Soft tissue development around abutments with a circular macro-groove in healed sites of partially edentulous posterior maxillae and mandibles: a clinical pilot study

Department of Fixed and Removable Prosthodontics, Dental School Vienna, University of Vienna, Vienna, Austria.
Clinical Oral Implants Research (Impact Factor: 3.12). 12/2010; 22(7):743-52. DOI: 10.1111/j.1600-0501.2010.02054.x
Source: PubMed

ABSTRACT The aim of this study was to evaluate soft tissue development at concave circular macro-grooved titanium abutments in healed sites.
In a split-mouth pilot study 10 patients received two implants each at healed posterior sites in contralateral maxillary or mandibular jaw quadrants. Either circular macro-grooved concave study abutments or conventional convex control abutments were immediately provisionalized and received permanent crowns 3 months postimplantation. Marginal bone level, papilla index, modified plaque and bleeding index were recorded. The esthetic outcome was evaluated with standardized perpendicular pictures according to the Pink Esthetic Score (PES). Statistical analysis included the description of all variables by mean value, standard deviation and range. PES values were compared using the Wilcoxon signed rank test for paired data.
Cumulative survival rate for all 20 implants was 100%. At the 1-year follow-up, there was no statistical significant difference of marginal bone levels between sites restored with the study (-0.11 ± 0.77 mm) vs. the control (-0.34 ± 0.53 mm) abutments (P>0.05). Esthetic evaluation (PES) revealed statistically significant differences in scores between the study group [study abutment group] (7.2 ± 2.82, 8 ± 1.89) and the control group [control abutment group] (9.5 ± 1.58, 10.5 ± 1.72) at the time of prosthetic delivery and the 1-year follow-up. Whereas PES scores for mesial papilla at control sites at the 1-year follow-up demonstrated statistically significant higher values, both soft tissue level and soft tissue contour at control sites revealed statistically significantly higher PES values (P<0.05) at time of prosthetic delivery and at 1-year follow-up when compared with study sites.
Concave macro-grooved abutments in healed posterior maxillary and mandibular sites did not exhibit a superior soft tissue development compared with standard convex abutments.

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    • "achieve steady improvement in PES score (Cosyn et al. 2013). Following type 2 (4–8 weeks after tooth extraction) and type 3 (12– 16 weeks after tooth extraction) implants placement, spontaneous improvements of PES score might occur in the short-term follow-up , and then the PES score will likely reverse to the baseline level when the observational time was prolonged to at least 3 years after crown installation (Buser et al. 2011, 2013; Weinlander et al. 2011; Pieri et al. 2013). It is worth mentioning that only bone-level implant systems were used in the above studies . "
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    ABSTRACT: Objective The aim of this prospective study was to assess the esthetic outcome and alterations of peri-implant soft tissue using tissue-level implants. Furthermore, the influencing factors, including grafting and gingival biotype, of esthetic outcome of peri-implant soft tissue were also evaluated.Materials and methodsOf 38 patients with single missing anterior tooth in maxilla were treated with a Straumann ® Standard Plus SLA implant. Bone augmentation was performed in 24 patients. Follow-up was conducted at 12 and 24 months after definitive crowns placement. Esthetic outcome using the pink esthetic score/white esthetic score (PES/WES) and clinical parameters were evaluated.ResultsThe mean PES/WES value at baseline, 1-year, and 2-year examination was 13.79, 14.87, and 14.96. Significant improvement was found between baseline and 1-year examination (P < 0.01). And the improvement between 1-year and 2-year examination was not significant (P = 0.40). The mean PES changing value in patients with thick biotype was significantly higher than those with thin biotype at 2-year after definitive crowns placement (P = 0.03). Graft procedure had an unfavorable effect on mean PES value both at baseline and at follow-up (P < 0.01). No implants were lost at 2-year examination. Three patients experienced peri-implant infection. No significant difference was found with the passage of time in modified plaque index (mPI), probing pocket depth (PPD), and modified bleeding index (mBI).Conclusion According to the present prospective clinical study, it can be concluded that it is feasible to use tissue-level implant to support single crowns in esthetic area. Favorable short-term esthetic outcome and stability of soft tissue around single implant crowns can be expected in patients with or without graft. However, graft procedures might have an unfavorable effect on the esthetic outcome. Gingival biotype can be considered as prognostic factor for esthetic outcome. RCTs with long-term follow-up are needed to provide evidence for the long-term stability of peri-implant soft tissue using tissue-level implant systems.
    Clinical Oral Implants Research 04/2014; DOI:10.1111/clr.12408 · 3.12 Impact Factor
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    • "After abutment and crown placement, the periimplant soft tissue is still under remodeling. With the relief of the pressure on the soft-tissue contour, color, and texture may become relatively more mature and healthy at a shortterm follow-up (Weinlander et al. 2011; Payer et al. 2012). And this process was not affected by the timing of implant placement. "
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    ABSTRACT: The aim of the current review was to systematically appraise the esthetic outcome of soft tissue around single implant crowns following type 1 and type 3 implants placement in published dental literature. A PubMed, Embase, and the Cochrane Central Register of Controlled Trials search up to March 2013 was conducted for articles published in the dental literature and limited to human trials with no language restricted. Furthermore, the reference lists of related articles were systematically screened, and additional manual searches were also performed. The primary outcome was pink esthetics score (PES). The electronic search in the database of PubMed, Embase, and the Cohrane Central Register of Controlled Trials resulted in the identification of 463 titles. These titles were initially screened by the two independent reviewers for possible inclusion. Screening the abstracts and titles led to 28 articles for future full-text consideration. From these articles, 18 studies were excluded. Manual search identified one article. After quality assessment, eight studies were included in this review. This review showed that no significant difference of PES index could be found between type 1 and type 3 implant placement. According to the current evidence, short-term esthetic outcomes of peri-implant soft tissue did not show significant difference following type 1 and type 3 implants placement with well-selected patients. However, caution should be taken for clinicians to extrapolate this result to all types of patients, as more randomized clinical trials are needed for long-term soft-tissue esthetic outcome in patients with high esthetic risk following type 1 implant placement. PES frequency, peri-implant condition and other risk factors for peri-implantitis are recommended to be reported for future studies.
    Clinical Oral Implants Research 01/2014; 26(7). DOI:10.1111/clr.12334 · 3.12 Impact Factor
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    ABSTRACT: To describe contact, thickness, density, and orientation of connective tissue fibers around healing abutments of different geometries by means of a new method using coordinates. Following the bilateral extraction of mandibular premolars (P2, P3, and P4) from six fox hound dogs and a 2-month healing period, 36 titanium implants were inserted, onto which two groups of healing abutments of different geometry were screwed: Group A (concave abutments) and Group B (wider healing abutment). After 3 months the animals were sacrificed and samples extracted containing each implant and surrounding soft and hard tissues. Histological analysis was performed without decalcifying the samples by means of circularly polarized light under optical microscope and a system of vertical and horizontal coordinates across all the connective tissue in an area delimited by the implant/abutment, epithelium, and bone tissue. In no case had the connective tissue formed a connection to the healing abutment/implant in the internal zone; a space of 35 ± 10 μm separated the connective tissue fibers from the healing abutment surface. The total thickness of connective tissue in the horizontal direction was significantly greater in the medial zone in Group B than in Group A (p < .05). The orientation of the fibers varied according to the coordinate area so that internal coordinates showed a higher percentage of parallel fibers in Group A (p < .05) and a higher percentage of oblique fibers in Group B (p < .05); medial coordinates showed more oblique fibers (p < .05); and the area of external coordinates showed the highest percentage of perpendicular fibers (p < .05). The fiber density was higher in the basal and medial areas (p < .05). Abutment geometry influences the orientation of collagen fibers; therefore, an abutment with a profile wider than the implant platform favors oblique and perpendicular orientation of collagen fibers and greater connective tissue thickness.
    Clinical Implant Dentistry and Related Research 10/2013; 70. DOI:10.1111/cid.12161 · 2.80 Impact Factor
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