Background: Current implant protocols require not only osseointegration but also high levels of soft-tissue stability and esthetics. Crestal bone changes and their impact on soft-tissue architecture are the most unpredictable and undesirable consequences of implant therapy, especially in the anterior maxilla.
Hypotheses about the etiology of crestal bone remodeling around dental implants can be categorized into three main proposals: 1) mechanical factor that will disturb the surrounding tissues when occlusal forces are transmitted through the prosthetic component to the implant; 2) peri-implant inflammatory cell infiltrate caused by bacteria located at the implant/abutment microgap that will trigger crestal bone changes; and 3) adaptive response of the biologic width to the local condition not related to stress factors or inflammatory factors.
Key point
In this study, prototype test implants were fabricated to combine all current microgap and abutment profile variables. All implants integrated and there were no biologic or technical complications. The one-piece nonsubmerged implant design with a straight profile demonstrated the least crestal bone remodeling. Implant-abutment connections with a concave profile established crestal bone levels immediately apical to the concavity, regardless of the microgap variable.
Author
Dr. Santiago J. Caram, Department of Prosthodontics, Dental School, National University of Cuyo, Mendoza, Argentina, and colleagues
Purpose
Scientists aimed to evaluate the peri-implant tissue response around different implant-abutment interface configurations when compared side-by-side. Two different soft-tissue adaptation variables and three different microgap interface variables were analyzed.
Materials and methods
Six different experimental implant abutment design groups (A to F) were evaluated in six mixed-breed dogs: (A) straight/matching; (B) straight/nonmatching; (C) straight/one-piece; (D) concave/matching; (E) concave/nonmatching; and (F) concave one-piece. At month 0, implant placement was performed and baseline standardized radiographs were taken. After three months of healing, standardized radiographs were taken and preformed titanium crowns were screw-retained to the top part of the abutments. Radiographs were taken every month for a period of six months. Dogs were fed a soft diet and implants were cleaned once each week with chemical and mechanical plaque control.
Results
All implants (72) integrated successfully and remained stable during the entire study period. When comparing radiographs of groups with straight profiles, crestal bone remodeling in Group C (one-piece design) was significantly less than in Group A (matching diameters) and Group B (nonmatching diameter). Implant Group C (one-piece design) showed the least crestal bone remodeling of all groups. When comparing radiographs of groups with a concave profile but different microgap configurations, all three designs demonstrated bone loss with no significant differences among the three groups.
More information
For a complete copy of the study and the JOMI September/October “Table of Contents,” visit www.osseo.org/NEWIJOMI.html. To join AO and begin receiving JOMI (bi-monthly) or obtain online access to JOMI, visit www.osseo.org/NEWmembershipApply.html.
Note: This article was published in Implant Tribune U.S. Edition, Vol. 10, No. 1, January 2015 issue.
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