| PubMed ID | Author / Year | Patient Group | Study type (level of evidence) |
| 20809428 | Sherif/2011 | 102 patients, 49% female; mean age 47.3 ± 14.9 years; ≥1 maxillary anterior implants/patient; 214 implants included; 53.4% screw-retained restorations, 46.6% cement-retained restorations | Multi-center prospective cohort study |
| Key results | Statistically significant differences were found in peri-implant tissue health (p ≤ 0.05) after 60 months following restoration delivery. Soft tissues around cement-retained restorations showed higher modified plaque scores and sulcular bleeding indices than those of screw-retained restorations. Despite the differences, these parameters of the tissue health were considered low. There were no statistically significant differences in measurements of keratinized mucosae and gingival levels (p ≥ 0.05) between the study groups after 60 months. As with clinician-assessed outcomes, there were no statistically significant differences between groups (p ≥ 0.05) in patient-assessed fit, function, and esthetics after 60 months. | ||
| 16907767 | Weber/2006 | 80 patients, 152 maxillary anterior implants; 93 (61.9%) screw-retained, 59 (38.1%) cement-retained | Multi-center prospective cohort study |
| Key results | Statistically significantly higher mean plaque scores (p < 0.05) were shown on cement-retained restorations at 12- and 36-month follow-up assessments. Similar results for cement-retained restorations were found regarding sulcular bleeding indices (p < 0.05). Despite the differences, these parameters were considered low; and the keratinized mucosae and gingival levels of both study groups remained unchanged. The study suggests that patient-assessed outcomes were equally satisfactory between groups. However, clinician-assessed outcomes regarding esthetic fulfillment favored that of the cement-retained restorations (p < 0.05). | ||
The Evidence
| Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
| by Damian Black (San Antonio, TX) on 09/14/2012 Apart from the esthetics of anterior implant-retained restorations, clinicians must understand the basic biology of peri-implant soft tissues to maximize longevity of these restorations (PMID: 18498584 ). A dog study by Berglundh, et al. demonstrated the relationship between peri-implant soft tissues and titanium implant/abutment surfaces as consisting of junctional epithelium and connective tissue, as in the periodontium of natural teeth. Even though these tissues differed in fiber content and organization compared to natural teeth, the investigators suggested that they provide an adequate seal around implants/abutments so long as adequate plaque control is performed. Teeth and implant-restorations share similar pathogeneses in plaque-induced soft tissue inflammation. This illustrates the importance of maintaining adequate oral hygiene and providing appropriate local debridement (e.g. prophylaxis) around implant-retained restorations. Another dog study by Berglundh and Lindhe demonstrated a constant of gingival dimension – analogous to biologic width – that has implications in soft tissue placement during implant surgeries. Appropriate soft tissue placement will influence its stability after the restoration is placed. Besides, the type of prosthetic abutment and the type of prosthesis may also play a role in the long term outcome of implant supported restorations as it will directly interface with the peri-implant soft tissues. |
| Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
| None available |