Clinical, radiographic, and esthetic evaluation of immediately loaded laser microtextured implants placed into fresh extraction sockets in the anterior maxilla: a 2-year retrospective multicentric study

Clinical outcomes of dental implants placed in fresh sockets: A five-year retrospective study

Purpose

This retrospective clinical study aimed to evaluate the implants placed in fresh sockets and investigate the effect of varied oral health conditions and treatment plan details on the clinical and radiographic outcomes.

Materials and methods

Fifty-nine participants (102 implants) were included in this study. Four variables, including mean probing depth (PD), mean marginal bone loss (MBL), pink esthetic score (PES), and patient satisfaction, were significant dependent variables, and the effects of independent variables on these four items were studied. The data were analyzed by the analysis of covariance (ANCOVA) using a statistical software.

Results

The mean follow-up period was 4.75 ± 1.74 years, and the mean MBL was 1.21 ± 0.81 mm. The survival rate was 97 %. There were significant effects of the finish line site, keratinized gingival width, and attached gingival width on PD after adjusting the factors. Also, the implant brand, plaque index, and uncemented prosthesis affected MBL significantly. In addition, significant effects of the surgeon, implant brand, and proximal contact on PES were found.

Conclusion

More PD was found around restorations with a finish line site > 1.5 mm subgingival. Sufficient attached gingiva was a more effective factor on PD than keratinized gingiva. Implants with more plaque scores showed more MBL.

Comparison of Metrics for Shape Quality Evaluation of Textures Produced by Laser Structuring by Remelting (Waveshape)

The study is focused on investigating approaches for assessing the texture shape deviation obtained by laser structuring by remelting (Waveshape). A number of metrics such as Fourier spectrum harmonic ratio, cross-correlation coefficient (reverse value), and spectral entropy are investigated in terms of surface-texture shape deviation estimation. The metrics are compared with each other by testing two hypotheses: determination of target-like shape of texture (closest to harmonic shape) and determination of texture presence on the cross-section. Spectral entropy has the best statistical indicators for both hypotheses (Matthews correlation coefficient is equal to 0.70 and 0.77, respectively). The reverse cross-correlation coefficient proved to be close in terms of statistical indicators (Matthews correlation coefficient is equal to 0.58 and 0.75 for the first and second hypothesis), but is able to estimate the shape similarity of regular texture independent on its type. The provided metrics of shape assessment are not limited to the texturing process, so the presented results can be used in a broad range of scientific fields.

Success Rates and Complications Associated with Single Immediate Implants: A Systematic Review

This study examined the success rates of single immediate implants and their associated biological, hardware and aesthetic complications. Using a developed search strategy, randomized controlled trials (RCTs) on single-unit immediate implants with at least six human participants, a minimum follow-up time of 12 months and published between January 1999 and January 2021 were identified. Data was extracted independently using pre-designed data extraction forms. Information on success rates and associated biological, hardware and aesthetic complications were obtained and assessed. Out of 191 potentially eligible studies, 26 RCTs assessing 1270 patients with a total of 1326 single implants were included and further evaluated. In this review, success rate was reported to be 96.7–100% over a total of 9 studies. However, there was a lack of consensus on a universal success criterion between authors emphasizing the need for agreement. The average follow up was 29 months and most reported complications were aesthetic (63 cases, 4.7%), whilst there were relatively fewer biological, (20 cases, 1.5%), and hardware complications (24 cases, 1.8%). Success rate is an uncommon clinical outcome with 9 out of 26 of the selected RCTs reporting it. In these studies, single immediate implants showed a high success rate with low numbers of biological and hardware complications, and high patient satisfaction with aesthetics were reported in the short-term follow-up of one year.

Interaction between Different Implant Surfaces and Liquid Fibrinogen: A Pilot In Vitro Experiment

Background

Platelet concentrates like leucocyte- and platelet-rich fibrin (L-PRF) have been widely evaluated in different oral surgical procedures to promote the healing process. However, liquid L-PRF products such as liquid fibrinogen have been poorly explored, especially in the biomimetic functionalization of dental implants. The aim of this in vitro study is to evaluate the interaction between 5 different dental implant surfaces and liquid fibrinogen.

Methods

Five commercially available dental implants with different surfaces (Osseospeed™, TiUnite™, SLActive®, Ossean®, and Plenum®) were immersed for 60 minutes in liquid fibrinogen obtained from healthy donors. After this period, the implants were removed and fixed for scanning electron microscopy (SEM).

Results

All dental implants were covered by a fibrin mesh. However, noticeable noncontact areas were observed for the Osseospeed™, TiUnite™, and SLActive® surfaces. On the other hand, Ossean® and Plenum® surfaces showed a dense and uniform layer of fibrin covering almost the entire implant surface. The Osseospeed™, TiUnite™, and SLActive® surfaces presented with lower blood cell numbers inside the fibrin mesh compared with the others. Moreover, at higher magnification, thicker fibrin fibers were observed in contact with Ossean® and Plenum® surfaces. The Plenum ®surface showed the thickest fibers which also inserted and interconnect to the microroughness.

Conclusion

The initial contact between an implant surface and the fibrin network differs significantly among different implant brands. Further studies are necessary to explore the clinical impact of these observations in the osseointegration process of dental implants.

Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

Immediate implant placement with or without connective tissue graft: A systematic review and meta-analysis

OBJECTIVES

To assess the effect of connective tissue graft (CTG) in terms of vertical mid-facial soft tissue change when applied at the buccal aspect 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 January 2020. Randomized controlled trials (RCTs) and non-randomized controlled studies (NRSs) comparing IIP with CTG and without CTG over a mean follow-up of at least 12 months were included for a qualitative analysis. Meta-analyses were performed on data provided by RCTs.

RESULTS

Out of 1814 records, 5 RCTs and 3 NRSs reported on 409 (IIP + CTG: 246, IIP: 163) immediately installed implants with a mean follow-up ranging from 12 to 108 months. Only 1 RCT showed low risk of bias. Meta-analysis revealed a significant difference in terms of vertical mid-facial soft tissue change between IIP + CTG and IIP pointing to 0.41 mm (95% CI [0.21; 0.61], p < .001) in favour of soft tissue grafting. This outcome was clinically relevant since the risk for ≥1 mm asymmetry in mid-facial vertical soft tissue level was 12 times (RR 12.10, 95% CI [2.57; 56.91], p = .002) lower following IIP + CTG. Soft tissue grafting also resulted in a trend towards less bleeding on probing (MD 17%, 95% CI [-35%; 1%], p = .06). Meta-analyses did not reveal significant differences in terms of pink aesthetic score, marginal bone level change and probing depth. Results were inconclusive for horizontal mid-facial soft tissue change and papilla height change. Based on GRADE guidelines, a moderate recommendation for the use of a CTG following IIP can be made.

CONCLUSION

CTG contributes to mid-facial soft tissue stability following IIP. Therefore, CTG should be considered when elevated risk for mid-facial recession is expected in the aesthetic zone (thin gingival biotype, <0.5 mm buccal bone thickness).

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.

Survival rates and bone loss after immediate loading of implants in fresh extraction sockets (single gaps). A clinical prospective study with 4 year follow-up

Background

The aim of this prospective study was to report the outcome of treatment with implants inserted after tooth extraction and immediately loaded.

Material and Methods

Fifty-six patients with single tooth loss were treated with 116 IPX Galimplant® implants with internal connections and a sandblasted, acid-etched surface. All implants were placed after tooth extraction using a flapless approach without bone regeneration, and they were then immediately loaded with cemented acrylic prostheses. After a period of three months, definitive cemented ceramic prostheses were placed. Patients were examined throughout a total of 4 years of follow-up. Marginal bone loss and survival rates were evaluated using digital periapical radiographs, taking into account clinical variables such as age, gender, smoking, history of periodontitis, etiology of extraction, placement site, diameter, and implant length. The Mann-Whitney U and Kruskal-Wallis non-parametric tests were used to compare differences between subgroups created based on the different clinical variables identified.

Results

Clinical results indicate an implant survival and success rate of 97.4%. Three implants were lost. Of the 116 immediate acrylic single crowns initially placed, 113 were replaced with definitive ceramic crowns after 3 months. A total of 77.8% of implants were inserted in the maxilla, while 22.2% were inserted in the mandible. No further complications were reported after the follow-up period (4 years). The mean marginal bone loss was 0.67 mm ± 0.40 mm. No differences were found among the subgroups of study patients.

Conclusions

This study indicates that dental implants that are inserted after tooth extraction and immediately loaded may constitute a successful and predictable alternative implant treatment.

Key words:Dental implants, post-extraction implants, fresh sockets, immediate loading, immediate prostheses, implant dentistry.

Influence of Laser-Microtextured Surface Collar on Marginal Bone Loss and Peri-Implant Soft Tissue Response: A Systematic Review and Meta-Analysis

BACKGROUND

A laser-microtextured surface (LMS) dental implant collar appears to promote a more tooth-like gingival collagen fiber attachment, which may help to stabilize peri-implant tissues. The purpose of this systematic review is to assess the clinical effect of an LMS versus non-LMS collar on crestal bone level and peri-implant soft tissue response.

METHODS

Electronic and manual literature searches were performed by two independent reviewers for articles written in English up to December 2016. Studies were included if they were human clinical trials with the purpose of evaluating the impact of an LMS collar on peri-implant hard and soft tissues. Cumulative marginal bone loss (MBL), probing depth (PD), and survival rate (SR) with 95% confidence intervals (CIs) were calculated to show the performance of LMS implant collars. MBL, PD, and SR data were analyzed with a random effects model to compare the influence of LMS collars with non-LMS collars (e.g., roughened surface and machined surface).

RESULTS

Fifteen human clinical studies (three randomized controlled trials, six cohort studies, and six case series) with 772 implants met the inclusion criteria. For the overall data, the weighted mean MBL was 0.72 mm (95% CI: 0.59 to 0.85 mm), PD was 1.81 mm (95% CI: 1.13 to 2.49 mm), and SR was 0.97 (95% CI: 0.95 to 0.98). MBL around an LMS collar was significantly less than around machined-surface collars (weighted mean difference [WMD]: -0.77; 95% CI: -1.01 to -0.52; I2 = 95.2%; P <0.001). PD in the LMS group was significantly shallower than in the machined-surface group (WMD: -1.34; 95% CI: -1.62 to -1.05; I2 = 81.4%; P <0.001). However, no statistically significant difference was detected for MBL between the LMS and roughened-surface groups (WMD: -0.04; 95% CI: -0.16 to 0.08; I2 = 0.0%; P = 0.75). No statistically significant difference was found for SR between the LMS and non-LMS groups (risk ratio: 1.01; 95% CI: 0.97 to 1.04; I2 = 0.0%; P = 0.91).

CONCLUSIONS

Meta-analysis showed that an LMS collar can reduce the amount of MBL and PD compared with a machined-surface collar. Due to high heterogeneity between the included studies, results should be interpreted cautiously.