Rehabilitation of anterior maxilla with a novel hyperbolic profile transmucosal implants in elderly patients

Rehabilitation of anterior maxilla with a novel hyperbolic profile transmucosal implants in elderly patients
Fausto Zamparini, Chiara Pirani, Daniel Chavarria-Bolanos, Maria G. Gandolfi, Carlo Prati

Minerva Stomatologica 2019 October;68(5):249-58, doi: 10.23736/S0026-4970.19.04259-6

This interesting study conducted by the University of Bologna aimed to evaluate the response of peri-implant tissues to the use of Prama intramucosal implants in the rehabilitation of a single element in the aesthetic area.
For the protocol, 12 patients with an average age of 65.8 years were recruited. They first underwent atraumatic extraction of the compromised element, without flap elevation and with socket preservation. After about 3 months, a Prama intramucosal implant was inserted, following a flapless protocol and leaving the implant connection about 1 mm above the level of the gingival margin. Waiting for the prosthetic loading, a Maryland bridge was placed. 3 months after insertion, the impression for the temporary prosthesis was taken. The provisional restoration was designed to close the margin of the crown on the neck of the implant, and it was cemented after approximately a week. At this stage, clinicians paid attention not to excessively compress the papillae in order to preserve their integrity. The definitive metal-ceramic crown, designed following the principles of the B.O.P.T. technique, was delivered after about 20 days.
During the rehabilitation and for the successive 2 years, both periodontal and esthetic indices were measured, while bone resorption was assessed by mean of periapical radiograph.
Of the 12 patients included in the study, 8 were affected by chronic periodontal disease before treatment, with increased values of Clinical Attachment Levels (CAL) and Pocket Probing Depth (PPD) respect to the range related with age. The same parameters improved after 6 months from the implant insertion and remained stable at 24 months. Bleeding on probing (BoP), positive before implant insertion, was then negative in subsequent follow-ups. Bone level was measured after 1, 3, 6, 12 and 24 months from implant insertion: there were no statistically significant differences in terms of MBL between the various time points. Pink Esthetic Score (PES) increased throughout the follow-up period, demonstrating an improvement in the peri-implant soft tissue complex already in the period from 6 to 12 months.
The results suggest that the proposed treatment protocol, combined with the use of Prama intramucosal implants, induces a valid and favorable biologic response by both hard and soft tissues even in elderly patients, especially given the unfavorable initial situation. The authors also highlight the central role of implant morphology in the success of rehabilitation: only an implant with convergent profile neck, 2.80 mm high, allows simultaneously to design the crowns following the B.O.P.T. technique and to position the implant-abutment interface outside the soft tissues without the need for a second surgery that would interrupt the vascular supply affecting the healing time.

Read the abstract here