Immediate placement of endosseous implants into the extraction sockets

Comprehensive analysis of the maxillary esthetic zone for immediate implant placement using cone beam computed tomography: A study of 352 maxillary images

STATEMENT OF PROBLEM

Previous studies have examined the maxillary esthetic zone for immediate implant placement, but these studies had small sample sizes and did not investigate multiple parameters.

PURPOSE

The purpose of this cross-sectional study was to use cone beam computed tomography (CBCT) to evaluate the sagittal root position (SRP), alveolar bone concavity, labial bone perforation (LBP), and tooth-ridge angle in the maxillary anterior teeth region.

MATERIAL AND METHODS

A total of 352 CBCT images of patients (180 men and 172 women) who visited the dental hospital between 2018 and 2023 were analyzed. The sample included 2112 anterior maxillary teeth. SRP, alveolar bone concavity, tooth ridge angle, and LBP were assessed using virtual implant simulation. The data were analyzed by using chi-squared and kappa tests to analyze distributions and agreement, respectively, dependent and independent t-tests to assess sex and tooth-specific differences, and the Spearman correlation test to explore potential correlations (α<.05).

RESULTS

The CBCT images revealed that the majority of SRP were in Class I (85.4%), with smaller percentages in Class II (12.5%) and Class IV (2.3%); Class III was the least common (1%). The canine exhibited the most significant alveolar bone concavity angle average (149.14 ±6.35 degrees), followed by the lateral incisor (142.32 ±8.7 degrees). The canines had the highest occurrence of LBP (63.1%) (P<.01). Women had a higher frequency of labial bone perforation and deeper alveolar bone concavities than men (P<.01).

CONCLUSIONS

The findings of this study indicate that careful assessment and planning are necessary for immediate implant placement in the maxillary anterior region. The significant occurrence of LBP highlights the importance of thorough planning and evaluation to avoid surgical mishaps and complications which may necessitate bone grafting and result in added costs and time. Special attention should be given to women and the canine area.

Clinical outcomes of 3-5 years follow-up of immediate implant placement in posterior teeth: a prospective study

BACKGROUND

Immediate implant placement in posterior teeth has become popular in recent years. However, only a few studies focused on evaluating the long-term success of immediate implant placement.

PURPOSE

To analyze the clinical outcomes of immediate implant placement in the posterior region with conventional loading with 3-5 years follow-up following the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference.

METHOD

The study was done in 25 bone-level implants (Straumann® SLActive® bone level tapered implant, Straumann®, Basel, Switzerland) in 19 patients who underwent immediate implant placement in a posterior tooth with conventional loading with 3-5 years follow-up. The overall success and survival of these placements were evaluated following the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference using chart records, clinical examination, radiographic evaluation, and outcomes measurement. Patient satisfaction was evaluated by using a numeric rating scale. The biological and technical status, modified Pink Esthetic Score (mPES), complications, and marginal bone change were also evaluated. The analysis was done using SPSS version 21 (SPSS Inc., Chicago, IL, USA). The data were analyzed using a paired samples t-test.

RESULTS

It was found that 24 out of the 25 (96%) dental implants survived for an average of 57 ± 8.07 months. All of the 24 surviving dental implants were considered an operational success. The average mPES was 9.75 ± 0.44. The major prosthetic complications seen were: (1) proximal contact loss (41.67%), (2) loosening of the screw (8.33%), and (3) cement debonding (4.17%).

CONCLUSIONS

Immediate implant placement in a posterior tooth with conventional loading yields a predictable result with some complications. The most prominent complications were proximal contact loss, followed by loosening of the screw and cement debonding. The implant survival rate was 96% at a mean time follow-up of 4 years and 9 months.

One-Stage Approach to Rehabilitate a Hopeless Tooth in the Maxilla by Means of Immediate Dentoalveolar Restoration: Surgical and Prosthetic Considerations

Contemporary dentistry has increased the demand for predictable functional and esthetic results in a short period of time without compromising the long-term success of rehabilitation. Recent advances in surgical techniques have provided alternatives that allow the prosthetic rehabilitation of complex implant-supported cases through minimally invasive techniques. In this context, immediate dentoalveolar restoration (IDR) was described aiming at restoring function and esthetics through the reconstruction of lost periodontal tissues followed by immediate implant placement in order to minimize treatment time and surgical morbidity in a one-stage approach. Therefore, the aim of this clinical case is to describe the reconstruction and rehabilitation of a hopeless tooth in the maxillary region in a one-stage approach by means of IDR. The proposed steps to rehabilitate the case involved atraumatic dental extraction, immediate implant placement, and hard tissue augmentation by means of cortical-medullary bone graft harvested from the maxillary tuberosity. Afterwards, a provisional restoration was manufactured and installed to the implant allowing immediate prosthesis provisionalization and function in the same operatory time. Six months after the surgical procedure, the final prosthesis was manufactured and installed. The follow-up of nine years demonstrated the preservation of hard and soft tissue without tissue alteration and a successful esthetic outcome. The surgical protocol used allowed the ideal three-dimensional placement of the implant with the restoration of the bone buccal wall, favoring the esthetic and functional outcome of the case with harmony between white and pink esthetics. In conclusion, the employed treatment validated immediate implant-supported restoration of the missing tooth with high predictability. Furthermore, this protocol resulted in fewer surgical interventions, regeneration, and preservation of peri-implant tissues reaching the patient's expectations.

Complications following alveolar ridge augmentation procedures

Oral rehabilitation through implant supported dental restorations often requires a ridge augmentation procedure (RAP) prior to implant fixture placement since tooth extraction/loss results in alveolar ridge deficiencies. Although RAP-related surgical techniques and biomaterials have been in practice for several decades, outcomes are not always predictable. Post-surgical complications experienced during the early or late wound healing phases may jeopardize the targeted ideal ridge dimensions, required for implant fixture placement, and may have other consequences, such as negatively impacting the patient's quality of life. This review describes reported post-surgical complications following RAP under the following subtitles: complications by tissue type, complications in function and aesthetics, complications by healing time, complications by biomaterial type, and complications by surgical protocol modalities. Specifically, RAP performed by using particulate bone graft substitutes and related complications are explored. Modalities developed to prevent/manage these complications are also discussed.

Graftless Immediate Dual Implant Anatomic Placement With Immediate Provisional Passive Loading and Definitive Hybrid Crown for the Restoration of Mandibular Molar: A Clinical Report

Immediate implant placement is well-known science and treatment in implant dentistry. It is a multitasking treatment consisting of surgical, prosthodontic, and periodontal aspects, implemented to obtain long-term clinically esthetic and functioning prosthesis. Immediate placement enables clinicians to reduce the number of surgical steps and shorter treatment duration. It has become a standard surgical protocol in modern implant practice. According to existing literature, dual implant placement can be done to avoid any cantilever effect in a single implant and to distribute masticatory forces. This clinical report describes the extraction of an infected mandibular right first molar, (46, Federation Dentaire Internationale) followed by immediate dual placement of dental implants in the rinsed and cleansed sockets. The tooth was atraumatically extracted from the socket, and the latter was prepared to the required depth, and endosseous implants were placed in both the mesial and distal sockets. This atraumatic graft-free operating technique and immediate placement resulted in the preservation of hard and soft tissues. It also increased the patient's comfort, acceptance, and satisfaction due to immediate loading with a provisional removable prosthesis. This was later replaced with a dual screw-retained hybrid implant crown.

Antibiotic Use in Dental Implant Procedures: A Systematic Review and Meta-Analysis

Background and Objectives: This project was developed from anecdotal evidence of varied practices around antibiotic prescribing in dental procedures. The aim of the study was to ascertain if there is evidence to support whether antibiotic (AB) use can effectively reduce postoperative infections after dental implant placements (DIPs). Materials and Methods: Following PRISMA-P© methodology, a systematic review of randomised controlled clinical trials was designed and registered on the PROSPERO© database. Searches were performed using PubMed®, Science Direct® and the Cochrane© Database, plus the bibliographies of studies identified. The efficacy of prophylactic antibiotics, independent of the regimen used, versus a placebo, control or no therapy based on implant failure due to infection was the primary measured outcome. Secondary outcomes were other post-surgical complications due to infection and AB adverse events. Results: Twelve RCTs were identified and analysed. Antibiotic use was reported to be statistically significant in preventing infection (p < 001). The prevention of complications was not statistically significant (p = 0.96), and the NNT was >5 (14 and 2523 respectively), which indicates that the intervention was not sufficiently effective to justify its use. The occurrence of side effects was not statistically significant (p = 0.63). NNH was 528 indicating that possible harm caused by the use of ABs is very small and does not negate the AB use when indicated. Conclusion: The routine use of prophylactic antibiotics to prevent infection in dental implant placement was found to be not sufficiently effective to justify routine use. Clear clinical assessment pathways, such as those used for medical conditions, based on the patients’ age, dental risk factors, such as oral health and bone health, physical risk factors, such as chronic or long-term conditions and modifiable health determinants, such as smoking, are required to prevent the unnecessary use of antibiotics.

Comparison of the effects of two extraction methods on the alveolar ridge preservation of Maxillary Anterior Teeth

Objective

To compare the effects of high-speed turbodrill root extraction and piezosurgery tooth socket enlargement on the alveolar ridge preservation of maxillary anterior teeth.

Methods

Thirty-six clinically eligible patients admitted to the No.2 Hospital of Baoding or the Baoding First Central Hospital from January 2018 to November 2019 were selected and randomly divided into two groups. Group-A were extracted by high-speed turbodrill root extraction, while Group-B were extracted by piezosurgery tooth socket enlargement. After extraction, GBR bone grafting and soft tissue transplantation were performed on the extraction sockets. The extraction time, integrity rate of labial bone plate of the extraction socket, pain-free rate, satisfaction rate, reduction of the height and width of the alveolar ridge, alveolar bone mineral density score, and new bone contour score of the alveolar bone of two groups were compared.

Result

Group-B was significantly superior to Group-A in terms of tooth extraction time, pain-free rate, satisfaction rate and reduction of alveolar ridge height at three sites on the palatal side, with a statistically significant difference (p<0.05).

Conclusions

Piezosurgery tooth socket enlargement is more worthy of clinical application due to its advantages of less impact on the preservation of the palatal alveolar ridge height of the maxillary anterior teeth, shorter tooth extraction time, postoperative pain-free rate and high final satisfaction rate.

An innovative application of pre-medicated collagen sponges with regenerative biomaterials for management of an infected extraction socket: A case report

Localized infection of the extraction socket can compromise bone quality and quantity within the socket and bone support for the adjacent dentition. These events can preclude immediate rehabilitative interventions, such as implant placement, and increase the technical sensitivity of guided bone regeneration procedures for successful tissue and bone gain. The use of local scaffolds containing effective antimicrobial agents may suppress local infection and facilitate the regenerative process related to the introduced bone graft particles and barrier collagen membrane. In this case report, pre-medicated collagen sponges containing chlorhexidine and metronidazole were used in conjunction with a bone graft and collagen membrane for guided tissue and bone regeneration, which was followed by delayed implant placement with 2 years of follow-up evaluations.

Lipid Nanocarriers-Loaded Nanocomposite as a Suitable Platform to Release Antibacterial and Antioxidant Agents for Immediate Dental Implant Placement Restorative Treatment

Immediate implant placement is a single-stage restorative approach for missing teeth widely used to overcome the ridge remodeling process occurring after dental extractions. The success of this procedure relies on opportune osseointegration in the surrounding tissues. To support this process, a multifunctional nanocomposite, to be applied in the fresh post-extraction socket, was here designed, prepared, and characterized. This formulation consists of quercetin (QRC)-loaded nanostructured lipid carriers (NLCs) entrapped in a chitosan-based solid matrix containing ciprofloxacin (CPX). QRC-NLCs were prepared by homogenization followed by high-frequency sonication, and thereafter this dispersion was trapped in a chitosan-based CPX-loaded gel, obtaining the nanocomposite powder (BioQ-CPX) by lyophilization. BioQ-CPX displayed desirable properties such as high porosity (94.1 ± 0.5%), drug amounts (2.1% QRC and 3.5% CPX). and low swelling index (100%). Moreover, the mechanism of drug release from BioQ-CPX and their ability to be accumulated in the target tissue were in vitro and ex vivo elucidated, also by applying mathematical models. When trapped into the nanocomposite, QRC stressed under UV light exposure (50 W) was shown to maintain its antioxidant power, and CPX and QRC under natural light were stable over nine months. Finally, both the measured antioxidant power and the antimicrobial and antibiofilm properties on Staphylococcus aureus demonstrated that BioQ-CPX could be a promising platform to support the single-stage dental restorative treatment.

Improvement of Osseointegration by Ultraviolet and/or Simvastatin Treatment on Titanium Implants with or without Bone Graft Materials

We evaluated and compared ultraviolet (UV) treatment and simvastatin (SIM) immersion effects on the osseointegration of sandblasted, large-grit, acid-etched (SLA) titanium dental implants at two different time points in rabbit tibias, with or without xenogenic bone graft materials. The surface alteration on simvastatin treatment titanium discs was analyzed using an infrared spectrometer. Implants were categorized into four groups according to the surface treatment type. Twelve rabbits received two implants per tibia. A tibial defect model was created using a trephine bur, with implants in contact with the bone surface and bovine bone graft materials for gap filling. The rabbits were sacrificed after 2 or 4 weeks. UV treatment or SIM immersion increased the bone-to-implant contact (BIC) on nongrafted sides, and both increased the BIC and bone area (BA) on grafted sides. The application of both treatments did not result in higher BIC or BA than a single treatment. At two different time points, BIC in the nongrafted sides did not differ significantly among the UV and/or SIM treated groups, whereas BA differed significantly. UV or SIM treatment of SLA titanium implants accelerates osseointegration in tibias with or without xenogenic bone graft materials. The combination of both treatments did not show synergy.

Effect of Porous Microstructures on the Biomechanical Characteristics of a Root Analogue Implant: An Animal Study and a Finite Element Analysis

BACKGROUND

Full ceramic or metal custom-made root analogue implants (RAIs) are made by replicating the natural tooth geometry. However, it may lead to the stress shielding of the surrounding bone, and an RAI is unable to easily achieve primary stability. Therefore, to improve primary stability and reduce stress shielding, RAI porous structures are proposed. The purpose of this study was to evaluate the effect of porous microstructures on the biomechanical characteristics of the custom-made RAI.

METHODS

Porous and bulk titanium cylinders and porous RAI and conventional implants for in vivo tests were fabricated using a selective laser melting (SLM) technology. The elastic modulus and the compressive strength of porous titanium cylinders were evaluated. These samples were then implanted into rabbit femurs (cylinders) and beagle dog mandibles (RAI and conventional implants). A simplified three-dimensional geometry of the anterior maxilla of a patient was constructed. Then, based on the extracted standard template library (STL) data, five different RAI models were constructed: (A) smooth surface, (B) pit surface, (C) bulb surface, (D) threaded surface, and (E) porous surface. A conventional implant model was also constructed. A static load of 100 N was applied to the crown in the multivectoral direction.

RESULTS

The results of the in vivo experiment confirmed that the porous structure decreased the elastic modulus of Ti6Al4V. Additionally, the implantation of the porous custom-made RAIs resulted in increased new bone ingrowth and decreased bone resorption compared to conventional implants. Moreover, the 3D finite element analysis suggested that the bone surrounding porous custom-made RAIs was subjected to a more uniform stress distribution, and the strain values of the surrounding bone were more conducive to bone formation.

CONCLUSION

Based on these findings, a custom-made RAI with a porous surface accelerates bone formation and might reduce the stress-shielding effect.

The clinical significance of implant stability quotient (ISQ) measurements: A literature review

Implant stability quotients (ISQ values) are obtained in dental clinical practice on a non-invasive basis by resonance frequency measurement rapidly after surgical placement of implants. The ISQ-values are used as indicator for mechanical implant stability, and are believed to have predictive power for clinical outcome. It is the aim of this review to provide a synopsis of all factors described in the literature that influence ISQ measurements by performing an exhaustive literature review; moreover, this review aims at elucidating the key factors relevant for a rapid clinical predictive assessment. We searched systematically and exhaustively all major databases for publications relating to ISQ measurement methodology and for ISQ-influencing factor analyses. The reports identified were ordered in experimental (preclinical) studies and in clinical publications. We were able to identify 13 basic factors influencing ISQ-measurements. Among these, local bone quality, playing a key role in such measurements, was subdivided in four specific subfactors; thus a total of 17 individual factors was identified and reported to influence ISQ-measurements. A comprehensive list of these factors is provided in Table-form. A critical analysis points out that only 6 of these factors are of a sound predictive power useful for a rapid clinical assessment; and only two of these factors appear to have a well-documented scientific basis.

Immediate Implant Placement in Non-Infected Sockets versus Infected Sockets: a Systematic Review and Meta-Analysis

Objectives

The aim of this systematic review is to compare immediate implant placement in infected extraction sockets with non-infected extraction sockets in terms of implant survival and function.

Material and Methods

An electronic search was conducted in PubMed, ScienceDirect, ISI Web of Knowledge and Google Scholar between January 2010 and February 2020. Studies evaluating implant survival rate and main clinical parameters were included for a qualitative and quantitative analysis.

Results

In total, nine studies were included and a pool of 2281 sockets were analysed. Compared with the non-infected group, the infected group showed no significant differences in implant survival rates (risk ratio [RR] = 0.99; 95% confidence interval [CI] = 0.98 to 1; P = 0.08). No significant statistical differences were found in marginal bone level (mean difference [MD] = -0.03; 95% CI = -0.1 to 0.04; P = 0.41), marginal gingival level (MD = -0.07; 95% CI = -0.17 to 0.04; P = 0.23), probing depth (MD = 0.06; 95% CI = -0.24 to 0.36; P = 0.7), modified bleeding index (MD = -0.00162196; 95% CI = -0.09 to 0.09; P = 0.97) and slight but significant changes were seen in width of keratinized gingiva (MD = 0.25; 95% CI = -0.3 to 0.8; P = 0.38) between the groups at the latest follow-up.

Conclusions

There were no significant difference in implant survival rates, marginal bone level, marginal gingival level, modified bleeding index and probing depth between infected sockets and non-infected sockets. However, slight but significant changes were seen in width of keratinized gingiva favouring the non-infected group.

The role of TiO2 nanotube surface on osseointegration of titanium implants: Biomechanical and histological study in rats

The nanoscale surface of titanium has been studied to improve the cellular recognition of the biological microenvironment and to increase bone-implant interaction. The aim of this study was to analyze the effect of a titanium oxide (TiO₂ ) nanotube surface with a machined surface on osseointegration tibia implants without primary stability. This study used an experimental design, divided into two groups (n = 16): commercially pure titanium machined implants (Cp-Ti Ma) and commercially pure titanium anodized implants (Cp-Ti An). Titanium nanotubes were produced by anodic oxidation, and the topography of surface was analyzed using field emission scanning microscope (FE-SEM). The implants (2.1 × 2.8 mm Ø) were surgically placed in the right tibia (defects with milling drill 2.5 × 3.2 mm Ø) of 32 Wistar male rats (250-300 g). The animals were euthanized at 7 weeks postoperatively. The maximum value of removal torque was measured (N/cm) in the right tibia half of each group (8 animals/8 tibiae); the other half of each group underwent a nondecalcified protocol, stained with Stevenel blue/Alizarin red, and the formation of bone tissue in close contact to the implant was measured. The obtained data were analyzed statistically (t test). Differences were considered statistically significant for α < 0.05. Cp-Ti An implants were significantly higher in removal torque and peri-implant bone healing compared with Cp-Ti Ma implants (p < .01). Within the limitations of this study, it was observed that the surface modification of titanium by anodization (TiO₂ nanotubes) can improve osseointegration, and this may be very useful to reduce the time required for peri-implant bone formation.

Immediate placement of tapered implants with a moderately rough anodized surface and smooth collar in fresh extraction sockets: A retrospective analysis with 10-year follow-up

BACKGROUND

There is limited long-term data on hard- and soft-tissue outcomes of implants immediately placed in postextraction sockets with immediate or early loading.

PURPOSE

To evaluate the clinical outcomes of immediately placed anodized tapered implants in consecutive patients with at least 10 years of follow up.

MATERIALS AND METHODS

This retrospective analysis evaluated outcomes of 61 consecutive patients who received 89 tapered implants with an anodized implant body and machined collar. Implants were placed in fresh extraction sites and functionalized using an immediate- or early-loading protocol. Outcome measures included survival, marginal bone level change (ΔMBL), and papilla index.

RESULTS

The 10-year cumulative survival rate was 100%. ΔMBL at the 10-year follow up was -0.86 ± 2.10 mm. At 10 years, patients had mesial and distal papilla index scores of 2 or 3 for 95.9% and 87.8% of implants, respectively.

CONCLUSIONS

When used for immediate placement and immediate- or early-loading protocols, this implant produced excellent long-term hard- and soft-tissue outcomes.