Giovanni E. Salvi

Objectives To test the reliability of full zirconia implant‐supported fixed dental prostheses with cantilever extension (FDPCs) after at least 1 year of function. Materials and Methods Thirty‐five patients in need of implant‐supported single unit crowns (SUC) and FDPCs in posterior areas were enrolled. After implant placement, patients were rehabilitated with screw‐retained full‐zirconia FDPCs. Implant survival rate, pocket probing depth (PPD), presence/absence of bleeding on probing (BoP), and presence/absence of mechanical/technical complications were recorded. Mesial and distal radiographic marginal bone levels (mBLs) from baseline (i.e., recall appointment 3–6 months after implant loading [T0]) to the follow‐up examination (i.e., latest recall appointment after at least 12 months after T0 [T1]), were calculated. Results Thirty patients with 34 FDPCs (31 SUCs and 3 FDPs) supported by 37 implants were available for analysis after a mean loading time of 2.6 ± 1.5 years (range: 13–87 months). No implants were lost. MBLs and mean PPD values did not change statistically significantly from T0 to T1 from 0.92 mm ± 0.42 to 0.96 mm ± 0.38 (95% CI: −0.07/0.17; p = .418) and from 2.99 mm ± 0.70 to 3.27 mm ± 0.71 (95% CI: −0.11/0.68; p = .25) respectively. Peri‐implant mucositis was diagnosed in 22 cases. Screw‐loosening and zirconia chipping occurred 1× in 4 patients. Conclusion Within the limitations of the present proof‐of‐principle study, the use of full‐zirconia FDPCs in posterior areas seems a valid and safe short‐term treatment option.

Background Peri‐implant health is characterized by the absence of clinical signs of soft tissue inflammation. Peri‐implant diseases are initiated by the presence of bacterial biofilms and share a similar etiology as that involved in the onset of periodontal diseases. Purpose To summarize available evidence on the physiopathology of peri‐implant diseases with emphasis on similarities and differences with periodontal diseases. Materials and Methods Evidence on the biologic mechanisms involved in the pathogenesis of peri‐implant mucositis and peri‐implantitis were explored in the recent scientific literature. Results Findings of studies in animals and in humans indicate that experimental peri‐implant mucositis leads to a larger inflammatory connective tissue infiltrate and to a higher frequency of bleeding sites around implants compared with teeth. Tissue destruction at experimental peri‐implantitis sites is more pronounced compared with that at experimental periodontitis sites. Although human periodontitis and peri‐implantitis lesions share similarities with respect to etiology and clinical features, they represent distinct entities from a physiopathologic point of view. Conclusions Diagnosis of peri‐implant health requires a clinical examination to confirm absence of peri‐implant soft tissue inflammation. In order to make a correct diagnosis and select the appropriate therapeutic steps to manage peri‐implant diseases, knowledge of their pathogenetic mechanisms is required.

Aim To present the 20‐year clinical outcomes of tissue‐level implants in partially edentulous patients previously treated for periodontitis and in periodontally healthy patients (PHP). Material and Methods The original population consisted of 149 partially edentulous patients consecutively enrolled in a private specialist practice and divided into three groups: PHP, moderately periodontally compromised patients (mPCP) and severely PCP (sPCP). After successful completion of periodontal/implant therapy, patients were enrolled in an individualized supportive periodontal care (SPC) programme. Results Eighty‐four patients rehabilitated with 172 implants reached the 20‐year examination. During the observation time, 12 implants were removed (i.e., 11 due to biological complications and 1 due to implant fracture), leading to an overall implant survival rate of 93% (i.e., 94.9% for PHP, 91.8% for mPCP and 93.1% for sPCP [ p = .29]). At 20 years, PCP compliant with SPC did not present with significantly higher odds of implant loss compared with PHP compliant with SPC ( p > .05). Conversely, PCP not compliant with SPC experienced implant loss with odds ratio of 14.59 (1.30–164.29, p = .03). Conclusions Tissue‐level implants, placed after comprehensive periodontal therapy and SPC, yield favourable long‐term results. However, patients with a history of periodontitis and non‐compliant with SPC are at higher risk of biological complications and implant loss.