Periimplant mucosa, probing & BW (3-5)

Question 1

Periodontium Vs periimplant mucosa

Answer 1

• • Berglundh 91(H/x analysis), dogs: imp preseted: 3.8mm vs 3.17, //collagen fibers, LESS <Fibrob.-vessels, ,leukocytes, residual tx.
• • Berglundh 94 (vascular supply), dogs: TEETH has 1-PDL vasc. & 2-subperiosteal vssels. IMP. has ONLY subperiosteal vasc.supply, dense circular fibers, CT//imp., impaired defense (low leukocytes)
• • Abrahamsson & Soldibni 2006 (probing imp vs teeth) 4dogs: JE 1.7mm both, CT 1.2mm imp. vs 0.9mmTeeth, PTbone 1.04mm imp. vs 1.03 teeth.
• Probing acceptable D/x tool in imp. maintenance

• Berglundh 91
• Berglundh 94
• Abrahamsson 2006

Question 2

Hermann 2001

Answer 2

5dogs, 1 vs 2 piece, submerged vs nn-sub. 4.1X9mm, 60 imp.total.
* All imp. had oss.integ. BUT diff. degrees of inflamm. was observed (1 piece better w/ <inflamm.)
* Diff. in JE but no diff for CT/sulcus -> Most JE imp.type F
* Less BW for imp.A ~2.84 (after B-D-F)
* No diff. soft tx. dimens. between the 2 piece non-sub(C) & sub (D-E-F)
* INTERFACE presence/nn influence soft tx. dimens.
* SUB vs NN-sub had no relation on crestal BL (±C=D)
* MICROGAP influenced crestal BL (C lost ging.height due to Alv.BL.)
* CORONAL microgap minimize influence soft tx (±E=B)
* APICAL microgap most influence on soft & hard tx. (F>BL&JE)
* >Crest.BL & >Apical Ging.Marg. for 2 piece vs 1.
* BW vary w/ imp. design (1 piece similar to natural dentition & less periimp. inlamm.)

Question 3

Factors that influence soft tx outcomes around implants

Answer 3

Schwartz 2010 Probing while healing: 12dogs, TL, freq. probing 2w-4-8-12-24w.
Frequent clinical probing at short intervals = dimensional and structural changes of mucosal seal
Initial healing period starts at 12w. Split formation and separation of peri-implant mucosa can facilitate bacterial colonization
Etter 2002: first probing was after healing at 12w + used pressure-sensitive probe  D0: complete separation D1: 0.5mm attachment of JE in most apical part. D5: complete attachment of JE

Abrahamsson 1997 Ab.Dis./Reconnection. 5dogs, (Nobel extern.hex)T
est: JE 1.65mm, CT 0.65mm, BIC 1.5mm apical to interface (BL of 0.7mm) -> Smaller BW= 2.50mm Distance mucosal margin to interface 1.02mm => 1.5mm soft tx. recession.
Mucosal barrier disruption = epithelial proliferation to cover the wound + bone resorption to allow proper CT barrier
Multiple connections resulted in a more apically positioned CT

Berglundh 1996 5dogs, submerged imp. soft tx. excision.
Once imp. exposed to oral environment -> mucosal attach. foramtion to protect oss.integ.
Minimum width of periimplant tx is needed -> Bone resorption to allow space for BW to form
Wound healing included bone resorption + angular bone defect
BW around implants grows in an apical manner with bone resorption to allow proper dimension of mucosal seal

Lazzara 2006 RX evaluation 13y followup
Factors C.bone around imp.:
1. 3mm soft tx.
2. Position Ab. ICT (inflamm.cell.infiltrate)
3. Imp. surface topography
When IAJ (imp.Ab.Junction) positioned away (inside) from outer edge of implant (shoulder) & bone –> ICT exposure is reduced. THUS Platform switching repositions Ab ICT away from crestal bone and locates ICT <90° confined area. (instead 180° like p.matching)

Rodriguez 2009 37 PATIENTS, P.S. imp <3mm apart.
BW around PS imp is located more coronally
PS can preserve periimplant bone
Vest.Bone resoption 0.5-0.7mm; Bone Peak rent. ~0.24nn

Schwartz 2010 (vs etter 2002)
Abrahamsson 1997
Berglundh 1996
Lazzara 2006 –> Rodriguez 2009

Question 4

Probing trauma

Answer 4

Schwartz 2010 Probing while healing: 12dogs, TL, freq. probing 2w-4-8-12-24w.
Frequent clinical probing at short intervals = dimensional and structural changes of mucosal seal
Initial healing period starts at 12w. Split formation and separation of peri-implant mucosa can facilitate bacterial colonization
Etter 2002: first probing was after healing at 12w + used pressure-sensitive probe.
D0: complete separation
D1: 0.5mm attachment of JE in most apical part. D5: complete attachment of JE

Schwartz 10 vs Etter 2002

Question 5

Vertical soft tx. thickness & bone remodeling

Answer 5

Berglundh 1996 5dogs, submerged imp. soft tx. excision.
Once imp. exposed to oral environment -> mucosal attach. foramtion to protect oss.integ.
Minimum width of periimplant tx is needed -> Bone resorption to allow space for BW to form
Wound healing included bone resorption + angular bone defect
BW around implants grows in an apical manner with bone resorption to allow proper dimension of mucosal seal

Lazzara 2006 RX evaluation 13y followup
Factors C.bone around imp.:
1. 3mm soft tx.
2. Position Ab. ICT (inflamm.cell.infiltrate)
3. Imp. surface topography
When IAJ (imp.Ab.Junction) positioned away (inside) from outer edge of implant (shoulder) & bone –> ICT exposure is reduced. THUS** Platform switching** repositions Ab ICT away from crestal bone and locates ICT <90° confined area. (instead 180° like p.matching)

Rodriguez 2009 37 PATIENTS, P.S. imp <3mm apart.
BW around PS imp is located more coronally
PS can preserve periimplant bone
Vest.Bone resoption 0.5-0.7mm; Bone Peak rent. ~0.24nn

Valles 2018 Syst.Rev.(14). SCL=<MBL (confirm Barros 2010), <CBL, >JE.
MICROGAP OF SCL W/ P.S. SHOWS >PERIIMPLANT MUCOSA

Berglundh 1996
Lazzara 2006
Rodriguez 2009
Valles 2018