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Peri-implantitis is an infectious disease that leads to progressive bone loss. Surgical therapy has been advocated as a way of halting its progression and re-establishing peri-implant health. One of the most challenging but crucial tasks in the management of peri-implantitis is biofilm removal to achieve reosseointegration and promote the reduction of peri-implant pockets. A wide variety of strategies have been used for implant surface decontamination. Mechanical means have been demonstrated to be effective in eliminating calculus deposits and residual debris; however, the presence of undercuts and the grooves and porosities along the roughened implant surface make it difficult to achieve an aseptic surface. In conjunction with mechanical measures, use of chemical adjuncts has been advocated to dilute bacterial concentrations, destroy the bacteria’s organic components and eliminate endotoxins. Pharmacological adjuncts have also been recommended to diminish the bacterial load. Other strategies, such as use of lasers, implantoplasty and electrolysis, have been suggested for implant surface decontamination to promote predictable clinical and radiographic outcomes. Keywords: dental implant, dental implantation, peri-implant endosseous healing, peri-implantitis Conflict-of-interest statement: The authors declare that they have no direct conflicts of interest. Dr Monje owns royalties to a peri-implantitis kit that includes burs for mechanical detoxi

Maxillary sinus elevation by the lateral window approach has been shown to be a highly predictable surgical procedure for increasing bone volume in the posterior maxilla. There are occasions, however, where this procedure may be difficult or impossible to perform in a highly predictable manner. There are many presurgical conditions and anatomical features that can make lateral window access difficult, leading to an increase in intraoperative complications and procedural failures. These complicating factors include complex internal sinus anatomy (multiple septa, anteroposterior septa), a narrow available window space, a thin or absent labial plate on adjacent teeth, and the presence of a root apex in the proposed window area, or it may be due to iatrogenically created defects, such as a previous failed sinus elevation, a healed oroantral fistula, or defects created by difficult extractions. While not frequently used or routinely reported in the literature, the palatal window approach may negate many of these obstacles. When it is reported, success rates are similar to those of lateral window procedures, and as an added advantage, postoperative morbidity is dramatically reduced, allowing the patient to wear a removable appliance immediately after surgery. There are, however, anatomical limitations that dictate when this procedure can be used. This case report is unique in that many of the lateral window complicating factors are present, and the palatal anatomy proved ideal for performing the technique.

Alveolar ridge preservation (ARP) is indicated to attenuate anatomic and physiologic changes following tooth extraction. A properly contoured ovate pontic placed immediately into an extraction socket may be adequate to maintain alveolar ridge architecture for improved esthetic results. This prospective clinical study evaluated the ability of immediately placed ovate pontics in conjunction with ARP to attenuate postextraction tissue dimensional changes in the esthetic zone and maintain alveolar ridge contour. Ten patients (11 sites) completed the study. All subjects received a combination of socket grafting with allogeneic particulate graft material and socket sealing with an ovate pontic provisional restoration. A set of clinical linear and volumetric outcomes were assessed after a 6-month healing period. At 6 months postoperative, the linear measurements for the mean ridge dimensional loss were 0.9 ± 0.6 mm (range: 0.2 to 1.8 mm) in height and 1.4 ± 0.6 mm (range: 0.1 to 2.4 mm) in width. The mean volumetric tissue loss observed was 24.4 ± 15.4 mm3 (range: 2.6 to 50.1 mm3) at 3 months postoperative and 32.2 ± 14.2 mm3 (range: 3.8 to 50.5 mm3) at 6 months postoperative. Resorption pattern assessment showed the overall cervical area to have less resorption than the apical areas at 6 months postoperative, with the least amount of resorption in the midbuccal cervical section. When compared to the data of a previous pilot study, no statistically significant difference was seen between the dimensional losses when using ovate pontics with and without ARP. This may be evidence that the use of an ovate pontic provisional restoration immediately after extraction effectively attenuates postextraction dimensional changes.

A novel macro-hybrid implant design was introduced to afford high apical primary stability and more coronal space to preserve the circumferential extraction socket architecture. This study presents 1-year data from a prospective single-arm cohort study. The data was distilled based on the following criteria: (1) single-tooth immediate tooth replacement therapy (ITRT) in the maxillary anterior and premolar regions in intact (Type 1) extraction sockets that were (2) treated with the dual-zone grafting technique. The clinical and radiographic outcomes of 48 ITRT implants were evaluated. The mean ± SD labial plate dimension changes were 0.33 ± 0.41 mm at the implant abutment interface (L1) and 0.34 ± 0.40 mm at 5.0 mm below (L2). The mean labial plate dimension (thickness) at the 1-year recall was 2.27 ± 0.88 mm (L1) and 1.95 ± 0.95 mm (L2). At ITRT, the ridge contour at the free gingival margin and 3.0 mm below it were 7.54 ± 0.93 mm and 9.44 ± 2.36 mm, respectively; after final restoration delivery, the corresponding values were 7.45 ± 0.95 mm and 10.23 ± 2.30 mm, respectively. The peri-implant soft tissue thickness (PISTT) at the time of implant-level impression-making was 3.29 ± 0.73 mm, with an average Pink Esthetic Score of 12.79. A macro-hybrid implant design showed high levels of primary stability (~60 Ncm), stable ridge contour at 1 year, a labial plate dimension between 1.5 and 2.0 mm, and PISTT > 3.0 mm, which may be a critical factor in providing stable, long-term esthetic outcomes.

There is a need to modify the definition of attached gingiva (AG) as it applies to healthy and diseased teeth and implants. There are two parts to this new definition: Part A is when the biologic width is supracrestal (epithelial attachment and gingival fibers) and is attached to a healthy tooth or tissue-level implant, and the zone of AG is measured from the base of the sulcus to the mucogingival junction (MGJ); Part B is when the biologic width is subcrestal—as with infrabony defects on periodontally involved teeth, periodontally involved tissue-level implants, and bone-level implants placed at or below the bone crest—and the zone of AG is measured from the bone crest (not the base of the sulcus) to the MGJ. Further, what the AG is actually attached to around teeth and different types of implants, and the clinical significance of these differences, are thoroughly discussed.

Immediate tooth replacement therapy (ITRT), ie, immediate implant placement and provisional restoration in postextraction sockets, has been shown to achieve favorable outcomes in reference to soft tissue stability and esthetics. However, avoiding socket perforation with uniaxial implants in the anterior maxilla can be challenging due to the inherent anatomy. Dual or co-axis subcrestal angle correction (SAC) implants have been developed to change the restorative angle of the clinical crown restoration subcrestally at the implant-abutment interface to enhance the incidence of screw-retained definitive restorations. An additional benefit of this macrodesign implant feature is variable platform switching (VPS) that increases soft tissue gap distance above the implant platform. The purpose of this prospective study on ITRT in maxillary anterior postextraction sockets was to investigate the effect of SAC with VPS (SAC/VPS) compared to conventional platform-switch–design implants (PS) relative to ridge dimension stability and peri-implant soft tissue thickness. A total of 29 patients had undergone ITRT and received either a PS or SAC/VPS implant; previously described measurements were made compared to the contralateral natural tooth sites. When the comparison of buccal soft tissue thickness was made, SAC/VPS showed a greater increase compared to PS (3.12 mm vs 2.39 mm, respectively) with statistical significance (P = .05). The increase was independent from periodontal phenotype. Therefore, SAC/VPS may increase peri-implant soft tissue thickness and help minimize recession following ITRT.

This prospective randomized controlled clinical trial aimed to compare changes in the horizontal and vertical soft tissue and the alveolar ridge dimension over the course of 12 months following immediate implant placement and temporization with or without simultaneous augmentation with a deproteinized bovine bone mineral with 10% collagen (DBBM-C). Thirty-two patients with a hopeless maxillary anterior tooth and fully intact sockets received an immediate implant and provisional or custom healing abutment after a flapless extraction. Patients were randomized to a control group (n = 16), which received no graft, or to a test group (n = 16), which received DBBM-C grafts. Horizontal and vertical soft tissue changes as well as soft tissue thickness were compared digitally between groups on casts obtained from impressions made at baseline and 3, 6, and 12 months. The test group showed less horizontal dimensional change than the control group; however, the change between the two groups was not statistically significant. Vertical dimensional soft tissue changes from baseline to 12 months showed a statistically significant difference at the distal papilla, favoring the test group. No statistically significant difference was observed for vertical changes between both groups at mesial papillae and midbuccal soft tissue; however, the test group showed lower values overall. No statistically significant differences in soft tissue thickness between groups were detected. Immediate implant placement and temporization with and without adding DBBM-C demonstrate favorable clinical outcomes regarding horizontal and vertical soft tissue changes. Both groups showed loss of tissue volume. Adding DBBM-C in the gap of immediately placed implants slightly lowered the change in tissue parameters, which was not statistically significant, for the first 12 months after implant placement.

Purpose: To compare the optical effects of an immediately placed anodized pink-neck implant and abutment vs a conventional gray implant and abutment in relation to soft tissue thickness 6 months after the restoration was completed. Materials and Methods: Forty patients with a hopeless maxillary anterior tooth received an immediate implant and an immediate provisional or custom healing abutment after flapless extraction. Participants were randomized to receive either a conventional titanium implant (control) or a pink-neck implant (test). All patients then received two identical CAD/CAM titanium abutments (one conventional gray, delivered first, and one anodized to appear pink, delivered 3 weeks after) and a zirconia crown. A spectrophotometer was used to record the color of the peri-implant mucosa and gingiva 3 weeks after delivery of each abutment and 6 months after the final restoration was delivered. The color difference between the two sites was calculated (ΔL*, Δa*, Δb*), and correlations with soft tissue thickness, change in ridge dimension, and implant position were assessed. Results: Irrespective of the randomization group, changing the abutments from gray to pink showed a change in color between the peri-implant mucosa and the natural gingiva. Patients with a thin gingival biotype showed a statistically significant color change (P = .00089) in the a* axis, meaning that the gingiva appeared more pink (Δa*). No significant correlation between the soft tissue color and buccolingual collapse, vertical recession, or implant position was observed in either group. Conclusion: The difference in color observed between the peri-implant mucosa and the gingiva was considerable in all groups. Anodized pink implants and abutments could reduce the difference in the red aspect (Δa*) of the peri-implant mucosa compared to the adjacent gingiva in patients with a thin biotype.