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      Systematic review of clinical and patient-reported outcomes following oral rehabilitation on dental implants with a tapered compared to a non-tapered implant design

      1 , 2 , 3
      Clinical Oral Implants Research
      Wiley

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          Clinical outcomes of GBR procedures to correct peri-implant dehiscences and fenestrations: a systematic review.

          To analyze the clinical outcomes of endosseous implants following guided bone regeneration (GBR) procedures to correct dehiscence/fenestration defects associated with implant placement. METHODS/SEARCH STRATEGY: A Medline search was performed for human studies published in English focusing on GBR procedures for the correction of dehiscence/fenestration defects associated with the placement of screw-shaped titanium implants. The selected studies had to include at least 10 consecutively treated patients with a minimum follow-up of 12 months after the start of prosthetic loading. The clinical outcomes in terms of the complication rate of the GBR procedure, implant survival, and stability of marginal soft tissues around implants were evaluated. Seven publications were included in this review. A total of 238 patients received 374 implants. Defects were treated with resorbable or non-resorbable membranes, in association with or without graft materials. Patients were followed for 1-10 years after the start of prosthetic loading. In the postoperative period, 20% of the non-resorbable membranes and 5% of the resorbable ones underwent exposure/infection. However, in the majority of cases, a complete or an almost complete coverage of the initial defect was obtained. The overall survival rate of implants, irrespective of the type of membrane and grafting materials, was 95.7% (range: 84.7-100%). No significant modifications of probing depth and/or variation of clinical attachment level around implants were observed during the follow-up period. Despite the favorable results obtained, it was difficult to draw a significant conclusion as far as the more reliable grafting material and membrane barrier for the correction of dehiscence/fenestration defects are concerned, due to the limited sample of patients and the wide variety of grafting materials and membranes, used alone or in combination. Moreover, due to the lack of randomized clinical trials, it was impossible to demonstrate that such augmentation procedures are actually needed to allow the long-term survival of implants.
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            Analysis of the socket bone wall dimensions in the upper maxilla in relation to immediate implant placement.

            Animal and human researches have shown that immediate implant placement into extraction sockets failed to prevent socket dimensional changes following tooth extraction. It has been suggested that a minimal width of 1-2 mm of buccal bone is necessary to maintain a stable vertical dimension of the alveolar crest. To determine the dimensions of the bony wall at extraction sites in the esthetic zone (anterior teeth and premolars in the maxilla) and relate it to immediate implant placement. As part of an ongoing prospective randomized-controlled multicenter clinical study on immediate implant placement, the width of the buccal and palatal bony walls was recorded at 93 extraction sites. The mean width of the buccal and palatal bony walls was 1 and 1.2 mm, respectively (P<0.05). For the anterior sites (canine to canine), the mean width of the buccal bony wall was 0.8 mm. For the posterior (premolar) sites, it was 1.1 mm (P<0.05). In the anterior sites, 87% of the buccal bony walls had a width < or = 1 mm and 3% of the walls were 2 mm wide. In the posterior sites, the corresponding values were 59% and 9%, respectively. If the criterion of a minimal buccal bone width of 2 mm to maintain a stable buccal bony wall is valid, only a limited number of sites in the anterior maxilla display such a clinical situation. The data suggested that in the majority of extraction sites in the anterior maxilla, thin (< or = 1 mm) buccal walls were present. This, in turn, means that in most clinical situations encountered, augmentation procedures are needed to achieve adequate bony contours around the implant.
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              Factors influencing ridge alterations following immediate implant placement into extraction sockets.

              To identify factors that may influence ridge alterations occurring at the buccal aspect of the extraction site following immediate implant placement. In 93 subjects, single-tooth implants were placed immediately into extraction sockets in the maxilla (tooth locations 15-25). A series of measurements describing the extraction site were made immediately after implant installation and at re-entry, 16 weeks later. The implant sites were stratified according to four factors: (i) implant location (anterior/posterior), (ii) cause of tooth extraction (periodontitis/non-periodontitis), (iii) thickness of the buccal bone walls ( 1 mm) and (iv) the dimension of the horizontal buccal gap ( 1 mm). (i) The location where the implant was placed (anterior/posterior) as well as (ii) the thickness of the buccal bone crest and (iii) the size of the horizontal buccal gap significantly influenced the amount of hard tissue alteration that occurred during a 4-month period of healing. At implant sites in the premolar segment, the fill of the horizontal gap was more pronounced than in the incisor-canine segment, while the vertical crest reduction was significantly smaller. Furthermore, at sites where the buccal bone wall was thick (>1 mm) and where the horizontal gap was large (>1 mm), the degree of gap fill was substantial. The thickness of the buccal bone wall as well as the dimension of the horizontal gap influenced the hard tissue alterations that occur following immediate implant placement into extraction sockets.
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                Author and article information

                Journal
                Clinical Oral Implants Research
                Clin Oral Impl Res
                Wiley
                09057161
                October 2018
                October 2018
                October 17 2018
                : 29
                : 41-54
                Affiliations
                [1 ]Faculty of Health Sciences; UiT The Arctic University of Norway; Tromsø Norway
                [2 ]South Florida Center for Periodontics & Implant Dentistry; Boca Raton FL USA
                [3 ]Nova Southeastern University College of Dental Medicine; Ft. Lauderdale FL USA
                Article
                10.1111/clr.13128
                30328207
                518c39e5-4b63-465f-906f-486802bb32d4
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

                http://creativecommons.org/licenses/by-nc/4.0/

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