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Volume 28 , Issue 2
March/April 2013

Pages 494502

Soft and Hard Tissue Histologic Dimensions Around Dental Implants in the Canine Restored with Smaller-Diameter Abutments: A Paradigm Shift in Peri-implant Biology

David L. Cochran, DDS, PhD/Lian Ping Mau, DDS/Frank L. Higginbottom, DDS/Thomas G. Wilson, DDS/Dieter D. Bosshardt, PhD/John Schoolfield, MS/Archie A. Jones, DDS

PMID: 23527352
DOI: 10.11607/jomi.3081

Purpose: To evaluate the biologic width dimensions around implants with nonmatching implant-abutment diameters. Materials and Methods: Five canines had their mandibular premolars and first molars removed bilaterally and replaced with 12 implants that had nonmatching implant-abutment diameters. On one side, six implants were placed in a submerged surgical approach, and the other side utilized a nonsubmerged approach. Two of the implants on each side were placed either 1 mm above, even with, or 1 mm below the alveolar crest. Two months later, gold crowns were attached, and the dogs were sacrificed 6 months postloading. Block sections were processed for histologic and histomorphometric analyses. Results: The bone level, connective tissue length, epithelial dimension, and biologic width were not significantly different when the implants were initially placed in a submerged or nonsubmerged surgical approach. The bone level was significantly different around implants placed 1 mm above the crest compared to implants placed even with or 1 mm below the alveolar crest. The connective tissue dimension was not different for any implant level placement. The epithelial dimension and biologic width were significantly greater for implants placed 1 mm below the alveolar crest compared to implants placed even with or 1 mm above the alveolar crest. For five of six implant placements, connective tissue covered the implant/abutment interface. Conclusions: This study reveals a fundamental change in the biologic response to implants with nonmatching implant-abutment diameters. Unlike implants with matching implant-abutment diameters, the connective tissue extended coronally past the interface (microgap). This morphologic tissue alteration represents a significant change in the biologic reaction to implant-abutment interfaces and suggests that marginal inflammation is eliminated or greatly reduced in these implant designs. Int J Oral Maxillofac Implants 2013;28:494502. doi: 10.11607/jomi.3081

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