| 1. |
- Cosyn, Jan, et al.
(author)
-
A 5-year prospective study on single immediate implants in the aesthetic zone
- 2016
-
In: Journal of Clinical Periodontology. - : Wiley-Blackwell. - 0303-6979 .- 1600-051X. ; 43:8, s. 702-709
-
Journal article (peer-reviewed)abstract
- Aim There is a paucity of long-term data on soft tissue aesthetics of single immediate implants. The objective of this study was to evaluate the 5-year clinical and aesthetic outcome of this treatment concept. Materials and methods Twenty-two periodontally healthy patients (12 men, 10 women; mean age 50) with low risk for aesthetic complications (thick gingival biotype, intact buccal bone wall, both neighbouring teeth present) were consecutively treated with a single immediate implant in the aesthetic zone (15-25). Flapless surgery was performed and the gap between the implant and buccal bone wall was systematically filled with bovine bone particles. Implants were immediately non-functionally loaded with a screw-retained provisional crown. Cases demonstrating major alveolar process changes and/or advanced mid-facial recession (>1mm) at 3months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6months. The clinical and aesthetic results at 5years were compared to those obtained at 1 year Results Seventeen patients attended the 5-year re-assessment, of whom five had been treated with a CTG for early aesthetic complications. There was one early implant failure and one complication after 1 year (porcelain chipping). Mean marginal bone loss was 0.12mm at 1 year and 0.19mm at 5years (p=0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5years (p0.007), whereas mid-facial contour (p=0.005) and alveolar process deficiency (p=0.008) deteriorated. Mean mid-facial recession was on average 0.28mm (SD 0.48) at 1 year and 0.53mm (SD 0.53) at 5years (p=0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession (>1mm) at 5years. All three were in a central incisor position and none had been treated with a CTG. Thus, 8/17 implants showed aesthetic complications (five early and three late aesthetic complications). Implants in a lateral incisor position showed stable soft tissue levels. The pink aesthetic score was on average 12.15 at 1 year and 11.18 at 5years (p=0.030 Conclusion Single immediate implants showed high implant survival and limited marginal bone loss in the long term. However, mid-facial recession, mid-facial contour and alveolar process deficiency deteriorated after 1year. With an aesthetic complication rate of 8/17 in well-selected patients who had been treated by experienced clinicians, type I placement may not be recommended for daily practice
|
|
| 2. |
- Cosyn, Jan, et al.
(author)
-
Disparity in embrasure fill and papilla height between tooth- and implant-borne fixed restorations in the anterior maxilla : a cross-sectional study
- 2013
-
In: Journal of Clinical Periodontology. - : John Wiley & Sons. - 0303-6979 .- 1600-051X. ; 40:7, s. 728-733
-
Journal article (peer-reviewed)abstract
- Purpose The objective of the present study was to compare inter-proximal fill and papilla height between different embrasures. Material & Methods One hundred and fifty non-smoking consecutive patients (mean age 54, range 32–73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician. Results Tooth-pontic and tooth-implant embrasures demonstrated comparable inter-proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant-implant and implant-pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic-pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002). Conclusions The re-establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant-borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.
|
|
| 3. |
- Cosyn, Jan, et al.
(author)
-
Predictors of Alveolar Process Remodeling Following Ridge Preservation in High-Risk Patients
- 2016
-
In: Clinical Implant Dentistry and Related Research. - : Wiley-Blackwell. - 1523-0899 .- 1708-8208. ; 18:2, s. 226-233
-
Journal article (peer-reviewed)abstract
- Purpose(1) To clinically evaluate horizontal remodeling of the alveolar process (hard and soft tissues) following ridge preservation in high-risk patients and (2) to identify predictors of such remodeling. Materials and MethodsPeriodontally healthy nonsmoking patients with a failing tooth in the anterior maxilla (15-25) were selected for a prospective case series. All were in need of a single implant and demonstrated high risk for aesthetic complications given an incomplete buccal bone wall and/or thin-scalloped gingival biotype. Following flapless tooth extraction, ridge preservation was performed using one or more collagen-enriched, bovine-derived block grafts (Geistlich Bio-Oss (R) Collagen (R) 100mg, Geistlich Pharma AG, Wolhusen, Switzerland) without the additional use of membranes or soft tissue grafts. The change in buccopalatal dimension of the alveolar process between baseline (prior to tooth extraction) and 4 months was assessed on the basis of superimposed occlusal slides. Regression analysis was performed to identify predictors of alveolar process remodeling ResultsForty-two patients (21 females, 21 males; mean age 38) met the selection criteria and consented to the treatment. Mean alveolar process remodeling was 14% (SD 7, range 4-30) with minimal remodeling (10%) in 16 patients (38%) and advanced remodeling (>20%) in 10 patients (24%). A single implant could be installed in all subjects without additional guided bone regeneration. Connective tissue grafting was performed later on in the treatment for aesthetic purposes, hereby compensating for tissue loss at the buccal aspect. Predictors of alveolar process remodeling were tooth location (central incisors and cuspids>laterals incisors and premolars), tooth abscess (p=.025), and buccal bone loss (p=.035 ConclusionAlveolar process remodeling seems inevitable yet acceptable following ridge preservation in high-risk patients. Proper case selection may reduce the incidence of advanced remodeling
|
|
| 4. |
- Cosyn, Jan, et al.
(author)
-
Regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen-enriched bovine-derived xenograft : a 1-year prospective study on clinical and aesthetic outcome
- 2012
-
In: Journal of Clinical Periodontology. - : Wiley-Blackwell. - 0303-6979 .- 1600-051X. ; 39:10, s. 979-986
-
Journal article (peer-reviewed)abstract
- AIM: To evaluate the clinical and aesthetic outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft (1); to identify risk factors for failure (clinical attachment level (CAL) gain ≤ 1 mm) and advanced gingival recession (REC) increase (>1 mm) (2). MATERIAL AND METHODS: Ninety-five non-smoking patients, with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated inter-dental infrabony defect were recruited. Patients were consecutively treated by the same clinician using minimally invasive surgery and a collagen-enriched bovine-derived xenograft. Clinical, radiographic and aesthetic data were collected before surgery and up to 1 year. Multivariate analyses were used to identify risk factors for failure and advanced REC increase. RESULTS: Eighty-four patients (39 men, 45 women; mean age 53) complied and demonstrated mean probing depth (PD) of 7.8 mm, CAL of 10.0 mm and defect depth of 5.2 mm before surgery. At 1 year, postsurgery mean PD reduction was 3.5 mm (range 0.0-8.0), CAL gain was 3.1 mm (range 0.0-7.0) and radiographic defect fill was 53% (range 0-100). Forty-nine percentage showed ≥ 4 mm CAL gain, whereas 15% were considered failures. Mean inter-dental and midfacial REC increase was 0.3 mm (range-2.0-2.0) and 0.5 mm (range-1.5-2.0) respectively. Midfacial REC increase and contour deterioration contributed most to a small, yet significant reduction in the Pink Esthetic Score from 10.06 to 9.42 (p = 0.002). Risk factors for failure included defects with a non-supportive anatomy (OR: ≥ 10.4), plaque (OR: 14.7) and complication(s) (OR: 12.0). Risk factors for advanced midfacial REC increase included defects with a non-supportive anatomy (OR: 58.8) and a thin-scalloped gingival biotype (OR: 76.9). CONCLUSIONS: RPT using minimally invasive surgery and a collagen-enriched bovine-derived xenograft demonstrated favourable clinical outcome after 1 year, even though soft tissue aesthetics could not be fully preserved. Defects with a non-supporting anatomy may be at risk for failure and advanced midfacial recession.
|
|
