Early Healing of Immediate Implants Connected With Two Types of Healing Abutments

Peri-implant soft tissue conditioning of immediate posterior implants by CAD-CAM socket sealing abutments: a randomized clinical trial

BACKGROUND

Anatomically formed healing abutments were suggested in literature to address many of the issues associated with immediate posterior implant insertion such as large extraction sockets that are extremely hard to seal without reflecting the mucoperiosteal flap, extraction sockets anatomy that are not suitable for regular healing abutment placement, and potentially high occlusal stresses when planning a temporary implant supported prothesis to improve the conditioning of supra implant tissue architecture and the emergence profile of the implant supported restorations.

PURPOSE

To clinically evaluate the peri-implant soft tissue profile of single posterior implant retained restorations and to assess patient related outcomes of the implant restorations that were conditioned immediately by CAD-CAM socket sealing abutments (SSA) versus those conditioned by Titanium (Ti) standard healing abutments (SHA).

METHODS

Twenty participants received twenty-two single maxillary immediate implants after flapless minimally invasive tooth extraction and 3D guided implant placement in the posterior area (premolar and molar) and allocated randomly into two groups (n = 11), the intervention group: patients received PEEK SSA and the control group: the patients received Ti SHA. Modified Pink Esthetic Score (PES) was evaluated at 3 observation periods: Baseline T0 (immediate after implant supported crown insertion), 6 months T1 and 1 year of clinical performance T2. Patient satisfaction was assessed one week and one year after crown insertion using visual analogue scale (VAS).

RESULTS

At base line, after six as well as 12 months, SSA group showed statistically significant higher total modified PES scores than SHA group (P-value < 0.001). At the 2 clinical observation periods (baseline and after one year), SSA group showed statistically significantly higher overall satisfaction score than SHA group (P-value < 0.001).

CONCLUSION

After one year of clinical observation period, CAD-CAM PEEK socket sealing abutments together with flapless minimally invasive tooth extraction and 3D guided implant placement provided superior outcomes compared to Ti SHA in terms of peri-implant soft tissue profile.

TRIAL REGISTRATION

This study was registered on clinicaltrials.gov with ID no. NCT05276765 on 03/03/2022.

Systematic review of peri-implant conditions and aesthetic outcomes of customized versus conventional healing abutments

PURPOSE

Customized healing abutments are utilized to enhance aesthetics and peri-implant soft and hard tissue health, and play a crucial role in the implant-prosthetic workflow. This systematic review was performed to assess and compare the clinical outcomes of customized healing abutments with conventional ones.

METHODS

The review was registered with PROSPERO (ID: CRD42024532449) and followed the PRISMA-guidelines. The PICO-question addressed was: "In patients with dental implants, do customized healing abutments result in beneficial peri-implant conditions compared with conventional healing abutments?" Clinical trials involving immediate and late implant placement that compared different healing abutments based on quantifiable outcomes were included. The "PubMed", "PubMed Central", "Cochrane Library", and "Web of Science databases" were screened for eligible studies until 4/20/2024.

RESULTS

Of 1,396 titles retrieved, 5 studies met the inclusion criteria and were analyzed. The included studies showed a low risk of bias as assessed by the RoB2 tool and Joanna Briggs Institute Critical Assessment questionnaire. Compared to conventional healing abutments, customized abutments were associated with a trend toward better clinical outcomes in peri-implant soft and hard tissue, as well as aesthetics. Several results within the cohorts using customized healing abutments showed significantly improved values in soft and hard tissue results as well as aesthetic parameters. Importantly, none of the included studies reported biological or aesthetic disadvantages associated with the use of customized healing abutments.

CONCLUSIONS

Customized healing abutments maintain stability of peri-implant hard and soft tissue. However, further studies with larger sample sizes and longer follow-up periods are needed to validate these findings.

3D-Printed Temporary Wing Bride as a Temporary Restoration in the Posterior

The fear of a missing tooth often leads to postponing the visit at the dentist. While extraction itself is a major stressful experience for the patient, the presence of visible gaps or missing teeth inside or outside the aesthetic zone is a deal breaker for a lot of patients. Bridging the time spent until inserting any final restoration with a provisional enables the patients to still take part in everyday life. This case report shows a new approach for a fixed dental provisional in the anterior region using a printed wing bridge approach to replace an extracted tooth. The provisional was prefabricated, and extraction and integration of the provisional could be placed in a single visit. The chosen approach shows the integrability of 3D printing in everyday practice providing immediate economical and aesthetic treatment.

Posterior open wound healing in immediate implant placement using reactive soft tissue versus absorbable collagen sponge: a retrospective cohort study

The soft and hard tissue healing of open wounds in immediate implant placement are yet to be explored. The aim of this study was to compare the clinical outcomes of open wound healing using reactive soft tissue (RST) and absorbable collagen sponge (ACS). Forty implants placed immediately in posterior sockets were included; autologous RST was used in 20 and ACS substitute was used in 20. Soft tissue healing was primarily assessed through a novel scoring system and the evaluation of gingival recession. The horizontal bone width (HBW) and interproximal marginal bone level (MBL) were measured on radiographs to observe the hard tissue healing. No significant difference in total soft tissue healing score was observed at 2 weeks postoperatively. Notably, the ACS group showed better tissue colour (P = 0.016) but worse fibrous repair (P = 0.043) scores than the RST group. Gingival recession levels were comparable in the two groups, both before tooth extraction and after placement of the restoration. Regarding hard tissue, HBW and MBL changes showed no intergroup differences. Within the limitations of this study, both RST and ACS seemed effective for open wound closure, achieving ideal soft and hard tissue healing in immediate implant placement.

Biomaterials and Clinical Applications of Customized Healing Abutment-A Narrative Review

Customized healing abutments have been introduced in clinical practice along with implant surgery to preserve or create natural-appearing hard and soft tissue around the implant. This provides the benefits of reducing the overall treatment time by eliminating the second stage and reducing the elapsed time of the fabrication of the final prostheses. This article aims to review the types and properties of materials used for the fabrication of customized healing abutments and their clinical applications. Articles published in English on customized healing abutments were searched in Google Scholar, PubMed/MEDLINE, ScienceDirect, and the Scopus databases up to August 2022. The relevant articles were selected and included in this literature review. Customized healing abutments can be fabricated from materials available for dental implants, including PEEK, PMMA, zirconia, resin composite, and titanium. All the materials can be used following both immediate and delayed implant placement. Each material provides different mechanical and biological properties that influence the peri-implant tissues. In conclusion, the studies have demonstrated promising outcomes for all the materials. However, further investigation comparing the effects of each material on peri-implant soft and hard tissues is required.

Immediate Implant Placement with Buccal Bone Augmentation in the Anterior Maxilla with Thin Buccal Plate: A One-Year Follow-Up Case Series

PURPOSE

To evaluate the buccal bone thickness of immediate implant placement with buccal bone augmentation in patients with a thin buccal plate in the esthetic zone.

MATERIALS AND METHODS

Eighteen consecutive patients requiring a single tooth replacement in the anterior maxillary zone with a thin plate (<1 mm) were included and received immediate implant placement with narrow-diameter implants. Patients received buccal bone augmentation (both internal and external socket bone grafting) with deproteinized bovine bone mineral (DBBM) and an absorbable membrane. The final restoration was delivered after 8 months. Cone-beam CT scans were performed before surgery (CBCT0), immediately after surgery (CBCT1), at final restoration delivery (CBCT2), and at 1-year follow-up after the final restoration (CBCT3) to evaluate the buccal bone thickness and ridge width. A repeated measures ANOVA and Bonferroni correction for multiple comparisons were applied for statistical analysis of changes within different time points (α = 0.05).

RESULTS

Fifteen of the 18 enrolled patients were available for analysis at the 1-year follow-up after final restoration. The mean buccal bone thickness at 2 mm apical to the implant-abutment junction (IAJ-2) were 3.59 mm (range: 3.04-4.58 mm), 2.79 mm (range: 2.25-3.78 mm), and 2.52 mm (range: 1.72-3.36 mm), respectively, at CBCT1, CBCT2, and CBCT3. A statistical significance was observed for buccal bone thickness change between CBCT1 and CBCT2 at IAJ-2 (F = 17.948, p = 0.001). The net gains of the ridge width from CBCT0 to CBCT1, CBCT1 to CBCT2, and CBCT2 to CBCT3 were 1.08 mm, -0.94 mm and -0.04 mm at 4 mm apical to the cementum-enamel junction, respectively. No statistical significance was observed for the change in ridge width from CBCT0 to CBCT3 (F = 10.518, p = 1.000).

CONCLUSIONS

Simultaneous buccal bone augmentation may maintain a predictable buccal bone thickness for immediate implant placement in the maxillary anterior sites with a thin buccal plate (<1 mm) at 1-year follow-up after final restoration.

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).