Immediate implant placement in fresh alveolar sockets with a minimal split-thickness envelope flap: A randomised controlled clinical trial

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.

Hard and soft tissue alterations using dual-zone concept versus connective tissue graft at maxillary immediate implant placement: A 1-year randomized clinical and volumetric trial

OBJECTIVES

To evaluate the esthetic outcome, as well as clinical, radiographic, and volumetric tissue alterations 1 year after immediate implant placement (IIP) with connective tissue grafting (CTG) versus dual-zone concept (DZ) at sites with thin labial bone in the esthetic zone.

MATERIALS AND METHODS

This randomized clinical trial included 30 patients treated with IIP simultaneous with either CTG or DZ (n = 15 each). Pink esthetic score (PES) was assessed 6 months after crown placement as the primary outcome. Amount of bone labial to the implant, labio-palatal ridge reduction, and crestal bone changes were measured via CBCT after 1 year. Volumetric analysis of linear labial soft tissue contour, interdental, and mid-facial soft tissue level changes, and total volume loss (mm3) were measured after 1 year.

RESULTS

Similar PES was observed in the CTG (12.53 ± 1.13) and DZ (12.13 ± 1.55) groups, with no significant difference (p = 0.42). Likewise, there were no statistically significant differences found between the two groups in labio-palatal bone reduction (mm&%), interdental papillae, and mid-facial gingival levels (p > 0.05). However, the mean vertical crestal bone changes in the CTG and DZ groups were -1.1 ± 0.6 mm and 0.2 ± 1.0 mm, respectively, with a statistically significant difference (p = 0.0002). Moreover, CTG revealed less linear and total volume (mm3) loss in the labial soft tissue which was statistically significant compared to DZ (p = 0.007).

CONCLUSION

Both groups demonstrated the same PES, nevertheless, volumetric analysis revealed twice total labial volume loss in DZ compared to CTG. It might be concluded that the use of CTG with IIP caused less horizontal reduction in the supra-implant complex compared to the DZ.

Critical review on bone grafting during immediate implant placement

In the last 20 years, immediate implant placement has been proposed as a predictable protocol to replace failing teeth. The research conducted in preclinical and clinical studies have focused on soft and hard tissue changes following tooth extraction and immediate implant placement. Different approaches for hard and soft tissue grafting together with provisional restorations have been proposed to compensate tissue alterations. This review analyzed some relevant clinical and preclinical literature focusing on the impact of bone grafting procedures on immediate implant placement in terms of hard and soft tissue changes, aesthetic results, and patient-related outcomes.

Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta-analysis

OBJECTIVES

The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone.

MATERIALS AND METHODS

An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias-corrected and study size-weighed bootstrap tests. A study time-correcting meta-analysis was then performed to obtain an overall effect for the study pool.

RESULTS

A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow-up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of -1.9 percentage points [PP], 95% CI: [-0.3, -4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004).

CONCLUSIONS

Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments.

The clinical effect of the digital guide in the early implant restoration of second molars

BACKGROUND

In the absence of contraindications to implants, implant repair is the preferred method to treat mandibular second molar loss.

OBJECTIVE

To compare the clinical effects of a traditional implant guide and digital implant guide in the early implant restoration of second molars.

METHODS

The study included 35 patients with second molar loss randomly divided into two groups. Eighteen patients in the experimental group had an implant procedure using a computer-aided design/computer-assisted manufacturing (CAD/CAM) digital implant guide, and 17 patients in the control group had the procedure using a traditional film pressing implantation guide. Then, the surgical procedure was completed using the two different implant guides. At 3 months after surgery, four parameters including screw hole exit position, coronal deviation of the implant site, disease improvement rate, and clinical effects, which included marginal adaptation, anatomic form, marginal discoloration, postoperative sensitivity, surface roughness, and secondary caries of the upper prosthesis were compared between the two groups.

RESULTS

The screw hole exit position in the experimental group was directed to the functional cusp of the opposite jaw, and there was a statistically significant difference between the two groups. There was no statistically significant difference in the rate of disease improvement and the clinical effect of the upper prosthesis between the two groups. There was no statistically significant difference in the bilateral coronal deviation and deviation direction of implants in the two groups. The bilateral coronal deviation of the experimental group was smaller than that of the control group.

CONCLUSION

The digital implant guide can effectively reduce the deviation of the screw hole and the upper prosthesis in the restoration of the second molar. The prosthesis used in the experimental group had a good clinical outcome, which provides a theoretical basis for the restoration of the posterior molar.

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

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 utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial

OBJECTIVE

The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year.

MATERIALS AND METHODS

Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n = 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n = 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap.

RESULTS

All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p < 0.001). Similarly, changes in mesial papilla (test = -0.64 ± 0.95 mm, control = -1.20 ± 0.81 mm), distal papilla (test = -0.56 ± 1.17 mm, control = -1.26 ± 0.63 mm), horizontal soft-tissue (test = -0.82 ± 0.95 mm, control = -1.84 ± 0.88 mm; p < 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes.

CONCLUSION

The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.