Subject population
bleeding, periodontitis, PD, tooth, bruxism, diabetes
BLEEDING, PERIODONTITIS, DEHISCENCES, PLAQUE, DIABETES
Consecutive patients were selected from those attending the Postgraduate Clinic in Restorative Dentistry based in the New Technologies, University Complutense of Madrid. The screening examination included the following:Cone-beam CT to determine the bone availability for dental implants.Clinical examination to evaluate the patient inclusion and exclusion criteria.Standardized intraoral photographs for registering the baseline site status.Patients were selected based on the following criteria.Inclusion criteriaMale or female ≥ 18 years old.Need for implant-supported fixed prosthesis in the posterior area of the upper or lower jaw (up to 2 implants and three units bridge). Free-ended situations without a distal tooth were allowed.Bone quantity at the implant site to allow the insertion of Sweden and Martina Premium or Prama implants (Due Carrare, Padova, Italy) with diameters between 3.8 and 5 mm (mm) and lengths between 10 and 13 mm.Healthy ASA type I and II patients.Full-mouth plaque index < 20% (percentage of sites with plaque measured at 6 sites per tooth in every tooth of the mouth).Presence of ≥ 2 mm of keratinized mucosa at the buccal and lingual portion of the implant.Exclusion criteriaSmokers ≥ 10 cigarettes/day.Presence of implant-supported restorations adjacent to the study site.Active periodontitis defined as the presence of pockets with probing depth (PD) ≥ 5 mm and bleeding on probing (BoP).Systemic medication that contraindicates surgery (bisphosphonates or steroid therapy).Uncontrolled diabetes (HbA1c > 7.5).Severe bruxism.Pregnancy.Previous history of radiotherapy.Exclusion criteria at surgeryVertical soft tissue thickness < 2 mm assessed with a periodontal probe after placing anesthesia at the mid crestal portion of the edentulous site.Lack of primary stability defined as < 10 Ncm measured by hand torque wrench.Need of augmentation procedures in the presence of dehiscences or fenestrations.Unable to place the implant according to the prosthetic requirements.