Marco Clementini

Impact of plasma of argon cleaning treatment on implant abutments in patients with a history of periodontal disease and thin biotype: radiographic results at 24‐month follow‐up of a RCT

BACKGROUNDnA lack of evidence is present in literature regarding the clinical relevance of micropollution and bacterial contamination present on customized titanium abutments following laboratory stages and steaming cleaning procedures. To preserve abutments from such pollutants, plasma of argon cleaning of customized abutments was advocated.nnnAIMnThe aim of this prospective, randomized, match-paired, triple-blinded, controlled, clinical trial is to longitudinally assess radiographical marginal bone-level changes around implants restored according to the platform switching and one-abutment-one-time concepts, using commercially available abutments, with and without plasma of argon cleaning treatment after customization.nnnMATERIALS AND METHODSnThirty patients with thin gingival biotype, a history of periodontal disease, and in general good health received one implant in the anterior maxilla or premolar region. Patients were randomly assigned to control (abutment subjected only to usually adopted cleaning protocol by steam) and test group (abutment subjected to plasma of argon treatment). Periapical standardized digital radiographs were taken at the time of crown connection (T0), 6 (T1) and 24 months after the final restoration (T2). Average mesial-distal bone-level changes mean values with standard deviations (SD) were calculated. The Mann-Whitney U-test was selected to identify differences in bone-level changes between test and control groups.nnnRESULTSnAn average interproximal bone loss of 0.16 mm (SD: 0.17) and 0.07 mm (SD: 0.34) was revealed in the control and test group at 6 months (T1), respectively, while after 24 months, groups showed a mean bone-level changes of 0.38 mm (SD: 0.44) and 0.11 mm (SD: 0.14), respectively. Statistically significant differences among control and test groups were found at both time points. Intergroup comparison relived absence of statistically significant difference.nnnCONCLUSIONnPlasma-cleaning treatment of implant titanium abutments, together with platform switching and one-abutment-one-time concepts, could be favorable in terms of hard-tissue-level changes, also in critical conditions such as in patients with a history of periodontal disease, presenting thin gingival biotype.

Flap approaches in plastic periodontal and implant surgery: critical elements in design and execution.

AIMnTo identify critical elements in design and execution of coronally advanced flap, lateral positioned flap and their variations for the treatment of facial gingival recessions or peri-implant soft tissue dehiscences.nnnMATERIALS AND METHODSnClinical studies were identified with both electronic and hand searches, and examined for the following aspects: flap design and incision techniques, flap elevation, root conditioning, flap mobility, flap stability and suturing. Moreover, prognostic factors for complete recession coverage were identified.nnnRESULTSnSome critical elements are evident in flap design and execution: the dimension and the thickness of tissue positioned over the denuded roots; the use on root surface of enamel matrix derivate; the stability and suturing of the flap in a position coronal to the cemento-enamel junction. The pre-determination of the clinical cemento-enamel junction, smoking status, operator surgical skills and the compliance to a supportive care programme have a role in obtaining and maintaining a complete root coverage.nnnCONCLUSIONSnDifferent flap approaches are available when performing periodontal plastic surgery, resulting in a great variability in clinical outcomes. The possibility of using pedicle flaps alone to achieve complete soft tissue coverage of facial implant dehiscence has not yet been investigated.

Microscopical and microbiologic characterization of customized titanium abutments after different cleaning procedures

AIMnTo assess and characterize pollution micro-particles and bacterial growth on customized titanium abutments after steaming, ultrasonic and plasma cleaning treatments.nnnMATERIALS AND METHODSnThirty commercially available implant abutments, after customization, were randomly divided into 3 groups of 10 and cleansed by steam (considered as control group), ultrasonic cleaning (test group 1) and plasma of Argon (test group 2). For all specimens, SEM analysis and EDAX microanalysis were performed to count and characterize pollution micro-particles, both on the abutment surface and implant-abutment connection. For the control and test groups, mean values and standard deviations were calculated for number and density of micro-particles. Statistical differences were determined by one-way ANOVA with Scheffe multiple comparison test. The level of statistical significance was set at Pxa0≤xa00.05. Additional microbiologic analysis was performed to detect bacterial contamination on the abutment surface.nnnRESULTSnIn the control group, the number of micro-particles on average was 117.5, and 14.1, respectively, on the abutment surface and connection. In the test groups, no pollution was revealed on the abutment (average of 1.09 and 1.13 spots, respectively, in test group 1 and test group 2) and connection (1.28 and 1.41, respectively, in test group 1 and test group 2). The analysis of variance (ANOVA) showed a statistically significant difference for all the variables examined. For each variable, at least one of the groups differs from the others. Scheffe multiple comparison test showed that all comparisons for every variables between the control group and both groups are significant, while there were some comparisons between test group 1 and test group 2 that were not significant. EDAX microanalysis identified micro-particles as residual of lubricant mixed with traces of Titanium and other metals. Microbiologic analysis demonstrated the presence of bacterial growth on the abutment surface only in the control group (111.5xa0±xa011.43xa0CFU/ml/implant-abutment as mean value). In the test groups, absence of growing microorganisms was found.nnnCONCLUSIONSnThis study confirmed that both plasma and ultrasonic treatments can be beneficially adopted for abutment cleaning process after laboratory technical stages, to supposedly favor soft tissue healing and implant-prosthetic connection stability.

Dimensional changes after immediate implant placement with or without simultaneous regenerative procedures: A systematic review and meta-analysis

OBJECTIVEnTo analyse alveolar ridge volume changes after immediate implant placement, with or without a regenerative technique.nnnMETHODSnStudies investigating the effect of immediate implant placement on ridge dimensional changes were identified through an electronic search conducted using MEDLINE (PubMed) and EMBASE. Weighted mean changes (WMC) between baseline and follow-up time were calculated and subgroup analysis was performed according to study design, evaluation method and regenerative strategies.nnnRESULTSnAfter immediate implant placement alone WMC of RCTs showed a loss in width and height of 1.1xa0mm. After flapless immediate implant placement with immediate provisionalization and a graft WMC showed a loss in width and height of 1.02xa0mm and 0.79xa0mm, while after flapped immediate implant placement and a graft WMC showed a gain of 1.79xa0mm. After immediate implant placement plus a non-resorbable membrane WMC showed a loss in height of 0.07xa0mm. After immediate implant placement plus a resorbable membrane and a graft WMC showed a gain in height of 1.09xa0mm.nnnCONCLUSIONSnImmediate implant placement does not seem to counteract alveolar ridge modelling after tooth extraction. Furthermore, the currently available evidence does not allow for any conclusive statements regarding the efficacy of a concomitant regenerative technique in preventing the amount of alveolar reduction.

Influence of subcrestal implant placement compared with equicrestal position on the peri-implant hard and soft tissues around platform-switched implants: a systematic review and meta-analysis

AimThe aim of this article is to systematically review the effect of subcrestal implant placement compared with equicrestal position on hard and soft tissues around dental implants with platform switch.Material and methodsA manual and electronic search (National Library of Medicine and Cochrane Central Register of Controlled Trials) was performed for animal and human studies published up to December 2016. Primary outcome variable was marginal bone level (MBL) and secondary outcomes were crestal bone level (CBL), soft tissue dimensions (barrier epithelium, connective tissue, and peri-implant mucosa), and changes in the position of soft tissue margin. For primary and secondary outcomes, data reporting mean values and standard deviations of each study were extracted and weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated.ResultsA total of 14 publications were included (7 human studies and 7 animal investigations). The results from the meta-analyses have shown that subcrestal implants, when compared with implants placed in an equicrestal position, exhibited less MBL changes (human studies: WMDu2009=u2009−u20090.18 mm; 95% CIu2009=u2009−u20091.31 to 0.95; Pu2009=u20090.75; animal studies: WMDu2009=u2009−u20090.45 mm; 95% CIu2009=u2009−u20090.66 to −u20090.24; Pu2009<u20090.001). Furthermore, the CBL was located at a more coronal position in subcrestal implants with respect to the implant shoulder (WMDu2009=u2009−u20091.09xa0mm; 95% CIu2009=u2009−u20091.43 to −u20090.75; Pxa0<u20090.001). The dimensions of the peri-implant mucosa seem to be affected by the positioning of the microgap and were greater at implants placed in a subcrestal position than those inserted equicrestally (WMDu2009=u20090.60xa0mm; 95% CIu2009=u20090.26 to 0.95; Pu2009<u20090.001). While the length of the barrier epithelium was significantly greater in implants placed in a subcrestal position (WMDu2009=u20090.39xa0mm; 95% CIu2009=u20090.19 to 0.58; Pu2009<u20090.001), no statistical significant differences were observed between equicrestal and subcrestal implant positioning for the connective tissue length (WMDu2009=u20090.17xa0mm; 95% CIu2009=u2009−u20090.03 to 0.36; Pu2009=u20090.10).ConclusionThis systematic review suggests that PS implants placed in a subcrestal position have less MBL changes when compared with implants placed equicrestally. Furthermore, the location of the microgap seems to have an influence on the dimensions of peri-implant soft tissues.Clinical relevanceWhen compared with PS placed in an equicrestal position, subcrestal implant positioning demonstrated less peri-implant bone remodeling.

Treatment of class III multiple gingival recessions: Prognostic factors for achieving a complete root coverage

BACKGROUNDnThis report is intended to present a supplemental analysis of data from a prior report (Aroca etxa0al., ) to investigate factors associated with a complete root coverage at 1xa0year. The purpose of the prior report was to investigate at 1xa0year the adjunction effect of EMD for the treatment of Millers class III recession defects using a coronally advanced modified tunnel/CTG technique with (test group) or without (control group). The purpose of this report was to investigate additional factors associated with root coverage in the same data set.nnnMATERIALS AND METHODSnOn the 138 observations collected from 20 patients, a regression model was used to highlight the relationship between the percentages of root coverage (RC) and three following covariates: the distance from the tip of the papilla and the contact point (DCP) at baseline, the group membership (control vs. test) and tooth position in the mouth (maxillary vs. mandibular).nnnRESULTSnThe statistical analysis showed that there was a significant effect of the DCP at baseline (pxa0=xa00.01) and of the tooth type (pxa0<xa0.001) on the percentage of RC at 1xa0year, whereas no significant difference between the two techniques (group membership effect) was shown (pxa0=xa00.69).nnnCONCLUSIONnThe probability to obtain a complete root coverage decreases when the DCP at baseline increases. Moreover, maxillary teeth are more likely to give better RC than mandibular teeth. However, in this analysis similar to the last, there was no group effect.

Biologically guided flap stability: the role of flap thickness including periosteum retention on the performance of the coronally advanced flap–A double‐blind randomized clinical trial

AIMnTo evaluate the possible benefit on wound healing and flap stability of periosteum inclusion, comparing a split-full-split thickness flap elevation versus a split thickness approach performed during CAF for the treatment of isolated-type gingival recessions in the upper jaw.nnnMATERIAL AND METHODSnForty patients were randomized, 20 were treated with split-full-split (test group) and 20 with a split approach (control group). Analysed parameters at 1xa0year were CRC, percentage of recession coverage (RC), keratinized tissue (KT) gain and patient-related outcome measurements.nnnRESULTSnAfter 12xa0months, CRC was 80% in the test group and 35% in the control group. Percentages of RC and KT gain were higher in the test group, and a significant association between CRC and the thickness of the flap after elevation was found. Patient-related outcomes measurements were better for the test group.nnnCONCLUSIONSnFlap thickness preservation and the presence of the periosteum in part of the flap may play a fundamental role in obtaining CRC.

Outcomes After 25 Years of Periodontal Treatment and Maintenance of a Patient Affected by Generalized Severe Aggressive Periodontitis

This report describes the long-term outcomes of nonsurgical periodontal therapy and supportive periodontal treatment (SPT) of a 21-year-old patient affected by generalized aggressive periodontitis at multiple teeth with a compromised prognosis. After 25 years of SPT, no teeth had been extracted and no periodontal pockets associated with bleeding on probing were present. Radiographic analysis showed an improvement in infrabony defects, demonstrating long-term improvement is possible with nonsurgical periodontal treatment provided that smoking is not present and the patient is included in a strict SPT.