Open Access, Peer-reviewed, Quarterly
pISSN 0301-2875
eISSN 2005-3789
    J Korean Acad Prosthodont. 2011 Oct;49(4):346-353. Korean.
    Published online Oct 31, 2011.
    https://doi.org/10.4047/jkap.2011.49.4.346
    Copyright © 2011 The Korean Academy of Prosthodontics
    Review

    Considerations in implant crestal module to preserve peri-implant tissue

    Hong-Jun Kim, DDS, Jee-Hwan Kim, DDS, PhD, Sung-Tae Kim, DDS, PhD, Jae-Hoon Lee, DDS, PhD and Young-Bum Park, DDS, MS, PhD
      • Department of Prodthodontics, Yonsei University College of Dentistry, Seoul, Korea.
    • Corresponding Author: Young-Bum Park. Department of Prosthodontics, College of Dentistry, Yonsei University, 250 Seongsanno, Seodaemun-gu, Seoul, 120-752, Korea. +82 2 2228 3164: Email: drypark@yuhs.ac
    Received July 09, 2011; Revised October 17, 2011; Accepted October 24, 2011.

    Abstract

    Purpose

    The peri-implant soft tissue is remodeled by the initial marginal bone resorption affecting the prognosis and esthetic result of treatment. Thus various designs on implant neck design are studied to preserve peri-implant bone. The purpose of this study is to review on the causes of initial marginal bone resorption, the configuration of peri-implant soft tissue, and the implant crestal module favorable in preserving peri-implant tissue.

    Materials and methods

    The studies on the causes of initial marginal bone resorption and the implant crestal modules are researched and reviewed using Pubmed database. The implant crestal modules including one piece and two-piece implant, internal and external hex abutment, taper and butt joint connection, scalloped design abutment, and platform switching concept are reviewed.

    Results

    A number of clinical and experimental studies preferred one piece implant to two-piece in preserving initial peri-implant tissue. For two piece implants, internal hex abutment and taper joint connection appear more favorable than external hex abutment and butt joint connection relatively. Controversial issues still exist on scalloped design requiring more studies on it. Although the rationale is not certain, the concept of platform switching seems favorable in preserving initial peri-implant tissue based on clinical and experimental studies.

    Conclusion

    Each implant crestal module contains its own advantages and disadvantages with various controversial issues. In the aspect of preservation of initial peri-implant tissue, however, one-piece implant seems beneficial. In cases when two-piece implant is more appropriate due to prosthodontic concerns or any other problems, the application of platform switching concept, internal connection abutment, and taper joint connection may be favorable for the preservation of peri-implant tissues.

    Keywords
    Implant crestal module; Implant neck design; One piece implant; Internal hex abutment; Taper joint connection; Platform switching concept

    Figures

    Fig. 1
    Infiltrated connective tissue zone around the implant.

    Fig. 2
    Sealing around the soft tissue is excellent and adequate thickness could be maintained at the fixture-abutment interface in platform switching concept.

    Tables

    Table 1
    Advantages and disadvantages of external hex abutment and internal hex abutment

    Table 2
    Clinical outcome of platform switching concept

    References

      1. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1986;1:11–25.
      1. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, Steigmann M, Rebaudi A, Palti A, Pikos MA, Schwartz-Arad D, Choukroun J, Gutierrez-Perez JL, Marenzi G, Valavanis DK. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent 2008;17:5–15.
      1. Davies JE. Mechanisms of endosseous integration. Int J Prosthodont 1998;11:391–401.
      1. Wiskott HW, Belser UC. Lack of integration of smooth titanium surfaces: a working hypothesis based on strains generated in the surrounding bone. Clin Oral Implants Res 1999;10:429–444.
      1. Kitamura E, Stegaroiu R, Nomura S, Miyakawa O. Biomechanical aspects of marginal bone resorption around osseointegrated implants: considerations based on a three-dimensional finite element analysis. Clin Oral Implants Res 2004;15:401–412.
      1. Quirynen M, Naert I, van Steenberghe D. Fixture design and overload influence marginal bone loss and fixture success in the Brånemark system. Clin Oral Implants Res 1992;3:104–111.
      1. Ericsson I, Persson LG, Berglundh T, Marinello CP, Lindhe J, Klinge B. Different types of inflammatory reactions in peri-implant soft tissues. J Clin Periodontol 1995;22:255–261.
      1. Berglundh T, Lindhe J. Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 1996;23:971–973.
      1. Hermann JS, Schoolfield JD, Schenk RK, Buser D, Cochran DL. Influence of the size of the microgap on crestal bone changes around titanium implants. A histometric evaluation of unloaded non-submerged implants in the canine mandible. J Periodontol 2001;72:1372–1383.
      1. Misch CE, Dietsh-Misch F, Hoar J, Beck G, Hazen R, Misch CM. A bone quality-based implant system: first year of prosthetic loading. J Oral Implantol 1999;25:185–197.
      1. Isidor F. Histological evaluation of peri-implant bone at implants subjected to occlusal overload or plaque accumulation. Clin Oral Implants Res 1997;8:1–9.
      1. Quirynen M, van Steenberghe D. Bacterial colonization of the internal part of two-stage implants. An in vivo study. Clin Oral Implants Res 1993;4:158–161.
      1. Persson LG, Lekholm U, Leonhardt A, Dahlen G, Lindhe J. Bacterial colonization on internal surfaces of Brånemark system implant components. Clin Oral Implants Res 1996;7:90–95.
      1. Lindhe J, Berglundh T, Ericsson I, Liljenberg B, Marinello C. Experimental breakdown of peri-implant and periodontal tissues. A study in the beagle dog. Clin Oral Implants Res 1992;3:9–16.
      1. Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B, Thomsen P. The soft tissue barrier at implants and teeth. Clin Oral Implants Res 1991;2:81–90.
      1. Abrahamsson I, Berglundh T, Wennström J, Lindhe J. The peri-implant hard and soft tissues at different implant systems. A comparative study in the dog. Clin Oral Implants Res 1996;7:212–219.
      1. Cochran DL, Hermann JS, Schenk RK, Higginbottom FL, Buser D. Biologic width around titanium implants. A histometric analysis of the implanto-gingival junction around unloaded and loaded nonsubmerged implants in the canine mandible. J Periodontol 1997;68:186–198.
      1. Berglundh T, Lindhe J, Marinello C, Ericsson I, Liljenberg B. Soft tissue reaction to de novo plaque formation on implants and teeth. An experimental study in the dog. Clin Oral Implants Res 1992;3:1–8.
      1. Zitzmann NU, Berglundh T, Marinello CP, Lindhe J. Experimental peri-implant mucositis in man. J Clin Periodontol 2001;28:517–523.
      1. Bullon P, Fioroni M, Goteri G, Rubini C, Battino M. Immunohistochemical analysis of soft tissues in implants with healthy and peri-implantitis condition, and aggressive peri-odontitis. Clin Oral Implants Res 2004;15:553–559.
      1. Iacono VJ. Committee on Research, Science and Therapy, the American Academy of Periodontology. Dental implants in periodontal therapy. J Periodontol 2000;71:1934–1942.
      1. Berglundh T, Abrahamsson I, Welander M, Lang NP, Lindhe J. Morphogenesis of the peri-implant mucosa: an experimental study in dogs. Clin Oral Implants Res 2007;18:1–8.
      1. Hermann JS, Buser D, Schenk RK, Cochran DL. Crestal bone changes around titanium implants. A histometric evaluation of unloaded non-submerged and submerged implants in the canine mandible. J Periodontol 2000;71:1412–1424.
      1. Heijdenrijk K, Raghoebar GM, Meijer HJ, Stegenga B, van der Reijden WA. Feasibility and influence of the microgap of two implants placed in a non-submerged procedure: a five-year follow-up clinical trial. J Periodontol 2006;77:1051–1060.
      1. Broggini N, McManus LM, Hermann JS, Medina RU, Oates TW, Schenk RK, Buser D, Mellonig JT, Cochran DL. Persistent acute inflammation at the implant-abutment interface. J Dent Res 2003;82:232–237.
      1. Maeda Y, Satoh T, Sogo M. In vitro differences of stress concentrations for internal and external hex implant-abutment connections: a short communication. J Oral Rehabil 2006;33:75–78.
      1. Levine RA, Clem DS 3rd, Wilson TG Jr, Higginbottom F, Solnit G. Multicenter retrospective analysis of the ITI implant system used for single-tooth replacements: results of loading for 2 or more years. Int J Oral Maxillofac Implants 1999;14:516–520.
      1. Merz BR, Hunenbart S, Belser UC. Mechanics of the implant-abutment connection: an 8-degree taper compared to a butt joint connection. Int J Oral Maxillofac Implants 2000;15:519–526.
      1. Pieri F, Aldini NN, Marchetti C, Corinaldesi G. Influence of implant-abutment interface design on bone and soft tissue levels around immediately placed and restored single-tooth implants: a randomized controlled clinical trial. Int J Oral Maxillofac Implants 2011;26:169–178.
      1. Wöhrle PS. Nobel Perfect esthetic scalloped implant: rationale for a new design. Clin Implant Dent Relat Res 2003;5:64–73.
      1. McAllister BS. Scalloped implant designs enhance interproximal bone levels. Int J Periodontics Restorative Dent 2007;27:9–15.
      1. Nowzari H, Chee W, Yi K, Pak M, Chung WH, Rich S. Scalloped dental implants: a retrospective analysis of radiographic and clinical outcomes of 17 NobelPerfect implants in 6 patients. Clin Implant Dent Relat Res 2006;8:1–10.
      1. Jansen VK, Conrads G, Richter EJ. Microbial leakage and marginal fit of the implant-abutment interface. Int J Oral Maxillofac Implants 1997;12:527–540.
      1. Maeda Y, Miura J, Taki I, Sogo M. Biomechanical analysis on platform switching: is there any biomechanical rationale? Clin Oral Implants Res 2007;18:581–584.
      1. López-Marí L, Calvo-Guirado JL, Martín-Castellote B, Gomez-Moreno G, López-Marí M. Implant platform switching concept: an updated review. Med Oral Patol Oral Cir Bucal 2009;14:e450–e454.
      1. Vigolo P, Givani A. Platform-switched restorations on wide-diameter implants: a 5-year clinical prospective study. Int J Oral Maxillofac Implants 2009;24:103–109.
      1. Wagenberg B, Froum SJ. Prospective study of 94 platform-switched implants observed from 1992 to 2006. Int J Periodontics Restorative Dent 2010;30:9–17.
      1. Tarnow DP, Cho SC, Wallace SS. The effect of inter-implant distance on the height of inter-implant bone crest. J Periodontol 2000;71:546–549.
      1. Tarnow D, Elian N, Fletcher P, Froum S, Magner A, Cho SC, Salama M, Salama H, Garber DA. Vertical distance from the crest of bone to the height of the interproximal papilla between adjacent implants. J Periodontol 2003;74:1785–1788.
      1. Hermann F, Lerner H, Palti A. Factors influencing the preservation of the periimplant marginal bone. Implant Dent 2007;16:165–175.
      1. Calvo Guirado JL, Saez Yuguero MR, Pardo Zamora G, Muñoz Barrio E. Immediate provisionalization on a new implant design for esthetic restoration and preserving crestal bone. Implant Dent 2007;16:155–164.
    MeSH Terms
    Bone Resorption
    Joints
    Neck
    Pectinidae
    Prognosis
    Prosthodontics
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide

    1 / 2

    PERMALINK