Immediate placement and loading of maxillary single-tooth implants: a 3-year prospective study of marginal bone level

Clinical and Radiographic Evaluation of Soft Tissue and Bone Status in Immediate Loaded Implants Placed Following Their Extraction in the Maxillary Anterior Region

INTRODUCTION

In the maxillary anterior region, teeth extraction leads to significant soft and hard tissue changes. Immediate implant placement following extraction aims to reduce bone loss and overall treatment time. However, it may result in adverse soft tissue changes impacting esthetics. This study evaluates the clinical and radiographic outcomes of immediately loaded implants in the maxillary anterior region, focusing on soft tissue preservation and bone status.

MATERIALS AND METHODS

This study, conducted from April 2022 to August 2024 at the Department of Oral and Maxillofacial Surgery, Ragas Dental College and Hospital, included 10 immediately loaded implants in seven patients. Following atraumatic extraction, implants were placed and loaded with functional provisional crowns fabricated using three-dimensional (3D) rapid prototyping models. Parameters such as crestal bone loss, buccal and palatal bone width, and interdental papilla thickness were evaluated preoperatively and postoperatively using radiographs and clinical assessments.

RESULTS

The study found significant crestal bone loss at both mesial and distal sites over time, with the greatest loss observed at the three-month follow-up. Buccal and palatal bone width showed no significant differences preoperatively and postoperatively. Interdental papilla thickness and overall pink esthetic scores also showed no significant differences between preoperative and postoperative evaluations.

CONCLUSION

Immediate implant placement in the maxillary anterior region, using 3D rapid prototyping for custom splint fabrication, demonstrated effective preservation of soft tissue profile and bone architecture. This approach provides functional and esthetic benefits, although careful monitoring of crestal bone loss is necessary.

A one-piece CAD-CAM printed custom implant healing abutment: A dental technique

This clinical technique describes a method of fabricating a 1-piece computer-aided design and computer-aided manufacturing (CAD-CAM) printed custom healing abutment. A digital surgical guide and a virtual model based on the proposed implant position were generated. Then, a digitally designed healing abutment was fabricated using the Dental Designer software program. The definitive abutment design was printed from an interim crown resin material. The described method combines the guided implant placement and a 1-piece CAD-CAM printed custom healing abutment to develop appropriate tissue contours.

Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level

AIM

The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment.

MATERIALS AND METHODS

A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading.

RESULTS

Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years.

CONCLUSION

The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level.

CLINICAL SIGNIFICANCE

Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

One-time versus repeated abutment connection for platform-switched implant: A systematic review and meta-analysis

Objective

This review aims to compare peri-implant tissue changes in terms of clinical and radiographic aspects of implant restoration protocol using one-time abutment to repeated abutment connection in platform switched implant.

Method

A structured search strategy was applied to three electronic databases, namely, Pubmed, Embase and Web of Science. Eight eligible studies, including seven randomised controlled studies and one controlled clinical study, were identified in accordance with inclusion/exclusion criteria. Outcome measures included peri-implant bone changes (mm), peri-implant soft tissue changes (mm), probing depth (mm) and postsurgical complications.

Result

Six studies were pooled for meta-analysis on bone tissue, three for soft tissue, two for probing depth and four for postsurgical complications. A total of 197 implants were placed in one-time abutment group, whereas 214 implants were included in repeated abutment group. The implant systems included Global implants, Ankylos, JDEvolution (JdentalCare), Straumann Bone level and Conelog-Screwline. One-time abutment group showed significantly better outcomes than repeated abutment group, as measured in the standardised differences in mean values (fixed- and random-effect model): vertical bone change (0.41, 3.23) in 6 months, (1.51, 14.81) in 12 months and (2.47, 2.47) in 3 years and soft tissue change (0.21, 0.23). No significant difference was observed in terms of probing depth and complications.

Conclusion

Our meta-analysis revealed that implant restoration protocol using one-time abutment is superior to repeated abutment for platform switched implant because of less bone resorption and soft tissue shifts in former. However, future randomised clinical trials should be conducted to further confirm these findings because of the small samples and the limited quality of the original research.

Definitive Abutments Placed at Implant Insertion and Never Removed: Is It an Effective Approach? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

To assess whether repeated abutment disconnections and reconnections have any impact on peri-implant bone resorption and soft tissue healing.

MATERIALS AND METHODS

Electronic and manual searches were conducted for English-language articles published up to March 2017 that identified a relation between repeated disconnections of implant abutments (PA group) and prosthetic or implant failures, complications, marginal bone loss (MBL), soft tissue healing, and esthetic evaluation (pink esthetic score [PES]) after at least 1 year of function compared with implants receiving a final abutment at the time of implant placement (DA group).

RESULTS

Fourteen articles (535 patients with 994 implants) were selected for qualitative analysis. Six of these were included in the meta-analysis. Five prostheses failed in the PA group and 1 failed in the DA group (P = .1047). Seven biologic complications occurred in the PA group and 6 occurred in the DA group (P = .8121). MBL was significantly less in the DA group (difference, 0.279 mm; P = .000). Greater buccal recession occurred in the PA group (difference, 0.198 mm; P = .0004). The PES evaluation showed no differences between groups (P = .289).

CONCLUSIONS

Repeated abutment disconnections and reconnections considerably increased MBL and buccal recession. Further studies are needed to confirm these results.

Classification of the Root Position of the Maxillary Central Incisors and its Clinical Significance in Immediate Implant Placement

PURPOSE

The aim was to classify the relationship of the sagittal root positions of the maxillary central incisor to alveolar bone using cone beam computed tomography (CBCT).

METHODS

CBCT images of 934 maxillary central incisors were retrospectively reviewed included 542 men and 392 women. The sagittal root position in the alveolar bone was classified as buccal, middle, or palatal. The sagittal buccal type was further classified into 3 subtypes: I, II, and III.

RESULTS

The root position type was buccal in 95.4% of the 934 incisors, middle in 4.4%, and palatal in 0.2%. In the buccal type, 47.5%, 44.2%, and 8.3% were subtypes I, II, and III, respectively. There was no significant difference in the major and subtypes of root position between the male and female subjects (both P > 0.05).

CONCLUSIONS

In Chinese adults, the predominant type of sagittal root position of the maxillary central incisor is buccal. This classification system is useful in planning the implant site for immediate placement in the maxillary esthetic zone.