Immediate implant placement combining socket seal abutment and peri-implant socket filling: A prospective case series

Primary implant stability of two implant macro-designs in different alveolar ridge morphologies: an in vitro study

PURPOSE

The primary aim of this in vitro study was to investigate the primary implant stability obtained in immediate and late implant placement scenarios. Secondary aims evaluated the effect of two distinct implant macro-designs and examined the correlation between resonance frequency analysis (RFA) and final insertion torque.

METHODS

Partially edentulous maxillary models including six single sites simulating extraction sockets and healed alveolar ridges were used. Virtual implant planning facilitated static computer-assisted implant placement of bone level implants with either a shallow-threaded and cylindrical (BL), or deep-threaded and tapered implant macro-design (BLX). The insertion torque was continuously measured during implant placement, and RFA was performed after final implant positioning.

RESULTS

One-hundred and forty-four implants were equally distributed to two alveolar ridge morphologies and implant designs. Higher final insertion torque and RFA values were observed for implants placed in healed ridges compared to extraction sockets (40.8 ± 13.5 vs. 20.6 ± 8.4 Ncm, and RFA 70.7 ± 2.8 vs. 59.6 ± 6.5, both p < 0.001), and for BL implants compared to BLX implants (35.7 ± 13.0 vs. 25.7 ± 8.9 Ncm, and RFA 66.7 ± 4.4 vs. 63.6 ± 4.9, both p < 0.001). Insertion torque and mean RFA values positively correlated (r = 0.742; p < 0.001).

CONCLUSION

Primary implant stability is significantly affected by the alveolar ridge morphology and the implant macro-design, demonstrating higher values in healed sites and shallow-threaded, cylindrical implants. Therefore, a tailored selection of the implant design depending on the implant placement and loading protocol is recommended.

Influence of Implant Component Materials on Peri-Implant Soft Tissue Healing: A Comparative Histological and Immunohistochemical Study in Humans

BACKGROUND

Recently, the importance of peri-implant soft tissue integration quality has been recognised as an essential factor in the long-term success of dental implant rehabilitation.

AIM

The aim of this study was to explore the influence of three materials commonly used in implant dentistry, namely titanium (Ti), dental adhesive resin (Re) and polyetheretherketone (PEEK), on the peri-implant soft tissues.

METHODS

In this clinical randomised comparative study, 37 bone-level implants were placed, and experimental transmucosal healing abutments made of different materials were randomly assigned to each implant. These abutments were removed together with the surrounding soft tissues after 8 weeks. Immunohistochemical analyses were performed to determine the presence and localisation of different immune cells. In addition, clinical and radiographic data were collected and peri-implant bone remodeling was assessed.

RESULTS

Compared to the Ti and PEEK groups, Re abutments revealed a higher infiltration of macrophages in the connective tissue (p = 0.04) and neutrophils in the adjacent epithelium (p = 0.03). In the Re abutments, peri-implant bone remodeling was higher compared to the other groups (p = 0.01).

CONCLUSION

The use of resin material as a transmucosal healing abutment should be carefully considered as it was associated with a higher presence of inflammatory cells at 8 weeks post-implantation as well as superior bone remodeling compared to PEEK and Ti.

Retrospective study on the clinical and radiographic outcomes of 2.8 mm diameter implants supporting fixed prostheses up to 11 years

OBJECTIVES

This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations.

MATERIALS AND METHODS

Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated.

RESULTS

An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis.

CONCLUSION

Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.

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.

Sealing socket with custom healing abutment in case of immediate posterior implant placement: A case report

Replacing a hopeless molar with a dental implant is one of the most common treatment modalities in implant dentistry. However, immediate implant post-extraction in the posterior region requires managing the bone gap and ensuring primary closure of the socket. To address this anatomical consideration, several authors have proposed using a custom abutment to seal the socket after immediate implant placement, maintain soft tissue contour, and stabilize the surrounding tissues. For example, the "Sealing Socket Abutment" (SSA) enhances the anatomical emergence profile, which facilitates the biological, prosthetic, and aesthetic integration of the future supra-implant prosthesis. A 32-year-old female patient in good general health consulted the Outpatient and Implantology Department of the dental clinic in Monastir, Tunisia, for the extraction of the root tip of the left first mandibular molar (tooth number 36) and subsequent implant rehabilitation. The patient's medical history was unremarkable, with no known allergies, or chronic conditions. Follow-up appointments were scheduled to monitor the healing process and ensure successful integration of the implant. The aim of this paper is to present, through this clinical case report, the SSA abutment fabrication protocol using the direct technique and to discuss the advantages and limitations of this technique.

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.

Immediate loading on two adjacent single dental implants with definitive nonsplinted restorations: A proof of concept in the posterior zone

OBJECTIVES

To evaluate clinical, clinician- and patient-reported outcomes (PROs) of two adjacent single posterior implants immediately loaded with definitive single crowns up to 1 year. Ten patients in need of two adjacent posterior single implants were included. All implants were placed applying a fully digital workflow. Definitive screw-retained single zirconia crowns were delivered within 72 h after implant placement. Clinical parameters, patient- and clinician-reported outcomes were assessed up to 1 year of follow-up.

CLINICAL CONSIDERATIONS

Clinical outcomes remained stable, with no implant failures or technical and biological complications throughout the observation period. Patient satisfaction was very high at baseline (crown delivery) and remained consistently high at 6 and 12 months of follow-up. Crown insertion 3 days after implant placement was rated as an easy procedure by clinicians.

CONCLUSIONS

Two adjacent single implants with immediate definitive restorations (<72 h) in the posterior region appear to be a viable and easy treatment option to shorten the overall treatment time and potentially enhancing patient satisfaction. However, randomized controlled trials are needed to confirm the advantages of this treatment protocol over a delayed loading approach.

CLINICAL SIGNIFICANCE

In selected cases, immediate implant loading with definitive restorations in the posterior region appears a valuable and straightforward option to shorten the overall treatment time.

Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial

OBJECTIVE

To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up.

MATERIALS AND METHODS

Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites.

RESULTS

The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14).

CONCLUSION

The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up.

CLINICAL RELEVANCE

These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

A biologically oriented preparation technique (BOPT) for immediate posterior implant placement, immediate provisionalization, and definitive implant crown fabrication: A complete digital workflow

OBJECTIVE

Immediate implants and immediate alveolar sealing have been a widely utilized treatment with high predictability and biological advantages. The improvement in technology has made it possible to simplify clinical processes. The aim of the present report was to describe the complete digital workflow of the Biologically oriented preparation technique for immediate posterior implant, immediate provisionalization and fabrication of definitive implant crowns.

CLINICAL CONSIDERATIONS

The surgical process and prosthetic management to preserve the gingival contours of the extracted natural tooth during immediate implant placement and provisionalization are described. Additionally, during the same clinical intervention, the definitive intraoral digital implant scans for capturing the implant position, peri-implant tissue contours, adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured for the fabrication of the definitive crown.

CONCLUSIONS

Based on the technique described, the immediate implant placement and provisionalization in the posterior area provides biological and clinical advantages, reducing the number of abutment-implant disconnections and the number of clinical appointments, as well as increases patient comfort.

CLINICAL SIGNIFICANCE

The present article describes a technique for an immediate implant placement and provisionalization in the posterior region for maintaining the gingival architecture of the extracted tooth. During the same appointment, the implant position, peri-implant tissue contours, and adjacent and antagonist dentition, and profile emergence of the interim implant crown are captured by using an intraoral scanner and used for the fabrication of the definitive crown. This technique aims to reduce the number of abutment-implant disconnections and clinical appointments.

Clinical performance of single implant prostheses restored using titanium base abutments: A systematic review and meta-analysis

PURPOSE

The aim of this review was to evaluate the survival rates of restorations utilizing titanium base abutments (TBA) for restoring single-unit implant prostheses.

MATERIALS AND METHODS

This review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The focus question was: In patients who require the restoration of a single dental implant utilizing a titanium base abutment, what are the determining factors and outcomes relating to implant prosthesis prognosis and survival? A comprehensive search of databases (PubMed, EMBASE, and Cochrane Library) was conducted on 16 April 2023 and updated on 5 May 2023. Randomized clinical trials (RCT), retrospective studies and prospective studies, reporting on the use of TBA for single implant prostheses, were reviewed. A Cochrane collaboration risk of bias assessment analysis was performed for randomized clinical studies, and the Newcastle-Ottawa Scale tool was applied for non-randomized studies. A meta-analysis was performed on clinical trials reporting on survival rates of both TBA and other abutments. Other clinical studies, reporting on TBA only, were included for descriptive statistics.

RESULTS

The search provided 1159 titles after duplicates were removed. Six RCTs were included to perform a meta-analysis and compare the survival of the TBA to other abutments [OR 0.74; 95% CI: 0.21-2.63, heterogeneity; I2 0%; p = .99]. Twenty-three prospective and retrospective studies fulfilled the criteria and were included in the meta-analysis after 12 months of function. A total of 857 single implant-supported prostheses fabricated with a TBA were included. TBA abutments have an estimate 98.6% survival rate after 1 year in function (95% CI: 97.9%-99.4%). The mean follow-up period was 31.2 ± 16.9 months.

CONCLUSIONS

Single implant prosthesis restored with titanium base abutments showed favourable short-term survival rates.

Influence of using collagen on the soft and hard tissue outcomes of immediate dental implant placement: A systematic review and meta-analysis

OBJECTIVE

To compare the effects of bone grafting materials, collagen-infused grafting materials, and no grafting materials on the soft and hard tissue outcomes when an immediate implant is placed.

MATERIALS AND METHODS

In addition to hand searching, electronic searches were performed in Pubmed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL). Only RCTs were included in our review. The Cochrane ROB 2.0 tool was used to assess the risk of bias (ROB). Two subgroups were used to evaluate implant failure rate, buccal bone resorption, soft tissue thickness, and esthetic scores. In the meta-analysis, both the fixed-effects model and the random-effects model were employed.

RESULT

7 RCTs were selected after screening 580 studies, and 205 patients were included in the review, with 279 implants. Two RCTs were at low bias of risk, three were at moderate bias, and two were deemed at high risk of bias. The failure rate (95% CI: 0.17 to 11.84) and soft tissue thickness were not significantly different between collagen with bone grafting materials and without bone grafting materials. On the basis of the failure rate and buccal bone thickness, there was no significant difference between collagen with bone grafting materials and bone grafting materials. While we found collagen with bone grafting materials could have a significant advantage on the buccal bone thickness (MD: -0.43,95% CI -0.72 to -0.41) and esthetic outcome (MD: -1.23,95% CI -1.90 to -0.55).

CONCLUSION

In the statement of immediate implant implantation, the thickness of the buccal bone and esthetic outcomes did significantly benefit from bone grafting materials with collagen inserted in the "jumping gap".

Full mouth oral rehabilitation of a severely worn dentition based on a fully digital workflow

OBJECTIVE

To demonstrate the use of a complete digital workflow for a full mouth rehabilitation in a severely worn dentition.

CLINICAL CONSIDERATIONS

The present case report successfully rehabilitated a full-mouth case of a severely worn dentition based on the use of digital technologies, making the diagnosis and treatment process faster, accurate and less expensive. A long-lasting esthetic and functional result are showed after 30-months follow up.

CONCLUSIONS

An appropriate knowledge on dental erosion and oral rehabilitation, combined with a digital dentistry approach could lead the clinician to deliver a fast, accurate and predictable noninvasive restorative treatment in cases like the one described.

CLINICAL SIGNIFICANCE

Bruxism-based severely worn dentition is being found more often in population. In this situation, a detailed diagnosis and tailored treatment are mandatory to obtain a predictable treatment outcome. In this sense, the development of adhesive dentistry, new restorative materials and the incorporation of digital technologies can create a predictable synergy to rehabilitate these types of patients with a modern and less invasive approach.

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.