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ePaper created 2018-03-14, 10:36:46 | version 1.38.0
case study_ pink biomimetic implant system I ‘... All implants in this multicenter study population have surpassed three years of survival, function and success; the vast majority of them were immediate placements.’ to a specific treatment protocol yielded good esthet- ics with the three different interface designs tested (conical, flat or platform-switched). One-year results from the larger five-year randomized clinical trial by Cooper et al10 represented by those cases demon- strated that difference in interface design had sig- nificant impact on marginal bone stability but not on gingival mucosal architecture or position (including the apical-most aspect of the facial gingival margin contour, i.e., zenith).10 The case series presented here represents another ongoing five-year clinical study comprising 120 patients who required replacement of one or more anterior or posterior teeth, now in its third year of post-marketing surveillance to evaluate clinical implant efficacy and soft-tissue esthetics of this unique implant system developed with the objective of overcoming color discrepancy-driven challenges. Three additional representative case reports from this study have been published.11 This system uses a biomimetic implant–bone interface produced by anodic spark deposition or discharge (ASD, also known as microarc oxidation or glow discharge deposition) to the threaded tita- nium implant surface (BioSpark™, Keystone Dental, Inc.)12-16 via electrochemical anodization to form a nanorough, osteoconductive titanium-oxide im- plant surface rich in calcium and phosphorus ions as a bone interface.13,15,16 In global use since November 2010, this system also features a variety of prefabricated and custom- izable pink abutments and other restorative compo- nents, including implant collars and matching pre- fabricated customizable titanium abutments. Unless otherwise customized, the transmucosal portion of the abutment and/or the implant collar are uniformly pink throughout the system. The pink color is produced on the implant surface by a proprietary electrochemical anodization process (AnaTite™, Keystone Dental, Inc.), which produces a layer of titanium oxide on the implant surface. The resulting pink coloration also helps mask the gray hue that could be observed with conventional implants under the gingiva of thin-biotype patients, thus offering the clinician an alternative to zirconia for creating, enhancing and refining gingival esthetics. Published preclinical studies have evaluated this implant system’s surface in regard to bone-to- implant contact.12,17,18 In vitro studies on cell behav- ior13,14 and studies on the effects of pink on gingival esthetics have evaluated this system from clinical19,20 and animal-tissue perspectives.21 Spectrophotometric analyses published by Park et al confirmed that there is a measurable difference between the colors of natural maxillary labial gingiva and the surfaces of conventional titanium implants.19 More specifically, colorimetric data reported by Ishikawa-Nagai, et al, suggest that (in comparison to other colors) light pink coloration of the implant neck produces an optimal color that is clinically indistinguishable from that of natural gingiva.20 Patient-specific shading of the implant collar using a similar approach has also been described in a three- case series published by Sumi, et al, who reported such specificity to provide stable gingival esthetics at a 1.5-year follow-up, especially in patients with a thin gingival biotype.22 A case report by Polack published in 2012 specifi- cally evaluated the pink nanorough implant system presented in the current case series (Genesis). An excellent result was achieved in an esthetically demanding case that required multiple extractions and site development for the replacement of four maxillary incisors (using narrow-diameter, 3.8-mm x 13-mm fixtures to replace two laterals, creating a four-unit implant bridge) in a severely resorbed ridge.23 _Functional considerations of immediate implant placement In the authors’ experience, the aggressive thread pitch of the implant fixture used in this case series also facilitates its efficacy in immediate place- ment and loading scenarios. Of note, all implants in this multicenter study population have surpassed three years of survival, function and success; the vast majority of them were immediate placements (78 percent; 22 percent were staged). Results of a meta-analysis published by Kinaia, et al, in 2014 comprising 16 controlled studies sug- gests that immediate implant placement preserves crestal bone significantly more effectively than implant placement in healed bone after at least 12 months of functional loading.24 Furthermore, this meta-analysis also identified a significant advantage for the use of platform switching in such immediate placement scenarios.24 Preliminary results from an ongoing randomized clinical study by Huynh-Ba, et al, showed no short- term differences in esthetic outcomes in immediate vs. early implant placements.25 Cosyn, et al, also reported minimal midfacial recession (in two of 25 patients after three-years’ follow-up) following an immediate implant placement protocol in the ante- rior maxilla in patients with thick gingival biotypes.26 A recent systematic review by Slagter, et al, that also encompassed immediate provisionalization reported similar findings.27 Another systematic review by Cosyn, et al, found conflicting evidence regarding contributory factors to midfacial recession after im- mediate implant placement but suggested this risk is lowest in patients who have a thick biotype and an intact buccal bone wall and receive immediate implants 1_2018 I 11