Literature Update 2017.4, July-August

ITI Literature Update
July - August 2017
ITI International Team for

Implantology
ITI Headquarters
Peter Merian-Strasse 88
CH-4052 Basel
Compiled by: Dr. Kati Benthaus Tel. +41 (0)61 270 83 83

Fax +41 (0)61 270 83 84
e-mail: headquarters@iti.org headquarters@iti.org
ITI International Team for
www.iti.org
Implantology
ITI Center
Peter Merian-Weg 10
CH-4052 Basel
Tel. +41 (0)61 270 83 83

Table of Contents
Journal of Dental Research ............................................................................................................................. 3

Clinical Oral Implants Research ...................................................................................................................... 4
Journal of Clinical Periodontology ............................................................................................................... 17
Journal of Dentistry ........................................................................................................................................ 20
Journal of Periodontology ............................................................................................................................. 21
Clinical Implant Dentistry and Related Research ........................................................................................ 22
The International Journal of Oral and Maxillofacial Implants .................................................................... 24
The Journal of Prosthetic Dentistry.............................................................................................................. 28
Journal of Oral and Maxillofacial Surgery.................................................................................................... 31
The International Journal of Prosthodontics............................................................................................... 32
The International Journal of Periodontics & Restorative Dentistry .......................................................... 35
Compendium of Continuing Education in Dentistry ................................................................................... 36
2
Journal of Dental Research
J Dent Res. 2017 Jul;96(7):822-831. doi: 10.1177/0022034517700131. Epub 2017 Mar 22.
Relationships among Bone Quality, Implant Osseointegration, and Wnt Signaling.

Li J, Yin X, Huang L, Mouraret S, Brunski JB, Cordova L, Salmon B, Helms JA.
Keywords: alveolar ridge; bone density; bone mineralization; dental implants; osteotomy; stem cell
Abstract: A variety of clinical classification schemes have been proposed as a means to identify sites in the
oral cavity where implant osseointegration is likely to be successful. Most schemes are based on structural
characteristics of the bone, for example, the relative proportion of densely compact, homogenous (type I)
bone versus more trabeculated, cancellous (type III) bone. None of these schemes, however, consider
potential biological characteristics of the bone. Here, we employed multiscale analyses to identify and
characterize type I and type III bones in murine jaws. We then combined these analytical tools with in vivo
models of osteotomy healing and implant osseointegration to determine if one type of bone healed faster and
supported osseointegration better than another. Collectively, these studies revealed a strong positive
correlation between bone remodeling rates, mitotic activity, and osteotomy site healing in type III bone and
high endogenous Wnt signaling. This positive correlation was strengthened by observations showing that the
osteoid matrix that is responsible for implant osseointegration originates from Wnt-responsive cells and their
progeny. The potential application of this knowledge to clinical practice is discussed, along with a theory
unifying the role that biology and mechanics play in implant osseointegration.
See abstract on PubMed Central
J Dent Res. 2017 Jul;96(8):909-916. doi: 10.1177/0022034517707513. Epub 2017 May 8.
Contribution of the PDL to Osteotomy Repair and Implant Osseointegration.

Pei X, Wang L, Chen C, Yuan X, Wan Q, Helms JA.
Keywords: bone; extraction socket; histology; immediate implant; periostin; regeneration
Abstract: Our objective was to clarify the fate of the periodontal ligament (PDL) retained in the socket after
tooth extraction, then determine if this tissue contributed to the osseointegration of "immediate" implants
placed in these fresh extraction sockets. Mice underwent maxillary first molar extraction, the residual PDL
was removed by an osteotomy, and titanium implants were placed. The osteotomy was created in such a
way that the palatal surface was devoid of PDL remnants while the buccal, mesial, and distal surfaces
retained PDL fibers. At multiple time points after surgery, tissues were analyzed using a battery of molecular,
cellular, and histomorphometrical assays. We found that PDL remnants mineralized and directly contributed
to new bone formation in the extraction site. Compared with regions of an extraction site where the PDL was
removed by osteotomy, regions that retained PDL fibers had produced significantly more new bone. Around
immediate implants, the retained PDL remnants directly contributed to new bone formation and
osseointegration. Thus, we conclude that PDL remnants are inherently osteogenic, and if the tissue is
healthy, it is reasonable to conclude that curetting out an extraction socket prior to immediate implant
placement should be avoided. This recommendation aligns with contemporary trends toward minimally
invasive surgical manipulations of the extraction socket prior to immediate implant placement.
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Clinical Oral Implants Research
Clin Oral Implants Res. 2017 Jul;28(7):765-773. doi: 10.1111/clr.12874. Epub 2016 Jun 14.
EMG correlations of edentulous patients with implant overdentures and fixed dental
prostheses compared to conventional complete dentures and dentates: a
systematic review and meta-analysis.
von der Gracht I, Derks A, Haselhuhn K, Wolfart S.
Keywords: electromyography; implant prosthesis; meta-analysis; systematic review

OBJECTIVES: The goal of this meta-analysis was to evaluate how muscular activity, measured by
electromyography (EMG), differs among edentulous patients treated with a complete denture (CD),
removable implant overdentures (IO), implant-retained fixed dental prostheses (IFDP), and dentates. The
differences during clenching and chewing were of particular interest.
MATERIALS AND METHODS: An electronic literature review was carried out on MEDLINE (Pubmed) and
the Cochrane Library covering the period January 1980 through September 2013. This was accomplished
independently by three different reviewers and supplemented by a manual search. The review included
randomized controlled trials, controlled clinical trials, and clinical trials which evaluated surface
electromyography, bite force, chewing, and implants or complete dentures. In addition, the research was
adjusted using MeSH terms.
RESULTS: The search garnered 646 titles and abstracts. Sixteen articles which met the inclusion criteria
were analyzed. The effect size for muscular activity after implant support increased after therapy during
clenching 2.18 (95% CI: 1.14, 3.23) and during chewing 1.45 (95%CI: 1.21, 1.69). Moreover, the EMG data
of IO and IFDP groups (pooled) were lower than that of dentate control subjects during clenching (effect size:
-1.01 [95%CI: -1.37, -0.65]). In contrast, the IFDP-wearers showed higher values than dentates during
chewing. Among the edentulous control patients, the IO and IFDP groups (pooled) displayed higher values
during clenching (effect size: 1.12 [95%CI: 0.7, 1.55]) and chewing (effect size: 1.33 [95%CI: -0.57, 2.10]).
Furthermore, the muscular activity during chewing correlated with the hardness of the food.
CONCLUSIONS: In general, edentulous patients with CDs can achieve a greater degree of muscular activity
after rehabilitation with IOs during clenching and chewing. During clenching, patients with IFDPs achieved
higher values than those with dentates. The muscular activity increases with the hardness of the food.
Clin Oral Implants Res. 2017 Jul;28(7):779-784. doi: 10.1111/clr.12881. Epub 2016 May 19.
Long-term outcomes of simultaneous guided bone regeneration using native and

cross-linked collagen membranes after 8 years.
Schwarz F, Schmucker A, Becker J.
Keywords: Bone regeneration; Bone substitutes; Clinical assessment; Clinical research; Clinical trials;
Diagnosis; Guided tissue regeneration
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OBJECTIVES: To assess the clinical outcomes of simultaneous guided bone regeneration using native
(CM) and cross-linked (VN) collagen membranes at 8 years.
MATERIALS AND METHODS: A total of n = 19 patients (19 implants) were available for the analysis. Each
subject had received a simultaneous grafting of dehiscence-type defects using a natural bone mineral (NBM)
and a random allocation to either CM and VN membranes (submerged healing of 4 months). Clinical
parameters (e.g., bleeding on probing - BOP, probing pocket depth - PD, mucosal recession - MR, clinical
attachment level - CAL) were recorded at 8 years after prosthesis installation.
RESULTS: At 8 years, CM and VN groups revealed comparable median BOP, PD, MR and CAL values at
both vestibular and oral aspects. From 4 to 8 years (n = 14 patients), median CAL at the vestibular aspect
improved in both groups; however, these changes were significantly higher at CM-treated sites (CM: 0.7 mm
vs. VN: 0.5 mm).
CONCLUSIONS: The clinical long-term outcomes at 8 years were comparable in both VN and CM groups.
Social media patient testimonials in implant dentistry: information or

misinformation?
Ho A, McGrath C, Mattheos N.
Keywords: YouTube; implant dentistry; patient education; patient testimonials; social media
OBJECTIVES: This study aims to assess the educational value of YouTube patient testimonial videos in
implant dentistry and qualitatively analyse the themes mentioned.
METHODS: Videos were sampled consecutively on YouTube, using the keywords "dental implant patients'
testimonials experience," sorted "by relevance." Patient testimonials on dental implant treatment were
examined. Inaudible or non-English videos were excluded. Four calibrated investigators scored the videos
for educational content, using a matrix derived from the European Association for Osseointegration
information booklet, and demographic details were recorded. Data were analysed qualitatively through
inductive thematic analysis.
RESULTS: A total of 202 videos were analysed (48 exclusions). Inter-examiner reliability was fair to
moderate for informative statements and poor to substantial for misleading statements. A mean of 1.8
informative statements were made per video, compared with misleading, 0.5. Many topics were rarely
mentioned, with 19/30 themes appearing fewer than 5% of videos. Patients often informed that implants
could improve aesthetics and function, but were misleading on aspects of pain control. Some statements
may heighten expectations or imply permanency of treatment.
CONCLUSIONS: Balanced presentation in YouTube testimonials may be limited by bias of clinician-

uploaded content. Greater magnitude and breadth of information would improve educational value. Many
important parameters of implant therapy were overlooked, whilst information was often potentially
misleading.
5
The effect of rigid and non-rigid connections between implants and teeth on
biological and technical complications: a systematic review and a meta-analysis.
Tsaousoglou P, Michalakis K, Kang K, Weber HP, Sculean A.
Keywords: attachment; biological complication; dental implant; non-rigid connection; partial FDP; rigid
connection; survival; technical complication; tooth-implant connection
OBJECTIVE: To assess survival, as well as technical and biological complication rates of partial fixed dental
prostheses (FDPs) supported by implants and teeth.
METHOD: An electronic Medline search was conducted to identify articles, published in dental journals from
January 1980 to August 2015, reporting on partial FDPs supported by implants and teeth. The search terms
were categorized into four groups comprising the PICO question. Manual searches of published full-text
articles and related reviews were also performed.
RESULTS: The initial database search produced 3587 relevant titles. Three hundred and eighty-six articles
were retrieved for abstract review, while 39 articles were selected for full-text review. A total of 10 studies
were selected for inclusion. Overall survival rate for implants ranged between 90% and 100%, after follow-up
periods with a mean range of 18-120 months. The survival of the abutment teeth was 94.1-100%, while the
prostheses survival was 85-100% for the same time period. The most frequent complications were
"periapical lesions" (11.53%). The most frequent technical complication was "porcelain occlusal fracture"
(16.6%), followed by "screw loosening" (15%). According to the meta-analysis, no intrusion was noted on the
rigid connection group, while five teeth (8.19%) were intruded in the non-rigid connection group [95% CI
(0.013-0.151)].
CONCLUSIONS: The tooth-implant FDP seems to be a possible alternative to an implant-supported FDP.

There is limited evidence that rigid connection between teeth and implants presents better results when
compared with the non-rigid one. The major drawback of non-rigidly connected FDPs is tooth intrusion.
Short implants placed with or without grafting into atrophic sinuses: the 5-year
results of a prospective randomized controlled study.
Nedir R, Nurdin N, Abi Najm S, El Hage M, Bischof M.
Keywords: atrophic maxilla; bone gain; bone graft; bone regeneration; crestal bone loss; dental implants;
internal sinus lift; no grafting; osteotome sinus floor elevation; posterior maxilla; prospective randomized
clinical trial; sinus lift
OBJECTIVES: Over 5 years, (i) to evaluate the clinical efficiency of 8-mm implants placed with osteotome
sinus floor elevation (OSFE) in extremely atrophic maxillae and (ii) to compare bone levels around implants
placed with and without grafting.
MATERIAL AND METHODS: TE® SLActive® implants (Institut Straumann AG, Basel, Switzerland) were
placed in sites with a residual bone height (RBH) of ≤4 mm. Before surgery, sinuses were randomized to
receive anorganic bovine bone (control) or no graft (test). After 10 weeks of healing, implants were
functionally loaded with single crowns. Bone levels were measured from standardized peri-apical
radiographs.
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RESULTS: Thirty-seven (17 test, 20 control) implants were placed in 12 patients (RBH: 2.4 ± 0.9 mm). Two
early and one late failures occurred. The success rate was 91.9% (94.1% test, 90.0% control). All implants
gained endo-sinus bone (3.8 ± 1.0 mm test, 4.8 ± 1.2 mm control; P = 0.004). Mean crestal bone loss (CBL)
was 0.6 ± 1.1 mm, without a significant difference between the groups (P = 0.527). Mean bone gain and CBL
did not change significantly between 1 and 5 years (P = 0.249 and P = 0.293, respectively).
CONCLUSIONS: Atrophic posterior maxillae can be predictably rehabilitated using OSFE with a
simultaneous implant placement. The new bone formed around implants after 1 year was stable after 5
years, irrespective of the presence or the absence of graft. Grafting was unnecessary to achieve an average
bone augmentation of 3.8 mm, but more bone was gained with grafting.
Four-unit fixed dental prostheses replacing the maxillary incisors supported by two
narrow-diameter implants - a five-year case series.
Moráguez O, Vailati F, Grütter L, Sailer I, Belser UC.
Keywords: case series; clinical study; esthetics; implant-supported fixed dental prostheses; maxillary
incisors; narrow-diameter implants
OBJECTIVES: (1) To determine the survival rate of 10 four-unit fixed dental prostheses (FDPs) replacing
the four maxillary incisors, supported by 20 narrow-diameter implants (NDIs), (2) to assess the incidence of
mechanical and biological complications, and (3) to evaluate bone level changes longitudinally after final
FDP insertion.
MATERIALS AND METHODS: Ten patients (six women, four men), mean age 49.4 ± 12.6 years, were
treated with a four-unit anterior maxillary FDP (six screw-retained; four cemented). Biological parameters,
eventual technical complications, radiographic measurements, and study casts were assessed at 1
(baseline), 3, and 5 years after implant placement. A multilevel logistic regression test was performed on
clinical parameters and bone level changes (significance level P < 0.05).
RESULTS: The 5-year implant and FDP survival rate was 100%. Mean modified plaque index (mPI) values
were 0.03 and 0.02 at 3 and 5 years, significantly lower when compared to mPI (0.11 ± 0.31) at 1 year. Mean
modified sulcus bleeding index (mSBI) was 0.08, 0.08, and 0.15 over time. Probing depth (PD) values were
1.57, 1.64, and 2.03 mm. Statistically significant differences were found between 1 vs. 5 year (P = 0.0003)
and 3 vs. 5 year (P = 0.001). Keratinized mucosa (3.65 mm) remained stable during observation period. DIB
mean values were 2.01 ± 0.34, 2.13 ± 0.13, and 2.17 ± 0.38 mm. Patient satisfaction based on visual analog
scale revealed favorable fulfillment of overall treatment and esthetic expectations.
CONCLUSIONS: Two NDIs supporting a four-unit FDP to replace the four missing maxillary incisors may be
considered a predictable treatment modality.
Clin Oral Implants Res. 2017 Jul;28(7):e1-e9. doi: 10.1111/clr.12844. Epub 2016 Mar 23.
Bruxism and dental implant treatment complications: a retrospective comparative

study of 98 bruxer patients and a matched group.
Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A.
7
Keywords: bruxism; dental implant; implant failure; mechanical complications; risk factor
OBJECTIVES: To analyze the complications of dental implant treatment in a group of patients with bruxism
in comparison with a matched group of non-bruxers.
MATERIAL AND METHODS: Patients being diagnosed as bruxers were identified within a group of patients
consecutively treated with implant-supported prostheses at one specialist clinic, based on the most recent
listed sign and symptoms of bruxism according to the International Classification of Sleep Disorders. A
diagnostic grading system of "possible," "probable," and "definite" sleep or awake bruxism was used,
according to a recent published international consensus. A case-control matching model was used to match
the bruxers with a group of non-bruxers, based on five variables. Implant-, prosthetic-, and patient-related
data were collected, as well as 14 mechanical complications, and compared between groups.
RESULTS: Ninety-eight of 2670 patients were identified as bruxers. The odds ratio of implant failure in
bruxers in relation to non-bruxers was 2.71 (95% CI 1.25, 5.88). Considering the same number of patients
with the same total number of implants equally distributed between groups, the bruxers group had a higher
prevalence of mechanical complications in comparison with the non-bruxers group.
CONCLUSIONS: This study suggests that bruxism may significantly increase both the implant failure rate
and the rate of mechanical and technical complications of implant-supported restorations. Other risk factors
may also have influenced the results.
Clin Oral Implants Res. 2017 Jul;28(7):e16-e20. doi: 10.1111/clr.12849. Epub 2016 Jun 9.
Implant surface roughness alterations induced by different prophylactic

procedures: an in vitro study.
Cafiero C, Aglietta M, Iorio-Siciliano V, Salvi GE, Blasi A, Matarasso S.
Keywords: bacterial biofilm; dental implants; peri-implant diseases; prophylaxis; titanium

AIM: To evaluate surface roughness alterations at the smooth neck of dental implants after the use of eight
different prophylactic procedures.
MATERIALS AND METHODS: 50 tissue level implants (Institut Straumann AG, Basel, Switzerland) were
used for the present investigation. The smooth collar of each implant was divided into two segments, each
treated with one of eight cleaning procedures: use of a rubber cup (RCZ) or a brush (BZ) combined with an
abrasive paste containing zirconium or a paste derived from perlite (RCP, BP); use of 2 composite resin burs
reinforced by zirconium glass fibers (F1, F2); and use of an air-polishing system with glycine powder and two
power settings (AP1, AP2). The qualitative alterations were recorded by means of a laser profilometer and
the mean roughness (Ra ) and mean roughness profile depth (Rz ) were reported. Twenty untreated
surfaces were used as controls.
RESULTS: The implant collars treated with RCZ (Ra = 0.33 μm, Rz = 2.43 μm) or BZ (Ra = 0.30 μm, Rz
= 3.70 μm) yielded the highest roughness values, followed by the surfaces treated with RCP (Ra = 0.28 μm,
Rz = 2.02 μm), with BP (Ra = 0.25 μm, Rz = 2.16 μm) and by the use of F1 (Ra = 0.27 μm, Rz = 2.22 μm)
and F2 (Ra = 0.27 μm, Rz = 2.04 μm). The lowest roughness values were observed in the AP1 (Ra = 0.23
μm, Rz = 1.60 μm) and AP2 (Ra = 0.16 μm, Rz = 1.06 μm) group, respectively. Implant collars treated with
AP2 yielded statistically significantly lower (P = 0.01) Rz values compared with untreated surfaces.
CONCLUSIONS: All tested procedures did not increase implant surface roughness significantly. Treatment
with an air-powder abrasive system at high-pressure setting resulted in a smoothening of the implant collar
surface.
8
Clin Oral Implants Res. 2017 Jul;28(7):e21-e30. doi: 10.1111/clr.12850. Epub 2016 Apr 15.
Sinus mucosa elevation using Bio-Oss® or Gingistat® collagen sponge: an

experimental study in rabbits.
Caneva M, Lang NP, Garcia Rangel IJ, Ferreira S, Caneva M, De Santis E, Botticelli D.
Keywords: animal study; collagen; deproteinized bovine bone mineral; sinus elevation
OBJECTIVE: To describe the sequential healing in augmented sinus cavities with deproteinized bovine bone
mineral (DBBM) granules or collagen sponges.
MATERIAL AND METHODS: Twenty albino New Zealand rabbits were included in the study. An incision
was performed along the midline of the nasal dorsum, and the nasal bone was exposed. Circular bony
windows with a diameter of 5 mm were prepared bilaterally. After elevation of the mucosa, the two sites were
randomly filled with either DBBM or a collagen sponge. Five animals each were randomly sacrificed after 7,
14, 21 and 40 days, respectively.
RESULTS: At both sides, new bone was found forming from the resident pristine bone. During the first stage
of healing, DBBM granules were surrounded by a denser connective tissue that was attached to the
biomaterial surface and that was progressively mineralized. At the collagen sponge side, the biomaterial was
almost completely resorbed and the space was reduced by to two-thirds already after 21 days. At both sides,
after 40 days, mineralized bone and marrow spaces were occupying large areas of the elevated space.
CONCLUSIONS: New bone was found forming from the pristine bony walls of the sinus and extending
toward the most peripheral regions in both sites. While DBBM particles yielded osteoconductivity and were
able to preserve over time the space within the elevated mucosa, the collagen sponge failed the goal of
maintaining the space.
Clin Oral Implants Res. 2017 Jul;28(7):e31-e38. doi: 10.1111/clr.12851. Epub 2016 Apr 19.
Single-staged vs. two-staged implant placement in vertically deficient alveolar

ridges using bone ring technique - Part 2: implant osseointegration.
Nakahara K, Haga-Tsujimura M, Sawada K, Kobayashi E, Schaller B, Saulacic N.
Keywords: animal experiments; bone implant interactions; bone regeneration; guided tissue; morphometric
analysis; regeneration; surgical; techniques
OBJECTIVES: The aim of this study was to evaluate the osseointegration of implants placed in a single-
staged compared to two-staged procedure using bone ring technique.
MATERIAL AND METHODS: In this study were used standardized, vertical alveolar bone defects in dogs. In
the test group, dental implants (Straumann BL®, Basel, Switzerland) were inserted simultaneously with bone
ring technique. As control group served implants inserted 6 months following grafting. Implants of both
groups were left for an osseointegration period of 3 and 6 months. The peri-implant bone loss and bone-to-
implant contact within the bone ring and native bone were analyzed morphometrically. An explorative
statistical analysis was performed.
9
RESULTS: The peri-implant bone level remained relatively stable within groups and between groups per
given time period. Most of bone apposite on the implant surface in two groups was composed of newly
formed bone. A nonparametric analysis of variance (ANOVA) revealed no significant advantage for two-
staged implant placement for new and total bone, except for residual bone (P = .0084). Furthermore, two
groups of implants performed similarly in bone ring and in native bone throughout the observation period.
CONCLUSIONS: In terms of osseointegration, both techniques are likely equally efficient in the present
defect model. The single-staged implant placement with cortical bone grafts warrants further documentation
in clinical studies.
This study was supported by a research grant from the ITI Foundation, Switzerland.
Clin Oral Implants Res. 2017 Jul;28(7):e51-e59. doi: 10.1111/clr.12855. Epub 2016 Jun 6.
Comparable responses of osteoblast lineage cells to microstructured hydrophilic

titanium-zirconium and microstructured hydrophilic titanium.
Lotz EM, Olivares-Navarrete R, Hyzy SL, Berner S, Schwartz Z, Boyan BD.
Keywords: hydrophilic surfaces; mesenchymal stem cells; nanostructures; osteoblast; titanium; zirconium
OBJECTIVES: Although titanium (Ti) is commonly used for dental implants, Ti alloy materials are being
developed to improve their physical material properties. Studies indicate that osteoblast differentiation and
maturation of human mesenchymal stem cells (MSCs) and normal human osteoblasts (NHOsts) respond to
microstructured Ti and titanium-aluminum-vanadium (Ti6Al4V) surfaces in a similar manner. The goal of this
study was to determine whether this is the case for osteoblast lineage cells grown on microstructured TiZr
surfaces and whether their response is affected by surface nanotexture and hydrophilicity.
MATERIALS AND METHODS: Grade 4 Ti and TiZr (13-17% Zr) disks were modified by large grit sand-
blasting and acid-etching with storage in saline solution, resulting in a complex microstructured and
hydrophilic surface corresponding to the commercially available implants SLActive® and Roxolid®
SLActive® (Institut Straumann AG, Basel, Switzerland). The subsequent Ti modSLA and TiZr modSLA
surfaces were characterized and osteogenic markers were measured.
RESULTS: Evaluation of physical parameters revealed that the fabrication method was capable of inducing
a microstructured and hydrophilic surface on both the Ti and TiZr disks. Overall, the surfaces were similar,
but differences in nanostructure morphology/density and surface chemistry were detected. On Ti modSLA
and TiZr modSLA, osteoblastic differentiation and maturation markers were enhanced in both MSCs and
NHOsts, while inflammatory markers decreased compared with TCPS.
CONCLUSIONS: These results indicate a similar positive cell response of MSCs and NHOsts when cultured
on Ti modSLA and TiZr modSLA. Both surfaces were hydrophilic, indicating the importance of this property
to osteoblast lineage cells.
10
Clin Oral Implants Res. 2017 Jul;28(7):e60-e67. doi: 10.1111/clr.12863. Epub 2016 May 6.
One-year results of maxillary overdentures supported by 2 titanium-zirconium

implants - implant survival rates and radiographic outcomes.
Zembic A, Tahmaseb A, Jung RE, Wismeijer D.
Keywords: alveolar bone loss; ball anchor; bone resorption; dental implants; dental prosthesis; edentulous;
implant-supported; jaw; maxilla; survival rate; titanium-zirconium
OBJECTIVE: To assess implant survival rates and peri-implant bone loss of 2 titanium-zirconium implants
supporting maxillary overdentures at 1 year of loading.
MATERIAL AND METHODS: Twenty maxillary edentulous patients (5 women and 15 men) being
dissatisfied with their complete dentures were included. In total, 40 diameter-reduced titanium-zirconium
implants were placed in the anterior maxilla. Local guided bone regeneration (GBR) was allowed if the
treatment did not compromise implant stability. Following 3 to 5 months of healing, implant-supported
overdentures were inserted on two ball anchors. Implants and overdentures were assessed at 1, 2, 4, and 8
weeks after implant insertion and 2, 4, and 12 months after insertion of overdentures (baseline).
Standardized radiographs were taken at implant loading and 1 year. Implant survival rates and bone loss
were the primary outcomes.
RESULTS: Nineteen patients (1 dropout) with 38 implants were evaluated at a mean follow-up of 1.1 years
(range 1.0-1.7 years). One implant failed resulting in an implant survival rate of 97.3%. There was a
significant peri-implant bone loss of the implants at 1 year of function (mean, 0.7 mm, SD = 1.1 mm; median:
0.48 mm, IQR = 0.56 mm).
CONCLUSIONS: There was a high 1-year implant survival rate for edentulous patients receiving 2 maxillary
implants and ball anchors as overdenture support. However, several implants exhibited an increased amount
of bone loss of more than 2 mm. Overdentures supported by 2 maxillary implants should thus be used with
caution as minimally invasive treatment for specific patients encountering problems with their upper dentures
until more long-term data is available.
Clin Oral Implants Res. 2017 Jul;28(7):e84-e90. doi: 10.1111/clr.12878. Epub 2016 May 20.
Effects of different titanium zirconium implant surfaces on initial supragingival

plaque formation.
John G, Becker J, Schwarz F.
Keywords: material sciences; microbiology; surface chemistry

OBJECTIVES: The aim of the current study was the evaluation of biofilm development on different implant
surfaces.
MATERIAL AND METHODS: Initial biofilm formation was investigated on five different implant surfaces,
machined titanium (MTi), modified machined acid-etched titanium (modMATi), machined titanium zirconium
(MTiZr), modified machined and acid-etched titanium zirconium (modMATiZr) and sandblasted large grid
and acid-etched titanium zirconium surface (SLATiZr) for 24 and 48 h. Biocompatibility was tested after tooth
brushing of the samples via cell viability testing with human gingival fibroblasts.
11
RESULTS: After 24 h of biofilm collection, mean plaque surface was detected in the following descending
order: After 24 h: MTiZr > MTi > SLATiZr > modMATiZr > modMATi. Both M surfaces showed significant
higher biofilm formation than the other groups. After 48 h: MTiZr > MTi > SLATiZr > modMATiZr > modMATi.
After tooth brushing: SLATiZr > modMATi > modMATiZr > MTi > MTiZr. All native samples depicted
significant higher cell viability than their corresponding surfaces after biofilm removal procedure.
CONCLUSIONS: The TiZr groups especially the modMATiZr group showed slower and less biofilm
formation. In combination with the good biocompatibility, both modMA surfaces seem to be interesting
candidates for surfaces in transgingival implant design.
Clin Oral Implants Res. 2017 Aug;28(8):902-910. doi: 10.1111/clr.12896. Epub 2016 Jun 7.
The effect of placing a bone replacement graft in the gap at immediately placed
implants: a randomized clinical trial.
Sanz M, Lindhe J, Alcaraz J, Sanz-Sanchez I, Cecchinato D.
Keywords: bone grafts; bone healing; dental implants; immediate implants

OBJECTIVE: To assess the added value of using a bone replacement graft in combination with immediate
implants in reducing the bone dimensional changes occurring in the residual ridge.
MATERIAL AND METHODS: Randomized parallel controlled clinical trial to study the efficacy of grafting
with demineralized bovine bone mineral with 10% collagen (DBBM-C) in the gap between the implant
surface and the inner bone walls when the implants were immediately placed in the anterior maxilla. The
changes between implant placement and 16 weeks later in the horizontal and vertical crestal bone changes
in relation to the implant were evaluated through direct bone measurements using a periodontal probe. Mean
changes were compared between the experimental and control sites using parametric statistics.
RESULTS: A total of 86 implant sites in 86 subjects were included in the analysis (43 in the test group and
43 in the control group). The horizontal crest dimension underwent marked changes during healing mainly at
the buccal aspect of the alveolar crest where this reduction amounted to 1.1 (29%) in the test group and 1.6
mm (38%) in the control group, being these statistically significant (P = 0.02). This outcome was even more
pronounced at sites in the anterior maxilla and with thinner buccal bone plates.
CONCLUSIONS: In conclusion, the results from this clinical trial demonstrated that placing a DBBM-C bone
replacement graft significantly reduced the horizontal bone resorptive changes occurring in the buccal bone
after the immediate implantation in fresh extraction sockets.
Dental implants in the elderly population: a systematic review and meta-analysis.

Srinivasan M, Meyer S, Mombelli A, Müller F.
Keywords: aged 65 years and over; dental implants; edentulous jaws; elderly patients; implant survival;
meta-analysis; survival rate; systematic review
12
OBJECTIVE: This systematic review was conducted to evaluate the outcome of dental implant therapy in
elderly patients (≥65 years).
MATERIAL AND METHODS: Online database and hand searches were systematically performed to identify
studies reporting on dental implants placed in the partially/completely edentulous jaws of elderly patients.
Only prospective studies reporting on regular-diameter (≥3 mm), micro-rough surface implants were included
in this review. Two investigators performed the search and data extraction. An inter-investigator reliability
was verified using kappa statistics (κ). A meta-analysis was performed on implant survival rates, while the
mean peri-implant marginal bone level changes (PI-MBL), technical/mechanical complications, and
biological complications were reported descriptively.
RESULTS: The systematic search yielded 2221 publications, of which 11 studies were included for statistical
analyses. The calculated κ for the various parameters extracted was κ = 0.818-1.000. A meta-analysis was
performed on the post-loading implant survival rates at 1, 3, 5, and 10 years. The random-effects model
revealed an overall 1-year implant survival of 97.7% (95% CI: 95.8, 98.8; I2 = 0.00%, P = 0.968; n = 11
studies). The model further revealed an overall implant survival of 96.3% (95% CI: 92.8, 98.1; I2 = 0.00%, P
= 0.618; n = 6 studies), 96.2% (95% CI: 93.0, 97.9; I2 = 0.00%, P = 0.850; n = 7 studies), and 91.2% (95%
CI: 83.4, 95.6; I2 = 0.00%, P = 0.381; n = 3 studies) for 3, 5, and 10 years, respectively. The reported 1-year
average PI-MBL ranged between 0.1 and 0.3 mm, while the reported 5- and 10-year PI-MBL were 0.7 and
1.5 mm, respectively. Information obtained pertaining to the technical and biological complications in the
included studies was inadequate for statistical analysis. The frequent technical/mechanical complications
reported were abutment screw loosening, fracture of the overdenture prostheses, activation of retentive
clips, ceramic chipping, and fractures. The common biological complication reported included peri-implant
mucositis, mucosal enlargement, bone loss, pain, and implant loss.
CONCLUSIONS: This review provides robust evidence favoring dental implant therapy in elderly patients as
a predictable long-term treatment option, in terms of implant survival, clinically acceptable PI-MBL changes,
and minimal complications. Therefore, age alone should not be a limiting factor for dental implant therapy.
Clin Oral Implants Res. 2017 Aug;28(8):931-937. doi: 10.1111/clr.12899. Epub 2016 Jul 8.
The relationship between facial bone wall defects and dimensional alterations of
the ridge following flapless tooth extraction in the anterior maxilla.
Chen ST, Darby I.
Keywords: dehiscence defect; extraction; fenestration defect; flapless; wound healing

PURPOSE: To evaluate the relationship between defects of the facial socket wall at extraction and
dimensional changes 8 weeks later in maxillary central and lateral incisor sockets.
MATERIALS AND METHODS: A total of 34 consecutive patients requiring single tooth implants in the
anterior maxilla (27 central and 7 lateral incisors) were evaluated. Orofacial external ridge, bone dimensions
and the location of the socket bone crest were measured at extraction and again 8.5 ± 2.91 weeks later. The
status of the facial bone wall was recorded at the same time points.
13
RESULTS: At extraction, 16 of 34 sites (47%) had intact facial bone. There were fenestration defects at 9 of
34 sites (26.5%) and dehiscence defects at 9 of 34 sites (26.5%). A significant reduction (P < 0.001) in the
external orofacial ridge dimension occurred (mesial 1.4 ± 1.30 mm or 12.1%, facial 2.5 ± 1.46 mm or 22.2%,
distal 1.1 ± 0.83 mm or 10.5%), with greatest change at dehiscence (3.3 ± 1.80 mm or 28.4%) and
fenestration sites (2.8 ± 1.40 mm or 24.9%). A significant reduction in orofacial bone dimension occurred
(mesial 0.8 ± 0.80 mm or 9.3%, P < 0.001; facial 1.2 ± 1.03 mm or 18.3%, P < 0.001; distal 0.4 ± 0.65 mm or
5.5%, P < 0.01). Vertical resorption of the bone crest was most marked at the mid-facial aspect (1.4 ± 1.94
mm, P < 0.001). Initial fenestration defect sites demonstrated the greatest vertical dimensional change (2.9 ±
2.67 mm; P = 0.008). Of 16 sites with initially intact facial bone, 9 sites (56.3%) developed dehiscence
defects after 8 weeks. Of the 9 initial sites with fenestration defects, 5 (55.6%) turned into dehiscence
defects. All 9 sites with initial dehiscence defects healed with persistence of the dehiscence.
CONCLUSIONS: Eight weeks after flapless extraction of maxillary central and lateral incisors, a reduction in
the orofacial dimensions of the ridge was observed due to resorption of the facial bone of the socket. Tooth
type (maxillary central incisor) and thin tissue phenotype significantly influenced the outcomes. The
dimensional alterations were most pronounced at sites that initially had fenestration and dehiscence defects
of the facial bone.
The effect of a flapless alveolar ridge preservation procedure with or without a

xenograft on buccal bone crest remodeling compared by histomorphometric and
microcomputed tomographic analysis.
de Barros RRM, Novaes AB Jr, de Carvalho JP, de Almeida ALG.
Keywords: animal model; bone formation; extraction socket; grafting

OBJECTIVES: This study evaluated buccal bone crest remodeling, socket composition after healing, and
dimensional ridge preservation after flapless tooth extraction procedures with or without a xenograft
comparing histomorphometric and microcomputed tomographic (micro-CT) data.
MATERIAL AND METHODS: The mandibular premolars of eight dogs were extracted without flaps. One
socket on each side received a grafting material (test group), and the other remained only with a blood clot
(control group). Twelve weeks after treatment, buccal bone crest, alveolar ridge dimensions, and
composition were analyzed by histomorphometry and micro-CT.
RESULTS: Two- and three-dimensional evaluations showed better results for the grafted group when
compared to the non-grafted group.
CONCLUSIONS: The flapless alveolar ridge preservation procedure with deproteinized bovine bone material
enhanced buccal bone crest, alveolar ridge dimensions and bone formation when compared to sockets with
the blood clot only, as observed by histomorphometric and micro-CT analysis.
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Clin Oral Implants Res. 2017 Aug;28(8):954-960. doi: 10.1111/clr.12902. Epub 2016 Sep 23.
Performance and safety of collagenated xenogeneic bone block for lateral alveolar
ridge augmentation and staged implant placement. A monocenter, prospective
single-arm clinical study.
Schwarz F, Mihatovic I, Ghanaati S, Becker J.
Keywords: alveolar ridge augmentation; clinical study; collagenated xenogeneic bone block (CXBB);
histological analysis
OBJECTIVES: To assess the clinical safety and performance of collagenated xenogeneic bone block
(CXBB) for lateral alveolar ridge augmentation and two-stage implant placement.
MATERIAL & METHODS: In ten patients exhibiting a single-tooth gap, the surgical procedure included the
preparation of mucoperiosteal flaps, a rigid fixation of CXBB (Geistlich Bio-Graft®) using an osteosynthesis
screw, and contour augmentation. After 24 weeks of submerged healing, the primary endpoint was defined
as the final ridge width sufficient to place an adequately dimensioned titanium implant at the respective sites.
Secondary outcomes included, for example, the gain in ridge width (mm). Clinical parameters (e.g., bleeding
on probing - BOP, probing depth - PD, mucosal recession - MR) were assessed immediately after the
cementation of the crown and at the final visit.
RESULTS: At 24 weeks, implant placement could be achieved in 8 of 10 patients exhibiting a mean gain in
ridge width (mean ± SD) of 3.88 ± 1.75 mm. Histological analysis has pointed to a homogeneous osseous
organization of CXBB. The changes of mean BOP, PD, and MR values at the final visit amounted to 16.62 ±
32.02%, 0.04 ± 0.21 mm, and -0.04 ± 0.12 mm, respectively.
CONCLUSIONS: CXBB may be successfully used to support lateral alveolar ridge augmentation and two-
stage implant placement.
Hard and soft tissue changes following alveolar ridge preservation: a systematic
review.
MacBeth N, Trullenque-Eriksson A, Donos N, Mardas N.
Keywords: alveolar ridge preservation; gingival tissue; histology; tooth extraction

OBJECTIVE: Two focused questions were addressed within this systematic review. Q1) What is the effect
of alveolar ridge preservation on linear and volumetric alveolar site dimensions, keratinised measurements,
histological characteristics and patient-based outcomes when compared to unassisted socket healing. Q2)
What is the size effect of these outcomes in three different types of intervention (guided bone regeneration,
socket grafting and socket seal).
MATERIALS AND METHODS: An electronic search (MEDLINE, EMBASE, Cochrane Central Register
LILACS, Web of Science) and hand-search was conducted up to June 2015. Randomised controlled trials
(RCT) and controlled clinical trials (CCT); with unassisted socket healing as controls: were eligible in the
analysis for Q1. RCTs, CCTs and large prospective case series with or without an unassisted socket healing
as control group were eligible in the analysis for Q2.
15
RESULTS: Nine papers (8 RCTs and 1 CCTs) were included in the analysis for Q1 and 37 papers (29
RCTs, 7 CCTs and 1 case series) for Q2. The risk for bias was unclear or high in most of the studies. Q1:
the standardised mean difference (SMD) in vertical mid-buccal bone height between ARP and a non-treated
site was 0.739 mm (95% CI: 0.332 to 1.147). The SMD when proximal vertical bone height and horizontal
bone width was compared was 0.796mm (95% CI: -1.228 to 0.364) and 1.198 mm (95% CI: -0.0374 to
2.433). Examination of ARP sites revealed significant variation in vital and trabecular bone percentages and
keratinised tissue width and thickness. Adverse events were routinely reported, with three papers reporting a
high level of complications in the test and control groups and two papers reporting greater risks associated
with ARP. No studies reported on variables associated with the patient experience in either the test or the
control group. Q2: A pooled effect reduction (PER) in mid-buccal alveolar ridge height of -0.467 mm (95%
CI: -0.866 to -0.069) was recorded for GBR procedures and -0.157 mm (95% CI: -0.554 to 0.239) for socket
grafting. A proximal vertical bone height reduction of -0.356 mm (95% CI: -0.490 to -0.222) was recorded for
GBR, with a horizontal dimensional reduction of -1.45 mm (95% CI: -1.892 to -1.008) measured following
GBR and -1.613 mm (95% CI: -1.989 to -1.238) for socket grafting procedures. Five papers reported on
histological findings after ARP. Two papers indicated an increase in the width of the keratinised tissue
following GBR, with two papers reporting a reduction in the thickness of the keratinised tissue following GBR.
Histological examination revealed extensive variations in the treatment protocols and biomaterials materials
used to evaluate extraction socket healing. GBR studies reported a variation in total bone formation of 47.9 ±
9.1% to 24.67 ± 15.92%. Post-operative complications were reported by 29 papers, with the most common
findings soft tissue inflammation and infection.
CONCLUSIONS: ARP results in a significant reduction in the vertical bone dimensional change following
tooth extraction when compared to unassisted socket healing. The reduction in horizontal alveolar bone
dimensional change was found to be variable. No evidence was identified to clearly indicate the superior
impact of a type of ARP intervention (GBR, socket filler and socket seal) on bone dimensional preservation,
bone formation, keratinised tissue dimensions and patient complications.
Experimental mucositis and experimental gingivitis in persons aged 70 or over.

Clinical and biological responses.
Meyer S, Giannopoulou C, Courvoisier D, Schimmel M, Müller F, Mombelli A.
Keywords: adult; aged; biomarkers; dental implants; gingival crevicular fluid; gingivitis; mucositis; oral
hygiene
OBJECTIVES: To compare in persons aged 70 years or older the clinical and inflammatory changes
occurring around implants and natural teeth during and after a phase of undisturbed plaque accumulation.
MATERIAL AND METHODS: Twenty partially edentulous participants with titanium implants refrained from
oral hygiene practices while being clinically monitored in weekly intervals for 21 days. Teeth and implants
were then cleaned, oral hygiene resumed, and the participants were further monitored for 3 weeks. Twelve
biomarkers were assessed in gingival and peri-implant crevicular fluid (GCF, PCF).
RESULTS: During 3 weeks of oral hygiene abstention, the gingival index (GI) continuously increased. On
day 21, there were significantly more sites with GI >1 at implants than at teeth. After restarting oral hygiene,
the GI decreased markedly in both groups. Throughout the experiment, the plaque index was significantly
higher on teeth than on implants. The different biomarkers reacted variably. IL-1β increased significantly with
plaque accumulation. IL-1β, GM-CSF, TNF-α, and IFN-γ were significantly higher in GCF compared to PCF
at day 21. IL-8 decreased significantly in GCF up to day 14. MIP-1β decreased significantly in GCF, but not
in PCF. At the 3-week follow-up, the levels of all biomarkers assessed in GCF and PCF had returned to
baseline values.
16
CONCLUSIONS: In an elderly cohort, plaque accumulation induced an inflammatory reaction around both
teeth and implants. Although there was less plaque accumulation on implants, the peri-implant mucosa
showed a stronger clinical response than gingiva.
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Decontamination of titanium implants using physical methods.

Al-Hashedi AA, Laurenti M, Benhamou V, Tamimi F.
Keywords: biomaterials; laser; periodontology; surface chemistry

OBJECTIVES: Current decontamination methods of titanium (Ti) implant present limited success in
achieving predictable re-osseointegration. We hypothesized that even though these techniques could be
useful in elimination of bacteria, they might be unsuccessful in removing organic contaminants and restoring
the original surface composition. The aim of this study was to assess the effect of four decontamination
methods on the surface chemistry and bacterial load of biofilm-contaminated implant surfaces in order to
improve implant surface decontamination.
MATERIAL AND METHODS: The ability of clinically available methods such as metal and plastic curettes,
Ti brushes and Er: YAG laser to decontaminate Ti implant surfaces was assessed. Surface morphology,
chemical composition and properties of machined Ti discs (Ø 5.0 and 1.0 mm thick) were analysed before
and after oral biofilm contamination using scanning electron microscope and X-ray photoelectron
spectroscopy. The presence and viability of bacteria were evaluated with live-dead assays.
RESULTS: Biofilm contamination created an organic layer rich in hydrocarbons and bacteria that covered
entirely the Ti surfaces. This organic layer has tightly adhered to Ti surfaces and could not be completely
removed with any of the methods assessed. Ti brushes achieved greater elimination of organic
contaminants and bacteria than curettes and Er: YAG laser; however, none of them was able to restore the
original surface chemistry. Alternatively, Er: YAG laser-treated surfaces showed the lowest live-to-dead
bacterial ratio.
CONCLUSIONS: Ti brushes were more effective than curettes (metal or plastic) and Er: YAG laser in
decontaminating Ti implant surfaces, although none of these techniques was able to completely eliminate
surface contamination. Er: YAG laser was more effective than curettes and Ti brushes in killing the biofilm
bacteria.
Journal of Clinical Periodontology
J Clin Periodontol. 2017 Jul;44(7):756-761. doi: 10.1111/jcpe.12738. Epub 2017 Jun 20.
Non-surgical treatment of peri-implant mucositis and peri-implantitis at two-piece

zirconium implants: A clinical follow-up observation after up to 3 years.
John G, Becker J, Schmucker A, Schwarz F.
17
Keywords: Non-surgical therapy; peri-implant diseases; zirconium implants
OBJECTIVES: To assess the long-term clinical outcomes following non-surgical therapy of peri-implant
diseases at two-piece zirconium implants.
MATERIAL AND METHODS: A total of 27 patients suffering from either (i) peri-implant mucositis (n = 24
implants), or (ii) peri-implantitis (n = 16 implants) completed a mean follow-up period of 32.8 ± 2.85 months
(median: 34 months). The initial treatment procedures included (i) mechanical debridement + local antiseptic
therapy using chlorhexidine digluconate (MD + CXH), or (ii) Er:YAG laser monotherapy (ERL). The primary
outcome was disease resolution (i.e. absence of bleeding on probing (BOP) at mucositis sites/absence of
BOP and probing pocket depths (PD) ≥6 mm at peri-implantitis sites).
RESULTS: Resolution of peri-implant mucositis and peri-implantitis was obtained in 7/14 (50.0%; p = .003)
and 5/13 (38.5%; p = .001) of the patients investigated. This corresponded to 54.2% (13/24) and 50.0%
(8/16) at the implant level respectively.
CONCLUSIONS: Both MD + CHX and ERL were effective on the long-term, but failed to achieve a complete
disease resolution.

Peri-implant bone density around implants of different lengths: A 3-year follow-up

of a randomized clinical trial.
Sahrmann P, Schoen P, Naenni N, Jung R, Attin T, Schmidlin PR.
Keywords: RCT; bone level; dental implants; dental radiography

OBJECTIVES: Short dental implants are frequently placed, however, little is known about the effect of the
loading force regarding an enhanced crown-to-implant ratio. The aim of this study was therefore to assess
bone density changes after a 3-year period, on radiographs acquired from a randomized, controlled two-
centre clinical study comparing implants of 6 and 10 mm of length.
MATERIALS AND METHODS: Three predefined areas were chosen on standardized X-rays in order to
assess grey-scale values of the peri-implant bone: One at the tip of the apex and two at half-length on the
mesial and distal sides of the implant. Radiographs at all follow-up appointments had previously been
calibrated using control fields in areas of constant density.
RESULTS: Around short implants, peri-implant bone displayed significantly higher differences in grey-scale
values (p = .031) after 3 years, indicating a higher degree of mineralization. This phenomenon was not
observed around long implants.
CONCLUSIONS: A higher degree of mineralization around short implants was recorded. Whether this
finding goes along with hampered bone adaptability, and accordingly, higher failure rates of short implants
must be studied further in long-term clinical trials.
Xenogeneic collagen matrix versus connective tissue graft for buccal soft tissue
augmentation at implant site. A randomized, controlled clinical trial.
Cairo F, Barbato L, Tonelli P, Batalocco G, Pagavino G, Nieri M.
18
Keywords: collagen matrix; connective tissue graft; dental implants; keratinized tissue; randomized clinical
trial; soft tissue augmentation
BACKGROUND: Peri-implant soft tissue may be critical to prevent inflammation and promote gingival
margin stability. The purpose of this randomized clinical trial (RCT) is to compare xenogeneic collagen
matrix (XCM) versus connective tissue graft (CTG) to increase buccal soft tissue thickness at implant site.
MATERIALS AND METHODS: Soft tissue augmentation with XCM (test) or CTG (control) was performed at
60 implants in 60 patients at the time of implant uncovering. Measurements were performed by a blinded
examiner at baseline, 3 and 6 months. Outcome measures included buccal soft tissue thickness (GT), apico-
coronal keratinized tissue (KT), chair time and post-operative discomfort. Visual Analogue Scale (VAS) was
used to evaluate patient satisfaction.
RESULTS: After 6 months, the final GT increase was 0.9 ± 0.2 in the XCM group and 1.2 ± 0.3 mm in the
CTG group, with a significant difference favouring the control group (0.3 mm; p = .0001). Both procedures
resulted in similar final KT amount with no significant difference between treatments. XCM was associated
with significant less chair-time (p < .0001), less post-operative pain (p < .0001), painkillers intake (p < .0001)
and higher final satisfaction than CTG (p = .0195).
CONCLUSIONS: CTG was more effective than XCM to increase buccal peri-implant soft tissue thickness.

J Clin Periodontol. 2017 Aug;44(8):842-853. doi: 10.1111/jcpe.12747. Epub 2017 Jul 26.
Hard and soft tissue integration of immediate and delayed implants with a modified
coronal macrodesign: Histological, micro-CT and volumetric soft tissue changes
from a pre-clinical in vivo study.
Sanz-Martin I, Vignoletti F, Nuñez J, Permuy M, Muñoz F, Sanz-Esporrín J, Fierravanti L, Shapira L, Sanz M.
Keywords: Immediate implant; animal model; dental implants; histology; implant macrodesign; micro-CT;
volumetric analysis
AIM: To study the healing of peri-implant tissues around implants with a triangular coronal third (test) or
cylindrical (control).
MATERIALS AND METHODS: In eight beagle dogs, immediate and delayed implants were placed. Test and
control implants were randomly assigned and the hard and soft tissue healing was evaluated with histology
and micro-CT analysis at 4 and 12 weeks. The soft tissue contour changes were assessed by image
analysis software.
RESULTS: When measured at the implant shoulder level, the buccal crestal width (primary outcome
assessed in mm) attained similar values in test and control implants. More apically (3 mm) test implants had
greater buccal crestal width in delayed and immediate sites. For vertical soft and hard tissue measurements,
no significant differences were found between Test and Control. Micro-CT evaluation of the buccal volume of
interest showed less volume of implant component in T implants in all sites, although bone volume was not
significantly different between T/C. Soft tissue contours were similar around T/C implants.
CONCLUSIONS: Triangular implants showed similar percentage of osseointegration, buccal bone volume
and soft tissue contours, although attaining greater buccal crestal bone width. No differences were found in
regard to soft tissue dimensions and the position of the first bone-to-implant contact.
19
Journal of Dentistry
J Dent. 2017 Jul;62:1-12. doi: 10.1016/j.jdent.2017.04.011. Epub 2017 May 3.
Prevalences of peri-implantitis and peri-implant mucositis: systematic review and

meta-analysis.
Lee CT, Huang YW, Zhu L, Weltman R.
Keywords: Diagnosis; Epidemiology; Evidence-based dentistry; Inflammation; Review literature as topic;

Symptom assessment
OBJECTIVES: Due to the inconsistent definitions, reporting methods and study characteristics, prevalences
of peri-implant diseases significantly varied in studies. This study aimed to systematically analyze implant-
based and subject-based prevalences of peri-implant diseases and assess clinical variables potentially
affecting the prevalence.
SOURCES: Electronic search of studies was conducted using MEDLINE (PubMed), EMBASE and Web of
Science. Publication screening, data extraction, and quality assessment were performed.
STUDY SELECTION: Clinical studies having an at least average three-year follow-up period were selected.
The numbers of subjects and implants in the studies had to be equal to or more than thirty.
DATA: Forty seven studies were selected and prevalences of peri-implant diseases were analyzed. Since
heterogeneity existed in each outcome (I2=94.7, 95.7, 95.3, and 99.3 for implant-based and subject-based
peri-implantitis and peri-implant mucositis, respectively), the random-effects model based on the
DerSimonian and Laird method, which incorporate an estimate of heterogeneity in the weighting, was applied
to obtain the pooled prevalence. Weighted mean implant-based and subject-based peri-implantitis
prevalences were 9.25% (95% Confidence Interval (CI): [7.57, 10.93]) and 19.83% (CI [15.38, 24.27)
respectively. Weighted mean implant-based and subject-based peri-implant mucositis prevalences were
29.48% (CI: [22.65, 36.32]) and 46.83% (CI: [38.30, 55.36]) respectively. Functional time and implant to
subject ratio were associated with subject-based peri-implantitis prevalence, but not peri-implant mucositis
prevalences.
CONCLUSIONS: Peri-implant diseases were prevalent and prevalence of peri-implantitis increased over
time. Prevalences of peri-implantitis and peri-implant mucositis might not be highly associated since the
prevalences were influenced by distinct variables. The results should be carefully interpreted because of
data heterogeneity.
CLINICAL SIGNIFICANCE: Peri-implant diseases affect a significant number of dental implants and
patients. It is important to understand the difficulties in diagnosis of these diseases and risk factors which
may be modified to reduce the potential for disease occurrence or progression.
J Dent. 2017 Aug;63:85-93. doi: 10.1016/j.jdent.2017.05.022. Epub 2017 Jun 3.
Combination of straight and tilted implants for supporting screw-retained dental

prostheses in atrophic posterior maxillae: A 2-year prospective study.
Casar-Espinosa JC, Castillo-Oyagüe R, Serrera-Figallo MÁ, Garrido-Serrano R, Lynch CD, Menéndez-Collar
M, Torres-Lagares D, Gutiérrez-Pérez
Keywords: Angled implants; Atrophic maxilla; Axial implants; Fixed dental prostheses (FDPs); Straight
implants; Tilted implants
20
OBJECTIVES: To evaluate the two-year survival rate (SR) and marginal bone loss (MBL) of fixed dental
prostheses (FDPs) supported by straight (S) and tilted (T) implants under the influence of diverse study
variables.
METHODS: A prospective investigation comprising 21 patients provided with a total of 27 maxillary screw-
retained restorations fixed to 70 dental implants was developed. Two groups of implants were considered
depending on their inclination with respect to the occlusal plane: Group 1 (S, n=37): straight/axial implants
and Group 2 (T, n=33): tilted/angled fixations. Each FDP was supported by a combination of S and T
implants. SR and MBL were assessed at the time of loading and two years after surgery. Patient-, surgical-
and/or rehabilitation-related information was gathered. Data were statistically analysed at the α=0.05
significance level.
RESULTS: After 24 months, a 100% SR was achieved and the MBL of S and T implants were statistically
similar. T implants located in the molar region showed lower MBL than did those replacing premolars
(p=0.031).
CONCLUSIONS: Upright and angled fixations inserted at posterior maxillary areas resulted in comparable
survival rates and peri-implant MBL after two years. The marginal bone resorption around tilted implants
depended on their location.
CLINICAL SIGNIFICANCE: Screw-retained restorations fixed to straight and tilted implants seem to be a
safe treatment option in posterior atrophic maxillae.
Journal of Periodontology
J Periodontol. 2017 Aug;88(8):752-761. doi: 10.1902/jop.2017.160751. Epub 2017 Apr 25.
Biomarkers and Bacteria Around Implants and Natural Teeth in the Same
Individuals.
Gürlek Ö, Gümüş P, Nile CJ, Lappin DF, Buduneli N.
Keywords: Biomarkers; cytokines; dental implants; peri-implantitis; periodontitis
BACKGROUND: This cross-sectional study assesses cytokine levels in peri-implant crevicular fluid
(PICF)/gingival crevicular fluid (GCF) and a selection of subgingival/submucosal plaque bacteria from
clinically healthy or diseased sites in the same individuals.
METHODS: Samples from 97 implants/teeth (58 implants [19 healthy, 20 mucositis, 19 peri-implantitis] and
39 natural teeth [19 healthy, 12 gingivitis, eight periodontitis] in 15 systemically healthy patients were
investigated by immunoassay and real-time polymerase chain reaction. Samples were obtained first, with
probing depth, clinical attachment level, bleeding on probing, plaque index scores, and keratinized tissue
width then recorded. Data were analyzed by Wilcoxon, Mann-Whitney U, and permutation tests on
dependent, independent, and mixed dependent and independent samples and Spearman correlation.
RESULTS: Interleukin (IL)-1β levels were significantly higher in PICF samples of healthy implants than in
GCF samples of healthy teeth (P = 0.003), and soluble receptor activator of nuclear factor-κB ligand
(sRANKL) concentrations were significantly higher in the gingivitis than the mucositis group (P = 0.004).
Biomarker levels were similar in peri-implantitis and periodontitis groups (P >0.05). Actinomyces naeslundi
and Streptococcus oralis levels were significantly higher in the healthy implant group than in healthy teeth (P
<0.05). Prevotella intermedia and Treponema denticola (Td) levels were lower in the mucositis group than
the gingivitis group (P <0.05). Prevotella oralis and S. oralis levels were significantly higher in the
periodontitis group (P <0.05), and Td levels were significantly higher in the peri-implantitis group (P <0.05).
21
CONCLUSIONS: There were many similarities but, crucially, some differences in biomarker levels (IL-1β
and sRANKL) and bacterial species between peri-implant and periodontal sites in the same individuals,
suggesting similar pathogenic mechanisms.
Clinical Implant Dentistry and Related Research
Clin Implant Dent Relat Res. 2017 Aug;19(4):608-615. doi: 10.1111/cid.12490. Epub 2017 May 2.
Comparison of allografts and xenografts used for alveolar ridge preservation. A

clinical and histomorphometric RCT in humans.
Serrano Méndez CA, Lang NP, Caneva M, Ramírez Lemus G, Mora Solano G, Botticelli D.
Keywords: allograft; alveolar ridge reconstruction; bone grafting; tooth extraction; xenograft
BACKGROUND: Several types of bone grafts are used in ridge preservation procedures.
PURPOSE: To compare the healing of allografts and xenografts applied for alveolar ridge preservation.
MATERIALS AND METHODS: Twenty volunteers in need of extraction of a single-rooted tooth prior to
implant installation were randomized into two groups. One group received a deproteinized cancellous bovine
bone xenograft embedded in a 10% collagen matrix and the other a demineralized freeze-dried cortical bone
allograft. A collagen membrane was used to cover the grafts, flaps were sutured. At baseline and 6 months
later, clinical measurements including vertical and horizontal bone dimensions were taken.
Histomorphometric analysis was performed.
RESULTS: Both groups showed shrinkage of bone dimensions. At mesial, center and distal sites, the
vertical changes in dimension were -0.6, 0.5, and -0.1 mm for the allograft and -1.1, -0.4, and -0.9 mm for
the xenograft. The horizontal changes in dimensions were -1.4 mm for the allograft and -2.6 mm for the
xenograft. New bone and residual graft material were 25.5 ± 10.1% and 33.8 ± 9.4% at the allograft and
35.3 ± 16.8% and 22.2 ± 13.4% at the xenograft sites. None of the differences was statistically significant.
CONCLUSIONS: Both grafting materials are suitable for the preservation of the alveolar ridge.
Does osteoporosis influence the marginal peri-implant bone level in female

patients? A cross-sectional study in a matched collective.
Wagner F, Schuder K, Hof M, Heuberer S, Seemann R, Dvorak G.
Keywords: atrophy; bone loss; bone-implant interface; crestal bone loss; implant
22
BACKGROUND/PURPOSE: Osteoporosis, being a homeostatic imbalance, affects the remodeling of bone.
Whether this catabolic bone disease influences peri-implant marginal bone remodeling remains unknown so
far. The purpose of this study was to evaluate the influence of osteoporosis on peri-implant marginal bone
loss (MBL) in postmenopausal women.
MATERIALS AND METHODS: In a matched collective, radiographic peri-implant bone level (at baseline and
at follow-up examinations) was compared in healthy and osteoporotic women. General health and behavioral
history of the patients were recorded using a printed questionnaire.
RESULTS: A best fit matching procedure generated a sample of 48 women with a total of 204 implants
matched at patient and implant level that was further statistically analyzed. The mean mesial MBL-
statistically corrected to report the first year-was -0.6 ± 1.2 mm (range: -5.1 to 2.2) in the healthy control
group and -1.1 ± 1.3 mm (range: -5.3 to 2.2) in the osteoporotic group. Similarly, the mean distal MBL was -
0.5 ± 1.3 mm (range: -5.1 to 4.8) in the healthy control group and -1.2 ± 1.3 mm (range: -4.7 to 1.6) in the
osteoporotic group, respectively. The base linear regression models including solely osteoporosis and time
without any other confounders revealed a significant influence of osteoporosis and time since implant
placement on the MBL at the mesial and the distal implant aspect. The significance of osteoporosis on bone
loss did not change incorporating the confounders: bone level at implantation, smoking, jaw, location,
surface, concrement, plaque, augmentation, edentulism in opposing and implant jaw, bisphosphonates,
vitamin D, fixed versus removable prosthetics, connection type.
CONCLUSIONS: There is no contraindication to place dental implants in osteoporotic patients. This study
implicates to respect the bone level at implant placement and not to place the implant below bone level if
possible.
Risk factors for single crowns supported by short (6-mm) implants in the posterior
region: A prospective clinical and radiographic study.
Villarinho EA, Triches DF, Alonso FR, Mezzomo LAM, Teixeira ER, Shinkai RSA.
Keywords: crown-to-implant ratio; dental implants; peri-implant bone loss; prospective clinical study;
prosthetic complications; short implants
BACKGROUND: The use of short implants is still not a consensus for challenging clinical situations, such as
unfavorable crown-to-implant (C/I) ratio.
PURPOSE: This prospective study evaluated the rates of prosthetic complications and implant failure, the
mean marginal bone loss of 6-mm dental implants with single crowns in posterior regions and the potential
risk factors.
MATERIALS AND METHODS: Forty-six dental implants, 6-mm long and 4.1-mm wide, were placed in the
posterior region in 20 patients. Patients were clinically and radiographically examined after the restoration
with single crowns and on a yearly basis. Potential risk factors (arch, bruxism, maximum bite force,
anatomical and clinical C/I ratios, and occlusal table area) were analyzed according to the following
outcomes: implant survival, bone loss, and prosthetic complications.
RESULTS: The mean follow-up time was 45 ± 9 (16-57) months. There was no early loss of implants. After
prosthetic loading, 4 implants were lost (2 in the mandible and 2 in the maxilla; 91.3% survival), and there
were 13 prosthetic complications (28.3%), yielding a 65.2% success rate. The frailty term showed a 95%
greater chance of loss in the mandible than the maxilla. Mean peri-implant bone loss was of 0.2 ± 0.4 mm,
0.1 ± 0.2 mm, 0.1 ± 0.3 mm, and 0.2 ± 0.4 mm in the first, second, third, and fourth years, respectively, with a
mean cumulative loss of 0.3 ± 0.5 mm at 48 months. In the multilevel model, the effects of the clinical C/I
ratio and time were significant for bone loss (P < .001). It was estimated that a mean bone loss of 0.1 mm is
associated with both a one-unit increase in time (12 months) and a 0.1 increase in the clinical C/I ratio. The
other potential risk factors showed no significant relationship with the outcomes.
23
CONCLUSIONS: The 6-mm implants supporting single crowns performed well, but the mandible shows a
higher risk of failure. The time and clinical C/I ratio are predictors for bone loss.
Clin Implant Dent Relat Res. 2017 Aug;19(4):694-702. doi: 10.1111/cid.12487. Epub 2017 Apr 21.
Immediate implant placement and restoration in the anterior maxilla: Tissue

dimensional changes after 2-5 year follow up.
Arora H, Khzam N, Roberts D, Bruce WL, Ivanovski S.
Keywords: aesthetics; dental implants; immediate placement and restoration; osseointegration; soft tissue
BACKGROUND: Immediate implant placement followed by an immediate restoration has proven to be a
viable technique in the anterior maxillary region.
PURPOSE: This prospective study evaluated the mid-long term (2-5 years) tissue changes around
immediately placed and restored implants in the anterior maxilla using flapless surgery and simultaneous
hard tissue augmentation.
MATERIALS AND METHODS: Thirty AstraTech implants were immediately placed in 30 patients, followed
by the delivery of an immediate provisional restoration on the same day. All participating 30 patients
underwent the same treatment strategy that involved flapless removal of a failing maxillary anterior tooth,
immediate implant placement, simultaneous augmentation with a deproteinized particulate xenograft,
followed by the connection of a screw-retained provisional restoration. Radiographs and photographs were
used to measure hard and soft tissue changes. Aesthetic evaluation was performed using the Pink Esthetic
Score (PES).
RESULTS: All implants remained osseointegrated during the follow up period of 2-5 years (mean 47 ± 15
months). Twelve of the thirty patients completed the 5 year follow up. Radiographic evaluation revealed
average gains in bone levels of 0.18 and 0.34 mm mesially and distally, respectively. Soft tissue evaluation
showed a mean tissue loss of 0.05 ± 0.64 mm and 0.16 ± 0.63 mm at the mesial and distal papillae,
respectively, while mid-facial mucosal recession was 0.29 ± 0.74 mm. A significant improvement in the Pink
Esthetic Scores was seen at the final follow-up (mean PES 11.50), as compared to the baseline (mean PES
10.27) (P = .001).
CONCLUSIONS: In addition to a favorable implant success rate and peri-implant bony response, the soft
tissue levels and overall aesthetics around single immediately placed and restored implants can also be
maintained in the mid-long term.
The International Journal of Oral and Maxillofacial Implants
Int J Oral Maxillofac Implants. 2017 July/August;32(4):759–767. doi: 10.11607/jomi.5364. Epub 2017 Mar 23.
Intra- and Postoperative Complications of Lateral Maxillary Sinus Augmentation in

Smokers vs Nonsmokers: A Systematic Review and Meta-Analysis.
Ghasemi S, Fotouhi A, Moslemi N, Chinipardaz Z, Kolahi J, Paknejad M.
24
Keywords: intraoperative complications, meta-analysis, oral surgical procedure, postoperative
complications, sinus floor augmentation
PURPOSE: This meta-analysis and systematic review focused on the following question: Does tobacco
smoking increase the risk of intra- or postoperative complications of lateral maxillary sinus floor elevation?
MATERIALS AND METHODS: The following electronic databases were searched up to and including
November 2015 without language restriction: CENTRAL, MEDLINE, Google Scholar, Scopus, Sirous, and
Doaj. Studies were included if rates of intra-or postoperative complications of sinus floor elevation in
smokers and nonsmokers were recorded separately. The following complications were assessed: sinus
membrane perforation, bleeding, wound dehiscence, wound infection, sinusitis, hematoma, and oroantral
fistula. The Critical Appraisal Skills Programme was used to assess the risk of bias in included studies.
Random-effects meta-analyses were used to assess the number of each complication in smokers and
nonsmokers.
RESULTS: Out of 929 eligible publications, 11 articles were included. Meta-analysis of the studies revealed
a significantly increased risk of developing wound dehiscence after sinus floor elevation among smokers
compared with nonsmokers (Risk Ratio [RR]: 7.82; 95% confidence interval [CI]: 2.38, 25.74; P = .0007).
Moreover, risk of developing wound infection was greater in smokers when prospective studies were
included in the meta-analysis (RR: 5.33; 95% CI: 1.34, 21.25; P = .02). However, the meta-analysis of
included studies did not show significant differences between smokers and nonsmokers concerning risk of
sinus membrane perforation and bleeding during sinus floor elevation (P = .46 and P = .33, respectively).
CONCLUSION: Considering the lack of randomized controlled trials and the small number of included
studies, the results indicate that smoking seems to be associated with increased risk of wound dehiscence
and infection after the sinus augmentation procedure.
Int J Oral Maxillofac Implants. 2017 July/August;32(4):768–773. doi: 10.11607/jomi.5366. Epub 2017 Feb 17.
Bone-to-Implant Contact and New Bone Formation Within Human Freeze-Dried

Bone Blocks Grafted Over Rabbit Calvaria.
Artzi Z, Anavi-Lev K, Kozlovsky A, Chaushu L, Schwarz F, Tal H.
Keywords: bone-implant contact, FDB bone blocks, freez-dried bone, graft vascularization, new bone
formation, osseointegration
PURPOSE: To assess the extent of osseointegration with rough-surface implants and new bone formation
(NBF) within human freeze-dried bone blocks (h-FDB) grafted over rabbit calvaria.
MATERIALS AND METHODS: A total of 18 rectangular h-FDB blocks were stabilized bilaterally to the
calvaria of nine New Zealand rabbits by two mini titanium screws each. A total of 18 rough-surface implants
(5.0 × 6.0-mm) were placed, 9 simultaneously (immediate placement [IP]) on one side and 9 at 3 months
after block grafting (delayed placement [DP]) on the contralateral side. At 12 weeks after the second surgical
procedure, block biopsies were harvested and processed for histologic analysis. Morphometric
measurements consisted of bone-to-implant contact (BIC) and the extent of NBF from the calvarial surface
and outward into the block. A paired t test was applied for statistical analysis.
RESULTS: All h-FDB blocks were integrated, and the implants showed clinical stability. Histologically, the
BIC was primarily between the apical end of the implants and the host rabbit calvaria. Bone growth between
the implant threads was minimal and inconsistent among all animals. Morphometric measurements showed
that the mean BIC of the IP and DP implants with the blocks was 10.50% ± 5.99% and 23.06% ± 9.58%,
respectively (P < .001). NBF was observed primarily in the cancellous compartment of the block adjacent to
the recipient calvarial bed. The extent of NBF into the block around the IP and DP implants was 9.95% ±
8.41% and 12.90% ± 11.07%, respectively (P = 0.2).
25
CONCLUSION: In this model, a significantly lower BIC was demonstrated when implants were placed
simultaneously with h-FDB block grafting compared to those placed in a two-stage mode. However, both
techniques showed limited osseointegration.
Int J Oral Maxillofac Implants. 2017 July/August;32(4):774–778. doi: 10.11607/jomi.5402. Epub 2017 May
18.
Cleaning, Disinfection, and Sterilization Protocols Employed for Customized

Implant Abutments: An International Survey of 100 Universities Worldwide.
Canullo L, Tallarico M, Chu S, Peñarrocha D, Özcan M, Pesce P.
Keywords: customized abutments, disinfection, implant abutments, implant-abutment, cleaning oral

implants, peri-implant tissues, sterilization, survey
PURPOSE: American and European standards recommend sterilization of customized abutments before
connecting them to implants, as customized abutments are considered semi-critical medical devices. Since
standardized procedures could not be identified in the literature on implantology, this survey evaluated the
protocols employed at different universities worldwide to clean, disinfect, and/or sterilize customized
abutments before their connection to bone-level implants.
MATERIALS AND METHODS: The survey took place between October 2015 and January 2016. A single
question acquiring information on how customized abutments were treated prior to connection to the
implants was sent by email to researchers affiliated at 100 universities worldwide. To avoid any bias, the
survey was kept rigorously anonymous. A total of 100 universities from Europe (56), USA and Canada (25),
Latin America (9), South Africa (1), Asia (6), and Australia and New Zealand (3) were invited to participate in
the survey.
RESULTS: Altogether, 85 universities responded to the survey question, and 22 (25.9%) declared that no
cleaning protocols were adopted. More than half of the respondents (n = 49, 57.6%) performed only one of
the three procedures required by the standards (cleaning, disinfection, or sterilization). Twelve respondents
(14.1%) adopted two procedures, and only two universities performed all three required procedures (2.4%).
CONCLUSION: This survey indicated substantial heterogeneity in treating customized abutments before
connecting them to implants. This study demonstrated that the majority of the universities applied either
cleaning, disinfection, or sterilization which may not meet the prevailing standards.
Int J Oral Maxillofac Implants. 2017 Jul/Aug;32(4):801-806. doi: 10.11607/jomi.5546.
Influence of the Posterior Mandible Ridge Morphology on Virtual Implant Planning.

Gallucci GO, Khoynezhad S, Yansane AI, Taylor J, Buser D, Friedland B.
Keywords: dental implants, mandibular classification, posterior edentulous mandible, ridge morphology,
virtual implant planning
26
PURPOSE: The purpose of this study was to examine the anatomy of the mandibular posterior region to
develop an anatomical categorization for implant-prosthodontic planning.
MATERIALS AND METHODS: Using cone beam computed tomography scans, 313 cross-sectional views
of edentulous posterior mandibular sites were evaluated with respect to the anatomical ridge morphology.
Virtual implant planning was performed, and the need for bone grafting was assessed. The level of
complexity for planning implants in those positions was assessed. Sites were classified as straightforward,
advanced, or complex sites based on the need for bone grafting.
RESULTS: Five well-defined cross-sectional configurations were observed: straight (53.6%), oblique
(26.2%), s-shape (7.4%), hourglass shape (1.9%), and basal bone (10.8%). There was a statistically
significant association between the ridge shape and the feasibility of placing an implant with or without bone
grafting; the straight and oblique ridge shapes were more likely to be associated with a favorable anatomy for
implant placement.
CONCLUSION: The ridge shape significantly influenced the ease or difficulty of placing an implant. The s-
shape, hourglass, and basal bone posterior mandibular cross-sectional shapes were associated with a
higher degree of difficulty.
Int J Oral Maxillofac Implants. 2017 July/August;32(4):880–892. doi: 10.11607/jomi.5454. Epub 2017 Mar 23.
Benchmarking Outcomes in Implant Prosthodontics: Partial Fixed Dental

Prostheses and Crowns Supported by Implants with a Turned Surface over 10 to 28
Years at the University of Toronto.
Jokstad A, Gussgard AM, Fava J, Lin M, Shokati B, Somogyi-Ganss E, Winnett B, Zahran M.
Keywords: dental implantation, dental implants, edentulous jaw, endosseous, implant placement, implant-
supported dental prostheses, stomatognathic system
PURPOSE: The aim of this noninterventional, retrospective study was to benchmark the outcomes of
patients with partial fixed prostheses supported by implants treated at the University of Toronto at least 10
years earlier. A study protocol for assessing outcomes on like patients developed at the University of Bern,
Switzerland, was followed.
MATERIALS AND METHODS: All patients who had received at least one implant before 2002 were
considered eligible to be included in the study (n = 298). The treatment histories were recorded from the
patient chart of the participants, or from the participants' dentists by consent. Calibrated clinicians examined
the study participants clinically and radiologically and recorded peri-implant mucosal status and observable
technical and mechanical failures. Past adverse events were identified in the patient charts. Independent
assessors measured bone levels on digitized radiographs. Statistical analysis included descriptive statistics
at implants, teeth, and study participant levels, respectively.
RESULTS: Of the 298 eligible patients, 121 attended a clinical examination (41%), while 12 declined (4%).
The 121 study participants had received 321 implants between 1983 and 2001. The implants showed a
success rate of 88.9% and a survival rate of 94% after an average of 17.5 years (SD 5.2, range 10 to 28
years). Approximately 5% of the surviving implants showed signs, or were associated with a prior history, of
peri-implantitis. The distance from the implant shoulder to the first bone contact varied from -3 mm to 7 mm
(mean = 1.52 mm [SD 1.57], median = 2.2 mm). Approximately half of the study participants had
experienced at least one defect of their superstructure, representing a 52% "success rate," while the survival
rate was 70%. The majority were very satisfied or satisfied with the treatment (102/121).
27
CONCLUSION: A high proportion (94%) of conventional machined Brånemark System implants placed
between 1983 and 2001 remained in function after an average of 17.5 years. The original superstructures
predominantly fabricated as prefabricated acrylic teeth and acrylic resin reinforced with a cast palladium-
silver alloy core were still in place for 70% of the participants, and 48% of the superstructures had never
undergone any form of repairs.
Int J Oral Maxillofac Implants. 2017 Jul/Aug;32(4):904-911. doi: 10.11607/jomi.5578.
Assessment of Long-Term Survival of Immediately Loaded Tilted Implants

Supporting a Maxillary Full-Arch Fixed Prosthesis.
Testori T, Galli F, Fumagalli L, Capelli M, Zuffetti F, Deflorian M, Parenti A, Del Fabbro M.
Keywords: immediate loading, maxilla, tilted impalnts, 10-year follow-up

PURPOSE: To analyze the long-term outcome of fixed prostheses supported by six implants, two of which
were tilted, placed in the maxilla and immediately loaded more than 10 years earlier.
MATERIALS AND METHODS: A retrospective review of implants placed between May 29, 2003 and
February 12, 2005 and used to support immediately loaded fixed dental prostheses in the maxilla was
conducted. The features of failed implants were analyzed. In the most recent follow-up visits, survival of
individual implants and prostheses was verified, and modified Plaque Index as well as modified Sulcular
Bleeding Index were assessed. Patients also filled out a questionnaire requiring graded responses from 0
(poor) to 10 (excellent) that was designed to assess their quality of life.
RESULTS: A total of 162 implants were placed between May 29, 2003 and February 12, 2005 to support
immediately loaded maxillary fixed prostheses of 27 totally edentulous patients (19 female, 8 male). Three
patients (1 male, 2 female) dropped out, so 144 implants were followed up. Seven of the 144 original
implants failed, corresponding to a survival rate of 95.1% over 10 years. All the failures occurred within 2
years after surgery. Patients' responses to the questionnaire produced an average score of 8.4 to 8.8,
showing a relevant degree of satisfaction.
CONCLUSION: Based upon this study of 27 patients who received immediately loaded maxillary full-arch
fixed implant-supported prostheses supported by two tilted and four axial implants, it appears that this is a
reliable procedure with a high long-term survival rate and a high level of patient satisfaction.
The Journal of Prosthetic Dentistry
J Prosthet Dent. 2017 Jul;118(1):10-17. doi: 10.1016/j.prosdent.2016.10.036. Epub 2017 Apr 3.
Clinician assessments and patient perspectives of single-tooth implant restorations

in the esthetic zone of the maxilla: A systematic review.
Arunyanak SP, Pollini A, Ntounis A, Morton D.
28
STATEMENT OF PROBLEM: Esthetic outcomes associated with implant dentistry are important to both
clinicians and patients. However, esthetic satisfaction may vary between the 2 groups. In order to evaluate
the current publications relating to this topic, the following focused question was developed, "what are the
quantitative and qualitative differences between clinician evaluations and patient perspectives in the
assessment of single-tooth implant outcomes in the esthetic zone?"
PURPOSE: The purpose of this systematic review was to identify differences in esthetic satisfaction between
clinicians and patients when evaluating single-tooth implant-supported restorations.
MATERIAL AND METHODS: An electronic search of the Medline database and Cochrane Central Register
of Controlled Trials (2000 to 2014) was performed. The search was supplemented by a manual search of
specific journals. A quality assessment of full-text articles was performed according to Cochrane
Collaboration's tool and Newcastle-Ottawa scale for risk of bias assessment. Information regarding
outcomes was collected and compared.
RESULTS: The search term combinations identified 555 titles. Subsequent to further review, 11
publications, including 2 randomized controlled trials, were selected for inclusion. Because of the
heterogeneity of the study designs, study interventions, and esthetic assessment methods, no meta-analysis
was performed. The clinicians identified a satisfactory outcome in 51% to 100% for peri-implant soft tissue
and 62% to 90% for implant restorations. Patients showed a mean range score of 43% to 93% for peri-
implant soft tissue and 81% to 96% for implant restorations. The visual analog scale score of the dentists
was always lower than that of the patients. The review identified correlations between subjective and
objective assessments for the Pink Esthetic Score (PES), the Papilla Index (PI), the Implant Crown Aesthetic
Index (ICAI), and the modified (mod-ICAI) indices.
CONCLUSION: Clinicians are more critical of esthetic outcomes than patients. The PES and the PI
correlated with the patients' responses concerning the peri-implant soft tissue. The ICAI and the mod-ICAI
showed a correlation of both the peri-implant mucosa and implant-supported crown satisfaction. Thus, a
comprehensive and practical index should be developed to assess the esthetic outcomes for single-tooth
implant restorations in the esthetic zone.
J Prosthet Dent. 2017 Jul;118(1):31-35. doi: 10.1016/j.prosdent.2016.10.002. Epub 2016 Dec 4.
In vitro effects of dental cements on hard and soft tissues associated with dental
implants.
Rodriguez LC, Saba JN, Chung KH, Wadhwani C, Rodrigues DC.
STATEMENT OF PROBLEM: Dental cements for cement-retained restorations are often chosen based on
clinician preference for the product's material properties, mixing process, delivery mechanism, or viscosity.
The composition of dental cement may play a significant role in the proliferation or inhibition of different
bacterial strains associated with peri-implant disease, and the effect of dental cements on host cellular
proliferation may provide further insight into appropriate cement material selection.
PURPOSE: The purpose of this in vitro study was to investigate the cellular host response of bone cells
(osteoblasts) and soft tissue cells (gingival fibroblasts) to dental cements.
MATERIAL AND METHODS: Zinc oxide (eugenol and noneugenol), zinc phosphate, and acrylic resin
cements were molded into pellets and directly applied to confluent preosteoblast (cell line MC3T3 E1) or
gingival fibroblast cell cultures (cell line HGF) to determine cellular viability after exposure. Controls were
defined as confluent cell cultures with no cement exposure. Direct contact cell culture testing was conducted
following International Organization for Standardization 10993 methods, and all experiments were performed
in triplicate. To compare either the MC3T3 E1 cell line, or the HGF cell line alone, a 1-way ANOVA test with
multiple comparisons was used (α=.05). To compare the MC3T3 E1 cell line results and the HGF cell line
results, a 2-way ANOVA test with multiple comparisons was used (α=.05).
29
RESULTS: The results of this study illustrated that while both bone and soft tissue cell lines were vulnerable
to the dental cement test materials, the soft tissue cell line (human gingival fibroblasts) was more susceptible
to reduced cellular viability after exposure. The HGF cell line was much more sensitive to cement exposure.
Here, the acrylic resin, zinc oxide (eugenol), and zinc phosphate cements significantly reduced cellular
viability after exposure with respect to HGF cells only.
CONCLUSION: Within the limitation of this in vitro cellular study, the results indicated that cell response to
various implant cements varied significantly, with osteoblast proliferation much less affected than gingival
fibroblast cells. Furthermore, the zinc oxide noneugenol dental cement appeared to affect the cell lines
significantly less than the other test cements.
Evaluation of the accuracy of 7 digital scanners: An in vitro analysis based on 3-

dimensional comparisons.
Renne W, Ludlow M, Fryml J, Schurch Z, Mennito A, Kessler R, Lauer A.
STATEMENT OF PROBLEM: As digital impressions become more common and more digital impression
systems are released onto the market, it is essential to systematically and objectively evaluate their
accuracy.
PURPOSE: The purpose of this in vitro study was to evaluate and compare the trueness and precision of 6
intraoral scanners and 1 laboratory scanner in both sextant and complete-arch scenarios. Furthermore, time
of scanning was evaluated and correlated with trueness and precision.
MATERIAL AND METHODS: A custom complete-arch model was fabricated with a refractive index similar
to that of tooth structure. Seven digital impression systems were used to scan the custom model for both
posterior sextant and complete arch scenarios. Analysis was performed using 3-dimensional metrology
software to measure discrepancies between the master model and experimental casts.
RESULTS: Of the intraoral scanners, the Planscan was found to have the best trueness and precision while
the 3Shape Trios was found to have the poorest for sextant scanning (P<.001). The order of trueness for
complete arch scanning was as follows: 3Shape D800 >iTero >3Shape TRIOS 3 >Carestream 3500
>Planscan >CEREC Omnicam >CEREC Bluecam. The order of precision for complete-arch scanning was
as follows: CS3500 >iTero >3Shape D800 >3Shape TRIOS 3 >CEREC Omnicam >Planscan >CEREC
Bluecam. For the secondary outcome evaluating the effect time has on trueness and precision, the
complete- arch scan time was highly correlated with both trueness (r=0.771) and precision (r=0.771).
CONCLUSION: For sextant scanning, the Planscan was found to be the most precise and true scanner. For
complete-arch scanning, the 3Shape Trios was found to have the best balance of speed and accuracy.
Randomized controlled within-subject evaluation of digital and conventional

workflows for the fabrication of lithium disilicate single crowns. Part II: CAD-CAM
versus conventional laboratory procedures.
Sailer I, Benic GI, Fehmer V, Hämmerle CHF, Mühlemann S.
30
STATEMENT OF PROBLEM: Clinical studies are needed to evaluate the entire digital and conventional
workflows in prosthetic dentistry.
PURPOSE: The purpose of the second part of this clinical study was to compare the laboratory production
time for tooth-supported single crowns made with 4 different digital workflows and 1 conventional workflow
and to compare these crowns clinically.
MATERIAL AND METHODS: For each of 10 participants, a monolithic crown was fabricated in lithium
disilicate-reinforced glass ceramic (IPS e.max CAD). The computer-aided design and computer-aided
manufacturing (CAD-CAM) systems were Lava C.O.S. CAD software and centralized CAM (group L), Cares
CAD software and centralized CAM (group iT), Cerec Connect CAD software and lab side CAM (group CiL),
and Cerec Connect CAD software with centralized CAM (group CiD). The conventional fabrication (group K)
included a wax pattern of the crown and heat pressing according to the lost-wax technique (IPS e.max
Press). The time for the fabrication of the casts and the crowns was recorded. Subsequently, the crowns
were clinically evaluated and the corresponding treatment times were recorded. The Paired Wilcoxon test
with the Bonferroni correction was applied to detect differences among treatment groups (α=.05).
RESULTS: The total mean (±standard deviation) active working time for the dental technician was 88 ±6
minutes in group L, 74 ±12 minutes in group iT, 74 ±5 minutes in group CiL, 92 ±8 minutes in group CiD, and
148 ±11 minutes in group K. The dental technician spent significantly more working time for the conventional
workflow than for the digital workflows (P<.001). No statistically significant differences were found between
group L and group CiD or between group iT and group CiL. No statistical differences in time for the clinical
evaluation were found among groups, indicating similar outcomes (P>.05).
CONCLUSION: Irrespective of the CAD-CAM system, the overall laboratory working time for a digital
workflow was significantly shorter than for the conventional workflow, since the dental technician needed less
active working time.
Journal of Oral and Maxillofacial Surgery
J Oral Maxillofac Surg. 2017 Jul;75(7):1387-1391. doi: 10.1016/j.joms.2017.03.024. Epub 2017 Mar 23.
Public and Patient Knowledge About Dental Implants.

Deeb G, Wheeler B, Jones M, Carrico C, Laskin D, Deeb JG.
PURPOSE: The more informed a patient is about a given procedure, the better the ultimate outcome. This
study was designed to compare general public awareness and knowledge regarding oral implant treatment
with those of patients presenting for such treatment and to determine the sources from which they may have
obtained such information, as well as the accuracy of the information.
PATIENTS AND METHODS: In this cross-sectional study, 2 groups of patients were asked to complete a
questionnaire containing implant knowledge questions and questions regarding any sources they may have
used to obtain information about dental implants. Group I consisted of patients presenting for treatment of a
dental emergency (general population group), and group II consisted of patients presenting for an implant
consultation. The χ2 test was used to determine whether there were differences in knowledge and
information sources between the 2 groups.
RESULTS: A total of 126 adult patients (76 dental emergency patients and 50 implant consultation patients)
participated in the study. The general population group was less informed about dental implants, especially
information relating to implant material and longevity, and received information from less reliable sources
than patients presenting for implant screening (friends or relatives vs primary dentist). Both groups reported
cost of the procedure as a primary barrier to receiving implants (89% and 90%).
31
CONCLUSION: There is still a need for continued education of the general public regarding dental implants.
J Oral Maxillofac Surg. 2017 Aug;75(8):1644-1655. doi: 10.1016/j.joms.2017.03.010. Epub 2017 Mar 18.
Influence of Lateral-Medial Sinus Width on No-Grafting Inlay Osteotome Sinus

Augmentation Outcomes.
Cheng X, Hu X, Wan S, Li X, Li Y, Deng F.
PURPOSE: Intrasinus new bone formation (BF) has been observed after no-grafting osteotome sinus
augmentation, and it is hypothesized to be influenced by the dimensions of the maxillary sinus. The aim of
this clinical trial is to evaluate the influence of lateral-medial sinus width (SW) on no-grafting osteotome sinus
augmentation outcomes using cone-beam computed tomography.
PATIENTS AND METHODS: All patients recruited for this prospective study were treated with no-grafting
osteotome sinus augmentation with simultaneous implant placement. Cone-beam computed tomography
was obtained before, immediately after, and 6 months after the surgical procedure to use for measurements.
Descriptive statistics were calculated and univariate, bivariate, and multivariate analysis were conducted to
evaluate the influence of average SW and other relevant factors on procedure outcomes, including new BF,
residual bone resorption (BR), and change of peri-implant bone height (CPBH).
RESULTS: A total of 48 implants placed in 32 elevated sinuses of 29 patients were included. The average
SW was 11.3 ± 1.8 mm. Intrasinus BF measured 1.7 ± 0.9 mm at 6 months after surgery. The amount of BR
was 0.3 ± 0.9 mm, and CPBH was calculated as 1.3 ± 1.3 mm. Multivariate analysis showed a negative
correlation between SW and BF (r = -0.469, P = .001), as well as between SW and CPBH (r = -0.562, P =
.001). A positive correlation was discovered between SW and BR (r = 0.311, P = .027) in general.
CONCLUSION: The lateral-medial SW was observed to have a negative correlation with new BF and CPBH
after no-grafting osteotome sinus augmentation.
The International Journal of Prosthodontics
Int J Prosthodont. 2017 Jul/Aug;30(4):321-326. doi: 10.11607/ijp.5023.
Economic Evaluation of Implant-Supported Overdentures in Edentulous Patients: A

Systematic Review.
Zhang Q, Jin X, Yu M, Ou G, Matsui H, Liang X, Sasaki K.
PURPOSE: Edentulous patients benefit significantly from implant-supported overdenture prostheses. The
purpose of this systematic review was to evaluate the cost-effectiveness of implant-supported overdentures
(IODs) for edentulous patients.
32
MATERIALS AND METHODS: The search was limited to studies written in English and included an
electronic and manual search through MEDLINE (Ovid, 1946 to November 2015), Embase (Ovid, 1966 to
November 2015), Cochrane Central Register of Controlled Trials (CENTRAL) (to November 2015), and
PubMed (to November 2015). Two investigators extracted the data and assessed the studies independently.
No meta-analysis was conducted due to the high heterogeneity within the literature.
RESULTS: Of the initial 583 selected articles, 10 studies involving 802 participants were included. Of these,
6 studies had a high risk of bias and the rest had an unclear risk of bias. Implant-supported prostheses were
more cost-effective when compared to conventional dentures and fixed implant-supported prostheses.
Overdentures supported by two implants and magnet attachment were reported as cost-effective.
CONCLUSION: Implant-supported overdentures are a cost-effective treatment for edentulous patients. More
clinical studies with appropriate scientific vigor are required to further assess the cost-effectiveness of
implant-supported overdentures.
Does Surgical Experience Influence Implant Survival Rate? A Systematic Review

and Meta-Analysis.
Sendyk DI, Chrcanovic BR, Albrektsson T, Wennerberg A, Zindel Deboni MC.
PURPOSE: The aim of this study was to assess the evidence of a correlation between the expertise of
surgeons and the survival rate of dental implants.
MATERIALS AND METHODS: An electronic search in four databases (MEDLINE, EMBASE, SCOPUS, and
the Cochrane Library) was performed for publications from their inception to May 2016 and was
supplemented by manual searches. Prospective and retrospective cohorts were included if they met the
following criteria: (1) the presence of an exposed group (inexperienced surgeons); and (2) the presence of a
control group (experienced surgeons). Meta-analyses were performed to evaluate the effect of expertise on
implant failure.
RESULTS: Of 609 potentially eligible articles, 8 were included in the qualitative analysis and 6 in the
quantitative synthesis. Two meta-analyses were performed for different definitions of experienced surgeons.
In the first meta-analysis, which included four retrospective comparative studies that defined experienced
professionals as specialists, the experience of the surgeon did not significantly affect the implant failure rate
(P = .54), with an odds ratio (OR) of 1.24 (95% CI, 0.62-2.48). In the second meta-analysis, which included
two retrospective studies that defined experienced surgeons as professionals that had placed more than 50
implants, the expertise of the surgeon did significantly affect the implant failure rates (P = .0005), with an OR
of 2.18 (95% CI, 1.40-3.39).
CONCLUSION: The data from the included publications suggest that surgical experience did not significantly
affect implant failure when considering experience based on specialty but were significantly affected when
considering experience based on the number of implants placed. Further standardized prospective studies
with a control of confounding factors are needed to clarify the role of surgical expertise on implant survival
rates.
33
Reliability of a CAD/CAM Surgical Guide for Implant Placement: An In Vitro

Comparison of Surgeons' Experience Levels and Implant Sites.
Park SJ, Leesungbok R, Cui T, Lee SW, Ahn SJ.
PURPOSE: This in vitro study evaluated the reliability of a surgical guide with regard to different levels of
operator surgical experience and implant site.
MATERIALS AND METHODS: A stereolithographic surgical guide for epoxy resin mandibles with three
edentulous molar sites was produced using a computer-aided design/computer-assisted manufacture
(CAD/CAM) system. Two surgeons with and two surgeons without implant surgery experience placed
implants in a model either using or not using the CAD/CAM surgical guide. Four groups were created:
inexperienced surgeon without the guide (group 1); experienced surgeon without the guide (group 2);
inexperienced surgeon with the guide (group 3); and experienced surgeon with the guide (group 4). Planned
implants and placed implants were superimposed using digital software, and deviation parameters were
calculated.
RESULTS: There were no significant differences in any of the deviation parameters between the groups
when using the surgical guide. With respect to the implant sites, there were no significant differences among
the groups in any parameter.
CONCLUSION: Use of the CAD/CAM surgical guide reduced discrepancies among operators performing
implant surgery regardless of their level of experience. Whether or not the guide was used, differences in the
anterior-posterior implant site in the molar area did not affect the accuracy of implant placement.
Osseointegration of a Zirconia Implant: A Histologic Assessment.

Schepke U, Meijer GJ, Meijer HJ, Walboomers XF, Cune M.
PURPOSE: The aim of this study was to describe the histologic and histomorphometric features of a
retrieved, functional endosseous zirconia implant in a human subject.
MATERIALS AND METHODS: A maxillary zirconia implant (ZV3) placed in a 52-year-old man was retrieved
after 2 years of uncompromised service and prepared for light microscopic evaluation.
RESULTS: Histologic examination demonstrated good osseointegration. Bone contact measurements
revealed a mean percentage of bone-to-implant contact of 55.8% (SD 3.8%).
CONCLUSION: The histologic data provide further evidence of the potential of zirconia implants to
osseointegrate to a similar degree as titanium in humans.
Comparison of Clinical, Radiographic, and Immunologic Inflammatory Parameters

Around Dental Implants with Cement-Retained and Screw-Retained Restorations: A
5-Year Prospective Cohort Study in Men.
Al Amri MD, Al-Rasheed AS, Al-Kheraif AA, Alfadda SA.
34
PURPOSE: To compare bleeding on probing (BoP), probing depth (PD; ≥ 4 mm), radiographic (peri-implant
crestal bone loss [CBL]), and immunologic inflammatory (interleukin-1beta [IL-1β] and matrix
metalloproteinase-9 [MMP-9]) parameters around dental implants with cement-retained (CR) and screw-
retained (SR) implant-supported crowns.
MATERIALS AND METHODS: Based on the mode of retention of the restoration, 51 patients were divided
into two groups: Group 1, consisting of 26 single implants restored with CR crowns, and Group 2, consisting
of 25 single implants restored with SR crowns. Peri-implant BoP, PD, and CBL were scored, and levels of IL-
1β and MMP-9 in the peri-implant crevicular fluid (PICF) in both groups were measured in duplicate using
enzyme-linked immunosorbent assay. Full-mouth mechanical debridement was performed biannually in both
groups. Statistical analysis was performed using Kruskal-Wallis test with the significance level set at P < .05.
RESULTS: The mean CBL among implants in groups 1 and 2 was 1.7 ± 0.5 mm and 1.7 ± 0.4 mm,
respectively. There was no statistically significant difference in mean BoP, PD, and CBL among implants in
both groups (P > .05). There was no statistically significant difference between groups 1 and 2 in the PICF
levels of IL-1β (7.3 ± 0.5 and 7.2 ± 0.5, respectively) and MMP-9 (165 ± 9.4 and 182 ± 10.6, respectively) (P
> .05).
CONCLUSION: The mode of retention of implant-supported crowns does not appear to affect their clinical
correlations with BoP, PD, CBL, and levels of IL-1β and MMP-9 in the PICF when zinc oxide eugenol cement
is used.
The International Journal of Periodontics & Restorative

Dentistry
Int J Periodontics Restorative Dent. 2017 Jul/Aug;37(4):481-489. doi: 10.11607/prd.2844.
Correlation of Three-Dimensional Radiologic Data with Subsequent Treatment

Approach in Patients with Peri-implantitis: A Retrospective Analysis.
Bender P, Salvi GE, Buser D, Sculean A, Bornstein MM.
Abstract: The purpose of this retrospective radiographic study was to evaluate and correlate the dimensions
and morphology of peri-implant bone defects as determined via cone beam computed tomography (CBCT)
scans with regard to the selected treatment approach. Vertical and horizontal peri-implant bone defects
(mesial, distal, mesio-oral, mesiobuccal, disto-oral, distobuccal, oral, and buccal) in peri-implantitis cases
were measured. Three-dimensional data and defect morphology were correlated to the treatment approach
chosen (explantation versus implant retention). A total of 19 patients and 28 implants met the inclusion
criteria, resulting in a sample size of 224 sites and a total of 896 measurements. The mean percent bone
loss did not correlate to the type of treatment chosen (P = .1286). In contrast, when only the maximum
vertical values per implant were selected, maximum percent bone loss exhibited a significant correlation to
the type of treatment chosen (P = .0021). The effect of the defect morphology on the treatment strategy
chosen did not show a statistically significant correlation (P = .4685). Based on the data presented, the
maximum bone loss around the implant seems to be a critical factor in deciding whether or not an implant
should be explanted. The use of CBCT for treatment planning in cases of peri-implantitis can offer valuable
additional information but should be considered only after initial clinical examination and two-dimensional
imaging.
35
Int J Periodontics Restorative Dent. 2017 Jul/Aug;37(4):e204-e209. doi: 10.11607/prd.3180.
Effect of Ceramic Barriers of Different Thicknesses on Microhardness of Light-

Cured Resin Cements.
do Nascimento YA, de Oliveira Correia AM, Lima DM, Griza S, Takeshita WM, Melo de Mendonça AA.
Abstract: This study evaluated the microhardness of two resin cements and a low-viscosity resin composite
when light-cured under different ceramic thicknesses. A total of 20 samples (10.0 × 1.0 mm) of each material
were polymerized by means of a LED light source with an intensity of 1,100 mW/cm2 for 20 seconds. For
each experimental group, different ceramic thicknesses (0.5 mm, 1.0 mm, and 1.5 mm) were applied to
each sample. For the control group, the samples were polymerized without the presence of ceramics. Each
material was then stored in dry vials that inhibited the passage of light for a period of 24 hours. After that
time, each sample underwent Vickers hardness test (HMV, Shimadzu: 25 g/10 seconds). The data were
collected and analyzed using analysis of variance and Tukey test (P < .05). For the control group, RelyX
Veneer (3M ESPE), Filtek Flow Z350XT (3M ESPE), and Allcem Veneer (FGM) showed mean
microhardness values and standard deviations of 44.42 ± 4.9, 44.25 ± 2.4, and 31.71 ± 2.4, respectively.
The lowest microhardness value (24.13) was found when the greatest ceramic thickness (1.5 mm) was used
on the Allcem Veneer cement (P < .01). The microhardness of resin-based materials was affected when the
1.5-mm-thick ceramic material was interposed during photoactivation.
Compendium of Continuing Education in Dentistry
Compend Contin Educ Dent. 2017 Jul;38(7):436-443; quiz 444.
Risk Indicators and Prevention of Implant Soft-Tissue Complications: Interproximal

Papillae Loss and Midfacial Implant Mucosal Recessions.
Mailoa J, Miron RJ, Wang HL.
Abstract: Achieving a long-term esthetic implant restoration in the maxillary anterior area is sometimes
unpredictable. This article reviews several risk indicators of implant mucosal recession and loss of
interproximal papillae, and how to prevent these risks. Results obtained from the literature suggest that the
following factors are strongly related to implant soft-tissue complications: buccally positioned implant
placement, a thin gingival biotype, lack of an adequate amount of keratinized mucosa, implant placement
after ridge augmentation procedures, an increased distance of tooth bone peak to the contact point, and an
inadequate horizontal implant-tooth distance. Factors that have been shown to favor longterm stability and
improve implant esthetic outcomes include implant placement in an ideal 3-dimensional position, use of
platform-switching implant/abutment designs, and performing soft-tissue grafting. Careful assessment of the
above factors and adoption of suggested guidelines are critical to executing successful implant placement
with favorable esthetic outcomes while minimizing soft-tissue complications.
Compend Contin Educ Dent. 2017 Jul;38(7):492-494.
Digital Imaging and Prosthetic-Driven Implant Planning: Efficient, Accurate, and

Reliable Treatment.
Harris BT, Chen L, Lin WS.
36
Abstract: Implant-supported and -retained restorations have been widely accepted as predictable treatment
modalities for partially or fully edentulous patients. Proper implant position and angulation facilitates the
construction of an optimal restoration and is critical for its long-term success. The continuous technological
evolution in digital imaging and prosthetic-driven implant planning allows clinicians to surgically place
implants more accurately, predictably, and efficiently. Current digital imaging, digital prosthetic-driven implant
planning, and computer-guided implant surgery technology have dramatically changed dental implant
treatment, moving the conventional workflow into a digital one. More efficient, accurate, and reliable implant
placement can be achieved with current and continuous technology advancement.
See abstract on Journals website
37

Literature Update 2017.4, July-August

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Literature Update 2017.4, July-August

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ITI Literature Update

July - August 2017

ITI International Team for

Compiled by: Dr. Kati Benthaus Tel. +41 (0)61 270 83 83

Tel. +41 (0)61 270 83 83

Journal of Dental Research ............................................................................................................................. 3

Relationships among Bone Quality, Implant Osseointegration, and Wnt Signaling.

See abstract on PubMed Central

J Dent Res. 2017 Jul;96(8):909-916. doi: 10.1177/0022034517707513. Epub 2017 May 8.

Contribution of the PDL to Osteotomy Repair and Implant Osseointegration.

Keywords: bone; extraction socket; histology; immediate implant; periostin; regeneration

See abstract on PubMed Central

Keywords: electromyography; implant prosthesis; meta-analysis; systematic review

See abstract on PubMed Central

Long-term outcomes of simultaneous guided bone regeneration using native and

See abstract on PubMed Central

Social media patient testimonials in implant dentistry: information or

CONCLUSIONS: Balanced presentation in YouTube testimonials may be limited by bias of clinician-

See abstract on PubMed Central

CONCLUSIONS: The tooth-implant FDP seems to be a possible alternative to an implant-supported FDP.

See abstract on PubMed Central

See abstract on PubMed Central

See abstract on PubMed Central

Bruxism and dental implant treatment complications: a retrospective comparative

See abstract on PubMed Central

Implant surface roughness alterations induced by different prophylactic

Keywords: bacterial biofilm; dental implants; peri-implant diseases; prophylaxis; titanium

See abstract on PubMed Central

Sinus mucosa elevation using Bio-Oss® or Gingistat® collagen sponge: an

See abstract on PubMed Central

Single-staged vs. two-staged implant placement in vertically deficient alveolar

See abstract on PubMed Central

Comparable responses of osteoblast lineage cells to microstructured hydrophilic

See abstract on PubMed Central

One-year results of maxillary overdentures supported by 2 titanium-zirconium

See abstract on PubMed Central

Effects of different titanium zirconium implant surfaces on initial supragingival

Keywords: material sciences; microbiology; surface chemistry

See abstract on PubMed Central

Keywords: bone grafts; bone healing; dental implants; immediate implants

See abstract on PubMed Central

Dental implants in the elderly population: a systematic review and meta-analysis.

See abstract on PubMed Central

Keywords: dehiscence defect; extraction; fenestration defect; flapless; wound healing

See abstract on PubMed Central

The effect of a flapless alveolar ridge preservation procedure with or without a

Keywords: animal model; bone formation; extraction socket; grafting

See abstract on PubMed Central

See abstract on PubMed Central

Keywords: alveolar ridge preservation; gingival tissue; histology; tooth extraction

See abstract on PubMed Central

Experimental mucositis and experimental gingivitis in persons aged 70 or over.

See abstract on PubMed Central

Decontamination of titanium implants using physical methods.

Keywords: biomaterials; laser; periodontology; surface chemistry

See abstract on PubMed Central

Journal of Clinical Periodontology

Non-surgical treatment of peri-implant mucositis and peri-implantitis at two-piece

See abstract on PubMed Central

Peri-implant bone density around implants of different lengths: A 3-year follow-up

Keywords: RCT; bone level; dental implants; dental radiography

See abstract on PubMed Central

See abstract on PubMed Central