Clemens Raabe

Objective: To assess the impact of keratinized mucosa width (KMW) and mucosal thickness (MT) on peri‐implant conditions over 25 years in patients with adequate oral hygiene enrolled in regular supportive peri‐implant care. Methods: Partially edentulous patients rehabilitated with tissue‐level implants were clinically and radiographically evaluated by calibrated examiners. Patient‐reported brushing discomfort was recorded, and associations with variables of interest were analysed. Results: A total of 149 patients, 235 implants, with a mean follow‐up of 25.4 ± 3 years, were included. Peri‐implantitis prevalence was 11.1%, 0% and 7.1% in the 0‐mm, < 2‐mm and ≥ 2‐mm KMW groups, respectively ( p = 0.98). Sites with 0 mm KMW showed significantly greater crestal bone loss (CBL) than < 2 mm (−0.28 mm) and ≥ 2 mm (−0.40 mm) ( p = 0.01). Absence of KMW was associated with an increased risk of peri‐implant soft‐tissue dehiscence (PSTD) and implant platform visibility ( p ≤ 0.01). No significant differences were observed for probing depth (PD), bleeding on probing (BOP), plaque index or peri‐implant diseases ( p > 0.05). MT was not associated with CBL, PD, BOP, suppuration on probing (SOP) or peri‐implant diseases ( p > 0.05). Thin MT (< 2 mm) was linked to increased PSTD ( p = 0.005), greater implant platform visibility ( p = 0.04) and lower plaque index ( p = 0.01). Brushing discomfort was reported in 11.4% of sites with 0 mm KMW, compared with 3.4% and 2.4% in the < 2 mm and ≥ 2 mm groups, respectively, with no significant associations across KMW or MT groups ( p > 0.05). Conclusions: KMW was associated with long‐term peri‐implant tissue stability, whereas thin MT was primarily associated with an increased risk of PSTD. Neither KMW nor MT was significantly associated with long‐term brushing discomfort.

Objective: To assess 25‐year implant survival, success rates, peri‐implant conditions, and variables influencing peri‐implant mucositis (PM), peri‐implantitis (PI), and loss of osseointegration. Methods: Partially edentulous patients rehabilitated with tissue‐level implant‐supported prostheses were evaluated. Calibrated examiners performed clinical and radiographic assessments, and potential variables for PM and PI were analyzed at the final follow‐up. Results: At the 10‐ and 25‐year follow‐ups, 303 and 159 patients with 511 and 252 implants, respectively, were included. Implant failure (IF) was 1.2% at 10 years and 6.0% at 25 years, with implant survival rates of 98.8% and 94.0%, respectively ( p < 0.001). Implant success rates ranged from 97.0% at 10 years to 90.8% at 25 years ( p < 0.001). IF due to loss of osseointegration increased from 0.6% to 3.6% at the implant level and from 1.0% to 2.5% at the patient level, and were located only in premolar or molar sites. At implant level, peri‐implant health (PH) was 14.4% at 10 and 25 years ( p = 1.00), while PM decreased from 82.1% to 76.5% ( p = 0.08), and PI increased from 3.5% to 9.1% ( p = 0.001). At patient level, PH remained stable between 10 and 25 years, ranging from 10.0% to 10.3% ( p = 0.94), while PM decreased from 80.0% to 71.6% ( p = 0.06), and PI increased from 10.0% to 18.1% ( p = 0.01). In the multivariate analysis, history of periodontitis (OR = 3.87) and facial mucosal thickness (OR = 0.42) were associated with PM, whereas facial mucosal thickness was associated with PI (OR = 0.02). Conclusions: After 25 years, implant survival and success exceeded 90%. Loss of osseointegration accounted for approximately 60% of IF. While PI and IF increased over time, PM decreased but remained prevalent.

Objectives: This study aimed to assess patient-reported outcomes (PROs) and clinician-reported outcomes (CROs) following tooth autotransplantation, and to identify factors influencing PROs and CROs. Materials and methods: Patients with autotransplanted teeth underwent a follow-up examination and completed visual analogue scale (VAS)-based questionnaires assessing multiple treatment domains. Corresponding items were independently evaluated by three oral surgeons and three general practitioners, based on standardized photographs, periapical radiographs, and digital scans of the region of interest. Inter-rater agreement was assessed, and associations between transplant characteristics and outcomes were analyzed. Results: The sample comprised 33 patients with 37 autotransplanted teeth and a mean follow-up of 8.5 ± 5.8 years. Patients’ satisfaction exceeded 90% for oral hygiene accessibility and fulfillment of expectations, whereas esthetic satisfaction (81%) and quality-of-life impact (60.5%) were rated lowest. CROs were significantly lower than PROs for esthetic satisfaction, oral hygiene accessibility, and fulfillment of expectations, whereas PROs were lower for quality-of-life impact ( p ≤ 0.005). Inter-rater agreement among clinicians ranged from poor to fair. Infraposition significantly reduced both PROs and CROs ( p ≤ 0.05). Additionally, general practitioners assigned significantly lower CROs than to oral surgeons, particularly in the presence of healing sequelae and gingival recession defects ( p ≤ 0.045). Conclusions: Tooth autotranslantation was associated with high-long-term patient satisfaction, whereas clinicians rated outcomes more critically. Infraposition was the only variable negatively affecting both PROs and CROs. Clinical relevance: Despite more critical clinician assessments, patients reported high satisfaction following tooth autotransplantation, supporting this treatment approach as a valuable option for replacement of missing teeth.

Objectives: To compare the survival and success rates of autotransplanted immature teeth versus mature teeth treated with extraoral root-end resection (EORER), and assess inter-rater agreement in radiographic evaluation between oral surgeons (OS) and general practitioners (GPs). Materials and methods: Patients who underwent autotransplantation between 2000 and 2022 were retrospectively identified and invited for clinical and radiographic follow-up examinations. Periapical radiographs were independently evaluated by three OS and three GPs. Predictors of survival and success were analyzed using univariate generalized estimating equation models. Results: Fifty-eight autotransplanted teeth (39 immature, 19 mature) in 50 patients were included. Immature transplants showed higher survival (89.7% vs. 73.7%; mean follow-up 8.4 vs. 5.6 years) and higher success rates (63.3% vs. 31.3%) than EORER-treated mature transplants. Pulp revascularization was observed in 88.5% of immature and 54.5% of EORER-treated mature teeth. Longer splinting and pristine recipient sites were associated with higher survival; premolar and molar sites with higher success (p ≤ 0.047). Inter-rater agreement was lowest for pulp canal obliteration, with OS showing higher agreement than GPs ( p = 0.02). GPs generally reported more pathological findings on the radiographs. Conclusions: Immature transplants demonstrated higher survival and success rates than EORER-treated mature transplants. However, pulp revascularization was observed in over half of mature transplants. Radiographic assessment varied considerably between OS and GPs. Clinical Relevance: Immature donor teeth remain the preferred option for autotransplantation. Nevertheless, EORER extends eligibility to mature donor teeth by promoting pulp revascularization, potentially avoiding root canal treatment. Standardized radiographic criteria and calibration are warranted for follow-up over time.

Background: This study aimed to evaluate the prevalence of peri‐implant soft tissue deformities, including dehiscences (PSTDs) and deficiencies, around bone‐level (BL) and tissue‐level (TL) implants in the anterior maxilla, assess associated variables, and patient‐reported outcomes (PROs). Methods: Adults with implant‐supported prostheses (ISPs) in the anterior maxilla were recruited. Clinical and digital assessments were performed, and related variables were analyzed. Results: A total of 205 ISPs in 193 patients were evaluated. Mean follow‐up after implant placement was 11.3 ± 1.4 years. PSTD prevalence was comparable between BL and TL implants (88.8% vs. 94.4%; p = 0.19), or when PSTD ≥ 1 mm (23.9% vs. 22.5%; p = 0.97). Similarly, 99.25% and 100% of BL and TL showed deformities, p = 1.00. Prevalence of prosthetic interface/abutment (12.7% vs. 2.5%) and implant shoulder exposure (4.2% vs. 0%), and overcontoured ISP (35.2% vs. 12.7%) was significantly higher in TL implants ( p < 0.01). Greater papilla dimensions and lower volume deficiency (90.3% vs. 98.6%; p < 0.01) were observed around BL implants, while mucosal discoloration was similar between groups (16.4% vs. 15.5%; p > 0.05). Greater PSTD depth was associated with older age, reduced keratinized mucosa width (< 2 mm), wider implant diameter, prosthetic overcontouring, lower mucosal volume, and papilla deficiencies ( p < 0.05). Wider prosthetic emergence angles were associated with reduced papilla dimensions ( p < 0.05). Thin mucosa (< 2 mm) was associated with grayish mucosal discoloration (OR = 2.79). Despite these findings, OHIP‐14 scores were low, and PROs were high, with no significant differences between groups. Conclusions: Prevalence of peri‐implant soft tissue deformities in the anterior maxilla is high irrespective of implant type and is associated with age, soft tissue phenotype, mucosal volume, papilla deficiencies, wider implant diameters, and prosthetic overcontouring. However, this does not seem to have a measurable impact on patient perception.

Objective: This one‐year randomized clinical trial compared the effects of mandibular implant‐overdentures (IODs) on two two‐piece regular‐neck tissue‐level implants (Group A) or on four mini‐implants (Group B) with different loading protocols in edentulous patients concerning dental Patient‐Reported Outcomes (dPROs). Material and Methods: Seventy‐two participants were randomly assigned to Group A ( n = 35) for treatment with two standard implants (3.3 mm diameter, conventional loading) with a stud‐type abutment, or to Group B ( n = 37) for treatment with four mini‐implants (2.4 mm diameter, immediate loading) with a mini‐stud‐type abutment. Primary outcomes were measured using the General Oral Health Assessment Index (GOHAI), the 14‐item Oral Health Impact Profile (OHIP‐G14), and the Denture Satisfaction Index (DSI), at visit #1—baseline (pre‐treatment), visit #2—implant placement (immediate loading, Group B), visit #3–8‐10‐week follow‐up (conventional loading, Group A; control visit, Group B), and visit #4–1‐year post‐placement. Data analysis included descriptive statistics, non‐parametric comparison tests, effect‐size measures, and multiple regression. Results: Sixty‐two participants completed the 1‐year follow‐up (Group A = 32; Group B = 30). Significantly improved dPROs were observed for both treatments after 1 year, compared with baseline ( p < 0.01), with similar effects in the two Groups. In the mini‐implant group, higher improvement in satisfaction was observed after implant placement and immediate loading, compared to Group A ( p < 0.001). Conclusion: Significant improvements in satisfaction and Oral Health Related Quality of Life were observed after 1 year, and benefits were observed earlier for mini‐implants using immediate loading. Overall, findings support the use of four immediately loaded mini‐implants in the mandible as a suitable treatment alternative for edentulous patients. Registration: ClinicalTrials.Gov ID: NCT03837158. https://clinicaltrials.gov/study/NCT03837158 .

Objective: To evaluate long‐term crestal bone level changes (ΔCBL) and prevalence of peri‐implant conditions according to the type of implant‐supported fixed dental prosthesis (IFDP), and to identify implant‐, prosthetic‐, and patient‐related factors associated with ΔCBL. Materials and Methods: This single‐center observational study evaluated patients rehabilitated with single crowns (SCs), splinted crowns (SPs), or bridges (BRs) on tissue‐level implants after 10 and 25 years of function. Standardized clinical and radiographic evaluations were performed, and peri‐implant conditions were diagnosed according to established consensus definitions. Results: A total of 147 patients with 233 implants were included. The prevalence of peri‐implantitis (PI) increased from 10 to 25 years, from 2.3% to 7.8% for SC, from 1.6% to 6.3% for SP, and from 0% to 4.9% for BR, with no significant differences between IFDP types at either time point ( p ≥ 0.95). SP tended to have higher peri‐implant mucositis (PM) rates at 25 years (87.3%), compared to SC (74.4%) and BR (80.5%). Mean ΔCBL was −0.37 ± 0.91 mm for SC, −0.25 ± 0.85 mm for SP, and −0.70 ± 1.0 mm for BR, with no significant differences between IFDP types ( p = 0.37). Multivariate analyses demonstrated that greater ΔCBL was significantly associated with incisor region location (−0.74 mm), increased probing depth (−0.16 mm per mm), and suppuration on probing (−0.97 mm), all p ≤ 0.05. In contrast, prosthetic retention, marginal misfit, and prosthet emergence geometry were not significantly associated with ΔCBL. Conclusions: Over 25 years, the type of IFDP did not significantly affect ΔCBL or the prevalence of PM and PI around tissue‐level implants. Long‐term bone stability was primarily influenced by implant location in the incisor region, increased probing depths, and the presence of suppuration.

Objectives: This cross‐sectional study primarily aimed at investigating the association between the transmucosal emergence geometry and the prevalence of peri‐implant diseases in bone‐ and tissue‐level implants (BL/TL). As secondary objectives, the association of other implant‐, prosthesis‐, and patient‐related variables with crestal bone levels (CBL) and additional radiographic findings was explored. Material and Methods: Patients with non‐molar single tooth implant‐supported prostheses were retrospectively identified for inclusion. Clinical and radiographic examinations were performed cross‐sectionally to assess peri‐implant diseases (peri‐implant mucositis, peri‐implantitis), emergence geometry at the transmucosal region (profile type, emergence angles at two levels, and prosthetic platform height), and peri‐implant radiographic variables, including CBL. Data were analyzed using multivariate regression. Results: A total of 332 implants (166 BL/166 TL) in 266 patients (60 ± 17 years) were evaluated at a mean of 11.2 ± 1.5 years after implant placement. Peri‐implant mucositis was significantly influenced by the crown emergence angle (Level 2; OR = 1.03, p = 0.01) and peri‐implantitis by implant diameter (OR = 3.82, p < 0.0001). Crown emergence angles > 30° in BL implants and > 48° in TL implants were consistently associated with peri‐implant diseases. Mean CBL was 0.54 ± 1.34 mm, with lower values in TL (−0.24 mm; p = 0.036), females (−0.27 mm, p = 0.029), and implants with greater platform height (−0.175 mm/mm, p = 0.01). Peri‐implant sheathing was detected in 13.4% of implants, showing no association with implant‐related characteristics. Conclusions: Wider crown emergence angles were associated with peri‐implant diseases, whereas wider implant diameters were associated with increased peri‐implantitis prevalence. TL implant design and greater platform height were associated with reduced CBL.

Aim: To explore the treatment outcome of surgical peri‐implantitis protocols in a university‐based setting. Materials and Methods: Four‐hundred and six implants in 223 patients were surgically treated by four trained surgeons using open‐flap debridement (OFD, 37 implants), implantoplasty (Impl, 39 implants), reconstructive surgery (Rec, 241 implants) or a combined approach (Comb, 89 implants). Treatment success after 1 year (maximum probing depth (max PD) ≤ 5 mm, bleeding on probing (BOP) at ≤ 1 site and no suppuration) was the primary outcome. Logistic regression was used to explore associations between patient‐/implant‐related factors, treatment modalities and treatment success, implant loss and surgical retreatment. Results: Treatment was successful in 54.7% of implants after 1 year: OFD 62.5%, Impl 58.3%, Rec 55.4%, Comb 48.3%, with no significant group differences. Over a mean follow‐up of 30.80 ± 19.62 months, 40 implants (9.9%) were lost and 38 (9.4%) required surgical retreatment. In exploratory multivariable analyses, systemic antibiotic use (pre‐operative: OR = 3.54, p = 0.04; pre‐ and post‐operative: OR = 4.49, p = 0.02) and surgeon experience (OR = 0.12, p = 0.003) showed associations with treatment success. Molar site (OR = 3.21, p = 0.03), antibiotic (pre‐ and post‐operative: OR = 3.13, p = 0.02) and baseline suppuration (OR = 4.51, p = 0.002) were associated with implant loss. Surgical retreatment was associated with overdenture (OR = 3.59, p = 0.003) and max PD at baseline (OR = 1.30, p = 0.001). Conclusions: Surgical peri‐implantitis outcome was associated with systemic antibiotic, surgeon, molar site, overdenture, baseline suppuration and PD.

Objectives: This retrospective study primarily evaluated whether early radiographic bone loss (ERBL) predicts progressive bone loss (PBL), and secondarily assessed its association with implant survival and peri‐implant diseases. Methods: Adults with dental implants who were followed for at least 5 years were included. Implants presenting ERBL, defined as apical migration of the interproximal marginal bone involving exposure of the implant rough surface before insertion of the final prosthesis, were classified as ERBL+; non‐exposure group was defined as implants without evidence of ERBL (ERBL−). Regression analyses were performed to evaluate associations with PBL. Results: A total of 261 implants, 87 ERBL+, and 174 ERBL− were included. [Correction added on 8 March 2026, after first publication: The preceding sentence has been corrected.] Mean follow‐up periods were 8.8 ± 3.0 years for the ERBL+ and 11.5 ± 1.7 years for the ERBL−. ERBL+ exhibited significantly greater PBL than ERBL− (−1.6 ± 1.0 mm to −2.3 ± 1.7 mm vs. −0.4 ± 1.2 mm to −0.5 ± 1.2 mm; p < 0.001). Implant survival was lower in ERBL+ (67.8%) compared with ERBL− (98.3%; p < 0.001). Peri‐implantitis was diagnosed in 63.2% of implants in the ERBL+ group versus 5.2% in ERBL− ( p < 0.001), and 68.4% of patients versus 6.1% of ERBL− ( p < 0.001). [Correction added on 8 March 2026, after first publication: The preceding sentence has been corrected.] ERBL was the strongest predictor of greater PBL (+1.46 mm; p < 0.0001). Male sex (+0.40 mm; p = 0.02), smoking (+0.61 mm; p = 0.004), each additional implant (+0.17 mm; p < 0.0001), single‐crown restorations (+0.66 mm; p = 0.005), and bone‐level implants (+0.32 mm; p = 0.005) were associated with increased PBL. Conclusions: ERBL is a strong predictor of PBL and is associated with a higher risk of implant loss and peri‐implantitis onset.