moderate versus thick: p = 0.089). GW was directly correlated with GT (Spearman correlation p < 0.01). The sensitivity of the new classification tool for diagnosing a thin GB was 91.3%. No adverse events or complications were reported. CONCLUSION: GT differs significantly between the presented GB groups, hence, an alternative classification especially focusing on thin biotypes based on a modified periodontal probe might be advantageous. In addition, the presence of a thick gingiva is associated with a wide band of keratinized tissue. CLINICAL RELEVANCE: This clinical setting might to be useful to identify high-risk patients with a very thin biotype and, consequently, higher risk for gingival recession after dental treatments

Influence of local administration of pamidronate on extraction socket healing : a histomorphometric proof-of-principle preclinical in vivo evaluation

Background: Tooth extraction is conventionally performed without any additional tissue manipulation and left for healing by secondary intention. Maintaining hard and soft tissue volume after tooth extraction may be crucial to achieve a highly aesthetic restoration and it may also facilitate stability of the results on the long-term. Therefor, different approaches have been proposed to eliminate post-extraction ridge reduction. Today, however, no technique seems to be able to preserve the entire socket volume. Aim/Hypothesis: To evaluate histomorphometrically the influence of local administration of pamidronate, adsorbed on a deproteinized porcine bone substitute, on extraction socket healing. Material and methods: Two American Fox-hound dogs were used within this proof-of-principle study. Following endodontic treatment of the distal root of the three lower premolars, the teeth were hemisected and the mesial roots were extracted flapless. The sockets were then loosely filled, in a split-mouth fashion, with a deproteinized porcine bone substitute in particulate form (Osteobiol Gen-Os; DPB), rehydrated either with sterile saline (control) or 90 mg/ml pamidronic acid solution (Aredia ; test). Extraction sockets were sealed with connective tissue punches obtained from the palate and secured with sutures. After 4 months of healing, specimens containing the sockets sites and remaining roots were retrieved and histomorphometrically evaluated. Vertical and horizontal ridge changes were evaluated comparing the section containing the remaining root and the corresponding extraction sites. Results: Histological evaluation of the sections revealed significant differences in healing patterns between test and controls. While the latter group presented complete closure of the sockets with newly formed bone, pamidronate treated sites presented with open socket entrances, only sealed with soft connective tissue. Within the socket, control sites presented with various amounts of newly formed bone and no evidence of DPB; limited amounts of bone healing were observed within test sites, that were filled with DPB mainly embedded in connective tissue. Socket (bone) wall loss in a vertical dimension showed only minor differences between tests and controls sites (buccal: – 1.01 vs – 1.15 mm; lingual: – 0.92 vs – 1.15 mm;). Horizontal bone loss, measured at a level corresponding to 3 mm below the cemento-enamel-junction (CEJ), was nearly three times higher in control sites ( 2.19 1.81 mm vs. – 0.80 0.91 mm;), while no differences were observed between groups at a level corresponding to 5 mm below the CEJ. Conclusion and clinical implications: Local administration of pamidronate adsorbed on a deproteinized porcine bone substitute in particulate form appeared to delay extraction socket healing, but may also reduce post-extraction dimensional changes in the alveolar ridge, in terms of horizontal bone loss. Additionally, pamidronate appears to obstruct resorption of the porcine bone substitute