Literature Update, 2017, 6, November-December

ITI Literature Update
November – December 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
Dental Materials ................................................................................................................................................ 3
Clinical Oral Implants Research ...................................................................................................................... 5
European Journal of Oral Implantology ....................................................................................................... 18
Journal of Clinical Periodontology ............................................................................................................... 20
Journal of Dentistry ........................................................................................................................................ 24
Journal of Periodontology ............................................................................................................................. 25
Clinical Implant Dentistry and Related Research ........................................................................................ 26
The Journal of Periodontal Research ........................................................................................................... 30
The Journal of Prosthodontic Research ...................................................................................................... 31
Clinical Oral Investigations ........................................................................................................................... 31
The International Journal of Oral and Maxillofacial Implants .................................................................... 34
The Journal of Oral Rehabilitation ................................................................................................................ 37
The Journal of Prosthetic Dentistry.............................................................................................................. 38
Oral & Maxillofacial Surgery Clinics ............................................................................................................. 41
Journal of Oral and Maxillofacial Surgery.................................................................................................... 41
The International Journal of Prosthodontics............................................................................................... 42
The Journal of Oral Implantology ................................................................................................................. 43
The International Journal of Periodontics & Restorative Dentistry .......................................................... 46
Dental Mater Journal ...................................................................................................................................... 47
Implant Dentistry ............................................................................................................................................ 47
International Journal of Oral Maxillofacial Surgery .................................................................................... 49
Journal of Dentistry (Shiraz, Iran) ................................................................................................................. 50
Publications in 2017 that resulted from ITI-funded research projects ...................................................... 51
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Dental Materials
Dent Mater. 2017 Nov;33(11):1298-1314. doi: 10.1016/j.dental.2017.08.193. Epub 2017 Sep 23.
Nanoparticles in dentistry.
Schmalz G, Hickel R, van Landuyt KL, Reichl FX.
Keywords: Composites; Nanoparticles; Organs; Risc assessment; Titan

OBJECTIVE: Nanoparticles having a size from 1 to 100nm are present in nature and are successfully used
in many products of daily life. Nanoparticles are also embedded per se or as byproducts from milling
processes of larger filler particles in many dental materials.
METHODS AND RESULTS: Recently, possible adverse effects of nanoparticles have gained increased
interest with the lungs being a main target organ. Exposure to nanoparticles in dentistry may occur in the
dental laboratory, by processing gypsum type products or by grinding and polishing materials. In the dental
practice virtually no exposure to nanoparticles occurs when handling unset materials. However,
nanoparticles are produced by intraoral adjustment of set restorative materials through grinding/polishing
regardless whether they contain nanoparticles or not. Nanoparticles may also be produced through wear of
restorations or released from dental implants and they enter the environment when removing restorations.
The risk for dental technicians is taken care of by legal regulations. Based on model worst case mass-based
calculations, the exposure of dental practice personnel and patients to nanoparticles through intraoral
grinding/polishing and wear is low to negligible. Accordingly, the additional risk due to nanoparticles
exposure from present materials is considered to be low. However, more research is needed, especially on
vulnerable groups (asthma or COPD). An assessment of risks for the environment is not possible due to the
lack of data.
SIGNIFICANCE: Measures to reduce exposure to nanoparticles include intraorally grinding/polishing using

water coolants, proper sculpturing to reduce the need for grinding and sufficient ventilation of treatment
areas.
See abstract on PubMed Central
Dent Mater. 2017 Nov;33(11):e385-e392. doi: 10.1016/j.dental.2017.07.011. Epub 2017 Aug 5.
Aging of 3Y-TZP dental zirconia and yttrium depletion.

Pandoleon P, Kontonasaki E, Kantiranis N, Pliatsikas N, Patsalas P, Papadopoulou L, Zorba T,
Paraskevopoulos KM, Koidis P.
Keywords: Aging; FTIR; Fluorescence; Oxygen vacancies; SEM–EDS; Transformation; XPS; XRD; Yttrium
depletion; Zirconia ceramics
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OBJECTIVE: Yttrium-stabilized zirconia is susceptible to low temperature degradation after interaction with
water. Various mechanisms by which water molecules destabilize the tetragonal phase have been proposed,
while the concept of yttrium depletion by the incorporation of hydroxyl ions in the crystalline structure either
through the formation of YOH/ZrOH bonds or small α-Y(OH)3 crystallites, is prevailing. The present study
was performed to investigate the surface alterations on a 3Y-TZP dental ceramic during the process of in-
vitro aging and to further explore the yttrium depletion mechanism that occurs upon interaction with water.
METHODS: Surface structural changes of zirconia specimens where investigated before and after in-vitro
aging with X-ray diffraction analysis, Fourier-transformed infrared spectroscopy, X-ray photoelectron
spectroscopy, fluorescence microscopy and scanning electron microscopy.
RESULTS: High luminescence generated from the non-aged specimen was explained by the high amount of
oxygen vacancies. The phase transformation from the t-ZrO2 to the m-ZrO2 phase after aging was
accompanied by a significant loss of yttrium, a clear decrease of oxygen vacancies and a profound decrease
of luminescence. Surface oxygen vacancies either migrated into the inner of the specimens or/and/engaged
oxygen from the ZrO2 and formed the metallic phase of Y2O3 on the surface after aging.
SIGNIFICANCE: An "ideal" amount of oxygen vacancies that could stabilize the tetragonal phase in Y-TZP
zirconia ceramics, without compromising esthetics and LTD resistance, is still a matter of further research
and different susceptibilities to LTD among various dental zirconia ceramics are based on the amount of
oxygen vacancies that can be annihilated by water molecules.
Dent Mater. 2017 Nov 6. pii: S0109-5641(17)31059-X. doi: 10.1016/j.dental.2017.10.008. [Epub ahead of
print]
Osseointegration of zirconia dental implants in animal investigations: A systematic

review and meta-analysis.
Pieralli S, Kohal RJ, Lopez Hernandez E, Doerken S, Spies BC.
Keywords: BIC; Ceramics; Dental implants; Push-in; RTQ

OBJECTIVE: To determine the osseointegration rate of zirconium dioxide (ZrO2) dental implants in
preclinical investigations.
DATA: Data on the osseointegration rate was extracted considering the bone to implant contact (BIC),
removal torque analysis (RTQ) and push-in tests. Meta analyses were conducted using multilevel
multivariable mixed-effects linear regression models. The Šidák method was used in case of multiple testing.
SOURCES: An electronic screening of the literature (MEDLINE/Pubmed, Cochrane Library and Embase)
and a supplementary manual search were performed. Animal investigations with a minimum sample size of
3 units evaluating implants made of zirconia (ZrO2) or its composites (ZrO2>50vol.%) were included.
STUDY SELECTION: The search provided 4577 articles, and finally 54 investigations were included and
analyzed. Fifty-two studies included implants made from zirconia, 4 zirconia composite implants and 37
titanium implants. In total, 3435 implants were installed in 954 animals.
CONCLUSIONS: No significant influence of the evaluated bulk materials on the outcomes of interest could
be detected. When comparing different animal models, significant differences for the evaluated variables
could be found. These results might be of interest for the design of further animal investigations.
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Clinical Oral Implants Research
Clin Oral Implants Res. 2017 Nov;28(11):1325-1333. doi: 10.1111/clr.12988. Epub 2016 Sep 29.
Comparison of early osseointegration of SLA® and SLActive® implants in maxillary

sinus augmentation: a pilot study.
Alayan J, Vaquette C, Saifzadeh S, Hutmacher D, Ivanovski S.
Keywords: animal model; bone grafting; bone regeneration; bone substitute; dental implant;
histomorphometry; maxillary sinus augmentation
OBJECTIVE: To assess the impact of a hydrophilic implant surface (SLActive® ) placed into augmented
maxillary sinuses on bone-to-implant contact (BIC) and surrounding tissue composition when compared to a
hydrophobic surface (SLA® ).
MATERIAL AND METHODS: Four sheep underwent bilateral sinus augmentation. Each sinus received
anorganic bovine bone mineral + autogenous bone (ABBM + AB). Sixteen implants were subsequently
placed 12 weeks postgrafting with each sinus receiving a control (SLA® ) and test implant (SLActive® ). Two
animals were sacrificed at 2 weeks and another two animals were sacrificed at 4 weeks postimplantation.
The eight sinuses and 16 implants were processed for histomorphometry, which assessed bone-to-implant
contact (%BIC) and tissue elements (woven bone - WB, lamellar bone - LB, soft tissue - ST) in the
interthread region of implants within the augmented sinus.
RESULTS: There was a statistically significant increase in %BIC at week 4 compared to the week 2 animals
in both test (P < 0.005) and control (P < 0.005) groups. There was a statistically significant greater %BIC
around test implants when compared to control implants in both week 2 (P < 0.05) and week 4 animals (P <
0.05). Greater %WB (11.17% ±6.82) and %LB (11.06% ±3.67) were seen in the test implants when
compared to the control implants independent of time. This was only statistically significant for %LB (P <
0.05). A statistically significant reduction of 16.78% (±6.19) in %ST was noted in test implants when
compared to control implants (P < 0.05) independent of time.
CONCLUSION: Both time and the use of hydrophilic implant surface had a positive impact on %BIC around
implants placed into augmented maxillary sinuses. Hydrophilic implant surfaces also had a positive impact
on surrounding tissue composition. Larger trials are needed to better assess and detect differences between
these two surfaces in augmented maxillary sinuses.
Clin Oral Implants Res. 2017 Nov;28(11):1348-1353. doi: 10.1111/clr.12992. Epub 2016 Oct 14.
Survival of dental implants placed in sites of previously failed implants.

Chrcanovic BR, Kisch J, Albrektsson T, Wennerberg A.
Keywords: dental implants; implant failure; reimplantation; survival rate
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OBJECTIVES: To assess the survival of dental implants placed in sites of previously failed implants and to
explore the possible factors that might affect the outcome of this reimplantation procedure.
MATERIALS AND METHODS: Patients that had failed dental implants, which were replaced with the same
implant type at the same site, were included. Descriptive statistics were used to describe the patients and
implants; survival analysis was also performed. The effect of systemic, environmental, and local factors on
the survival of the reoperated implants was evaluated.
RESULTS: 175 of 10,096 implants in 98 patients were replaced by another implant at the same location
(159, 14, and 2 implants at second, third, and fourth surgeries, respectively). Newly replaced implants were
generally of similar diameter but of shorter length compared to the previously placed fixtures. A statistically
significant greater percentage of lost implants were placed in sites with low bone quantity. There was a
statistically significant difference (P = 0.032) in the survival rates between implants that were inserted for the
first time (94%) and implants that replaced the ones lost (73%). There was a statistically higher failure rate of
the reoperated implants for patients taking antidepressants and antithrombotic agents.
CONCLUSIONS: Dental implants replacing failed implants had lower survival rates than the rates reported
for the previous attempts of implant placement. It is suggested that a site-specific negative effect may
possibly be associated with this phenomenon, as well as the intake of antidepressants and antithrombotic
agents.
Clin Oral Implants Res. 2017 Nov;28(11):1360-1367. doi: 10.1111/clr.12994. Epub 2016 Dec 31.
Digital vs. conventional full-arch implant impressions: a comparative study.

Amin S, Weber HP, Finkelman M, El Rafie K, Kudara Y, Papaspyridakos P.
Keywords: dental implants; digital dentistry; digital implant impressions; edentulous; full-arch implant
impressions
PURPOSE: To test whether or not digital full-arch implant impressions with two different intra-oral scanners
(CEREC Omnicam and True Definition) have the same accuracy as conventional ones. The hypothesis was
that the splinted open-tray impressions would be more accurate than digital full-arch impressions.
MATERIAL AND METHODS:A stone master cast representing an edentulous mandible using five internal
connection implant analogs (Straumann Bone Level RC, Basel, Switzerland) was fabricated. The three
median implants were parallel to each other, the far left implant had 10°, and the far right had 15° distal
angulation. A splinted open-tray technique was used for the conventional polyether impressions (n = 10) for
Group 1. Digital impressions (n = 10) were taken with two intra-oral optical scanners (CEREC Omnicam and
3M True Definition) after connecting polymer scan bodies to the master cast for groups 2 and 3. Master cast
and conventional impression test casts were digitized with a high-resolution reference scanner (Activity 880
scanner; Smart Optics, Bochum, Germany) to obtain digital files. Standard tessellation language (STL)
datasets from the three test groups of digital and conventional impressions were superimposed with the STL
dataset from the master cast to assess the 3D deviations. Deviations were recorded as root-mean-square
error. To compare the master cast with conventional and digital impressions at the implant level, Welch's F-
test was used together with Games-Howell post hoc test.
RESULTS: Group I had a mean value of 167.93 μm (SD 50.37); Group II (Omnicam) had a mean value of
46.41 μm (SD 7.34); Group III (True Definition) had a mean value of 19.32 μm (SD 2.77). Welch's F-test was
used together with the Games-Howell test for post hoc comparisons. Welch's F-test showed a significant
difference between the groups (P < 0.001). The Games-Howell test showed statistically significant 3D
deviations for all three groups (P < 0.001).
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CONCLUSION: Full-arch digital implant impressions using True Definition scanner and Omnicam were
significantly more accurate than the conventional impressions with the splinted open-tray technique.
Additionally, the digital impressions with the True Definition scanner had significantly less 3D deviations
when compared with the Omnicam.
Clin Oral Implants Res. 2017 Nov;28(11):1368-1380. doi: 10.1111/clr.12996. Epub 2016 Dec 25.
The influence of collagen membrane and autogenous bone chips on bone

augmentation in the anterior maxilla: a preclinical study.
Janner SFM, Bosshardt DD, Cochran DL, Chappuis V, Huynh-Ba G, Jones AA, Buser D.
Keywords: anterior maxilla; autogenous bone; bone healing; bovine bone; collagen membrane; dehiscence
defect; dental implant; dog; early implant placement; guided bone regeneration; osseointegration; titanium-
zirconium alloy
OBJECTIVES: To evaluate the effect of a resorbable collagen membrane and autogenous bone chips
combined with deproteinized bovine bone mineral (DBBM) on the healing of buccal dehiscence-type defects.
MATERIAL AND METHODS: The second incisors and the first premolars were extracted in the maxilla of
eight mongrels. Reduced diameter, bone-level implants were placed 5 weeks later. Standardized buccal
dehiscence-type defects were created and grafted at implant surgery. According to an allocation algorithm,
the graft composition of each of the four maxillary sites was DBBM + membrane (group D + M), autogenous
bone chips + DBBM + membrane (group A + D + M), DBBM alone (group D) or autogenous bone chips +
DBBM (group A + D). Four animals were sacrificed after 3 weeks of healing and four animals after 12 weeks.
Histological and histomorphometric analyses were performed on oro-facial sections.
RESULTS: The pattern of bone formation and resorption within the grafted area showed high variability
among the same group and healing time. The histomorphometric analysis of the 3-week specimens showed
a positive effect of autogenous bone chips on both implant osseointegration and bone formation into the
grafted region (P < 0.05). The presence of the collagen membrane correlated with greater bone formation
around the DBBM particles and greater bone formation in the grafted region after 12 weeks of healing (P <
0.05). The oro-facial width of the augmented region at the level of the implant shoulder was significantly
reduced in cases where damage of the protection splints occurred in the first week of healing (P < 0.05).
CONCLUSIONS: The addition of autogenous bone chips and the presence of the collagen membrane
increased bone formation around DBBM particles. Wound protection from mechanical noxa during early
healing may be critical for bone formation within the grafted area.
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Clin Oral Implants Res. 2017 Nov;28(11):1388-1395. doi: 10.1111/clr.12998. Epub 2017 Jan 5.
Comparison between two antimicrobial protocols with or without guided bone

regeneration in the treatment of peri-implantitis. A histomorphometric study in
dogs.
Ramos UD, Suaid FA, Wikesjö UME, Susin C, Taba M Jr, Novaes AB Jr.
Keywords: animal experiments; biomaterials; bone regeneration; bone substitutes; guided tissue
regeneration; wound healing
OBJECTIVES: This study used a dog model to evaluate two antimicrobial protocols with or without guided
bone regeneration (GBR) in the surgical reconstruction of peri-implantitis defects.
MATERIAL AND METHODS: Eight beagle dogs subject to ligature-induced peri-implantitis were used. The
animals either received antimicrobial photodynamic therapy or topical tetracycline hydrochloride combined
with GBR or as stand-alone surgical interventions. Block biopsies of the defect sites for histological analysis
were obtained at euthanasia, 12 weeks postsurgery. The primary outcome of the study was re-
osseointegration; secondary outcomes included alveolar bone gain and remaining defect characteristics.
The effects of the implant site, early exposure, and type of antimicrobial protocol on bone regeneration were
also evaluated.
RESULTS: No significant differences were observed between the two antimicrobial protocols, and the
adjunctive use of GBR failed to significantly improve re-osseointegration or bone gain using either protocol.
Buccal sites and implant early exposure negatively affected bone regeneration.
CONCLUSION: Both antimicrobial therapies stand-alone or combined with GBR allowed similar and limited
bone gain.
Clin Oral Implants Res. 2017 Nov;28(11):1406-1410. doi: 10.1111/clr.13003. Epub 2017 Feb 13.
Retention of implant-supported overdentures at different implant angulations:

comparing Locator and ball attachments.
Sultana N, Bartlett DW, Suleiman M.
Keywords: Biomechanics; finite elemente analysis; material sciences; prosthodontics
OBJECTIVES: To assess the effect of implant angulation on the retention of two different attachment
systems for implant-supported overdentures after a simulated fatigue period of 5.5 years.
MATERIAL AND METHODS: Two test set-ups were constructed. A two-implant mandibular implant-
supported overdenture design was simulated using acrylic resin blocks to support implant replicas (Model 1
and Model 2). The replicas were set up in the canine regions (22-mm inter-implant distance). In Model 1, the
implants were parallel (0° to the vertical axis) and in Model 2 they were divergent (20° to the vertical axis).
The Locator and the ball attachment systems were tested at both set-ups. A simulated fatigue period of 5.5
years that equated to 10,000 cycles of insertion and removal of the denture was used. Retention values for
each attachment system at each angulation set-up were measured at baseline, every 500 cycles until 4000
cycles and then every 1000 cycles.
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RESULTS: After simulated fatigue, the retention for both systems at both set-ups reduced. The Locator
system reduced from 108.9 to 20.2 N in the parallel set-up and from 82.3 to 17.3 N in the divergent set-up.
For the ball system, the retention reduced from 56.2 to 46 N when parallel and from 45.7 to 40.7 N when
divergent.
CONCLUSION: Both attachment systems showed a significant reduction in retention after simulated fatigue
at both parallel and divergent set-ups. The change in implant angulation caused a significant reduction in
retention for the ball attachment system only, although this was still higher at the end of testing than the
Locator attachment system. The Locators also had a significantly faster rate of loss of retention at both set-
ups. Clinically, this may indicate that the ball attachments may perform better with divergent implants.
Clin Oral Implants Res. 2017 Nov;28(11):1411-1420. doi: 10.1111/clr.13005. Epub 2017 Mar 9.
Implant-guided supracrestal alveolar bone growth using scaffolds, BMP-2, and

novel scaffold-retaining device.
Wen B, Shafer D, Schleier P, Pendrys D, Kuhn L, Freilich M.
Keywords: Biomaterial scaffold; ng/rhBMP-2; scaffold retainer; vertical supracrestal bone growth
OBJECTIVE: To evaluate the efficacy of various scaffold systems and a Ti scaffold-retaining device with and
without non-glycosylated rhBMP-2 (BMP-2) for increasing the vertical alveolar bone growth in the intra-oral
mini-pig model.
METHODS: Forty-eight Straumann Bone Level implants with hydrophilic (SLActive) surfaces were partially
embedded in mandibles of 12 adult mini-pigs with the shoulder of the implant located 3 mm above the bone
crest. Twenty-four implants were placed in conjunction with BMP-2 (50 μg) incorporated within resorbable
scaffolds. Twenty-four additional control implants were placed with scaffolds only. Scaffolds were placed
around the implant and stabilized with a newly developed Ti "umbrella" scaffold retainer. Scaffolds included
(i) HA-coated collagen (Healos); (ii) biphasic HA/β-TCP crystals (Straumann Bone Ceramic, SBC); and (iii)
SBC crystals infused with polyethylene glycol (PEG) hydrogel. Eight test and control pairs for each scaffold
group were implanted. At 9 weeks, soft tissue healing was assessed and the extent of new vertical bone was
evaluated with microCT and histomorphometry.
RESULTS: microCT analysis revealed a mean of 167 ± 47 mm3 new supracrestal mineralized tissue
volume formation around the test sites where BMP-2 was released from the scaffold whereas the control
group (no BMP-2) showed a significantly lower mineralized tissue volume of 106 ± 55 mm3 . The SBC+BMP-
2 group had the highest mineralized tissue volume of 189 ± 36 mm3 . Histomorphometry showed bone-to-
implant contact of 54.5% for the test groups and 33.3% for the control groups and new vertical bone growth
of 2.2 ± 1.0 and 1.0 ± 0.9 mm, respectively. The SBC+BMP-2 group again demonstrated the best outcome
(2.7 ± 0.4 mm). The qualitative scoring of soft tissue dehiscence showed that the presence of BMP-2 yielded
far superior outcomes, 0.63 vs. 1.75 for all control implant sites (with scores ranging from 0, reflecting no soft
dehiscence, to 4, showing a completely exposed umbrella).
CONCLUSION: The release of BMP-2 from a SBC scaffold adjacent to a hydrophilic, rough Ti implant and
scaffold retention umbrella consistently regenerated the greatest volume and height of new vertical bone
along the length of the implant.
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Clin Oral Implants Res. 2017 Nov;28(11):1421-1432. doi: 10.1111/clr.13007. Epub 2017 Feb 13.
A systematic review of the survival and complication rates of resin-bonded fixed

dental prostheses after a mean observation period of at least 5 years.
Thoma DS, Sailer I, Ioannidis A, Zwahlen M, Makarov N, Pjetursson BE.
Keywords: Resin-bonded bridges; biological complications; complication rates; de-bonding; failures; fiber-
reinforced composite; fixed dental prostheses; longitudinal; success; survival; systematic review; technical
complications
OBJECTIVES: The objective of this systematic review was to assess the 5-year and 10-year survival of
resin-bonded fixed dental prostheses (RBBs) and to describe the incidence of technical and biological
complications.
MATERIALS AND METHODS: An electronic MEDLINE search complemented by manual searching was
conducted to identify prospective and retrospective cohort studies and case series on RBBs with a mean
follow-up time of at least 5 years. Patients had to have been examined clinically at the follow-up visit.
Assessment of the identified studies and data extraction were performed independently by two reviewers.
Failure and complication rates were analyzed using robust Poisson regression models to obtain summary
estimates of 5- and 10-year proportions.
RESULTS: The search provided 367 titles and 87 abstracts. Full-text analysis was performed for 22 articles
resulting in seven studies that met the inclusion criteria. Five articles were found through manual search, and
17 studies were provided from (Pjetursson et al. 2008, Clinical Oral Implants Research, 19, 131), resulting in
an overall number of included studies of 29. Meta-analysis of these studies reporting on 2300 RBBs
indicated an estimated survival of resin-bonded bridges of 91.4% (95 percent confidence interval [95% CI]:
86.7-94.4%) after 5 years and 82.9% (95% CI: 73.2-89.3%) after 10 years. A significantly higher survival rate
was reported for RBBs with zirconia framework compared with RBBs from other materials. RBBs with one
retainer had a significantly higher survival rate (P < 0.0001) and a lower de-bonding rate (P = 0.001)
compared with RBBs retained by two or more retainers. Moreover, the survival rate was higher for RBBs
inserted in the anterior area of the oral cavity compared with posterior RBBs. The most frequent
complications were de-bonding (loss of retention), which occurred in 15% (95% CI: 10.9-20.6%) and
chipping of the veneering material that was reported for 4.1% (95% CI: 1.8-9.5%) of the RBBs over an
observation period of 5 years.
CONCLUSION: Despite the high survival rate of RBBs after 5 and 10 years, technical complications like de-
bonding and minor chipping were frequent. RBBs with zirconia framework and RBBs with one retainer tooth
showed the highest survival rate.
Socket Shield Technique for immediate implant placement - clinical, radiographic

and volumetric data after 5 years.
Bäumer D, Zuhr O, Rebele S, Hürzeler M.
Keywords: alveolar bone preservation; buccal bone; esthetic zone; extraction socket; immediate implant;
socket shield
10
OBJECTIVES: Implant placement immediately after tooth extraction is often accompanied by resorption of
surrounding tissues. A clinical technique was developed where the buccal portion of the root is retained to
preserve the periodontal ligament and bundle bone. This technique is based on animal studies showing the
potential to preserve the facial tissues utilizing this approach. The purpose of this study was to gain more
insight regarding the safety of the technique with regard to biological and implant-related long-term
complications and to observe the clinical appearance of the peri-implant tissues. Another objective was to
evaluate volumetric changes of the affected facial contours in long-term and the esthetic outcomes.
MATERIAL AND METHODS: This study is a retrospective case series of 10 consecutive patients with
implant replacement between the maxillary first premolars. Impressions were made prior to extraction (t1)
and 5 years post-implant placement (t2). 3D-surface scans of the casts were digitally superimposed for
quantitative evaluation of alterations of the facial peri-implant tissue contours and soft tissue recessions.
Additionally, clinical data were collected (PPD, BOP, peri-apical radiographs and photographs).
RESULTS: All implants healed without adverse events. Peri-implant probing revealed healthy conditions.
The comparison of radiographic images showed physiologic bone remodeling at the implant shoulders.
Mean tissue loss on the facial side in oro-facial direction was -0.21 ± 0.18 mm. Average recession at
implants was -0.33 ± 0.23 mm and at neighboring teeth -0.38 ± 0.27 mm. Mean loss of the marginal bone
level at the implant shoulder amounted to 0.33 ± 0.43 mm at the mesial and 0.17 ± 0.36 mm at the distal
aspect of the implants. A mean pink esthetic score of 12 was recorded.
CONCLUSION: Volumetric analysis showed a low degree of contour changes from extraction and implant
placement to the follow-ups. Mucosal recession at the implant restoration was comparable to that of the
neighboring teeth. Within the limitations of this descriptive study, the socket shield technique offers reduced
invasiveness at the time of surgery and high esthetic outcomes with effective preservation of facial tissue
contours. This technique should not be used in routine clinical practice until a higher level evidence in the
form of prospective clinical trials is available.
Volumetric changes and peri-implant health at implant sites with or without soft
tissue grafting in the esthetic zone, a retrospective case-control study with a 5-year
follow-up.
Bienz SP, Jung RE, Sapata VM, Hämmerle CHF, Hüsler J, Thoma DS.
Keywords: dental implants; fixed partial denture; subepithelial connective tissue graft; volume stability;
volumetric analysis
OBJECTIVES: To evaluate the volumetric changes and peri-implant health at implant sites with and without
previous soft tissue grafting over a 5-year observation period.
MATERIAL AND METHODS: In 18 partially edentulous patients, dental implants were placed in the esthetic
zone (15-25) with simultaneous guided bone regeneration, followed by submerged healing. During the
healing phase, eight patients (test) received a subepithelial connective tissue graft, whereas 10 patients
(control) did not receive any soft tissue augmentation. Subsequently, abutment connection was performed
and final reconstructions were inserted. Impressions were taken 1 week after crown insertion and at 5 years.
Obtained casts were scanned and superimposed for volumetric and linear measurements. The mean
distance (MD) in the mid-buccal area between the two surfaces and the differences in buccal marginal
mucosal level (bMMLchange ) and in ridge width (RWchange ) were evaluated. Peri-implant health was
assessed using probing pocket depth (PPD) values, plaque index (PlI) and bleeding on probing (BOP).
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RESULTS: At a median follow-up time of 60.5 months a median MD of -0.38 mm (Min: -0.94; Max: -0.03)
(test) and of -0.51 mm (Min: -0.76; Max: 0.05) (control) was calculated. The level of the margo mucosae
(bMMLchange ) demonstrated a median loss of -0.42 mm (Min: -1.1; Max: -0.01) (test) and of -0.33 mm
(Min: -1.02; Max: 0.00) (control). The median RWchange ranged between -0.44 mm and -0.73 mm (test) and
between -0.49 mm and -0.54 mm (control). Mean PPD values slightly increased, whereas PlI and BOP
remained stable over time in both groups. None of the comparisons between the groups revealed statistically
significant differences (P > 0.35). A small sample size must be considered, however.
CONCLUSIONS: Limited by a retrospective case-control study design, implant sites with and without soft
tissue grafting on the buccal side revealed only minimal volumetric and linear changes and stability of peri-
implant parameters over 5 years.
Clin Oral Implants Res. 2017 Nov;28(11):e262-e270. doi: 10.1111/clr.13011. Epub 2017 Apr 4.
Guided bone regeneration with particulate vs. block xenogenic bone substitutes: a
pilot cone beam computed tomographic investigation.
Benic GI, Thoma DS, Jung RE, Sanz-Martin I, Unger S, Cantalapiedra A, Hämmerle CHF.
Keywords: alveolar ridge augmentation; alveolar ridge defect; animal study; block; bone; bone graft; bone
substitute; cone beam computed tomography; dental implants; guided bone regeneration; membrane
AIM: To test whether an equine bone substitute block used for guided bone regeneration (GBR) of peri-
implant defects differs from bovine block or particulate bone substitutes regarding the hard and soft tissue
contours of the augmented ridge.
MATERIAL & METHODS: Two semi-saddle bone defects were prepared in each side of the mandible of
eight dogs, and one titanium implant was inserted into every defect. The defects were randomly allocated to
receive one of the following treatments: bone augmentation by GBR using (1) particulate deproteinized
bovine bone mineral (DBBM) + a collagen membrane (CM), (2) block DBBM + CM, (3) equine bone
substitute block + CM, and (4) empty controls. After 4 months, the jaws were scanned by means of cone
beam computed tomography (CBCT). CBCT analysis was performed in one central and two lateral (mesial
and distal) regions of interest (ROI) of each site evaluating the horizontal thickness of the augmented hard
tissue (HThard tisue ) and the total thickness of hard and soft tissue (HTtotal ). The Wilcoxon-Pratt signed
rank test was used for statistical analysis.
RESULTS: In the majority of ROIs, equine and bovine blocks rendered significantly higher values in HThard
tissue and HTtotal than controls (P < 0.05). Generally, equine blocks reached the highest values in HThard
tissue and HTtotal followed by DBBM blocks and particulate DBBM. The differences in HThard tissue and
HTtotal between GBR groups were not statistically significant (P > 0.05). In the central ROI, HThard tissue at
the level of the implant shoulder measured 1.7 ± 1.4 mm for equine blocks, 1.7 ± 1.0 mm for DBBM blocks,
0.9 ± 1.2 mm for particulate DBBM, and 0 ± 0 mm for controls. The corresponding values in the lateral ROI
reached 1.9 ± 1.1 mm for equine blocks, 1.2 ± 0.8 mm for DBBM blocks, 1.0 ± 0.9 mm for particulate DBBM,
and 0 ± 0 mm for controls.
CONCLUSIONS: GBR with bone substitute blocks lead to higher ridge dimensions than empty controls. The
equine block with CM rendered the most favorable outcomes in hard and soft tissue contours followed by
DBBM block and DBBM granulate with CM.
12
Clin Oral Implants Res. 2017 Dec;28(12):1478-1483. doi: 10.1111/clr.13015. Epub 2017 Mar 28.
6-mm-long implants loaded with fiber-reinforced composite resin-bonded fixed

prostheses (FRCRBFDPs). A 5-year prospective study.
Rossi F, Lang NP, Ricci E, Ferraioli L, Marchetti C, Botticelli D.
Keywords: dental implants; early loading; fiber-reinforced resin-bonded; fixed partial dentures; implant
length; prospective study; short implants
AIM: To evaluate the clinical and radiographic outcomes and the survival rates of fiber-reinforced composite
resin-bonded fixed prostheses (FRCRBFDPs) placed in the posterior area supported by two short (6 mm)
implants.
MATERIALS AND METHODS: Twenty consecutive patients received 40 SLActive 6-mm-long implants with
a diameter of 4.1 mm (n = 29) or 4.8 mm (n = 11). Insertion torques and RFA (Resonance Frequency
Analysis) were measured at implant installation. The prosthetic rehabilitation was performed after 8 weeks
from insertion with a screw-retained two- or three-unit fixed dental prosthesis fabricated of FRCRBFDPs.
Implant survival rates and marginal bone levels were evaluated at various time intervals until 5 years after
loading.
RESULTS: Two of 20 patients lost four implants supporting two FRCRBFDPs between the second and the
third year of follow-up (cumulative survival rate: 90% after 5 years). Four patients suffered a fracture of the
prosthetic reconstruction, and the success rate of the rehabilitation was 70% after 5 years. A mean marginal
bone loss of 0.30 ± 0.34 mm was found after 5 years of function at the remaining implants.
CONCLUSION: The survival of short implants was 90% owing to two bridges losses in the maxilla. However,
the success rate of FRCRBFDPs over 5 years was only at 70%.
Clin Oral Implants Res. 2017 Dec;28(12):1492-1500. doi: 10.1111/clr.13017. Epub 2017 Mar 28.
Randomized clinical trial of ridge preservation using porcine bone/cross-linked

collagen vs. bovine bone/non-cross-linked collagen: cone beam computed
tomographic analysis.
Lim HC, Jung UW, You H, Lee JS.
Keywords: bone substitutes; collagen; cone beam computed tomography; randomized controlled trial; tooth
extraction
PURPOSE: The aim of this study was to radiographically compare horizontal and vertical alterations of the
alveolar ridge after ridge preservation using different combinations of biomaterials.
MATERIALS AND METHODS: The patients were randomly assigned into two groups: (a) the test group,
which received collagenated porcine bone plus cross-linked collagen membrane (n = 15), and (b) the control
group, which received collagenated bovine bone plus non-cross-linked collagen membrane (n = 15). Cone
beam computed tomography (CBCT) was performed immediately after ridge preservation and 4 months
thereafter to compare the horizontal and vertical alterations of the ridge. Intention-to-treat (ITT) and per
protocol (PP) analyses were performed.
RESULTS: In both analyses, there was no statistically significant difference in the horizontal alteration of the
alveolar ridge between the test and control groups: -1.3 ± 0.6 (ITT)/1.2 ± 0.5 (PP) vs. -1.5 ± 0.9 mm at the 1-
mm level; -1.2 ± 0.7 (ITT and PP) vs. -1.2 ± 0.7 mm at the 3-mm level; and -0.9 ± 0.7 (ITT)/ -0.9 ± 0.7 (PP)
vs. -0.9 ± 0.9 mm at the 5-mm level, whereas the vertical height in the midfacial area was significantly
reduced in the test group compared with the control group: --1.1 ± 2.8 (ITT)/1.5 ± 3.0 (PP) vs. -0.7 ± 1.8 mm.
13
CONCLUSIONS: The horizontal ridge alteration in ridge preservation did not differ significantly between
using the test the control groups, but the vertical ridge alteration was more pronounced when using the test
group (KCT0001709).
Clin Oral Implants Res. 2017 Dec;28(12):1515-1522. doi: 10.1111/clr.13020. Epub 2017 Apr 13.
The influence of the emergence profile on the amount of undetected cement excess
after delivery of cement-retained implant reconstructions.
Sancho-Puchades M, Crameri D, Özcan M, Sailer I, Jung RE, Hämmerle CHF, Thoma DS.
Keywords: cementation; dental cements; dental implants; peri-implantitis

OBJECTIVE: To test whether or not one of two emergence profile designs (concave or convex) is superior
to the other in terms of remaining cement following cementation of reconstructions on individualized
abutments and careful cement removal.
MATERIALS AND METHODS: A central incisor with a single implant-supported reconstruction was selected
as a model. Six types of abutments (n = 10) with two different emergence profile designs (concave (CC) and
convex (CV)) and three crown-abutment margin depths (epimucosal, 1.5 mm submucosal, 3 mm
submucosal) were fabricated through a CAD/CAM procedure. Lithium disilicate reinforced ceramic crowns
were cemented with chemically polymerized resin cement. A blinded investigator attempted to remove all
cement excess. Thereafter, the entire reconstruction was unscrewed and analyzed for the overall amount
and the depth of cement excess. Kruskal-Wallis and Mann-Whitney tests were used to investigate
differences between groups. When more than two groups were compared between each other, a Bonferroni
correction of the P value was performed.
RESULTS: Concave abutments presented significantly more cement remnants than CV abutments when
the entire abutment area of the epimucosal margin groups was evaluated (CC0 mm: mean 2.31 mm2 (SD
0.99) vs. CV0 mm: mean 1.57 mm2 (SD 0.55); P = 0.043). A statistically significant increase in remnants
was detected when the crown-abutment margin was located more submucosally for every abutment studied
(0 mm vs. 1.5 mm: P < 0.000, 0 mm vs 3 mm: P < 0.000, 1.5 mm vs. 3 mm: P < 0.000). The buccal
quadrant demonstrated the least, whereas the oral and interdental quadrants showed the greatest amount of
cement excess.
CONCLUSIONS: Concave emergence profile abutments and deep crown-abutment margin positions
increased the risk of cement excess. Oral and interdental areas are more prone to cement remnants than
other surface areas.
Clin Oral Implants Res. 2017 Dec;28(12):1577-1583. doi: 10.1111/clr.13028. Epub 2017 Jun 18.
Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized

bovine bone mineral with 10% collagen: 7-year-results.
Roccuzzo M, Pittoni D, Roccuzzo A, Charrier L, Dalmasso P.
Keywords: biomaterial; bone substitute; defect fill; peri-implantitis; surgical treatment
14
OBJECTIVES: The aim of this study was to evaluate the long-term results of the surgical treatment of single
peri-implantitis intrabony defects, by means of deproteinized bovine bone mineral with 10% collagen
(DBBMC).
MATERIAL AND METHODS: The original population consisted of 26 patients with one crater-like defect,
around either sandblasted and acid-etched (SLA) or titanium plasma-sprayed (TPS) dental implants, with a
probing depth (PD) ≥6 mm and no implant mobility (Roccuzzo et al. J Clin Periodontol. 2011; 38: 738).
Implants were mechanically debrided and treated using EDTA gel and chlorhexidine gel. The bone defects
were filled with DBBMC, and the flap was sutured around the non-submerged implant. Patients were placed
on an individually tailored supportive periodontal therapy (SPT).
RESULTS: Two patients were lost to follow-up. During SPT, additional antibiotic and/or surgical therapy was
necessary in eight implants, and four of these were removed for biologic complications. At 7-year, the
survival rate was 83.3% for SLA implants and 71.4% for TPS. PD was significantly reduced from 6.6 ± 1.3 to
3.2 ± 0.7 mm in SLA and 7.2 ± 1.5 to 3.4 ± 0.6 mm in TPS. Bleeding on probing decreased from 75.0 ±
31.2% to 7.5 ± 12.1% (SLA) and from 90.0 ± 12.9% to 30.0 ± 19.7% (TPS). When successful therapy was
defined as PD ≤5 mm, absence of bleeding/suppuration on probing, and no further bone loss, treatment
success was obtained in 2 of 14 (14.3%) of the TPS and in 7 of 12 (58.3%) of the SLA implants.
CONCLUSIONS: Seven years after surgical treatment with DBBMC, patients, in an adequate SPT,
maintained sufficient peri-implant conditions in many cases, particularly around SLA implants. Nevertheless,
some patients required further treatment and some lost implants. The clinical decision on whether implants
should be treated or removed should be based on several factors, including implant surface characteristics.
Clin Oral Implants Res. 2017 Dec;28(12):1592-1599. doi: 10.1111/clr.13030. Epub 2017 Jun 26.
Guided bone regeneration at zirconia and titanium dental implants: a pilot

histological investigation.
Benic GI, Thoma DS, Sanz-Martin I, Munoz F, Hämmerle CHF, Cantalapiedra A, Fischer J, Jung RE.
Keywords: alveolar ridge augmentation; alveolar ridge defect; animal study; bone; bone graft; bone
substitute; dental implants; guided bone regeneration; histology; membrane; zirconia; zirconium dioxide
AIM: To test whether guided bone regeneration (GBR) of peri-implant defects at zirconia (ZrO2 ) implants
differs from GBR at titanium (Ti) implants regarding the bone integration of the implant and of the grafting
material.
MATERIALS AND METHODS: Maxillary premolars and molars were extracted in seven dogs. After 5
months, four semi-saddle bone defects were created in each maxilla. Implant placement and simultaneous
GBR were performed using the following randomly assigned modalities: (1) ZrO2 implant + deproteinized
bovine bone mineral (DBBM) granules + a collagen membrane (CM), (2) ZrO2 implant + DBBM with 10%
collagen matrix + CM, (3) ZrO2 implant + DBBM block + CM, and (4) Ti implant + DBBM granules + CM.
After 3 months, one central histological section of each site was prepared. Histomorphometrical
assessments were performed evaluating the augmented area (AA) within the former bone defect (primary
outcome), the area of new bone (NB), bone substitute (BS), and non-mineralized tissue (NMT) within AA in
mm2 . In addition, the distance between the most coronal bone-to-implant contact and the margin of the
former bone defect (fBIC-DEF), and the bone-to-implant contact fraction (BIC) were measured in mm.
15
RESULTS: AA measured 8.6 ± 4.0 mm2 for ZrO2 implant + DBBM granules, 4.7 ± 1.6 mm2 for ZrO2
implant + DBBM-collagen, 5.1 ± 1.9 mm2 for ZrO2 implant + DBBM block, and 7.6 ± 2.8 mm2 for Ti implant
+ DBBM granules. There were no statistically significant differences between the treatment modalities (P >
0.05). NB reached 2.0 ± 1.7 mm2 for ZrO2 implant + DBBM granules, 0.9 ± 0.9 mm2 for ZrO2 implant +
DBBM-collagen, 2.1 ± 0.9 mm2 for ZrO2 implant + DBBM block, and 0.8 ± 0.6 mm2 for Ti implant + DBBM
granules. fBIC-DEF amounted to 2.1 ± 1.7 mm2 for ZrO2 implant + DBBM granules, to 2.7 ± 1.1 mm2 for
ZrO2 implant + DBBM-collagen, to 2.9 ± 1.2 mm2 for ZrO2 implant + DBBM block, and to 3.4 ± 0.4 mm2 for
Ti implant + DBBM granules. BIC measured 70 ± 19% for ZrO2 implant + DBBM granules, 69 ± 22% for
ZrO2 implant + DBBM-collagen, 77 ± 30% for ZrO2 implant + DBBM block, and 66 ± 27% for Ti implant +
DBBM granules.
CONCLUSIONS: The findings of the present pilot study suggest that zirconia and titanium implants grafted
with DBBM granules and covered with a collagen membrane do not perform differently regarding the
augmented ridge contour, the NB formation, and the implant osseointegration.
Clin Oral Implants Res. 2017 Dec 30. doi: 10.1111/clr.13112. [Epub ahead of print]
Bone response to functionally loaded, two-piece zirconia implants: A preclinical

histometric study.
Janner SFM, Gahlert M, Bosshardt DD, Roehling S, Milz S, Higginbottom F, Buser D, Cochran DL.
Keywords: acid-etched sandblasted; crestal bone; dental implants; dog; histomorphometric analysis;
osseointegration; zirconia implant
OBJECTIVE: To evaluate the bone response to a two-piece zirconia implant in comparison with a control
titanium implant in the canine mandible 4 and 16 weeks after restoration.
MATERIAL AND METHODS: Zirconia and titanium implants were alternately placed bilaterally in healed
mandibular molar and premolar sites of five canines. Full-ceramic single-tooth restorations were cemented
after 6 weeks of transmucosal healing, allowing for full functional loading of the implants. Histologic and
histometric analyses were performed on orofacial and mesiodistal undecalcified sections of the specimens
obtained upon sacrifice after 4 and 16 weeks of functional loading. Bone-to-implant contact (BIC),
multinucleated giant cells-to-implant contact (MIC), crestal bone level, and peri-implant bone density were
histometrically assessed.
RESULTS: All 60 implants and 60 restorations were still in function after 4 and 16 weeks of loading in both
test and control groups. No implant loss, no implant or abutment fracture, and no chipping of the restorations
could be detected. Histometric analysis showed no statistically significant differences between zirconia and
titanium implants in BIC, crestal bone level, and peri-implant bone density at both time points. Between 4 and
16 weeks, the crestal bone level around zirconia implants showed a small but statistically significant increase
in its distance from the implant shoulder. MIC was very low on both implant types and both time points and
decreased statistically significantly overtime.
CONCLUSION: The present two-piece zirconia implant showed a similar bone integration compared to the
titanium implant with similar surface morphology after 4 and 16 weeks of loading.
16
Clin Oral Implants Res. 2017 Dec 12. doi: 10.1111/clr.13107. [Epub ahead of print]
A prospective controlled trial comparing xenograft/autogenous bone and collagen-

stabilized xenograft for maxillary sinus augmentation-Complications, patient-
reported outcomes and volumetric analysis.
Alayan J, Ivanovski S.
Keywords: Bio-Oss; Bio-Oss Collagen; Sinus floor elevation; anorganic bovine bone; bone substitute;
clinical trial; guided bone regeneration; patient-centred outcomes; volumetric outcomes
OBJECTIVE: Compare maxillary sinus augmentation (MSA) using two different materials-anorganic bovine
bone mineral (ABBM) + autogenous bone (AB) (control group) vs. collagen-stabilized ABBM (test group) in
terms of complications, patient-reported outcome measures (PROMs) and volumetric analysis.
MATERIALS AND METHODS: Sixty patients underwent sinus augmentation (30 control + 30 test group).
Intra- and postoperative complications were recorded. PROMs measured the impact of grafting on daily
activities, pain and morbidity. CT scans were used to measure graft volume, ridge height, material selection
and degree of contact of graft-to-surrounding sinus walls. Dental implant placement parameters were also
recorded.
RESULTS: All complications were minor and did not prevent completion of the augmentation or subsequent
implant placement. Schneiderian membrane perforation was the most frequently encountered complication.
Both treatment groups reported moderate limitation in the 1st 48 hr post-surgery but little or none by day 3 or
4. Jaw opening, chewing and bruising were significantly higher in the control group. The impact on work and
social life was moderate initially but reduced to little or none by the 2nd day. Mild to moderate pain and
interference to daily activities were reported for the first 3 days requiring the use of NSAIDs only. A mean
graft volume of 1.46 cm3 (±0.77) was calculated in the control group and 1.27 cm3 (±0.65) in the test group.
Extent of contact between graft and surrounding sinus walls had a significant impact on bone volume.
Shorter (8 mm) implants were utilized more frequently in the test group, which was also more likely to require
additional vertical augmentation, but this was not statistically significant.
CONCLUSION: MSA using a lateral wall approach is safe and associated with mild to moderate pain and
restrictions to daily activities for 48-72 hr. Patients' reports of morbidity were greater with autogenous bone
harvesting. Collagen-stabilized ABBM provides comparable bone volume to AB + ABBM that is sufficient for
placement of implants of adequate size with no need for further vertical augmentation. Engaging the
surrounding sinus walls had a significant positive impact on graft volume.
17
European Journal of Oral Implantology
Eur J Oral Implantol. 2017;10(4):373-390.
The influence of repeated abutment changes on peri-implant tissue stability: 3-year

post-loading results from a multicentre randomised controlled trial.
Bressan E, Grusovin MG, D'Avenia F, Neumann K, Sbricoli L, Luongo G, Esposito M.
PURPOSE: To evaluate the influence of at least three abutment disconnections in conventional loaded
implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard
and soft tissue changes. A secondary aim was to evaluate whether the presence of less than 2 mm of
keratinised mucosa is associated with increased peri-implant marginal bone loss and soft tissue recessions.
MATERIALS AND METHODS: Eighty patients requiring one single crown or one fixed partial prosthesis
supported by a maximum of three implants were randomised, after implants were placed with more than 35
Ncm, according to a parallel group design to receive definitive abutments that were loaded immediately
(definitive abutment or immediate loading group) or transmucosal abutments, which were delayed loaded
after 3 months and removed at least three times: 1. At impression taking (3 months after implant placement);
2. When checking the zirconium core on titanium abutments at single crowns or the fitting the metal structure
at prostheses supported by multiple implants; 3. At delivery of the definitive prostheses (repeated
disconnection or conventional loading group). Patients were treated at four centres and each patient
contributed to the study, with only one prosthesis followed for 3 years after initial loading. Outcome measures
were: prosthesis failures, implant failures, complications, pink aesthetic score (PES), buccal recessions,
patient satisfaction, peri-implant marginal bone level changes and height of the keratinised mucosa.
RESULTS: Forty patients were randomly allocated to each group according to a parallel group design. Six
patients from the definitive abutment group dropped out or died, and one left from the repeated
disconnection group. One implant, from the repeated disconnection group, fractured (difference = 3%; CI
95%: -2%, 8%; P = 1). Four provisional crowns and one definitive single crown had to be remade because of
poor fitting, and one definitive crown and one definitive prosthesis because of ceramic and implant fracture,
respectively, in the repeated disconnection group vs one provisional prosthesis from the definitive abutment
group due to frequent debondings (difference = 15%; CI 95%: 2%, 28%; P = 0.060). Five patients from the
definitive abutment group and four patients from the repeated disconnection group were affected by
complications (difference = 4%; CI 95%: -11%, 20%; P = 0.725). PES scores assessed at 3 years post-
loading were 11.7 (standard deviation = 1.8) mm for the definitive abutment group and 11.3 (1.5) mm for the
repeated abutment changes group (difference = 0.4; CI 95%: -0.4, 1.2; P = 0.315). However, there was a
difference of 0.26 out of a maximum score of 2 in favour of the definitive abutment group for soft tissue
contour only. Buccal recessions at 3 years post-loading amounted to -0.1 (0.8) mm for the definitive
abutment group and -0.1 (1.2) mm for the repeated abutment changes group (it was actually a soft tissue
gain; difference = 0.01 mm CI 95%: -0.48, 0.50; P = 0.965). All patients declared being very satisfied or
satisfied with the function and aesthetics of the prostheses and said they would undergo the same procedure
again, with the exception of one patient from the repeated disconnection group who was uncertain regarding
function. Mean peri-implant marginal bone loss 3 years after loading was 0.07 (0.18) mm for the definitive
abutment group and 0.50 (0.93) mm for the repeated abutment changes group (difference = 0.43 mm; CI
95%: 0.13, 0.74; P = 0.007). The height of keratinised mucosa at 3 years post-loading was 2.8 (1.3) mm for
the definitive abutment group and 2.8 (1.6) mm for the repeated abutment changes group (difference = 0.03;
CI 95%: -0.67, 0.73; P = .926). Up to 3 years after initial loading there were no statistically significant
differences between the two procedures, with the exception of 0.4 mm more marginal bone loss at implants
subjected to three abutment disconnections. There were no significantly increased marginal bone loss
(difference = 0.1 mm, CI 95%: -0.3, 0.5, P = 0.590) or buccal recessions (difference = 0.1 mm, CI 95%: -0.4,
0.7, P = 0.674) at implants with less than 2 mm of keratinised mucosa at loading.
18
CONCLUSIONS: Three-year post-loading data showed that repeated abutment disconnections significantly
increased bone loss of 0.43 mm, but this difference may not be considered clinically relevant; therefore
clinicians can use the procedure they find more convenient for each specific patient. Immediately non-
occlusally loaded dental implants are a viable alternative to conventional loading and no increased bone loss
or buccal recessions were noticed at implants with less than 2 mm of keratinised mucosa. Conflict of interest
statement: This trial was partially funded by Dentsply Sirona Implants, the manufacturer of the implants and
other products evaluated in this investigation. However, data belonged to the authors and by no means did
the manufacturer interfere with the conduct of the trial or the publication of the results, with the exception of
rejecting a proposal to change the protocol, after the trial was started, allowing the use of indexed
abutments.
Short implants as an alternative to crestal sinus lift: a 3-year multicentre

randomised controlled trial.
Gastaldi G, Felice P, Pistilli R, Barausse C, Trullenque-Eriksson A, Esposito M.
PURPOSE: To evaluate the efficacy of short (5 or 6 mm long) dental implants vs 10 mm or longer implants
placed in crestally lifted sinuses.
MATERIALS AND METHODS: Twenty partially edentulous patients with 5 to 7 mm of residual crestal height
and at least 7 mm thickness below the maxillary sinuses as measured on computed tomography scans were
randomised according to a parallel group design to receive either one to two 5 or 6 mm long implants (10
patients) or 10 mm long implants (10 patients) after crestal sinus lifting and grafting with anorganic bovine
bone. Implants were left to heal submerged for 4 months and were loaded with reinforced acrylic provisional
prostheses, replaced, after 4 months, by definitive provisionally cemented or screw-retained metal-ceramic
or metal-composite prostheses. Outcome measures were: prosthesis and implant failures, any
complications, radiographic peri-implant marginal bone level changes, and patient's satisfaction assessed by
blinded assessors, when possible. All patients were followed up to 3 years after loading.
RESULTS: Two patients from the augmented group dropped out after the 1-year follow-up. No implant or
prosthesis failure occurred. One short implant patient was affected by two complications vs one complication
in the long implant group. There was no difference for patients experiencing complications between the two
groups (difference in proportions = -0.03 %; 95%CI: -0.32 to 0.27; P = 1.000). Short implants lost 0.89 ± 0.25
mm and long implants lost 1.08 ± 0.29 mm of peri-implant marginal bone 3 years after loading, the difference
between the two groups being not statistically significant (difference = -0.19 mm; 95%CI: -0.46 to 0.09; P =
0.165). All patients were fully or partially satisfied with function and fully satisfied with aesthetics.
CONCLUSIONS: Both techniques achieved excellent results and no differences were observed between
prostheses supported by one to two 5 or 6 mm long implants vs 10 mm long in posterior atrophic maxillae up
to 3 years after loading; therefore it is up to clinicians to decide which procedure to use, although longer
follow-ups with larger patient populations are needed to better understand if one of these procedures could
be more effective in the long-term. Conflict of interest statement: this study was partially supported by
Zimmer Biomet. However, data property belonged to the authors, and by no means did the manufacturer
interfere with the conduct of the trial or the publication of its results.
19
Intraoral radiography lacks accuracy for the assessment of peri-implant bone level -
a controlled clinical study.
Christiaens V, Jacobs R, Dierens M, Vervaeke S, De Bruyn H, Koole S, Cosyn J.
PURPOSE: The aim of this study was to compare clinical and radiographic bone level assessments to intra-
surgical bone level registration around implants with peri-implantitis and to identify the clinical variables
rendering peri-implant bone level assessment accuracy.
MATERIALS AND METHODS: The study sample included 50 implants with peri-implantitis in 23 patients.
Registration methods included probing of the vertical distance between the implant/abutment interface and
the bottom of the pocket (= VPD), intraoral radiography, bone sounding without flap elevation and intra-
surgically assessed interproximal bone level. The latter was considered the true bone level (gold standard).
Twenty clinicians evaluated all radiographs.
RESULTS: VPD and intraoral radiography resulted in a significant underestimation of the true bone level by
1.0 mm (95% CI: 0.495-1.585; P < 0.001) and 2.3 mm (95% CI: 1.650-2.980; P < 0.013) respectively. Bone
sounding without flap elevation did not differ significantly from the true bone level (mean difference 0.2 mm;
95% CI: -0.775 - 0.335; P = 0.429). Duplicate magnification registration of 50 implants resulted in excellent
intra- and inter-rater reliability (ICC intra ≤ 0.99; ICC inter = 0.964; P < 0.001). Radiographic underestimation
was significantly affected by defect depth (P < 0.001). Variation among clinicians was substantial (mean
underestimation range 1.1 mm to 3.8 mm); however, clinical experience had no impact on radiographic
underestimation (P = 0.796).
CONCLUSIONS: Bone sounding without flap elevation was the best predictor of peri-implant bone level,
whereas intraoral radiography was the most inferior. Consequently, peri-implantitis may be under-diagnosed
if examination is only based on radiographs. Conflict-of-interest statement: Prof Hugo De Bruyn is associated
with education and research collaboration agreements with Dentsply Sirona and Southern Implants, on
behalf of Ghent University. Prof Cosyn has a collaboration agreement with Nobel Biocare. All other authors
declare that they have no conflict of interest.
Journal of Clinical Periodontology
J Clin Periodontol. 2017 Dec;44(12):1274-1284. doi: 10.1111/jcpe.12788. Epub 2017 Nov 21.
Exploring the microbiome of healthy and diseased peri-implant sites using Illumina
sequencing.
Sanz-Martin I, Doolittle-Hall J, Teles RP, Patel M, Belibasakis GN, Hämmerle CHF, Jung RE, Teles FRF.
Keywords: DNA ; dental implant; microbiome; peri-implantitis; periodontal; sequencing
AIM: To compare the microbiome of healthy (H) and diseased (P) peri-implant sites and determine the core
peri-implant microbiome.
MATERIALS AND METHODS: Submucosal biofilms from 32 H and 35 P sites were analysed using 16S
rRNA sequencing (MiSeq, Illumina), QIIME and HOMINGS. Differences between groups were determined
using principal coordinate analysis (PCoA), t tests and Wilcoxon rank sum test and FDR-adjusted. The peri-
implant core microbiome was determined.
20
RESULTS: PCoA showed partitioning between H and P at all taxonomic levels. Bacteroidetes, Spirochetes
and Synergistetes were higher in P, while Actinobacteria prevailed in H (p < .05). Porphyromonas and
Treponema were more abundant in P while Rothia and Neisseria were higher in H (p < .05). The core peri-
implant microbiome contained Fusobacterium, Parvimonas and Campylobacter sp. T. denticola, and P.
gingivalis levels were higher in P, as well as F. alocis, F. fastidiosum and T. maltophilum (p < .05).
CONCLUSION: The peri-implantitis microbiome is commensal-depleted and pathogen-enriched, harbouring

traditional and new pathogens. The core peri-implant microbiome harbours taxa from genera often
associated with periodontal inflammation.
J Clin Periodontol. 2017 Dec;44(12):1285-1293. doi: 10.1111/jcpe.12805.
Open flap debridement of peri-implantitis with or without adjunctive systemic

antibiotics: A randomized clinical trial.
Hallström H, Persson GR, Lindgren S, Renvert S.
Keywords: antibiotics; microbiota; peri-implantitis; surgical treatment

AIMS: To investigate clinical, radiographic and microbiological outcome over 12 months following open flap
debridement of peri-implantitis with or without antibiotics.
MATERIALS AND METHODS: Peri-implantitis was surgically treated with or without Zithromax® in 19
control and 20 test individuals. Probing pocket depth (PPD), gingival inflammation (BOP), intra-oral
radiographs and microbial samples were studied. Per protocol and intent-to-treat analyses were performed.
RESULTS: The mean difference (reduction) in PPD values between baseline and month 12 in the test and
control groups was 1.7 mm (SD ± 1.1, 95% CI: 1.1, 2.3, p < .001) and 1.6 mm (SD ± 1.5, 95% CI: 0.8, 2,4, p
< .001), respectively. Data analysis failed to show study group differences for BOP, PPD, radiographic bone
level and microbial load. Successful treatment (per protocol: PPD ≤ 5 mm, no BOP, no suppuration and no
bone loss ≥0.5 mm) at 12 months in test and control groups was 7/15 (46.7%) and 4/16 (25.0%). Bacterial
load reduction was similar in study groups with a temporary reduction following treatment.
CONCLUSIONS: Surgical treatment of peri-implantitis with adjunctive systemic azithromycin did not provide
1-year clinical benefits in comparison with those only receiving open flap debridement.
Surgical treatment of peri-implantitis: 3-year results from a randomized controlled

clinical trial.
Carcuac O, Derks J, Abrahamsson I, Wennström JL, Petzold M, Berglundh T.
Keywords: dental implant; implant surface characteristics; surgical treatment
21
OBJECTIVES: This study reports on the 3-year follow-up of patients enrolled in a randomized controlled
clinical trial on surgical treatment of advanced peri-implantitis.
MATERIAL AND METHODS: A total of 100 patients with advanced peri-implantitis were randomly assigned
to one of four treatment groups. Surgical therapy aiming at pocket elimination was performed and, in three
test groups, supplemented by either systemic antibiotics, use of an antiseptic agent for implant surface
decontamination or both. Outcomes were evaluated after 1 and 3 years by means of clinical and radiological
examinations. Differences between groups were explored by regression analysis.
RESULTS: Clinical examinations at 3 years after treatment revealed (i) improved peri-implant soft tissue
health with a mean reduction in probing depth of 2.7 mm and a reduction in bleeding/suppuration on probing
of 40% and (ii) stable peri-implant marginal bone levels (mean bone loss during follow-up: 0.04 mm). Implant
surface characteristics had a significant impact on 3-year outcomes, in favour of implants with non-modified
surfaces. Benefits of systemic antibiotics were limited to implants with modified surfaces and to the first year
of follow-up.
CONCLUSION: It is suggested that surgical treatment of peri-implantitis is effective and that outcomes of
therapy are affected by implant surface characteristics. Potential benefits of systemic antibiotics are not
sustained over 3 years.
J Clin Periodontol. 2017 Dec 19. doi: 10.1111/jcpe.12860. [Epub ahead of print]
Volumetric changes following ridge preservation or spontaneous healing and early

implant placement with simultaneous guided bone regeneration.
Naenni N, Bienz SP, Muñoz F, Hämmerle CHF, Jung RE, Thoma DS.
Keywords: alveolar ridge augmentation; dental implants (MeSH); guided bone regeneration; ridge
preservation; volume stability
AIM: To assess volumetric and linear changes following ridge preservation (RP) or spontaneous healing plus
early implant placement with or without simultaneous guided bone regeneration (GBR).
MATERIALS AND METHODS: In eight adult beagle dogs, the mesial roots of the mandibular P3, P4 and M1
were extracted. Sites were randomized to either ridge preservation (RP) or spontaneous healing (SH). Four
weeks later dental implants were placed either with (RP2) or without removing non-integrated DBBM (RP1).
In RP2 and SH sites, GBR was applied using a demineralized bovine bone mineral and a resorbable
membrane. Impressions were taken post extraction (SH)/post ridge preservation (RP1;RP2), before and
after implant placement and after healing of 4 and 12 weeks. Casts were digitized to allow for
superimposition and measurement of contour alterations.
RESULTS: Median ridge width reduction from post extraction (SH)/post ridge preservation (RP1;RP2) to
implant placement ranged from -13.9%(SH) to -19.7%(RP)(p>0.05), whereas from implant placement to
sacrifice it was statistically significantly lower in group RP1(-5.5%) compared to group SH(-23.4%;p=0.0013)
and group RP2(-22.1%;p=0.0026). Encompassing the entire study period, median ridge width changes
ranged between -17.8%(SH), -24.8%(RP2) and -32.5%(RP1)(p>0.05).
CONCLUSIONS: Irrespective of the treatment modality and the healing period, part of the ridge contour was
lost. Early implant placement after ridge preservation without additional GBR resulted in a more stable ridge
contour after implant placement compared to controls.
22
J Clin Periodontol. 2017 Dec 31. doi: 10.1111/jcpe.12865. [Epub ahead of print]
Non-interventional 1-year follow-up study of peri-implant soft tissues following

previous soft tissue augmentation and crown insertion in single tooth gaps.
Huber S, Zeltner M, Hämmerle CHF, Jung RE, Thoma DS.
Keywords: 1-year follow-up; collagen-based matrix; dental implant; soft tissue augmentation; soft tissue
volume; subepithelial connective tissue graft
AIM: To assess peri-implant soft tissue dimensions at implant sites, previously augmented with a collagen
matrix (VCMX) or an autogenous subepithelial connective tissue graft (SCTG), between crown insertion and
1 year.
METHODS: Twenty patients with single-tooth implants received soft tissue augmentation prior to abutment
connection randomly using VCMX or SCTG. Following abutment connection 3 months later, final
reconstructions were fabricated and inserted (baseline). Patients were recalled at 6 months (6M) and at 1
year (FU-1). Measurements included: clinical data, soft tissue thickness, volumetric outcomes and patient-
reported outcome measures (PROMs).
RESULTS: The buccal soft tissue thickness showed a median decrease of -0.5mm (-1.0;0.3) (VCMX) and
0.0mm (-0.5;1.0) (SCTG) (p=0.243) up to FU-1. The soft tissue volume demonstrated a median decrease
between BL and FU-1 of -0.1mm (-0.2;0.0) (p=0.301) for VCMX and a significant decrease of -0.2mm (-0.4:-
0.1) (p=0.002) for SCTG respectively. Intergroup comparisons did not reveal any significant differences
between the groups for peri-implant soft tissue dimensions and changes up to FU-1 (p>0.05). PROMs did
not show any significant changes over time nor differences between the groups.
CONCLUSION: Between crown insertion and 1 year, the buccal peri-implant soft tissue dimensions
remained stable without relevant differences between sites that had previously been grafted with VCMX or
SCTG.
Healing of two-wall intra-bony defects treated with a novel EMD-liquid-A pre-clinical

study in monkeys.
Shirakata Y, Miron RJ, Shinohara Y, Nakamura T, Sena K, Horai N, Bosshardt DD, Noguchi K, Sculean A.
Keywords: animal study; carrier; enamel matrix proteins; intra-bony defect; periodontal regeneration
AIM: To investigate the effect of a novel enamel matrix derivative formulation (EMD-liquid or Osteogain)
combined with an absorbable collagen sponge (ACS) on periodontal wound healing in intra-bony defects in
monkeys.
MATERIALS AND METHODS: Chronic two-wall intra-bony defects were created at the distal aspect of eight
teeth in three monkeys (Macaca fascicularis). The 24 defects were randomly assigned to one of the following
treatments: (i) open flap debridement (OFD) + ACS alone, (ii) OFD + Emdogain + ACS (Emdogain/ACS), (iii)
OFD + Osteogain + ACS (Osteogain/ACS) or (iv) OFD alone. At 4 months, the animals were euthanized for
histologic evaluation.
RESULTS: Osteogain/ACS resulted in more consistent formation of cementum, periodontal ligament and
bone with limited epithelial proliferation compared to OFD alone, Emdogain/ACS and OFD + ACS. Among
the four treatment groups, the Osteogain/ACS group demonstrated the highest amount of regenerated
tissues. However, complete periodontal regeneration was not observed in any of the defects in the four
groups.
23
CONCLUSIONS: The present findings indicate that in two-wall intra-bony defects, reconstructive surgery
with Osteogain/ACS appears to be a promising novel approach for facilitating periodontal wound
healing/regeneration, thus warranting further clinical testing.
Journal of Dentistry
J Dent. 2017 Dec;67:58-65. doi: 10.1016/j.jdent.2017.09.008. Epub 2017 Sep 20.
All-ceramic, bi-layered crowns supported by zirconia implants: Three-year results

of a prospective multicenter study.
Spies BC, Balmer M, Jung RE, Sailer I, Vach K, Kohal RJ.
Keywords: CAD-CAM; Ceramics; Crown; Dental implant; Dental porcelain; Zirconia

OBJECTIVES: To determine the clinical and patient-reported outcomes of bi-layered, all-ceramic posterior
single crowns (SCs) supported by zirconia implants in an uncontrolled, prospective, multicenter study.
METHODS: In two centers, 60 patients received 71 one-piece zirconia oral implants to be restored with
either SCs (n=49) or three-unit fixed dental prostheses (n=11). Of these patients, 45 implants were restored
with all-ceramic, zirconia-based posterior SCs (one per patient). Survival rates of implants and
reconstructions were assessed, and technical success was evaluated according to modified U.S. Public
Health Service (USPHS) criteria. Furthermore, patient-reported outcome measures (PROMs) were assessed
by applying visual analog scales (VAS). Kaplan-Meier (KM) plots and log-rank tests were used for
success/survival analyses. The Wilcoxon matched-pairs signed-rank test was used to evaluate time effects
on response variables (PROMs, USPHS criteria).
RESULTS: Forty patients with 40 SCs could be evaluated after 36.7±1.2months. No SC was replaced,
resulting in 100% survival. The KM success estimate was 87.5% (two chippings, one restoration margin, and
one contour were rated Charlie). In general, the incidence of chipping (p=.0005) and occlusal roughness
(p=.0003) was frequent. Compared with the pre-treatment patient surveys (67-93%), all surveys at prosthetic
delivery except for speech (p=.139) showed significantly improved VAS scores (81-94%; p<.0001).
Thereafter, no decrease in satisfaction could be observed over time until the 3-year follow-up (86-93%;
p≥.390).
CONCLUSION: Veneered, zirconia-based SCs supported by zirconia implants satisfied patients' needs
highly. However, significant incidence of chipping and roughness of the veneering ceramic may compromise
the clinical long-term outcome for this indication.
CLINICAL SIGNIFICANCE: Posterior, zirconia-based SCs supported by zirconia oral implants entirely
survived the follow-up period of 3 years, but two major chippings, one a significant marginal opening and one
pronounced over-contouring, resulted in a reduced KM success estimate of 87.5% after 36 months of
observation.
24
J Dent. 2017 Dec;67:72-76. doi: 10.1016/j.jdent.2017.09.014. Epub 2017 Sep 28.
Immediately loaded implant-supported full-arches: Peri-implant status after 1-

9years in a private practice.
Cercadillo-Ibarguren I, Sánchez-Torres A, Figueiredo R, Schwarz F, Gay-Escoda C, Valmaseda-Castellón E.
Keywords: Immediate loading; Implant-supported full-arch; Peri-implant diseases; Private practice

OBJECTIVE: Evaluate the peri-implant status on the long-term (1-9years) of patients treated with
immediately-loaded full-arch prostheses in a private practice.
METHODS: A retrospective cohort study was carried out in patients consecutively treated with immediately
loaded full-arch restorations supported with a minimum of 4 implants (Replace® Tapered, Nobel Biocare AB)
and Multi-Unit conical abutments (MUA®, Nobel Biocare AB) with a follow-up of over 12months after
placement of the final prosthesis.
RESULTS: A total of 378 implants were placed in 56 patients. Forty upper and 32 lower arches were
restored, and 16 patients received bimaxillary rehabilitation. The mean duration of follow-up was 50 months,
and the implant and patient peri-implantitis prevalences were 14.3% and 50%, respectively. Mucositis
affected 56.9% of the implants and 50% of the patients. The survival rate was 96.4% by patient, but reached
99.5% in the implant-based analysis, and the success rate was 95.5% for implants and 80.4% for patients.
CONCLUSIONS: Immediately-loaded full-arch restorations have an acceptable outcome after 1-9years of

follow-up. However, the incidence of peri-implant diseases is high, and further research is needed to confirm
whether these may compromise the predictability of the prostheses over the long-term.
CLINICAL SIGNIFICANCE: After a mean follow-up of 50months, the incidence of mucositis and peri-
implantitis affected the 96.4% and 50% of patients, respectively. However, these results were reduced
almost by half when the threshold of bleeding on probing and peri-implant bone loss applied was less strict.
Journal of Periodontology
J Periodontol. 2017 Nov;88(11):1153-1162. doi: 10.1902/jop.2017.160796. Epub 2017 May 26.
Patient-Centered Perspectives and Understanding of Peri-Implantitis.

Insua A, Monje A, Wang HL, Inglehart M.
Keywords: Dental implants; patient education as topic; patient reported outcome measures; peri-implantitis;
quality of life
BACKGROUND: Patients undergoing dental treatment have an uncertain understanding about dental
implant therapy and its complications. Therefore, the aims of this study assess the following: 1) level of
knowledge, awareness, and attitudes about peri-implantitis; 2) information provided by dentists/specialists
who perform the treatment; and 3) perceptions, level of satisfaction, and impact on patient quality of life
(QoL).
25
METHODS: Patients with implant restorative therapy currently undergoing peri-implant maintenance therapy
were recruited. Participants completed an anonymous questionnaire that included general aspects of
prognosis, including the following: 1) peri-implantitis; 2) etiology; 3) awareness; 4) attitudes; 5) treatment; 6)
prevention; 7) risk factors; 8) quality of information; 9) level of patient satisfaction; and 10) QoL. Associations
among questionnaire data were identified using univariate and multivariate analyses.
RESULTS: Overall, 411 implants were included from 135 patients with implants. Frequency of peri-
implantitis in the survey was 17.8% at the participant level, with 70% of them reporting high level of post-
surgical satisfaction. Worry and concern were frequent findings among patients with peri-implantitis (64%),
and 32% reported that living with the disease was terrible. The vast majority of patients (74.1%) did not have
knowledge about peri-implant pathology. Patients with peri-implantitis showed statistically significantly better
understanding of implant therapy (P <0.001) and also higher average concern (P = 0.004).
CONCLUSIONS: Patients generally have a poor understanding and perception of peri-implantitis and its
impact. QoL was impaired by the presence of peri-implantitis with high level of concern and low level of
therapeutic satisfaction. Therefore, it is important to develop standardized information brochures to educate
patients on risk factors and indicators of the disease to assist in the prevention of peri-implantitis.
Clinical Implant Dentistry and Related Research

Clin Implant Dent Relat Res. 2017 Dec;19(6):980-988. doi: 10.1111/cid.12539. Epub 2017 Sep 8.
A retro-prospective effectiveness study on 3448 implant operations at one referral

clinic: A multifactorial analysis. Part I: Clinical factors associated to early implant
failures.
Jemt T.
Keywords: 1-stage surgery; 2-stage surgery; complications; effectiveness study; efficacy study; follow-up;
immediate placement; implant failure; implants; inflammation
BACKGROUND: Limited numbers of large effectiveness studies on routine dental implant treatment are
available in the literature.
PURPOSE: To report retro-prospective data on prevalence of early implant failures in a large number of
routine patients/operations at 1 referral clinic.
MATERIALS AND METHODS: A total of 2848 patients were consecutively provided with 9582 implants with
an anodized surface (Nobel Biocare AB) during 3448 implant operations between 2003 and 2011. All
patients were invited to a follow-up program and early implant failures up to first annual examination were
consecutively identified. A logistic multivariate data analysis was performed to identify possible factors with
an association to early implant failures.
RESULTS: A total of 43, 73, and 81 implant operations were denoted as early failures depending on when
cut-off time was defined, using: abutment connection, prosthesis placement, or at first year of follow-up,
respectively. Five factors showed significant association to "early implant failures," where the highest risk for
a failure was associated to "surgeon" (hazard ratio [HR] 5.13), followed by "not prosthetic treatment at the
referral clinic" (HR 2.71). When all 5 significant factors were present, the risk for an early failure after an
operation was 7.0%, and the risk decreased to 0.1% when none/lowest risk factors were present.
CONCLUSIONS: The role of the surgeons/dentists involved in the rehabilitation of the implant patients and
numbers of placed implants (degree of tooth loss) showed the strongest associations to early implant failures
in the present clinic. Also increased bone resorption was associated to increased risk for implant failure.

26
Clin Implant Dent Relat Res. 2017 Dec;19(6):972-979. doi: 10.1111/cid.12538. Epub 2017 Sep 8.
A retro-prospective effectiveness study on 3448 implant operations at one referral

clinic: A multifactorial analysis. Part II: Clinical factors associated to peri-
implantitis surgery and late implant failures.
Jemt T.
Keywords: 1-stage surgery; 2-stage surgery; complication; effectiveness study; efficacy study; follow-up;
immediate placement; implant failure; implants; inflammation; learning curve; mucositis; peri-implantitis;
smoking habits
BACKGROUND: Little knowledge is available on implant treatment in large effectiveness studies in routine
practice.
PURPOSE: To report retro-prospective data on prevalence of peri-implantitis surgery and late implant
failures in a large number of routine patients at 1 referral clinic.
MATERIALS AND METHODS: Altogether 9582 implants with an anodized surface (Nobel Biocare AB) were
consecutively placed between 2003 and 2011 and followed-up to end of 2015. All peri-implantitis operations
and late implant failures were consecutively identified. A logistic multivariate data analysis was performed to
identify association between the complications and different clinical factors. Furthermore, data on prevalence
on risk for inflammation and bone loss at implants ("peri-implantitis") and surgery related to peri-implantitis
was collected for another reference group of about 10 000 implant patients during 3 consecutive years
(2013-2015).
RESULTS: Cumulative survival rates for implant operations without peri-implantitis surgery or implant
failures were calculated to 96.4% (95% CI: 97.3-95.4) and 95.0% (95% CI: 96.0-94.1) after 10 years,
respectively. Risk for "peri-implantitis surgery" showed a significant association (P < .05) to number of placed
implants (hazard ratio [HR] 1.40; 95% CI: 1.24-1.59). Three factors showed significant association to risk for
"late implant failures," where "treatment in lower jaw" had the highest risk; HR 2.03. "Overall implant failures"
were associated to 4 significant factors where "surgeon" (HR 2.50) showed highest impact on risk. "Numbers
of implants" and "bone resorption" at surgery were the 2 significant factors that were consistent for all the
time periods of failures during follow-up (early/late/total). On an average 7.4% of examined patients in the
reference group were denoted with highest risk group ("peri-implantitis") of which on an average 12.7% of
these patients had surgery related to peri-implantitis.
CONCLUSIONS: "The dentist" involved in the surgical and prosthetic rehabilitation of the implant patients,
"number of implants" and degree of "bone resorption" seem to have most impact on overall implant
complications and failures in the present patient group.
Clin Implant Dent Relat Res. 2017 Dec;19(6):1009-1014. doi: 10.1111/cid.12528. Epub 2017 Aug 30.
Assessment of the effectiveness of platelet rich fibrin in the treatment of

Schneiderian membrane perforation.
Öncü E, Kaymaz E.
Keywords: dental implants; peri-implantitis; peri-implantitis treatment
27
BACKGROUND: The objective of this study is to evaluate the effect of Platelet rich fibrin (PRF) treatment of
maxillary sinus membrane perforation on bone formation and new vascular supply and the success of dental
implant survival rate.
METHODS: The dataset for this retrospective study consists of patients who received sinus augmentation
using the lateral wall technique. A total of 16 patients (20 sinuses) the patients without sinus membrane
perforation (10 maxiller sinus area with sinus floor augmentation) and with Schneiderian perforation (10
maxiller sinus area repairing with PRF and augmented sinus floor area) were included in this study. The
bone height was measured by comparing the preoperative and postoperative dental CBCT scans.
Histological sections were evaluated for possible vasculogenesis augmented sinuses area.
RESULTS: In both groups, it was observed that the possible vasculogenesis augmented sinuses area
increased. Implant survival rates in both groups found that one hundred percent and any bone loss around
implants were not observed. An apparent increase in alveolar bone height was observed and measured in
CBCT scans.
CONCLUSIONS: PRF can be considered as an alternative material for repairing sinus perforations because
it is fully autogenous and easy manipulated.
Clin Implant Dent Relat Res. 2017 Dec;19(6):1015-1022. doi: 10.1111/cid.12527. Epub 2017 Aug 29.
Survival rate of titanium-zirconium narrow diameter dental implants versus

commercially pure titanium narrow diameter dental implants: A systematic review.
Iegami CM, Uehara PN, Sesma N, Pannuti CM, Tortamano Neto P, Mukai MK.
Keywords: dental implants; endosseous dental implantation; root cause analysis; survival rate
BACKGROUND: Despite the existence of several studies validating the use of narrow diameter implants,
most of them are based on pure Ti alloys. There is few clinical evidence of the success of TiZr narrow
diameter implants (TiZr NDIs) regarding survival rate (SR) and marginal bone loss (MLB).
PURPOSE: The aim of this review was to systematically assess SR, as well as MBL of TiZr NDIs compared
to commercially pure titanium narrow diameter implants (cpTi NDIs).
MATERIAL AND METHODS: The search was conducted in Medline/PubMed, Cochrane, Scopus, and
Embase databases (year 2000 to November 2016). Cohort studies and randomized trials were included.
RESULTS: Six clinical studies from the 3453 articles initially identified met the inclusion criteria. There were
no statistically significant differences in SR when TiZr NDIs and cpTi NDIs were compared in the 1-year
follow up (P = .5), or when comparing TiZr NDIs placed in posterior and anterior regions. There was no
difference between groups regarding 1-year SR: -0.01 (95% CI, -0.05-0.03) and MLB: -0.01 mm (95% CI: -
0.14-0.12).
CONCLUSION: It can be concluded that TiZr NDIs present similar success rates and peri-implant bone
resorption to cpTi NDIs.
28
Clin Implant Dent Relat Res. 2017 Dec;19(6):1090-1098. doi: 10.1111/cid.12546. Epub 2017 Oct 12.
The influence of crown-to-implant ratio on marginal bone levels around splinted

short dental implants: A radiological and clincial short term analysis.
Hingsammer L, Watzek G, Pommer B.
Keywords: crestal bone resorption; implant survival; prospective; short implants

BACKGROUND: The amount of marginal bone resorption around dental implants is considered to have a
significant impact on implant stability as well as implant survival rates.
PURPOSE: The aim of this prospective study was to investigate the influence of prosthetic as well as patient
specific factors on marginal bone loss around short dental implants.
MATERIALS AND METHODS: Seventy-six implants, which supported splinted crowns were included for
investigation. All implants were from the same type and had an intraosseous length of 6.5 mm and a
diameter of 4.0 mm. Twenty implants were additionally splinted onto longer ones. Measurements of marginal
bone loss were performed at a mean of 12.38 months after prosthetic loading and the mean follow-up for
clinical evaluation was 20.52 months.
RESULTS: Overall two implant failures were recorded, revealing a survival rate of 97.3%. Marginal bone
resorption around 72 short implants measured 0.71 mm (SD: 0.74 mm) and was found to have a strong
correlation with calculated Crown-to-Implant ratio (r = .71; P < .001). Age, gender, insertion torque, implant
surface area, location, position, bone quality, and insertion torque did not influence peri-implant bone loss
after one year of loading.
CONCLUSION: Within the limitations of the study, it is suggested that Crown-to-Implant ratios should not
exceed 1.7 to avoid increased early marginal bone loss.
Clin Implant Dent Relat Res. 2017 Nov 6. doi: 10.1111/cid.12552. [Epub ahead of print]
Bioactive treatments in bone grafts for implant-based rehabilitation: Systematic

review and meta-analysis.
da Rosa WLO, da Silva TM, da Silva AF, Piva E.
Keywords: bone morphogenetic protein; bone transplantation; dental implants; review

BACKGROUND: The use of bioactive proteins, such as rhBMP-2, may improve bone regeneration in oral
and maxillofacial surgery.
PURPOSE: Analyze the effect of using bioactive proteins for bone regeneration in implant-based
rehabilitation.
MATERIALS AND METHODS: Seven databases were screened. Only clinical trials that evaluated the use
of heterologous sources of bioactive proteins for bone formation prior to implant-based rehabilitation were
included. Statistical analyses were carried out using a random-effects model by comparing the standardized
mean difference between groups for bone formation, and risk ratio for implant survival (P ≤ .05).
RESULTS: Seventeen studies were included in the qualitative analysis, and 16 in the meta-analysis. For
sinus floor augmentation, bone grafts showed higher amounts of residual bone graft particles than bioactive
treatments (P ≤ .05). While for alveolar ridge augmentation bioactive treatments showed a higher level of
bone formation than control groups (P ≤ .05). At 3 years of follow-up, no statistically significant differences
were observed for implant survival (P > .05).
29
CONCLUSIONS: Bioactive proteins may improve bone formation in alveolar ridge augmentation, and reduce
residual bone grafts in sinus floor augmentation. Further studies are needed to evaluate the long-term effect
of using bioactive treatments for implant-based rehabilitation.
The Journal of Periodontal Research
J Periodontal Res. 2017 Dec;52(6):955-964. doi: 10.1111/jre.12470. Epub 2017 Jun 15.
Effect of cross-linked vs non-cross-linked collagen membranes on bone: A

systematic review.
Jiménez Garcia J, Berghezan S, Caramês JMM, Dard MM, Marques DNS.
Keywords: bone grafting; membranes; regeneration; systematic review/meta-analysis

Abstract: The aim of this study was to conduct a systematic review to compare the clinical outcomes of two
different resorbable collagen membranes in terms of regenerated bone volume, postoperative complications
and membrane degradation during bone regeneration procedures. Randomized controlled trials (RCT) or
controlled trials (CT) that compared both techniques were reviewed on four electronic databases up to
December 2015, a manual search was performed on the bibliography of the collected articles and the
authors were contacted for additional references if undetected on the electronic and manual search.
Membrane exposure was evaluated as a dichotomous outcome and the statistical unit was the membrane.
The results were presented as relative risk (RR) with a 95% confidence interval. Eight RCTs and one CT
were included in this study. The majority of the studies depicted a bone augmentation area, which ranged
from 46.15% to 94.6% for the non-cross-link membranes and from 44% to 92.6% for the cross-link
membranes at the 4-6 month re-entry surgery. From a total of 289 patients, a forest plot concerning the
membrane exposure was constructed using the obtained RR of the included studies. The overall RR was
1.43 (95% CI: 0.85-2.39) with no statistically significant differences between the two groups, although with a
marginal tendency towards higher exposure in the cross-link membrane group. This systematic review
suggests the different membranes present themselves as appropriate for bone regeneration procedures,
although cross-link membranes present higher rates of postoperative complications. However, more RCT
with higher sample sizes are needed to evaluate the different membranes. The suggested lack of clinical
differences between the compared membranes suggest that further cost-benefit ratio, tissue integration and
postoperative complication oriented studies should be performed so that clinicians can take a patient-
centred, evidence-based decision.
30
The Journal of Prosthodontic Research
J Prosthodont Res. 2017 Dec 14. pii: S1883-1958(17)30116-0. doi: 10.1016/j.jpor.2017.11.002. [Epub ahead
of print]
Ultimate force and stiffness of 2-piece zirconium dioxide implants with screw-
retained monolithic lithium-disilicate reconstructions.
Joda T, Voumard B, Zysset PK, Brägger U, Ferrari M.
Keywords: DIN ISO 14801; Dental implants; Failure mode; Lithium disilicate (LS(2)); Zirconium dioxide
(ZrO(2))
PURPOSE: The aims were to analyze stiffness, ultimate force, and failure modes of a 2-piece zirconium
dioxide (ZrO2) implant system.
METHODS: Eleven 2-piece ZrO2 implants, each mounted with ZrO2 abutments plus bonded monolithic
lithium disilicate (LS2) restorations, were grouped for 3.3mm (A) and 4.1mm (B) diameter samples. Quasi-
static load was monotonically applied under a standardized test set-up (loading configuration according to
DIN ISO 14801). The ultimate force was defined as the maximum force that implants are able to carry out
until fracture; stiffness was measured as the maximum slope during loading. An unpaired t-test was
performed between group A and B for ultimate force and stiffness (p<0.05).
RESULTS: Force-displacement curves revealed statistically homogenous inner-group results for all
samples. Failure modes showed characteristic fractures at the neck configuration of the implants
independent of the diameter. Mean stiffness was 1099N/mm (±192) for group A, and significantly lower
compared to group B with 1630N/mm (±274) (p<0.01); whereas mean ultimate force was 348N (±53) for
group A, and significantly increased for group B with 684N (±29) (p<0.0001).
CONCLUSIONS: The examined 2-piece ZrO2 implant system mounted to LS2-restorations seems to be a
stable unit under in-vitro conditions with mechanical properties compared to loading capacity of physiological
force. The metal-free implant reconstructions demonstrated high stiffness and ultimate force under quasi-
static load for single tooth replacement under consideration of the dental indication of narrow and standard
diameter implants.
Clinical Oral Investigations
Clin Oral Investig. 2017 Dec 7. doi: 10.1007/s00784-017-2276-y. [Epub ahead of print]
How frequent does peri-implantitis occur? A systematic review and meta-analysis.

Rakic M, Galindo-Moreno P, Monje A, Radovanovic S, Wang HL, Cochran D, Sculean A, Canullo L.
Keywords: Dental implants; Epidemiology; Peri-implantitis; Prevalence

OBJECTIVES: The objective of this study is to estimate the overall prevalence of peri-implantitis (PI) and the
effect of different study designs, function times, and implant surfaces on prevalence rate reported by the
studies adhering to the case definition of Sanz & Chapple 2012.
31
MATERIAL AND METHODS: Following electronic and manual searches of the literature published up to
February 2016, data were extracted from the studies fitting the study criteria. Meta-analysis was performed
for estimation of overall prevalence of PI while the effects of the study design, function time, and implant
surface type on prevalence rate were investigated using meta-regression method.
RESULTS: Twenty-nine articles were included in this study. The prevalence rate in all subset meta-analyses
was always higher at patient level when compared to the prevalence rate at the implant level. Prevalence of
PI was 18.5% at the patient level and 12.8% at the implant level. Meta-regression analysis did not identify
any association for different study designs and function times while it was demonstrated the significant
association between moderately rough surfaces with lower prevalence rate of PI (p = 0.011).
CONCLUSIONS: The prevalence rate of PI remains highly variable even following restriction to the clinical
case definition and it seems to be affected by local factors such as implant surface characteristics. The
identification of adjuvant diagnostic markers seems necessary for more accurate disease classification.
CLINICAL RELEVANCE: The occurrence of PI is affected by local factors such as implant surface
characteristics hence the careful assessment of the local factors should be performed within treatment
planning.
Clin Oral Investig. 2017 Dec 22. doi: 10.1007/s00784-017-2319-4. [Epub ahead of print]
Clinical and histologic evaluation of different approaches to gain keratinized tissue

prior to implant placement in fully edentulous patients.
Thoma DS, Alshihri A, Fontolliet A, Hämmerle CHF, Jung RE, Benic GI.
Keywords: Augmentation; Autologous; Collagen; Gingival graft; Keratinized mucosa; Keratinized tissue;
Matrix; Patient-reported outcome measures; Transplantation
OBJECTIVES: This work aimed to investigate the effectiveness and predictability of different treatment
modalities for gain of keratinized tissue (KT) in fully edentulous jaws prior to dental implant placement:
apically positioned flap (APF), APF plus xenogeneic collagen matrix (XCM), and APF plus free gingival graft
(FGG).
MATERIALS AND METHODS: In fully edentulous patients with insufficient zones of KT at the prospective
implant positions, four treatment modalities were performed in the lower jaw: APF, XCM, FGG, and an
untreated control group (control). APF and XCM were applied in the first molar positions, FGG and control in
the canine positions. Assessed outcomes up to 3 months post-surgery included changes in width of KT (over
a 3-month period), histomorphometric analysis of harvested soft-tissue biopsies (at 3 months
postoperatively), and patient-reported outcomes measures (PROMs).
RESULTS: For the primary outcome, changes in KT width demonstrated an increase of 1.93 ± 1.6 mm
(APF), whereas XCM and FGG showed an increase of 4.63 ± 1.25 mm and 3.64 ± 2.01, respectively.
Histomorphometric analyses revealed a thickness of the epithelium ranging between 375 ± 122 μm (APF),
410 ± 116 μm (XCM), 336 ± 122 μm (FGG), and 413 ± 109 μm (control). All biopsies showed a regular muco-
periosteal structure with a keratinized epithelium of comparable thickness in all groups.
CONCLUSION: All three methods were suitable to increase the width of KT, although APF alone rendered
roughly 50% less gain compared to XCM and FGG.
CLINICAL RELEVANCE: The use of XCM in conjunction with an APF represents a valuable treatment
option for the gain of keratinized tissue in edentulous sites.
32
Effect of flapless ridge preservation with two different alloplastic materials in

sockets with buccal dehiscence defects-volumetric and linear changes.
Naenni N, Sapata V, Bienz SP, Leventis M, Jung RE, Hämmerle CHF, Thoma DS.
Keywords: Alveolar ridge augmentation (MeSH); Ridge preservation; Volume stability

OBJECTIVE: To test whether or not one out of two alloplastic materials used for ridge preservation (RP) is
superior to the other in terms of volumetric and linear ridge changes over time.
MATERIALS AND METHODS: In 16 adult beagle dogs, the distal roots of P3 and P4 were extracted and
50% of the buccal bone plate removed. Ridge preservation was performed randomly using two different
alloplastic bone grafting substitutes (poly lactic-co-glycolic acid (PLGA) coated biphasic calcium phosphate
particles consisting of 60% hydroxyapatite (HA) and 40% beta-tricalcium phosphate (ß-TCP=test 1), (a
biphasic calcium phosphate consisting 60% HA and 40% ß-TCP=test 2) and a resorbable collagen
membrane or a control group (sham). Sacrifice was performed at three time-points (4, 8, 16 weeks later).
Impressions were taken before extraction, after RP, and at sacrifice, allowing for assessment of volumetric
changes. A multi-way ANOVA was computed, and partial Type-II F tests were performed.
RESULTS: Both ridge preservation procedures minimized the volume loss compared to spontaneous
healing. The median buccal volume changes between pre-extraction and sacrifice were - 1.76 mm (Q1 = -
2.56; Q3 = - 1.42) for test 1, - 1.62 mm (Q1 = - 2.06; Q3 = - 1.38) for test 2, and - 2.42 mm (Q1 = - 2.63; Q3 = -
2.03) for control. The mean ridge width measurements did not show statistically significant differences
between test 1 (- 2.51 mm; Q1 = - 3.25; Q3 = - 1.70) and test 2 (- 2.04 mm; Q1 = - 3.82; Q3 = - 1.81)
(p = 0.813), but between test and control (- 3.85 mm; Q1 = - 5.02; Q3 = - 3.27) (p = 0.003).
CONCLUSIONS: Both RP techniques were successful in maintaining the buccal contour from pre-extraction
to sacrifice to a similar extent and more favorable compared to spontaneous healing.
CLINICAL RELEVANCE: Alloplastic materials can successfully be used for RP procedures.
Clinical and laboratory evaluation of the effects of different treatment modalities on

titanium healing caps: a randomized, controlled clinical trial.
Schmidt KE, Auschill TM, Heumann C, Frankenberger R, Eick S, Sculean A, Arweiler NB.
Keywords: Attachment of fibroblasts; Biocompatibility; Biofilm formation; Bleeding on probing; Healing caps;
Instrumentation; Matrix metalloproteinase-8; Probing depths; Surface roughness; Titanium dental implants
OBJECTIVES: The objective of this study is to evaluate the effects of treatment modalities on titanium
surface characteristics and surrounding tissues.
MATERIALS AND METHODS: Eighteen participants each had four titanium healing caps (HC) attached to
four newly inserted implants. After healing, each HC was randomly assigned to either (1) titanium curettes
(TC), (2) stainless steel ultrasonic tip (PS), (3) erythritol air-polishing powder (EP), or (4) only rubber cup
polishing (CON). Probing depths (PD), bleeding on probing (BOP), matrix metalloproteinase 8 (MMP-8), and
periopathogens were recorded before and 3 months following instrumentation. After final assessments, HCs
were removed, cleaned, and subjected to (a) bacterial colonization (Streptococcus gordonii, 24 h; mixed
culture, 24 h) and (b) gingival fibroblasts (5 days). HC surfaces were analyzed with a scanning electron
microscope (SEM).
33
RESULTS: No significant differences between the groups were evident before or after instrumentation for
PD and BOP (except TC showed a significant decrease in PD; p = 0.049). MMP-8 levels and bacterial loads
were always very low. MMP-8 decreased further after instrumentation, while bacteria levels showed no
change. No significant differences (p > 0.05) were evident in bacterial colonization or fibroblast attachment. A
comparison of the overall mean SEM surface roughness scores showed a significant difference between all
groups (p < 0.0001) with the lowest roughness after EP.
CONCLUSIONS: All treatments performed yielded comparable outcomes and may be implemented safely.
CLINICAL RELEVANCE: Clinicians may fear implant surface damage, but all instrumentation types are safe
and non-damaging. They can be implemented as needed upon considering the presence of staining and soft
and hard deposits.
The International Journal of Oral and Maxillofacial Implants
Int J Oral Maxillofac Implants. 2017 Nov/Dec;32(6):1281-1287. doi: 10.11607/jomi.5962.
Cytotoxicity of Dental Implants: The Effects of Ultrastructural Elements.

Cal E, Cetintas VB, Boyacioglu H, Güneri P.
Keywords: cell culture, cytotoxicity, dental implants, energy-dispersive x-ray analysis, osteoblasts
PURPOSE: In this in vitro study, the purpose was to assess the cytotoxicity profiles of seven commercial
dental implant materials by using cell culture methods on an osteoblastic cell line.
MATERIALS AND METHODS: The microstructure of seven commercial dental implants (each given a letter
code) was investigated via scanning electron microscopy and energy-dispersive x-ray analysis. Medium
extracts were collected on the first and fifth days for each group and tested using MC3T3-E1 cell line.
Cytotoxicity was evaluated with Xcelligance System and XTT reagent, and apoptosis was determined by
Annexin-V staining. One-way analysis of variance (ANOVA) and Tukey's multiple range tests were used for
statistical analyses. In all tests, P was set as .05.
RESULTS: ANOVA results disclosed that Ti (P = .001), Na (P = .001), Ca (P = .019), Al (P = .024), and P (P
= .020) amounts were significantly different between test materials. Cytotoxicity and apoptosis analyses
revealed that implant materials (C) and (E) were the materials with the lowest cell vitality and the highest
apoptosis rates among the test materials. Phosphorus was the only element that presented the highest
amount in C and E (14.23% and 12.29%, respectively) compared with the other implant materials tested. (F)
and (G) had favorable results for all experiments.
CONCLUSION: The results suggest that pure dental implant materials with a lower number of additional
elements may possess fewer cytotoxic effects than the other implant materials tested in this study.
34
Implant-Abutment Connections: A Review of Biologic Consequences and Peri-

implantitis Implications.
Sasada Y, Cochran DL.
Keywords: alveolar bone loss, dental implant-abutment interface, dental implants, inflammation, platform
switching, review literature
Abstract: Clinicians very often have seen marginal bone loss around dental implants at the crest level early
on after implant placement and uncovering. Early clinical publications had suggested that this bone loss
occurred during the first year of loading. Thus, numerous attempts have been made to minimize or eliminate
such bone loss. However, the timing and reason for this bone loss are not always apparent. The objective of
this study was to review the evidence regarding marginal bone loss around dental implants from the
standpoint of biologic consequences to help understand marginal bone changes around dental implants.
One hypothesis for the bone loss around these implants was related to the presence of bacteria in the
interfaces between the implant and abutment connections. The literature was reviewed regarding the three
major types of implant-abutment crestal connections, including butt-joint, platform-switched, and no interface
(tissue-level or one-body). This review article revealed that 1.5 to 2.0 mm of bone loss occurred around
bone-level, butt-joint connections when the interface was created because the microgap was wide enough
for penetration and colonization of bacteria, and that this bone loss was not observed around implants with
no interface because they did not have a contaminated interface at the bone crest. Many studies have shown
an advantage in the amount of marginal bone resorption for implants with a platform-switched connection,
and there appears to be a significantly different biologic reaction. Recent publications indicate that such
contaminated implant-abutment connections might have an effect on peri-implantitis and failure over time.
Success and Failure Rates of 1,344 6- to 9-mm-Length Rough-Surface Implants

Placed at the Time of Transalveolar Sinus Elevations, Restored with Single Crowns,
and Followed for 60 to 229 Months in Function.
Fugazzotto PA.
Keywords: implant success, osteotomes, shorter implants, sinus augmentation, trephines
PURPOSE: To assess the success and stability of 6-, 7-, 8-, and 9-mm-long, 6.5-mm-wide-neck tissue-level
implants placed at the time of transalveolar sinus augmentation therapy, utilizing a trephine and osteotome
approach, which were restored with single crowns.
MATERIALS AND METHODS: In total, 1,344 implants were placed by the author, varying in length from 6 to
9 mm, with parallel-wall 4.8-mm-diameter implant bodies and 6.5-mm-diameter implant necks. The implants
were restored with single abutments and crowns by a variety of practitioners. They were followed for 60 to
229 months in function, with a mean time of 121.1 months in function. Implant success was evaluated by the
author utilizing a combination of the Albrektsson et al criteria, and buccal and palatal/lingual bone sounding
under anesthesia.
RESULTS: The overall cumulative success rate was 98.8%. One hundred ninety 6-mm-long implants
demonstrated a cumulative success rate of 97.5% at a mean time of 109.2 months in function. Eleven 7-
mm-long implants demonstrated a cumulative success rate of 100% at a mean time of 218.5 months in
function. One thousand ninety-four 8-mm-long implants demonstrated a cumulative success rate of 98.9% at
a mean time of 112.3 months in function. Forty-nine 9-mm-long implants demonstrated a cumulative
success rate of 100% at a mean time of 212.1 months in function.
35
CONCLUSION: Implants of 6 to 9 mm in length, placed at the time of trephine and osteotome transalveolar
sinus elevation procedures and restored with abutments and single crowns, demonstrate a high level of long-
term clinical success, assuming specific comprehensive treatment criteria are met.
Consistency of Dental Hygiene Therapy Utilizing Various Dental Hygiene

Instrumentation and Its Effect on Peri-implant Health and Survival of Dental
Implants: A Retrospective Study.
Hoerler SB, Nietz SK, Zook VL, Lohse CM, Salinas TJ, Carr AB, Assad DA.
Keywords: dental implants, dental phophylaxis, dental prosthesis implant-supported, dental scaling
PURPOSE: The purpose of this retrospective study was to provide practice-based evidence to determine if
the consistency of dental hygiene therapy, despite utilizing instrumentation literature that has proven to
cause alterations to implant surfaces, affects peri-implant health or survival.
MATERIALS AND METHODS: The study sample comprised patients with implant-supported full-arch fixed
dental prostheses who were distributed into two groups. The consistent hygiene group patients had dental
hygiene therapy at a minimum biannually and were exposed to at least three dental hygiene instrument
materials. The inconsistent hygiene group patients had dental hygiene therapy at a minimum once every 3 to
10 years and were exposed to at least three dental hygiene instrument materials. Years of survival free of
soft tissue pathology and/or implant failure were estimated. Continuous features were summarized with
medians, interquartile ranges (IQRs), and ranges; categorical features were summarized with frequency
counts and percentages.
RESULTS: Among 48 patients in the consistent hygiene group, 11 patients experienced soft tissue
pathology or implant failure at a median of 11.3 years; among 99 patients in the inconsistent hygiene group,
17 patients experienced soft tissue pathology or implant failure at a median of 4.8 years. The survival free of
soft tissue pathology or implant failure rate at 5 years was 94% for the consistent hygiene group and 91% for
the inconsistent hygiene group. The survival free of soft tissue pathology or implant failure rate at 20 years
was 70% for the consistent hygiene group and 79% for the inconsistent hygiene group (P = .91).
CONCLUSION: Although no statistical differences were found between the groups, this practice-based
evidence suggests more consistent dental hygiene therapy increases the median in years in which soft
tissue pathology or implant failure is present.
Implant Mandibular Overdentures Retained by Immediately Loaded Implants: A 1-

Year Randomized Trial Comparing the Clinical and Radiographic Outcomes
Between Mini Dental Implants and Standard-Sized Implants.
Zygogiannis K, Aartman IH, Parsa A, Tahmaseb A, Wismeijer D.
Keywords: immediate loading, implant overdentures, marginal bone loss, mini dental implants
36
PURPOSE: The aim of this 1-year randomized trial was to evaluate and compare the clinical and
radiographic performance of four immediately loaded mini dental implants (MDIs) and two immediately
loaded standard-sized tissue-level (STL) implants, placed in the interforaminal region of the mandible and
used to retain mandibular overdentures (IODs) in completely edentulous patients.
MATERIALS AND METHODS: A total of 50 completely edentulous patients wearing conventional maxillary
dentures and complaining about insufficient retention of their mandibular dentures were divided into two
groups; 25 patients received four MDIs and 25 patients received two STL implants. The marginal bone loss
(MBL) at the mesial and distal sides of each implant was assessed by means of standardized intraoral
radiographs after a period of 1 year. Implant success and survival rates were also calculated.
RESULTS: Immediate loading was possible for all patients in the first group. In the second group, an
immediate loading protocol could not be applied for 10 patients. These patients were treated with a delayed
loading protocol. A mean MBL of 0.42 ± 0.56 mm for the MDIs and 0.54 ± 0.49 mm for the immediately
loaded STL implants was recorded at the end of the evaluation period. There was no statistically significant
difference between the MDIs and the immediately loaded STL implants. Two MDIs failed, resulting in a
survival rate of 98%. The success rate was 91%. For the immediately loaded conventional implants, the
survival rate was 100% and the success rate 96.7% after 1 year of function. However, in 10 patients, the
immediate loading protocol could not be followed.
CONCLUSION: Considering the limitations of this short-term clinical study, immediate loading of four
unsplinted MDIs or two splinted STL implants to retain mandibular overdentures seems to be a feasible
treatment option. The marginal bone level changes around the MDIs were well within the clinically
acceptable range.
The Journal of Oral Rehabilitation
J Oral Rehabil. 2017 Nov 10. doi: 10.1111/joor.12585. [Epub ahead of print]
Mini-implants and narrow diameter implants as mandibular overdenture retainers:

A systematic review and meta-analysis of clinical and radiographic outcomes.
Marcello-Machado RM, Faot F, Schuster AJ, Nascimento GG, Del Bel Cury AA
Keywords: edentulous; jaw; meta-analysis; mini-implant; narrow dental implants; overdenture; systematic
review
Abstract: This study reviews the clinical and radiographic outcomes of Mini-implants (MI) and Narrow
Diameter Implants (NDI) as mandibular overdenture (MO) retainers. Six databases were consulted for
clinical studies that evaluated implants with diameter ≤3.5 mm. Data on the MI and NDI for survival and
success rate and peri-implant bone loss and were collected and submitted to meta-analysis. Thirty-six
studies were included, 24 reporting MI performance and 12 describing NDI results. The MI group comprised
data from 1 cross-sectional clinical study, 3 retrospective longitudinal (RL) clinical studies, 13 prospective
longitudinal (PL) clinical studies and 7 randomised clinical trials (RCT) with follow-up periods ranging from 1
day to 7 years. Eight studies used conventional loading, thirteen used immediate loading, two studies used
both loading types, and one study did not report. The NDI group comprised data from 3 RL clinical studies, 6
PL clinical studies and 3 RCT with follow-up ranging from 6 months to 10 years. Ten studies used
conventional loading, 1 study used immediate loading, and 1 study did not report. The average survival rates
of MI and NDI studies were 98% and 98%, respectively, while the average success rates were 93% and
96%, respectively. The average peri-implant bone loss after 12, 24 and 36 months was 0.89, 1.18 and 1.02
mm for MI and 0.18, 0.12 and -0.32 mm for NDI. Both MI and NDI showed adequate clinical behaviour as
overdenture retainers. The NDI showed a better long-term predictability to retain OM with most studies
adopting conventional loading.
37
The Journal of Prosthetic Dentistry
J Prosthet Dent. 2017 Nov;118(5):587-595. doi: 10.1016/j.prosdent.2016.11.019. Epub 2017 Apr 3.
A meta-analysis of retention systems for implant-supported prostheses in partially

edentulous jaws.
Ramamoorthi M, Narvekar A, Esfandiari S.
STATEMENT OF PROBLEM: Choosing an appropriate retention system for patients with partial edentulism
and dental implants is impeded by a paucity of evidence. The available evidence is extrapolated from either
completely edentulous or mixed study populations.
PURPOSE: The purpose of this systematic review was to assess the effects of different retention systems
used for implant-supported prostheses in patients with partially edentulous jaws by measuring the rates of
failure, survival, and event-free situations.
MATERIAL AND METHODS: An electronic database search supplemented by a manual search was
conducted to identify the best, good, and fair quality studies reporting at least 10 participants with a 1-year
follow-up (PROSPERO-CRD 42015024649). Summary estimates of the survival, failure, and event-free
proportions were obtained using a random effects model with a 95% confidence interval.
RESULTS: Among the 896 citations from 3875 titles identified by the search, 104 studies reporting over
5317 participants with 9568 reconstructions and a total exposure time of 46553.18 years were included in the
analysis. Screw-retained single crowns showed twofold minor complication even rates (8.5%; 95%
confidence interval [CI]: 5.5-12.9) compared with cement-retained single crowns (4.2%. 95% CI; 3.2-5.4).
None of the retention systems were more advantageous than the others in relation to failure and event-free
outcomes. However, the summary of the findings suggests that cement-retained single crowns, splinted
crowns, and cantilever-fixed partial dentures performed better (with fewer events) than screw-retained
restorations in the long term.
CONCLUSIONS: Results suggest that cement retention may be an appropriate system for implant-
supported restorations in partial edentulism. However, high-quality prospective studies and cost evaluation
are recommended to confirm the evidence.
A combined digital and stereophotogrammetric technique for rehabilitation with

immediate loading of complete-arch, implant-supported prostheses: A randomized
controlled pilot clinical trial.
Peñarrocha-Diago M, Balaguer-Martí JC, Peñarrocha-Oltra D, Balaguer-Martínez JF, Peñarrocha-Diago M5,
Agustín-Panadero R.
STATEMENT OF PROBLEM: Traditional impressions for complete-arch restorations are complex and time-
consuming, and they can be uncomfortable for the patient. New digital techniques such as
stereophotogrammetry may mitigate this.
38
PURPOSE: The purpose of this randomized controlled pilot clinical trial was to compare the patient and
dentist satisfaction and work times of traditional impressions (control group) and digital impressions with
stereophotogrammetry in complete-arch, implant-supported prostheses. Success rates, implant survival,
marginal bone loss around the dental implants, and prosthesis survival were also analyzed.
MATERIAL AND METHODS: This randomized controlled pilot clinical trial included 18 participants who
received 131 dental implants. Implant impressions in the experimental group were made with
stereophotogrammetry (8 participants with 66 implants), while traditional impressions were made in the
control group (10 participants with 65 implants). Working times were measured in minutes starting from
removal of the healing abutments to their replacement after the impression. Patient and dentist satisfaction
was analyzed using a questionnaire with a visual analog scale, and implant success was assessed using the
Buser success criteria. Prosthesis survival was defined as the presence of the prosthesis in the mouth,
without screw loosening or fracture.
RESULTS: The work times were 15.6 (experimental group) and 20.5 minutes (control group) (P<.001). The
patient satisfaction scores were 8.8 in the experimental and 7.9 in the control group (P=.02). The dentist
satisfaction scores were 9.1 in the experimental group and 8.5 in the control group (P=.03). The implant
success rate was 100% in both groups. Marginal bone loss was 0.6 ±0.5 mm (experimental group) and 0.6
±0.2 mm (control group) (P=.72).
CONCLUSIONS: Digital impressions using stereophotogrammetry may be an alternative to traditional

impressions. Patient and dentist satisfaction improved, and the work time was reduced in the experimental
group. No statistically significant differences were found in terms of the implant success rate, implant
survival, marginal bone loss, or prosthesis survival between the 2 groups.
Effect of coarse grinding, overglazing, and 2 polishing systems on the flexural

strength, surface roughness, and phase transformation of yttrium-stabilized
tetragonal zirconia.
Mohammadi-Bassir M, Babasafari M, Rezvani MB, Jamshidian M.
STATEMENT OF PROBLEM: Limited information is available for the best polishing systems and methods to
obtain minimally abrasive monolithic zirconia surfaces after contouring and occlusal adjustment.
PURPOSE: The purpose of this in vitro study was to evaluate the effect of grinding and polishing procedures
on the flexural strength, quality and quantity of surface roughness, topography, and phase transformation of
a zirconia-based ceramic system.
MATERIAL AND METHODS: Fifty bar-shaped yttrium-stabilized zirconium oxide specimens (20×4×2 mm)
were cut from presintered zirconia blanks. The specimens were wet-polished and divided into 5 groups
(n=10): standard polishing without any surface treatment (group SP); grinding with a diamond rotary
instrument (group Gr); grinding with a diamond rotary instrument (DRI) and over-glazing (group Gl); grinding
with a DRI and polishing with an intraoral zirconia polishing kit in a 2-step procedure (group BP); and grinding
with a DRI and polishing with an intraoral polishing kit (group MP). The Ra and Rz surface roughness values
(μm) were measured with a profilometer. One specimen of each group was subjected to x-ray diffraction
(XRD) to estimate the monoclinic phase and evaluated using scanning electron microscopy (SEM) for
surface topography. The 3-point flexural strength of the bars was measured in a universal testing machine at
a crosshead speed of 0.5 mm/min. The mean flexural strength (MPa) and surface roughness values were
calculated, and the results were analyzed using 1-way ANOVA and Tukey honest significant difference tests
(α=.05).
39
RESULTS: Statistically significant differences were noted among the experimental groups for Ra, Rz
(P<.001), and flexural strength values (P<.001). The highest Ra and Rz values were found in group Gr
(P<.001) and the lowest in group Gl, which were significantly lower than the values in group Gr (P<.001). The
2 polishing systems (BP and MP) were not significantly different in terms of Ra and Rz values (P=.755 for Ra
and P=.319 for Rz). The highest flexural strength was found in group Gr (283.35 ±49.85 MPa) without
significant differences from those of MP and BP (P=.958 for BP and P=.404 for MP). The lowest flexural
strength was found in Gl, which had no significant differences from those of the control group (P=1.000). In
XRD the monoclinic phase was observed in Gr (26%), BP (24%), and MP (23%) groups. However, groups
Gl and SP did not have any monoclinic phase. SEM showed deep unidirectional scratches after grinding that
were smoothened by glazing and polishing.
CONCLUSIONS: Roughness increased significantly after grinding, but polishing and glazing similarly
diminished it. Glazing after grinding significantly decreased the flexural strength values, but polishing did not.
J Prosthet Dent. 2017 Dec;118(6):725-731. doi: 10.1016/j.prosdent.2016.12.008. Epub 2017 Apr 4.
The effect of 2 versus 4 implants on implant stability in mandibular overdentures: A

randomized controlled trial.
Al-Magaleh WR, Swelem AA, Radi IAW.
STATEMENT OF PROBLEM: Dental research is rich with articles that investigated the influence of host-site
variables, some implant-related variables (implant length, diameter, taper, design, location, and surface
topography), different loading protocols or surgical procedures, and measurement methodology on dental
implant stability. However, the number of implants and its effect on implant stability remain unclear.
PURPOSE: The purpose of this randomized clinical trial was to investigate the influence of implant number
on implant stability by comparing 2 versus 4 implants in mandibular implant overdentures.
MATERIAL AND METHODS: The trial included 20 participants with edentulous mandibular ridges.
Participants were randomly assigned to 2 equal groups, a 4-implant (experimental) group consisting of 4
implants installed in lateral-canine and premolar regions; and a 2-implant (control) group, consisting of 2
implants in lateral-canine regions. Implant stability was measured using resonance frequency analysis at
implant placement and then at 1, 3, 6, 9, and 12 months. The Student t test was used to compare the
implant stability quotient (ISQ) values of the anterior implants in the 4-implant and 2-implant groups. One-
way ANOVA followed by the post hoc Bonferroni test was used to compare ISQ values among the different
follow-up periods within each group (α=.05).
RESULTS: Mean ISQ values for anterior implants in the 4-implant group were slightly higher than those
recorded for the 2-implant group at all follow-up periods. However, these differences were not statistically
significant (P>.05). Within-group comparison revealed an initial decrease in implant stability for all implants.
This decrease was statistically significant for the 2-implant group (P<.001) and for posterior implants in the 4-
implant group (P<.001). This was then followed by a gradual increase in ISQ values for all implants in both
groups.
CONCLUSIONS: Increasing the number of implants from 2 to 4 in mandibular implant overdentures did not
have a significant influence on implant stability.
40
Oral & Maxillofacial Surgery Clinics
Oral Maxillofac Surg Clin North Am. 2017 Nov;29(4):525-535. doi: 10.1016/j.coms.2017.07.007.
Controversies in Implant Surgery.

Aghaloo TL, Mardirosian M, Delgado B.
Keywords: Growing patients; Implants; Mini implants; Short implants
Abstract: Dental implants are a mainstream treatment protocol to replace missing teeth. Patient and
clinician demands have led to shorter length and narrower diameter implants, immediately placed implants
into infected sites, and the use of implants in children. This article reviews some of the controversial topics in
implant dentistry, and presents the evidence that supports and challenges these newer techniques. Because
long-term studies are often not available, especially for implants in infected sites, mini implants, and implants
in the growing patient, the field continues to evolve.
Journal of Oral and Maxillofacial Surgery
J Oral Maxillofac Surg. 2017 Dec;75(12):2559.e1-2559.e8. doi: 10.1016/j.joms.2017.08.001. Epub 2017 Aug
5.
How Accurate Are Implant Surgical Guides Produced With Desktop

Stereolithographic 3-Dimentional Printers?
Deeb GR, Allen RK, Hall VP, Whitley D 3rd, Laskin DM, Bencharit S.
PURPOSE: The use of tooth-supported static stereolithographic guides has greatly improved the ability to
ideally place implants. This study was designed to determine the accuracy of in office-printed implant
surgical guides.
MATERIALS AND METHODS: Using 3shape Implant Studio, a treatment plan for implant placement for
tooth 8 was developed using a digital intraoral scan from a Trios scanner and cone-beam computed
tomography. Ten stereolithographic guides were printed using a Form2 3-dimensional printer. Pre- and post-
implant insertion digital scans were used to determine distance and angulation differences in the mesiodistal
and faciolingual positions of the implants compared with the planned position.
RESULTS: The mean difference in mesiodistal direction at the alveolar crest between planned implants and
placed implants was 0.28 mm (range, 0.05 to 0.62 mm) and the difference in the faciolingual direction was
0.49 mm (range, 0.08 to 0.72 mm). The mean mesiodistal angulation deviation was 0.84° (range, 0.08° to
4.48°) and the mean faciolingual angulation deviation was 3.37° (range, 1.12° to 6.43°).
CONCLUSIONS: In-office fabricated stereolithographic implant surgical guides show similar accuracy to
laboratory- or manufacturer-prepared guides. This technique provides a convenient and cost-effective
means of assuring proper implant placement.
41
The International Journal of Prosthodontics
Int J Prosthodont. 2017 November/December;30(6):545–552. doi: 10.11607/ijp.5281. Epub 2017 Oct 30.
Effects of Cement, Abutment Surface Pretreatment, and Artificial Aging on the

Force Required to Detach Cantilever Fixed Dental Prostheses from Dental Implants.
Kappel S, Chepura T, Schmitter M, Rammelsberg P, Rues S.
PURPOSE: To examine the in vitro effects of different cements, abutment surface preconditioning, and
artificial aging on the maximum tensile force needed to detach cantilever fixed dental prostheses (FDPs)
from dental implants with titanium abutments.
MATERIALS AND METHODS: A total of 32 tissue-level implants were combined with standardized titanium
abutments. For each test group, eight cantilever FDPs were fabricated using selective laser melting (cobalt-
chromium [CoCr] alloy). The inner surfaces of the cantilever FDPs and half of the abutments were
sandblasted and then joined by use of four different cements (two permanent and two semi-permanent) in
two different amounts per cement. Subgroups were tested after either artificial aging (thermocycling and
chewing simulation) or 3 days of water storage. Finally, axial pull off-tests were performed for each abutment
separately.
RESULTS: Cement type and surface pretreatment significantly affected decementation behavior. The
highest retention forces (approximately 1,200 N) were associated with sandblasted abutments and
permanent cements. With unconditioned abutments, temporary cements (Fu < 100 N), as well as glass-
ionomer cement (Fu ≈ 100 N), resulted in rather low retention forces. Zinc phosphate cement guaranteed
high retention forces. After aging, retention was sufficient only for cementation with zinc phosphate cement
and for the combination of sandblasted abutments and glass-ionomer cement.
CONCLUSIONS: When glass-ionomer cement is used to fix cantilever FDPs on implants, sandblasting of
standard titanium abutments may help prevent loss of retention. Retention forces were still high for FDPs
fixed with zinc phosphate cement, even when the abutments were not pretreated. Use of permanent
cements only, however, is recommended to prevent unwanted loosening of cantilever FDPs.
Int J Prosthodont. 2017 November/December;30(6):586–591. doi: 10.11607/ijp.5400. Epub 2017 Oct 30.
Influence of Attachment Height and Shape on Lateral Force Transmission in

Implant Overdenture Treatment.
Ying Z, Gonda T, Maeda Y.
PURPOSE: The purpose of this preliminary study was to examine the influence of overdenture attachment
height and shape on lateral force on implants and denture displacement.
MATERIALS AND METHODS: A straight model was fabricated to simulate the edentulous ridge. Two strain
gauges were attached to the mesial and distal surfaces of the implant in the canine area. Five types of ball
attachments and three types of Locator attachments with three types of replacement male attachments were
used. A vertical load of 49 N was applied. The lateral force on the implant and the denture displacement
were measured. Statistical comparisons were performed using one-way analysis of variance, Tukey post hoc
comparison test, and multivariate analysis. P < .05 was considered significant.
42
RESULTS: Ball attachments of 4-mm height exerted the highest lateral force on the implant, and the
greatest displacement was also observed with attachments of 4-mm height. Different lateral forces were
observed for different shapes of ball attachments, but there were no significant differences in denture
displacement among the shapes. For Locator attachments, the highest lateral force was observed with the
white male type, and the greatest denture displacement occurred with attachments of 4-mm height. There
were no significant differences among male white, pink, and blue types.
CONCLUSION: The height of the stud attachments in implant overdentures had a marked effect on the
lateral force on implants and on denture displacement. To protect implants supporting an overdenture and to
prevent bone resorption, the height of the attachment should be carefully considered.
The Journal of Oral Implantology
J Oral Implantol. 2017 Dec;43(6):429-436. doi: 10.1563/aaid-joi-D-16-00147. Epub 2017 Oct 3.
Antimicrobial Effects of Three Different Treatment Modalities on Dental Implant

Surfaces.
Larsen OI, Enersen M, Kristoffersen AK, Wennerberg A, Bunæs DF, Lie SA, Leknes KN.
Keywords: P. gingivalis; decontamination; dental implant; laser; microstructure; surface alteration

Abstract: Resolution of peri-implant inflammation and re-osseointegration of peri-implantitis affected dental
implants seem to be dependent on bacterial decontamination. The aims of the study were to evaluate the
antimicrobial effects of 3 different instrumentations on a micro-textured dental implant surface contaminated
with an avirulent or a virulent Porphyromonas gingivalis strain and to determine alterations to the implant
surface following instrumentation. Forty-five dental implants (Straumann SLA) were allocated to 3 treatment
groups: Er:YAG laser, chitosan brush, and titanium curette (10 implants each) and a positive (10 implants)
and a negative (5 implants) control. Each treatment group and the positive control were split into subgroups
of 5 implants subsequently contaminated with either the avirulent or virulent P. gingivalis strain. The
antimicrobial effect of instrumentation was evaluated using checkerboard DNA-DNA hybridization. Implant
surface alterations were determined using a light interferometer. Instrumentation significantly reduced the
number of attached P. gingivalis ( P < .001) with no significant differences among groups ( P = .310). A
significant overall higher median score was found for virulent compared with avirulent P. gingivalis strains ( P
= .007); the Er:YAG laser uniquely effective removing both bacterial strains. The titanium curette significantly
altered the implant surface micro-texture. Neither the Er:YAG laser nor the chitosan brush significantly
altered the implant surface. The 3 instrumentations appear to have a similar potential to remove P.
gingivalis. The titanium curette significantly altered the microstructure of the implant surface.
Antimicrobial Effects of Three Different Treatment Modalities on Dental Implant

Surfaces.
Larsen OI, Enersen M, Kristoffersen AK, Wennerberg A, Bunæs DF, Lie SA, Leknes KN.
Keywords: P. gingivalis; decontamination; dental implant; laser; microstructure; surface alteration
43
Abstract: Resolution of peri-implant inflammation and re-osseointegration of peri-implantitis affected dental
implants seem to be dependent on bacterial decontamination. The aims of the study were to evaluate the
antimicrobial effects of 3 different instrumentations on a micro-textured dental implant surface contaminated
with an avirulent or a virulent Porphyromonas gingivalis strain and to determine alterations to the implant
surface following instrumentation. Forty-five dental implants (Straumann SLA) were allocated to 3 treatment
groups: Er:YAG laser, chitosan brush, and titanium curette (10 implants each) and a positive (10 implants)
and a negative (5 implants) control. Each treatment group and the positive control were split into subgroups
of 5 implants subsequently contaminated with either the avirulent or virulent P. gingivalis strain. The
antimicrobial effect of instrumentation was evaluated using checkerboard DNA-DNA hybridization. Implant
surface alterations were determined using a light interferometer. Instrumentation significantly reduced the
number of attached P. gingivalis ( P < .001) with no significant differences among groups ( P = .310). A
significant overall higher median score was found for virulent compared with avirulent P. gingivalis strains ( P
= .007); the Er:YAG laser uniquely effective removing both bacterial strains. The titanium curette significantly
altered the implant surface micro-texture. Neither the Er:YAG laser nor the chitosan brush significantly
altered the implant surface. The 3 instrumentations appear to have a similar potential to remove P.
gingivalis. The titanium curette significantly altered the microstructure of the implant surface.
Comparing the Healing Potential of Late-Stage Periodontitis and Peri-Implantitis.

Wong RL, Hiyari S, Yaghsezian A, Davar M, Lin YL, Galvan M, Tetradis S, Camargo PM, Pirih FQ.
Keywords: implants; ligature removal; murine model; peri-implantitis; periodontitis; treatment

Abstract: Peri-implantitis is defined as an inflammatory disease affecting the tissues around
osseointegrated functioning implants. Unfortunately, detailed peri-implantitis pathogenesis is not well
understood and current treatments lack predictability. Compare the healing potential of late-stage ligature-
induced periodontitis and peri-implantitis after ligature removal. Four-week-old C57BL/6J male mice had
their left maxillary molars extracted. After 8 weeks, implants were placed in healed sockets and allowed to
osseointegrate. Mice were separated into control (no ligature) and experimental (ligature) groups. In the
experimental group, ligatures were placed around the implant and the contralateral second molar. Four
weeks later, the ligature group was randomly divided into ligature-retained and ligature-removed groups.
Mice were sacrificed at 2 time points: 1 and 2 weeks after ligature removal. The samples were analyzed by
microcomputed tomography (micro-CT) and histology. Ligature-induced significant bone loss in peri-
implantitis and periodontitis were compared with respective controls. At the 2-week time point, bone
formation was observed in the ligature-removed groups compared with respective controls; however, more
bone was regained in periodontitis ligature-removed compared with the peri-implantitis ligature-removed
group. Histologically, the peri-implantitis ligature-retained group had higher inflammatory levels and a higher
number of osteoclasts compared with the periodontitis ligature-retained group. Moreover, in the peri-
implantitis ligature-retained group, collagen appeared less organized compared with the periodontitis
ligature-retained group at both time points; although collagen tended to reorganize following ligature removal
in both conditions. Peri-implantitis does not respond to treatment as well as periodontitis. Future work
includes understanding peri-implantitis pathogenesis and developing predictable treatment protocols.
44
J Oral Implantol. 2017 Dec;43(6):476-481. doi: 10.1563/aaid-joi-D-17-00166. Epub 2017 Nov 1.
A Qualitative Study on Patients' Perceptions of Two Types of Attachments for

Implant Overdentures.
Pisani M, Bedos C, da Silva CHL, Fromentin O, de Albuquerque RF Jr.
Keywords: dental implants; edentulous mandible; overdentures; precision attachment; qualitative research
Abstract: The aim of this qualitative study was to gain a deeper understanding of patient perceptions of
wearing implant-retained overdentures with ball-shaped or cylindrical attachment systems. Twenty-two
wearers of implant-supported overdentures participated in this qualitative study based on a randomized
crossover clinical trial that aimed to compare a cylindrical attachment and a ball attachment. In phase I of the
study, group A experienced ball attachments (n = 11) and group B Locator attachments (n = 11) for 1 year.
Afterward, in phase II, the attachments were changed; group A received Locator attachments and group B
received ball attachments. One week after the attachment's replacement, semistructured individual
interviews were conducted. All interviews were audiotaped and transcribed. The analysis was guided by
thematic content analysis. Most of the patients from both groups preferred the attachment they received in
phase II, regardless the type. A major theme raised by the participants to justify their preference between the
attachment types was prosthesis retention/stability, sometimes considered as a positive and other times as a
negative factor. Other themes were also explored: oral function, pain, hygiene, previous experiences,
confidence on the dentist's work, and esthetic. Aspects related to the retention/stability of the overdentures
are the main concerns associated with the perceptions of most patients treated with implant overdentures
regardless of the type of attachment. Adequate retention level should be identified and adjusted on an
individual basis and maintained overtime as possible. Therefore, follow-up appointments should be planned
for readjustment of the attachment's retention. Overretention should be avoided.
J Oral Implantol. 2017 Dec;43(6):491-496. doi: 10.1563/aaid-joi-D-17-00035. Epub 2017 Sep 5.
Parameters to Define Peri-Implantitis: A Review and a Proposed Multi-Domain

Scale.
Lin GH, Kapila Y, Wang HL.
Keywords: dental implants; implant-supported dental prosthesis; peri-implantitis; periodontal pocket; risk
factors
Abstract: Peri-implant diseases have received much attention since dental implants are generally used in
contemporary dentistry. Several contributing factors associated with the development of peri-implant
diseases have also been investigated. The prevalence of peri-implantitis has been reported but with great
heterogeneity because of a lack of a universally accepted classification system that could define the extent
and severity of peri-implantitis. Several parameters-including radiographic bone loss, probing depth, bleeding
on probing, and suppuration-have been introduced in these reports to assist with clinical diagnosis. This
article provides an objective evaluation of these parameters based on currently available evidence, offers
further recommendations, and proposes a multidomain scale for diagnosis of peri-implantitis. Future
investigations and modifications may be needed to develop a comprehensive, evidence-based classification
system that addresses the multifactorial etiology of peri-implant diseases.
45
The International Journal of Periodontics & Restorative
Dentistry
Int J Periodontics Restorative Dent. 2017 Nov/Dec;37(6):781-788. doi: 10.11607/prd.3324.
Efficacy of Er:YAG Laser in the Decontamination of Peri-implant Disease: A One-

Year Prospective Closed Cohort Study.
Norton MR.
Abstract: A significant number of articles have been published to describe a variety of techniques for the
treatment of peri-implant disease, with varying success. Previous reports have presented limited data on the
use of lasers for the decontamination of implant surfaces prior to defect augmentation using guided bone
regeneration techniques. The current study is a prospective closed cohort study of 20 patients with a follow-
up of 1 year. It was established to assess the efficacy of the Er:YAG water-cooled laser following initially
promising reports suggesting the laser can decontaminate and sterilize the implant surface and allow for
reosseointegration of the affected portion of the implant.
The Management of Peri-implant Mucosa Deficiencies in Esthetic Sites: Case

Report of a Combined Surgical-Prosthetic Approach.
Jurczyk K, Belser UC, Sculean A.
Abstract: In cases of single missing teeth, implant rehabilitation is generally the preferred treatment option.
However, obtaining pleasing esthetic results in the anterior maxillary region and maintaining or rebuilding
peri-implant papillae remain challenging tasks. The loss of papillae may cause not just functional but also
phonetic and esthetic problems. There is scarce information on the reliability of surgical approaches
concerning the peri-implant papilla. The purpose of this case report is to present a modified prosthetic-
surgical technique to enhance the convex facial contour of the peri-implant mucosa and volume and height
of papillary tissue in an esthetically highly demanding patient.
The Lip-Tooth-Ridge Classification: A Guidepost for Edentulous Maxillary Arches.

Diagnosis, Risk Assessment, and Implant Treatment Indications.
Pollini A, Goldberg J, Mitrani R, Morton D.
Abstract: Prosthetic rehabilitation of the edentulous maxilla is known to be challenging and requires
meticulous planning. The purpose of this article is to describe a novel classification system, the Lip-Tooth-
Ridge (LTR), that offers a guidepost for treatment planning the edentulous maxilla for fixed or removable
prostheses. This tool will help clinicians identify the final prosthetic design and will provide a case-specific
risk assessment guide regarding two different areas. A high (HER) or low (LER) esthetic risk will be
determined based on lip dynamics, as well as a high or low structural risk according to the prosthetic space
availability.
46
Dental Mater Journal
Dent Mater J. 2017 Nov 23. doi: 10.4012/dmj.2017-111. [Epub ahead of print]
Correlations between fracture load of zirconia implant supported single crowns and
mechanical properties of restorative material and cement.
Rohr N, Märtin S, Fischer J.
Keywords: Flexural strength; Fracture load; Fracture toughness; Resin composite cement; Zirconia implant
Abstract: Zirconia implants that were restored with veneered zirconia displayed severe chipping rates of the
restorations in clinical studies. Purpose of this study was to evaluate the fracture load of different zirconia
implant supported monolithic crown materials (zirconia, alumina, lithium disilicate, feldspar ceramic and
polymer-infiltrated ceramic) cemented with various cements (Harvard LuteCem SE, Harvard Implant Semi-
permanent, Multilink Automix, VITA Adiva F-Cem). Flexural strength and fracture toughness of crown
materials and compressive strength of the cements were measured. Fracture load values of crowns
fabricated from lithium disilicate, feldspar ceramic and polymer-infiltrated ceramic were increased when
cement with high compressive strength was used. Fracture loads for zirconia and alumina crowns were not
influenced by the cement. Flexural strength and fracture toughness of the ceramics correlated linearly with
the respective fracture load when using adhesive cement with high compressive strength. To achieve
sufficient fracture load values, cementation with adhesive cement is essential for feldspar and polymer-
infiltrated ceramic.
The publisher grants you free access to the contents of this paper.
Implant Dentistry
Implant Dent. 2017 Dec;26(6):841-847. doi: 10.1097/ID.0000000000000673.
Comparative Study on Early Osseointegration of Implants According to Various

Drilling Speeds in the Mandible of Dogs.
Seo DU, Kim SG, Oh JS, Lim SC.
PURPOSE: This study evaluated the effect of drilling speed on early bone healing in the mandible of dogs.
MATERIAL AND METHODS: Six dogs were selected, and mandibular premolars and molars were
extracted. After 2 months, 3 hydroxyapatite-surfaced fixtures were implanted with drilling speeds of 50, 800,
and 1200 rpm on the right side first and then on the left side after 2 weeks. Implant stability quotient (ISQ)
was measured on insertion, after 2 and 4 weeks.
RESULTS: Based on the ISQ measurement, the 1200-rpm group showed a higher value than the 50-rpm
group at 2 weeks and 4 weeks (P < 0.05). New bone formation around the implant was highest for the 800-
rpm group at 2 weeks and the 1200-rpm group at 4 weeks. The bone-implant contact of the superior half of
the alveolar bone was highest for the 800-rpm group at 2 weeks and the 1200-rpm group at 4 weeks. There
was no statistically significant difference.
CONCLUSION: This study suggests that 50, 800, and 1200 rpm are drilling speeds which can expect
favorable outcome, yet, higher drilling speed presented overall the best biological responses.
47
Effect of 2 Different Drilling Speeds on the Osseointegration of Implants Placed

With Flapless Guided Surgery: A Study in Rabbits.
Landazuri-Del Barrio RA, Nunes de Paula W, Spin-Neto R, Chaves de Souza JA, Pimentel Lopes de Oliveira
GJ, Marcantonio-Junior E.
OBJECTIVE: The aim of this study was to evaluate the influence of the drilling speed on bone healing and
the osseointegration of implants placed with a guided flapless surgical technique in rabbit tibias.
METHODS: For the evaluation of bone healing, a total of 30 perforations (defects) were made in both tibias
of 15 rabbits using 2 different drilling speeds (1500 rpm-control group; 50 rpm-test group). The regeneration
of bone tissue in the surgical sites was evaluated at 0, 7, and 14 days. For the evaluation of implant
osseointegration, another 15 rabbits underwent drilling in both tibias for implant placement. Thirty implants
(3.75 × 10 mm) were placed to evaluate osseointegration at 4, 8, and 12 weeks after surgery.
RESULTS: Both groups showed a progressive healing of the defect, which involved the complete closure of
the perforation. The osseointegration occurred in all groups with no statistically significant differences in the
assessment of the osseointegration between the groups.
CONCLUSION: In the experimental models used, the drilling speed does not prejudice the pattern of bone
healing and osseointegration of implants placed with guided flapless surgery.
Validity of Collagen Plugs for Ridge Preservation in a Canine Model.

Kim DM, Lim HC, Hong JY, Shin SI, Chung JH, Herr Y, Shin SY.
PURPOSE: The purpose of the present study was to evaluate healing outcomes after collagen plug insertion
in extraction-related defects.
MATERIALS AND METHODS: The third and fourth mandibular premolars in canines were extracted, and
the septal bone was removed. The following treatments were performed for the defects: porcine atelo-
collagen plug, bovine atelo-collagen plug, and no intervention (control). The experimental animals were killed
after 6, 12, or 24 weeks (n = 4, respectively). Histologic and histomorphometric analyses were performed.
RESULTS: Clinical healing was uneventful, and no difference was detected among the 3 groups.
Histologically, similar healing patterns were observed in all groups. Gingival healing was complete at 6
weeks, but discontinuity in the buccal crestal bone was observed. At 12 weeks, various degrees of buccal
bone depression and increase in bone marrow were observed. At 24 weeks, no further healing was
observed. Histomorphometrically, the ridge width at 1, 3 and 5 mm levels below the crest and the ridge
dimensions 1, 3, and 5 mm above the level were not statistically different among groups or healing periods.
CONCLUSION: The healing following the use of collagen plug in the extraction socket may correspond to
the natural healing after extraction.
48
International Journal of Oral Maxillofacial Surgery
Int J Oral Maxillofac Surg. 2017 Nov 7. pii: S0901-5027(17)31666-1. doi: 10.1016/j.ijom.2017.10.013. [Epub
ahead of print]
Evaluation of peri-implant bone levels and soft tissue dimensions around zirconia
implants-a three-year follow-up study.
Kniha K, Schlegel KA, Kniha H, Modabber A, Hölzle F, Kniha K.
Keywords: aesthetics; bone crest; ceramic; dental implant; papilla; zirconium oxide
Abstract: The aim of this study was to measure bone levels around zirconia implants during follow-up of up
to 3 years. Additionally, the effect of clinical contact point positions on the papilla deficit was evaluated.
Eighty-one patients with 105 zirconia implants were examined at the 3-year follow-up. Bone levels were
measured on the date of implant placement and at 3 months, 1year, and 3 years thereafter. Distances
between the first bone-implant contact and the contact point of the crowns and between the bone level at the
adjacent tooth and the contact point of the crowns were assessed. The effect of the clinical contact point
position on the papilla deficit was also assessed. Significant reductions in the distances between the bone-
implant contact and the implant shoulder, as well as the contact point of the crowns, and between the bone
level at the adjacent tooth and the contact point of the crowns, were found. A significant association was
found between the papilla deficit and the height of the contact point. Implant survival was 100% and implant
success was 95.4%. While zirconia implants presented little bone loss up to 1year, significant bone
apposition was observed up to 3years. Low contact points correlated with full papillae, whereas high contact
points were associated with a papilla deficit.
Int J Oral Maxillofac Surg. 2017 Nov 13. pii: S0901-5027(17)31671-5. doi: 10.1016/j.ijom.2017.10.018. [Epub
ahead of print]
Effect of implant loading protocols on failure and marginal bone loss with
unsplinted two-implant-supported mandibular overdentures: systematic review and
meta-analysis.
Helmy MHE, Alqutaibi AY, El-Ella AA, Shawky AF.
Keywords: dental implants; implant failure; implant placement loading protocols; meta-analysis; systematic
review
Abstract: The aim of this study was to compare implant failure and radiographic bone level changes with
different loading protocols for unsplinted two-implant-supported mandibular overdentures. An electronic
search of two databases (PubMed, Cochrane Library) was performed, without language restriction, to identify
randomized controlled trials (RCTs) comparing immediate or early versus conventional dental implant
loading protocols for unsplinted two-implant-supported mandibular overdentures. Data were extracted
independently by two reviewers. The Cochrane tool was used to assess the quality of included studies. A
meta-analysis was performed. Eight RCTs were identified, seven of which were included; one trial was
excluded because related outcomes were not measured. Four of the seven studies were considered to have
a high risk of bias and three an unclear risk. Meta-analysis revealed no difference between immediate
versus conventional or early versus conventional implant loading protocols regarding implant failure (risk
difference (RD) -0.02, 95% confidence interval (CI) -0.13 to 0.10; RD 0.09, 95% CI -0.03 to 0.20) or marginal
bone loss (mean difference (MD) 0.09, 95% CI -0.10 to 0.28; MD -0.05, 95% CI -0.12 to 0.02) for implants
supporting mandibular overdentures. These findings should be interpreted with great caution given the
serious numerical limitations of the studies included.
49
Journal of Dentistry (Shiraz, Iran)
J Dent (Shiraz). 2017 Dec;18(4):272-276.
Comparison of the Marginal Bone Loss in One-stage versus Two-stage Implant

Surgery.
Gheisari R, Eatemadi H, Alavian A.
Keywords: Marginal Bone Loss ; Periapical Radiography; Dental Implant

Statement of the Problem: Dental implant is one of the best choices for reconstruction of aesthetic and
function. High success rate of these treatments are related to some considerations such as case selection,
implant system selection and surgical methods. One-stage or two-stage surgical approaches are routine
surgical methods in dental implant treatments. The minimum rate of bone loss around fixtures is the most
important criteria for evaluation of implant treatment success that can be affected by different methods of
surgery.
Purpose: This experimental study has been done to compare the crestal bone loss at mesial and distal
surface of implants installed through either one-stage or two-stage surgical approach.
Materials and Method: In the present randomized clinical trial, 310 Astra Tech implant system were divided
into two unequal groups to be used for 140 patients. One hundred and seventy implants were inserted
through one-stage and 140 through two-stage surgical approach. The baseline parallel periapical
radiography was provided immediately after the surgery. Six months after the functional loading, another
radiographic image was provided by using the same technique and machine. Marginal bone loss was
calculated by using Adobe Photoshop CS5 software. Data were statistically analyzed with SPSS software. p
values less than 0.05 were considered as significant.
Results: The mean Bone loss on the mesial and distal surfaces of implants inserted through one-stage
surgery and two-stage surgery was 0.76±0.04 and 0.842±0.04 mm respectively. No notable marginal bone
change was observed between the maxilla (0.860mm) and mandible (0.729mm). Moreover, p Value
was>0.05 in all samples, indicating no significant difference in the crestal bone loss.
Conclusion: Accordingly, one-stage surgical technique may provide better esthetic and function for dental
implants. There is no significant difference between the two approaches concerning the marginal bone loss.
50
Publications in 2017 that resulted from ITI-funded research
projects
In addition to the publications indicated above, the following papers also resulted from ITI-funded research
projects in 2017:
Int J Biomater. 2017;2017:9439036. doi: 10.1155/2017/9439036. Epub 2017 Aug 29.
Influence of Vanadium 4+ and 5+ Ions on the Differentiation and Activation of

Human Osteoclasts.
König MA, Gautschi OP, Simmen HP, Filgueira L, Cadosch D.
BACKGROUND: In the pathophysiology of implant failure, metal ions and inflammation-driven osteoclasts
(OC) play a crucial role. The aim of this study was to investigate whether vanadium (V) ions induce
differentiation of monocytic OC precursors into osteoresorptive multinucleated cells. In addition, the influence
of V ions on the activation and function of in vitro generated OC was observed.
METHODS: Human monocytes and osteoclasts were isolated from peripheral blood monocytic cells
(PBMCs). Exposition with increasing concentrations (0-3 μM) of V4+/V5+ ions for 7 days followed.
Assessment of OC differentiation, cell viability, and resorptional ability was performed by standard
colorimetric cell viability assay 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenil)-2H-
tetrazolium (MTS), tartrate-resistant acid phosphatase (TRAP) expression, and functional resorption assays
on bone slides during a period of 21 days.
RESULTS: No significant differences were noted between V4+/V5+ ions (p > 0.05). MTS showed significant
reduction in cellular viability by V concentrations above 3 μM (p < 0.05). V concentrations above 0.5 μM
showed negative effects on OC activation/differentiation. Higher V concentrations showed negative effects
on resorptive function (all p < 0.05) without affecting cell viability. V4+/V5+ concentrations below 3 μM have
negative effects on OC differentiation/function without affecting cell survival.
CONCLUSION: Vanadium-containing implants may reduce implant failure rate by influencing osteoclast
activity at the bone-implant interface. V-ligand complexes might offer new treatment options by accumulating
in the bone.
Open access abstract
J Craniomaxillofac Surg. 2017 Aug;45(8):1190-1196. doi: 10.1016/j.jcms.2017.05.025. Epub 2017 Jun 3.
The influence of different abutment materials on tissue regeneration after surgical

treatment of peri-implantitis - a randomized controlled preclinical study.
Moest T, Wrede J, Schmitt CM, Stamp M, Neukam FW, Schlegel KA.
Keywords: Animal model; Dental abutment; Dental implant; Peri-implantitis; Wound healing
51
OBJECTIVES: This study aimed to assess the impact of different abutment materials on peri-implant tissue
regeneration after surgical treatment of peri-implantitis in a large animal model.
MATERIAL AND METHODS: Titanium implants (n = 51) were inserted in the upper and lower jaw of eight
beagle dogs and a peri-implant infection was induced. After two months the peri-implant infection was
surgically treated and abutments with different surfaces (Ti-2: n = 14; CoCrMb: n = 13; Ag-modified Ti-4: n =
14; Ti-4 control: n = 10) were applied. Clinical attachment level (CAL), modified sulcus bleeding index (mBI),
bleeding on probing (BoP), and the sulcus fluid flow rate (SFFR) were determined 4, 8, and 12 weeks after
surgical treatment to document the peri-implant tissue reaction.
RESULTS: Superior levels for CAL and mBI were found with the Ti-4 control and the Ag-modified
abutments, with the Ag-modified abutments showing the best values after 12 weeks. Lowest SFFR values
compared with the other treatment groups underlined the superior soft tissue reaction adjacent to Ag-
modified abutments. After 12 weeks inferior CAL, SFFR, BOP and mBI values were documented for the Ti-2
surface.
CONCLUSION: Within limitations of the study, Ag-modified abutments lead to superior tissue reactions.
Further studies are needed to investigate the properties of abutment materials.
Biomaterials. 2017 Aug;137:49-60. doi: 10.1016/j.biomaterials.2017.05.020. Epub 2017 May 12.
Mining for osteogenic surface topographies: In silico design to in vivo osseo-

integration.
Hulshof FFB, Papenburg B, Vasilevich A, Hulsman M, Zhao Y, Levers M, Fekete N, de Boer M, Yuan H,
Singh S, Beijer N, Bray MA, Logan DJ, Reinders M, Carpenter AE, van Blitterswijk C, Stamatialis D, de Boer
J.
Keywords: Bone implants; Computational modeling; Differentiation; High-throughput screening; Micro-

fabrication; Surface topography
Abstract: Stem cells respond to the physicochemical parameters of the substrate on which they grow.
Quantitative material activity relationships - the relationships between substrate parameters and the
phenotypes they induce - have so far poorly predicted the success of bioactive implant surfaces. In this
report, we screened a library of randomly selected designed surface topographies for those inducing
osteogenic differentiation of bone marrow-derived mesenchymal stem cells. Cell shape features, surface
design parameters, and osteogenic marker expression were strongly correlated in vitro. Furthermore, the
surfaces with the highest osteogenic potential in vitro also demonstrated their osteogenic effect in vivo: these
indeed strongly enhanced bone bonding in a rabbit femur model. Our work shows that by giving stem cells
specific physicochemical parameters through designed surface topographies, differentiation of these cells
can be dictated.
Colloids Surf B Biointerfaces. 2017 Nov 1;159:151-158. doi: 10.1016/j.colsurfb.2017.07.079. Epub 2017 Jul
29.
Nanoscale silver depositions inhibit microbial colonization and improve

biocompatibility of titanium abutments.
Kheur S, Singh N, Bodas D, Rauch JY, Jambhekar S, Kheur M, Rajwade J.
Keywords: Antimicrobial; Cytocompatibility; DC Plasma; Human gingival fibroblasts; Silver; Titanium
52
Abstract: Although titanium dental implants are biocompatible, exhibit excellent corrosion resistance and
high mechanical resistance, the material fails in providing resistance to infection because it exhibits poor
antimicrobial activity. To address these issues, we deposited silver onto titanium abutments (Grade 5
titanium discs) using direct current (DC) sputtering and assessed the antimicrobial activity and
biocompatibility of the modified implant material. Atomic absorption spectrometry and X-ray photoelectron
spectroscopy were employed to investigate the concentration and elemental composition of the deposited
silver. As expected, silver deposited using DC plasma was uniform and good control over the deposition
could be achieved by varying the sputtering time. Moderate biocompatible responses (up to 69% viability)
were observed in primary human gingival fibroblast cells incubated in the presence of Ti sputtered with Ag
for 5min. Silver deposited titanium (Ti-Ag) showed excellent antibacterial effects on Pseudomonas
aeruginosa and Streptococcus mutans at a very low concentration (Ag content 1.2 and 2.1μg/mm2).
However, higher concentration of silver (6μg/mm2) was required to achieve a reduction in cell viability of
Staphylococcus aureus and Candida albicans. The silver sputtered Ti abutments could maintain a long-term
antibacterial activity as evidenced by the release of silver up to 22days in simulated body fluid. Our study
illustrates that silver deposited titanium is indeed a promising candidate for soft tissue integration on dental
abutments and prevents initial microbial adhesion.
Clin Oral Implants Res. 2017 Jun;28(6):640-647. doi: 10.1111/clr.12848. Epub 2016 May 4.
Pre-augmentation soft tissue expansion improves scaffold-based vertical bone

regeneration - a randomized study in dogs.
Kaner D, Zhao H, Arnold W, Terheyden H, Friedmann A.
Keywords: animal experiments; biomaterials; bone regeneration; guided tissue regeneration; surgical
techniques; wound healing
OBJECTIVE: Soft tissue (ST) dehiscence with graft exposure is a frequent complication of vertical
augmentation. Flap dehiscence is caused by failure to achieve tension-free primary wound closure and by
the impairment of flap microcirculation due to surgical trauma. Soft tissue expansion (STE) increases ST
quality and quantity prior to reconstructive surgery. We hypothesized that flap preconditioning using STE
would reduce the incidence of ST complications after bone augmentation and that optimized ST healing
would improve the outcome of bone regeneration.
MATERIALS AND METHODS: Self-filling tissue expanders were implanted in mandibular bone defects in
ten beagle dogs. After expansion, alloplastic scaffolds were placed for vertical bone augmentation in STE
sites and in control sites without STE pre-treatment. ST flap microcirculation was analysed using laser
Doppler flowmetry. The incidence of graft exposures was evaluated after 2 weeks. Bone formation was
assessed after 2 months, using histomorphometry and immunohistochemistry.
RESULTS: Test sites showed significantly less impairment of perfusion and faster recovery of
microcirculation after bone augmentation. Furthermore, no flap dehiscences occurred in STE sites. Bone
regeneration was found in both groups; however, significantly greater formation of new bone was detected in
test sites with preceding STE.
CONCLUSIONS: Preconditioning using STE improved ST healing and bone formation after vertical
augmentation. The combination of STE and the subsequent placement of alloplastic scaffolds may facilitate
the reconstruction of severe bone defects.
53
Clin Implant Dent Relat Res. 2017 Aug;19(4):671-680. doi: 10.1111/cid.12494. Epub 2017 May 10.
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.
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.
J Dent Res. 2017 Apr;96(4):430-436. doi: 10.1177/0022034516681761. Epub 2017 Jan 3.
Histatin 1 Enhances Cell Adhesion to Titanium in an Implant Integration Model.

van Dijk IA, Beker AF, Jellema W, Nazmi K, Wu G, Wismeijer D, Krawczyk PM, Bolscher JG, Veerman EC,
Stap J.
Keywords: dental implant(s); epithelia; fibroblast(s); histatins; hydroxyapatite; osteoblast(s)
54
Abstract: Cellular adhesion is essential for successful integration of dental implants. Rapid soft tissue
integration is important to create a seal around the implant and prevent infections, which commonly cause
implant failure and can result in bone loss. In addition, soft tissue management is important to obtain good
dental aesthetics. We previously demonstrated that the salivary peptide histatin 1 (Hst1) causes a more than
2-fold increase in the ability of human adherent cells to attach and spread on a glass surface. Cells treated
with Hst1 attached more rapidly and firmly to the substrate and to each other. In the current study, we
examine the potential application of Hst1 for promotion of dental implant integration. Our results show that
Hst1 enhances the attachment and spreading of soft tissue cell types (oral epithelial cells and fibroblasts) to
titanium (Ti) and hydroxyapatite (HAP), biomaterials that have found wide applications as implant material in
dentistry and orthopedics. For improved visualization of cell adhesion to Ti, we developed a novel technique
that uses sputtering to deposit a thin, transparent layer of Ti onto glass slides. This approach allows detailed,
high-resolution analysis of cell adherence to Ti in real time. Furthermore, our results suggest that Hst1 has
no negative effects on cell survival. Given its natural occurrence in the oral cavity, Hst1 could be an attractive
agent for clinical application. Importantly, even though Hst1 is specific for saliva of humans and higher
primates, it stimulated the attachment and spreading of canine cells, paving the way for preclinical studies in
canine models.
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.
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).
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.
55
Int J Oral Maxillofac Implants. 2017 September/October;32(5):1145–1152. doi: 10.11607/jomi.5359. Epub
2017 Mar 17.
Implant Stability and Bone Characteristics in Free Fibula Flaps Used for Jaw
Reconstruction: A Prospective Cohort Study.
Kumar VV, Kumar U, Pillai V, Ponnusamy V, Al-Nawas B, Kuriakose MA.
PURPOSE: The primary objective of this prospective cohort study was to evaluate primary and secondary
implant stability values of implants placed into healed free fibula-reconstructed mandibles. The secondary
objective was to investigate whether a correlation existed between primary implant stability and the quantity
of cortical bone-implant contact and of cortical fibular bone in contact with the implants.
MATERIALS AND METHODS: The study participants are patients enrolled in a registered trial (No.
CTRI/2012/07/002764). Patients with healed segmental mandibular reconstruction by means of free fibula
flaps were chosen to undergo implant-supported dental rehabilitation. Preoperatively, computed tomography
(CT) scans were used to measure the quality (density) of bone in Hounsfield units (HU). Implant stability
quotients (ISQ) were obtained at the time of implant placement (primary), as well as 6 months later
(secondary). The amount of cortical bone-to-implant contact (CBIC) was measured from postoperative
panoramic radiographs using image analysis software (Image J). A paired t test was used to compare the
mean primary and secondary ISQ values. Pearson correlation was used to determine the relationship
between primary ISQ and CBIC. Statistical significance was set at the 5% level (P < .05).
RESULTS: Of 54 patients (156 implants) who were enrolled, 35 (104 implants) were assessed. The reasons
for exclusion were as follows: 11 patients (34 implants) had inadequate preoperative CT documentation, 7
patients (16 implants) had unreadable panoramic radiographs, and 1 patient (2 implants) had partial necrosis
of the flap. The mean primary and secondary ISQ values were 78.1 (SD = 4.3) and 77.8 (SD = 4.6),
respectively (P = .348). The mean density of cortical fibula bone was 1,344 HU (SD = 93.6). The mean CBIC
was 3.7 mm (SD = 1.4). The study results showed a positive correlation between CBIC and implant stability
(r = 0.274, P = .005).
CONCLUSION: This study showed no differences in primary and secondary ISQ values of implants placed
into the fibula. Implant stability quotients correlated positively with CBIC.
56

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Literature Update, 2017, 6, November-December

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ITI Literature Update

November – December 2017

ITI International Team for

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

Tel. +41 (0)61 270 83 83

Keywords: Composites; Nanoparticles; Organs; Risc assessment; Titan

SIGNIFICANCE: Measures to reduce exposure to nanoparticles include intraorally grinding/polishing using

See abstract on PubMed Central

Dent Mater. 2017 Nov;33(11):e385-e392. doi: 10.1016/j.dental.2017.07.011. Epub 2017 Aug 5.

Aging of 3Y-TZP dental zirconia and yttrium depletion.

See abstract on PubMed Central

Osseointegration of zirconia dental implants in animal investigations: A systematic

Keywords: BIC; Ceramics; Dental implants; Push-in; RTQ

See abstract on PubMed Central

Comparison of early osseointegration of SLA® and SLActive® implants in maxillary

See abstract on PubMed Central

Survival of dental implants placed in sites of previously failed implants.

Keywords: dental implants; implant failure; reimplantation; survival rate

See abstract on PubMed Central

Digital vs. conventional full-arch implant impressions: a comparative study.

See abstract on PubMed Central

The influence of collagen membrane and autogenous bone chips on bone

See abstract on PubMed Central

Comparison between two antimicrobial protocols with or without guided bone

See abstract on PubMed Central

Retention of implant-supported overdentures at different implant angulations:

Keywords: Biomechanics; finite elemente analysis; material sciences; prosthodontics

See abstract on PubMed Central

Implant-guided supracrestal alveolar bone growth using scaffolds, BMP-2, and

See abstract on PubMed Central

A systematic review of the survival and complication rates of resin-bonded fixed

See abstract on PubMed Central

Socket Shield Technique for immediate implant placement - clinical, radiographic

See abstract on PubMed Central

See abstract on PubMed Central

See abstract on PubMed Central

6-mm-long implants loaded with fiber-reinforced composite resin-bonded fixed

See abstract on PubMed Central

Randomized clinical trial of ridge preservation using porcine bone/cross-linked

See abstract on PubMed Central

Keywords: cementation; dental cements; dental implants; peri-implantitis

See abstract on PubMed Central

Surgical treatment of peri-implantitis intrabony lesions by means of deproteinized

Keywords: biomaterial; bone substitute; defect fill; peri-implantitis; surgical treatment

See abstract on PubMed Central

Guided bone regeneration at zirconia and titanium dental implants: a pilot

See abstract on PubMed Central

Bone response to functionally loaded, two-piece zirconia implants: A preclinical

See abstract on PubMed Central

A prospective controlled trial comparing xenograft/autogenous bone and collagen-

See abstract on PubMed Central

Eur J Oral Implantol. 2017;10(4):373-390.

The influence of repeated abutment changes on peri-implant tissue stability: 3-year

See abstract on PubMed Central

Eur J Oral Implantol. 2017;10(4):391-400.

Short implants as an alternative to crestal sinus lift: a 3-year multicentre

See abstract on PubMed Central

See abstract on PubMed Central

Journal of Clinical Periodontology

Keywords: DNA ; dental implant; microbiome; peri-implantitis; periodontal; sequencing

CONCLUSION: The peri-implantitis microbiome is commensal-depleted and pathogen-enriched, harbouring

J Clin Periodontol. 2017 Dec;44(12):1285-1293. doi: 10.1111/jcpe.12805.

Open flap debridement of peri-implantitis with or without adjunctive systemic

Keywords: antibiotics; microbiota; peri-implantitis; surgical treatment