Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients

Delayed and Immediately Loaded Implants Placed in Fresh Extraction Socket - A Clinical and Radiological Study

Purpose

To present the outcomes of immediately loaded single implants placed in the anterior region compared to conventional protocol.

Methodology

10 patients requiring single anterior tooth extraction was randomised either into immediate or delayed loaded group. Implants were positioned immediately after extraction and prosthesis was providing for the immediately loaded group. The cases were followed up for a period of 9 months at regular 3-month interval after the placement of definitive crowns. The parameters taken were probing depth, pain score and crestal marginal bone loss.

Results

A total of 10 AD1N-Touareg Spiral tapered Implant with spiral tap, 5 immediately loaded and 5 delayed loaded were evaluated. For immediate loaded cases, there was 0.93 ± 0.04 mm bone lost after 3 months, 1.26 ± 0.21 mm after 6 months and 1.72 ± 0.13 mm after 9 months. For delayed loading, there was 0.90 ± 0.02 mm bone lost after 3 months, 1.26 ± 0.15 mm after 6 months and 1.80 ± 0.07 mm after 9 months. Pain and probing depth showed gradual reduction in both the groups during the course of treatment.

Conclusion

In the present study, the success rate and radiographic results of immediate loading of implants in freshly extracted sockets in the anterior region where comparable to those obtained from delayed groups.

Complete-arch fixed reconstruction by means of guided surgery and immediate loading: a retrospective clinical study on 12 patients with 1 year of follow-up

Background

Guided implant surgery is considered as a safe and minimally invasive flapless procedure. However, flapless guided surgery, implant placement in post-extraction sockets and immediate loading of complete-arch fixed reconstructions without artificial gum are still not throughly evaluated. The aim of the present retrospective clinical study was to document the survival and success of complete-arch fixed reconstructions without artificial gum, obtained by means of guided surgery and immediate loading of implants placed also in fresh extraction sockets.

Methods

A total of 12 patients (5 males and 7 females, with a mean age of 50.0 ± 13.8) were enrolled in this study. Implant planning was performed with a guided surgery system (RealGuide®, 3Diemme, Como, Italy), from which 3D-printed surgical templates were fabricated. All implants (Esthetic Line-EL®, C-Tech, Bologna, Italy) were placed through the guides and immediately loaded by means of a temporary fixed full-arch restoration without any artificial gum; the outcome measures were implant stability at placement, implant survival, complications, prosthetic success, soft-tissue stability, and patient satisfaction.

Results

One hundred ten implants (65 of them post-extractive) were placed flapless through a guided surgery procedure and then immediately loaded by means of provisional fixed full arches. Successful implant stability at placement was achieved in all cases. After a provisionalization period of 6 months, 72 fixed prosthetic restorations were delivered. Only 2 implants failed to osseointegrate and had to be removed, in one patient, giving a 1-year implant survival rate of 98.2% (108/110 surviving implants); 8/12 prostheses did not undergo any failure or complication during the entire follow-up period. At the 1-year follow-up control, soft-tissue was stable in all patients and showed satesfactory aesthetic results.

Conclusions

Within the limits of this study, complete-arch fixed reconstruction by means of guided surgery and immediate loading of implants placed in fresh extraction sockets appears to be a reliable and successful procedure. Further long-term prospective studies on a larger sample of patients are needed to confirm these positive outcomes.

Immediately loaded implant-supported full-arches: Peri-implant status after 1-9years in a private practice

OBJECTIVE

Evaluate the peri-implant status on the long-term (1-9years) of patients treated with immediately-loaded full-arch prostheses in a private practice.

METHODS

A retrospective cohort study was carried out in patients consecutively treated with immediately loaded full-arch restorations supported with a minimum of 4 implants (Replace^® Tapered, Nobel Biocare AB) and Multi-Unit conical abutments (MUA^®, Nobel Biocare AB) with a follow-up of over 12months after placement of the final prosthesis.

RESULTS

A total of 378 implants were placed in 56 patients. Forty upper and 32 lower arches were restored, and 16 patients received bimaxillary rehabilitation. The mean duration of follow-up was 50 months, and the implant and patient peri-implantitis prevalences were 14.3% and 50%, respectively. Mucositis affected 56.9% of the implants and 50% of the patients. The survival rate was 96.4% by patient, but reached 99.5% in the implant-based analysis, and the success rate was 95.5% for implants and 80.4% for patients.

CONCLUSIONS

Immediately-loaded full-arch restorations have an acceptable outcome after 1-9years of follow-up. However, the incidence of peri-implant diseases is high, and further research is needed to confirm whether these may compromise the predictability of the prostheses over the long-term.

CLINICAL SIGNIFICANCE

After a mean follow-up of 50months, the incidence of mucositis and peri-implantitis affected the 96.4% and 50% of patients, respectively. However, these results were reduced almost by half when the threshold of bleeding on probing and peri-implant bone loss applied was less strict.

Bimaxillary simultaneous immediate loading of full-arch restorations: A case series

Aim

To describe a bimaxillary simultaneous immediate loading protocol with full-arch implant-supported fixed prostheses.

Material and Methods

A prospective case series of 8 patients who required full-arch rehabilitation was conducted. The main inclusion criteria were patients with teeth that required extraction. At least 1 molar per arch was temporarily employed to stabilize the surgical template and the provisional prosthesis during intraoral relining.

Results

Two upper implants failed in 1 patient. Structural fracture was registered in 3 patients, around 3 months after loading. All of them had bruxism. Three esthetic complications were registered: midline deviation, canting of the oclusal plane and color mismatch.

Conclusions

Although this protocol achieves optimal results, some mechanical complications were encountered. The fracture of the provisional prosthesis is a relatively common mechanical complication but does not seem to jeopardize the final treatment result.

Key words:Implant-supported full-arch, provisional prosthesis fracture, bimaxillary simultaneous rehabilitation, conical abutments.

Immediate implant placement into fresh extraction sockets versus delayed implants into healed sockets: A systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to compare the survival rate of the implants and the peri-implant tissue changes associated with implants inserted in fresh extraction sockets and those inserted in healed sockets. This review has been registered at PROSPERO under the number CRD42016043309. A systematic search was conducted by two reviewers independently in the databases PubMed/MEDLINE, Embase, and the Cochrane Library using different search terms; articles published until November 2016 were searched for. The searches identified 30 eligible studies. A total of 3,049 implants were installed in a total of 1,435 patients with a mean age of 46.68 years and a minimum of 6 months of follow-up. The survival rate of delayed implants (98.38%) was significantly greater than immediate implants (95.21%) (p=.001). For the marginal bone loss (p=.32), implant stability quotients values (p=.44), and pocket probing depth (p=.94) there was no significant difference between the analysed groups. The immediate implants placed in fresh sockets should be performed with caution because of the significantly lower survival rates than delayed implants inserted in healed sockets.

From Guided Surgery to Final Prosthesis with a Fully Digital Procedure: A Prospective Clinical Study on 15 Partially Edentulous Patients

Scope. To demonstrate guided implant placement and the application of fixed, implant-supported prosthetic restorations with a fully digital workflow. Methods. Over a 2-year period, all patients with partial edentulism of the posterior maxilla, in need of fixed implant-supported prostheses, were considered for inclusion in this study. The protocol required intraoral scanning and cone beam computed tomography (CBCT), the superimposition of dental-gingival information on bone anatomy, surgical planning, 3D-printed teeth-supported surgical templates, and modelling and milling of polymethylmethacrylate (PMMA) temporaries for immediate loading. After 3 months, final optical impression was taken and milled zirconia frameworks and 3D-printed models were fabricated. The frameworks were veneered with ceramic and delivered to the patients. Results. Fifteen patients were selected for this study. The surgical templates were stable. Thirty implants were placed (BTK Safe®, BTK, Vicenza, Italy) and immediately loaded with PMMA temporaries. After 3 months, the temporaries were replaced by the final restorations in zirconia-ceramic, fabricated with a fully digital process. At 6 months, none of the patients reported any biological or functional problems with the implant-supported prostheses. Conclusions. The present procedure for fully digital planning of implants and short-span fixed implant-supported restorations has been shown to be reliable. Further studies are needed to validate these results.