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Clinical Assessment of the Gingiva and Alveolus

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Abstract

The first step heading to successful implant outcomes is a meticulous clinical examination. It provides implantologists a clear picture for diagnosis, treatment plan, and prevention of possible complications. This chapter suggests a guideline for comprehensive clinical evaluation on both gingiva and alveolus as well as general checking via palpation, probing, and visual perception. Prior to evaluation of future implant sites, an overall investigation is mandatory to verify the locations of anatomic structures, occlusion, esthetic, and pathologic conditions. Periodontal charting is of the essence in recording current soft tissue conditions to analyze periodontal/peri-implant health. Clinicians should also be aware of individual tissue biotype, keratinized mucosa, and biologic width for better soft tissue management. In addition to soft tissue, ridge dimension and ridge deformities should be entailed. With the aids of both clinical and radiographic examinations, these data found the basis for the precise diagnosis and comprehensive treatments, leading to uneventful outcomes and successful implant therapy.

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References

  • Abrahamsson I, Berglundh T et al (1997) The mucosal barrier following abutment dis/reconnection. An experimental study in dogs. J Clin Periodontol 24(8):568–572

    Article  Google Scholar 

  • Allen EP, Gainza CS et al (1985) Improved technique for localized ridge augmentation. A report of 21 cases. J Periodontol 56(4):195–199

    Article  Google Scholar 

  • Apostolakis D, Brown JE (2012) The anterior loop of the inferior alveolar nerve: prevalence, measurement of its length and a recommendation for interforaminal implant installation based on cone beam CT imaging. Clin Oral Implants Res 23(9):1022–1030

    Article  Google Scholar 

  • Bengazi F, Botticelli D et al (2013) Influence of presence or absence of keratinized mucosa on the alveolar bony crest level as it relates to different buccal marginal bone thicknesses. An experimental study in dogs. Clin Oral Implants Res. 25(9):1065–1071

    Article  Google Scholar 

  • Berglundh T, Lindhe J (1996) Dimension of the periimplant mucosa. Biological width revisited. J Clin Periodontol 23(10):971–973

    Article  Google Scholar 

  • Berglundh T, Lindhe J et al (1991) The soft tissue barrier at implants and teeth. Clin Oral Implants Res 2(2):81–90

    Article  Google Scholar 

  • Bouri A Jr, Bissada N et al (2008) Width of keratinized gingiva and the health status of the supporting tissues around dental implants. Int J Oral Maxillofac Implants 23(2):323–326

    PubMed  Google Scholar 

  • Boynueğri D, Nemli SK et al (2013) Significance of keratinized mucosa around dental implants: a prospective comparative study. Clin Oral Implants Res 24(8):928–933

    Article  Google Scholar 

  • Brånemark P-I, Zarb GA et al (1985) Tissue-integrated prostheses: osseointegration in clinical dentistry. Quintessence, Chicago

    Google Scholar 

  • Bragger U, Burgin WB et al (1997) Associations between clinical parameters assessed around implants and teeth. Clin Oral Implants Res 8(5):412–421

    Article  Google Scholar 

  • Cardaropoli D, Re S et al (2004) The Papilla Presence Index (PPI): a new system to assess interproximal papillary levels. Int J Periodontics Restor Dent 24(5):488–492

    Article  Google Scholar 

  • Carlsson GE, Persson G (1967) Morphologic changes of the mandible after extraction and wearing of dentures. A longitudinal, clinical, and x-ray cephalometric study covering 5 years. Odontol Revy 18(1):27–54

    PubMed  Google Scholar 

  • Cawood JI, Howell RA (1988) A classification of the edentulous jaws. Int J Oral Maxillofac Surg 17(4):232–236

    Article  Google Scholar 

  • Chan HL, Brooks SL et al (2011) Cross-sectional analysis of the mandibular lingual concavity using cone beam computed tomography. Clin Oral Implants Res 22(2):201–206

    Article  Google Scholar 

  • Chan HL, Leong DJ et al (2010) The significance of the lingual nerve during periodontal/implant surgery. J Periodontol 81(3):372–377

    Article  Google Scholar 

  • Chung DM, Oh TJ et al (2006) Significance of keratinized mucosa in maintenance of dental implants with different surfaces. J Periodontol 77(8):1410–1420

    Article  Google Scholar 

  • Claffey N, Shanley D (1986) Relationship of gingival thickness and bleeding to loss of probing attachment in shallow sites following nonsurgical periodontal therapy. J Clin Periodontol 13(7):654–657

    Article  Google Scholar 

  • Cook DR, Mealey BL et al (2011) Relationship between clinical periodontal biotype and labial plate thickness: an in vivo study. Int J Periodontics Restorative Dent 31(4):345–354

    PubMed  Google Scholar 

  • De Rouck T, Eghbali R et al (2009) The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 36(5):428–433

    Article  Google Scholar 

  • Eghbali A, De Rouck T et al (2009) The gingival biotype assessed by experienced and inexperienced clinicians. J Clin Periodontol 36(11):958–963

    Article  Google Scholar 

  • Eke PI, Page RC et al (2012) Update of the case definitions for population-based surveillance of periodontitis. J Periodontol 83(12):1449–1454

    Article  Google Scholar 

  • Ericsson I, Lindhe J (1984) Recession in sites with inadequate width of the keratinized gingiva. An experimental study in the dog. J Clin Periodontol 11(2):95–103

    Article  Google Scholar 

  • Evans CD, Chen ST (2008) Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 19(1):73–80

    Google Scholar 

  • Fu JH, Hasso DG et al (2011) The accuracy of identifying the greater palatine neurovascular bundle: a cadaver study. J Periodontol 82(7):1000–1006

    Article  Google Scholar 

  • Fu JH, Hsu YT et al (2012) Identifying occlusal overload and how to deal with it to avoid marginal bone loss around implants. Eur J Oral Implantol 5(Suppl):S91–103

    PubMed  Google Scholar 

  • Fu JH, Yeh CY et al (2010) Tissue biotype and its relation to the underlying bone morphology. J Periodontol 81(4):569–574

    Article  Google Scholar 

  • Garaicoa-Pazmino C, Suarez F et al (2014) Influence of crown-implant ratio upon marginal bone loss. A systematic review. J Periodontol 85:1214

    Article  Google Scholar 

  • Goodacre CJ, Bernal G et al (2003) Clinical complications with implants and implant prostheses. J Prosthet Dent 90(2):121–132

    Article  Google Scholar 

  • Grunder U, Gracis S et al (2005) Influence of the 3-D bone-to-implant relationship on esthetics. Int J Periodontics Restor Dent 25(2):113–119

    Google Scholar 

  • Hsu YT, Fu JH et al (2012) Biomechanical implant treatment complications: a systematic review of clinical studies of implants with at least 1 year of functional loading. Int J Oral Maxillofac Implants 27(4):894–904

    PubMed  Google Scholar 

  • Jacobs R, Schotte A et al (1992) Posterior jaw bone resorption in osseointegrated implant-supported overdentures. Clin Oral Implants Res 3(2):63–70

    Article  Google Scholar 

  • Jemt T (1997) Regeneration of gingival papillae after single-implant treatment. Int J Periodontics Restor Dent 17(4):326–333

    Google Scholar 

  • Johnson K (1969) A study of the dimensional changes occurring in the maxilla following tooth extraction. Aust Dent J 14(4):241–244

    Article  Google Scholar 

  • Juodzbalys G, Wang HL et al (2013) Inferior alveolar nerve injury associated with implant surgery. Clin Oral Implants Res 24(2):183–190

    Article  Google Scholar 

  • Kan JY, Morimoto T et al (2010) Gingival biotype assessment in the esthetic zone: visual versus direct measurement. Int J Periodontics Restor Dent 30(3):237–243

    Google Scholar 

  • Kan JY, Rungcharassaeng K et al (2003) Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans. J Periodontol 74(4):557–562

    Article  Google Scholar 

  • Kent JN, Quinn JH et al (1983) Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone. J Oral Maxillofac Surg 41(10):629–642

    Article  Google Scholar 

  • Kois JC (2004) Predictable single-tooth peri-implant esthetics: five diagnostic keys. Compend Contin Educ Dent 25(11):895–896 898, 900 passim; quiz 906–897

    Google Scholar 

  • Lang NP, Loe H (1972) The relationship between the width of keratinized gingiva and gingival health. J Periodontol 43(10):623–627

    Article  Google Scholar 

  • Lekholm U, Zarb G (1985) Patient selection and preparation. In: Brånemark P-I (ed). Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry.Quintessence, Chicago 199–209

    Google Scholar 

  • Lin GH, Chan HL et al (2013) The significance of keratinized mucosa on implant health: a systematic review. J Periodontol 84(12):1755–1767

    Article  Google Scholar 

  • Malchiodi L, Cucchi A et al (2014) Influence of crown-implant ratio on implant success rates and crestal bone levels: a 36-month follow-up prospective study. Clin Oral Implants Res 25(2):240–251

    Article  Google Scholar 

  • Mardinger O, Namani-Sadan N et al (2008) Morphologic changes of the nasopalatine canal related to dental implantation: a radiologic study in different degrees of absorbed maxillae. J Periodontol 79(9):1659–1662

    Article  Google Scholar 

  • Maurer S, Hayes C et al (2000) Width of keratinized tissue after gingivoplasty of healed subepithelial connective tissue grafts. J Periodontol 71(11):1729–1736

    Article  Google Scholar 

  • Misch C (1990) Classifications and treatment options of the completely edentulous arch in implant dentistry. Dent Today 9(8):26 28-30

    PubMed  Google Scholar 

  • Misch CE (2008) Contemporary implant dentistry. Mosby/Elsevier, St. Louis

    Google Scholar 

  • Miyata T, Kobayashi Y et al (2000) The influence of controlled occlusal overload on peri-implant tissue. Part 3: a histologic study in monkeys. Int J Oral Maxillofac Implants 15(3):425–431

    PubMed  Google Scholar 

  • Neiva RF, Gapski R et al (2004) Morphometric analysis of implant-related anatomy in Caucasian skulls. J Periodontol 75(8):1061–1067

    Article  Google Scholar 

  • Neugebauer J, Ritter L et al (2010) Evaluation of maxillary sinus anatomy by cone-beam CT prior to sinus floor elevation. Int J Oral Maxillofac Implants 25(2):258–265

    PubMed  Google Scholar 

  • Nisapakultorn K, Suphanantachat S et al (2010) Factors affecting soft tissue level around anterior maxillary single-tooth implants. Clin Oral Implants Res 21(6):662–670

    Article  Google Scholar 

  • Nordland WP, Tarnow DP (1998) A classification system for loss of papillary height. J Periodontol 69(10):1124–1126

    Article  Google Scholar 

  • Park YB, Jeon HS et al (2011) Analysis of the anatomy of the maxillary sinus septum using 3-dimensional computed tomography. J Oral Maxillofac Surg 69(4):1070–1078

    Article  Google Scholar 

  • Pietrokovski J, Starinsky R et al (2007) Morphologic characteristics of bony edentulous jaws. J Prosthodont 16(2):141–147

    Article  Google Scholar 

  • Pyun JH, Lim YJ et al (2013) Position of the mental foramen on panoramic radiographs and its relation to the horizontal course of the mandibular canal: a computed tomographic analysis. Clin Oral Implants Res 24(8):890–895

    Article  Google Scholar 

  • Reiser GM, Bruno JF et al (1996) The subepithelial connective tissue graft palatal donor site: anatomic considerations for surgeons. Int J Periodontics Restor Dent 16(2):130–137

    Google Scholar 

  • Sarver D, Jacobson RS (2007) The aesthetic dentofacial analysis. Clin Plast Surg 34(3):369–394

    Article  Google Scholar 

  • Schropp L, Wenzel A et al (2003) Bone healing and soft tissue contour changes following single-tooth extraction: a clinical and radiographic 12-month prospective study. Int J Periodontics Restor Dent 23(4):313–323

    Google Scholar 

  • Seibert JS (1983) Reconstruction of deformed, partially edentulous ridges, using full thickness onlay grafts. Part I. Technique and wound healing. Compend Contin Educ Dent 4(5):437–453

    PubMed  Google Scholar 

  • Spray JR, Black CG et al (2000) The influence of bone thickness on facial marginal bone response: stage 1 placement through stage 2 uncovering. Ann Periodontol 5(1):119–128

    Article  Google Scholar 

  • Tallgren A (1972) The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed-longitudinal study covering 25 years. J Prosthet Dent 27(2):120–132

    Article  Google Scholar 

  • Tan WL, Wong TL et al (2012) A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res 23(Suppl 5):1–21

    Article  Google Scholar 

  • Tozum TF, Guncu GN et al (2012) Evaluation of maxillary incisive canal characteristics related to dental implant treatment with computerized tomography: a clinical multicenter study. J Periodontol 83(3):337–343

    Article  Google Scholar 

  • von Arx T, Matter D et al (2011) Evaluation of location and dimensions of lingual foramina using limited cone-beam computed tomography. J Oral Maxillofac Surg 69(11):2777–2785

    Article  Google Scholar 

  • Wang HL, Al-Shammari K (2002) HVC ridge deficiency classification: a therapeutically oriented classification. Int J Periodontics Restor Dent 22(4):335–343

    Google Scholar 

  • Watanabe H, Mohammad Abdul M et al (2010) Mandible size and morphology determined with CT on a premise of dental implant operation. Surg Radiol Anat 32(4):343–349

    Article  Google Scholar 

  • Wen SC, Chan HL et al (2013) Classification and management of antral septa for maxillary sinus augmentation. Int J Periodontics Restor Dent 33(4):509–517

    Article  Google Scholar 

  • Wennstrom JL, Bengazi F et al (1994) The influence of the masticatory mucosa on the peri-implant soft tissue condition. Clin Oral Implants Res 5(1):1–8

    Article  Google Scholar 

  • Worthington P (2004) Injury to the inferior alveolar nerve during implant placement: a formula for protection of the patient and clinician. Int J Oral Maxillofac Implants 19(5):731–734

    PubMed  Google Scholar 

  • Yildirim YD, Guncu GN et al (2014) Evaluation of mandibular lingual foramina related to dental implant treatment with computerized tomography: a multicenter clinical study. Implant Dent 23:57

    Article  Google Scholar 

  • Zetu L, Wang HL (2005) Management of inter-dental/inter-implant papilla. J Clin Periodontol 32(7):831–839

    Article  Google Scholar 

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Correspondence to Hom-Lay Wang DDS, MSD, PhD .

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Hsu, YT., Wang, HL. (2017). Clinical Assessment of the Gingiva and Alveolus. In: Karateew, E. (eds) Implant Aesthetics. Springer, Cham. https://doi.org/10.1007/978-3-319-50706-4_7

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  • DOI: https://doi.org/10.1007/978-3-319-50706-4_7

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