Fig. 3. Peri-implant bone level at baseline, 3 months post-operative, and 6 months post-operative. a Mesial defect depth. b Mesial defect width. c Distal defect depth. d Distal defect width
Fig. 3. Peri-implant bone level at baseline, 3 months post-operative, and 6 months post-operative. a Mesial defect depth. b Mesial defect width. c Distal defect depth. d Distal defect width
Fig. 2. Test group (PRF augmentation)
Fig. 2. Test group (PRF augmentation)
Fig. 1. Control group (no PRF augmentation)
Fig. 1. Control group (no PRF augmentation)
Illustration 11. ive (a), 1 week post-operative (b), 1 month post-operative (c), and 3 months post-operative (d)
Illustration 11. a–d Post-operative healing process at 3 days post-operative (a), 1 week post-operative (b), 1 month post-operative (c), and 3 months post-operative (d)
Illustration 10. a–d Second measuring, reentry, and insertion of a screwed, full ceramic crown
Illustration 10. a–d Second measuring, reentry, and insertion of a screwed, full ceramic crown
Illustration 9. a–c Radiographic control a at time of implant placement (a), 3 months post-operative (b), and 6 months post-operative (c)
Illustration 8. Fixation of the flap with Seralene® 6.0
Illustration 8. Fixation of the flap with Seralene® 6.0
Illustration 7. Insertion of PRF membranes in a double-layered technique for tissue augmentation
Illustration 7. Insertion of PRF membranes in a double-layered technique for tissue augmentation
Illustration 6. PRF membrane made by centrifugating and pressing the patient’s blood
Illustration 6. PRF membrane made by centrifugating and pressing the patient’s blood
Illustration 5. Implant placed with a split-flap technique
Illustration 5. Implant placed with a split-flap technique
Illustration 4. NobelSpeedy Replace® (source: https://www.nobelbiocare.com/de/de/home/products-and-solutions/implant-systems/nobelspeedy.html)
Illustration 4. NobelSpeedy Replace® (source: https://www.nobelbiocare.com/de/de/home/products-and-solutions/implant-systems/nobelspeedy.html)
Illustration 3. Insertion of the implant
Illustration 3. Insertion of the implant
Illustration 2. Crestal incision and preparation of a split-flap
Illustration 2. Crestal incision and preparation of a split-flap
Illustration 1. Measurement of tissue thickness with an endodontic micro-opener
Illustration 1. Measurement of tissue thickness with an endodontic micro-opener
Hehn, J., Schwenk, T., Striegel, M. et al. The effect of PRF (platelet-rich fibrin) inserted with a split-flap technique on soft tissue thickening and initial marginal bone loss around implants: results of a randomized, controlled clinical trial.
Int J Implant Dent 2, 13 (2016). https://doi.org/10.1186/s40729-016-0044-4
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Received: 30 July 2015
Accepted: 23 ...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were...
Julia Hehn, Thomas Schwenk, Marcus Striegel, and Markus Schlee declare that they have no competing interests. This study was self-supported.
JH was responsible for the study design and recruitment of the patients, carried out the implant surgery and follow-up examinations, and drafted the manuscript. TS participated in the surgical treatment and follow-up examinations. MS performed the digital me...
Periodontology, Edel & Weiß Clinic, Ludwigsplatz 1a, 90403, Nuremberg, Germany
Julia Hehn
Esthetic Dentistry, Edel & Weiß Clinic, Nuremberg, Germany
Thomas Schwenk & Markus Striegel
Private Clinic for Periodontology, Forchheim and Department of Maxillofacial Surgery, Goethe University, Frankfurt, Germany
Markus Schlee
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The authors thank Dr. Wolfgang Reimers of MedCommTools for performing the statistics.
Abrahamsson I, Berglundh T. Effects of different implant surfaces and designs on marginal bone-level alterations: a review. Clin Oral Implants Res. 2009;20 Suppl 4:207–15.
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Dohan DM et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3):e45–50.
Choukroun J, et al. Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part IV: clinical effects on tissue healing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;101(3)...
Cardaropoli G et al. Tissue alterations at implant-supported single-tooth replacements: a 1-year prospective clinical study. Clin Oral Implants Res. 2006;17(2):165–71.
Fickl S et al. Dimensional changes of the alveolar ridge contour after different socket preservation techniques. J Clin Periodontol. 2008;35(10):906–13.
Vela-Nebot X et al. Benefits of an implant platform modification techniqu...
platelet-derived growth factor
platelet-rich fibrin
standard deviation
transforming growth factor-b
Soft tissue augmentation with PRF using a split-flap technique cannot be recommended to alter thin gingiva types. Future experimental and clinical studies will be necessary to evaluate whether augmentation with PRF is suitable for mucosa thickening.
With respect to marginal bone loss, it could be shown that there were no significant differences when comparing dimension of bone loss between test and control groups. The study of present research data shows, to the best knowledge of the authors, no other RCTs about tissue thickening with PRF and peri-implant bone loss. However, several studies focused on mucosa thickening with tissue grafts and ...
In this study over a period of 6 months, it could be demonstrated that mucosal tissue thickening above implants with PRF led to reduced tissue thickness when performed in a split-flap technique.
The initial post-operative dehiscence and the associated complete loss of mucosal and augmented tissue above the implant were observed in all test patients.
PRF is supposed to be a good healing aid in v...
The mean marginal bone level alterations are displayed in Fig. 3.
Six months after surgery, both groups showed a statistically significant peri-implant bone loss.
The mesial resp. distal defect depth was 0.70 mm ± 0.72 SD resp. 0.64 mm ± 0.66 SD at baseline. Six months later, the marginal bone defect increased to 1.47 mm ± 0.65 SD on the mesial side resp. 1.46 mm ± 0.54 ...
At time of surgery, the patients ranged in age from 33 to 79 years (mean age 53.8 years).
The first surgeries for implant placement in the test group were carried out as described above. Two layers of a PRF matrix were placed on top of the implant. Though surgical flaps were all sutured completely free of tension, a post-operative dehiscence above the implant could be observed in all test pati...
Comparison of bone level alterations between test and control groups.
Data were expressed as means ± standard deviation. Comparisons were made using the Wilcoxon test, the Mann–Whitney U test, and the multiple comparisons test by Schaich-Hamerle (p = 0.05).
After the implantation, standardized digital X-rays were taken with parallel technique (baseline) (illustration 9). For each patient, an individual customized digital film holder was fabricated to ensure a reproducible radiographic analysis. Patients were instructed to avoid chewing hard nutrition in the treated area and to use chlorhexidine mouthwash and a soft brush twice a day for the first 2 ...
Patients aged 18+ who required an implant in the posterior mandible were eligible for this study.
Exclusion criteria were the following:
general contraindications to implant surgery
insufficient oral hygiene and periodontitis
patients with a history of severe periodontitis
bone augmentation required
smokers
substance abuse
uncontrolled diabetes
severe cardiovascular problems
treated or u...
As a consequence, recent research focused on soft tissue augmentation of thin gingiva types prior to or simultaneous to implant insertion. Wiesner et al. published a significant gain of soft tissue by thickening the gingiva with a connective soft tissue graft harvested from the palate [12]. Soft tissues at augmented sites were 1.3 mm thicker than on control sites and had a better pink esthetic sc...
The initial bone modeling around implants within the first year after insertion presents a challenging topic in current research. Previous studies have shown that this process is characterized by a remodeling of the horizontal and vertical bone dimension with a range of 0.7 to 3 mm within the first year [1].
First attempts to reduce this loss of tissue focused on changes of implant shapes, impla...
Previous studies have shown that adequate thickness or initial augmentation of soft tissue has a positive effect on the stability of peri-implant bone. This randomized, controlled trial aimed to evaluate the influence of augmenting soft tissue with platelet-rich fibrin (PRF) on crestal bone and soft tissue around implants.
After randomization, 31 fully threaded titanium implants were inserted in ...
Fig. 4. Vestibular view of contralateral lateral incisor
Fig. 4. Vestibular view of contralateral lateral incisor
Fig. 3. Vestibular view of right lateral implant supported crown
Fig. 3. Vestibular view of right lateral implant supported crown
Fig. 2. Probing of the peri-implant sulcus
Fig. 2. Probing of the peri-implant sulcus
Fig. 1. a Pre-operative panoramic radiograph of the patient, (b) abutment in place, following the osseointegration period, (c) periapical radiograph at 1-year follow up, (d) final restoration at 1-year follow up, and (e) smile line
Fig. 1. a Pre-operative panoramic radiograph of the patient, (b) abutment in place, following the osseointegration period, (c) periapical radiograph at 1-year foll...
Smile line
VAS
Smile line
Correlation coefficient
1
− .699a
...
PES result
Smile line
Low (n = 4)
Medium (n = 10)
High (n = 5)
Poor (0–...
PES
WES
VAS
Spearman’s rho
VAS
Correlation coefficient
...
Esthetic score
0
1
2
PES
Mesial papilla
...
Number of patients
Percentage
Pink esthetic score
Poor (0–7)
2
10.5%
...
Implant site
Biotype
Smile line
Placement timing
PES
WES
...
Altay, M.A., Sindel, A., Tezerişener, H.A. et al. Esthetic evaluation of implant-supported single crowns: a comparison of objective and patient-reported outcomes.
Int J Implant Dent 5, 2 (2019). https://doi.org/10.1186/s40729-018-0153-3
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Received: 25 July 2018
Accepted: 09 December 2018
Published: 07 January 2019
DOI: https://doi.org/10.1186/s40729-018-0...
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were m...
This study was approved by the Akdeniz University Ethical Review Board.
All participants consented to publish their information details.
Dr. Altay has provided consultancy for Checkpoint Surgical LLC in 2014. All other authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Dumlupinar Boulevard, Campus, 07058, Antalya, Turkey
Mehmet Ali Altay, Alper Sindel, Hüseyin Alican Tezerişener & Nelli Yıldırımyan
Department of Prosthodontics, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
Mehmet Mustafa Özarslan
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Not applicable.
This study was conducted without external funding.
All data generated and analyzed during this study are included in this article.
Jivraj S, Chee W. Treatment planning of implants in the aesthetic zone. British Dental J. 2006;201(2):77–89.
Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2004;19:43–61.
Huynh-Ba G, Meister DJ, Hoders AB, Mealey BL, Mills MP, Oates TW, Cochran DL, Prihoda TJ, McMahan C...
Hof M, Umar N, Budas N, Seemann R, Pommer B, Zechner W. Evaluation of implant esthetics using eight objective indices-comparative analysis of reliability and validity. Clin Oral Implants Res. 2018;29(7):697–706.
Li X, Wu B, Cheng X, Li Y, Xie X, Deng F. Esthetic evaluation of implant-supported single crowns: the implant restoration esthetic index and patient perception. J Prosthodont. 2017. htt...
Rokn A, Bassir S, Ghahroudi AR, Kharazifard M, Manesheof R. Long-term stability of soft tissue esthetic outcomes following conventional single implant treatment in the anterior maxilla: 10-12 year results. Open Dent. 2016;10:602.
Angkaew C, Serichetaphongse P, Krisdapong S, Dart MM, Pimkhaokham A. Oral health-related quality of life and esthetic outcome in single anterior maxillary implants. Clin...
Pink esthetic score
Standard deviation
Statistical Package for the Social Sciences
Visual analogue scale
White esthetic score
Professionally reported esthetic outcomes (PES and WES results) may not significantly correlate with patient-reported outcomes, although they are helpful in monitorization of implants in the anterior zone during follow-ups. This study reveals that smile line is a significant factor in patient satisfaction, which should be evaluated thoroughly prior to implant placement in the anterior maxilla.
Only a limited number of studies compared esthetic outcomes of implants placed using different protocols [3, 25, 26]. A majority of these studies compared the results of immediate implant placement (type 1) with other protocols. Huynh-Ba et al. found no difference in terms of esthetics between type 1 and type 2 implant placement [25]. Similarly, Boardman et al. observed higher PES results followin...
In the present study, only two implants in patients with thin gingival biotypes failed to reach the clinically acceptable PES level. All other patients with both thick and thin biotypes achieved either acceptable or almost perfect scores for both PES and WES. According to the results of Angkaew et al., the PES/WES scores of patients with thick gingival biotype were significantly higher than those ...
Ever since the introduction of dental implants in the 1960s, they have been used worldwide with high success rates and accepted predictability [13]. Initial efforts of implant treatment mainly focused on osseointegration and function, whereas today, esthetics is also regarded as an essential component, which is commonly addressed together with functional goals of rehabilitation with dental implant...
All implants were loaded 3–6 months after implant surgery (conventional loading protocol); therefore, this parameter was not analyzed in this study.
The overall effect of gingival biotype and smile line on PES, WES, or VAS was studied using a general linear regression analysis for multivariate tests. Although both PES and WES were not affected (p = 0.580, p = 303; respectively), VAS wa...
Question4. “How do you feel about the color of the gum that is around your new implant tooth?” Mean patient rating was calculated as 8.4 (range 2–10, SD ± 2.0). Median score was 9. Fifteen patients responded with a score of ≥ 8 and 17 patients responded with a score of ≥ 6.
Question5. “What is your overall satisfaction with the new implant tooth?” Mean patient rating was ca...
A total of 19 (7 female and 12 male) patients, who were rehabilitated with a single implant in the anterior maxilla, were included in this study. Patients’ ages ranged between 19 and 42 with a mean of 31.8 years. None of the implants were associated with increased probing depth, bleeding, suppuration, foreign body sensation, pain, morbidity, or infection. Clinical features related to anterior s...
All patients were assessed according to the White Esthetic Score [8] which comprised the evaluation of five variables including general tooth form, tooth contour, tooth color (hue and value), surface texture, and translucence. Each variable was given a score of 0, 1, or 2. A score of 0 indicated the worst and a score of 2 indicated the best result for each variable. The implant-supported tooth was...
This study was conducted in accordance with the Declaration of Helsinki on medical protocol and was approved by the Akdeniz University Ethical Review Board.
The patients rehabilitated with a single implant-supported fixed prosthesis in the maxillary esthetic zone at the departments of Oral and Maxillofacial Surgery and Prosthetic Dentistry of Akdeniz University between June 2015 and April 2017 we...
Patient satisfaction, which indicates the success of the implant treatment from the patient’s perspective, is another important outcome measure and is commonly performed with questionnaires or a visual analog scale (VAS) [2, 8]. A current review of the literature, however, reveals only a limited number of studies reporting on patient-centered outcomes in addition to objective evaluations of impl...
Rehabilitation of missing teeth in the anterior maxilla with an implant-supported fixed prosthesis is a widely accepted treatment modality [1]. Dental implants have high rates of predictability in terms of osseointegration, particularly due to improvements in treatment techniques and surface topography [2]. However, rehabilitation with dental implants is not yet considered a perfect treatment moda...
This study investigated objective and patient-reported esthetic outcomes and their correlation for single-tooth implant restorations in the maxillary anterior region.
Nineteen patients were included. Gingival biotypes and smile lines were evaluated. Esthetic evaluation was performed according to the pink and white esthetic scores (PES and WES). Patients rated their satisfaction regarding the impl...
Figure 4. Patient satisfaction throughout the study
Figure 3. Bone level changes from loading to 5-year follow up
Figure 2. Clinical parameters and soft tissue parameters. a Modified plaque index. Error bars indicate standard deviation. * = p ≤ 0.05, *** = p ≤ 0.001. b Sulcus bleeding index. Error bars indicate standard deviation. * = p ≤ 0.05, *** = p ≤ 0.001. c Pocket probing depth. The asterisk represents statistically significant differences (* = p ≤ 0.05) observed between ...
Figure 1. Study flow diagram: follow up status and reasons for not completing the study; six-month, 2-year and 4-year follow up was optional
Figure 1. Study flow diagram: follow up status and reasons for not completing the study; six-month, 2-year and 4-year follow up was optional
Table 4 Life table analysis showing the cumulative success rate according to Albrektsson et al. and Buser et al.
Interval(months)
Implants in interval
According to Albrektsson et al.
According to Buser et al.
Implants withdrawn during interval
Failures during interval
Cumulative success rate (%)
Implants withdrawn during interval
Failures during interval
Cumulativ...
Table 3 Patient demographics with respect to implants
Overall
Subgroup*
Platform switching
Platform matching
Total Implants, n
285
203*
68*
Number of implants placed per patient, n (%)
1
125 (63.8)
97 (67.4)
20 (48.8)
2
56 (28.6)
37 (25.7)
16 (39.0)
3
12 (6.1)
7 (4.9)
5 (12.2)
4
3 (1.5)
3 (2.1)
0 (0.0)
Implant...
Table 2 Patient demographics
Overall
Subgroup*
Platform switching
Platform matching
Patients, n (%)
196 (100)
144
41
Sex, n (%)
Male
87 (44.4)
62 (43.1)
19 (46.3)
Female
109 (55.6)
82 (56.9)
22 (53.7)
Age, years
Mean (SD)
51.5 (14.2)
53.1 (14.4)
47.4 (12.9)
Range
17.9–82.1
17.9–82.1
19.3–78.5
Pr...
Investigator*
City/country
Number of patients included
Number of implants included
Dr. Helfried Hulla
Strass in Steiermark, Austria
10
15
Prof. DDr. Gerald Krennmair
Marchtrenk, Austria
10
20
Dr. S. Marcus Beschnidt (PI)
Baden-Baden, Germany
8
12
Dr. Karl-Ludwig Ackermann
Filderstadt, Germany
14
18
Dr. Thomas Barth
Leipzig, Germany
15
28
Dr...
Abbreviations
ASA:
American Society of Anesthesiologists
MPI:
Modified Plaque Index
PPD:
Pocket probing depth
RCT:
Randomized controlled clinical trial
SBI:
Sulcus Bleeding Index
SD:
Standard deviation
SLA:
Sand-blasted, large grit, acid-etched
References
Hjalmarsson L, Gheisarifar M, Jemt T. A systematic review of survival of s...
The appearance of poorer oral hygiene later in the study also appears to correspond with the drop in follow-up attendance, which again supports the importance of follow-up. All other complications could be resolved and were not persisting. Furthermore, patients selected for inclusion in this study were optimal candidates for dental implants. Though the inclusion criteria predestinate the patient s...
At 5-year follow-up, the overall SBI was 0.32 ± 0.49, reflective of no bleeding given that 0 equals no bleeding and 1 equals isolated bleeding spots visible [27]. The PPD initially decreased within the first 6 months from which point it significantly increased to 2.34 ± 1.18 mm at 5-year follow-up.
Nevertheless, the measured mean PPD still reflects the norm for conventionally placed i...
On the one hand, the variety of bone level changes in this study may be explained by different vertical soft tissue thicknesses, but cannot be validated due to these missing data. On the other hand, there are multiple confounding factors influencing the change in bone level, such as the size of the platform (mismatch), occlusal loading, and the microgap. Additional to the standard success criteria...
Over the 5-year study period, we report
At 3-year follow-up, bone loss was noted in one patient (reclassified as peri-implantitis at the 4-year follow-up) and an important bone loss (due to poor oral hygiene and bruxism; two implants) in a patient with psychosocial issues who could not be treated during the study. Such a patient would not have been included in an RCT.
Consequently, three implants were lost based on the bone loss criter...
Discussion and conclusions
This large, multicenter study provides real-life long-term data on 285 implants placed in 196 patients. The results show that the placement of CAMLOG SCREW-LINE implants with platform-matching or platform-switching abutments results in high survival and success in the long term. The overall success rate for implants was 97.1% at 5-year post-loading, and 97.4% and 96.2...
Jemt papilla score
At loading, the Jemt papilla score was 1.93 ± 1.01, significantly increasing to 2.14 ± 0.95 at 5-year follow-up (p = 0.023) (Fig. 2d). For the platform-switching subgroup, a significant difference was observed between baseline and 5-year follow-up (p
Implant survival
The cumulative survival rate was 100% at 1-year follow-up, 99.6% at 3-year follow-up, and 98.6% at 5-year follow-up. All three late failures were in the platform-switching subgroup.
Clinical parameters/soft tissue parameters
Plaque index
Mean modified plaque indices were very low at below 0.5 for all but one measurement throughout the course of the study (Fig. 2a). At loading...
Results
Patient demographics
In total, 196 patients from 17 centers met the inclusion criteria for this study and were included in the per-protocol analysis. In total, 285 implants were placed (Table 1). At the 5-year follow-up, data were available for the 137 patients who completed the study (Fig. 1). Patient demographic data is presented in Tables 2 and 3.
Implant success
Implant success...
The primary stability of the implant was assessed during surgery. Implant success and survival were evaluated in the group of implants restored with abutments [5, 29] at both placements of the provisional and definitive prostheses and at each follow-up visit thereafter. Implants were deemed successful in accordance with the criteria for implant success laid down by Albrektsson et al. [30]. Implan...
Assessments
Throughout the study, only radiographs consistent with standard implant procedures were taken. Bone level changes were assessed based on available and evaluable standardized periapical radiographs with a film-holder using parallel-technique or panoramic radiographs (depending on the standard in the study centers). Baseline was defined as the time of the first prosthetic installati...
The treatment indications were single or multiple tooth replacement in the maxilla or mandible without the use of simultaneous augmentation or membrane, of which the implants were to be restored with either fixed single crown or fixed partial denture restorations.
Treatment procedure
Patients were to be treated according to standard practice for implant procedures applicable in the countries par...
Methods
Study design
This was a prospective multicenter non- interventional study to assess implant success and survival rates in daily dental practices using the CAMLOG SCREW-LINE implants (CAMLOG Biotechnologies AG, Basel, Switzerland) used with or without platform-switching abutments. Patients were enrolled over a period of 2 years from October 2008 to September 2010 from 17 sites across f...
In the present study, CAMLOG SCREW-LINE implants with the Promote plus surface (sandblasted and acid-etched surface) were used. These implants in combination with platform-matching abutments have been shown to have high long-term success rates ranging from 97.8 to 100% at 5-year to 10-year follow-up [9,10,11,12,13]. They can be restored with either platform-matching or platform-switching abutments...
Background
Success and survival rates of endosseous implants are well-documented in a number of controlled clinical trials and systematic reviews [1,2,3]. Generally, controlled trials evaluate endosseous implants in specific clinical situations; thus, the patient population is subjected to rigorous inclusion criteria and follow-up. Accordingly, controlled clinical trials do not reflect th...
Implant success and survival rates in daily dental practice: 5-year results of a non-interventional study using CAMLOG SCREW-LINE implants with or without platform-switching abutments
Abstract
Background
The performance of dental implants in controlled clinical studies is often investigated in homogenous populations. Observational studies are necessary to evaluate the outcome of implant resto...
How do we define a case of peri‐implantitis in day‐to‐day clinical practice and teaching situations?
Diagnosis of peri‐implantitis requires:
Presence of bleeding and/or suppuration on gentle probing.
Increased probing depth compared to previous examinations.
Presence of bone loss beyond crestal bone level changes resulting from initial bone remodeling.
In the a...
The following case definitions and characteristics of peri‐implant health, peri‐implant mucositis, and peri‐implantitis should be viewed within context of several potential confounding factors.
It is known that there is no generic implant and that there are numerous implant designs with different surface characteristics, surgical and loading protocols. The degree of physiological remodeli...
What are the main factors associated with hard‐ and soft‐tissue deficiencies at potential implant sites?
The healing process following tooth loss leads to diminished dimensions of the alveolar process/ridge representing hard‐ and soft‐tissue deficiencies. Larger deficiencies may occur at sites exposed to the following factors: loss of periodontal support, endodontic in...
What is peri‐implantitis?
Peri‐implantitis is a plaque‐associated pathological condition occurring in tissues around dental implants, characterized by inflammation in the peri‐implant mucosa and subsequent progressive loss of supporting bone.
What is the evidence for plaque/biofilm as a principal etiological factor for peri‐implantitis?
There is evidence ...
What are the clinical characteristics of peri‐implant mucositis?
The main clinical characteristic of peri‐implant mucositis is bleeding on gentle probing. Erythema, swelling and/or suppuration may also be present.
Does peri‐implant mucositis exist in the absence of clinical signs of inflammation?
Clinical signs of inflammation are necessary for a diagnosis of peri...
What are the clinical characteristics of a healthy peri‐implant site?
In health, the peri‐implant site is characterized by absence of erythema, bleeding on probing, swelling and suppuration.
What are the main clinical differences between healthy peri‐implant and periodontal tissues?
In health, there are no visual differences between peri‐implant and periodontal t...
The objective of Workgroup 4 was to present a classification on peri‐implant diseases and conditions. Five position papers describing the characteristics of peri‐implant health, peri‐implant mucositis, peri‐implantitis, soft and hard tissue deficiencies and case definitions and diagnostic considerations were prepared prior to the workshop.
In preparing this consensus report regarding...
Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions
Abstract
A classification for peri‐implant diseases and conditions was presented. Focused questions on the characteristics of peri‐implant health, peri‐implant mucositis, peri‐implantitis, and soft‐ and hard‐tissue deficiencies were addressed.
...
Figure 36. Day 60 - 180 : Initial periosteum formation
After 60 to 90 days, newly formed woven bone forms a bridge across the entrance of the socket. The epithelium covering the bone is keratinized. Soft tissue healing at this stage has been completed. At 90 to 180 days after tooth extraction, the woven bone is gradually remodeled into cortical bone. A periosteum is established with collagen ...
Figure 35. Day 21 - 30 : keratinized epithelium
After 21 to 30 days, the marginal soft tissue compartment of the socket is characterized by a well-organized fibrous connective tissue lined with a keratinized epithelium.
Figure 34. Day 4 - 14 : Epithelial proliferation & connective tissue
After 4 to 5 days, the epithelium from the margins of the soft tissue starts to proliferate to cover the granulation tissue in the socket. At 14 days, the connective tissue at the marginal portion of the extraction socket is partially lined by epithelial cells.
Figure 33. Day 3: granulation tissue & inflammatory cells
After 3 days, small segments of the coagulum at the margins of the socket are replaced by a highly vascularized granulation tissue with an inflammatory cell infiltrate.
Figure 32. Day 1: Coagulum & inflammatory cells
Figure 33. Day 3: granulation tissue & inflammatory cells
The soft tissue healing at the entrance of the socket also follows a specific pattern: At day 1 after extraction, the marginal portion of the coagulum is covered with a layer of inflammatory cells, mainly neutrophils. After 3 days, small segments of the coagulum a...