The Impact of Implant–Abutment Connection on Clinical Outcomes and Microbial Colonization: A Narrative Review

Lauritano, D; Moreo, Giulia; Lucchese, Alberta; Viganoni, C; Limongelli, Luisa

doi:10.3390/ma13051131

Cited by 51 publications

(51 citation statements)

References 25 publications

(31 reference statements)

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“…The implant surface structure and abutment interface may affect microbial colonization and disease progression (Belibasakis et al 2015; Lauritano et al 2020), whereas modification of its characteristics may enhance antimicrobial properties and clinical outcomes (Asensio et al 2019). The occurring biocorrosion of the implant surface can result in release of titanium particles and biological implant complications (Mombelli et al 2018).…”

Section: Implant Surface As a Modifier Of The Peri-implant Nichementioning

confidence: 99%

Microbial Community-Driven Etiopathogenesis of Peri-Implantitis

2020

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Osseointegrated dental implants are a revolutionary tool in the armament of reconstructive dentistry, employed to replace missing teeth and restore masticatory, occlusal, and esthetic functions. Like natural teeth, the orally exposed part of dental implants offers a pristine nonshedding surface for salivary pellicle-mediated microbial adhesion and biofilm formation. In early colonization stages, these bacterial communities closely resemble those of healthy periodontal sites, with lower diversity. Because the peri-implant tissues are more susceptible to endogenous oral infections, understanding of the ecological triggers that underpin the microbial pathogenesis of peri-implantitis is central to developing improved prevention, diagnosis, and therapeutic strategies. The advent of next-generation sequencing (NGS) technologies, notably applied to 16S ribosomal RNA gene amplicons, has enabled the comprehensive taxonomic characterization of peri-implant bacterial communities in health and disease, revealing a differentially abundant microbiota between these 2 states, or with periodontitis. With that, the peri-implant niche is highlighted as a distinct ecosystem that shapes its individual resident microbial community. Shifts from health to disease include an increase in diversity and a gradual depletion of commensals, along with an enrichment of classical and emerging periodontal pathogens. Metatranscriptomic profiling revealed similarities in the virulence characteristics of microbial communities from peri-implantitis and periodontitis, nonetheless with some distinctive pathways and interbacterial networks. Deeper functional assessment of the physiology and virulence of the well-characterized microbial communities of the peri-implant niche will elucidate further the etiopathogenic mechanisms and drivers of the disease.

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Section: Implant Surface As a Modifier Of The Peri-implant Nichementioning

confidence: 99%

Microbial Community-Driven Etiopathogenesis of Peri-Implantitis

2020

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“…Furthermore, under load conditions, both microgaps can be widened further [ 19 ]. In this context, it could be demonstrated that the geometry of the implant–abutment connection can have an influence on the extent of microbial penetration and that implants with internal morse taper connection exhibit a lower contamination level compared to other geometries [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Marginal Adaptation and Microbial Leakage at Conometric Prosthetic Connections for Implant-Supported Single Crowns: An In Vitro Investigation

Gehrke

Hartjen

Smeets

et al. 2021

IJMS

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Encouraging clinical results were reported on a novel cone-in-cone coupling for the fixation of dental implant-supported crowns (Acuris, Dentsply Sirona Implants, Mölndal, Sweden). However, the presence or absence of a microgap and a potential bacterial leakage at the conometric joint has not yet been investigated. A misfit and a resulting gap between the conometric components could potentially serve as a bacterial reservoir that promotes plaque formation, which in turn may lead to inflammation of the peri-implant tissues. Thus, a two-fold study set-up was designed in order to evaluate the bidirectional translocation of bacteria along conometrically seated single crowns. On conometric abutments filled with a culture suspension of anaerobic bacteria, the corresponding titanium nitride-coated (TiN) caps were fixed by friction. Each system was sterilized and immersed in culture medium to provide an optimal environment for microbial growth. Positive and negative controls were prepared. Specimens were stored in an anaerobic workstation, and total and viable bacterial counts were determined. Every 48 h, samples were taken from the reaction tubes to inoculate blood agar plates and to isolate bacterial DNA for quantification using qrt-PCR. In addition, one Acuris test system was subjected to scanning electron microscopy (SEM) to evaluate the precision of fit of the conometric coupling and marginal crown opening. Throughout the observational period of one week, blood agar plates of the specimens showed no viable bacterial growth. qrt-PCR, likewise, yielded a result approaching zero with an amount of about 0.53 × 10−4 µg/mL DNA. While the luting gap/marginal opening between the TiN-cap and the ceramic crown was within the clinically acceptable range, the SEM analysis failed to identify a measurable microgap at the cone-in-cone junction. Within the limits of the in-vitro study it can be concluded that the Acuris conometric interface does not allow for bacterial translocation under non-dynamic loading conditions.

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“…It allows to create a coagulum chamber, described by Degidi et al, which is essential for the proper healing of the socket with the consequent reduction of bone resorption [ 50 ]. Furthermore, since the bacterial leakage in the implant-abutment interface is raised as the most important factor in the occurrence of inflammatory reactions around the implant [ 51 , 52 ], B.O.I.L protocol allows to not unscrew the healing abutment, before its final insertion, so as to prevent bacterial infiltration and the detachment of the hemidesmosomial junctions.…”

Section: Discussionmentioning

confidence: 99%

Biological Oriented Immediate Loading: A New Mathematical Implant Vertical Insertion Protocol, Five-Year Follow-Up Study

et al. 2021

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One of the current major challenges in implant therapy is to minimize marginal bone loss around implants, since it can trigger bacterial colonization of the implant’s neck, leading to its failure. The present study aimed (1) to scientifically validate a new mathematical rule based on soft tissues thickness, for choosing the correct implant position with respect to the bone level, in order to provide a better tissue adaptation to the abutment/implant surface to avoid bacterial invasion, and (2) to apply this mathematical rule to the Biological Oriented Immediate Loading (B.O.I.L.) surgical protocol, avoiding peri-implant bone resorption. N. 127 implants were inserted following B.O.I.L. protocol: implants were placed according to the mathematical rule Y = X − 3, which correlates the position of the implant from the bone crest level (Y) with the thickness of the soft tissues (X). All the implants were inserted in fresh extraction sockets, and immediately loaded with temporary abutments and prostheses. Bone levels were evaluated through radiographic examination just after surgical procedure (T0), and after 10 days (10D), 6 months (6M), 1 year (1Y), and 5 years (5Y). After 5 years, the implant survival rate was 100%, with a medium marginal bone loss around implants of 0.0704 mm (SD = 0.169 mm). One-way ANOVA, followed by Tukey’s multiple comparison test was performed for statistical evaluations (p < 0.05). This protocol provided a safe and successful procedure, with a good soft tissue seal against bacterial challenge. The application of the mathematical rule allows the implant placement in a correct vertical position from the bone crest, avoiding bone resorption and bacterial infiltrations. Moreover, the use of Multi Unit Abutment (MUA) determined a stable biological seal, favouring the implant healing and preserving the adhesion of hemidesmosomes to the titanium of MUA.

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The Impact of Implant–Abutment Connection on Clinical Outcomes and Microbial Colonization: A Narrative Review

Cited by 51 publications

References 25 publications

Microbial Community-Driven Etiopathogenesis of Peri-Implantitis

Microbial Community-Driven Etiopathogenesis of Peri-Implantitis

Marginal Adaptation and Microbial Leakage at Conometric Prosthetic Connections for Implant-Supported Single Crowns: An In Vitro Investigation

Biological Oriented Immediate Loading: A New Mathematical Implant Vertical Insertion Protocol, Five-Year Follow-Up Study

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