1. Gingival papillae after single-implant computer guided
Topic: Implant therapy outcomes, surgical aspects
Gingival papillae after single-implant computer guided
flapless surgery
DUŠAN GROŠELJ (1) P , HELENA GROŠELJ (1) ,
(1) MEGFID d.o.o. LJUBLJANA, Slovenia.
256
Abstract
27 Hexcel, EHC (It) single-implants were placed in both jaws using computer-guided flapless one-stage surgical approach in 22 patients; <x> = 57 ± 12 years. Except two all implants had diameter 3.75 mm. The classical healing period was 3-6 months. With the aid of GPI (Fig.1) we clinically and photographically (A2, B2, and C2) evaluated the degree of change of 33 available papillae and alveolar bone crest from intraoral radiographs at time of crown insertion and during follow-up. The mean time since crown insertion was 36 ± 25 months. The changes in GPI scores of two groups on both proximal sides were tested using t test. We analysed also the relation between GPI scores and distances from the contact point between the crown of the tooth and the implant to the crest of bone using intraoral radiographs (A1, B1, and C1).
Computer-guided dental implant planning increases the predictability of replacing missing teeth in partially and fully edentulous cases and makes also possible safe flapless osteotomies. All single-implants in this study were placed using computer-guided flapless surgery.
Many different factors seem to have influence on the level of soft tissue around dental implants (2, 3). Among them we investigated the effect of surgical technique, interproximal bone crest level and mucosal quality.
With the aid of Gingival Papilla Index (GPI) we clinically and photographically evaluated the degree of change (regeneration / recession) of 33 available papillae at time of crown insertion and during follow-up (1). Interproximal bone crest levels were investigated on intraoral radiographies.
Our results suggest that the level of papillae between single-implant and tooth remain stable for 3 years after fixture placement using computer guided flapless surgery.
Results
The difference of mean values of GPI scores at crown placement and at follow-up was not statistically significant. Table 1 shows that the highest number of present† papillae are found when the distance (mm) from the crown contact point to the bone crest reached ≤ 5 millimetres.
Background and Aim
Table 1. Presence/absence of papilla around single implant in relation to distance (mm) from crown contact point to bone crest
The computer-guided flapless implantology has numerous advantages including better preservation of circulation, soft tissue as well as bone volume at the site (4). The literature brings the evidence that the papilla regeneration depends on surgery technique. It would be interesting to know how gingival papillae fill up the proximal space after single-implants flapless surgery.
The aim was to compare the degree of change of papillae between the time of crown insertion and follow-up and to analyse the relation between Gingival Papilla Index (GPI, Jemt 1997) scores and distances from the coronal contact point to the crest of bone.
DISTANCE (mm)
< 3 3 4 5 6 7 8 9
>10
NUMBER 1 15
PRESENT †
ABSENT ‡ 2
Jemt Index Score 12
†Jemt Index 2 and 3 combined; ‡Jemt Index 0 and 1 combined.
Methods and Materials
Conclusions
Our results suggest that the level of papillae between single-implant and tooth after computer guided flapless surgery remain stable in <x> = 3 years.
The data show that papillae are present† 5,5 time more frequent than absent‡ ones when the distance from crown contact point to bone crest is ≤ 5mm.
References
1. Jemt T. Regeneration of Gingival Papillae After Single-Implant Treatment. Int J Periodont Rest Dent 1997:17:
2. Nisapakultorn K, Suphanantachat S, Silkosessak O, Rattanamongkolgul S. Factors affecting soft tissue level
around anterior maxillary single-tooth implants. Clin. Oral Impl. Res. 21, 2010; 662–670.
3. Sorní-Bröker M, Peñarrocha-Diago M, Peñarrocha-Diago M. Factors that influence the position of the peri-implant soft tissues: A review. Med Oral Patol Oral Cir Bucal Sep 1;14 (9):e475-9.
4. Tsoukaki M, Kalpidis CDR, Sakellari D, Tsalikis L, Mikrogiorgis G, Konstantinidis A. Clinical, radiographic,
microbiological and immunological outcomes of flapped vs. flapless dental implants: a prospective randomized controlled
clinical trial. Clin. Oral Impl. Res. 24, 2013, 969–976.
Presented at the 22nd Annual Scientific Meeting of the European Association of Osseointegration
17-19 October 2013, Dublin, Ireland