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

Socket shield technique for immediate implant placement after dental trauma: a case report

Anterior teeth are often extracted due to dental trauma, periodontal disease, and other factors. During the healing period of sockets, the loose bundle bone in the buccal side of the anterior teeth usually produces vertical and horizontal bone absorption. How to remain and reconstruct alveolar crest contour in the esthetic zone is a challenge to dentists. In this case, a 26-year-old man reported with the chief complaint of a traumatic fracture in upper front teeth region, accompanied by pain. After examination, he was diagnosed with tooth fracture (11,12 crown-root fracture). The socket shield technique was planned for treatment of tooth 11. Meanwhile, we converted the broken tooth as a temporary crown. After 6 months healing period, a porcelain crown was placed on the custom abutment. Through a 1-year follow-up, the alveolar crest contour was still stable. Consequently, socket shield technique can effectively maintain alveolar crest contour.

Clinical study of dynamic navigation-assisted immediate implant placement in posterior maxillary alveolar bone defects

OBJECTIVE

To evaluate the accuracy and clinical effect of immediate implant placement(IIP) using real-time dynamic navigation in the posterior maxilla with alveolar bone defects.

METHODS

A total of 55 patients with 72 implants placed in the posterior maxillary region with alveolar bone defects were retrospectively analyzed between January 1, 2021, and October 31, 2024. The study was divided into two groups, navigation group and freehand implant group.The preoperative planning implant data and postoperative CBCT data of the actual implant were imported into the dynamic navigation accuracy verification software, and the deviations of the actual implant neck, root, depth and angle were calculated and reported. Clinical indicators including implant deviation, initial stability, implant success were recorded.

RESULTS

There were 38 implants in the navigation group and 34 in the freehand group. All implants were successfully placed without serious complications such as perforation of the maxillary sinus mucosa. The initial stability of the implant in the navigation group was (28.53 ± 5.81)N.cm and (18.47 ± 3.64)N.cm, respectively. The initial stability of the implant in the navigation group was higher than that in the free hand group (P < 0.05). The deviations in the cervical, root, depth, and angulation of the navigation group were all significantly smaller than those of the free-hand implant group, with statistically significant differences (P < 0.05). The median follow-up was 29.6 ± 11.2 months and the implant success rate was 100%.

CONCLUSIONS

Immediate implant placement in the maxillary posterior region with bone deficiency assisted by real-time dynamic navigation can achieve good implant accuracy and satisfactory clinical results.

CLINICAL RELEVANCE

Dynamic navigation is an advantage for the IIP of an alveolar bone defect in the posterior region of the maxilla.

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.

Comparative accuracy of dCAIS and freehand techniques for immediate implant placement in the maxillary aesthetic zone: An in vitro study

OBJECTIVE

To evaluate the accuracy of immediate implant placement in fresh extraction sockets in the maxillary aesthetic zone using a dynamic computer-assisted implant surgery system (dCAIS), with the evaluation of possible deviations versus freehand placement.

METHODS

A total of 18 implants were placed by an experienced surgeon in fresh extraction sockets of anterior teeth in 6 maxillary models. Nine implants were placed using the dCAIS system and 9 implants were placed using the conventional freehand technique. The following outcome parameters were measured and compared: positional deviation at entry, apex point and angular deviations between planned and placed implant position. Surgery time was measured for each procedure. Descriptive and statistical analyses were performed on all outcome parameters.

RESULTS

Global entry deviations were not significantly different between the two techniques (p = 0.078). dCAIS resulted in significantly more accurate implant placement in terms of global apex deviation with values of 1.28±0.36 mm and angular deviations with values of 1.29±0.64°, compared to 2.06±0.60 mm and 5.05±2.54° with freehand placement (p < 0.001). The dental implant placement time was approximately three times longer when using dCAIS (10.99 ± 3.43 min) versus freehand (3.25± 0.63 min) (p < 0.001).

CONCLUSIONS

dCAIS achieved more precise immediate implant placement in terms of apex deviation and angulation than freehand placement, but increased the surgery time.

CLINICAL SIGNIFICANCE

dCAIS provides greater accuracy in the placement of immediate implants in the maxillary aesthetic zone following prosthetic-driven digital planning compared to freehand surgery.

Immediate loading of implants inserted in implant beds prepared with conventional or ultrasonic osteotomy in the esthetic zone: Randomized clinical trial with 12-month follow-up

PURPOSE

This randomized clinical trial compared 12-month outcomes of narrow platform implants (NP) or regular platform implants (RP) in beds prepared with conventional versus ultrasonic osteotomy and immediately loaded.

MATERIALS AND METHODS

Patients requiring narrow (3.0 mm) or regular (3.75 mm) implants in the upper esthetic zone were randomly allocated for conventional (10 NP, 15 RP implants) or ultrasonic (10 NP, 15 RP) osteotomy. Primary and secondary implant stability, operation time, patient discomfort, and probing depths were evaluated after different time periods.

RESULTS

Implant bed preparation time was longer (p < 0.001) with ultrasonic osteotomy versus conventional drilling (CD) in both RP and NP groups. Post-operative pain was lesser with ultrasonic preparation on postsurgical days 1 (p = 0.022) and 7 (p < 0.001) in the RP group and days 1, 4, and 7 (p = 0.015, p = 0.019, p = 0.003) in the NP group. Secondary stability at 3 months was higher in the NP group with ultrasonic preparation versus CD (p = 0.002). No significant differences in probing depth were found between 3 and 12 months in either group with either technique. The 12-month success rate was 100% in both groups with both preparations.

CONCLUSIONS

Regular diameter implants in beds prepared by ultrasonic osteotomy have comparable primary and secondary stability to those in beds prepared by conventional osteotomy and can be immediately loaded, showing a similar 12-month success rate. Narrow diameter implants placed in beds prepared by ultrasonic osteotomy have comparable primary stability values to those in conventionally prepared beds, but implant stability quotient values were always insufficient for immediate loading.

Global research interest and publication trends on guided surgery in implant dentistry: A metrics-based analysis

STATEMENT OF PROBLEM

Digital surgical guides improve precision by detailing the direction, position, and angle of implants, which reduces surgery time and complications. A bibliometric analysis of guided surgery in implant dentistry is lacking.

PURPOSE

The aim of this metrics-based analysis was to analyze the trends and key characteristics of articles related to guided surgery in implant dentistry.

MATERIAL AND METHODS

The search was conducted in February 2024 on the Web of Science. The main characteristics of the studies were extracted and analyzed. Collaborative networks were generated using the Vosviewer software program. Dimension was consulted to measure Altmetric data. Correlation among data was determined by using the Spearman test.

RESULTS

A total of 799 articles published between 1993 and 2023 were included. Most were case reports or series (n=26) using static guided surgery (n=672), primarily for dental implant placement (n=754). The studies typically employed a combination of cone beam computed tomography (CBCT) and digital scanning (n=316) for surgical planning. The most frequently used software program was coDiagnostiX (n=89), and the most commonly used guide type was the printed guide (n=161). The country with the most articles was the USA (n=137), though Europe stood out as the leading continent (n=398). The Vosviewer demonstrated strong collaborations among authors. According to Dimensions, significant mentions were identified in Mendeley, news outlets, and X.

CONCLUSIONS

An emerging trend in guided implant dentistry research was identified over the past 30 years through the use of software programs and 3D-printers for the fabrication of surgical guides. Europe showed the greatest interest in this topic, predominantly conducting research on static guided surgery for implant placement. Additional clinical studies and systematic reviews are needed.

Contemporary Digital Dentistry for Complex Cases in the Anterior Maxilla

OBJECTIVES

To demonstrate how contemporary digitally driven workflow can enhance outcomes for complex esthetic dental cases, focusing on three distinct clinical scenarios involving implant placement, esthetic crown lengthening, and tooth autotransplantation (ATT).

OVERVIEW

Three multidisciplinary clinical cases demonstrate our contemporary digital workflows, integrating diagnosis, treatment planning, patient communication, and guided execution. The first case involves replacing two anterior central incisors using digital planning, guided surgery, prefabricated customized healing abutments, and a digitally driven restorative process. The second case showcases an esthetic crown-lengthening procedure, where Multifunctional Anatomical Prototypes (MAPs) serve as both mock-up and surgical guides, enhancing patient communication on expected outcomes and ensuring precise tissue management to prevent soft tissue rebound. The final case features a tooth ATT, where virtual surgical planning and 3D-printed tooth replica and guides ensure predictability in the therapeutic outcome. These digitally enabled strategies underscore the predictability and customization achievable with contemporary dental technology.

CONCLUSIONS

Dental treatments in the esthetic zone require meticulous planning and precise execution to achieve controlled results that ensure patient satisfaction and long-term stability. Contemporary Digital Dentistry enhances predictability, creating a pathway that leads to success.

Feasibility of Immediate, Early and Delayed Implant Placement for Single Tooth Replacement in the Premaxilla: A Retrospective Cone-Beam Computed Tomography Study of 100 Cases

AIM

To assess the feasibility of immediate (IIP), early (EIP) and delayed implant placement (DIP) for single tooth replacement in the premaxilla on the basis of the complete indication area of each approach in routine practice.

MATERIALS AND METHODS

Data from 100 patients (59 women, 41 men, all Caucasians) aged between 19 and 81 years old (mean age 51.71) who had been consecutively treated with a single implant in the premaxilla (13-23) in one private periodontal practice were retrospectively collected. Demographic data, diagnostic information and linear measurements were extracted from patient files and CBCTs. The feasibility of IIP, EIP and DIP was assessed for all cases by both authors, based on the following criteria: availability of apical bone, position of the tooth in relation to the morphology of the alveolar process, buccal bone morphology and presence of midfacial recession. The reasons for not being able to perform an approach, and the viable alternatives for each approach were secondary outcomes. DIP was considered to have been preceded by alveolar ridge preservation (ARP).

RESULTS

Ninety-two patients could be treated by means of IIP, EIP or DIP. In eight patients none of these approaches were possible as they required bone augmentation prior to implant placement. Fifty-two patients (95% CI: 42%-62%) could by treated with IIP, 58 (95% CI: 48%-67%) with EIP and 88 (95% CI: 80%-93%) with DIP. The feasibility proportions of IIP and EIP were significantly lower than the one of DIP (p < 0.001). All patients who could be treated with IIP could also be treated with EIP or DIP. Lack of apical bone for implant anchorage was the main reason for not being able to perform IIP and EIP. Complete loss of the buccal bone wall and the need for bone augmentation prior to implant placement were the reasons for not being able to perform DIP.

CONCLUSION

From the results of this retrospective CBCT analysis, DIP is nearly always possible in contrast to IIP and EIP. Therefore, and since it is much easier than IIP and EIP, inexperienced clinicians should mainly focus on ARP and DIP in clinical practice deferring IIP and EIP until more surgical skills have been acquired.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives.

Immediate implant placement in compromised extraction sockets using vestibular socket therapy with acellular dermal matrix versus connective tissue grafts in the esthetic zone: a randomized controlled clinical trial

BACKGROUND

Immediate implant placement (IIP) in compromised extraction sockets poses significant challenges in maintaining the contour and level of mucosal tissues. This study compares the efficacy of vestibular socket therapy (VST) combined with acellular dermal matrix (ADM) versus connective tissue grafts (CTG) in IIP within the esthetic zone.

METHODS

Twenty participants requiring extraction in the maxillary esthetic zone were randomized into two groups: ADM and CTG (n = 10 each). Both groups underwent VST with bone grafting and dental implant placement. Clinical outcomes were evaluated at baseline, 6 months, and 12 months, measuring soft-tissue level and thicknesses, and the radiographic facial alveolar bone thicknesses and height.

RESULTS

Both groups resulted in statistically significant increase in coronal mucosal thickness, facial bone height and thickness over time. CTG showed statistically significant increase at apical mucosal thickness over time, whereas the ADM group had a significantly higher facial bone height after 12 months. No significant differences were observed between groups in mucosal thickness and level at any time point and both groups achieved 100% implant survival.

CONCLUSION

ADM and CTG are both effective for soft tissue augmentation and hard-tissue maintenance in IIP within compromised extraction sockets after 12 months. CTG may offer advantages in apical mucosal thickness, while ADM was associated with greater bone height.

CLINICAL RELEVANCE

Both ADM and CTG effectively enhance soft tissue and maintain hard-tissue levels, with CTG providing better apical mucosal thickness and ADM resulting in greater facial bone height after 12 months. These insights help clinicians to customize treatment plans based on individual goals and patient needs.

Incidence of straight and angulated screw channel following immediate implant placement in esthetic zone: A simulated cone-beam computed tomography study

STATEMENT OF PROBLEM

The demand for immediate implant placement (IIP) in the esthetic zone is rapidly increasing. Despite the treatment's benefits, the sagittal root position often dictates implant angulation, commonly necessitating the use of cement-retained restorations. This study investigates the impact of angulated screw channel on IIP in the esthetic zone.

PURPOSE

The purpose of this cone-beam computed tomography (CBCT) study was to determine the probability of IIP in the esthetic zone, using four different implant angulations.

MATERIALS AND METHODS

A retrospective review of CBCT images was conducted and accessed on 9 June 2021. The midsagittal images of maxillary anterior teeth were input into an implant planning software (Implant Studio®). Bone Level X Straumann® implant (BLX 3.5, 3.75, 4.0, 4.5, 5.0 mm) and Bone Level Tapered implant (BLT 2.9, 3.3 mm) were selected for 3D implant planning of IIP in the esthetic zone. The frequency distribution and probability of IIP were recorded and compared among all maxillary anterior teeth.

RESULTS

CBCT images from 720 teeth (120 patient) were evaluated, revealing an overall probability of IIP in the esthetic zone is 76.11% (548/720). Different implant restoration type was evaluated in this study, with the following results; straight screw-retained prosthesis at 3.47% (19/548), cement-retained prosthesis at 14.59% (80/548) and angle screw-retained prosthesis at 85.40% (468/548).

CONCLUSION

IIP with traditional straight screw-retained prosthesis demonstrated the lowest probability. Nevertheless, the use of angulated screw channels enhances the probability of achieving straight screw-retained prostheses.

CLINICAL IMPLICATIONS

The angulated screw channel is essential for increasing the probability of screw-retained prosthesis in IIP in the esthetic zone. However, limitation in screw angle correction still necessitate the use of cement-retained prostheses for numbers of patients undergoing IIP.

Comparative evaluation of conventional and socket-shield techniques on maxillary esthetics following immediate implant placement in fresh extraction sockets: A randomized controlled trial

Background

Dental implants in fresh extraction sockets of the maxillary esthetic area are technique-sensitive procedures where retaining a buccal root segment can enhance periodontium preservation and esthetics. This study aims to compare marginal bone levels and esthetic outcomes between conventional immediate implant placement and the socket-shield technique in fresh maxillary extraction sockets.

Materials and Methods

Twenty-four patients with type 1 extraction sockets were included in this randomized trial and assigned to either conventional immediate implant placement or the socket-shield technique. Implant survival, crestal bone levels, and pink esthetic scores (PES) were evaluated at 8 months (temporary prosthesis), 12 months, and 36 months (final crowns).

Results

All implant-supported restorations were successful within the study's observation period. The socket-shield technique showed significantly lower marginal bone loss (e.g. 1.40 ± 0.29 mm vs. 1.70 ± 0.36 mm at 36 months; P = 0.040) and superior PES (e.g., 10.50 ± 0.90 vs. 9.36 ± 0.98 at 36 months; P = 0.008) compared to the conventional technique. However, the technique's complexity underscores the need for expertise and careful execution to optimize tissue preservation in the maxillary esthetic zone.

Conclusion

The socket-shield technique better preserves hard and soft tissues around implant-retained prostheses than conventional implant placement in maxillary esthetic regions. Further studies with larger sample sizes and longer follow-up are required to validate these findings.

Management of an extensive soft tissue deficiency prior to immediate implant in the aesthetic zone: a 4-year follow-up

Soft tissue deficiency in a tooth extraction site in the aesthetic area is a common and challenging clinical situation. This case report demonstrates the successful treatment of extensive gingival recession and buccal bone dehiscence associated with a hopeless tooth. Initially, a connective tissue graft was used to cover the root and thicken the soft tissue. After 2 months, the tooth was extracted, an implant was immediately placed, and a temporary restoration was installed. After 3 months, the soft tissue exhibited a natural and harmonious architecture. A custom zirconia abutment and crown were then fabricated and placed. At the 4-year follow-up, the peri-implant tissue displayed satisfactory aesthetics, with a well-structured buccal bone plate and healthy peri-implant indicators. This two-stage approach, addressing gingival recession first and proceeding with immediate implant placement after soft tissue healing, proved to be a safe and effective method with stable long-term results.

Immediate loading of definitive restorations in partially edentulous patients requiring an implant-supported prosthesis: A scoping review

STATEMENT OF PROBLEM

Interest is growing in immediately loading definitive implant-supported prostheses. However, it appears that implant protocols are evolving faster than their scientific validation.

PURPOSE

The purpose of this scoping review was to identify the current trends, feasibility, and clinical outcomes of a specific clinical loading scenario (type A), where a single definitive implant-retained restoration is delivered within 3 days. The focus question was "In partially edentulous patients requiring an implant-retained prosthesis (population), is immediate loading with a definitive restoration (concept) a viable treatment option (context)?"

MATERIAL AND METHODS

An electronic search was conducted in the PubMed, CENTRAL, Scopus, Embase, and Web of Science databases. Two authors independently reviewed the studies, screened titles and abstracts, and performed full-text analysis. Cross-reference checks within the bibliography of included studies, relevant reviews, and guideline were conducted. Bibliometric information and study details were extracted.

RESULTS

The search identified 2568 titles after removing duplicates. Four studies involving 91 participant and 100 implant-retained restorations were included in this scoping review. The selected articles were a randomized controlled trial (RCT), a prospective clinical study, and the remaining 2 were case series. The follow-up periods investigated ranged from 6 to 26 months. All studies evaluated marginal bone loss as a primary outcome, and only 1 implant failure was reported. Patient-reported outcome measures were favorable, and no major biological or technical complications were reported in any study.

CONCLUSIONS

Immediate loading with a definitive restoration within 3 days appears to be a suitable approach in specific clinical situations.

Attitudes of Oral Surgeons and Periodontists towards Immediate Dental Implant Placement

Objectives

This cross-sectional study aimed to evaluate the factors that determine the choice of oral surgeons and periodontists to perform immediate dental implant placement.

Material and Methods

An anonymous survey was carried out from January 6, 2024 to February 29, 2024. The questionnaire was distributed online to Lithuanian specialists - oral surgeons and periodontists, who perform implantation procedures. A total of 186 professionals were included in this survey. Chi-square test, its degrees of freedom was used for the analysis of variables.

Results

The main reason for refusing immediate implant placement is a periapical lesion greater than 5 mm, reported by 91.7% of oral surgeons and 96.9% of periodontists. Good aesthetics and preservation of anatomical structures are identified as an advantage by 99.2% of oral surgeons and 92.3% of periodontists. In the aesthetic zone, for periodontists, the main criterion for choosing a method is the quantitative and qualitative indicators of the soft tissue of the extraction socket 96.9%, and for oral surgeons - the morphology of the bone walls of the socket 87.6%. Only 43.1% of periodontists and 33.9% of oral surgeons are familiar with and use extraction socket morphology assessment classifications for immediate dental implant placement.

Conclusions

Taking into account study's results, it is recommended to adjust the teaching programs at Universities and to increase the knowledge of specialists performing dental implantation procedures, by carrying out continuous educational programs.

Group 5 ITI Consensus Report: Implant placement and loading protocols

OBJECTIVES

Working Group 5 was convened to discuss and find consensus on the topics of implant placement and loading protocols associated with single missing teeth in the anterior maxilla (aesthetic zone). Consensus statements, clinical recommendations, patient perspectives and future research suggestions were developed and presented to the plenary for discussion and approval.

MATERIALS AND METHODS

Two systematic reviews were developed and submitted prior to the conference. The group considered in detail the systematic reviews and developed statements, clinical recommendations, patient perspectives and future research suggestions based on the findings of the reviews and experience of group members. Definitive versions were developed after presentation to and discussion by the plenary.

RESULTS

Five consensus statements were developed and approved from each systematic review. Twelve clinical recommendations were developed by the group based on both reviews and experience. Three patient perspectives were developed, and five suggestions made for future research.

CONCLUSIONS

Based on the findings of the systematic reviews and experience of group members, the Type 1A protocol (immediate placement and immediate loading), when utilized in the anterior maxilla under favorable conditions, is considered predictable and is associated with high survival rates. The procedure is considered clinically viable and is associated with aesthetic outcomes, although surgical, technical, and biological complications can occur.