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ABSTRACT Aim Materials and Methods Results Conclusions Biomechanical performance is a critical factor in the long‐term success of dental implants, with abutment screw loosening being a common clinical issue. This study aimed to examine the impact of abutment screw design and external load loading angles on abutment screw loosening.Abutments and abutment screws with 30°, 60°, 90°, and 180° fitting tapers were fabricated and tested for preload and initial loosening torque. Subsequently, dynamic loosening tests were conducted at loading angles of 15°, 30°, and 45°. Finite element analysis (FEA) was used to calculate the stress and strain distribution of the abutment screws.The findings indicated that large‐taper abutment screws exhibit a higher preload, whereas small‐taper abutment screws demonstrate greater loosening torque values. Additionally, as the loading angle increases, the loosening torque value decreases, and the stress and strain values of the abutment screw increase.Abutment screws with smaller taper heads exhibited superior resistance to loosening. Moreover, the anti‐loosening performance of the abutment screws decreased with higher external load loading angles. [ABSTRACT FROM AUTHOR]

Objective: The aim of this investigation was to evaluate the effect on clinical and radiological outcomes of the one‐abutment, one‐time protocol (test) versus placing the definitive abutment on the day of functional loading after having disconnected and connected three times the healing abutment during the prosthetic phase (control). Materials and methods: Forty patients with 80 implants were randomly allocated to either the test or the control group. Changes in the radiographic marginal bone levels (MBLs), clinical outcomes, prosthetic‐related outcomes, and patient‐reported outcomes measures (PROMs) were assessed and compared 6 and 12 months after functional loading. Results: Thirty‐seven patients with 74 implants were followed at 12 months. A statistically significant bone remodeling was observed in both groups following implant placement. MBLs were significantly greater in the control group at the 6‐ (−0.13 mm vs. −0.61 mm) and 12‐month visits (−0.01 mm vs. −0.53 mm). Bone loss was significantly greater in the control group from surgery to 6 and 12 months and from loading to 6 and 12 months. The abutment height was significantly greater in the test group, however, there were no significant differences in the restorative angle. Similarly, there were no statistically significant differences between groups for the measured clinical variables (probing depth, plaque, and bleeding index) and PROMs. Conclusions: Disconnecting and reconnecting the healing abutment was associated with significantly higher bone loss after 12 months, as compared to the placement of the definitive abutment at implant installation. [ABSTRACT FROM AUTHOR]

Objectives: To assess the impact of a two‐piece abutment workflow on enhancing the stability of the alveolar bone and gingiva surrounding the dental implant, and to determine the level of patient satisfaction. Materials and Methods: A total of 48 patients with dentition defect in the posterior region were included and divided into two groups: the two‐piece abutment workflow (TAW) and the sealing screw with submerged healing workflow (SHW). Marginal bone level (MBL), soft tissue indicators, oral hygiene indicators, and patient satisfaction were assessed and recorded partially at 0, 3, 6, and 12 months after surgery. The primary outcome was the change of MBL in different time periods. A generalized linear mixed model (GLMM) was used to take into account the correlated nature of the data, and adjust for potential confounding factors within inter‐group differences. Results: The survival rate of implants and prosthesis reached 100% at 12‐month follow‐up, with an average decrease of 0.25 mm (SD 0.23 mm) of MBL in the TAW group and 0.48 mm (SD 0.45 mm) in the SHW group. The change of MBL in the TAW group (0.15 ± 0.31 mm) was significantly lower than the SHW group (0.41 ± 0.41 mm) through the analysis of GLMM within 6 months, while no significance was found in 12 months. Moreover, less gingival pain and oppression during prosthesis loading, and less time consumption overall duration were showed in the TAW group through Visual Analogue Scale (VAS, p < 0.05). Conclusions: Within a 6‐month period, the two‐piece abutment workflow showed superior efficacy in preserving the integrity of the marginal bone level. Furthermore, it streamlined treatment procedures and mitigated discomfort, hence increasing patient satisfaction. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the influence on peri‐implant crestal bone loss exerted by the vertical mucosal thickness and the abutment height over 12 months after placement of the restoration on subcrestal implants with change of platform, using a restoration abutment platform smaller than the implant platform. Materials and Methods: A total of 99 implants were rehabilitated in the maxillary and mandibular posterior regions. A total of 22 implants were rehabilitated in the maxilla and 77 implants in the mandible, using digitally designed customized abutments with Atlantis weborder software, from the commercial house Dentsply Sirona (Dentsply Sirona S.A., Barcelona, Spain), version 4.6.5, adapting the height to the vertical thickness of the mucosa. Clinical and radiographic monitoring begins during the surgical procedure of placement of the implant and ends 12 months afterwards. Crestal bone loss was evaluated through the Carestream® CS8100 3D radiographic equipment. Results: In all cases, the greatest loss of marginal bone occurred between the day of surgery (Tx) and placement of the rehabilitation (To). The average bone loss between both times was greater when the abutment height and vertical mucosal thickness did not exceed 3 mm. Subsequently, bone loss slowed and stabilized at 12 months. Conclusions: The minimum abutment height and the vertical mucosal thickness are factors to take into account when minimizing peri‐implant marginal bone loss, the abutment height having the greatest importance according to the clinical data obtained. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of sterilization, conditioning method, and thermal aging on the retentive strength of two‐piece zirconia abutments. Materials and Methods: In total, 128 stock zirconia abutments were divided into four groups (n = 32) according to the conditioning parameters: (A) air‐abrasion using 50 μm alumina particles/1.0 bar, (B) 50 μm/2.0 bar, (C) 100 μm/1.0 bar, and (D) 100 μm/2.0 bar. All abutments were bonded onto titanium bases using DTK adhesive resin and stored in water bath (37°C) for 72 h. Each group was subdivided into two subgroups (n = 16), group 1 was disinfected, whereas group 2 followed disinfection and autoclave sterilization. Half of the specimens of each subgroup (n = 8) was directly subjected to the axial retention test (groups N), while the other half was first subjected to 150 days of thermocycling followed by retention test (groups T). Statistical analysis was performed with three‐way ANOVA, additional statistical analysis was performed by using separate one‐way ANOVAs followed by the Tukey's post‐hoc test for post hoc pairwise comparisons among groups. Results: The highest median retention strength was recorded for group B2N (1390 N), whereas the lowest strength was recorded for group C1T (688 N). No significant interaction (p ≥ 0.05) was detected between the different variables; conditioning method, sterilization, and the thermal cycling regarding the effect on the resulting retention. However, the sterilization always showed a positive effect. Thermocycling presented an adversely significant effect only in the absence of sterilization (p < 0.05), with the exception of subgroups A. For the sterilized groups, thermocycling had no statistically significant effect on the retention. Conclusion: Steam autoclaving increased the retention of hybrid zirconia abutments. DTK adhesive resin for two‐piece zirconia abutments performed well after sterilization and thermocycling. [ABSTRACT FROM AUTHOR]

This article examines the potential risks associated with the release of titanium-based particles from dental implants. It acknowledges that while titanium implants are commonly used and have high success rates, complications can occur due to wear and corrosion. The article emphasizes the lack of international standards for evaluating the biological response to implant wear particles and calls for increased awareness among dental implant providers. It also highlights the importance of reliable testing protocols and the availability of testing data to ensure the safety of dental implants. The authors urge manufacturers and clinicians to be mindful of these risks and to take responsibility for the products and treatments they offer. The authors disclose their contributions to the article and state that they have no conflicts of interest. They also note that no datasets were generated or analyzed during the study, so data sharing is not applicable. [Extracted from the article]

Introduction: This in vitro study aims to biomechanically evaluate the influence of medium contamination for example, saliva, blood, chlorhexidine (liquid and gel), and fluoride mouthwash on the biomechanical behavior of implant abutments' screws under static and dynamic loading. Methods: Forty five Ti6Al4V commercial dental implants and abutments were tested in this study. Two main mechanical tests were carried out in the selected media. The first, static, aimed to evaluate the torque loss after the first tightening. The second, dynamic, involved a random cyclic load range between 0 and 200 N to evaluate torque loss due to mastication. In addition, metallographic longitudinal and cross‐sections of the abutment‐implant apparatus were examined to evaluate the abutment screw–abutment‐implant interface. Results: The static torque test showed that irrespective of the media, no statistical difference in static torque loss was found prior to dynamic loading. For the dynamic tests, torque‐angle evolution analysis during tightening to 30 Ncm and after the spectrum loading, showed the same global mechanical behavior for all media, but the statistical analysis indicated a difference between the groups in reverse torque values (RTV) and in the torque loss due to dynamic loading. The medium groups CHX, CHX‐gel, and Fluoride mouthwash, showed a meaningful torque loss due to loading, but the medium groups, control (no medium), blood and saliva showed an opposite trend and required a higher torque to open the abutment screws. The microstructural analysis revealed clear signs of cold‐welding/galling, post‐dynamic loading in these latter groups. Conclusions: The presence of lubrication/contamination media (CHX mouthwash/CHX‐gel/Fluoride mouthwash) reduces the preload generated due to tightening but prevents damage due to galling. The observed reduction of RTV clearly emphasizes the need for frequent abutment screw retightening for implant‐supported prosthetic long‐term stability. [ABSTRACT FROM AUTHOR]

Peri‐implant mucosal integration is becoming a critical aspect for long term implant health and can be triggered the selection of implant components. The aim of this review is therefore to investigate the evidence concerning implant connection and abutment characteristics (abutment materials, design, handling) as predisposing or precipitating factor for peri‐implant mucositis and peri‐implantitis. Although the evidence that these features can directly predispose/precipitate peri‐implant diseases is limited, there are ‐few‐ studies showing a potential role of the implant connection, trans‐mucosal configuration, and handling in the development of early bone loss and/or peri‐implantitis. With bone level implants, conical internal connections (with inherent platform switching) might be preferred over internal flat‐flat and external connections to decrease the risk of early bone loss and potentially the risk of peri‐implant disease. Moreover, there is a trend suggesting moving the prosthetic interface coronally (to the juxta‐mucosal level) as soon as possible to reduce the number of disconnections and to limit the risk of cements remnants. This can be achieved by choosing a tissue‐level implant or to place a trans‐mucosal abutment (one abutment‐one time approach) to optimize the peri‐implant soft tissue seal. In absence of evidence for the biocompatibility regarding several restorative materials, biocompatible materials such as titanium or zirconia should be preferred in the trans‐mucosal portion. Finally, higher implants (≥2mm) with an emergence angle below 30° seem more favourable. It should however be noted that some of this information is solely based on indirect information (such as early bone loss) and more research is needed before making firm recommendations about abutment choice. [Correction added on 13 March 2023, after first online publication: 'longer implants (≥2mm)' was changed to 'higher implants (≥2mm)' in this version.] [ABSTRACT FROM AUTHOR]

Background: The influence of prosthetic design on prosthetic complications when monolithic or micro‐veneered zirconia prostheses are supported with titanium base (ti‐base) abutments is not well‐known. Purpose: The purpose of this single center, retrospective study was to assess the prevalence of prosthetic complications with monolithic or micro‐veneered single‐unit, multi‐unit, and complete‐arch zirconia prostheses supported with ti‐base abutments (implant level or multi‐unit abutment level). Material and Methods: This study retrospectively evaluated the electronic health record (EHR) of participants who received either monolithic or micro‐veneered implant‐supported single‐unit, multi‐unit, and/or complete‐arch prostheses supported by ti‐base or zirconia‐ti‐base hybrid abutments delivered between the years 2010 and 2021. Data were analyzed by using logistic regression and Exact Mantel–Haenszel chi‐square test (α = 0.05) to assess the clinical performance of prostheses and complications including crown decementation, feldspathic porcelain chipping, prosthesis fracture, zirconia‐ti‐base hybrid abutment decementation, abutment screw loosening, screw fracture, abutment fracture, implant loss, and prosthesis remake. Results: The study included 94 participants (50 female, 44 male) with a mean age of 59.5 years (range: 24–101 years of age). The retrospective EHR evaluation yielded 82 single‐unit, 51 multi‐unit, and 20 complete‐arch prostheses on 325 implants. Among 153 prostheses delivered, 108 were micro‐veneered (47 single‐unit, 41 multi‐unit, and 20 complete‐arch prostheses) and 45 were monolithic. The average duration was 72.35 months (6.02 years) with a follow‐up period of 5–132 months. From the time of insertion to the time of EHR review, of 153 prostheses, 78.43% did not exhibit any prosthetic complication. However, 33 prostheses (21.57%) from 29 participants (30.85%) had at least one prosthetic complication. Only four patients (4.25%) experienced two or more prosthetic complications. Prosthetic design affected the probability of having a complication (p = 0.005); complete‐arch prostheses had higher probability (p ≤ 0.028). Single‐unit prostheses had lower probability of complication than multi‐unit prostheses (p = 0.005). The most commonly observed complication was fracture of veneering material (5.88%) followed by prosthetic screw loosening (4.57%) and decementation between the zirconia and the ti‐base abutment (2.61%). Micro‐veneered complete‐arch prostheses had higher probability of having chipping than that of not having (p < 0.001), and other micro‐veneered prosthetic designs had similar probability of chipping with that of complete‐arch prostheses (p ≥ 0.082). Frequency of chipping was affected by veneering (p < 0.001). Monolithic prostheses had lower probability of chipping than micro‐veneered prostheses, regardless of the prosthetic design (p < 0.001). Conclusions: The frequency of prosthetic complications varied depending on prosthetic design. Complete‐arch prostheses had the highest probability of complications while the single‐unit prostheses had the lowest. Micro‐veneered prostheses had higher probability for chipping than monolithic prostheses. Probability of chipping was similar for micro‐veneered single‐unit, multi‐unit, and complete‐arch zirconia prostheses. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated the 10‐year survival and success of partial fixed dental prostheses (P‐FDPs) fabricated with a milled fiber‐reinforced composite (FRC) framework, supported by short or extra‐short implants. Methods: Patients restored with FRC P‐FDPs supported by short or extra‐short implants were included in this retrospective study. Kaplan–Meier analysis was used to calculate the survival and success rates of the prostheses. Univariate and multivariate Cox regression models, clustered to adjust for multiple implants and prostheses being placed in the same patient, were used to correlate changes in peri‐implant bone levels with patient, implant, and prosthesis‐related covariates. Results: This study followed 121 FRC P‐FDPs supported by 261 implants, placed in 96 patients. At 118 months in function, the P‐FDP survival rate was 95.9% (95% CI: 87.5%–98.7%), and the success rate was 89.8% (95%CI: 80.4%–94.8%). Differences in prosthesis span length, abutment/pontic ratio, and the presence of distal extensions (cantilevers) did not affect the prosthetic outcomes. Bone levels around implants were stable, with an average rate of change of −0.01 ± 0.05 mm/month. Cox regression revealed that grafted sites were correlated with peri‐implant bone loss, while longer prosthetic spans were correlated with bone gain. Conclusion: P‐FDPs comprised of milled fiber‐reinforced composite frameworks, supported by short and extra‐short implants, had high survival and success rates for up to 10 years. [ABSTRACT FROM AUTHOR]

Introduction: Dental implant abutments play an important role in the health and aesthetics of soft and hard tissues around implants. Purpose: To compare mechanical properties and marginal fit of prefabricated and customized dental implant abutments and provide references to evaluate the relationship between abutment choice and clinical indications. Methods: Titanium abutments were randomly divided into prefabricated and customized abutments. Static and dynamic loads were applied according to ISO14801:2016. Mechanical properties, including fracture strength, fatigue strength, rotational torque value, and torque loss rate, were measured. The biological properties of the implant abutments were assessed using an internal marginal fit. The samples were sliced, and the internal marginal fit was examined using a scanning electron microscope before and after cyclic loading. The length of the tight contact was calculated at the level of the conical connection, lower internal connection, and screw threads. Microleakage was evaluated by immersing the samples in 1% methylene blue and measuring the absorbance. Results: The fracture strengths of the prefabricated abutments were greater than those of the customized abutments before and after cyclic loading. The average fatigue strengths of the prefabricated and customized abutments were 350 and 300 N, respectively. The removal torque loss of the customized abutments was significantly greater than that of the prefabricated abutments. Significant differences were found in conical connection before loading, while the screw threads showed substantial differences between the two groups after loading. Microleakage in the customized abutments was significantly higher than that in the prefabricated abutments before and after loading. Conclusions: Prefabricated abutments showed superior mechanical and biological properties compared with customized abutments in vitro, suggesting a greater risk of mechanical and biological complications occurring with the use of customized abutments. This study provides a reference for the clinical selection of implant abutments. [ABSTRACT FROM AUTHOR]

Background: The fracture of a Morse tapered abutment connection in an osseointegrated implant is one of the most serious mechanical complications, and it is extremely hard to deal with this complication in clinical practice. Purpose: The aim of this study was to explore the cumulative mechanical complications focus on abutment of a platform switching Morse taper connection implant system after loading, and to perform a retrospective, approximately 1‐ to 9‐year follow‐up study to identify the predisposing factors. Materials and Methods: A total of 495 patients with 945 fitted implants were enrolled in this study with a follow‐up from January 2012 to January 2020. The data of mechanical complications of the abutment, including abutment fracture (AF) and abutment screw loosening (ASL), and possible causative factors were extracted and evaluated statistically. Results: A total of 25 out of 945 (2.65%) cumulative abutment mechanical complications occurred. AF was the most common complication (n = 13, 1.38%), followed by ASL (n = 12, 1.27%). For AF, gender, type of prosthesis, abutment design, and implant diameter were identified as the causative factors. AF was mostly observed in the single crown of males in molar areas, while ASL was more likely to occur on an angled abutment than on a non‐angled abutment. Moreover, the abutment with the positioning index (/X) had a higher incidence of fracture than the abutment without the positioning index (C/). Conclusions: This study shows that the Morse taper connection is a safe abutment connection. AF occurs more frequently within single crowns in molar area of males, especially with the positioning index (/X), while ASL is more likely to occur in an angled abutment. [ABSTRACT FROM AUTHOR]

Background: Although full‐arch immediately loaded rehabilitations are widely used nowadays, little information is available on which implant/abutment connection is the most suitable in this type of treatment. Purpose: The aim of the present multicentric split‐mouth clinical trial was to compare the clinical outcomes of two different implant‐abutment connections applied in full‐arch immediate loading rehabilitations: external hexagon connection (EHC) versus internal hexagon connection (IHC). Materials and methods: Twenty patients were rehabilitated with immediately loaded fixed full‐arch rehabilitations. All the implants presented the same macro‐ and micro‐topography but different implant/abutment connection. IHC were used in one randomly selected side of the jaw and EHC in the other side. Outcome measures were implant survival rate, peri‐implant marginal bone loss (MBL), plaque index (PI), probing depth (PD), and bleeding on probing (BoP) evaluated at 3, 6, 12, and 36‐month post‐loading. Any technical and biological complication was recorded. Kaplan–Meier procedure and linear mixed model were used to perform statistical analysis. Results: Forty‐three EHC and 40 IHC implants were inserted. No patients dropped out and two implants failed in the first 6 months. The CSR was 97.7% for EHC and 97.5% for IHC implants. No statistically significant differences were found among the two groups for any of the parameters at any time point. At the 36‐month follow‐up visit a slight difference was found in MBL with a mean value of 1.7 mm in the EHC and of 1.9 mm in the IHC group (p = 0.355). No biologic complications were identified. Seven loosed abutment screws were identified in the entire follow‐up period, two in the EHC, and five in the IHC group without a statistically significant difference (p = 0.394). Conclusions: After 36 months in function, both internal and external hexagon connections provided good clinical outcomes and were not associated with any significant difference. [ABSTRACT FROM AUTHOR]

Background: Rough and/or plasma‐activated abutments seem to be able to increase soft tissue adhesion and stability; however, limited evidence is available about bacterial contamination differences. Purpose: The aim was to investigate the oral microbiota on four dental abutments with different surfaces by quantitative real‐time polymerase chain reaction (qRT‐PCR) and culturomic approach. Methods: Forty patients needing a single implant rehabilitation were involved in the study. Forty healing abutments, especially designed for the study, were divided into four groups according to the surface topography (1. machined [MAC], 2. machined plasma of argon treated [plasmaMAC], 3. ultrathin threaded microsurface [UTM], 4. UTM plasma of argon treated [Plasma UTM]). Random assignment was performed according to predefined randomization tables. All patients underwent surgical intervention for implant and contextual healing abutment positioning. After 2 months of healing, a sterile cotton swab was used for microbiological sampling for culturomics, while sterile paper points inserted into the sulcus were used for qRT‐PCR. Results: At the end of the study, 36 patients completed all procedures and a total of 36 abutments (9 per group) were analyzed. qRT‐PCR retrieved data for 23 bacterial species whereas culturomics revealed the presence of 74 different bacteria, most of them not routinely included into oral cavity microbiological kits of analysis or never found before in the oral microenvironment. No statistically significant differences emerged analyzing the four different surfaces (p = 0.053). On the contrary, higher total and specific bacterial counts were detected in the plasma‐treated surfaces compared to the untreated ones (p = 0.021). Conclusions: Abutments with different topographies and surface treatments resulted contaminated by similar oral bacterial flora. Abutments with moderately rough surface were not associated with a greater bacterial adhesion compared to machined ones. Conversely, more bacteria were found around plasma‐treated abutments. Furthermore, data reported suggested to include new species not previously sought in the routine analyses of the oral bacterial microflora. [ABSTRACT FROM AUTHOR]

Background: Digitally customized abutments are increasingly used in contemporary implant prosthodontics. Purpose This systematic review and meta‐analysis aimed at comparing the peri‐implant clinical outcomes of digitally customized and prefabricated abutments. Materials and methods: The search strategies included electronic databases (PubMed, Embase, Scopus, and Cochrane clinical trials database) and related journals up to September, 2020. A qualitative and quantitative synthesis was performed on data extracted from the included studies. Results: Three RCTs (number of patients = 120; number of dental implants = 120) and two prospective cohort studies (number of patients = 144; number of dental implants = 144) with one to three‐year follow‐up periods were included. The quantitative analyses did not demonstrate a significant difference between digitally customized and prefabricated abutments for peri‐implant pocket depth (P = 0.62), plaque index (P = 0.67), bleeding on probing (P = 0.43), keratinized mucosa width (P = 0.75), and pink aesthetic score (P = 0.30) at one‐year follow‐up visit. The qualitative analyses for marginal bone level change, calculus accumulation, implant survival rate, implant success rate, white aesthetic score, and patient‐reported outcomes did not demonstrate a significant difference between two groups during 1 to 3‐year follow‐up visits. Conclusion: The current data do not provide evidence of significant differences between two abutment fabrication methods in terms of peri‐implant clinical outcomes within short‐term period (CRD42020170807). [ABSTRACT FROM AUTHOR]

Background: The relation between implant abutment disconnection (AD) and increased crestal bone loss is still debated. Purpose To compare bone changes below implant‐abutment junction of subcrestally placed implants between: (1) implant level restorations, that underwent four ADs and (2) implants with immediate tissue level abutment with no AD, 1 month (T2) and 1‐year (T3) after final restoration delivery. Materials and methods: Sixty‐four patients received 64 bone level implants with platform‐switching and conical connection in edentulous sites of posterior mandible and maxilla. All implants were placed 1.5 mm subcrestally and distributed among: (1) control group, that received a regular healing abutment and (2) test group with immediate tissue level (ITL) abutment, which was torqued to implants during surgery, transforming bone level implant to tissue level type. After 2–3 months of healing and a 1‐month temporization, final zirconia‐based screw‐retained crowns were delivered to both groups. Crestal bone levels were calculated after final crown delivery (T2); after 1‐year follow‐up (T3) and compared using Mann–Whitney U test (p ≤.05). Results: Early bone loss of the test and control groups was 0.14 ± 0.27 mm and 0.64 ± 0.64 mm, respectively; the 0.5 mm difference was statistically significant (p =.0001). Late bone loss was 0.06 ± 0.16 mm and 0.21 ± 0.56 mm for the test and control group, respectively; the 0.15 mm difference between the groups was no more statistically significant (p =.22). Both groups displayed bone gain, 0.08 and 0.43 mm, respectively, and the overall crestal bone loss was reduced. Conclusions: Immediate tissue level abutments can significantly reduce early bone loss when measured 1 month after final prosthesis delivery, however, after 1‐year follow‐up, difference between the groups was no more statistically significant. [ABSTRACT FROM AUTHOR]

Background: Soft tissue reaction to dental implant abutments influences the sustainability of restoration. Several abutment materials, such as titanium and gold alloy, have been introduced for strength and esthetic solutions. Zirconia and titanium‐base abutments have also become popular in recent years due to high esthetic demands. Purpose To investigate the immune cell infiltration into the soft tissue in response to different abutment materials. Materials and Methods: Twenty dental implants were placed in the posterior regions of 17 patients. Titanium, zirconia, gold alloy, and titanium‐base were randomly selected for each patient on the day of surgery. After 8 weeks of healing, the abutments were removed along with 1 mm of peri‐implant soft tissue. Immunohistochemical assessment was performed using labeled streptavidin‐biotin to identify T cells, B cells, macrophages, plasma cells, and microvascular infiltration. Results: Gold alloy demonstrated an overall higher inflammatory cell infiltration and highest number of CD3+, CD20+, and CD 68+ cells (P value <.05). The number of plasma cell and new microvascular infiltrations among abutment materials was not significantly different. Conclusion: Titanium, titanium‐base, and zirconia abutments showed comparable infiltration profiles; gold alloy abutments showed the highest B‐cell, T cell, and macrophage infiltration. None of the abutment materials caused clinical inflammation; hence, they can be effectively used. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to assess the microbiological and clinical outcomes of implant‐supported restorations on zirconia or titanium abutments after 3 years in function. Materials and methods: Twenty two‐part dental implants were placed in 20 healthy individuals in need of single‐tooth replacement. Ceramic‐based reconstructions were cemented in either zirconia or titanium abutments. Clinical, radiographic, and microbiological outcomes were examined at implant loading and then yearly up to 3 years post‐loading. Results: Cumulative survival/success implant rates were 95% after 3 years. Mean total marginal bone loss was 0.76 ± 0.21 mm for zirconia and 0.99 ± 0.41 mm for titanium, with no significant differences (P >.05). Overall, titanium and zirconia abutments presented similar values of probing depth, gingival recession, and bleeding on probing over time (P <.05). Microbial profile of implants restored with titanium or zirconia is quite similar to that found in the remaining teeth. Conclusions: Zirconia and titanium presented different microbial profile and genome counts. Clinical findings for both zirconia and titanium abutments were similar and consistent with a healthy condition, reflecting a high survival rate and low bone loss. Microbiota did not impact the clinical outcomes after 3 years of function. [ABSTRACT FROM AUTHOR]

Background: Placement of the implant‐abutment interface (IAI) away from the bone crest has been suggested to have positive impacts on maintenance of peri‐implant tissues. Purpose: To assess the effects of platform‐switched and platform‐matched implants, taking into consideration the IAI at different positions relative to the bone crest, on clinical, radiographic, and microbiological outcomes during 12 months following functional loading. Materials and Methods: The present prospective randomized study was performed upon 70 patients. Group I (n = 23) implants presenting a platform‐switched implant‐abutment connection design was inserted 1 mm subcrestally. Group II (n = 22) implants with similar properties were inserted crestally. Group III (n = 25) implants presenting a platform‐matched approach with an internal hexagon connection design was inserted crestally. The periodontal parameters were assessed at baseline, and 3, 6, and 12 months postloading. Radiographic marginal bone level (MBL) changes were analyzed at the 12‐month follow‐up. The amount of DNA copies of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Provetalla intermedia and total bacterial mean load in peri‐implant sulcus fluid (PISF) were assessed at the same periods. Results: There were no significant differences among the groups with respect to the periodontal parameters for all time periods. At 12‐month follow‐up, the MBL changes were 0.16 ± 0.29 mm and 0.17 ± 0.23 mm for group I, 0.15 ± 0.25 mm and 0.17 ± 0.26 mm for group II, 0.17 ± 0.26 mm and for group III in mesial and distal sites, respectively. The mean total bacterial load was found significantly higher for group III compared to the other groups in the three interval times (P <.05). Conclusion: Implants restored with platform‐switching and platform‐matching performed equally regarding clinical and radiographic outcomes. Platform‐matched implants inserted at the crestal level presented higher the mean bacterial total load in PISF. [ABSTRACT FROM AUTHOR]

Background: Dental implants and abutments are exposed to challenging oral environment. Corrosion of these materials can affect the overall performance of titanium implants. Purpose: To investigate the effects of biofilm‐induced bio‐aging on corrosion behavior of different implant materials surface. Materials and Methods: Commercial polished titanium (Polish), sand‐blasted, large grit, acid‐etched surface treated titanium (SLA), microarc oxidation (MAO), and hydroxyapatite (HA) coated titanium were bio‐aged with saliva biofilm for 30 days. Titanium surfaces topography, chemical composition, roughness, and water contact angle changes were evaluated. In addition, human gingival fibroblasts (HGFs) adhesion, Streptococcus sanguinis (S. sanguinis) biofilm formation were determined. Results: Surface topography, roughness, and chemical composition have no significant changes for all groups after bio‐aging (P >.05). Water contact angle of bio‐aged SLA was greatly increased (P <.05). While other groups showed no sign of change (P >.05). Adhesion and proliferation of HGFs on the bio‐aged SLA titanium surfaces were decreased (P <.05), but increased on bio‐aged Polish and HA titanium (P <.05). S. sanguinis biofilm viability was promoted with bio‐aging in HA group (P <.05). Conclusions: Biological characteristics of Polish, SLA, and HA titanium surfaces were influenced by bio‐aging. While MAO group was relatively resistant to saliva biofilm bio‐aging. [ABSTRACT FROM AUTHOR]

Background: Personality factors might influence participants' satisfaction and the effects of dental management on daily living. Purpose: This randomized controlled clinical trial aimed to assess the impacts of two types of implant‐supported maxillary anterior crown restorations on daily living and participants' satisfaction, and its correlations with personality profiles. Materials and Methods: One hundred and seventy participants (84 males and 86 females; mean age = 35 ± 9 years) obtained maxillary anterior implant‐supported crowns. They were allocated into two treatment groups (85 participants each: 43 females and 42 males). Group 1 was treated with titanium abutment‐supported porcelain fused to metal (PFM) restorations. Group 2 was treated with zirconium abutment‐supported ceramic restorations. A control group (85 participants each: 43 females and 42 males) that matched the treatment groups in gender and age was recruited. Precise clinical standards were followed to judge the clinical success of treatment. The NEO Five‐Factor Inventory was used to evaluate participants' personality profiles. The dental impact on daily living questionnaire (DIDL) was used to evaluate restoration impacts on daily living and participants' satisfaction. Statistical analysis was carried out with probability of α = .05. Results: Higher DIDL scores were reported after crown treatments (P < .001). Group 2 participants reported highest levels of satisfaction with appearance (P = .007). DIDL scores were significantly associated with neuroticism, extraversion, and openness scores (P < .05) before restoration, and, with neuroticism, extraversion, agreeableness, openness, and conscientiousness scores (P < .05) after restoration. Conclusion: Implant‐supported crown restorations in anterior maxillary region were associated with positive impacts on daily living and participants' satisfaction. Implant‐supported ceramic crowns and abutments were accompanied with higher levels of satisfaction with appearance than implant‐supported PFM crowns and titanium abutments. Certain personality and psychological features (neuroticism, extraversion, agreeableness, openness, and conscientiousness) might affect and predict dental satisfaction and impacts on daily living. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the present randomized clinical trial was to test whether or not the use of screw‐retained all ceramic implant‐borne reconstructions results in clinical, technical, and biologic outcomes similar to those obtained with cemented all ceramic reconstructions. The hypothesis was that there is no difference in clinical, technical, and biological parameters between the two types of retention. Materials and Methods: Forty‐four patients randomly received 20 cemented reconstruction (CR) and 24 screw‐retained (SR) all ceramic single crowns on two‐piece dental implants with nonmatching implant‐abutment junctions. All patients were recalled after crown insertion, at 6 months, 1 year, as well as at 3 years. At these visits, biological and radiographic evaluations were performed. Technical outcomes were assessed using modified USPHS (United States Public Health Service) criteria. Data were statistically analyzed with Wilcoxon‐Mann‐Whitney, Wilcoxon and Fisher exact tests. Results: During 3 years of follow‐up, eight patients (18.2%) lost the reconstruction due to technical (6 patients, 13.6%, 2 CR and 4 SR group) or biological complications (2 patients, 4.5%, only CR group). Thirty‐two subjects with 18 SR and 14 CR reconstructions attended the FU‐3Y, whereas four patients (9.1%, 2 SR, 2 CR) were not available (drop‐outs). Biological, technical, and radiographic outcomes did not differ significantly between the groups (P > 0.05). One implant (2.3%) was lost in the CR group. One more cemented crown (2.3%) had to be removed because of peri‐implant disease. Six patients (13.6%) lost the reconstructions due to a fracture of the zirconia abutment (4 SR, 2 CR). The mean marginal bone level at 3 years was −0.4 mm (−0.5; −0.3) in group SR and − 0.4 mm (−0.6; −0.3) group CR (P = 0.864). Conclusions: At 3 years, CR and SR exhibited similar survival technical, biological and radiographic outcomes. The rate of technical complications was high in both groups. [ABSTRACT FROM AUTHOR]

Background: Single implant crowns have become the preferred rehabilitation treatment option for replacing a missing tooth. Purpose: This study evaluates 5‐year clinical success of using tilted implants placed immediately after extraction followed by rehabilitation with all‐ceramic crowns. Materials and Methods: Twenty‐seven participants requiring 28 single implant crowns in the aesthetic zone of maxilla were recruited to participate in a single‐arm clinical trial. All participants were rehabilitated according to immediate implant placement using CP grade 4 titanium implants with roughened surfaces and a 12°‐angled platform. Provisional implant crowns were connected within 4 hours of implant placement and loaded according to progressive loading protocol. At 8 weeks (baseline), definitive screw‐retained crowns fabricated using densely sintered zirconia abutments with the veneering porcelain were delivered. Participants were followed up to 5 years and 16 participants with 17 single implant crowns attended Year 5 recall. Data collection included changes in marginal bone levels (MBLs), mid‐buccal mucosal levels (MBMLs), implant stability quotient (ISQ) values, and any prosthodontic maintenance issues. Results: The mean changes in MBLs at each recall was bone fill of 0.5 ± 1.18 mm (surgery—baseline), increase of 0.1 ± 0.57 mm (baseline—Year 1), and marginal bone loss of 0.1 ± 0.25 mm (Years 1‐5). A minimal change occurred with the MBMLs during the observation period. The mean ISQ value at each time point increased from 65.1 (implant placement), to 67.4 (baseline) and 69.9 (Years 1 and 5). Prosthodontic maintenance issues occurred only during the first year which included fracture of veneering ceramic and zirconia abutment as well as aesthetic concerns. Conclusions: Within the limitations of this study, the data collected would suggest that replacing a single missing tooth using titanium oral implants with 12° platform tilt and zirconia abutments can be a successful rehabilitation option in the esthetically demanding zone of anterior maxilla. [ABSTRACT FROM AUTHOR]

Background: Screw‐retained fixed partial dentures (FPD) have shown a lower incidence of biologic complications and an easier retrievability compared with cemented FPD. Purpose: To compare the marginal bone loss at conical connection implant restored with a screw retained cobalt‐chrome FPD in an implant‐level (IL) or an abutment‐level (AL) setup. Materials and Methods: Patients with at least two adjacent missing teeth were randomly allocated to be restored with IL or AL FPD. Periapical radiographs and clinical examination were taken at implant placement, prosthetic connection, 6 and 12 months to evaluate marginal bone loss (MBL), and soft tissue conditions. Complications were used to calculate prognostic indexes. Results: Fifty patients were treated with 50 FPD supported by 119 implants. The difference of MBL between the IL and AL groups was statistically significant (P = 0.003). At 1 year, MBL was 0.086 ± 0.313 mm and 0.005 ± 0.222 mm in the IL and AL groups, respectively. The presence of BoP increased with time in IL, whereas it decreased in AL group (P < 0.001). A minor complication was encounted in one FPD. Conclusions: A low grade of MBL was present after 1 year. IL showed greater amount of MBL and soft tissue inflammation indexes than AL. In FPD, AL may be a safer procedure than IL setup in order to preserve a healthy periimplant tissue. [ABSTRACT FROM AUTHOR]

Background: A new implant design was launched in 2015 with internal connection allowing for placement of abutments with angulated screw channels. Such devices may eliminate the use of nonauthentic components, which may present with poor fit and jeopardize the construction. It may also eliminate the use of cemented single‐crowns with the risk for excessive cement to cause marginal bone destruction. Purpose: To evaluate the outcome of a straight‐walled implant with conical connection (NobelParallel CC), when used in the single‐tooth situation of the anterior maxilla. Further, to elucidate the need for an abutment with angulated screw channel (ASC). Materials and Methods: Patients referred for both implant surgery and prosthetics to rehabilitate missing single maxillary incisors/canines. Implants were placed according to a two‐staged surgical procedure. Patients were followed up to delivery of prosthetic crowns with the purpose to extend the study up to 1‐, 3‐, and 5‐year follow up. Registrations of implant survival, marginal bone level measurements, hard/soft tissue complications, and the incidence of ASC to avoid the use of nonauthentic components or crown cementation, were performed at the end of the study. Results: A total of 47 patients were included in the current investigation. One patient deceased during the study period. In all 51 implants were inserted, of which 14 implant sites were bone augmented either prior to implant placement or in connection with the insertion procedure. Further, four remaining teeth were extracted in the region of interest during implant placement. One implant presented with infection and mobility at abutment connection and was consequently removed. Implant survival rate was 98.0%. Mean marginal bone level at crown placement was 0.41 mm (SD = 0.45 mm) and the corresponding measurements at 1 year for 22 implants revealed a marginal bone resorption of 0.41 mm (SD = 0.36 mm). Abutments with angulated screw channels were used in 42/49 sites. Conclusion: The NobelParallel CC implant seemed to work well together with the ASC abutment. No major complications were noted. [ABSTRACT FROM AUTHOR]

Background: A newly developed dental implant system combining advancements in surface chemistry, topography, nanostructure, color, and surface energy aims to address biological challenges and expand clinical applications. Purpose: To assess the short‐ and long‐term safety and efficacy of a novel, gradually anodized dental implant surface/anodized abutment. Materials and Methods: Twenty‐four Yucatan mini pigs (20‐24 months old) received two dental implants in each jaw quadrant. Each site was randomized to receive either a commercially available anodized implant/machined abutment or a gradually anodized implant/anodized abutment with a protective layer. Animals were euthanized at 3, 6, and 13 weeks. Microcomputed tomography and histological analyses were performed. Results: No significant histological differences in inflammation scores, epithelium length, bone‐to‐implant contact, or bone density were observed between groups for any healing time. Mucosal height was significantly higher at 3 weeks for controls (Δ = 0.2 mm); no differences were observed at 6 and 13 weeks. No significant differences in radiographic bone volume, bone‐to‐implant contact, trabecular thickness, and crestal bone levels were observed, irrespective of healing time. Trabecular spacing was borderline significant at 3 weeks in favor of the test implant sites; no differences were observed at 6 weeks. No significant differences were observed between experimental groups at 13 weeks. Conclusions: The new implant system yielded results comparable to a commercially available predicate device. [ABSTRACT FROM AUTHOR]

Background: Abutment surfaces are being designed to promote gingival soft tissue attachment and integration. This forms a seal around prosthetics and consequently ensures long‐term implant survival. New scalable and reproducible models are necessary to evaluate and quantify the performance of these surfaces. Purpose: To evaluate a novel implantation model by histomorphometric and immunohistochemical characterization of the interactions between human oral gingival tissue and titanium abutments with either novel anodized or conventional machined surface. Materials and Methods: Abutments were inserted into an organotypic reconstructed human gingiva (RHG) model consisting of differentiated gingival epithelium cells on a fibroblast populated lamina propria hydrogel following a tissue punch. Epithelial attachment, down‐growth along the abutment surface, and phenotype were assessed via histomorphology, scanning electron microscopy, and immunohistochemistry 10 days after implantation. Results: The down‐growing epithelium transitioned from a gingival margin to a sulcular and junctional epithelium. The sulcus depth and junctional epithelial length were similar to previously reported pre‐clinical and clinical lengths. A collagen IV/laminin 5 basement membrane formed between the epithelium and the underlying connective tissue. The RHG expanded in thickness approximately 2‐fold at the abutment surface. The model allowed the evaluation of protein expression of adhering soft tissue cells for both tested abutments. Conclusions: The RHG model is the first in vitro 3D model to enable the assessment of not only human epithelial tissue attachment to dental abutments but also the expression of protein markers involved in soft tissue attachment and integration. The two abutments showed no noticeable difference in epithelial attachment. [ABSTRACT FROM AUTHOR]

Background: Long‐term success and patient satisfaction of dental implant systems can only be achieved by fulfilling clinical as well as biological needs related to maintenance, aesthetics, soft tissue sealing, and osseointegration, among others. Surface properties largely contribute to the biological and clinical performance of implants and abutments. Purpose: To decipher the clinical and biological needs in implant dentistry. To address identified needs, next‐generation dental implant and abutment surfaces are designed and characterized in vitro. Materials and Methods: Novel implant and abutment surface designs were produced and characterized using surface chemical analysis, surface topography analysis, scanning electron microscopy, contact‐angle measurements, and cell‐culture experiments. Results: The novel anodized implant surface was gradually anodized, increasing the surface roughness, surface enlargement, and oxide‐layer thickness from platform to apex. The surface was phosphorus enriched, nonporous, and nanostructured at the collar, and showed micropores elsewhere. The novel anodized abutment surface was smooth, nanostructured, nonporous, and yellow. Pristine surfaces with high density of hydroxyl‐groups were protected during storage using a removable cell‐friendly layer that allowed dry packaging. Conclusions: A novel anodized implant system was developed with surface chemistry, topography, nanostructure, color, and surface energy designed to balance the clinical and biological needs at every tissue level. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the effect of veneering of the submucosal part of zirconia abutments and the type of retention (cemented vs screw‐retained) on clinical, microbiological, and histological outcomes of single‐tooth implant crowns. Material and Methods: A total of 44 patients with a single missing tooth to be replaced by an implant in the anterior region participated in the study. Implants were randomly assigned to receive zirconia‐based CAD/CAM reconstructions using either one of four treatment modalities: cement‐retained with submucosal veneering (CR‐P), cement‐retained without submucosal veneering (CR‐W), screw‐retained with submucosal veneering (SR‐P), and screw‐retained without submucosal veneering (SR‐W). Clinical parameters were assessed at baseline (after crown insertion), at 6 and 12 months. Histological and microbiological analyses were performed at 6 months. Descriptive statistics and the Kruskal‐Wallis test were applied. Results: The clinical evaluation revealed, in general, stable peri‐implant soft tissues with minimal differences for all measured parameters between the four groups, except for bleeding on probing with the two cemented groups exhibiting higher values at 12 months (35.0% ± 26.5% for CR‐W and 25.0% ± 38.8% for CR‐P versus 13.1 ± 14.8 for SR‐W and 13.0 ± 18.2 for SR‐P). The descriptive and semi‐quantitative histology showed a trend for a higher inflammatory reaction in the two cemented (a medium to high number of inflammatory cells) compared to the screw‐retained groups (low number of inflammatory cells) at 6 months. The microbiological test demonstrated low bacterial counts and a similar distribution in between the groups except for two species (Tannerella forsythia and Peptostreptococcus micros) that were found in higher counts in the cemented groups at 6 months. Conclusion: Submucosal veneering of zirconia abutments did not negatively affect the health of the peri‐implant tissues. The cemented groups, though, did show a clinical and histological trend to higher levels of inflammation. [ABSTRACT FROM AUTHOR]

Background: For long‐term success of dental implants, it is essential to maintain the health of the surrounding soft tissue barrier, which protects the bone‐implant interface from the microorganisms. Although implants based on titanium and its alloys still dominate the dental implant market, alumina (Al2O3) and zirconia (ZrO2) implant systems are widely used in the area. However, they provide smooth and bioinert surfaces in the transmucosal region, which poorly integrate with the surrounding tissues. Objective: The main aim of this research was to investigate the surface characteristics and biocompatibility of chitosan‐coated alumina and zirconia surfaces. Materials and Methods: The substrates were coated via solution casting technique. Additionally, an aging process with a thermocycle apparatus was applied on the coated materials to mimic the oral environment. To define the morphology and chemical composition of the surfaces of untreated, chitosan‐coated, and chitosan‐coated‐aged samples, scanning electron microscopy and energy dispersive X‐ray spectrometry were used. The phases and bonds characterized by Fourier transform infrared spectroscopy and X‐ray diffraction analysis. The human gingival fibroblast cells were used to evaluate cytocompatibility by a 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyl‐tetrazolium salt assay. Results: It was observed that both substrates were successfully coated with chitosan and the aging process did not significantly affect the integrity of the coating. The attachment and proliferation of human gingival fibroblast cells were shown to be good on both kinds of chitosan‐coated surfaces. Conclusion: Coating zirconia and alumina surfaces with chitosan is an efficient surface modification for increasing biocompatibility and bioactivity of these materials in vitro. [ABSTRACT FROM AUTHOR]

Background: More research is needed on the study of new materials for fixed prosthetic implant‐supported rehabilitations. Purpose The purpose of this study was to report the short‐term outcome of full‐arch implant‐supported fixed hybrid polyetheretherketone (PEEK)‐acrylic resin prostheses and the all‐on‐four concept. Materials and Methods: This prospective cohort clinical study included 37 patients (29 women, eight men) with an average age of 60 years (range: 38‐78 years) with 49 full‐arch hybrid PEEK‐acrylic resin prosthesis supported by implants through the all‐on‐four concept. Primary outcome measures were prosthetic survival. Results: Two patients with two maxillary prostheses were lost to follow‐up. One patient with a double full‐arch rehabilitation fractured the mandibular PEEK framework, rendering a 98% prosthetic survival rate. No implants were lost. The average (SD) marginal bone remodeling after 1 year of follow‐up was 0.37 mm (0.58 mm). Technical complications concerning the veneer adhesion occurred in six patients and were resolved in all patients (with exception of the patient with prosthetic failure) through the creation of mechanical retentions and changing the bonding primer. Mechanical complications occurred in three patients and five prostheses consisting in prosthetic screw loosening (n = 2 patients) and fracture of the acrylic resin teeth (the patient with a prosthetic failure). Conclusions: Within the limitations of this study, the results suggest that hybrid polymer (PEEK)‐acrylic resin prostheses supported by implants for full‐arch rehabilitation may represent a valid treatment option, still requiring longer‐term validation. [ABSTRACT FROM AUTHOR]

Background: Implant dentistry is progressing based on extensive scientific results including preclinical and clinical studies. Researchers and clinicians have focused on implant designs and surface characteristics, which has resulted in various features being developed and introduced for enhancing osseointegration and reducing complications. Purpose The purpose of this study was to determine the cumulative survival rates of Straumann tissue‐level dental implants over a 10‐year period and identify the patterns of implant loss at a single research institution. Materials and Methods: In total, 1692 implants were installed in 881 patients who visited the Department of Periodontology, Dental Hospital, Yonsei University, Seoul from January 2003 to December 2009. Cases in which the implant was completely removed were defined as implant failures. Electronic or paper charts and radiographs were used to determine whether the implants failed. The survival rate of implants was analyzed using lifetime tables and Kaplan‐Meier survival estimates. Log‐rank test and Cox regression with shared frailty were used to analyze the risk factors and the types of implant failure. Results: The 10‐year cumulative survival rates were 98.23% and 95.70% at the implant and patient levels, respectively. Before installing a prosthesis (defined as the early stage), 13 implants in 10 patients were removed, while eight implants in seven patients were removed after completing a prosthesis (defined as the late stage). The cumulative survival rate was related to the implant diameter, length, site, and insertion torque. Most implant failures within 1 year were attributable to osseointegration failure. There were several cases of failure in the late stage without apparent marginal bone loss. Conclusion: Straumann tissue‐level dental implants showed low failure rates and can be considered a useful long‐term treatment option. The length, placement site, and insertion torque might affect implant survival. [ABSTRACT FROM AUTHOR]

Background: Marginal bone loss (MBL) is considered an important determinant of implant success, and establishing the peri‐implant biological width has been regarded to influence MBL around implants. However, few studies have attempted to show the relationship between the crown/abutment gap and MBL. Purpose To evaluate the effect of the prosthetic abutment height on MBL of dental implants. Materials and Methods: This study evaluated data which were retrospectively collected through chart and panoramic radiographs of 145 patients (78 males and 67 females; aged 19 to 79 years, mean age 54.1 years) in whom 273 implants were placed by a single clinician between June 2009 and December 2014. The abutment height and the bone level were measured in digital panorama radiographs. All correlations between abutment height and MBL were analyzed using Spearman's test (P < .05). Results: The 273 implants comprised 126 in 67 female patients and 147 in 78 male patients. The mean age of the patients was 54.1 years (range 19‐79 years). The prevalence of MBL and the mean MBL decreased as the abutment height increased. Spearman's test showed a significant negative correlation between abutment height and MBL (P < .05). Conclusion: The present study suggests that implants with a higher prosthetic abutment show less MBL, with the abutment height recommended to not exceed 4 mm. [ABSTRACT FROM AUTHOR]

Background: The effect of different maintenance time of torque application and screw loosening in full‐arch implant‐supported prosthesis remains uninvestigated. Purpose To examine the effect of different maintenance time of torque application on detorque values of implant abutment screw in full‐arch implant‐supported fixed complete denture. Materials and methods: Passively fitting framework supported by four implants stabilized on resin model torqued to 35 N‐cm and maintained for different times; instant torque application (protocol A), 10 seconds (protocol B), and 30 seconds (protocol C) were used. Detorque values were recorded during removal of the screws. Comparison between mean torque and detorque values were made using paired sample t‐test. The mean removal torque values of each protocol were compared using three‐way analysis of variance (ANOVA). Results: The mean removal torque values were lower than the applied torque for all the protocols. The highest mean removal torque value was found in the immediate protocol (A) (24.44 ± 1.7), followed by the 30 seconds protocol (C) (23.37 ± 1.75), and then by the 10 seconds protocol (B) (23.35 ± 1.6). All these differences were found to be statistically significant between torque and detorque values (P = .001). However, the differences among detorque values were not statistically significant (P > .05). Conclusion: The application of 35 N‐cm for different maintenance time of torque application on implant abutment screw did not appear to affect the detorque value in a multiple implant‐supported fixed prosthesis. Maintaining the torque for prolonged time (10 seconds or 30 seconds) was not significantly associated with higher preload than instant torque application in full‐arch implant‐supported prosthesis. [ABSTRACT FROM AUTHOR]

Background: The implant‐abutment connection (IAC) is known to be a key factor for the long‐term stability of peri‐implant tissue. Purpose The aim of the present in vitro study was to detect and measure the mechanical behavior of different IACs by X‐ray imaging. Materials and Methods: A total of 20 different implant systems with various implant dimensions and IACs (13 conical‐, 6 flat‐, and 1 gable‐like IAC) have been tested using a chewing device simulating dynamic and static loading up to 200 N. Micromovements have been recorded with a high‐resolution, high‐speed X‐ray camera, and gap length and gap width between implant and abutment have been calculated. Furthermore, X‐ray video sequences have been recorded to investigate the sealing capacity of different IACs. Results: Out of the 20 implant systems, eight implant systems with a conical IAC showed no measurable gaps under static and dynamic loading (200 N). By contrast, all investigated implant systems with a flat IAC showed measurable gaps under dynamic and static loading. X‐ray video sequences revealed that a representative conical IAC had sufficient sealing capacity. Conclusion: Within the limits of the present in vitro study, X‐ray imaging showed reduced formation of microgaps and consecutive micromovements in implants with conical IAC compared to flat IACs. [ABSTRACT FROM AUTHOR]

Background: The type of cement used in cemented fixed implant‐supported restorations influences formation of undetected excess cement and composition of the peri‐implant biofilm. Excess cement and dysbiosis of the biofilm involve the risk of peri‐implant inflammation. Purpose The aim of the study was to investigate the impact of two different cements on the peri‐implant biofilm and inflammation. Materials and Methods: In an observational study, the suprastructures of 34 patients with cemented fixed implant‐supported restorations were revised. In 20 patients, a methacrylate cement (Premier Implant cement [PIC]) and in 14 patients, a zinc oxide eugenol cement (Temp Bond [TB]) were used. After revision, TB was used for recementation. During revision and follow‐up after 1 year, microbial samples were obtained. Results: Excess cement was found in 12 (60%) of the 20 patients with PIC. Suppuration was observed in two (25%) implants with PIC without excess cement (PIC−) and in all 12 (100%) implants with PIC and excess cement (PIC+). Implants cemented with TB had neither excess cement nor suppuration. The taxonomic analysis of the microbial samples revealed an accumulation of periodontal pathogens in the PIC patients independent of the presence of excess cement. Significantly, fewer oral pathogens occurred in patients with TB compared to patients with PIC. TB was used in all cases (PIC and TB) for recementation. In the follow‐up check, suppuration was not found around any of the implants with PIC−, only around one implant with PIC+ and around one implant with TB. Bacterial species associated with severe periodontal infections that were abundant in PIC− and PIC+ samples before the revision were reduced after 1 year to levels found in the TB samples. Conclusions: The revision and recementation with TB had a positive effect on the peri‐implant biofilm in cases with PIC. The cementation of suprastructures on implants with TB is an alternative method to be considered. [ABSTRACT FROM AUTHOR]

Background: Dental rehabilitation with conventional prostheses after microvascular jaw reconstruction is often unsuccessful because of the altered oral anatomy and the lack of adequate dentition for fixation. Purpose This retrospective study evaluated the long‐term outcomes of patients who underwent jaws reconstruction with a fibula free flap and subsequent rehabilitation with implant‐supported prostheses. Materials and Methods: In total, 21 patients were enrolled; 108 osseointegrated dental implants, positioned on 21 fibular free flaps were assessed. Follow‐up examinations were performed according to a standardized protocol, including clinical and radiological evaluations. The mean follow‐up after implant insertion was 90.2 (range, 20‐204) months. Results: The overall implant survival rate was 97.2% at the 12‐month follow‐up, 86.5% at 60 months, and 79.3% at 120 months. The rate of overall implant success was 95.4% at the 12‐month follow‐up, 73.5% at 60 months, and 64.7% at 120 months. Implant failure was more common in patients that had implants placed after they underwent radiation therapy. Peri‐implantitis and mucositis were identified in 14.8% and 20.3% of surviving implants, respectively, at the 5‐ and 10‐year follow‐up. The risk of developing peri‐implantitis was estimated to be higher (odds ratio = 1.5) for patients without connective tissue or skin grafts versus patients with one of them (18.2% vs 9.5%). Conclusions: Long‐term implant‐related outcomes show that the survival rate of implants placed into the fibula is acceptable. Radiotherapy negatively impacts survival and success, in particular in the short and medium‐term follow‐up. Moreover, a relevant peri‐implant bone resorption does occur over time and ultimately influences implants success, and it is mainly related to peri‐implant gingival mucositis. In this regard skin or connective tissue grafts seem to offer an aid to manage this problem. [ABSTRACT FROM AUTHOR]

Purpose The aim of current split‐mouth study is to compare crestal bone loss of hybrid with moderately rough implants in patients with a bar‐supported mandibular overdenture. Materials and Methods: Fully edentulous patients were enrolled for treatment with implant‐supported overdentures. Each patient received two implants of which one moderately rough (Sa: 1.3 μm) and one hybrid surface implant (moderately rough implant body [Sa: 1.3 μm] and a minimally rough implant neck [Sa: 0.9 μm]). Beside the difference in implant surface the two implants are identical. After 3 and 12 months, peri‐apical radiographs were taken to assess crestal bone levels and a Wilcoxon signed‐rank test was used for pairwise comparison. Results: Forty‐two implants were placed in 21 patients and no failures occurred after 1 year. An overall mean crestal bone loss of 0.40 mm (SD: 0.76; range: 0‐3.93) and 0.35 mm (SD: 0.59; range: 0‐2.56) was registered after a mean follow‐up of 3.4 and 15.8 months. There was no statistical significant difference in crestal bone loss between the different implant surfaces or between the different time intervals. Conclusion: From this randomized controlled trial, it can be concluded that hybrid surface implants may be a viable alternative for implant treatment in the edentulous mandible. [ABSTRACT FROM AUTHOR]

Background: Flapless implant surgery is mostly performed using guided surgical protocols, however, long‐term studies on free‐handed flapless surgery for single implants are lacking. Purpose This prospective study evaluates bone level changes, peri‐implant health, and complications of solitary implants placed using a conventional flap (F) or flaplessly (FL) after 6‐9 years. Materials and Methods: Fifty‐three single TiUnite Brånemark implants were originally inserted in 49 patients using an one‐stage delayed loading protocol with flap (n = 27, F) or flaplessly (n = 26, FL) based on available bone volume and surgeon's decision‐making. Thirty‐six patients with 37 implants participated in the prospective follow‐up investigation 6‐9 years later whereby survival, bone level changes, peri‐implant health, and complications were assessed. Results: After 88 months (range 76‐107), all implants were survived. For F and FL combined, the overall average radiographic bone level was above the first implant thread, 1.26 mm apical of the implant‐abutment junction (SD 1.08; 0‐4.9) and statistically comparable. Bone loss from time of loading was 0.49 mm (SD 1.1; −1.3 to 2.8) for F and −0.89 mm (SD 1.0; −2.8 to 0.7) for FL (P < .01), suggesting regrowth of bone in FL due to initial countersinking. One implant (2.7%) had a probing depth above 5 mm. Conclusion: Free‐handed flapless implant surgery for single implants with neighboring teeth is a predictable long‐term treatment provided when there is sufficient bone volume. [ABSTRACT FROM AUTHOR]

Background: There is a lack of studies evaluating the wear of the male components of the ball attachment systems of implant‐retained overdentures. Purpose The purpose of this study was to compare the volumetric wear patterns four commercially used ball abutments. Materials and Methods: Forty‐eight identical polyethylene and acrylic blocks were fabricated and four groups consisting of 12 polyethylene blocks with two implants and 12 acrylic blocks, which were used as overdentures, were generated (two groups with plastic females, one group with gold and one group with titanium females). Every specimen underwent 5000 insertion and removal cycles (~4.5 years) and retention forces were measured. For the evaluation of volumetric wear, all the ball abutments were scanned before and after the 5000 cycles using a three‐dimensional scanner and the data were analyzed using the software supplied by the manufacturer. Results: Statistically significant retention force differences were observed between the groups at each cycle (P < .05). Among the four groups, retention force was lowest in the group with titanium females (5.59 ± 2.27) and highest in the group with gold females (43.0 ± 6.3) at the end of 5000 cycles. Statistically significant dimensional changes in the male components were observed between the groups (P < .05). Volumetric losses were 11%‐13% in Group I and II, 1% in Group III, and 25% in Group IV. Group III showed significantly lower volumetric wear whereas Group IV showed significantly higher volumetric wear than all the other groups (P < .001). No significance was detected between Group I and II (P > .05). Conclusion: Within the limitations, it can be concluded that although clinical studies are needed to ensure the findings of the present study, due to severe retention loss and volumetric abutment wear, ball attachments with titanium female components should be used with caution. [ABSTRACT FROM AUTHOR]

Purpose: This study was aimed to investigate, over 5 years, bone response to "one‐abutment onetime" (OA‐OT) protocol in the restoration of implants inserted in the anterior maxilla. Additionally, influence of soft tissue biotype in the bone remodeling was investigated. Materials and Methods: From January 2011 to January 2012, all consecutive patients presented with a hopeless tooth in the maxillary area between canines were enrolled. Post‐extraction ridge preservation was performed. After 6 months, implant was midcrestaly inserted and intraoperative impression was taken. Two months thereafter an immediate definitive abutment with a provisional crown was inserted. At final crown connection, patients underwent a standardized periapical radiograph (T0). At 12 (T1), 24 (T2), 36 (T3), 48 (T4), and 60 (T5) months, radiographic follow‐up and clinical control were carried out. Independent sample t‐test was conducted to compare bone loss at different times. To detect the potential role of biotype, groups (thick TK vs thin TH) were compared by analysis of variance with general linear model. Results: Twenty‐five patients were enrolled, but only 22 patients concluded the study. The radiographic analysis showed a stable longitudinal condition of bone levels after the first‐year significant increasing (0.17 ± 0.25mm, 0.33 ± 0.25mm, 0.28 ± 0.27mm, 0.25 ± 0.26mm, 0.31 ± 0.35mm, and 0.31 ± 0.29mm, respectively at T1, T2, T3, T4, and T5). No statistical significant differences in bone loss among the two groups TH vs TK over the time (P = 0.952) were demonstrated. Conclusion: Results showed that the OA‐OT approach allow to obtain stable bone levels. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Different implant‐abutment connections are available and it has been claimed they could have an effect on marginal bone loss. The aim of this review is to establish if implant connection configuration influences peri‐implant bone loss (PBL) after functional loading. Methods: A specific question was formulated according to the Population, Intervention, Control, and Outcome (PICO): Does the type of implant‐abutment connection (external, internal, or conical) have an influence on peri‐implant bone loss? A PubMed/MEDLINE electronic search was conducted to identify English language publications published in international journals during the last decade (from 2006 to 2016). The search was conducted by using the Medical Subject Headings (MeSH) keywords “dental implants OR dental abutment AND external connection OR internal connection OR conical connection OR Morse Taper.” Selected studies were randomized clinical trials and prospective studies; in vitro studies, case reports and retrospective studies were excluded. Titles and abstracts and, in the second phase, full texts, were evaluated autonomously and in duplicate by two reviewers. Results: A total of 1649 articles were found, but only 14 studies met the pre‐established inclusion criteria and were considered suitable for meta‐analytic analysis. The network meta‐analysis (NMA) suggested a significant difference between the external and the conical connections; this was less evident for the internal and conical ones. Platform‐switching (PS) seemed to positively affect bone levels, non‐regarding the implant‐connection it was applied to. Conclusions: Within the limitations of this systematic review, it can be concluded that crestal bone levels are better maintained in the short‐medium term when internal kinds of interface are adopted. In particular, conical connections seem to be more advantageous, showing lower peri‐implant bone loss, but further studies are necessary to investigate the efficacy of implant‐abutment connection on stability of crestal bone levels. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study the effect of implanting the percutaneous bone‐anchored hearing system (BAHS) itself and inflammation of the peri‐abutment skin warrant clarification. In this study, we aimed to acquire further insight into the immune responses related to BAHS surgery and peri‐implant skin inflammation. Materials and Methods: During surgery and 12 weeks post‐implantation, skin biopsies were obtained. If applicable, additional biopsies were taken during cases of inflammation. The mRNA expression of IL‐1β, IL‐6, IL‐8, TNFα, IL‐17, IL‐10, TGF‐ß, MIP‐1α, MMP‐9, TIMP‐1, COL1α1, VEGF‐A, FGF‐2 TLR‐2, and TLR‐4 was quantified using qRT‐PCR. Results: Thirty‐five patients agreed to the surgery and 12‐week biopsy. Twenty‐two patients had mRNA of sufficient quality for analysis. Ten were fitted with a BAHS using the minimally invasive Ponto surgery technique. Twelve were fitted with a BAHS using the linear incision technique with soft‐tissue preservation. Five biopsies were obtained during episodes of inflammation. The post‐implantation mRNA expression of IL‐1β (P = .002), IL‐8 (P = .003), MMP9 (P = .005), TIMP‐1 (P = .002), and COL1α1 (P < .001) was significantly up‐regulated. IL‐6 (P = .009) and FGF‐2 (P = .004) mRNA expression was significantly down‐regulated after implantation. Within patients, no difference between post‐implantation mRNA expression (at 12 weeks) and when inflammation was observed. Between patients, the expression of IL‐1β (P = .015) and IL‐17 (P = .02) was higher during cases of inflammation compared with patients who had no inflammation at 12‐week follow‐up. Conclusions: As part of a randomized, prospective, clinical trial, the present study reports the molecular profile of selected cytokines in the soft tissue around BAHS. Within the limit of this study, the results showed that 12 weeks after BAHS implantation the gene expression of some inflammatory cytokines (IL‐8 and IL‐1β) is still relatively high compared with the baseline, steady‐state, expression. The up‐regulation of anabolic (COL1α1) and tissue‐remodeling (MMP‐9 and TIMP1) genes indicates an ongoing remodeling process after 12 weeks of implantation. The results suggest that IL‐1β, IL‐17, and TNF‐α may be interesting markers associated with inflammation. [ABSTRACT FROM AUTHOR]

Abstract: Background: It is claimed that bone remodeling is limited when the implant neck has microthreads and an internal abutment connection. However, comparative studies, excluding confounding factors, are scarce. Aim: This RCT aims to assess whether a coronal microthreaded design and an internal abutment connection affects crestal bone loss, up to one year of function. Materials and Methods: Twenty‐one maxillary edentulous patients were consecutively treated for a bar supported maxillary overdenture on four different implants with respectively: internal connection and microthreads on the implant neck (I MT); internal connection, no microthreads (I NMT), external connection, with microthreads (E MT), and external connection, without microthreads (E NMT). Other design features, s.a. width, surface topography, platform switch as well as surgical placement and prosthetic protocol were consistent. Implant survival and crestal bone loss in relation to the implant type were considered the main variables and a Friedman test for ordered alternatives was used to assess the difference in crestal bone loss between the different study implants. Results: Twenty‐one patients received 83 study implants. Three implants failed within three months and required replacement. The total survival rate was 96.39% after one year and based on 21 patients and 80 implants a mean crestal bone loss of 0.25 mm (SD: 0.38; range: 0‐1.48) was measured. After a follow‐up of 3, 6, 12, and 21 months no statistically significant differences in crestal bone loss between the different study implants or the different time intervals could be identified. Conclusions: From this RCT, it is concluded that the implant‐abutment connection and a microthreaded external thread configuration have limited influence on crestal bone remodeling. The latter can be considered a multifactorial process and is more dependent on other factors such as biologic considerations than on implant design. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To investigate the effect of the apico‐coronal implant position on early and late crestal bone loss (CBL), in bone and tissue level implants. Materials and methods: Electronic and manual literature searches were conducted for controlled clinical trials reporting on CBL before and after functional loading of implants. Random effects meta‐analyses were applied to analyze the weighted mean difference (WMD) and meta‐regression was conducted to investigate any potential influences of select confounding factors. Results: Fourteen articles were included in the systematic review and 12 were included in the quantitative synthesis. For bone level implants, WMD comparing early CBL in equi and subcrestal placement was 0.15 mm (P = .18). For analyses of late CBL in bone level implants, equi and subcrestal placement revealed a 0.03 mm WMD (P = .88). Where in supra and subcrestal placement, WMD was 0.04 mm (P = .86). The comparison presented considerable heterogeneity between these two arms, where the P value for chi‐square test presented as .006. Finally, for CBL between supra and equicrestal placement, WMD was −0.64 mm (P < .0001), favoring the supracrestal group. For tissue level implants, WM of early and late CBL in implants placed equi‐crestally was 0.68 ± 0.12 mm and 0.69 ± 0.54 mm, respectively, where for implants placed sub‐crestally, the WM of CBL was 1.72 ± 0.15 mm and 2.26 ± 0.63 mm, respectively. Conclusion: Within the limitations of this study, it is recommended to place tissue level implants equicrestally, and bone level implants subcrestally. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: In implant rehabilitation, a microspace is created at the abutment‐implant interface (AII). Previous research has shown that oral microbiome can proliferate in this microspace and affect periimplant tissues, causing inflammation in peri‐implant tissues. Preventing microbial leakages through the AII is therefore an important goal in implantology. Objective: To determine the presence of marginal bacterial microleakage at the AII according to the torque applied to the prosthetic implant in vitro. Material and Methods: Twenty‐five Ticare Inhex internal conical implants (MG Mozo‐Grau, Valladolid, España) were connected to a prosthetic abutment using torques of <10, 10, 20, 30, and 30 N and then sealed. The samples were submitted to cycles of occlusal loads and thermocycling, then one sample of each group was observed by micro TC, while the rest were mounted on devices according to the bacterial leakage model with Porphyromonas gingivalis. Results: Bacterial leakage was observed only in the <10 and 10 N torque samples, and the same groups presented poor abutment/implant adjustment as determined by micro‐CT. Conclusion: The different torques applied to the abutment‐implant system condition the bacterial leakage at the implant interface. No microleakage was observed at 20 and 30 N. [ABSTRACT FROM AUTHOR]

Abstract: Background: Implant healing abutments (IHA) have a vital role in soft tissue healing after implant placement. Although there is thorough investigation on the implant surface, little is known about the effects potentially damaging oral conditions impose on healing abutments. Purpose: To characterize the surface of titanium healing abutments before and after clinical placement to understand the effects of the oral environment and time on the device surface. Materials and Methods: Ten regular Straumann IHA were subjected to characterization pre and postplacement to elucidate the effects of the oral environment on device surfaces. Changes in surface crystallinity, morphology, and elemental composition were monitored with Raman spectroscopy, scanning electron microscopy, optical microscopy, and x‐ray photoelectron spectroscopy, respectively. In addition, corrosion rate and polarization resistance were obtained to assess electrochemical device stability after placement. Results: Control analysis indicated the titanium oxide of IHAs was thicker than natural commercially pure titanium and had the structure of crystalline anatase. After removal, the abutments possessed large amounts of biological debris, visible scratches, and discoloration sparsely on the surface. Spectroscopic analysis revealed the titanium oxide on the surface of IHAs was structurally unchanged, with crystalline titanium dioxide still present on the surface. Electrochemical results revealed that implanted healing abutments possessed a significantly higher corrosion rate than controls (change in corrosion rate = 2.34 ± 0.58 nm/year). Conclusions: Healing abutments were stable in the oral environment due to the chemical stability of the oxide, and were likely subjected to abrasions from unintentional loading and oral hygiene techniques. [ABSTRACT FROM AUTHOR]

Background Little knowledge is available on implant treatment in large effectiveness studies in routine practice. Purpose To report retro-prospective data on prevalence of peri-implantitis surgery and late implant failures in a large number of routine patients at 1 referral clinic. Materials and methods Altogether 9582 implants with an anodized surface (Nobel Biocare AB) were consecutively placed between 2003 and 2011 and followed-up to end of 2015. All peri-implantitis operations and late implant failures were consecutively identified. A logistic multivariate data analysis was performed to identify association between the complications and different clinical factors. Furthermore, data on prevalence on risk for inflammation and bone loss at implants ('peri-implantitis') and surgery related to peri-implantitis was collected for another reference group of about 10 000 implant patients during 3 consecutive years (2013-2015). Results Cumulative survival rates for implant operations without peri-implantitis surgery or implant failures were calculated to 96.4% (95% CI: 97.3-95.4) and 95.0% (95% CI: 96.0-94.1) after 10 years, respectively. Risk for 'peri-implantitis surgery' showed a significant association ( P < .05) to number of placed implants (hazard ratio [HR] 1.40; 95% CI: 1.24-1.59). Three factors showed significant association to risk for 'late implant failures,' where 'treatment in lower jaw' had the highest risk; HR 2.03. 'Overall implant failures' were associated to 4 significant factors where 'surgeon' (HR 2.50) showed highest impact on risk. 'Numbers of implants' and 'bone resorption' at surgery were the 2 significant factors that were consistent for all the time periods of failures during follow-up (early/late/total). On an average 7.4% of examined patients in the reference group were denoted with highest risk group ('peri-implantitis') of which on an average 12.7% of these patients had surgery related to peri-implantitis. Conclusions 'The dentist' involved in the surgical and prosthetic rehabilitation of the implant patients, 'number of implants' and degree of 'bone resorption' seem to have most impact on overall implant complications and failures in the present patient group. [ABSTRACT FROM AUTHOR]

Background Limited numbers of large effectiveness studies on routine dental implant treatment are available in the literature. Purpose To report retro-prospective data on prevalence of early implant failures in a large number of routine patients/operations at 1 referral clinic. Materials and methods A total of 2848 patients were consecutively provided with 9582 implants with an anodized surface (Nobel Biocare AB) during 3448 implant operations between 2003 and 2011. All patients were invited to a follow-up program and early implant failures up to first annual examination were consecutively identified. A logistic multivariate data analysis was performed to identify possible factors with an association to early implant failures. Results A total of 43, 73, and 81 implant operations were denoted as early failures depending on when cut-off time was defined, using: abutment connection, prosthesis placement, or at first year of follow-up, respectively. Five factors showed significant association to 'early implant failures,' where the highest risk for a failure was associated to 'surgeon' (hazard ratio [HR] 5.13), followed by 'not prosthetic treatment at the referral clinic' (HR 2.71). When all 5 significant factors were present, the risk for an early failure after an operation was 7.0%, and the risk decreased to 0.1% when none/lowest risk factors were present. Conclusions The role of the surgeons/dentists involved in the rehabilitation of the implant patients and numbers of placed implants (degree of tooth loss) showed the strongest associations to early implant failures in the present clinic. Also increased bone resorption was associated to increased risk for implant failure. [ABSTRACT FROM AUTHOR]

Background The Encode protocol (Biomet 3i, Palm Beach Gardens, Fla) has been proposed as a simplified implant restoration protocol. Purpose To compare the 1-year clinical outcome of the Encode and conventional protocols for restoring single implants. Materials and methods Forty-seven implants were inserted in 44 patients. After randomizing the implants, 24 implants were allocated to the Encode protocol and 23 implants were allocated to the conventional protocol. After 1 year, changes in esthetics, patient satisfaction, proximal contacts quality, occlusal contacts quality, marginal bone level (MBL), and probing pocket depth (PPD) were evaluated. Further, the prosthesis cleansability, mucosal health, bleeding on probing (BoP), metallic discoloration, and all forms complications were recorded. Results Forty patients with 41 implants (22 Encode and 19 conventional) were recalled. One conventional crown failed due to excessive looseness. Esthetics, patient satisfaction, and prosthesis cleansability were favorable for the two protocols. One Encode crown (4.5%) and six conventional crowns (33.3%) had slight mucosal redness. BoP was present around 8 Encode crowns (36.4%) and eight conventional crowns (45.4%). Only two conventional crowns showed metallic discoloration of the mucosa. The two protocols had similar PPD alteration (Encode = 0.04 mm, conventional = 0.13 mm), and MBL loss (Encode = 0.71 mm, conventional = 0.78 mm). Similar proximal contacts and occlusal contacts were observed for the two protocols. Conclusions After 1 year, the Encode protocol for restoring single implants appears to be comparable to the conventional protocol from the biological, prosthetic, and esthetic perspectives. [ABSTRACT FROM AUTHOR]