28 research outputs found
Smile esthetic evaluation of mucogingival reconstructive surgery
To assess the difference in smile esthetic impact of Coronally Advanced Flap (CAF) with or without the adjunct of a collagen matrix (CMX) used as root coverage procedures. Subjects with esthetic demands showing multiple upper gingival recessions of at least 2 mm, without interproximal attachment loss and cervical abrasion no more than 1 mm were recruited and randomized to CAF plus CMX or CAF alone. The Smile Esthetic Index (SEI) was adopted to quantify the quality of the smile recorded at baseline and 12 months after treatment for each treatment group. In addition, between group difference in the SEI was calculated. 24 Patients were treated and analysed. At baseline, mean gingival recession depths were 2.3 ± 0.7 mm for Test group and 2.6 ± 1.0 mm for Control group. After 1 year, the residual recession depth was 0.3 ± 0.4 mm in the CAF + CMX group and 0.6 ± 0.3 mm in the control group. The SEI at baseline was 8.1 ± 1.0 and 7.9 ± 0.7 for Test and Control group, respectively. The between groups difference at 12 months in SEI was 0.4 (95% C.I. − 0.0 to 0.8, P = 0.0697). Twelve months after treatment, CAF + CMX provided a similar SEI compared to CAF alone and the adjunct of a collagen matrix did not show a different impact on the smile esthetic appearance
Natural or Palatal Positioning of Immediate Post-extraction Implants in the Aesthetic Zone? Five-year Outcomes of a Multicentre Randomised Controlled Trial
PURPOSE. To evaluate whether there is a difference in aesthetic outcomes when positioning immediate post-extractive implants in the “central” position (where the natural tooth would be in relation to adjacent teeth/implants) as opposed to roughly 3 mm more pala-tally. MATERIALS AND METHODS. Just after tooth extraction, 20 patients requiring one single immediate maxillary post-extraction implant, from second premolar to second premolar, were randomly allocated to receive one implant positioned in either the natural “central” position (central group; 10 patients), or about 3 mm more palatally (palatal group; 10 pa-tients) according to a parallel-group design at two different centres. When needed, sites were reconstructed, and bone-to-implant gaps were filled with granules of anorganic bovine bone and covered by resorbable collagen barriers. Implants were left submerged for 4 months and rehabilitated with provisional crowns, replaced after 4 months by definitive metal-ceramic crowns. Patients were followed up to 5 years after loading. Outcome measures were: crown and implant failures; complications; aesthetics, assessed using the pink aesthetic score (PES); peri-implant marginal bone level changes; and patient satisfaction, recorded by blinded assessors. RESULTS. Three patients from each group dropped out within 3 years after loading. Five years after loading, there were no significant differences between the two groups in median PES score, assessed by a blind assessor, (central: 10 [IQR: 5.5], palatal: 8.5 [IQR: 6.75], median difference =-1.0; 95% CI:-7.0 to 4.0; P = 0.571); median bone level (central: 0.45 mm [IQR: 1.76], palatal: 0.45 mm [IQR: 1.93], median difference = 0 mm; 95% CI:-1.7 to 3.0; P = 1.000); bone level changes (central: 0.15 mm [IQR: 0.70], palatal:-0.05 mm [IQR: 1.23], median difference =-0.20 mm; P = 0.471); implant failures (one in each group, 14%, difference in proportion = 0.00; 95% CI:-0.39 to 0.39; P = 1.000); or complications (two palatal group patients and one central group patient, difference in proportion = 0.14; 95% CI:-0.28 to 0.52; P = 1.000). Furthermore, patients from both groups were equally satisfied with both function and aesthetics (both P = 0.699). CONCLUSIONS. These preliminary results suggest that positioning of immediate post-ex-traction implants 3 mm more palatally may not, in fact, improve aesthetics; however, the sample size of the present study was very limited, and larger trials are therefore required to confirm or refute these findings
Side effects and complications of intraosseous anesthesia and conventional oral anesthesia
Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion: A preliminary study of 23 patients
Microbiological assessment of the implant-abutment interface in different connections: Cross-sectional study after 5 years of functional loading
Objective: To evaluate the bacterial microflora present inside the implant connection and in the peri-implant sulcus fluid of healthy implants, and to analyze the relationships between these harboring sites for four different implant systems after at least 5 years of functional loading. Materials and methods: A cross-sectional study was performed involving 40 patients treated with metal-ceramic cemented bridges supported by at least two healthy implants functionally loaded for 5 years. Four different implant-abutment connections were studied: external hexagon (control group), double internal hexagon (test group 1), internal hexagon with external collar (test group 2), and conical connection (test group 3). Samples for microbiological analysis were obtained from three types of sites: peri-implant sulci, connections' inside and abutments surface and, as control, gingival sulci of neighboring teeth. Quantitative real-time PCR was carried out for Total Bacterial Count and for 10 microorganisms: Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythensis, Treponema denticola, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens, and Candida albicans. The response variables were percentage of positive sites and absolute bacterial load. The relations of the response variables with the type of connection and of sampling site were assessed using generalized estimating equations. Results: Regarding the analysis of positivity to bacteria in the peri-implant sulcus no significant differences were observed. Analyzing the connection's inside, none of the connection designs had the capacity to prevent microbiological leakage through the implant/abutment microgap. Test group 3 presented the lowest mean values for red complex bacteria and control group the highest, although differences were non-significant. Statistical significance was only reached for Treponema denticola in the bacterial load analysis inside the connection. Test groups 1 and 2 yielded lower values for orange complex bacteria but only for Peptostreptococos micros the differences resulted significant. Test groups 2 and 3 had significantly lower total bacterial counts in the peri-implant sulcus and inside the connection. Conclusions: Outcomes suggested that all the analyzed connections resulted contaminated after 5 years of functional loading. However, the connection design might influence bacterial activity levels qualitatively and quantitatively, especially inside the implant connection
Implant treatment in atrophic posterior mandibles: Vertical regeneration with block bone grafts versus implants with 5.5-mm intrabony length
Purpose: To retrospectively compare the outcomes of implants placed in posterior mandibles vertically regenerated with onlay autogenous block bone grafts and short dental implants. Materials and Methods: Consecutive patients with vertical bone atrophy in edentulous mandibular posterior regions (7 to 8 mm of bone above the inferior alveolar nerve) were treated with either implants placed in regenerated bone using autologous block bone grafts (group 1) or short implants (with 5.5-mm intrabony length) in native bone (group 2) between 2005 and 2010 and followed for 12 months after loading. The procedure used was the established treatment protocol for this type of patient at the Oral Surgery Unit (University of Valencia, Spain) at the time of surgery. All grafts were obtained using piezosurgery. The outcomes assessed were: complications related to the procedure, implant survival, implant success, and peri-implant marginal bone loss. Statistical analysis was done using the Fisher exact test and the Mann-Whitney test. Results: Thirtyseven patients were included, 20 (45 implants) in group 1 and 17 (35 implants) in group 2. In group 1, 13 implants were less than 10 mm long (2 were 7 mm and 11 were 8.5 mm), and 32 were 10 mm or longer; the diameter was 3.6 mm in 6 implants, 4.2 mm in 31, and 5.5 mm in 8. In group 2 all implants were 7 mm long; the diameter measured 4.2 mm in 14 implants and 5.5 mm in 21 implants. Complications related to the block bone grafting procedure were temporary hypoesthesia in one patient, wound dehiscence with graft exposure in three patients, and exposure of the osteosynthesis screw without bone graft exposure in one patient. After 12 months, implant survival rates were 95.6% in group 1 and 97.1 % in group 2; success rates were 91.1% and 97.1%, respectively. The average marginal bone loss was 0.7 ± 1.1 mm in group 1 and 0.6 ± 0.3 mm in group 2. Conclusions: When residual bone height over the mandibular canal is between 7 and 8 mm, short implants (with 5.5-mm intrabony length) might be a preferable treatment option over vertical augmentation, reducing chair time, expense, and morbidity
Does Apico-Coronal Implant Position Influence Peri-Implant Marginal Bone Loss? A 36-Month Follow-Up Randomized Clinical Trial
Purpose: Preserving peri-implant bone and reducing exposure of the rough implant surface might influence long-term outcomes of implant therapy. The aim of this study was to compare peri-implant clinical and radiologic parameters after crestal and subcrestal dental implant placement at 36 months’ follow-up. Materials and Methods: We carried out a randomized clinical trial involving partially edentulous patients in need of an implant-supported, partial fixed dental prosthesis or a single crown. Patients were randomized according to the implant insertion depth: implants placed approximately 2 mm below the bone crest (test group) or implants placed at bone crest level (control group). They were evaluated 6, 12, 24, and 36 months after prosthetic loading. Peri-implant marginal bone loss was the primary outcome, and the following secondary outcomes were registered: coronal bone changes, plaque index, probing depth, modified bleeding index, retraction and width of the peri-implant mucosa, and peri-implant health condition. Implant survival and success rates after 36 months’ follow-up were calculated. Results: The study comprised 128 patients (83 men and 45 women; mean age, 54.4 ± 12.2 years) and a total of 265 implants (133 in control group and 132 in test group). No statistically significant differences in the peri-implant clinical parameters were found. After 3 years’ follow-up, 53.4% of the crestal implants and 25.8% of the subcrestal implants presented marginal bone loss, with a mean exposed rough surface of –0.2 ± 0.3 mm and –0.09 ± 0.1 mm, respectively (P =.001). The overall success rate was 99.6%. Conclusions: Crestal and subcrestal implants showed similar clinical outcomes 3 years after prosthetic loading. Significant differences were observed in the radiologic parameters, showing less peri-implant marginal bone loss with subcrestal implants