Marco Caneva Influence of implants with different

Daniele Botticelli
Fabio Rossi
sizes and configurations installed
Leandro Carvalho Cardoso immediately into extraction sockets on
Fabio Pantani
Niklaus P. Lang
peri-implant hard and soft tissues: an
experimental study in dogs

Authors’ affiliations: Key words: animal study, bone healing, extraction socket, implant configurations, implant
Marco Caneva, Daniele Botticelli, Fabio Rossi, dentistry, implant surfaces, osseointegration
Fabio Pantani, UNESP – Faculty of Dentistry of
Araçatuba, São Paulo State University, São Paulo,
Brazil Abstract
Daniele Botticelli, ARDEC, Ariminum
Odontologica, Oral Surgery Division, Rimini, Italy
Aim: To study the influence on the healing of soft and hard peri-implant tissues when implants of
Niklaus P. Lang, The University of Hong Kong, different sizes and configurations were installed into sockets immediately after tooth extraction.
Prince Philip Dental Hospital, Hong Kong, SAR, Material and methods: Transmucosal cylindrical implants, 3.3 mm in diameter in the control sites,
China
Leandro Carvalho Cardoso, Goiás Dentistry, and conical 5 mm in diameter in the test sites, were installed into the distal socket of the fourth
Improvement School, EAP Goiás, Goiás, Brazil mandibular premolars in dogs immediately after tooth extraction. After 4 months, the hard and
soft tissue healing was evaluated histologically.
Corresponding author:
Dott. Daniele Botticelli Results: All implants were integrated in mineralized mature bone. Both at the test and control
Viale Pascoli 67 sites, the alveolar crest underwent resorption. The buccal bony surface at the implant test sites
I-47923 Rimini (conical; 3.8 mm) was more resorbed compared with the control sites (cylindrical; 1.6 mm). The soft
Italy
Tel.: +39 0541 393444 tissue dimensions were similar in both groups. However, in relation to the implant shoulder, the
Fax: +39 0541 397044 peri-implant mucosa was located more apically at the test compared with the control sites.
e-mail: daniele.botticelli@ardec.it
Conclusion: The present study confirmed that the distance between the implant surface and the
outer contour of the buccal alveolar bony crest influenced the degree of resorption of the buccal
bone plate. Consequently, in relation to the implant shoulder, the peri-implant mucosa will be
established at a more apical level, if the distance between the implant surface and the outer
contour of the alveolar crest is small.

Date:
Accepted 1 August 2011
To cite this article:
Caneva M, Botticelli D, Rossi F, Cardoso LC, Pantani F, Lang
NP. Influence of implants with different sizes and
configurations installed immediately into extraction sockets
on peri-implant hard and soft tissues: An experimental study
in dogs.
Clin. Oral Impl. Res. 23, 2012, 396–401
doi: 10.1111/j.1600-0501.2011.02310.x
Several clinical (e.g. Botticelli et al. 2004; Co-
vani et al. 2004; Sanz et al. 2010) as well as
experimental studies (e.g. Araújo et al. 2005;
Botticelli et al. 2006; de Sanctis et al. 2009;
Vignoletti et al. 2009; Caneva et al. 2010a,
2010b, 2010c, 2010d, 2011a, 2011b; Covani
et al. 2010; Barone et al. 2011) have demon-
strated that implant installation into the
alveolus immediately after tooth extraction
did not result in the maintenance of the buc-
cal bony wall at its original level.
This type of implant installation may be
affected by a number of factors, such as a
flapless installation (Blanco et al. 2008; Cane-
va et al. 2010a) or the use of bone fillers with
or without concomitant membrane coverage
(Caneva et al. 2010b, 2011a, 2011b). The
positioning of the implant within the extrac-
tion socket appears to be another important
factor influencing the final outcome (Caneva
et al. 2010c, 2010d; Tomasi et al. 2010). A
multilevel multivariate analysis (Tomasi
et al. 2010) performed on data from a multi-
center clinical study on implants placed
immediately after tooth extraction (Sanz
et al. 2010) revealed that the more buccally
an implant was installed, the less the
implant surface was covered by bone and soft
tissue after 4 months of healing.
Moreover, the importance of the position-
ing of implants into the extraction socket
was elaborated in experimental studies in
dogs (Caneva et al. 2010c, 2010d). In these
experiments, implants were placed in differ-
ent positions with respect to the buccal/lin-
gual alveolar bony walls (Caneva et al.
2010c), or implants had different sizes and
configurations (Caneva et al. 2010d). In both
studies, one implant was closer to the buccal
alveolar bony crest compared with that
placed in the contralateral side of the mandi-
ble. After 4 months of healing, the buccal

© 2011 John Wiley & Sons A/S 396

 Caneva et al
Peri-implant tissues and implant configuration

surface of the former implant was covered Table 1. Coronal diameter and depth of extraction sockets and width of the buccal and lingual
bone walls at 1 and 3 mm from the alveolar crest
less by bone compared with the latter
implant. This, in turn, means that the more Coronal diameter Depth Width at 1 mm Width at 3 mm
lingual the buccal surface of the implants m-d b-l b l b l b l
was placed, the less the surface was exposed.
Test 5 ± 0.7 5.2 ± 0.4 13.5 ± 1.5 14.5 ± 0.9 0.8 ± 0.3 1.4 ± 0.5 1.7 ± 0.8 2.4 ± 0.3
Unfortunately, none of the experimental Control 5.1 ± 0.5 5.1 ± 0.5 13.2 ± 0.9 14.3 ± 0.8 0.8 ± 0.2 1.6 ± 0.2 1.6 ± 0.3 2.6 ± 0.4
studies mentioned evaluated the adaptations
Mean values and standard deviations (SD) in millimeters. m-d, mesial-distal; b-l, buccal-lingual;
of the soft tissues encountered in relation to b, buccal; l, lingual.
the alveolar bone.
Hence, the aim of the present experiment
was to study the influence of implant instal-
(Table 1) using Iwanson calipers (KLS Martin The same surgical procedures and measure-
lation into sockets immediately after tooth
Group). A recipient site was prepared, and a ments were performed in the left side of the
extraction on the healing of soft and hard
titanium implant of 3.3 mm in diameter and mandible. However, the implant placed was
peri-implant tissues with implants of various
11.5 mm in length (Premium®, Sweden & conical, and filled almost the entire extrac-
sizes and configurations.
Martina) with a rough surface (DES; dual tion socket (Kohno® Straight DES 5 mm
engineered surface, Sweden & Martina) was wide, 11.5-mm long, Sweden & Martina)
installed. The implant was positioned in the (Fig. 1c). The rough margin of the implant
Material and methods
center of the alveolus (Fig. 1a), with the was placed flush with the buccal alveolar
margin of the rough surface placed flush to crest, as well as with the machined collar of
The research protocol was submitted to and
the alveolar buccal bony crest, so that the the implant (0.8 mm in height) exposed
approved by the local Ethical Committee for
machined collar of the implant (0.8 mm in above the bony crest (Fig. 1d). The flaps were
Animal Research (University of the State of
height) was exposed above the bony crest subsequently sutured to allow a non-sub-
São Paolo, Brazil).
(Fig. 1b). The following clinical landmarks merged healing. After the surgeries, the ani-
were identified: implant shoulder (IS), the mals were given a vitamin compound
Clinical procedures
Six Labrador dogs (each approximately 22 kg top of the bony crest (C), the base of the (Potenay®, Fort Dodge Animal Health, Camp-
and with a mean age of 2 years) were used. remaining defect (D), and the surface of the inas, Brazil), anti-inflammatory/analgesic
During surgical procedures, the animals implant (S). The following distances were drugs (Banamine®; Schering-Plough Animal
were pre-anesthetized with Acepran® measured using a UNC 15™ probe (Hu-Frie- Health, Campinas, Brazil) and antibiotics
(0.05 mg/kg; Univet-vetnil, São Paulo, Bra- dy): the horizontal distance between S and C (Pentabiotico®; Fort Dodge Animal Health).
zil), sedated with Zoletil® 10 mg/kg (Virbac, (S-C), and the vertical distance between IS The animals were kept in kennels and on
EUA) and Xilazina® (1 mg/kg; Cristália, São and D (IS-D), parallel to the long axis of the concrete runs at the university’s field labora-
Paulo, Brazil), and complemented with Keta- implant. tory with free access to water and feed of
mine®, (¼ of dose of 10 mg/kg; Cristália). A healing abutment was affixed to the moistened balanced dog’s chow.
During the entire surgery, the animals were implant, and the flaps were mobilized and A daily inspection of the wounds for clini-
kept with an intravenous infusion of sterile sutured to allow a non-submerged healing cal signs of complications, and healing abut-
saline. using interrupted Vicryl™ 4-0 sutures (John- ment cleaning was performed. The animals
As described previously (Caneva et al. son & Johnson, São José dos Campos, Brazil). were euthanized 4 months after surgery
2010d), the pulp tissue of the mesial roots of
4P4 was removed, and the root canals were
filled with gutta-percha and root canal
cement (Mtwo®, Endopocket®, Epfill®, Swe-
den & Martina, Due Carrare, Padova, Italy).
The crowns were subsequently restored with
composite (Adonis®, Sweden & Martina).
Full thickness flaps were elevated in the
right side of the mandible, and the buccal (a) (b)
and lingual alveolar bony plates were
exposed. The fourth premolar was hemi-sec-
tioned, and the distal root removed including
the corresponding portion of the crown. The
bucco-lingual and mesio-distal dimensions at
the coronal margin, as well as the depth of
the extraction socket were measured using
calipers (Castroviejo, KLS Martin Group, (c) (d)
Umkirch, Germany) and a UNC 15™ probe
(Hu-Friedy, Chigaco, IL, USA) respectively Fig. 1. Photographs illustrating the clinical aspect after the placement of the implants within the distal extraction
sockets of the mandibular premolars. (a) Occlusal view identifying the central positioning of the cylindrical implant.
(Table 1). The width of the buccal and
(b) Buccal view identifying the positioning of the rough/smooth surface limit of the cylindrical implant flush to the
lingual bony walls was measured at a 1 and alveolar crest. (c) Occlusal view identifying the positioning of the conical implant filling the entire alveolus. (d) Buccal
3 mm distance from the alveolar bony crest view identifying the positioning of the rough/smooth surface limit of the conical implant flush to the alveolar crest.

© 2011 John Wiley & Sons A/S 397 | Clin. Oral Impl. Res. 23, 2012 / 396–401
Caneva et al
Peri-implant tissues and implant configuration
applying overdoses of Thiopental® (Cristalia
Ltd, Campinas, Brazil).
Histologic preparation
Individual bone blocks containing the implant
and the surrounding soft and hard tissues were
fixed in 4% formaldehyde solution followed
by dehydration in a series of graded ethanol
solutions and finally embedded in resin (LR
White® hard grade; London Resin Company
Ltd, Berkshire, UK). The blocks were cut in a
bucco-lingual plane with a diamond band saw
fitted in a precision slicing machine (Exakt®;
Apparatebau, Norderstedt, Germany) and then
reduced to a thickness of approximately
50 lm using a cutting–grinding device
(Exakt®; Apparatebau).
The histologic slides were stained with
toluidine blue and examined under a standard
light microscope for histometric analysis.
Histologic evaluation
In a Nikon Eclipse 50i microscope (Nikon
Corporation, Tokio, Japan) at a magnification
of 9100, the following landmarks were iden-
tified (Fig. 2a–c): the shoulder of the implant
(IS), the most coronal bone-to-implant con-
tact (B), the top of the adjacent bony crest
(C), the implant surface at the buccal aspect
at the top of the threads (S), the outer con-
tour of the alveolar bony crest (OCbc), the
top of peri-implant mucosa (PM), the apical
termination of the barrier (junctional) epithe-
lium (aJE), and the outer contour of the alve-
olar crest, including soft tissue (OCst).
The following measurements were per-
formed (Fig. 2a–c): the vertical distance
between IS and C (IS-C) and IS and B (IS-B), the
amount of bone-to-implant contact (BIC%)
around the implant evaluated from B to the
apical termination of the implant, the vertical
distance between PM and B (PM-B) and aJE
and B (JE-B).
The distance between the coronal margin
of the rough surface (M) and B (M-B), and the
distance M-C were calculated by subtracting
0.8 mm of the machined implant collar from
the measurements IS-B and IS-C respectively.
The distance PM-aJE and PM-IS were also
calculated using the other parameters mea-
sured.
The width of the alveolar bony crest was
measured from S to OCbc at the IS level and
then, apically, at each subsequent millimeter,
up to 5 mm (S-OCbc0–5; Fig. 2b). The width
of the peri-implant mucosa was also mea-
sured from S to OCst at the IS level and then
coronally, up to 2 mm, and apically, up to
3 mm, at each subsequent mm (S-OCst 2to3;
Fig. 2c).
398 | Clin. Oral Impl. Res. 23, 2012 / 396–401
(a) (b) (c)
Fig. 2. Diagrams depicting the landmarks for the histologic evaluation. (a) PM: margin of the peri-implant mucosa;
IS: implant shoulder; M: coronal limit of rough/smooth implant surface, located 0.8 mm below IS; aJE: apical termi-
nation of the barrier (junctional) epithelium; B: most coronal bone-to-implant contact location; C: top of the alveo-
lar crest projected onto the implant surface. (b) Buccal width of the bony crest. S: the implant surface at the top of
the threads (yellow dotted line); OCbc: the outer contour of the alveolar bony crest (red dotted line). The width of
the alveolar bony crest was measured from S to OCbc at the IS level and then, apically to it, at each subsequent
mm, up to 5 mm (S-OCbc0–5). (c) Buccal width of the peri-implant mucosa. S: the implant surface at the top of the
threads (yellow dotted line); OCst: the outer contour of the soft tissue (red dotted line). The width of the peri-
implant mucosa was also measured from S to OCst at the IS level and then coronally, up to 2 mm, and apically, up
to 3 mm, at each subsequent mm (S-OCst 2to3).
Table 2. Clinical measurements of residual defects at test and control sites at implants installation
S-C IS-D
b l b l
Test 0.1 ± 0.2 0.1 ± 0.2 0.4 ± 0.9 0.6 ± 1.3
Control 0.9 ± 0,3 0.9 ± 0.3 4.2 ± 1.6 4 ± 1.5
Mean values and standard deviations (SD) in millimeters. IS-C, distance between IS (implant shoulder)
and C (top of alveolar bony crest; IS-D, distance between IS and D (base of the remaining defect); b,
buccal; l, lingual.
The percentage of mineralized bone deter- the buccal and lingual bony walls at 1 and
mined in an area from the implant surface to 3 mm from the top of the alveolar crest
a parallel line at a distance of approximately before implant installation are reported in
1 mm from S was also assessed between B Table 1.
and the apical termination of the implant. The distances S-C and IS-D measured clini-
Thus, a lattice (density 50 lm) was superim- cally after implant installation are reported
posed over this tissue area (magnification in Table 2. At the control site, S-C was
9200). 0.9 ± 0.3 mm whereas, at the test site, it was
only 0.1 ± 0.2 mm. In fact, the buccal-lingual
Data analysis
Mean values and standard deviations, as well
as 25th, 50th (median), and 75th percentiles (a) (b)
were calculated for each outcome variable.
The primary variables for the hard tissue
were M-C and M-B, whereas for the soft tis-
sue, these were PM-B and PM-IS. Differences
between test and control sites were analyzed
using Wilcoxon signed ranks test, using
PASW Statistics 18 (SPSS Inc. Chicago IL,
USA). The level of significance was set at
a = 0.05.
Results Fig. 3. Ground sections illustrating the healing after
4 months at the test (a) and control (b) sites. Toluidine
blue; original magnification 916. All implants were inte-
Clinical measurements grated in mature mineralized bone. The buccal bony
The coronal diameter and depth of the wall, as well as the peri-implant mucosa were located
extraction sockets, as well as the width of more apically at the test compared with the control sites.
© 2011 John Wiley & Sons A/S
 Caneva et al
Peri-implant tissues and implant configuration

Table 3. Histologic measurements at the peri-implant hard tissue after 4 months of healing
M-C mm M-B mm
BIC% Mineralization%
b* l b *
l Total Total*
Test Mean and SD 3.8 (1.6) 1.1 (1) 3.8 (1.6) 1.9 (2.2) 67.2 (4.2) 64.7 (3.8)
Percentiles 25th, 50th, 75th 2.7, 3.7, 5 0.3, 0.8, 1.3 2.7, 3.7, 5 0.3, 0.8, 3.7 66, 67.5, 70.5 62, 64.5, 67.8
Control Mean and SD 1.6 (0.8) 0.2 (0.6) 2.2 (0.3) 1.3 (0.7) 72.5 (13.6) 55.7 (3.5)
Percentiles 25th, 50th, 75th 1.3, 1.9, 2.2 0.1, 0.2, 0.6 2, 2.3, 2.4 1, 1.2, 1.4 60.8, 78.5, 82 54, 54.5, 56.5
P-value 0.027 0.173 0.027 0.917 0.293 0.042

Mean values, standard deviations (SD) and 25th, 50th (median) and 75th percentiles. M, rough–smooth implant limit; C, top of alveolar bony crest; B, most
coronal bone-to-implant contact; BIC, bone-to-implant contact; b, buccal; l, lingual.
*
P < 0.05 between test and control.

coronal dimension of the alveolus at the test
sites (conical implant) was consistently
slightly wider than the diameter of the
implant.
The width of the buccal bony crest was
similar at the test and control sites.
After 4 months of healing, all implants
were clinically stable without signs of com-
plications. During histologic processing, nei-
ther did artifacts occur, nor were there any
tissue blocks destroyed. Hence, test and con-
trol sites yielded n = 6.
The overall percentage of bone-to-implant
contact was slightly higher at the control
compared with the test sites. The difference
was, however, not statistically significant.
The overall percentages of mineralized bone
adjacent to test and control implants were
statistically greater at the test sites.
The mean values of S-OCbc0–5 both at the
test and control sites after 4 months of heal-
ing are reported in Fig. 5. A more apical posi-
tioning of the bony crest was observed at the
test compared with the control sites.
implants were compared as well. A more api-
cal repositioning of the buccal bony crest was
observed at the larger diameter implant sites
compared with the smaller diameter implant
sites. The results of the present study, how-
ever, are seemingly in disagreement with
those obtained in a clinical study (Sanz et al.
2010) in which two groups of implants with
different configurations, cylindrical and coni-
cal, were installed. After 4 months of

Histologic evaluation of the hard tissue
The implants at the histologic examination
appeared to be well integrated into mature
mineralized bone (Fig. 3a and b). Measure-
ments are reported in Table 3 and illustrated
in Fig. 4. The buccal bony wall at the test
sites was more apically positioned after heal-
ing (3.8 ± 1.6 mm) compared with the control
sites (1.6 ± 0.8 mm). The difference was sta-
tistically significant. The M-B at the test
sites (3.8 ± 1.6 mm) was also longer than at
the control sites (2.2 ± 0.3 mm), the differ-
ence being statistically significant as well.
Histologic evaluation of the soft tissue
Measurements are reported in Table 4 and
illustrated in Fig. 4. The soft tissue dimen-
sions were similar at the test and control
sites. The position of the peri-implant
mucosa was, however, more apically located
at the test compared with the control sites,
yielding a statistically significant difference.
This is graphically illustrated in the Fig. 6,
reporting the mean values of S-OCst 2to3
Fig. 5. Graphic representing the mean values of the
both at the test and control sites after
width of the alveolar bony crest measured from S to
4 months of healing. OCbc at the IS level (level 0) and then, apically to it, at
each subsequent mm, up to 5 mm. The test sites
showed slightly higher values at all levels evaluated
Discussion compared with the control sites.

This study has confirmed that implants

Fig. 4. Histogram illustrating the location of the hard
tissue in relation to the rough–smooth implant limit
(M) and of the dimensions of the soft peri-implant tis-
sues at the test and control sites. References are
reported within the text. Differences statistically signif-
icant are indicated with *.
placed into the sockets immediately after
tooth extraction did not prevent buccal bone
resorption. This finding is in agreement with
a series of clinical (e.g. Botticelli et al. 2004;
Covani et al. 2004; Sanz et al. 2010) and
experimental studies (e.g. Araújo et al. 2005;
Botticelli et al. 2006; de Sanctis et al. 2009;
Vignoletti et al. 2009; Caneva et al. 2010a,
2010b, 2010c, 2010d, 2011a, 2011b; Covani
et al. 2010; Barone et al. 2011). After
4 months of healing, the alveolar buccal bony
crest at the sites of the conical implants (test)
was more apically located compared with the Fig. 6. Graphic representing the mean values of the
width of the peri-implant mucosa measured from S to
control sites of the cylindrical implants (con-
OCst at the IS level and then coronally, up to 2 mm,
trol). This is in agreement with a previous and apically, up to 3 mm, at each subsequent mm. The
experimental study (Caneva et al. 2010d) in test sites showed slightly higher values at all levels
which smaller cylindrical and larger conical evaluated compared with the control sites.

© 2011 John Wiley & Sons A/S 399 | Clin. Oral Impl. Res. 23, 2012 / 396–401
Caneva et al
Peri-implant tissues and implant configuration
Table 4. Histologic measurements of soft tissue dimensions and location in relation to the implant shoulder (IS) after 4 months of healing
PM-B
b l
Test Mean and SD 4.4 (1.5)
3.4, 3.8, 5.5
Percentiles 25th, 50th,
75th
Control Mean and SD 4.1 (0.7)
3.6, 3.9, 4.3
Percentiles 25th, 50th,
75th
P-value 0.600
Mean values, standard deviations (SD) and 25th, 50th (median), and 75th percentiles. PM, peri-implant mucosa; B, most coronal bone-to-implant contact;
aJE, apical termination of the barrier (junctional) epithelium; IS, implant shoulder; b, buccal; l, lingual.
*
P < 0.05 between test and control.
healing, the buccal alveolar bony crest was
located at a similar vertical level, both at the
cylindrical and at the conical implant sites.
It has to be realized, however, that the
dimensions of the remaining gap between the
implant surface and the socket wall as well
as the width of the bony crest at the time of
implant installation were quite similar
between the two groups of implants. This, in
turn, means that the outer contour of the
buccal alveolar bony crest was also located at
a similar distance from the surface of the
implant. As opposed to that study, the outer
contour of the buccal alveolar bony crest was
located at a larger distance from the implant
surface at the control compared with the test
sites in the present study. In fact, while the
width of the buccal bony plate was similar
between the two implant sites, a virtually
absent buccal gap could be observed at the
test sites although, at the control sites, a gap
of 0.9 mm existed. This relationship between
the implant position within the socket and
buccal resorption was presented in clinical
(Ferrus et al. 2010; Sanz et al. 2010), as well
as in a few experimental studies (Araújo
et al. 2006; Caneva et al. 2010c, 2010d) on
implants installed into the sockets immedi-
ately after tooth extraction. A multilevel
multivariate analysis (Tomasi et al. 2010) on
data of the multicenter study mentioned
above (Sanz et al. 2010) demonstrated that
the closer the implant was to the buccal
bony wall, the more the buccal bone was re-
sorbed after 4 months of healing.
Despite the presence of a gap at the cylin-
drical implant (control) sites in the present
study, the buccal bony level of the crest was
more coronal compared with the test sites,
where a gap was virtually absent at the time
of implant installation.
The exposure of the implant surface at
the test sites in the present experiment
400 | Clin. Oral Impl. Res. 23, 2012 / 396–401
PM-aJE
b l
3.1 (1.4) 2.7 (1.2) 2.1 (1)
2.1, 2.6, 3.7 1.9, 2.2, 3.2 1.4, 1.7, 2.9
3.7 (1) 2.5 (0.5) 2.6 (0.8)
3, 4.1, 4.2 2.3, 2.5, 2.6 2, 2.9, 3.2
0.173 0.753 0.116
(3.8 mm) was higher compared with the
results reported in a previous similar experi-
ment in dogs (2.7 mm; Caneva et al. 2010d).
This may be explained by the larger dis-
tance of the outer contour of the buccal
alveolar bony crest to the implant surface
in the previous study compared with that of
the present study. The clinical study on
implants installed into sockets immediately
after extraction (Ferrus et al. 2010) men-
tioned before, has shown that at sites with
a width of the buccal bony crest  1 mm,
bone resorption was less compared with
sites with a corresponding width <1 mm. In
the present study, a very similar observation
was made.
The distance between the coronal margin
of the rough surface (M) and the most coronal
bone-to-implant contact (B) was higher at the
test compared with the control sites, yielding
statistical significance only at the buccal site.
This is in agreement with other experiments
in dogs (Araújo et al. 2006; Caneva et al.
2010c, 2010d), where higher M-B values were
reported at sites where the implant surface
was close to the buccal bony wall.
While the difference between test and con-
trol sites with regard to bone-to-implant con-
tact percentages (BIC%) was not statistically
significant, the difference in mineralization
of the surrounding bone reached statistical
significance. The higher degree of mineraliza-
tion at the test compared with the control
sites may be explained by the larger diameter
of the conical (test) implants, rendering the
surface to be closer to the compact cortical
bone of the mandible compared with the
smaller cylindrical (control) sites.
In the present experiment, soft tissue
dimensions were similar at both test and
control sites. However, the peri-implant
mucosa (PM) was located at different levels
at the test and control sites, both buccally
aJE-B PM-IS
b l b* l*
1.8 (0.5) 1 (0.6) 0.2 (0.5) 0.3 (1)
1.5, 1.7, 2 0.7, 0.8, 1 0.5, 0.3, 0.1 0.2, 0.4, 1.2
1.5 (0.4) 1.1 (0.3) 1.1 (0.8) 1.6 (0.9)
1.3, 1.5, 1.8 0.9, 1.1, 1.2 0.5, 1.1, 1.6 0.8, 1.7, 2.1
0.116 0.344 0.043 0.046
and lingually. In fact, at the test sites, PM
was located apically to the implant shoulder
(IS) whereas, at the control sites, PM was
located coronally to IS. The difference in
location was statistically significant. This is
explained by the fact that the most coronal
aspect of the bony crest was located more
apically at the test sites, so that the soft tis-
sue unit had shifted coronally as well. This
is in agreement with another experimental
study in dogs (Araújo et al. 2011) in which
the location of the buccal peri-implant
mucosa was positioned more apically in rela-
tion to the implant shoulder at the site
where more buccal bone resorption had
occurred.
In conclusion, the present study has con-
firmed that the distance between the implant
surface and the outer contour of the buccal
alveolar bony crest influenced the resorption
of the buccal bony plate. If the implant sur-
face was closer to the bony crest, a higher
exposure of the implant surface has to be
expected. Consequently, the peri-implant
mucosal unit will be established at a more
apical level at the test (larger conical
implant) when compared with the control
(smaller cylindrical implant) sites.
Acknowledgements: This study has
been supported by a grant from Sweden &
Martina SRL, Due Carrare, Padova, Italy and
by ARDEC, Ariminum Odontologica SRL,
Rimini, Italy. The competent contributions
of Professor Luiz Antonio Salata and Mr.
Sebastião Bianco (USP – Faculty of Dentistry
of Ribeirão Preto – University of São Paulo,
São Paulo, Brazil) in the histologic processing
are highly appreciated. Conflict of interest:
All the authors declare to have no conflict of
interest with the materials used in the
present study.
© 2011 John Wiley & Sons A/S

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