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ePaper created 2018-03-14, 10:36:46 | version 1.38.0
I case study_ pink biomimetic implant system A five-case representative cohort from an ongoing five-year study of marginal bone level and soft-tissue parameters of a novel pink biomimetic implant system Authors_Mariano A. Polack, DDS, MS; E. Todd Scheyer, DDS, MS; Kevin G. Murphy, DDS, MS; Joseph M. Arzadon, MD, DDS; Alan L. Rosenfeld, DDS; and George A. Mandelaris, DDS, MS Part One _Abstract This is Part One in a two-part clinical ar- ticle. Part Two will appear in the upcom- ing second-quarter edition of Implants C.E. magazine. Originally pub- lished in: Polack M, Scheyer ET, Murphy KG, et al. A report of five cases from an ongoing prospec- tive clinical study on a novel pink bio- mimetic implant system. Compen- dium of Continuing Education in Den- tistry. 2017;38(2): S1-S20. Copyright © 2017 to AEGIS Publications, LLC. All rights reserved. Used with permis- sion of the publish- ers. Color discrepancies between peri-implant soft tissues and materials used in implants, abutments, and restorations may influence overall esthetics at the implant—soft-tissue interface, particularly in the esthetic zone. In an ongoing five-year mul- ticenter prospective post-marketing surveillance study of 120 adult male and female participants at eight sites in the United States (total of 168 implants placed), the authors have been evaluating anterior and posterior single-tooth implants using a novel pink osteoconductive implant system (in clinical use since 2010) that features a variety of pink compo- nents, developed with the objective of improving peri-implant soft-tissue esthetics. Clinical analyses of the 18-month interim sur- vival rates, marginal bone and soft-tissue level changes, and esthetics have been completed, show- ing an overall success rate among all of the im- planted sites of 95.8 percent. This case series aims to summarize data on implant survival, probing- derived and radiographically assessed marginal bone and soft-tissue level changes, and qualitative photographic evidence of post-restorative soft- tissue esthetic outcomes by presenting a snapshot of five representative cases (two anterior and three posterior), at 18 months from the start of this study. Four of the five cases described here involve teeth visible in full smile and comprise three maxillary incisors and two maxillary premolars. The remaining case was a relatively straightforward mandibular first-molar replacement. However, all scenarios posed unique esthetic challenges. Three subjects received immediate implants; the remaining two required post-extraction regenerative procedures. Gingival inflammation, bleeding on probing and plaque were infrequently observed throughout the treatment period. Implant success and stabil- ity, alveolar bone-level stability, soft-tissue height and attached-gingiva width stability, and peri-im- plant soft-tissue esthetic outcomes were uniformly excellent at the 18-month follow-up visit. Data from the entire ongoing multicenter study popula- tion will be published both at three years and at study completion at five years. Those results will be necessary to assess any statistical differences in tissue changes and/or bone levels and apply meaningful interpretation to aggregate observed qualitative colorimetric soft-tissue parameters associated with this implant system. _Introduction Despite the high predictability of tooth replace- ment with osseointegrated implants,1-5 manage- ment of tissue esthetics at the facial restoration margin can pose significant challenges for the prosthodontist, restorative dentist and periodontist, and is of particular concern in the esthetic zone. In general, the closer natural shades of hard and soft tissue can be mimicked, the better the esthetic result. Gingival esthetic challenges have been ad- dressed specifically using externally placed pink porcelain on prosthetic components to simulate natural gingiva, with varying degrees of success.6-8 The current system (Genesis®, Keystone Dental, Inc, www.keystonedental.com) addresses a similar goal by modifying internal esthetics within the implant/ abutment–free gingival interface. The proximity of the facial implant—soft-tissue interface to that of a crown margin places an intense focus on harmonization of compatibilities among the inherent colorations of various metals, ceramics and gingiva in a variety of soft-tissue scenarios. The ideal treatment objective is to make this conver- gence visually indistinguishable. Esthetic impact of implant–abutment interface design has been reported in a recently published case series by McGuire et al9; specifically, adherence 10 I implants 1_2018