Dataset Information

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis.

ABSTRACT:

Objectives

In systematically healthy patients with an implant-supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri-implant soft tissues on aesthetic outcomes (O)?

Methods

Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant-supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random-effects meta-analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence.

Results

Thirty-four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross-sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow-up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = -0.24, 0.53]; p = .46). PES changes during the follow-up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, -0.62 mm (4 studies; [95% CI = -1.06, -0.18]; p = .006). Patient-reported outcome measures (patient satisfaction) were in favour of thick soft tissues -2.33 (6 studies; [95% CI = -4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non-randomized studies, high risk of bias and residual confounding.

Conclusion

Within the limitations of the present study (weak study designs and various soft tissue measurements or time-points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes.

SUBMITTER: Bienz SP

PROVIDER: S-EPMC9543651 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis.

Bienz Stefan P SP Pirc Miha M Papageorgiou Spyridon N SN Jung Ronald E RE Thoma Daniel S DS

Clinical oral implants research 20220601

<h4>Objectives</h4>In systematically healthy patients with an implant-supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri-implant soft tissues on aesthetic outcomes (O)?<h4>Methods</h4>Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant-supported fixed reconstruction. Measurement of the buccal soft tissue thicknes ...[more]

PMID: 35763024

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Project description:Background and Objectives: The influence of the quantity and quality of peri-implant soft tissue on implant health and long-term maintenance is controversial. This consensus aimed to assess the importance of peri-implant soft tissue by analyzing four aspects: the role of keratinized mucosa (KM), the efficacy of specific collagen matrix, the influence of abutment material, and soft-tissue thickness. Materials and Methods: Active members of the Italian Academy of Osseointegration (IAO) participated in the consensus. Four systematic reviews were conducted, and their results were discussed to provide guidelines on the importance of soft tissue around implants. The first review evaluated the effect of KM on soft-tissue health, peri-implant bone loss, and patient-related variables. The second one analyzed if there was a specific type of matrix that provided better results in terms of peri-implant buccal soft-tissue thickness and keratinized mucosa width compared to autogenous soft-tissue graft. The third review evaluated the influence of different abutment materials on the soft tissues, and the fourth assessed the effect of soft-tissue thickness on peri-implant marginal bone loss (MBL). Results and Conclusions: The agreements reached by the assembly were as follows: the presence of supra-periosteal keratinized tissue is considered to favorably influence peri-implant health and aesthetics but had no relation to preventing bone crest resorption unrelated to infection. It facilitates patient cleaning around implants and reduces patient-reported pain. The free gingival graft (FGG) is considered the best in terms of supra-periosteal KM increase. Connective tissue grafts (CTG) perform better than volume-stable collagen matrices to increase soft-tissue thickness. Collagen matrices reduce surgical time and patient morbidity and can give better camouflaging. The influence of abutment material (titanium or zirconia) on MBL remains controversial, and no conclusion could be reached on this issue. Peri-implant soft-tissue health and recession seem not to be influenced by abutment material, but data are limited to zirconia and titanium. Although this systematic review highlighted the absence of a correlation between soft-tissue thickness and MBL, the assembly failed to find a consensus on this issue.

Project description:Smokers are at high risk for 2 bacterially driven oral diseases: peri-implant mucositis and peri-implantitis. Therefore, the purpose of this investigation was to use a deep-sequencing approach to identify the effect of smoking on the peri-implant microbiome in states of health and disease. Peri-implant biofilm samples were collected from 80 partially edentulous subjects with peri-implant health, peri-implant mucositis, and peri-implantitis. Bacterial DNA was isolated and 16S ribsomal RNA gene libraries sequenced using 454-pyrosequencing targeting the V1 to V3 and V7 to V9 regions. In total, 790,692 classifiable sequences were compared against the HOMD database for bacterial identification. Community-level comparisons were carried out using UniFrac and nonparametric tests. Microbial signatures of health in smokers exhibited lower diversity compared to nonsmokers, with significant enrichment for disease-associated species. Shifts from health to mucositis were accompanied by loss of several health-associated species, leading to a further decrease in diversity. Peri-implantitis did not differ significantly from mucositis in species richness or evenness. In nonsmokers, by contrast, the shift from health to mucositis resembled primary ecological succession, with acquisition of several species without replacement of pioneer organisms, thereby creating a significant increase in diversity. Again, few differences were detected between peri-implantitis and mucositis. Thus, our data suggest that smoking shapes the peri-implant microbiomes even in states of clinical health, by supporting a pathogen-rich community. In both smokers and nonsmokers, peri-implant mucositis appears to be a pivotal event in disease progression, creating high-at-risk-for-harm communities. However, ecological succession follows distinctly divergent pathways in smokers and nonsmokers, indicating a need for personalized therapeutics for control and prevention of disease in these 2 cohorts.

Dataset Information

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis.

Objectives

Methods

Results

Conclusion

Publications

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis.

Similar Datasets

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