Immediate single-tooth implant placement with simultaneous bone augmentation versus delayed implant placement after alveolar ridge preservation in bony defect sites in the esthetic region: A 5-year randomized controlled trial

Immediate versus delayed single-tooth implant placement in bony defect sockets in the aesthetic zone: Is an intact buccal wall necessary?

A COMMENTARY ON

Meijer H J A, Slagter K W, Gareb B, Hentenaar D F M, Vissink A, Raghoebar G M. Immediate single-tooth implant placement in bony defect sites: a 10-year randomized controlled trial. J Periodontol 2025; 96: 151-163.

DESIGN

This single-center, 10-year randomized controlled trial (RCT) was conducted at the University Medical Center Groningen (UMCG), the Netherlands, to compare immediate and delayed implant placement in patients with a failing tooth in the aesthetic region and a buccal bony defect of ≥5 mm. Forty patients were randomly assigned to either the Immediate Group (immediate implant placement with bone grafting and delayed provisionalization) or the Delayed Group (ridge preservation followed by delayed implant placement and provisionalization). Cone beam computed tomography (CBCT) was used preoperatively to assess palatal bone availability. Surgical procedures were standardized and performed by a single experienced oral and maxillofacial surgeon, while prosthetic procedures were completed by a single prosthodontist. Patients were followed up for 10 years to assess marginal bone levels (MBL), buccal bone thickness (BBT), soft tissue changes, aesthetic outcomes, patient satisfaction, and biological and technical complications.

CASE SELECTION

Patients with a compromised tooth in the maxillary aesthetic zone and a buccal bone defect of ≥5 mm following extraction were included. Patients were excluded if they met any of the following criteria: poor oral hygiene, inadequate mesio-distal space for implant placement, presence of periodontal disease, smoking, an American Society of Anesthesiologists (ASA) score of ≥II, or a vertical bony defect of less than 5 mm in the labial socket wall after tooth extraction.

DATA ANALYSIS

The primary outcome, change in marginal bone level, was analyzed using a per-protocol strategy. Normally distributed data were summarized using means and confidence intervals and compared with the independent samples t-test, while non-normally distributed data were described using medians and interquartile ranges and compared using the Mann-Whitney U test. To check the robustness of the findings, sensitivity analyses were conducted, including an intention-to-treat analysis. For outcomes with repeated measurements, multivariable linear mixed-effect models were utilized to examine differences between the treatment groups over time. All statistical analyses were performed using the R software (version 4.0.5), and a p-value less than 0.05 was the criterion for statistical significance.

RESULTS

After 10 years, the mean marginal bone level change was -0.71 ± 0.59 mm in the Immediate Group and -0.36 ± 0.39 mm in the Delayed Group, with no statistically significant difference between them (p = 0.063). Secondary outcomes showed no significant variations between the two groups.

CONCLUSIONS

Immediate implant placement with bone augmentation in postextraction sockets with buccal bony defects ≥5 mm yielded similar long-term outcomes to delayed implant placement after ridge preservation in the aesthetic zone, with no significant differences in bone stability, clinical performance, aesthetics, or patient satisfaction over 10 years.

A Systematic Review on Immediate Implant Placement in Intact Versus Non-Intact Alveolar Sockets

Objectives: The primary objective of this systematic review was to compare IIP in intact versus non-intact sockets in terms of buccal bone thickness. Methods: Two independent reviewers carried out an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2024. Randomized controlled trials (RCTs), cohort studies, and case series on intact and/or non-intact sockets were included for analysis. The primary outcome was buccal bone thickness (BBT). Secondary outcomes were vertical midfacial soft tissue level change, pink esthetic score (PES), implant survival and complications. This systematic review was conducted in accordance with the PRISMA guidelines. Results: After screening 1001 unique titles and conducting manual searches, 20 articles reporting on 525 implants (intact: 265; non-intact: 260) in the anterior maxilla with a follow-up of up to 120 months were selected. The overall study quality was low, especially for non-intact sockets since only two RCTs could be found, and none demonstrated a low risk of bias. Meta-analyses were not feasible due to a lack of direct comparisons, and heterogeneity in terms of surgical approach, soft tissue handling, and restorative approach. BBT ranged between 1.10 and 3.18 mm (intact) and 1.18 and 3 mm (non-intact). Vertical midfacial soft tissue level change ranged between -0.13 and -0.58 mm (intact) and -0.03 and -0.59 mm (non-intact). Pink esthetic scores ranged between 10.48 and 12.80 (intact) and 9.25 and 12.43 (non-intact). Implant survival exceeded 90% in all studies and was 100% in the vast majority of the studies. Conclusions: This systematic review suggests a similar outcome of IIP in intact and non-intact sockets. However, the overall low study quality, a lack of direct comparisons, and heterogeneity rendered the comparison highly biased. Future studies should be conducted to establish an evidence-based treatment approach for IIP in non-intact sockets.

Oral Health-Related Quality of Life in Patients Rehabilitated with Dental Implants

Background: A considerable percentage of people in the population have lost their teeth. According to the Word Health Organization (WHO), 40% have lost teeth for multiple reasons. The lack of restorative treatments and the lack of fixed options could impact the quality of life of patients. Objective: To determine the quality of life of patients treated with dental implants at the School of Dentistry, University of the Americas, Quito, Ecuador, by the Medical Specialty in Oral Rehabilitation from 2017-2022. Materials: The inclusion criterion was patients treated with dental implants age 20 to 70 years old, who agreed to participate in this study, in Quito/Ecuador. The Oral Health Impact Profile (OHIP-14) survey was used. The patients' clinical history, psychological status, and social status were also recorded. Complementary tests (clinic analysis) were conducted to evaluate the general health status of each patient. Results: After the corresponding analysis, the total number of patients who wished to participate in this study in compliance with the inclusion criteria was n = 1303. The seven questions included patient sex, age, and type of prosthesis used in their rehabilitation (single implant, fixed prosthesis on an implant, overdentures, or hybrid prostheses). The obtained results indicated that single implants and overdentures (two jaw implants) improved quality of life, and no statistically significant difference was noted between the sexes. Conclusions: The quality of life of patients with total dentures who received dental implants improved substantially, and more fixed dentures helped them to recover their masticatory function appropriately. Single implants were not excluded. In the investigated population, the results were unanimous in how implants improved their comfort and even helped in the recovery of their self-esteem.

Influence of buccal bone lamella defects on hard and soft tissues with submerged and non-submerged healing in immediate implants - an experimental study in minipigs

PURPOSE

This study assessed the impact of the buccal bone on hard and soft tissues in submerged and non-submerged immediate implants using a minipig model.

METHODS

Sixty-five titanium implants (Camlog Progressive Line) were placed in four minipigs immediately after tooth extraction. All non-submerged (NSM) implants received a mechanically induced buccal bone defect (NSM-BD), whereas the submerged group (SM) was classified as defective (SM-BD) and intact (SM-BI). All bone defects underwent guided bone regeneration (GBR). After four months, the minipigs were sacrificed. Harvested specimens were analysed using histomorphometry and light and fluorescence microscopy. The evaluated parameters included the sulcus (S), implant epithelium (IE), connective tissue (CT), biological width (BW), highest soft tissue point (HSTP), and first hard tissue contact (FHTC).

RESULTS

Of the 65 implants four (6%) were lost, while all remaining implants demonstrated clinical stability (Periotest). Despite GBR failures caused by the pigs' hay consumption after one week, no significant differences (p > 0.5) were observed between SM-BD and NSM-BD in buccal parameters (NSM-BD/SM-BD: S = 0.6 mm, IE = 2.9/2.4 mm, CT = 3.5/3.4 mm, BW = 5.9/5.8 mm). Compared to SM-BI soft-tissue parameters increased in length with reduced buccal bone lamella (SM-BI/SM-BD: S = 0.4/0,6 mm; p ≤ 0.04, SM-BI/NSM-BD: IE = 1.8/2.9 mm; p ≤ 0.007, SM-BI/SM-BD: CT = 2.5/3.4 mm; p ≤ 0.01, BW = 4.0/5.8 mm; p ≤ 0.007). The buccal HSTP remained unaffected (p > 0.5; (NSM-BD = 1.8 mm, SM-BD = 1.0 mm, SM-BI = 2.0 mm; p > 0.5) for all groups.

CONCLUSION

A buccal bone defect resulted in prolonged S, IE, CT, and BW. However, the aesthetic parameter HSTP did not exhibit significant differences (p > 0.5) at the buccal implant site when comparing the SM and NSM healing protocols.

Local delivery of pamidronate with collagen matrix mitigates buccal bone resorption following immediate implant placement - An experimental in vivo study

AIMS

The aim of this experimental in vivo pilot study was to evaluate the effect of the local delivery of pamidronate within a collagen membrane on the changes in the buccal soft and hard tissue dimensions at the time of immediate implant placement and whether this effect was influenced by the placement of bone substitutes.

METHODS

In six beagle dogs, the distal roots of the third and fourth premolars were extracted, and immediate implants were placed. Treatment groups were randomly allocated to each socket: (i) covering the buccal bone with pamidronate-soaked collagen membrane (BP group), (ii) filling the gap defect with synthetic bone substitute (BS group), (iii) filling the gap defect with synthetic bone substitute and covering the buccal bone with pamidronate soaked collagen membrane (BP/BS group), (iv) no treatment (control group). Intraoral scanning was performed immediately after the surgery and at 20 weeks. Histomorphometric and micro-computed tomography (CT) outcomes were evaluated at 20 weeks.

RESULTS

The micro CT analysis demonstrated that the BP group showed no apparent difference in vertical bone level with residual mesial root area, while control group showed significant buccal bone resorption at the implant site. The histomorphometric analysis demonstrated that the vertical bone level of buccal plate was significantly differed between the BP and control group (0.34 ± 0.93 and 1.27 ± 0.56 mm, respectively; p = .041). There was no statistically significant difference in the horizontal ridge width (HRW 1, 2, 3) among the groups. Also, the thickness, height and buccal contours of the soft tissue did not reveal significant changes among the groups.

CONCLUSION

The local delivery of pamidronate to the outer surface of the buccal wall at the time of immediate implant placement effectively limits buccal bone resorption. The results from the present investigation should be interpreted with caution, as well as its clinical translatability. Further investigation is needed to understand the pamidronate binding and releasing kinetic, as well as the ideal carrier of this drug for its topical application.

Comparison of implant placement and loading protocols for single anterior maxillary implants: A systematic review and network meta-analysis

STATEMENT OF PROBLEM

With increasing esthetic needs, patients prefer missing anterior teeth to be restored as soon as possible, but how the timing of implantation and prosthetic loading influences peri-implant tissue and the esthetic results remains unclear.

PURPOSE

The purpose of this systematic review and network meta-analysis of randomized controlled trials was to investigate and rank the hard-tissue and soft-tissue outcomes, esthetics, and patient satisfaction of single maxillary implant placement and loading protocols.

MATERIAL AND METHODS

A systematic search was conducted to identify studies with at least a 1-year follow-up that compared different implant placement and loading protocols and reported on survival, marginal bone loss (MBL), soft tissue, and esthetics. A random effects model and a Bayesian approach were applied to compare protocols by using mean differences (MD) with 95% credible intervals (CrI) and surface under the cumulative ranking curve (SUCRA) values.

RESULTS

A total of 43 articles were included, with a follow-up of 1 to 5 years. All protocols had high survival rates and no significant differences for 1-year or 2-year MBL. Immediate placement with immediate loading ranked first in pink and white esthetic scores and satisfaction and was statistically significantly better than immediate placement with delayed loading or late placement protocols in pink esthetic scores, where its advantage over late placement with late loading was also clinically relevant [MD: -1.74, CrI: -2.34 to -1.15].

CONCLUSIONS

Immediate implantation with immediate loading showed a considerable esthetic advantage over later rehabilitation, whereas only a slight difference in MBL resulted from different protocols.

Outcomes of Dental Implants in Routine Clinical Practice: A Retrospective Multicenter Study

Purpose: This study evaluated the clinical and radiographic outcomes of subjects rehabilitated with dental implants placed in daily practice. Materials and Methods: This retrospective multicentric case series study involved 339 patients (168 males, 171 females, mean age 54.0 ± 14.7 (standard deviation) years, range 28-81 years) treated in five private clinics, who received 651 implants between January 2019 and January 2023. The main outcomes were marginal bone loss (MBL) and implant survival rate. The effect of variables such as soft tissue status, crestal/subcrestal implant placement, immediate/delayed implantation, bone grafting/no graft, screwed, or cemented prosthesis were analyzed. Results: The implant survival rate was 99.9%, with only one implant failure observed in a 71-year-old female with subcrestal placement. Implants immediately placed in post-extraction sites had significantly greater MBL compared to delayed placements (p=0.0002). Subcrestally positioned implants showed significantly less MBL than crestal implants (p < 0.0001), while grafted and non-grafted sites showed similar results, and cemented prostheses demonstrated lower MBL compared to screwed prostheses (p < 0.0001). The prevalence of peri-implant mucositis was only 3.6% on implant basis. No intra-operative complications nor adverse events in the follow-up period were reported. Conclusion: Following current guidelines for implant therapy, consisting of proper diagnosis and personalised treatment plan and maintenance, and adhering to implant system manufacturer's recommendations, it is possible to achieve satisfactory clinical and radiographic outcomes in routine practice.

Effectiveness of immediate implant placement into defective sockets in the esthetic zone: A systematic review and meta-analysis

STATEMENT OF PROBLEM

A defective socket is common after tooth extraction in the esthetic zone, but whether an implant can be immediately placed in a defective socket is unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to summarize relevant studies within the last 20 years on implant survival and changes in soft and hard tissues after immediate implant placement in esthetic areas with socket defects.

MATERIAL AND METHODS

A search was conducted for the relevant studies in the PubMed/Medline, the Cochrane Library, Web of Science, and Embase databases from January 2000 to March 2022. The literature review, data retrieval, and judgment whether the included studies had a risk of bias were handled independently by 2 reviewers, and a single-arm meta-analysis was performed using a statistical software program.

RESULTS

A total of 23 studies evaluating the immediate implant placement of 630 implants (9 studies without a flap and 14 studies with a flap) were included. A 98.1% implant survival rate (95% confidence interval (CI): 96.2%, 100.0%) was determined. Marginal bone loss (MBL) at 6, 12, and ≥24 months were 1.03 mm (95%CI: 1.02, 1.03), 0.72 mm (0.72, 0.73), and 1.15 mm (1.14, 1.16). Gingival recession at 12 months was 0.25 mm (95%CI: 0.17, 0.33). The pink esthetic score (PES) were 12.34 (95%CI: 12.16, 12.52) at 12 months and 12.58 (12.39, 12.76) at ≥24 months.

CONCLUSIONS

Current evidence shows that immediate implant placement into defective sockets in esthetic areas is feasible. Immediate implant placement can have a relatively good therapeutic effect in terms of implant survival rate, MBL, gingival recession, and PES.

Some superiority trials with nonsignificant results published in high impact factor journals correspond to noninferiority situations: a research-on-research study

OBJECTIVES

Many negative randomized controlled trials (RCTs) report spin in their conclusions to highlight the benefits of the experimental arm, which could correspond to a noninferiority (NI) objective. We aimed to evaluate whether some negative superiority RCTs comparing 2 active interventions could correspond to an NI situation and to explore associated trial characteristics.

STUDY DESIGN AND SETTING

We searched PubMed for superiority RCTs comparing 2 active interventions with non-statistically significant results for the primary outcome that were published in 2021 in the 5 journals with the highest impact factor in each medical specialty. Three reviewers independently evaluated whether trials could correspond to an NI situation (ie, an evaluation of efficacy as the primary outcome, with the experimental intervention presenting advantages including better safety profile, ease of administration, or decreased cost as compared with the control intervention).

RESULTS

Of the 147 trials included, 19 (12.9%, 95% CI [7.9%, 19.4%]) corresponded to a potential NI situation. As compared with trials not in a potential NI situation, they were published in a journal with a lower impact factor (median impact factor 8.7 vs 15.6), were more frequently rated at high or some concerns regarding risk of bias (n = 14, 73.7% vs n = 69, 53.9%) and reported spin in the article conclusions (n = 11, 57.9% vs n = 24, 18.8%).

CONCLUSION

A non-negligible proportion of superiority negative trials comparing 2 active interventions could correspond to an NI situation. These trials seemed at increased risk of bias and frequently reported spin in the conclusions, which may distort the interpretation of results.

PLAIN LANGUAGE SUMMARY

Noninferiority trials are designed to show that a new intervention is not worse in terms of efficacy than the reference intervention. It is adapted when the new intervention has an advantage in terms of safety, ease of use or cost over the reference one. However, the literature displayed some superiority negative trials comparing 2 active interventions that could correspond to a potential noninferiority situation. Our study aimed to assess whether some superiority trials with nonsignificant results for the primary outcome could correspond to an NI situation and to explore associated trial characteristics. Our findings indicate that a non-negligible proportion of superiority negative trials could correspond to a noninferiority situation. Moreover, those trials seemed at increased risk of bias and frequently reported spin in the conclusions.

A multi-centre randomized controlled trial on alveolar ridge preservation with immediate or delayed implant placement: Need for soft-tissue augmentation

AIM

To assess the impact of the timing of implant placement following alveolar ridge preservation (ARP) on the need for soft-tissue augmentation (STA) and to identify the risk factors for horizontal and vertical soft-tissue loss.

MATERIALS AND METHODS

Patients with a single failing tooth in the anterior maxilla (15-25) were treated at six centres. Following tooth extraction, they were randomly allocated to the test group (immediate implant placement, IIP) or control group (delayed implant placement, DIP). ARP was performed in both groups and implants were immediately restored with an implant-supported provisional crown. Six months after tooth extraction and ARP, a panel of five blinded clinicians assessed the need for STA on the basis of anonymized clinical pictures and a digital surface model. Lack of buccal soft-tissue convexity and/or mid-facial recession qualified for STA. Pre-operative and 6-month digital surface models were superimposed to assess horizontal and vertical soft-tissue changes.

RESULTS

Thirty patients were included per group (test: 20 females, 10 males, mean age 53.1; control: 15 females, 15 males, mean age 59.8). The panel deemed STA as necessary in 24.1% and 35.7% of the cases following IIP and DIP, respectively. The difference was not statistically significant (odds ratio [OR] = 1.77; 95% confidence interval [CI] [0.54-5.84]; p = .343). Loss of buccal soft-tissue profile was higher following DIP (estimated mean ratio = 1.66; 95% CI [1.10-2.52]; p = .018), as was mid-facial recession (mean difference [MD] = 0.47 mm; 95% CI [0.12-0.83]; p = .011). Besides DIP, regression analysis identified soft-tissue thickness (-0.57; 95% CI [-1.14 to -0.01]; p = .045) and buccal bone dehiscence (0.17; 95% CI [0.01-0.34]; p = .045) as additional risk factors for mid-facial recession. Surgeons found IIP significantly more difficult than DIP (visual analogue scale MD = -34.57; 95% CI [-48.79 to -20.36]; p < .001).

CONCLUSIONS

This multi-centre randomized controlled trial failed to demonstrate a significant difference in the need for STA between IIP and DIP when judged by a panel of blinded clinicians. Based on objective soft-tissue changes, patients with thin buccal soft tissues, with a buccal bone dehiscence and treated with a delayed approach appeared particularly prone to soft-tissue loss.

Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial

OBJECTIVES

The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla.

MATERIALS AND METHODS

Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12).

RESULTS

No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups.

CONCLUSION

Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters.

CLINICAL RELEVANCE

There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.

Efficacy of the Sausage Technique in Rebuilding the Crestal Buccal Bone Thickness: A Retrospective Analysis

The goal was to evaluate the efficacy of the sausage technique in reconstructing the crestal buccal bone thickness, focusing on the distribution shape of the regenerated volume. Ten implants were placed in five patients with Cawood-Howell class IV defects. A cone beam computed tomography (CBCT) was executed at T0 (before surgery). Guided bone regeneration (GBR) with the sausage technique utilized a resorbable collagen membrane, made of a 50% autologous bone and a 50% anorganic bovine bone matrix (ABBM) mixture. After 6 months, a CBCT (T1) was performed before implant placement. Using CBCT software, a plane parallel to the implant axis intersected perpendicular planes every 1.5 mm from the crest level. T0 and T1 CBCT sections were analyzed, yielding 140 measurements. Statistical analysis via SPSS revealed a significant increase in thickness (average 2.82 ± 1.79 mm). Maximum gains occurred at 4.5 mm from the coronal crest line (3.8 ± 1.51 mm). The GBR sausage technique was effective with minimal post-operative complications, yielding the biggest gain at the mid-ridge sagittal area. Within the analysis limitations, it can be assumed that the sausage technique is effective for horizontal GBR in the maxilla, but a lesser volume might be achieved at the crestal level because it seems to follow a bowed regeneration shape.

The influence of connective tissue grafting on the reconstruction of a missing facial bone wall using immediate implant placement and simultaneous bone reconstruction: a retrospective long-term cohort study

PURPOSE

This retrospective cohort study evaluates the influence of connective tissue grafts (CTG) on bone regeneration at implant sites with total loss of the buccal bone wall treated with flapless immediate implant placement (IIP) and reconstruction with autogenous bone chips (AB) within a follow-up of up to 13 years.

METHODS

Sixty implants were inserted in 55 patients in sites with total loss of the buccal bone wall between 2008 and 2021. The implants were inserted and the buccal gaps were grafted by AB. A subgroup of 34 sites was grafted additionally with CTG using tunnel technique. Primary outcome was the vertical bone regeneration in height and thickness. Secondary outcome parameters were interproximal marginal bone level, recession, soft tissue esthetics (PES), width of keratinized mucosa (KMW) and probing depths (PPD).

RESULTS

Mean follow-up period was 60.8 months. In 55 sites a complete vertical bone regeneration was documented. The mean buccal bone level increased by 10.6 mm significantly. The thickness of the buccal bone wall ranged between 1.7 and 1.9 mm, and was significantly thicker in sites without CTG. Interproximal marginal bone level was at implant shoulder level. The mean recession improved significantly by 1.2 mm. In sites with CTG, recessions and PES improved significantly more.

CONCLUSIONS

Additional CTG in extraction sites with total buccal bone loss followed by IIP with simultaneous AB grafting led to improved PES and recession, but also to a thinner buccal bone wall compared to sites grafted just with AB.

Finite Element Analysis and Fatigue Test of INTEGRA Dental Implant System

The study involved numerical FEA (finite element analysis) of dental implants. Based on this, fatigue tests were conducted according to the PN-EN 14801 standard required for the certification of dental products. Thanks to the research methodology developed by the authors, it was possible to conduct a thorough analysis of the impact of external and internal factors such as material, geometry, loading, and assembly of the dental system on the achieved value of fatigue strength limit in the examined object. For this purpose, FEM studies were based on identifying potential sites of fatigue crack initiation in reference to the results of the test conducted on a real model. The actions described in the study helped in the final evaluation of the dental system design process named by the manufacturer as INTEGRA OPTIMA 3.35. The objective of the research was to identify potential sites for fatigue crack initiation in a selected dental system built on the INTEGRA OPTIMA 3.35 set. The material used in the research was titanium grade 4. A map of reduced von Mises stresses was used to search for potential fatigue crack areas. The research [loading] was conducted on two mutually perpendicular planes positioned in such a way that the edge intersecting the planes coincided with the axis of the system. The research indicated that the connecting screw showed the least sensitivity (stress change) to the change in the loading plane, while the value of preload has a significant impact on the achieved fatigue strength of the system. In contrast, the endosteal implant (root) and the prosthetic connector showed the greatest sensitivity to the change in the loading plane. The method of mounting [securing] the endosteal implant using a holder, despite meeting the standards, may contribute to generating excessive stress concentration in the threaded part. Observation of the prosthetic connector in the Optima 3.35 system, cyclically loaded with a force of F ≈ 300 N in the area of the upper hexagonal peg, revealed a fatigue fracture. The observed change in stress peak in the dental connector for two different force application surfaces shows that the positioning of the dental system (setting of the socket in relation to the force action plane) is significantly decisive in estimating the limited fatigue strength.

One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

A Case Report of Atraumatic Tooth Extraction Followed by Ridge Preservation for Implant-Supported Prosthetic Rehabilitation Using an Alloplastic Bone Graft

Exodontia is a painful treatment that frequently causes the alveolar bone and surrounding soft tissues to be immediately destroyed and lost. With regard to the amount of resorption taking place after extraction, various treatment protocols aimed at preventing or decreasing alveolar ridge collapse have been presented over the past three decades. Ridge preservation is a clinical technique used to prevent the socket walls' bone resorption after tooth extraction. A 43‑year‑old female patient with a non-significant medical history visited the Department of Periodontology and Implantology with a chief complaint of a decayed tooth in the upper left back region (26) for three years and wants to get it replaced. The treatment option that was given to the patient was atraumatic extraction, followed by ridge preservation. A cautious and conservative treatment strategy is necessary to preserve the oral structures as they currently exist and are intact for a successful outcome; careful case selection and thorough treatment planning are crucial. Atraumatic tooth extraction is a procedure used to delicately remove a tooth while upholding the fundamental principles of preserving the surrounding bone and gingival structure. This will ultimately maximize the success of implant placement in terms of appearance and functionality.

Survival Rate of Ultrawide Diameter Implants Placed into Molar Postextraction Sockets and in Function for Up to 144 Months

PURPOSE

Innovations in macroimplant design, specifically ultrawide implants 7.0 mm or greater in diameter, have allowed immediate molar replacement. This is a retrospective study assessing the survival rates of ultrawide diameter implants (7.0, 8.0, 9.0 mm) immediately placed into molar extraction sockets. Implants were followed up to 144 months postplacement.

MATERIALS AND METHODS

A retrospective study was conducted of all patients treated in a private surgical practice between January 1, 2008 and December 31, 2020, who received ultrawide dental implants (7.0, 8,0, 9.0 mm.) placed immediately into molar extraction sockets. Wide diameter healing abutments were placed on all implants at the time of surgery. Abutments and crown restorations were fabricated after at least 4 months of unloaded healing. Patient age, sex, implant location and implant diameters were examined for survival. Insertion torque values at the time of placement and time in function were also evaluated. Biometric statistics were computed with p-values (<0.05. Descriptive and bivariate statistics were computed; p-values were set at 0.05.

RESULTS

Five hundred forty-four patients (225 males; 319 females) average age 62.5 years (range 27 to 95) had 563 implants placed. Five hundred thirty-five of five hundred sixty-three (535/563) implants survived; 28 failed [clinical survival rate (CSR) 95.03%]. Number and time in function were: 0 to 12 years 100%; 0 to 9 years 85%; 0 to 6 years 69%; 0 to 3 years 35% or 10 to 12 years 16%; 7 to 9 years 16%; 4 to 6 years 34%; 0 to 3 years 35%. No significant differences were found between sex and implant failures (p = 0.22). Maxillary (266/285; 93.3%) and mandibular (269/278; 96.8%) implant CSRs were not significantly different. Three implant diameters were used: 7.0 mm (206/563) [36.6%]; 8.0 mm (267/563) [47.4%]; 9.0 mm (90/563) [15.9%]. Clinical survival rates were: 7.0 mm (201/206) [97.6%]; 8.0 mm (252/267) [94.4%]; 9.0 mm (82/90) [91.1%]. Mean age for patients with failed implants did not show any significant differences (p = 0.1398). Fifteen of the 28 failed implants failed within 120 days of surgical placement (prior to definitive restoration; [53.6%]; 4 implants failed between 4 and 12 months [14.3%]; 9 implants failed at least 1-year postloading [32.1%].

CONCLUSIONS

The results of this long-term retrospective study regarding ultrawide diameter implants suggested that these implants were viable treatment options for immediate molar replacement following tooth extraction in either jaw with an unloaded healing protocol. High clinical survival rates were reported over a 144-month (12-year) timeframe.

Immediate implant placement with simultaneous bone augmentation versus delayed implant placement following alveolar ridge preservation: A clinical and radiographic study

OBJECTIVE

The present study aimed to evaluate the clinical and radiographic outcomes of immediate implant placement (IIP) with guided bone regeneration (GBR) as compared to delayed implant placement (DIP) following alveolar ridge preservation (ARP) and to identify the potential risk factors influencing these outcomes.

METHODOLOGY

A total of 56 patients (IIP = 28 vs. DIP = 28) with class I or II bony defects received 56 implants were included. GBR procedure using Bio-Oss® bone substitute mixed with advanced platelet-rich fibrin (A-PRF) and covered by Bio-Gide® membrane and additional A-PRF membrane was performed either simultaneously with the IIP or earlier at the time of ARP in DIP. Clinical and 3-D radiographic analyses of bone level, thickness, and density were performed at three-time intervals (T1, immediately; T2, 6-7 months; and T3, 1.5 to 2 years post-implantation), corresponding to the neck, coronal, middle, and apex of implants.

RESULTS

The survival rate was 100% in both groups. IIP showed significant favorable outcomes regarding distal marginal bone level (anterior maxilla, T1-T3) and neck and coronal horizontal facial bone thickness (HFBT) (posterior maxilla, T1; and anterior maxilla, T1-T3, respectively) compared to DIP. However, DIP showed significant facial bone density at the neck and coronal parts in the anterior maxilla (T1) and the coronal part in the posterior maxilla (T3). The facial marginal bone level change was positively correlated with HFBT change (P = 0.007), which is negatively correlated with the secondary implant stability (P = 0.019). The implant region (anterior or posterior maxilla) was the only factor affecting on Implant stability quotient value (ISQ) and change in HFBT (P ˂ 0.05).

CONCLUSION

Overall, the IIP combined with GBR in the post-extraction sites with pre-implant class I or II bony defects had some favorable outcomes compared to DIP after ARP. However, the clinical outcomes, ISQ value, and changes in bone level, thickness, and density from T1-T3 were comparable.

Clinical, radiographic, and esthetic evaluation of immediate implant placement with buccal bone dehiscence in the anterior maxilla: A 1-year prospective case series

OBJECTIVES

To evaluate the clinical, radiographic, and esthetic outcomes of immediate implant placement with buccal bone dehiscence in the anterior maxilla.

METHODS

In this case series, implants were inserted immediately after tooth extraction in sockets with buccal bone dehiscence. Guided bone regeneration (GBR) with a papilla preservation flap and simultaneous connective tissue grafting (CTG) was used. The following outcome variables were measured: mid-facial mucosal recession, probing depth, bleeding on probing, Pink Esthetic Score (PES), marginal bone loss, and thickness of buccal bone plate (TBP).

RESULTS

12 patients were recruited. Stable mid-facial mucosal level (-0.03 ± 0.17 mm) and excellent soft-tissue esthetic outcomes (PES, 9.17 ± 0.72) were achieved at 1 year. The TBP at platform level was 2.01 ± 0.31 mm at 1-year follow up with a resorption rate of 28.90% ± 15.14%.

CONCLUSIONS

Immediate implant placement using GBR performed with a papilla preservation approach and simultaneous CTG is a feasible treatment procedure in compromised extraction sockets in the anterior region. Favorable esthetic outcomes and buccal bone thickness were obtained. Further studies were needed to evaluate the long-term tissue alteration.

Minimal invasiveness in the alveolar ridge preservation, with or without concomitant implant placement

The aim of this systematic review was to evaluate the benefit of ridge preservation (RP) with minimally invasive (MI) approaches with or without concomitant implant placement on morbidity, esthetics, and patient-related outcomes. Three Internet sources were used to search for appropriate papers. The search strategy was designed to include any clinical study published on RP with MI approaches such as flapless surgery, socket shield and socket sealing techniques and, use of biological agents. Characteristics of the individual studies, regarding methodological aspects, quantitative and qualitative data were extracted. The potential risk of bias was estimated, and the acquired evidence was graded. Independent screening of 860 reports resulted in 26 included original articles. Nine publications evaluated MI approaches for RP without concomitant implant placement. Eleven studies evaluated interventions for RP with immediate implant placement (IIP). Six studies compared RP with IIP vs RP without IIP. This systematic review found that MI approaches in most of the studies failed to improve clinical variables regarding morbidity, esthetics, and patient-related outcomes. Based on the limited number of studies analyzed and the methodological discrepancies observed, it is not possible to confirm that MI approaches promote a significant benefit when applied to RP procedures.

Immediate implant placement with or without immediate provisionalization: a systematic review and meta-analysis

OBJECTIVES

To assess the effect of immediate provisionalization (IP) on soft tissue changes, hard tissue changes and clinical parameters following single immediate implant placement (IIP).

MATERIALS AND METHODS

Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase and Cochrane databases as well as a manual search to identify eligible clinical studies up to September 2021. Randomized Controlled Trials (RCTs) comparing IIP with IP (test) to IIP without IP (control) were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue changes. Secondary outcomes included horizontal midfacial soft tissue changes, implant survival, mesial and distal papillary changes, Pink Esthetic Score (PES) at final follow-up, marginal bone level changes, probing depth at final follow-up, and bleeding on probing at final follow-up.

RESULTS

Out of 8213 records, 7 RCTs were selected reporting on 323 patients who received 323 single immediate implants (IIP + IP: 161 implants in 161 patients; IIP: 162 implants in 162 patients) with a mean follow-up ranging from 12 to 60 months. Risk of bias assessment yielded some concerns for 5 RCTs and high risk for 2 RCTs. Meta-analysis on the cases with intact alveoli demonstrated 0.87 mm (95 % CI [0.57; 1.17], p < 0.001) less apical migration of the midfacial soft tissue level for IIP + IP when compared to IIP alone. Implant survival, papillary changes, marginal bone level changes, probing depth and bleeding on probing were not significantly affected by IP. Insufficient data were available for meta-analyses on horizontal midfacial soft tissue changes and PES.

CONCLUSION

IP may contribute to midfacial soft tissue stability at immediate implants. However, high-quality RCTs are needed since the strength of this conclusion is currently rated as low according to GRADE guidelines. This article is protected by copyright. All rights reserved.