Background: Gingival esthetics around dental implants have become a main focus for clinicians. This study analyzed the surgical, prosthetic, and anatomic factors involved in the management of peri-implant tissues. Methods: Forty-eight subjects with one tooth scheduled for tooth extraction and immediate implant placement were included in the study. After healing, the implants were restored with single-crown fixed prostheses. The following parameters were assessed after 12 months: presence/absence of the interproximal papilla, interimplant–tooth distance (ITD), distance from the base of the contact point to the interdental bone (CPB), and soft tissue biotype. ITD and CPB values were derived from computer analysis of periapical radiographs. A statistical analysis determined the effect of ITD and CPB on the presence of the interproximal papilla. Results: Papilla was significantly present (P <0.05) for ITD of 2.5 to 4 mm in anterior and posterior areas and for CPB ≤7 mm in posterior areas. Thick biotype was significantly associated (P <0.05) with the presence of the papilla. Conclusions: The combination of surgical and prosthetic plans represents the key factor to optimize predictability in single-implant esthetics. The recommended interproximal distance between the implant and the adjacent tooth is 2.5 to 4 mm. The distance from the contact point to the interdental bone is recommended to be <7 mm. Papilla presence is also correlated with a thick gingival biotype.

The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr −0.60 ± 0.69 mm and Ti Grade IV −0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. Registered on www.clinicaltrials.gov: NCT01878331

Objectives: To investigate in which clinical situations a cantilever fixed implant supported restorations can be a treatment alternative and which complications are reported.Materials and Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant fixed restorations with at least 10 patients and with a mean follow‐up of at least 5 year were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. Risk of bias assessment was evaluated. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5‐ and 10‐year survival and complication rates.Results: A total of nine papers were selected for partially edentulous patients and reported high survival rate of the prosthesis. The estimated survival rate for 5–10 years was calculated to be 98.4% for the implants and 99.2% for the rehabilitations. Mechanical, technical and biological complications were reported with a cumulative 5–10 years complication rate of 28.66% and 26.57% for the patients and for the prosthesis, respectively. Two papers for single implant supporting 2‐unit cantilever were not sufficient to draw conclusions.Conclusions: There is evidence that cantilever can be successful treatment in partially edentulous patients. In two adjacent edentulous sites, data are not yet sufficient.

Aim: To investigate fully edentulous patients rehabilitated with cantilever‐fixed implant‐supported restorations and to analyse which complications are reported for this type of treatment.Materials and Methods: Two operators screened the literature (MEDLINE, EMBASE) and performed a hand search on the main journals dealing with implantology and prosthetics until 31 December 2017. Only articles that considered cantilever implant‐fixed restorations with at least 10 patients and with a mean follow‐up of at least 5 years were selected. The outcome variables were survival of implants and prosthesis, mechanical, technical and biological complications, marginal bone loss. The review was performed according to the PRISMA statements. The risk of bias was evaluated for each article. Failure and complication rates were analysed using random effect Poisson regression models to obtain summary estimate of 5‐ and 10‐year survival and complication rates.Results: Fourteen papers for fully edentulous patients were selected. The estimated 5 to 10 years survival rate was calculated to be 99.00% and 96.7% for the implants and the prosthesis, respectively. A total of 299 complications (technical and biological) were reported with a cumulative 5–10 years complication rate of 44.41% and 39.46% for the patients and for the prosthesis, respectively.Conclusions: There is evidence that cantilever can be successful treatment in fully edentulous patients.

The goal of this extension study was to compare the 10‐year outcome of 3.3 mm diameter titanium–zirconium (TiZr) or grade IV titanium (Ti) implants in mandibular implant‐overdentures.Materials and Methods: This study is the 10‐year follow‐up from a randomised, controlled, double‐blind, split‐mouth multicentre clinical trial. Patients with edentulous mandibles had received two implants in the interforaminal region (bone‐level, diameter 3.3 mm, microrough surface), one of TiZr (test) and one of Ti (control). Implant survival and success, plaque and sulcus bleeding indices, probing pocket depth, gingival margin, clinical attachment level and radiographic crestal bone levels were evaluated.Results: Fifty of 91 patients with implants were available for the 10‐year examination and 36 patients were valid for the intent‐to‐treat (ITT) analysis. The implant success rate was calculated as 94.6% and 91.9% for the TiZr implants and the Ti implants respectively. Four implants were lost (TiZr = 1; Ti = 3) in the entire study period. Kaplan–Meier survival analyses estimated 10‐ year implant survival rate for TiZr to 98.9% and Ti 95.8%.The mean of total and functional crestal bone loss was 1.49 mm (±1.37 mm) and 0.82 mm (±1.09 mm) in the TiZr group and 1.56 mm (±1.34 mm) and 0.85 mm (±1.16 mm) in the Ti group.Conclusions: This split‐mouth design RCT on mandibular implant‐overdentures evidenced, bearing in mind its follow‐up time‐related reduced cohort size, high 10‐year implant success‐ and survival rates. These results confirm TiZr as well‐suited implant material for realising small‐diameter implants.Registered on www.clinicaltrials.gov: NCT01878331.