Peri‐implant soft tissue phenotype modification and its impact on peri‐implant health: A systematic review and network meta‐analysis

Journal of Periodontology, Год журнала: 2020, Номер 92(1), С. 21 - 44

Опубликована: Июль 25, 2020

Abstract Background The peri‐implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal height (STH). Numerous approaches to augment volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for health has subject of debate in field implant dentistry. aim this systematic review was analyze evidence regarding efficacy augmentation procedures aimed at modifying their impact on health. Methods A comprehensive search performed identify clinical studies that involved reported findings KMW, MT, and/or STH changes. effect intervention also assessed. Selected articles were classified based general type surgical approach increase PSP, either bilaminar or an apically positioned flap (APF) technique. network meta‐analysis including only randomized‐controlled trials (RCTs) reporting outcomes conducted assess compare different techniques. Results total 52 included qualitative analysis, 23 RCTs as part meta‐analysis. Sixteen therapy with techniques, whereas 7 use APF. analysis showed techniques combination grafts (connective graft [CTG], collagen matrix [CM], acellular dermal [ADM]) resulted a significant MT compared non‐augmented sites. In particular, CTG ADM associated higher gain CM However, no differences KMW observed across via utilizing effects marginal bone level stability. APF‐based free gingival (FGG), CTG, CM, APF alone, FGG exhibited significantly gain. any evaluated reduction probing depth, dehiscence plaque index sites loss preservation inconclusive. Conclusions Bilaminar involving obtained highest amount gain, most effective technique increasing KMW. index, regardless grafting material employed,

Язык: Английский

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Ultrasonographic tissue perfusion analysis at implant and palatal donor sites following soft tissue augmentation: A clinical pilot study

Journal Of Clinical Periodontology, Год журнала: 2021, Номер 48(4), С. 602 - 614

Опубликована: Янв. 19, 2021

ABSTRACT Aim To describe the application of power Doppler Ultrasonography (US) for evaluating blood flow at implant and palatal donor sites following soft tissue augmentation with connective graft (CTG). Materials Methods Five patients exhibiting a peri‐implant dehiscence received treatment coronally advanced flap corresponding CTG. Power US was used assessing volume baseline, 1 week, month, 6 months 12 post‐surgery blood‐flow dynamics sites. The speed‐weighted power‐weighted colour pixel density (CPPD) were computed from velocity (CV) (CP), respectively. Results A mean increase in CV 199.25% observed midfacial region after week compared to baseline. CP increased all month. At months, appeared lower than baseline CCPD great palatine foramen areas 1‐week 1‐month post‐operative evaluations. Conclusions is non‐invasive valuable tool estimating perfusion CPPD variation during different phases intra‐oral healing.

Язык: Английский

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Wound healing dynamics, morbidity, and complications of palatal soft‐tissue harvesting

Periodontology 2000, Год журнала: 2022, Номер 92(1), С. 90 - 119

Опубликована: Дек. 30, 2022

Abstract Palatal‐tissue harvesting is a routinely performed procedure in periodontal and peri‐implant plastic surgery. Over the years, several surgical approaches have been attempted with aim of obtaining autogenous soft‐tissue grafts while minimizing patient morbidity, which considered most common drawback palatal harvesting. At same time, treatment errors during may increase not only postoperative discomfort or pain but also risk developing other complications, such as injury to greater palatine artery, prolonged bleeding, wound/flap sloughing, necrosis, infection, inadequate graft size quality. This chapter described complications techniques, together for reducing morbidity accelerating donor site wound healing. The role biologic agents, photobiomodulation therapy, local systemic factors, genes implicated healing are discussed.

Язык: Английский

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Soft tissue phenotype modification predicts gingival margin long‐term (10‐year) stability: Longitudinal analysis of six randomized clinical trials

Journal Of Clinical Periodontology, Год журнала: 2022, Номер 49(7), С. 672 - 683

Опубликована: Май 13, 2022

Abstract Aim To assess the prognostic value of soft tissue phenotype modification following root coverage procedures for predicting long‐term (10‐year) behaviour gingival margin. Materials and Methods Participants from six randomized clinical trials on at University Michigan were re‐invited a longitudinal evaluation. Clinical measurements obtained by two calibrated examiners. A data‐driven approach to model selection with Akaike information criterion (AIC) was carried out via multilevel regression analyses partial plotting changes in level margin over time interactions early (6‐month) results phenotypic modification. Results One‐hundred fifty‐seven treated sites 83 patients re‐assessed recall. AIC‐driven demonstrated that 6‐month keratinized width (KTW) thickness (GT) influenced trajectory similarly concave manner; however, GT driving determinant predicted significantly less relapse treatments, stability beyond values 1.46 mm. Conclusions Among compliant patient cohort, irrespective rendered therapy, presence least 1.5 mm KTW correlated

Язык: Английский

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Alveolar ridge preservation: Complications and cost‐effectiveness

Periodontology 2000, Год журнала: 2022, Номер 92(1), С. 235 - 262

Опубликована: Дек. 29, 2022

Abstract Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction atrophy. Over past two decades numerous studies and reviews on this topic have populated literature. In recent years focus has primarily been analyzing efficacy outcomes pertaining to dimensional changes, whereas other relevant facets alveolar therapy remained unexplored. With premise, we carried out a comprehensive evidence‐based assessment complications associated different modalities modeled cost‐effectiveness therapeutic as function changes width height. We conclude that, among allogeneic xenogeneic bone graft materials, increased expenditure does not translate into effectiveness therapy. On hand, significant association between barrier membrane reduced horizontal vertical resorption was observed, though only certain degree, beyond which return investment significantly diminished.

Язык: Английский

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Aesthetic‐And patient‐related outcomes following root coverage procedures: A systematic review and network meta‐analysis

Journal Of Clinical Periodontology, Год журнала: 2020, Номер 47(11), С. 1403 - 1415

Опубликована: Июль 12, 2020

Aim of this systematic review (SR) randomized controlled trials (RCTs) was to evaluate effect different flap designs and graft materials for root coverage, in terms aesthetics, patient satisfaction self-reported morbidity (post-operative pain/discomfort).A comprehensive literature search performed. A mixed-modelling approach network meta-analysis utilized formulate direct indirect comparisons among treatments Root Coverage Esthetic Score (RES), with its individual components, subjective patient-reported post-operative pain/discomfort (visual analogue scale (VAS) 100).Twenty-six RCTs a total 867 treated patients (1708 recessions) were included. Coronally Advanced Flap (CAF) + Connective Tissue Graft (CTG) (0.74 (95% CI [0.24, 1.26], p = .005)), Tunnel (TUN) CTG (0.84 [0.15, 1.53]), .01) CAF substitutes (GS) (0.55 [0.006, 1.094], .04)) significantly associated higher RES than CAF. No significant difference between TUN detected (0.09 [-0.54, 0.72], .77)). Addition resulted less natural tissue texture (-0.21 [-0.34, -0.08]), .003) gingival colour (-0.06 [-0.12, -0.03], .03)) techniques increased morbidity.Connective procedures showed highest overall aesthetic performance although integration might impair soft appearance. Additionally, CTG-based also correlated greater morbidity.

Язык: Английский

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The peri‐implant phenotype and implant esthetic complications. Contemporary overview

Journal of Esthetic and Restorative Dentistry, Год журнала: 2021, Номер 33(1), С. 212 - 223

Опубликована: Янв. 1, 2021

Abstract Objective To provide a contemporary and comprehensive overview of the hard soft tissue biological structures surrounding an osseointegrated dental implant (peri‐implant referred to as peri‐implant phenotype), in context esthetic complications. Overview The individual components phenotype (keratinized mucosa width, mucosal thickness, supracrestal height, buccal bone) have been linked different aspects esthetics, well health‐related aspects. At time therapy, respecting biology tissues, anticipating their remodeling patterns can alleviate future Conclusions While current literature may not allow for point‐by‐point evidence based‐recommendation required amount each structure, bearing mind proposed values phenotype, at prior therapy lead more predictable treatment outcomes, avoidance Clinical Significance Knowledge implant, underlying process is crucial carrying out successful alleviating possible challenges.

Язык: Английский

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Prevalence and risk indicators of midfacial peri‐implant soft tissue dehiscence at single site in the esthetic zone: A cross‐sectional clinical and ultrasonographic study

Journal of Periodontology, Год журнала: 2021, Номер 93(6), С. 857 - 866

Опубликована: Ноя. 17, 2021

Esthetic complications of dental implants in the esthetic zone can have a major negative impact on patients' quality life and perception implant therapy. The aim present study was to evaluate prevalence peri-implant soft tissue dehiscence (PSTD) clinical ultrasonographic risk indicators for this condition.Subjects with ≥1 healthy single area were identified recruited. Clinical measurements, including PSTD class subclass, probing depth, keratinized mucosa width (KMW), mucosal thickness (MT) at 1 mm 3 mm, buccal bone distance (BBD) thickness, evaluated PSTD.A total 153 subjects 176 included. 54.2% 56.8% patient level, respectively. most frequent type one characterized by having both an implant-supported crown longer than homologous tooth visible abutment/implant fixture exposed oral cavity. multivariate analysis showed that presence adjacent implant, time function, limited MT, reduced KMW, increased BBD significantly associated PSTD.PSTDs are common findings region. Several condition, such as function higher BBD, lower MT identified.

Язык: Английский

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Efficacy of biologics for the treatment of periodontal infrabony defects: An American Academy of Periodontology best evidence systematic review and network meta‐analysis

Journal of Periodontology, Год журнала: 2022, Номер 93(12), С. 1803 - 1826

Опубликована: Окт. 24, 2022

Abstract Background A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for regenerative treatment periodontal infrabony defects. Biologic agents progressively gained popularity among clinicians are routinely used regeneration. In alignment with goals American Academy Periodontology (AAP) Best Evidence Consensus (BEC) on use biologic mediators contemporary clinical practice, aim this sytematic review was to evaluate effect agents, specifically autogenous blood‐dervied products (ABPs), enamel matrix derivative (EMD) recombinant human platelet‐derived growth factor‐BB (rhPDGF‐BB), outcomes Methods detailed systematic search conducted identify eligible randomized control trials (RCTs) reporting therapy using frequentist mixed‐modeling approach network meta‐analysis (NMA), characterized by assessment three individual components an defect (the bone graft material [BG], agent, application a barrier membrane) performed compare relative efficacy different components, therapeutic modalities Results total 153 RCTs were included, 150 studies contributing NMA. The quantitative analysis showed that addition significantly improves radiographic outcomes, as compared BG flap procedures alone. Barrier enhanced but did not provide further benefits combination biologics. type (autogenous, allogeneic, xenogeneic or alloplastic) agent (EMD, platelet‐rich fibrin [PRF], plasma [PRP] rhPDGF‐BB) played significant role final Allogeneic BGs exhibited statistically superior gain than synthetic (p < 0.05 all comparisons), while rhPDGF‐BB PRF demonstrated higher stability gingival margin 0.01) fill/gain 0.05), together greater, although significant, attachment level pocket depth reduction, EMD PRP. Overall, largest size most parameters, including gain, less recession linear gain. Considering relatively high number presenting unclear risk bias, strength recommendation supporting PRP judged weak, EMD, deemed favor. Conclusions Biologics enhance therapy. Combination therapies involving + membrane be monotherapies. choice seems impact

Язык: Английский

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Clinical and patient‐reported outcomes of tissue engineering strategies for periodontal and peri‐implant reconstruction

Periodontology 2000, Год журнала: 2022, Номер 91(1), С. 217 - 269

Опубликована: Сен. 27, 2022

Scientific advancements in biomaterials, cellular therapies, and growth factors have brought new therapeutic options for periodontal peri-implant reconstructive procedures. These tissue engineering strategies involve the enrichment of scaffolds with living cells or signaling molecules aim at mimicking cascades wound healing events clinical outcomes conventional autogenous grafts, without need donor tissue. Several been explored over years a variety scenarios, including regeneration, treatment gingival recessions/mucogingival conditions, alveolar ridge preservation, bone augmentation procedures, sinus floor elevation, regeneration therapies. The goal this article was to review that performed reconstruction implant site development, evaluate their safety, invasiveness, efficacy, patient-reported outcomes. A detailed systematic search conducted identify eligible randomized controlled trials reporting utilized aforementioned indications. total 128 were ultimately included qualitative analysis. Commonly involved enriched mesenchymal somatic (cell-based strategies), more often loaded molecules/growth (signaling molecule-based strategies). approaches found be safe when therapies development. Tissue demonstrated either similar superior than infrabony furcation defects, augmentation. can promote higher root coverage, keratinized width, thickness gain alone can, they obtain mean coverage compared grafts. There is some evidence suggesting positive effect on patient morbidity, preference, esthetics, quality life mucogingival deformities. Similarly, reduce invasiveness complications graft-based staged More studies incorporating are needed understand cost-benefits traditional treatments.

Язык: Английский

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