Status of teeth adjacent to single-tooth implants

PURPOSE: This study evaluated the status of teeth adjacent to single-tooth implants in the anterior and posterior jaw during a follow-up of more than 3 years. MATERIALS AND METHODS: Seventy-eight single-tooth implants and 148 adjacent teeth were followed for a mean of 58 months. Implant survival rate, peri-implant structures, and prosthetic complication rates were evaluated. Crowns and periodontal status of adjacent teeth were compared at crown placement and at the last examination. Horizontal distance from the implant edge to adjacent teeth was calculated and compared for anterior and posterior regions. The influence of approximal crestal bone resorption of the adjacent teeth was calculated using multivariate regression analysis. RESULTS: The clinical findings for implants (one loss), peri-implant structures, and prosthetic complication rates (three crown fractures) were excellent. There was a high proportion of intact adjacent teeth in both anterior and posterior regions at crown placement and at the follow-up examination. No adjacent teeth required extraction or endodontic treatment, and only four required restoration. Comparison of the periodontal status at crown placement and at follow-up revealed no differences for plaque and bleeding indices or for pocket depth of adjacent teeth. There was a significant influence of the horizontal distance on approximal bone loss in the closer distance of the anterior region, but not in the posterior region. CONCLUSION: The crown and periodontal status of teeth adjacent to single-implant restorations was excellent. The approximal bone crest reduction of the adjacent teeth was significantly influenced by the horizontal distance between the implant edge and neighboring tooth.     

Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region.

BACKGROUND: The regeneration of gingival papillae after single-implant treatment is an area of current investigation. This study was designed to determine: 1) whether the distance from the base of the contact point to the crest of the bone would correlate with the presence or absence of interproximal papillae adjacent to single-tooth implants, and 2) whether the surgical technique at uncovering influences the outcome. METHODS: A clinical and radiographic retrospective evaluation of the papilla level around single dental implants and their adjacent teeth was performed in the anterior maxilla in 26 patients restored with 27 implants. Six months after insertion, 17 implants were uncovered with a standard technique, while 10 implants were uncovered with a technique designed to generate papilla-like formation around dental implants. Fifty-two papillae were available for clinical and radiographic evaluation. The presence or absence of papillae was determined, and the effects of the following variables were analyzed: the influence of the 2 surgical techniques; the vertical relation between the papilla height and the crest of bone between the implant and adjacent teeth; the vertical relation between the papilla level and the contact point between the crowns of the teeth and the implant; and the distance from the contact point to the crest of bone. RESULTS: When the measurement from the contact point to the crest of bone was 5 mm or less, the papilla was present almost 100% of the time. When the distance was > or = 6 mm, the papilla was present 50% of the time or less. The mean distance between the crest of bone and the most coronal papilla level (interproximal soft tissue height) was 3.85 mm (SD = 1.04). When comparing the conventional and modified surgical technique, the relation shifted from 3.77 mm (SD = 1.01) to 4.01 mm (SD = 1.10), respectively. CONCLUSIONS: These results clearly show the influence of the bone crest on the presence or absence of papillae between implants and adjacent teeth. The data also show a positive influence for the modified surgical technique, aimed at reconstructing papillae at the implant uncovering.     

Dimension of keratinized mucosa and the interproximal papilla between adjacent implants

BACKGROUND: The interproximal papilla between two adjacent implants is gaining critical interest in the implant dentistry. The aims of this study were to evaluate the effect of 1) the width of keratinized mucosa, 2) the distance from the base of the contact point to the crestal bone, and 3) the horizontal distance between two implants on the radiographic dimension from the tip of the papilla to the crestal bone between two implants. METHODS: This study involved 72 interproximal papillae between two adjacent implants (interimplant papilla) in 52 patients who had implants placed adjacent to each other and had a prosthesis in place more than 1 year. The shortest distance between the radiopaque material on the tip of the interimplant papilla and most coronal portion of the interimplant crestal bone was measured (the radiographic length of the papilla [RL]). The width of keratinized mucosa from the tip of the papilla was measured (WK). The vertical distance between the base of the contact point and the interimplant crestal bone was measured (CC). The horizontal distance between the two adjacent implants was measured at the fixture-abutment interface level (HD). Multiple regression analysis was performed between WK-RL, CC-RL, and HD-RL. RESULTS: RL had a significant relation with WK between two adjacent implants (P = 0.001). However, RL was not related with other variables, such as CC and HD (CC, P = 0.641; HD, P = 0.901). CONCLUSION: The results of this study suggest that the width of keratinized mucosa between two adjacent implants might be related to the dimension of the interproximal papilla between two adjacent implants.     

Interproximal papilla levels following early versus delayed placement of single-tooth implants: a controlled clinical trial

PURPOSE: The aim of this study was to evaluate interproximal papillae and clinical crown height following the placement of single-tooth implants according to early and delayed protocols. MATERIALS AND METHODS: Forty-five patients were randomly allocated to either the "early" group or the "delayed" group. They were treated with a single-tooth acid-etched Osseotite implant in the maxillary or mandibular anterior or premolar region an average of 10 days (in the case of early placement) or 3 months (in the case of delayed placement) following tooth extraction. Interproximal papilla dimensions and clinical crown height were evaluated using a score index in 39 patients who attended a follow-up visit 16 to 18 months after prosthesis delivery. The patients were evaluated in photographs taken 1 week after crown placement (baseline) and approximately 1.5 years after crown placement (follow-up). RESULTS: It was demonstrated by logistic regression the risk of presenting no papilla or a negative papilla was 7 times greater at baseline for delayed cases than for early cases (33% versus 8%). However, the soft tissue fill in the proximal spaces improved significantly from baseline to the 1.5-year follow-up in both groups, with no significant difference between the groups found at follow-up. The papilla height almost 2 years after implant placement was inversely correlated with patient age. The clinical crown height was acceptable in significantly more cases in the early group than in the delayed group at follow-up. Half of the crowns in the delayed group exhibited an inappropriate height; of these, almost two thirds were assessed to be too short. DISCUSSION AND CONCLUSION: Early placement of single-tooth implants may be preferable to delayed implant placement technique in terms of early generation of interproximal papillae and the achievement of an appropriate clinical crown height, but no difference in papilla dimensions was seen at 1.5 years after seating of the implant crown.     

Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results

This study evaluated the soft tissue stability around 10 single-tooth implants. All cases were treated following the same protocol, which included guided bone regeneration and connective tissue grafting. One year after prosthesis insertion the soft tissue shrinkage on the buccal side of the implant crown was 0.6 mm on average. The soft tissue volume in the papilla area increased on average by 0.375 mm, and none of the papillae lost volume.     

Dimensions of hard and soft tissue around adjacent,compared with single-tooth,zirconia implants

Preservation or regeneration of the papilla has always been a challenge around consecutive implants or with implants next to teeth, and many studies have evaluated the papilla’s behaviour and patterns based on surgical technique and prosthetic design, though evidence about its behaviour around zirconia implants is scarce. The aim of this study was to evaluate papilla behaviour between implants and teeth (tooth-implant group) and between consecutive implants (implant–implant group). Ninety patients with 122 zirconia implants (Straumann^® PURE Ceramic Implant) were examined at the one-year follow up. We measured the effect of the distance: first from the base of the contact point of the crowns to the contact with bone at the implant site (D1); secondly, to the contact with the bone at the neighbouring tooth or implant site (D2); and thirdly on the papillary deficit (D3). In both the tooth-implant group and the implant–implant group, D1 and D2 correlated significantly with the papillary deficit (D3), whereas D2 was the major determinant factor (Spearman’s rho = 0.60). In both groups, when D1 and D2 were <6 mm, the papilla was present every time. The papillary deficit was significantly greater in the tooth-implant group than in the implant–implant group (p = 0.048). We conclude that the ideal distance from the base of the contact point to the bone contact at the implant and to the bone contact at the adjacent tooth in both groups is <6 mm. The height of the bone on the teeth adjacent to implants has a significant impact on that of the papilla.     

Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants

BACKGROUND: As patient demand increases for more natural restorations in the esthetic zone, clinicians must have the highest level of skill and knowledge to maintain or reform the interdental papilla between teeth, between implants and teeth, and between adjacent implants. To date, there are no reports that have measured the distance from the contact point to the bony crest between implants. One reason for this may be the fact that, with two adjacent implants, the contact point of the crown can be established at any distance from the gingival margin according to the restorative dentist's specifications. Therefore, in this study, the height of the soft tissue to the crest of bone was measured between two adjacent implants independent of the location of the contact point. The purpose of this study was to determine the range and average height of tissue between two adjacent implants. METHODS: A total of 136 interimplant papillary heights were examined in 33 patients by eight different examiners in five private dental offices. After administration of appropriate local anesthesia, a standardized periodontal probe was placed vertically from the height of the papilla to the crest of bone. The measurements were rounded off to the nearest millimeter. RESULTS: The mean height of papillary tissue between two adjacent implants was 3.4 mm, with a range of 1 mm to 7 mm. CONCLUSIONS: Clinicians should proceed with great caution when placing two implants adjacent to each other in the esthetic zone. In most cases, only 2, 3, or 4 mm of soft tissue height (average 3.4 mm) can be expected to form over the interimplant crest of bone. These results showed that modification of treatment plans may be necessary when esthetics are critical for success.     

Stress in bone adjacent to dental implants

summary Finite element analysis (FEA) was employed to assess patterns of stress in bone adjacent to an implant after application of loads through an attached distal extension cantilever. Under all loading conditions, the highest stresses occurred at the distal cervical bone margin adjacent to the cantilever. In clinical studies, this is not consistently the site of the greatest bone changes seen radiographically. This suggests that extrapolation of FEA studies to clinical implantology should be approached with caution until further data become available on both mechanical properties of bone and patterns of bone remodelling induced by defined functional stresses in mandible and maxillae.     

Immediate loading of single-tooth implants in the posterior region

PURPOSE: The aim of this study was to evaluate the clinical response and safety of immediately loaded single-tooth implants placed in the posterior region of the maxilla and mandible. MATERIALS AND METHODS: Single-tooth implants were placed in healed extraction sites in 20 adult patients. Temporary pre-fabricated acrylic resin crowns were prepared and adjusted. The crown occlusion was adjusted to obtain minimal contacts in maximum intercuspation. After 6 weeks a ceramometal or all-ceramic crown was cemented. Radiographic and clinical examinations were made at baseline and at 3, 6, and 12 months. Cortical bone response and peri-implant mucosal responses were evaluated. RESULTS: The marginal bone level at the time of implant placement was preserved. The mean change in marginal bone level was 0.01 mm at 12 months. The mean Periotest value after 360 days was -4. The peri-implant mucosal adaptation to the anatomic form of the provisional crown resulted in a natural esthetic outcome, and a gain in papilla length was observed. One implant failure was recorded because of provisional luting cement impaction. DISCUSSION: Clinical research has shown that immediate loading is a possible treatment modality. The immediate functional loading of implants placed in this study resulted in bone adaptation to loading. A satisfactory success rate with positive tissue responses was achieved. CONCLUSIONS: The results of this limited investigation indicated that immediate loading of unsplinted single-tooth implants in the posterior region may be a viable treatment option with an esthetic outcome.     

Interproximal tissue dimensions in relation to adjacent implants in the anterior maxilla: clinical observations and patient aesthetic evaluation

Objectives: This clinical study aimed to assess (i) interproximal tissue dimensions between adjacent implants in the anterior maxilla, (ii) factors that may influence interimplant papilla dimensions, and (iii) patient aesthetic satisfaction. Material and methods: Fifteen adults, who had two or more adjacent implants (total of 35) in the anterior maxilla, participated in the study. The study design involved data collection from treatment records, clinical and radiographic assessment, and a questionnaire evaluating aesthetic satisfaction. Results: The median vertical dimension of interimplant papillae, i.e., distance from tip of the papilla to the bone crest, was 4.2 mm. Missing papilla height (PH) at interimplant sites was on average 1.8 mm. Median proximal biologic width at interimplant sites was 7 mm. The most coronal bone‐to‐implant contact at implant–implant sites was located on average 4.6 mm apical to the bone crest at comparable neighbouring implant–tooth sites. The tip of the papilla between adjacent implants was placed on average 2 mm more apically compared with implant–tooth sites. The contact point between adjacent implant restorations extended more apically by 1 mm on average compared with implant–tooth sites. Median missing PH was 1 mm when an immediate provisionalization protocol had been followed, whereas in the case of a removable temporary it was 2 mm. Split group analysis showed that for missing PH≤1 mm, the median horizontal distance between implants at shoulder level was 3 mm. Patient satisfaction with the appearance of interimplant papillae was on average 87.5%, despite a Papilla Index of 2 in most cases. Conclusions: The apico‐coronal proximal biologic width position and dimension appear to determine papilla tip location between adjacent implants. There was a significant association between the provisionalization protocol and missing PH, which was also influenced by the horizontal distance between implants. Patient aesthetic satisfaction was high, despite a less than optimal papilla fill.     

Esthetic soft-tissue augmentation adjacent to dental implants

Patients and clinicians are becoming increasingly aware of the need to improve dental esthetics. After tooth extraction or trauma, there may be residual hard- or soft-tissue defects. These may be related to deficits in the bone or soft tissue. The evaluation of preoperative study casts, radiographs, and photographic documentation can aid the clinician in determining which types of augmentation are necessary. If adequate bone volume is present, the implants are placed according to protocol. Soft-tissue defects can be significantly reduced by implanting various biomaterials between the inner borders of the flap and surrounding bone. This case series describes patients who were successfully treated for soft-tissue defects with either demineralized freeze-dried bone or bovine bone.     

Further malignancy in field change adjacent to osseointegrated implants

The role of endosseous implants in oral rehabilitation following ablation of oral tumours is established, however the oncological review of these patients has rarely been discussed in the literature. We describe two cases where second primary malignancy in the peri-implant tissues necessitated further major resections. In both cases, the initial clinical appearance and histology suggested peri-implantitis. These cases demonstrate that second primary malignancy can masquerade as benign peri-implant complications and that a high degree of vigilance is required. Fixed prostheses should be regularly removed, especially in patients who have field change.     

Instant provisionalization of immediate single-tooth implants is essential to optimize esthetic treatment outcome

Objective: The immediate single-tooth implant has become a viable treatment option. However, the impact of the restorative procedure on esthetics is currently unclear. The goal of this study was to compare the soft tissue outline at immediate implants following two restorative protocols: immediate connection of a temporary crown or submerged healing during which a removable partial denture is used.
Material and methods: A 1-year single-blind randomized clinical study was performed in 49 patients. Twenty-four patients were assigned to the immediate restoration group and 25 to the delayed restoration group. Clinical and radiographic evaluations of soft and hard tissues were carried out after 3, 6 and 12 months.
Results: Implant survival, bone remodeling, probing depth and bleeding tendency were not influenced by the restorative protocol. Delayed restoration resulted in initial papilla loss taking up to 1 year to attain comparable height as for immediate restoration. Midfacial recession was systematically 2.5–3 times higher following delayed restoration pointing to a 0.75 mm additional loss in comparison with immediate restoration after 1 year.
Conclusions: If the primary implant stability permits it, immediate single-tooth implants should be instantly provisionalized in the interest of optimal midfacial esthetics.     

Clinical and esthetic outcomes of single-tooth implants in the anterior maxilla

The aim of this study was to evaluate the clinical and esthetic outcomes of 10 consecutive single-tooth implant restorations in the anterior maxilla. A specific treatment protocol consisting of (1) atraumatic extraction of the failing tooth, (2) placement of an SLActive bone-level implant with simultaneous guided bone regeneration at 6 to 8 weeks postextraction, (3) loading of a provisional restoration at 2 to 3 months following implant placement, (4) production of a customized impression coping, and (5) loading of the definitive all-ceramic abutment and crown 6 months after delivery of the provisional restoration was utilized in all cases. The outcomes were assessed 1 year after loading of the definitive restoration using standard clinical parameters: pink (PES) and white esthetic scores (WES). All implants were successfully integrated, accounting for a 100% survival and success rate. Besides clinical success, the application of the specific treatment protocol may be able to provide esthetically pleasing single-tooth implant restorations in the anterior maxilla, as was demonstrated by the results for PES (7.9 ± 1.7) and WES (7.0 ± 1.5).