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

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          Abstract

          Introduction: Osseointegration are often suffering from oral conditions, especially, the micro gap at the implant–abutment connection represents a site for bacterial plaque aggregation, leading to increased inflammatory cells and causing peri-implantitis. Aim: The aim of this narrative review was to describe the different kinds of implant–abutment connections and their ability to reduce bacterial leakage and thus prevent peri-implantitis. Materials and methods: The following databases were consulted: Pubmed, Scopus, Cochrane Library, and Research gate and a total of 528 articles were found. After reading the abstract and titles, 473 items were excluded. The remaining articles (n = 55) were assessed for full-text eligibility. Thirty-three studies were included in the review. Results and Conclusions: We selected 22 clinical trials and 11 reviews, examining a total sample of 2110 implants. From the review, it was clear that there exists a relationship between the implant–abutment interface and bacterial leakage. All the connections presented an amount of micro-gap and bacterial micro-leakage, though conical and mixed connection systems seemed to behave better. Moreover, both connections seemed to have a better load distribution and the mixed system also had anti-rotational properties which are very useful during the positioning of the prosthesis.

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          Most cited references36

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          Impact of Dental Implant Surface Modifications on Osseointegration

          Objective. The aim of this paper is to review different surface modifications of dental implants and their effect on osseointegration. Common marketed as well as experimental surface modifications are discussed. Discussion. The major challenge for contemporary dental implantologists is to provide oral rehabilitation to patients with healthy bone conditions asking for rapid loading protocols or to patients with quantitatively or qualitatively compromised bone. These charging conditions require advances in implant surface design. The elucidation of bone healing physiology has driven investigators to engineer implant surfaces that closely mimic natural bone characteristics. This paper provides a comprehensive overview of surface modifications that beneficially alter the topography, hydrophilicity, and outer coating of dental implants in order to enhance osseointegration in healthy as well as in compromised bone. In the first part, this paper discusses dental implants that have been successfully used for a number of years focusing on sandblasting, acid-etching, and hydrophilic surface textures. Hereafter, new techniques like Discrete Crystalline Deposition, laser ablation, and surface coatings with proteins, drugs, or growth factors are presented. Conclusion. Major advancements have been made in developing novel surfaces of dental implants. These innovations set the stage for rehabilitating patients with high success and predictable survival rates even in challenging conditions.
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            Performance of conical abutment (Morse Taper) connection implants: a systematic review.

            In this systematic review, we aimed to compare conical versus nonconical implant-abutment connection systems in terms of their in vitro and in vivo performances. An electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "dental implant" AND "dental abutment" AND ("conical" OR "taper" OR "cone"). Names of the most common conical implant-abutment connection systems were used as additional key words to detect further data. The search was limited to articles published up to November 2012. Recent publications were also searched manually in order to find any relevant studies that might have been missed using the search criteria noted above. Fifty-two studies met the inclusion criteria and were included in this systematic review. As the data and methods, as well as types of implants used was so heterogeneous, this mitigated against the performance of meta-analysis. In vitro studies indicated that conical and nonconical abutments showed sufficient resistance to maximal bending forces and fatigue loading. However, conical abutments showed superiority in terms of seal performance, microgap formation, torque maintenance, and abutment stability. In vivo studies (human and animal) indicated that conical and nonconical systems are comparable in terms of implant success and survival rates with less marginal bone loss around conical connection implants in most cases. This review indicates that implant systems using a conical implant-abutment connection, provides better results in terms of abutment fit, stability, and seal performance. These design features could lead to improvements over time versus nonconical connection systems.
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              Modifications of Dental Implant Surfaces at the Micro- and Nano-Level for Enhanced Osseointegration

              This review paper describes several recent modification methods for biocompatible titanium dental implant surfaces. The micro-roughened surfaces reviewed in the literature are sandblasted, large-grit, acid-etched, and anodically oxidized. These globally-used surfaces have been clinically investigated, showing survival rates higher than 95%. In the past, dental clinicians believed that eukaryotic cells for osteogenesis did not recognize the changes of the nanostructures of dental implant surfaces. However, research findings have recently shown that osteogenic cells respond to chemical and morphological changes at a nanoscale on the surfaces, including titanium dioxide nanotube arrangements, functional peptide coatings, fluoride treatments, calcium–phosphorus applications, and ultraviolet photofunctionalization. Some of the nano-level modifications have not yet been clinically evaluated. However, these modified dental implant surfaces at the nanoscale have shown excellent in vitro and in vivo results, and thus promising potential future clinical use.
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                Author and article information

                Journal
                Materials (Basel)
                Materials (Basel)
                materials
                Materials
                MDPI
                1996-1944
                03 March 2020
                March 2020
                : 13
                : 5
                : 1131
                Affiliations
                [1 ]Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milano-Bicocca, 20126 Milan, Italy; moreo.giulia@ 123456gmail.com (G.M.); c.viganoni@ 123456campus.unimib.it (C.V.)
                [2 ]Multidisciplinary Department of Medical and Dental Specialties, University of Campania-Luigi Vanvitelli, 80138 Naples, Italy; alberta.lucchese@ 123456unicampania.it
                [3 ]Interdisciplinary Department of Medicine, University of Bari, 70121 Bari, Italy; luisanna.limogelli@ 123456gmail.com
                [4 ]Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, 44121 Ferrara, Italy; crc@ 123456unife.it
                Author notes
                [* ]Correspondence: dorina.lauritano@ 123456unimib.it ; Tel.: +39-3356790163
                [†]

                These authors contribute equally to this work.

                Author information
                https://orcid.org/0000-0002-3550-1812
                Article
                materials-13-01131
                10.3390/ma13051131
                7085009
                32138368
                1a6cdc68-b504-4b4e-ad81-ae9682bf9bf3
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 12 January 2020
                : 27 February 2020
                Categories
                Review

                dental implants,dental implantation,peri-implantitis,periodontics,immediate dental implant loading,dental implant-abutment design,dental abutments

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