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Issue: 02/2011 - S. Schultze-Mosgau - C. K. Müller - J. Chen - S. Fröbisch
Evaluation of the influence of preoperative factors
on soft tissue consolidation around single tooth implants
in the esthetic zone – A pilot study

Aim: The study aimed at identifying patient-, defect- and treatment-related factors that influence the esthetic outcome following oral rehabilitation using single tooth implant crowns.

Materials and Methods: 34 patients, who received a total of 49 dental implants at the Department of Oral and Maxillofacial Surgery/Plastic Surgery, Jena University Hospital, were analyzed in a pilot study. Patient-, defect- and treatment-related factors were documented. Employing the "Pink Esthetic Score" (PES), the "red esthetics" were judged on standardized intraoral photos. The influence of patient-, defect- and treatment-related factors on the PES score was analyzed in a multivariate statistical approach.

Results: Defect size, SAC class and the condition of periimplant bone were found to be significant variables in the description of the PES.

Conclusion: Within the limitation of a pilot study employing a small sample size, it was confirmed that insufficient hard and soft tissue represents the greatest challenge for the implantologist. Current developments in minimally invasive implantology might have the potential to enhance the esthetic outcome in the future.

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Issue: 04/2010 - S. Schultze-Mosgau - M. Mtsariashvili - C. K. Müller
Influence of different soft tissue management concepts on the rate of peri-implant inflammation and implant success

Purpose: The aim of this study was to investigate the influence of different soft tissue management concepts on the rate of peri-implant inflammation and on implant success using a one- and two-stage procedure.

Material and methods: In an animal study using the Göttingen minipig model, flapless and flap surgery were compared with regard to the rate of peri-implant inflammation. One month after extraction of all upper premolars, twelve pigs had two Semados RI implants (4.1 mm x 10 mm, BEGO Implant Systems, Bremen, Germany) inserted per quadrant. The pigs were randomized to have minimally invasive exposure by trephine punch in one quadrant. The ridge was exposed conventionally on the contralateral side by raising a mucoperiosteal flap. Biopsies of the soft tissue were taken after a transmucosal healing period of one, two, four and twelve weeks and histological examination and pangenomic gene expression analysis were performed. In a retrospective clinical study involving 181 patients (521 implants), the influence of the main and releasing incisions as well as the exposure technique on implant success was evaluated by means of Kaplan-Meier survival analysis.

Results: The minipig study showed significantly greater inflammatory infiltration of the peri-implant soft tissue one week (p = 0.016), two (p = 0.010) and twelve (p = 0.039) weeks after insertion after flap surgery compared with flapless surgery. Immunofluorescence analysis confirmed macrophage predominance after one and two weeks and the absence of macrophages after twelve weeks. Pangenomic gene expression analysis showed reduced inflammation and improved wound detoxification in the early healing phases and faster re-epithelialization and reduced fibrosis in later phases following flapless surgery. The retrospective clinical study showed a significant (p = 0.022) influence of the releasing incisions on the implant survival rate.

Conclusions: The results of the minipig study suggest that the rate of peri-implant inflammation can be reduced by flapless surgery due to improved soft tissue architecture. An effect on the implant success rate was not found. When a two-stage implantation procedure is employed, only a very short distal releasing incision should be made during implant insertion.

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