Misch. Stage II Surgery: Uncovery and Treatment of Healing Complications (CH 32). pp 720-738. Contemporary Implant Dentistry, Misch, C.E., 3rd Edition, 2008, Mosby Year Book.
Part III Postoperative Complications (complications 33-35). pp 105-107. Surgical complications in oral implantology: etiology, prevention, and management Louie Al-Faraje. Quintessence Pub., c2011.
Boioli LT, Penaud J, Miller N. A meta-analytic, quantitative assessment of osseointegration establishment and evolution of submerged and non-submerged endosseous titanium oral implants. Clin Oral Implants Res. 2001 Dec;12(6):579-88.
Esposito M, Grusovin MG, et al. Interventions for replacing missing teeth: 1- versus 2-stage implant placement. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006698.
Yoo JH, Choi BH, et al. Influence of premature exposure of implants on early crestal bone loss: an experimental study in dogs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Jun;105(6):702-6
Delgado-Ruiz RA, Calvo-Guirado JL, et al. Connective Tissue Characteristics around Healing Abutments of Different Geometries: New Methodological Technique under Circularly Polarized Light. Clin Implant Dent Relat Res. 2013 Oct 10. doi: 10.1111/cid.12161. [Epub ahead of print]
Linkevicius T, Apse P, Grybauskas S, Puisys A. The influence of soft tissue thickness on crestal bone changes around implants: a 1-year prospective controlled clinical trial. Int J Oral Maxillofac Implants. 2009 Jul-Aug;24(4):712-9.
Rungcharassaeng K, Kan JY, et al. Immediate implant placement and provisionalization with and without a connective tissue graft: an analysis of facial gingival tissue thickness. Int J Periodontics Restorative Dent. 2012 Dec;32(6):657-63.
Linkevicius T, Puisys A, et al Crestal Bone Stability around Implants with Horizontally Matching Connection after Soft Tissue Thickening: A Prospective Clinical Trial. Clin Implant Dent Relat Res. 2013 Sep 17. [Epub ahead of print]
El-Kholey KE. Efficacy and safety of a diode laser in second-stage implant surgery: a comparative study. Int J Oral Maxillofac Surg. 2014 May;43(5):633-8.
Saade J, Sotto-Maior BS, et al. Pouch Roll Technique for Implant Soft Tissue Augmentation of Small Defects: Two Case Reports with 5-Years Follow-up. J Oral Implantol. 2013 Jun 10. [Epub ahead of print]
Tinti, C., Benfenati, S: The ramp mattress suture: A new suturing technique combined with a surgical procedure to obtain papillae between implants in the buccal areas. Int J Perioodontics Restooorative Dent. 2002 Feb; 22(1):63-9
Lee EK, Herr Y, et al. I-shaped incisions for papilla reconstruction in second stage implant surgery. J Periodontal Implant Sci. 2010 Jun;40(3):139-43.
Bressan E, Tessarolo F, Sbricoli L, et al. Effect of chlorhexidine in preventing plaque biofilm on healing abutment: a crossover controlled study. Implant Dent. 2014 Feb;23(1):64-8.
Koutouzis T, Koutouzis G, Gadalla H, Neiva R. The effect of healing abutment reconnection and disconnection on soft and hard peri-implant tissues: a short-term randomized controlled clinical trial. Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):807-14.
Lin MI, Shen YW, Huang HL, Hsu JT, Fuh LJ. A retrospective study of implant-abutment connections on crestal bone level. J Dent Res. 2013 Dec;92(12 Suppl):202S-7S. Cardoso RC, Gerngross PJ, Dominici JT, Kiat-amnuay S. Survey of currently selected dental implants and restorations by prosthodontists. Int J Oral Maxillofac Implants. 2013 Jul-Aug;28(4):1017-25.
Boioli 2001 one stage vs. two stage implants
D: Two implant placement methods are used in oral implantology: submerged (S, two-stage surgical procedure) and non-submerged (NS, one-stage surgery). However, a quantitative assessment of their influence on implant osseointegration, summarising the whole present experience, is not directly possible, owing to the lack of normalisation of the published results.
P: to help improve the quantitative assessment of this influence by defining normalization criteria, which would allow the pooling of the results with adequate statistical method.
M: meta-analysis of studies 1980-1999 (published in a peer, reviewed journal, reports on implants placed with a submerged (S) or non submerged (NS) procedure, reports clinical results on implant survival, early failure rates, survival rate. Statistical analysis was competed.
R: 13049 Type S and 5515 type NS implants were initially considered for follow-up with a life table. 16626 Type S and 4716 type NS implants were considered for at the calculation of early failure. Average early failure rate higher for S implants (3.3%), compared to NS implants (1.6%). With confidence level of 95%, expected cumulative survival rate (CSR) should be higher than 92% for S implants after 15 years and for NS implants, than 85% after 10 years or 89% after 8 years.
C: S and NS implants give acceptable results in terms of survival, and for both categories (but especially for S implants) the placement stage remains a noticeable individual cause of failure. S implants have been studied more and presents less dispersed results. NS implants, while osseointegrating better initially, are subject to causes of osseointegration loss, which persist over a longer period of time.
P: To evaluate whether a 1-stage implant placement procedure is as effective as a 2-stage procedure.
M: The Cochrane Oral Health Group’s Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching included several dental journals. Selection criteria : All RCTs of osseointegrated dental implants comparing the same dental implants placed according to 1- versus 2-stage procedures with a minimum follow up of 6 months after loading. Outcome measures were: prosthesis failures, implant failures, marginal bone level changes on intraoral radiographs, patient preference including aesthetics, aesthetics evaluated by dentists, and complications. Data collection and analysis: Data were extracted by two review authors independently using specially designed data extraction forms. Authors were contacted for missing information.
R: Five RCTs were identified and included reporting data on 239 patients in total. On a patient, rather than per implant basis, the meta- analyses showed no statistically significant differences for prosthesis and implant failures, however trends suggested less implant failures with the 2-stage approach especially in fully edentulous patients.
BL: The 1-stage approach might be preferable in partially edentulous patients since it avoids one surgical intervention and shortens treatment times, while a 2-stage approach could be indicated when an implant has not obtained an optimal primary stability, when GTR is needed, or when a removable prostheses could transmit excessive forces on the healing abutments especially in fully edentulous patients.
Cr: The number of patients included in the trials was too small to draw definitive conclusions.
Purpose: To compare the effects of both abutment-connected implants and prematurely exposed implants on crestal bone loss.
M&M: 6 mongrel dogs had implants placed at edentulated sites on each side. One side had a partially exposed cover screw and on the other side a smooth healing abutment was placed so that the coronal portion of the abutment remained exposed to the oral cavity. Animals were sacrificed 8 weeks after implantation. Bone blocks were taken and examined using micro-CT analysis.
Results: Bone around the implants was more abundant in the abutment-connected sites than partially exposed sites. Average bone height was greater in the abutment-connected sites (9.8 ±0.5 mm) than for the partially exposed fixture (9.3±0.5 mm; P < .05).
Conclusion: Abutment connection can limit crestal bone loss around exposed implants. In cases of early exposure of implants, the placement of a healing abutment may help limit bone loss around implants.
Delgado-Ruiz 2015 abutment geometry
Purpose: 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.
Materials and Methods: 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 3months 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.
Results: In no case had the connective tissue formed a connection to the healing abutment/implant in the internal zone; a space of 3510 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).
Conclusions: 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.
PURPOSE:
The aim of this clinical trial was to evaluate the influence of gingival tissue thickness on crestal bone loss around dental implants after a 1-year follow-up.
MATERIALS AND METHODS:
Forty-six implants (23 test and 23 control) were placed in 19 patients. The test implants were placed 2 mm supracrestal, whereas the control implants were positioned at the bone level. Before implant placement, the tissue thickness at implant sites was measured with a periodontal probe. After healing, metal-ceramic cement-retained prostheses were constructed. According to tissue thickness, the test implants were divided into A (thin) and B (thick) groups. Intraoral radiographs were performed and crestal bone changes were measured at implant placement and after 1 year.
RESULTS:
Mean bone loss around the test implants in group A (thin mucosa) was 1.61 +/- 0.24 mm (SE; range, 0.9 to 3.3 mm) on the mesial and 1.28 +/- 0.167 mm (range, 0.8 to 2.1 mm) on the distal. Mean bone loss in test group B (thick mucosa) implants was 0.26 +/- 0.08 mm (range, 0.2 to 0.9 mm) on the mesial aspect and 0.09 +/- 0.05 mm (range, 0.2 to 0.6 mm) on the distal aspect. Mean bone loss around control implants was 1.8 +/- 0.164 mm (range, 0.6 to 4.0 mm) and 1.87 +/- 0.166 mm (range, 0.0 to 4.1 mm) on the mesial and distal aspects, respectively. Analysis of variance revealed a significant difference in terms of bone loss between test A (thin) and B (thick) groups on both the mesial and the distal.
CONCLUSION:
Initial gingival tissue thickness at the crest may be considered as a significant influence on marginal bone stability around implants. If the tissue thickness is 2.0 mm or less, crestal bone loss up to 1.45 mm may occur, despite a supracrestal position of the implant-abutment interface.
Rungcharassaeng 2012
Background:
Facial gingival tissue thickness (FGTT) is important for an esthetically
pleasing anterior restoration since it determines the soft tissue's ability to
conceal the underlying restorative material.
Purpose: The purpose of this study was to investigate the change in FGTT after immediate implant placement and provisionalization with and without a connective tissue graft.
Material and Methods: Patients with a failing maxillary anterior tooth planned for immediate implant placement and provisionalization with (CT group) or without (NCT group) a subepithelial connective tissue graft were included in this study. After tooth extraction, direct measurement of the FGTT was performed; subsequent measurements were performed at the time of definitive prosthesis placement. Data were analyzed using independent and paired t tests at a significance level of α = .05.
Results: There was no statistically significant difference in the mean FGTT at tooth extraction between the CT and NCT groups. At prosthesis delivery, the mean FGTT for the CT group was significantly greater than that of the NCT group. The mean FGTT of both groups at prosthesis delivery was significantly higher than that at tooth extraction. The mean change in FGTT in the CT group was also significantly greater than that in the NCT group.
Conclusion: Immediate implant placement and provisionalization (IIPP) in conjunction with a connective tissue graft is more likely to result in sufficient peri-implant tissue thickness to conceal underlying implant restorative materials than when performed without a connective tissue graft. The tissue thickness is maintainable and is stable 6 months after IIPP.
P: The purpose of this study was to evaluate how implants maintain crestal bone level after soft tissue thickening with allogenic membrane in patients with thin soft tissue.
M&M: 103 partially edentulous patients were selected. A midcrestal incision in the center of edentulous ridge was performed, leaving at least 2 mm of keratinized gingiva bucally. Facial flap was reflected then the mucosal thickness of the lingual flap was measured. Based on thickness patients were divided into 3 groups;
A: <2 mm thickness- implants placed in thin soft tissues (n=34)
B: <2 mm thickness - implants placed in thin soft tissues and thickened with allogenic membrane at the time of implant placement (n=35)
C: >2 mm thickness - implants placed in naturally thick tissue (n=34)
One-stage surgery was used for groups A & C, and two-stage surgery for group B. All groups had received antibiotic prophylaxis but for B group post-operative antibiotic was also prescribed. Implants with horizontally matching connections and laser modified surfaces were placed. For groups A & C healing abutments were connected immediately after implant placemen and tissue was sutured around them.
For group B, after 2 months of healing, second stage surgery was performed, and tissue thickness was measured again. Healing abutments were placed and tissue sutured.
2 month later, prosthesis (screw-retained) were placed. Radiographic examination was performed: after implant placement, 2 months after healing, after restoration, and at 1-year follow-up. Crestal bone loss was measured mesially and distally.
R: Overall, the implant survival rate after 1 year of function in all groups was 100%. crestal bone resorption at 1-year follow-up was:
Group A: 1.65 ± 0.08-mm mesially - 1.81 ± 0.06 mm distally
Group B: 0.31 ± 0.05 mm mesially - 0.34 ± 0.05 mm distally (tissue thickness had increased to 3.83 ± 0.13 mm)
Group C: 0.44 ± 0.06 mm mesially - 0.47 ± 0.07 mm distally
Differences between A and B, and A and C were significant both mesially and distally, whereas differences between B and C were not significant mesially or distally. Implants in naturally thick and augmented soft tissues experienced minor bone remodeling, and implants in thin tissues experienced more bone loss.)
C: Results show a reduction of crestal bone loss from 1.81 mm to 0.44 mm when tissue was thickened with allogenic membrane. This outcome can be due to providing the site with adequate thickness for biologic width and therefore adequate peri-implant seal.
BL: thin mucosal tissues may cause early crestal bone loss, but thickening the tissue with allogenic membrane may significantly reduce bone resorption.
Critique: long-term evaluation? Different surgical placement approaches. (one-stage vs. two-stage)
P: To assess if dental implant uncovering is possible with a diode laser without anesthesia, and to compare its performance with traditional cold scalpel surgery.
M&M: 30 healthy pts (19W, 11M, ages 25-54yrs). 45 implants are placed with 2-stage technique (43 traditional flap, 2 flapless). After 12 weeks, patients returned for second-stage surgery. Patients were divided into two groups. Control Group: 15pts, 22 implants exposed through circular incision using a No. 15 surgical blade. Patients were asked to return after 1 week for clinical evaluation. Experimental group: 15pts, 23 implants exposed using a 970nm diode laser. For comparison of the two techniques, the following parameters were assessed: 1) Need for local anesthetic and amount; 2) Duration of surgery; 3) Intraoperative bleeding; 4) Subjective pain scale; 5) Patients asked to record their use of analgesic medication during the postoperative pain; 6) Time for taking final impression
R: Significant difference between the 2 groups regarding the need for local anesthetic. All control patients needed local anesthetic, and only 1 experimental patient needed local. No bleeding was encountered during the laser surgery, while normal bleeding occurred during traditional surgery. The duration of surgery was comparable for both methods. Postoperatively, no patient in either group suffered from significant pain, with no significant difference between the two groups. After 7 days, the laser-treated group was completely healed with no signs of inflammation or edema. In the control group, healing was adequate at 7 days, but there was some edema present at the gingival margins. The mean time to taking of impressions for the laser-treated patients was 7.13 days, while it was 12.0 days for the control group; however, this was not found to be statistically significant.
D: Application of the surgical lasers for uncovering implants offers a series of potential advantages: improved vision due to hemostasis, less mechanical trauma, elimination of need for local anesthetic, shortening time needed to take final impression. Punch incisions were not used in this study, but this could potentially improve healing process. The only limitations to the use of the laser to uncover implants are the lack of adequate zones of keratinized tissue and knowledge of where the implant has been placed. There is concern over damaging the implant with use of a laser, but studies have shown that the diode is one of the safest types of lasers to use around implants.
BL: The use of a diode laser in second stage implant surgery can minimize surgical trauma, eliminate the need for anesthesia, improve visibility during surgery due to absence of bleeding, and eliminate postoperative discomfort.
PURPOSE: To describe the pouch roll technique for implant soft tissue augmentation of small defects to achieve contemporary patient aesthetic expectations and preserve periodontal health longitudinally (5 years). Procedure was performed during placement of a nonsubmerged implant or during second stage surgery.
METHODS: Technique description: Intrasulcular buccal incision made, which continued interproximally along the teeth to the palate, followed by horizontal incision. A semilunar incision was then made, maintaining the delicate 1 to 2 mm of gingival sulcus, which will become the interproximal papillae. Minipedicle flap was de-epithelialized. Full thickness flap then elevated, creating a pouch the length of the minipedicle flap. The minipedicle is sutured beneath the full thickness flap on the buccal surface of the implant.
RESULTS/DISCUSSION/CONCLUSION: This study demonstrated that over 5 years of follow up, the pouch roll technique maintained its stability and is a less invasive option for restoring marginal gingival contour. It is recommended that this technique be performed concomitant to implant surgery so that second stage surgery may be used as an additional opportunity to modify soft tissues if necessary.
5 year follow up photographs of both cases:
BL: Pouch roll technique offers many advantages for restoring small soft tissue defects associated with implants. Advantages: preservation of papilla, increased soft tissue thickness, aesthetic improvements, healing by primary intention, less invasive, cost effective. Disadvantages: Cannot restore more than 2-3 mm soft tissue defects (bone grafting required for these defects).
Purpose:
to show the opportunity and predictability of
creating new papillae between
implants in the buccal aspect by dislodging a thick palatal flap buccaly and
sutured using the ramp mattress suture.
M&M:
8 patients aged between 37 and 63 years whom received Branemark implants in the
anterior and lateral sextants of the maxilla by a two-stage surgery has
consented to participate in this study. A Sharp linear incision in a distomesial
direction is performed with a full thickness approach slightly palatal to the
implants, starting 5 mm posterior to the most distal implant and ending 5 mm
mesial to the most mesial implant. The placed healing abutments will keep the
full-thickness buccal flap raised during the healing period and the vestibular
gingival margin will be coronal to the palatal gingival margin by 5 to 6 mm.
The ramp mattress suture is made by passing the needle through the vestibular
site of the buccal flap in the interproximal area in a vestibulopalatal
direction approximately 5 mm apical to the gingival margin. On the palatal site,
the palatal flap has been engaged from its entire thickness and approximately 5
mm apical to the gingival margin by passing it in a palatovestibular direction;
then it is immediately repassed in a vestibulopalatal direction, approximately 5
mm distal. At this point, the buccal flap has to be engaged in a
palatovestibular direction 5 mm apical to its gingival margin, and the knot is
placed on the vestibular site approximately 3 mm distal to the first entry
point. Second surgical phase, after an adequate healing period of approximately
4 to 5 weeks, a vestibular scalloped gingivectomy is performed around the
vestibular surface of the abutment to create either a scalloped gingival margin
or interproximal papillae only in the vestibular
area and a crown lengthening procedure is performed on the adjacent teeth.
Results:
After a 12-months healing period, the gingiva appeared healthy and not inflamed.
Probing depths
were 1 mm palatally, 2 mm buccaly and 3 mm interproximally without bleeding. The
newly formed papillae were cleansable, stable without shrinkage.
Radiographically, the bone crests remained flat
and unchanged. However, improved esthetics have been maintained throughout the
12 months follow up period.
Conclusion:
The authors confirm the capability of forming
interproximal papillae using the ramp mattress suture in conjunction with
delayed gingivectomy based on 56 treated papillae. The clinical results were
stable, shrinkage was no more than 30% of the buccaly displayed flap, and the
esthetics results were satisfying to the clinician and patient.
Above, First Surgical Procedure using the ramp mattress suture.
Above, Second Surgical Procedure using Gingivectomy to create the scalloped gingival margings and the interproximal papillae.
Above, Healing after 12 months Period.
Purpose: Pink gingival esthetics, especially on anterior teeth has been a critical factor in deciding the overall success of the implant-supported restoration. Soft tissue profile is one of the most important factors, and most specifically, inter-implant papillae are a critical factor for implant esthetics. Reconstructing a predictable implant papilla is the most complex aspect of implant dentistry. Various techniques for inter-implant papilla reconstruction, at the time of second surgery stage, have been introduced. The aim of this study is to suggest and evaluate a surgical technique for reconstructing inter-implant papillae.
M&M: A 28-year-old male had an implant placed on the 13 (6) and 14 (5) area. After a healing period of four months after implant placement, a second stage surgery was planned for inter-implant papilla reconstruction, using the method of an I-shaped incision, method modification of the suggested technique by Shahidi et al: A labial horizontal incision was performed mesiodistally 0.5 mm-1mm inside from the labial border of the implant. A horizontal incision was also performed parallel to the buccal side, on the palatal side, which was in contact with the palatal borderline of the implant different from the labial side. Another incision was done bucolingually over implant midline perpendicular to horizontal incision lines performed on labial and palatal sides. The flap was reflected and implant was exposed to connect the healing abutment and both flaps were folded up along the healing abutment, without a suture.
Results: Two weeks after surgery, soft tissue augmentation between the two implants was achieved.
Conclusion: I-shaped incisions for papilla reconstruction performed during the second stage implant surgery were useful for inter-implant papilla reconstruction and showed a good esthetic result. The advantage of this method is a decrease in chair time, less postoperative discomfort and great esthetics.
P: The study aimed at evaluating the effect of chlorhexidine (CHX) in preventing plaque biofilm (PB) formation on healing abutments (Has) in patients rehabilitated with osseointegrated implants
M&M: 54 Has were placed 1 week after implant surgery (test group). After 7 days, a new set of 50 Has were placed in the same implant sites and removed 1 week after (control group). During the 2 testing periods, patients were instructed to apply: CHS mouth rinsing twice daily and no brushing (test); no CHX mouth rinsing and no brushing (control). Scanning electron microscopy and image analysis were blindly used to objectively quantify plaque biofilm amount on removed HAs.
R: Median values and interquartile ranges of the percent ratio of titanium surfaced covered from PB were 0.9 (test) and 1.2 (control).
C: CHX mouth rinse significantly limited plaque formation on HAs, being a valid contribution to mechanical brushing in early phases of plaque control on dental implants.
P: to evaluate the effect of healing abutment disconnection and reconnection on soft and hard peri-implant tissues.
M&M: The study is a prospective randomized controlled clinical trial. 16 patients were included. An endodontic file was used to measure soft tissue thickness. Following one-stage implant placement, test group implants (n = 10) received a permanent abutment and control group implants (n = 11) received a healing abutment. After 2 months of healing, control group implants underwent a prosthetic protocol involving implant-level impressions and a two-time abutment disconnection and reconnection process prior to delivery of the definitive prosthesis. Test group implants underwent a prosthetic protocol involving abutment-level impressions without any abutment disconnection. Clinical parameters (PI, PD, BOP, KG, peri-implant mucosa height PMH) were recorded at 2 weeks, 2 (before impression taking), 3 (immediately after pros delivery), and 6 months after surgery. Marginal bone levels were assessed radiographically at implant placement at 3 and 6 months.
R: The overall survival rate from implant placement to the last follow-up visit was 100% for both groups. The mean marginal bone loss at the 6-month examination was 0.13 mm for test group implants and 0.28 mm for control group implants. There were no significant differences regarding changes in peri-implant mucosal dimensions between the two groups.
|
Marginal bone level changes (mean and standard variation-mm) |
|
|
time |
Test |
|
At 3 month |
-0.07 (0.13) |
|
At 6 month |
-0.13 (0.20) |
C: The study indicates that implants receiving a final abutment at the time of implant placement exhibited minimal marginal bone loss and were similar to implants subjected to abutment disconnection and reconnection two times.
BL: Disconnection and reconnection of the abutment two times did not cause negative dimensional changes in the peri-implant mucosa.
P: The aim of this retrospective study was to determine if peri-implant crestal bone level alterations at different time phases may depend on the type of implant abutment connection.
M&M: Only single implants or two implants splinted with a fixed prosthesis were used in this study. Diameters used (4 to 5mm) and length of implants used (10 to 12mm). Implants were embedded at crestal bone levels and cover screws to facilitate healing were placed (for 3 to 6 months). After connection of impression copings, a PA was taken, which served as the baseline for crestal bone level. The time intervals for radiographs: T0 (day of implant delivery); T1 (day of prosthesis delivery); T2 (3 months after loading); T3 (6 months after loading). All PA radiographs were taken with a cone indicator with a standardizing radiographing process. The following measurements were collected: Bone-implant contact (BIC) and vertical bone gap (VBG). Differences in the VBG measured at various time were used to quantify the changes in the peri-implant bone level. SPSS 18 was used for statistical analyses. Three-implant abutment connection types were analyzed (external hex, internal octagon, and internal Morse taper).
R: The results indicated that there were no SSD among the different types of implant-abutment connections
D: The mean changes of the peri-implant crestal bone were less than 1mm in the first year for all implants. One limitations of this study was the small sample size, which was due to the strict inclusion criteria. Further studies, with longer follow up times, are needed.
BL: The level of peri-implant crestal bone does not differ significantly during either the healing phase or the loading phases among 3 different implant-abutment connection designs. The level of peri-implant crestal bone changes significantly with the time interval (healing phase, loading phase 1, and loading phase 2), with it being slightly greater before the application of occlusal loading.
PURPOSE: To survey the prosthodontist of the American College of Prosthedontists (ACP) and the American Academy of Maxillofacial Prosthetics (AAMP) to determine the most used implant in training and current practice and determine what criteria/features make an implant system desirable.
METHODS: A 22 question electronic survey was sent via email to all 1739 members of the ACP and AAMP, targeting prosthodontists that restore implants. Questions requested information on most often used implants, restorative preference (abutment type/loading preference), and what characteristics of implants were important in selection. Questions were asked in the context of restoration to be completed: incisors and canines, premolars and molars, highly esthetic areas, completely edentulous arches (overdentures), and partially edentulous arches (implant retained RPD). Implant selection (most to least important) was assessed based on implant features, simplicity of surgical/restorative kit, literature support, esthetic outcomes, customer service and cost. Implant planning software usage was also assessed. Year of graduation, program type and years of experience/surgical experience was also assessed.
RESULTS/DISCUSSION: 317 surveys were completed and used in this study. Most responding prosthodontists were trained in the 80s and a 2 year residency was most common. 18 years was the average years of implant experience. Implant Selection: 79% of clinicians were trained on Nobel Biocare/Branemark implant systems, which was also the most common system used in all clinical situations. Prevalence of Nobel implant usage is most likely based on the fact that these implants were one of the few available for some time, and replacement parts are readily available. Implant features (60%), reviewed literature support (57%), and simplicity of restorative kit (40%) were the most influential criteria for implant selection (least: simplicity of surgical kit (71%) and cost (68%)). Restoration: Custom-milled ceramic abutments were most common in esthetic areas/incisor canine areas (53%/29%, respectively), and prefabricated metal abutments were most common in the premolar/molar area (39%). Stud attachments were preferred over bar attachments for overdentures (77%), with locator attachments being the most popular in both cases (86%/37%). Implant loading: In any situation, conventional loading is preferred, though immediate is most often used in anterior/esthetic zones. Technology: While 54% of responders use implant planning software sometimes, surgical guides were not ordered at all by most (48%). This could be due to preference, finance, or availability.
BL/C: Low responsiveness and only targeted prosthodontists. Prosthodontist, according to this study, are most likely to use the implant system they were trained on. Implants were most likely to be selected also based on their features and amount of literature support present.
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