Background: All-on-four protocols with tilted implants in the maxilla are used to rehabilitate the terminal dentition of the severe generalized periodontitis patients. Data on long-term biological complications are scarce. Methods: Eighty-four axial and forty-six tilted immediate implants have been placed in the extraction sockets of 23 patients according to a four–six implants protocol combined with ridge augmentation. Within 72 h, a provisional prosthesis was cemented to the implants; after 6 months, a cemented ceramic–metallic prosthesis was delivered. The patients were followed for up to 5 years. Results: The 5-year survival rate of the straight and tilted implants was 100% and 97.8, and the prosthetic one was 100%. Marginal bone loss (MBL) of the straight implants was 0.42 ± 0.67 and 0.59 ±1.01 mm on the mesial and distal sides; for the tilted, it was 0.37 ± 0.68 and 0.34 ±0.62 mm, and the differences were not statistically significant. Implant position, smoking, keratinized mucosal width, and cantilever did not affect MBL. Peri-implant mucositis involved 29.4% and 22.2% of the straight and tilted implants, respectively; peri-implantitis involved 5.8% and 4.4% of the straight and tilted implants, respectively, without statistical significance. Conclusions: This immediate loading protocol’s 5-year survival and success rates were high. No difference between the straight and tilted implants was found regarding survival, success rates, and MBL.

Omer Cohen, DMD, PhD/Eran Gabay, DMD, PhD/Eli E. Machtei, DMD: Purpose: One-piece dental implants are commonly used for the immediate restoration of missing teeth. In most cases, the clinician has to prepare the abutment intraorally to ensure a proper emergence profile and abutment angulation. However, this procedure might impair primary stability and thus potentially compromise osseointegration. The aim of this study was to determine the effect of abutment preparation on the primary stability of a one-piece implant system (UNO MIS). Materials and Methods: Implant stability was assessed by resonance frequency analysis with a novel custom-made external fixation device, validated previously, developed specifically for resonance frequency measurements of this implant. Thirty 3 ? 13-mm implants were inserted in porcine jawbone with insertion torque of 15 Ncm (group A, 15 implants) or 30 Ncm (group B, 15 implants). Abutments were prepared by reducing the facial aspect of the implant abutment with a high-speed dental turbine (400,000 rpm) equipped with a medium-roughness diamond bur. Implant stability quotients (ISQs) were measured before and after abutment preparation. Results: Mean ISQs measured in group A and group B before abutment preparation were very similar (58.2 ? 1.4 and 57.4 ? 0.9, respectively; P > .05). Following abutment preparation, three implants in group A lost primary stability. The mean ISQ value in group A was reduced from 58.2 ? 1.4 to 54.9 ? 7.9 following abutment preparation (P < .05). The mean ISQ in group B was not affected by abutment preparation (57.4 ? 0.9 versus 57.3 ? 1.0; P > .05). Conclusions: Abutment preparation of a one-piece dental implant inserted with low insertion torque might impair implant primary stability. Int J Oral Maxillofac Implants 2013;28:375?379. doi: 10.11607/jomi.2392

(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.

Background: Stress concentrated at an implant’s neck may affect bone-to-implant contact (BIC). The objective of this study was to evaluate four different implant neck designs using two different drilling protocols on the BIC. Methods: Ninety-six implants were inserted in 12 minipigs calvarium. Implants neck designs evaluated were: type 1–6 coronal flutes (CFs), 8 shallow microthreads (SMs); type 2–6 CFs,4 deep microthreads (DMs); type 3–4 DMs; type 4–2 CFs, 8 SMs. Two groups of forty-eight implants were inserted with a final drill diameter of 2.8 mm (DP1) or 3.2 mm (DP2). Animals were sacrificed after 1 and 3 months, total-BIC (t-BIC) and coronal-BIC (c-BIC) were evaluated by nondecalcified histomorphometry analysis. Results: At 1 month, t-BIC ranged from 85–91% without significant differences between implant types or drilling protocol. Flutes on the coronal aspect impaired the BIC at 3 m. c-BIC of implant types with 6 CFs was similar and significantly lower than that of implant types 3 and 4. c-BIC of implant type 4 with SMs was highest of all implant types after both healing periods. Conclusions: BIC was not affected by the drilling protocol. CFs significantly impaired the -BIC. Multiple SMs were associated with greater c-BIC.