International Journal of Oral Implantology, 04/2021

The coronally advanced flap technique is one of the most commonly used approaches for treating gingival recession. Several modifications of the technique have been proposed over the years, making it a highly predictable treatment option for gingival recession; however, as dental implants are structurally and biologically different from natural teeth, a further modification of the conventional coronally advanced flap technique has been suggested to overcome the challenges posed by the treatment of peri-implant soft tissue dehiscences. The present article aims to describe the state of the art of the technique at implant sites presenting with peri-implant soft tissue dehiscences, and highlight the main differences between this and the coronally advanced flap approach in natural teeth. The timing of crown removal and abutment modification/replacement are discussed, along with the different methods for management of the flap and connective tissue graft that are recommended at implant sites. The outcomes of this approach compared to the conventional coronally advanced flap technique, and other approaches are also presented. Keywords: connective tissue graft, dental implants, gingival recession, soft tissue augmentation, surgical flap Conflict-of-interest statement: The authors do not have any financial interests, either directly or indirectly, in the products or information listed in the paper.

Purpose: To evaluate the impact of implant surface characteristics on the initiation, progression and treatment outcomes of peri-implantitis based exclusively on in vivo investigations. Materials and methods: A literature search was conducted by two independent reviewers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify animal studies comparing at least two different implant surfaces affected by experimental peri-implantitis, with distinct characteristics and with or without subsequent surgical treatment that aims to arrest disease progression. The parameters evaluated included both radiographic (e.g., marginal bone level) and clinical (e.g., probing depth, bleeding on probing) aspects to determine changes in disease progression and treatment outcomes. Results: No statistically significant differences were found among the different implant surfaces during the initiation of peri-implantitis. On the other hand, the progression and treatment outcomes of peri-implantitis displayed statistically significant differences among the different implant systems, with turned surfaces reporting less bone loss during the progression period and greater bone gain after treatment. Conclusions: Implant surface characteristics play a critical role in the progression and treatment outcomes of peri-implantitis. Turned implant surfaces demonstrated the least amount of bone loss after ligature removal and recorded the most favourable treatment outcomes. Keywords: alveolar bone loss, dental implants, peri-implantitis, review (systematic), surface roughness Conflict-of-interest statement: The authors do not have any financial interests, either direct or indirect, in the products or manufacturers mentioned in this study.

Peri-implant diseases at implant sites represent the most considerable concern for many dental clinicians nowadays due to their detrimental effect on implant longevity. Preventive measures include patient education and motivation, supportive peri-implant therapy and routine assessment of the hard and soft tissues. Nevertheless, the reliability of clinical parameters to monitor peri-implant conditions is subject to debate. As such, the primary purpose of the present review was to gain further insight into the diagnostic accuracy of probing as a clinical tool to monitor dental implants and assist clinicians in preventing peri-implant diseases. Studies have recommended periodic probing to monitor the condition of the peri-implant tissues. Increased probing pocket depth, profuse bleeding on probing and suppuration at implants are clinical signs that have been associated with peri-implantitis; thus, if these clinical parameters are present, radiographic assessment is encouraged to make a definitive diagnosis considering potential inaccuracies related to local and/or systemic factors identified in the present review. Keywords: complications, diagnostic procedure, peri-implantitis, surgical Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Purpose: Long-term success of titanium dental implants is influenced by various factors, including the maintenance of good oral hygiene. The present study aimed to evaluate cleaning effectiveness and patient satisfaction with glycine powder air polishing and traditional professional oral hygiene treatments when applied to implant-supported full-arch restorations without removal of the fixed prosthesis. Materials and methods: A total of 85 patients with 357 implants supporting full-arch fixed restorations were included. After removal of the prosthesis (T0), the following parameters were recorded: Plaque Index, peri-implant spontaneous bleeding, probing depth and bleeding on probing. The prosthesis was then reinserted. The patients were divided into three groups, each of which received two hygiene therapies randomly administered in each hemiarch using a split-mouth design. The possible treatments were glycine powder air polishing and use of sponge floss vs sponge floss only in group 1; glycine powder air polishing vs use of an ultrasonic device with a polyetheretherketone fibre tip coating in group 2; and glycine powder air polishing vs use of carbon fibre curettes and sponge floss in group 3. After instrumentation, the prostheses were removed to assess the Plaque Index and peri-implant spontaneous bleeding. Questionnaires were used to record patients’ levels of comfort and satisfaction in relation to the various treatments. Results: Glycine powder air polishing resulted in a significantly higher reduction in plaque around implants compared to control treatments (sponge floss only, ultrasonic device with polyetheretherketone fibre tip coating, and manual scaling with carbon fibre curettes and use of sponge floss) (P = 0.020). Glycine powder air polishing followed by application of sponge floss provided the greatest reduction of plaque deposits on the prosthetic surfaces. On average, 80% of patients rated glycine powder air polishing highest with regard to satisfaction. Conclusions: Glycine powder air polishing is a highly effective and comfortable treatment to maintain good oral hygiene in clinical practice, and could be used as an alternative to manual and mechanical instrumentation when dealing with implant-supported restorations. Keywords: air polishing, dental implants, full-arch, glycine, oral hygiene Conflict-of-interest statement: The authors declare there are no conflicts of interest related to this study.

Purpose: To prospectively assess marginal bone loss and implant survival with Astra Tech (Dentsply Sirona, Charlotte, NC, USA) (group A) and Brånemark (Nobel Biocare, Zurich, Switzerland) (group B) implants in a split-mouth study conducted over a 20-year follow-up period. Materials and methods: A total of 95 implants (n = 50, group A and n = 45, group B) were randomly placed in the left or right side of the maxilla or mandible in 18 patients. Clinical and radiographic examinations were performed, and results were reported at 5, 10, 15 and 20 years after insertion of the prosthesis. Results: Ten patients were followed up for 20 years (n = 26 implants, group A and n = 25 implants, group B). No implant loss or prosthetic failures were observed. After 20 years of follow-up, no significant differences in marginal bone loss were found between both implant groups (P = 0.25). The proportion of marginal bone loss ≥ 0.5 mm was not significantly different between implant types (P > 0.05), and no statistically significant relationships were found between marginal bone loss and time (P ≥ 0.05). More specifically, there was no significant difference in marginal bone level between year 20 and baseline in group A (P = 0.70), whereas a difference of 0.5 to 1.0 mm was found in group B (P = 0.15). Conclusions: After 20 years of follow-up, marginal bone loss around screw-shaped titanium implants was clinically insignificant. Furthermore, no significant differences in survival and marginal bone loss were found between group A and B implants over the follow-up period. Keywords: bone remodelling, implant system, marginal bone level, osseointegration, split-mouth design Conflict-of-interest statement: The authors declare there are no conflicts of interest relating to this study.

Purpose: To introduce a novel and efficient procedure to solve a multidisciplinary issue connected to implant-related surgery in areas near periapical lesions of adjacent teeth using single-stage combined surgery while exploring a new way to prevent retrograde peri-implantitis. Materials and methods: A 31-year-old woman diagnosed with a Kennedy III dentition defect in the maxillary right central incisor and posttreatment apical periodontitis in the maxillary right lateral incisor was treated using a multidisciplinary procedure. First, the preoperative data were collected from intraoral, extraoral facial and CBCT scans. Then, the aesthetic appearance of the anterior teeth was planned digitally and implant insertion was simulated. Next, virtual bone augmentation was carried out with reference to the simulated implant position, and according to the virtual augmentation, the templates for bone shell harvesting (also used for apical osteotomy and root tip resection during endodontic microsurgery) and bone shell grafting of the edentulous area were designed and fabricated. The templates for combined surgery (endodontic microsurgery and horizontal bone augmentation) consisted of one basal template and multiple interchangeable attachments via a plugin design to make guided endodontic microsurgery and digitally guided bone augmentation more efficient. Combined surgery was then carried out using the templates for guidance. During surgery, the apical inflammation affecting the maxillary right lateral incisor was first removed and its preserved apical bony window was prepared as an autogenous bone shell for bone augmentation of the maxillary right central incisor site. Guided bone regeneration of the edentulous area and guided tissue regeneration were then performed for the adjacent tooth. Six months after the combined surgery, digital guided implant surgery was carried out for the edentulous area. The final prosthesis was delivered in accordance with the preoperative aesthetic design and achieved using an implant-supported restoration for the maxillary right central incisor, full crown restoration for the maxillary right lateral incisor, and ceramic veneers for the maxillary left central and lateral incisors for space closure. Results: The horizontal bone augmentation in the edentulous area and endodontic microsurgery on the neighbouring tooth were performed successfully in a single-stage surgical procedure; thus, augmentation of the resorbed alveolar bone and removal of infection in the adjacent site were achieved simultaneously. At the 1-year follow-up after combined surgery, the healing of the natural maxillary right lateral incisor and the area having undergone bone augmentation showed promising results with no postoperative complications. Conclusions: This novel digital workflow appears effective in addressing the problem of periapical lesions in retained teeth adjacent to the edentulous area that requires horizontal bone augmentation in one surgical procedure, providing an efficient way of resolving the problem using endodontics and implantology, and preventing retrograde peri-implantitis. Keywords: aesthetics, apical periodontitis, case report, case series, guided bone regeneration, guided implant surgery, guided tissue regeneration, horizontal bone augmentation, targeted endodontic microsurgery Conflict-of-interest statement: The authors declare that they have no conflicts of interest or personal relationships with other people or organisations that may influence this study.