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de Araújo Nobre M, Santos D, Ferro A, Lopes A, Antunes CJ, Vitor I. Five- and 18-Year Outcome of Two Cases with Full-Arch Rehabilitations Ad modum All-on-4 in the Presence of Challenging Conditions. Eur J Dent 2024. [PMID: 39043210 DOI: 10.1055/s-0044-1787961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024] Open
Abstract
Placing implants in fresh postextraction sites is a borderline rehabilitation procedure. The purpose of this report is to describe the pre-, per-, and postoperative procedures for maintaining long-term stability of two full-arch rehabilitations through the All-on-4 protocol, performed in the presence of challenging conditions. Two patients were referred for full-arch rehabilitation with immediate function, with both patients presenting infection in the jaws: patient 1 with an implant (position #45) inserted in a cystic cavity; patient 2 with one implant (position #24) inserted transsinus after the removal of a cyst on the base of the maxillary sinus and another implant (position #15) inserted with a dehiscence. Both patients received a preoperative dental hygiene appointment, a regenerative surgical protocol, and were enrolled in a postoperative maintenance protocol. After surgery a provisional prosthesis was provided ensuring immediate function, and 6 months after surgery, the final prosthesis was delivered. During the follow-up appointments (final follow-up at 5 and 18 years), the implants were stable, and no infection was observed for both patients. The present case report describes two full-arch rehabilitations in immediate function, supported by dental implants inserted in the presence of challenging conditions that do not represent the norm, rather are highly demanding for the clinical team, warranting caution in the interpretation of the results.
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Affiliation(s)
| | - Diogo Santos
- Department of Oral Surgery, Maló Clinic, Lisbon, Portugal
| | - Ana Ferro
- Department of Oral Surgery, Maló Clinic, Lisbon, Portugal
| | - Armando Lopes
- Department of Oral Surgery, Maló Clinic, Lisbon, Portugal
| | | | - Inês Vitor
- Department of Research, Development and Education, Maló Clinic, Lisbon, Portugal
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Fujii M, Nakano T, Ishigaki S. Pre- and Postoperative Evaluation of Immediate and Early Implant Placement in Esthetic Areas with Pre-Extraction Facial Dehiscence: A Retrospective Clinical Study. J Clin Med 2023; 12:6616. [PMID: 37892753 PMCID: PMC10607583 DOI: 10.3390/jcm12206616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.
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Affiliation(s)
| | - Tamaki Nakano
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan; (M.F.); (S.I.)
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Hamilton A, Gonzaga L, Amorim K, Wittneben JG, Martig L, Morton D, Martin W, Gallucci GO, Wismeijer D. Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:304-348. [PMID: 37750515 DOI: 10.1111/clr.14109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone. MATERIALS AND METHODS An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias-corrected and study size-weighed bootstrap tests. A study time-correcting meta-analysis was then performed to obtain an overall effect for the study pool. RESULTS A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow-up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of -1.9 percentage points [PP], 95% CI: [-0.3, -4.0], p = .02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p = .04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p = .004). CONCLUSIONS Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments.
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Affiliation(s)
- Adam Hamilton
- Division of Oral Restorative and Rehabilitative Sciences, University of Western Australia, Perth, Western Australia, Australia
- Division of Regenerative and Implant Sciences, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Luiz Gonzaga
- Center for Implant Dentistry, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - Karina Amorim
- Center for Implant Dentistry, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | | | | | - Dean Morton
- Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - William Martin
- Center for Implant Dentistry, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, Florida, USA
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Amid R, Kadkhodazadeh M, Moscowchi A. Immediate implant placement in compromised sockets: A systematic review and meta-analysis. J Prosthet Dent 2023; 130:307-317. [PMID: 34772483 DOI: 10.1016/j.prosdent.2021.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM Immediate implant placement provides a popular therapeutic option. However, compromised sockets may jeopardize the treatment outcome. PURPOSE The purpose of this systematic review and meta-analysis was to investigate the treatment outcome in terms of the implant survival rate and success parameters of immediate implant placement in compromised extraction sockets. MATERIAL AND METHODS An electronic search was conducted in PubMed, Embase, Cochrane Library, and ISI Web of Science up to January 2021. Studies evaluating implant survival rate and main success parameters were included for a qualitative and quantitative analysis (risk ratio and mean difference). RESULTS In total, 43 studies with analysis of 4825 sockets were included. Compared with the noncompromised sockets, the compromised group showed no significant differences in implant survival rates (risk ratio=0.992; 95% confidence interval (CI)=0.979 to 1.005; P=.246). No significant statistical differences were found in marginal bone level at ≤12 months (mean difference [MD]=0.033; 95% CI=-0.012 to 0.078; P=.154) or esthetic parameters. CONCLUSIONS Immediate implant placement in compromised sites does not appear to decrease the survival and success rates. However, randomized clinical trials with large sample sizes should be conducted to draw a definite conclusion about the efficacy and safety of this treatment protocol in compromised sockets.
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Affiliation(s)
- Reza Amid
- Associate Professor, Department of Periodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Kadkhodazadeh
- Professor, Department of Periodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anahita Moscowchi
- Assistant Professor, Department of Periodontics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Sarafidou K, Lazaridi I, Gotsis S, Kirmanidou Y, Vasilaki D, Hirayama H, Michalakis K. Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies. J Prosthodont 2022; 31:e87-e99. [PMID: 35794083 DOI: 10.1111/jopr.13560] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/11/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify studies with a minimum of 5-years follow-up, reporting on the management of periodontally compromised teeth with either extraction and subsequent implant placement or teeth preservation with conventional periodontal treatment and application of regenerative procedures. The outcomes of these two approaches, based on clinical and radiographic data and the incidence of tooth- and implant-loss, were also investigated. MATERIAL AND METHODS A systematic search for studies reporting on clinical and radiographic outcomes of periodontal treatment or replacement of periodontally compromised teeth with implants was conducted in 3 electronic databases, followed by a hand-search in 8 journals. Only randomized controlled trials (RCTs), cohort studies, and case series with prospective design were included. RESULTS The initial search resulted in 1080 papers. After the first two screenings, 24 publications were selected for inclusion in this systematic review. The treatment protocols for the teeth preservation group contained nonsurgical and/or surgical periodontal treatment with or without regeneration procedures. The implant studies included extraction of periodontally involved teeth and implant placement with or without bone and soft tissue augmentation, followed by restoration with fixed dental prostheses (FDPs). Survival rates ranged between 81.8% and 100% in the tooth retention group, and between 94.8% and 100% in the implant group. In the extraction group, no complications were reported for 76.09% of the implants. Similarly, no complications were reported for 86.83% of the tooth retention group. The lack of standardized comparable studies prohibited conduction of a metaanalysis. CONCLUSION Both treatment approaches, treatment of periodontally compromised teeth, or tooth extraction followed by implant placement, present high survival rates. The application of bone regeneration techniques improves the long-term prognosis of periodontally involved teeth. Hence, treatment of periodontally involved teeth with subsequent application of a rigorous maintenance protocol can be a viable alternative for a number of years, before proceeding to extraction and replacement with dental implants. More well-designed randomized controlled trials are needed in order to draw definite conclusions on the subject.
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Affiliation(s)
- Katia Sarafidou
- Department of Prosthodontics, Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Dentistry, Thessaloniki, Greece
| | - Ioanna Lazaridi
- Division of Regenerative Dentistry and Periodontology, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sotirios Gotsis
- Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Yvoni Kirmanidou
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Dimitra Vasilaki
- Private Practice limited to Prosthodontics, Thessaloniki, Greece
| | - Hiroshi Hirayama
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA
| | - Konstantinos Michalakis
- Department of Restorative Sciences and Biomaterials, Boston University Henry M. Goldman School of Dental Medicine, Boston, MA, USA
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Mizuno K, Nakano T, Shimomoto T, Fujita Y, Ishigaki S. The efficacy of immediate implant placement in the anterior maxilla with dehiscence in the facial alveolar bone: A case series. Clin Implant Dent Relat Res 2021; 24:72-82. [PMID: 34931737 DOI: 10.1111/cid.13059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is no clear evidence that immediate implant placement can be applied to cases with dehiscence in the facial alveolar bone prior to extraction. PURPOSE To evaluate the results of immediate implant placement in the anterior maxilla with facial alveolar bone dehiscence. MATERIALS AND METHODS We super positioned pre- and post-operative cone-beam computed tomography (CBCT) three-dimensional reconstruction images. A CBCT was taken before tooth extraction (T0), when the definitive restoration was placed (T1), and 1 year after placing the definitive restoration (T2). The depth and width of the dehiscence at T0, and the height and width of the facial hard and soft tissues are measured at the implant site at T1 and T2. We calculated the change in the amount of hard and soft tissues from T1 to T2 and determined the correlation between preoperative facial alveolar bone morphology and postoperative gingival recession. RESULTS 13 women and 7 men were recruited. A total of 20 implants were evaluated. The implant survival rate was 100%. The mean facial alveolar bone dehiscence width was 3.9 ± 1.6 mm, and the mean depth from platform level was 2.9 ± 1.7 mm. The mean implant body exposure on the buccal was 4.8 ± 1.7 mm, and the mean socket width gap was 2.1 ± 0.8 mm. At T1, the mean facial hard tissue width was 2.1 ± 0.7 mm, and the mean height was 2.0 ± 0.7 mm. The mean change in vertical gingival recession from T1 to T2 was 0.5 ± 0.5 mm. We found a positive correlation between facial alveolar bone dehiscence width and gingival recession (r = 0.46, p-value = 0.04) and between dehiscence depth and gingival recession (r = 0.48, p-value = 0.03). CONCLUSIONS The results of our CBCT superposition method indicated that immediate implant placement can be considered in patients with facial alveolar bone dehiscence. However, there may be a higher risk of gingival recession with wide or deep dehiscence.
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Affiliation(s)
- Keiichiro Mizuno
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tamaki Nakano
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takuya Shimomoto
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Yuya Fujita
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
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Rea M, Bengazi F, Velez JU, De Rossi EF, Mainetti T, Botticelli D. Implants placed into alveoli with periapical lesions: an experimental study in dogs. Oral Maxillofac Surg 2020; 25:351-357. [PMID: 33219872 DOI: 10.1007/s10006-020-00926-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To histologically analyze the effect of a curettage of the granulation tissue on healing at implants installed immediately after the extraction of teeth presenting periapical lesions. MATERIAL AND METHODS In seven dogs, the dental pulp was removed from the pulp chamber and from the root canals of the right and left third and the fourth mandibular premolars and of the left second premolar. The chambers were left opened and, after 3 months, apical lesions were present, and the premolars were extracted. One alveolus each premolar was selected and, before implant installation, the apical lesions of two alveoli were curetted (curettage group) while the other three were not treated (no-treatment group). The second right premolar was also extracted (Negative control group). Six implants each dog were installed, and a fully submerged healing was allowed. Four months after, biopsies were collected, and histological analyses were performed. RESULTS The proportions of new bone at the entire body of the implant was 70.2 ± 10.7% at the no-treatment group, 72.1 ± 14.8% at the curettage group, and 69.6 ± 3.7% at the negative control group. The respective new bone proportion at the apical aspect of the implants was 68.4 ± 17.5%, 61.5 ± 27.3%, and 78.1 ± 5.7%. None of the differences among the various groups were statistically significant. No inflammatory infiltrates were seen in the apical region. CONCLUSIONS In this experimental study, it is concluded that the removal of the granulation tissue seems not to be necessary to obtain a proper osseointegration of implants installed immediately after the extraction of teeth presenting a periapical lesion.
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Affiliation(s)
| | - Franco Bengazi
- Faculty of Dentistry, University of Medical Science, La Habana, Cuba
| | | | | | | | - Daniele Botticelli
- ARDEC Academy, Viale Giovanni Pascoli, 67, Rimini, Italy. .,Fundación ARDEC, Cartagena de Indias, Colombia.
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Parvini P, Obreja K, Becker K, Galarraga ME, Schwarz F, Ramanauskaite A. The prevalence of peri-implant disease following immediate implant placement and loading: a cross-sectional analysis after 2 to 10 years. Int J Implant Dent 2020; 6:63. [PMID: 33073302 PMCID: PMC7569077 DOI: 10.1186/s40729-020-00259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the prevalence of peri-implant disease after immediate implant placement and loading. Material and methods This cross-sectional analysis included a total of 47 patients with 64 implants exhibiting a mean loading time of 2 to 10 years (4.23 ± 1.7 years). The surgical and prosthetic procedures were standardized in all patients. Peri-implant health and disease was assessed based on the established case definitions. Results The prevalence of peri-implant health, peri-implant mucositis, and peri-implantitis amounted to 38.3%, 57.5%, and 4.2% of the patients, respectively. Mucosal recession of 1 mm was present at 4 (6%) implants. No suppuration, pain, or implant failures were reported. Ordinal logistic regression revealed that reduced keratinized mucosa height was significantly associated with the diagnosis of peri-implant mucositis and peri-implantitis (OR = 0.514, P = 0.0125). Conclusion Immediate implant placement and loading was associated with high success rates at 2 to 10 years.
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Affiliation(s)
- Puria Parvini
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Karina Obreja
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Kathrin Becker
- Department of Orthodontics, Westdeutsche Kieferklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
| | | | - Frank Schwarz
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
| | - Ausra Ramanauskaite
- Department of Oral Surgery and Implantology, Johann Wolfgang Goethe-University, Carolinum, Frankfurt am Main, Germany
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Management of Postsurgical Complication in Multiple Implant-Infected Postextraction Sites in the Lower Arch. Int J Dent 2020; 2020:8869046. [PMID: 33061974 PMCID: PMC7542513 DOI: 10.1155/2020/8869046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 11/17/2022] Open
Abstract
Currently, dental implants are a very frequent therapeutic alternative for replacing missing teeth. However, they are not exempt from developing complications of infectious origin. Therefore, this case report describes a 67-year-old female patient presenting infectious complications caused by suture rupture. Surgery combined with therapeutic management with antibiotics was performed, allowing preservation of the osseointegration of the implants in the lower arch. Within the limitations of this study, it was shown that more research is needed to determine the success and survival of implants presenting complications due to infections during the osseointegration process.
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Sisli SN, Pektas ZO. What Is the Role of Endodontic Predisposing Factors in Early Implant Failure? J ORAL IMPLANTOL 2020; 46:491-495. [PMID: 32315422 DOI: 10.1563/aaid-joi-d-19-00141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to investigate a possible relationship between early implant failure (EIF) and an adjacent root canal-treated tooth and/or tooth with a periapical lesion (PL), considering the duration between implantation and root canal treatment (RCT). The importance of prior RCT and/or presence of a PL before implantation was also investigated. A total of 810 implants from 342 patients were included and scored according to the implant failure before abutment connection, adjacent root canal treated teeth, adjacent teeth without RCT, no adjacent teeth, adjacent teeth with PL, extraction of teeth with PL, and/or RCT before implantation. The durations between the extraction and implantation and between RCT and implantation adjacent to the root canal-treated teeth were recorded. The time from the RCT of adjacent teeth to implant placement was categorized into 5 groups: less than 4 weeks before implantation, 4-12 weeks before implantation, at least 12 weeks before implantation, within 4 weeks after implantation, and at least 4 weeks after implantation. Among the endodontic predictors, a prior PL on the tooth extracted was associated with an increased risk of EIF (P < .05, odds ratio: 4.37; 95% confidence interval: 1.604-11.891). Furthermore, EIF was more likely to occur when the RCT of an adjacent tooth was performed within 4 weeks of implantation (P < .05). Additional investigations with larger sample sizes are necessary to validate our findings.
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Affiliation(s)
- Selen Nihal Sisli
- Baskent University Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Zafer Ozgur Pektas
- Private Clinic, Department of Oral and Maxillofacial Surgery, Adana, Turkey
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Lemos CAA, Verri FR, de Oliveira Neto OB, Cruz RS, Luna Gomes JM, da Silva Casado BG, Pellizzer EP. Clinical effect of the high insertion torque on dental implants: A systematic review and meta-analysis. J Prosthet Dent 2020; 126:490-496. [PMID: 32917400 DOI: 10.1016/j.prosdent.2020.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/29/2022]
Abstract
STATEMENT OF PROBLEM A consensus on the clinical performance in dental implants placed with different insertion torques is lacking. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the effect of high insertion torque compared with regular or low torques during dental implant placement in terms of implant survival rate and marginal bone loss. MATERIAL AND METHODS Two independent reviewers searched electronic databases for studies published until April 2019. The population, intervention, comparison, outcome (PICO) question was "Do patients who receive implants with a high torque (equal or higher than 50 Ncm) show similar implant survival rates and marginal bone loss as compared with those who receive implants with a regular or low torque (less than 50 Ncm)?". The meta-analysis was based on the Mantel-Haenszel (MH) and the inverse variance (IV) methods (α=.05). RESULTS The search yielded 6 articles, which included 389 patients (mean age: 55.28 years) who had received 651 dental implants (437 with high torque and 214 with low or regular torque). Most studies evaluated delayed loading, except 1 study that evaluated immediate implant loading (n=50 for each group). Low or regular insertion torque had a high failure rate (4.2%) compared with high insertion torque (1.1%), chiefly because of immediate loading. However, the meta-analysis indicated no significant difference between high- and regular- or low-torque implant placement in implant survival rate (P=.52, risk ratio [RR]: 0.51, 95% confidence interval [CI]: 0.06-4.06) and marginal bone loss (P=.30, mean difference [MD]: 0.15, 95% CI: -0.14 to 0.44). CONCLUSIONS A high insertion torque during implant placement does not affect implant survival rate or marginal bone loss. However, further research is recommended to reassess this clinical performance.
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Affiliation(s)
- Cleidiel A A Lemos
- Professor, Department of Dentistry (Division of Prosthodontics), Federal University of Juiz de Fora (UFJF-GV), Governador Valadres, MG, Brazil.
| | - Fellippo R Verri
- Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Olavo B de Oliveira Neto
- Postgraduate student, Institute of Health and Biological Sciences, Federal University of Alagoas, Maceió, AL, Brazil
| | - Ronaldo S Cruz
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | - Jéssica M Luna Gomes
- Postgraduate student, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, Brazil
| | | | - Eduardo P Pellizzer
- Professor, Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), Araçatuba, SP, Brazil
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Saijeva A, Juodzbalys G. Immediate Implant Placement in Non-Infected Sockets versus Infected Sockets: a Systematic Review and Meta-Analysis. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2020; 11:e1. [PMID: 32760474 PMCID: PMC7393932 DOI: 10.5037/jomr.2020.11201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/30/2020] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Aza Saijeva
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania
| | - Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health SciencesLithuania.,Dental Implant Centre "Stilus Optimus", KaunasLithuania
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Saleh MHA, Khurshid H, Travan S, Sinjab K, Bushahri A, Wang HL. Incidence of retrograde peri-implantitis in sites with previous apical surgeries: A retrospective study. J Periodontol 2020; 92:54-61. [PMID: 32452035 DOI: 10.1002/jper.20-0056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Retrograde peri-implantitis (RPI) is a rapidly progressing periapical infection that forms around the implant apex. It is usually associated with sites adjacent to teeth with apical lesions; previous endodontic failures, retained root fragments, etc. This study aimed to study the incidence of RPI in sites with a history of apical surgeries. METHODS Patients with sites treated for both apicoectomy and implant placement presenting to the University of Michigan School of Dentistry from 2001 to 2016 were screened. A total of 502 apicoectomies were performed, only 25 of these fit the predetermined eligibility criteria and were thus included in this retrospective analysis. RESULTS Implants that were placed in sites with a previous apical surgery had a cumulative survival rate of 92%. The incidence of peri-implantitis was 8%, while the incidence of RPI was 20%. There was an increased trend for RPI in cases where the cause of extraction was persistent apical periodontitis (35.7%), but this increase didn't reach the level of statistical significance (P = 0.061). CONCLUSION Implants placed in sites with previous apical surgery are not at an increased risk of implant failure or RPI.
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Affiliation(s)
- Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.,Department of Periodontics, University of Louisville School of Dentistry, Louisville, KY, USA
| | - Hadiya Khurshid
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Suncica Travan
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Khaled Sinjab
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Ali Bushahri
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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Kakar A, Kakar K, Leventis MD, Jain G. Immediate Implant Placement in Infected Sockets: A Consecutive Cohort Study. J Lasers Med Sci 2020; 11:167-173. [PMID: 32273958 DOI: 10.34172/jlms.2020.28] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Introduction: Immediate placement of implants in a fresh post-extraction socket is an increasingly popular and established treatment option. However, active infection in the extraction site may adversely affect the outcome of this procedure. This study was designed to assess the clinical results of immediate placement of dental implants in infected extraction sockets using a standardized protocol, which included (a) the use of an Er,Cr:YSGG laser for the decontamination of the infected socket prior to implant insertion, and (b) the utilization of an in situ hardening alloplastic bone graft substitute to augment the gap between the implant surface and the labial plate of bone. Patients and Methods: A retrospective record review was used to identify 68 patients who had implants placed as per the described protocol. A total of 126 implants were placed in 68 patients (65 implants in the maxilla, 61 implants in the mandible). The implants were loaded 136 ± 73 days (mean ± standard deviation; range: 37–400 days) after implant placement. Eight patients (16 implants) were subsequently lost to follow up. Results: 105 of the 110 implants (95.45%) placed immediately in the infected sites using the described protocol survived after prosthetic loading. Conclusion: Immediate implant placement in previously infected sites using the protocols mentioned in our study with laser decontamination of the socket, grafting with an in situ hardening alloplastic bone graft material and non-submerged healing shows a similar survival rate to the published success rates for immediate implants placed in non-infected sites.
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Affiliation(s)
- Ashish Kakar
- Sr. Consultant Indraprastha Apollo Hospitals and Private Practice, New Delhi, India
- Adjunct Assistant Professor- Rutgers School of Dental Medicine, Newark, NJ, USA
- Visiting Professor, Yenepoya University, Mangalore, India
| | | | - Minas D. Leventis
- Department of Oral & Maxillofacial Surgery, Dental School, University of Athens, Athens, Greece
| | - Gaurav Jain
- Clinical Associate, Dental Surgery, Indraprastha Apollo Hospitals and Private Practice, New Delhi, India
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15
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Liu Y, Chen Y, Chu C, Qu Y, Xiang L, Man Y. A prospective cohort study of immediate implant placement into posterior compromised sockets with or without primary wound closure of reactive soft tissue. Clin Implant Dent Relat Res 2019; 22:13-20. [PMID: 31755640 DOI: 10.1111/cid.12845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 06/18/2019] [Accepted: 09/07/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Yeyu Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan China
- Department of Oral Implantology West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Yilin Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan China
| | - Chenyu Chu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan China
- Department of Oral Implantology West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Yili Qu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan China
- Department of Prosthodontics West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Lin Xiang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan China
- Department of Oral Implantology West China Hospital of Stomatology, Sichuan University Chengdu China
| | - Yi Man
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu Sichuan China
- Department of Oral Implantology West China Hospital of Stomatology, Sichuan University Chengdu China
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de Oliveira-Neto OB, Lemos CAA, Barbosa FT, de Sousa-Rodrigues CF, Camello de Lima FJ. Immediate dental implants placed into infected sites present a higher risk of failure than immediate dental implants placed into non-infected sites: Systematic review and meta-analysis. Med Oral Patol Oral Cir Bucal 2019; 24:e518-e528. [PMID: 31232386 PMCID: PMC6667019 DOI: 10.4317/medoral.22954] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/04/2019] [Indexed: 12/13/2022] Open
Abstract
Background Alveolar infection is known as a risk factor for implant failure. Current meta-analysis on the theme could not prove statistically that immediate dental implants placed into infected sites have a higher risk of failure than immediate dental implants placed into non-infected sites. The purpose of this meta-analysis was to determine the effectiveness of immediate dental implants placed into infected versus non-infected sites. Material and Methods Seven databases were sought by two reviewers. Randomized or non-randomized clinical trials that compared the placement of dental implants into infected versus non-infected sites were eligible for the study. Exclusion criteria were: papers in which the survival rate was not the primary outcome; papers without a control group; studies with less than one year of follow-up; studies whose patients did not receive antibiotic therapy; studies with medically compromised patients; duplicated papers. Risk of bias assessment was performed with the Cochrane Collaboration tool. Results Of the 3.253 initial hits, 8 studies were included in both qualitative and quantitative synthesis (kappa=0.90; very good agreement). Forest plot for implant failure showed that immediate implants placed into infected sites presented a statistically significant risk of failure that is almost 3 times higher than when placed into non-infected sites (risk ratio= 2.99; 95% confidence interval: 1.04, 8.56; p= 0.04; 935 implants; i2= 0%). Peri-implant outcomes showed no statistical difference. Conclusions Immediate dental implants placed into infected sites presented a statistically significant higher risk of failure than immediate dental implants placed into non-infected sites. Peri-implant outcomes were not statistically affected in this intervention. Key words:Dental implants, infection, tooth socket, systematic review, immediate placement.
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Affiliation(s)
- O-B de Oliveira-Neto
- Department of Morphology, Anatomy Area, Piracicaba Dental School, University of Campinas, Av. Limeira, 901-Areião, Piracicaba, São Paulo, Brazil, Zip-Code: 13414-903,
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Xu J. [Immediate implantation following tooth extraction in fresh maxillary molar socket with poor bone quality]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:100-105. [PMID: 30692074 DOI: 10.12122/j.issn.1673-4254.2019.01.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the feasibility of immediate implantation after tooth extraction in the maxillary molar socket with poor bone quality beneath the sinus. METHODS We collected the data from the patients undergoing extraction of maxillary molars with poor bone quality between the sockets and sinuses. Sinus lifting and immediate implant following the extraction were performed simultaneously in these cases, and the primary stability of the implants, wound healing, and changes of the sinus were observed. At 6 months after the operations, the crowns were installed on the implants. The masticatory function was observed, and the growth of the alveolar bones and their changes after the operations were examined using microcomputed tomography (MCT). RESULTS We analyzed 32 extraction cases with immediate implantation in the maxillary molar sockets with poor bone quality beneath the sinus. The average age of the patients was 59.8 years, and the length and diameter of the implant ranged from 8.5 to 10 mm and from 4.5 to 5.5 mm, respectively. The torque force of the implants varied from the minimum (in which cases the implants remained fixed after insertion with fingers) to the maximum of 30 N·cm. The postoperative recovery was uneventful in all the cases and no failed or movable implants were found. At 6 months after the operation, none of the patients showed abnormalities in the sinus, and in all the cases the crowns were successfully installed on the implants with good recovery of the masticatory functions. Follow-up of the patients for 12 to 96 months after the operation showed successful immediate implantation in all the cases. After the operation, the changes of the mean alveolar ridge heights on the buccal, palatal, mesial, and distal sides of the patients were 0.8069±0.6253 mm (t=1.2904, P>0.1), 0.5272± 0.3331 mm (t=1.5836, P>0.05), 0.5416±0.4048 mm (t=1.3379, P>0.05), and 0.5172±0.3874 mm (t=1.3351, P>0.05), respectively; the change of the alveolar ridge width was 0.5522±0.4381 mm (t=1.2604, P>0.1) mm. The dimension of the alveolar bone underwent no significant changes after the operation in these patients. CONCLUSIONS Immediate implantation in the maxillary extraction socket with a poor bone quality can avoid damages to the sinus and achieve good outcomes with such advantages of less trauma, full use of the innate gingiva and alveolar ridge, and well preserved morphology of the alveolar ridge as compared with delayed implantation.
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Affiliation(s)
- Jing Xu
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, Southern Medical University (Guangdong Provincial Stomatological Hospital), Guangzhou 510280, China
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Immediate placement of dental implants into infected versus noninfected sites in the esthetic zone: A systematic review and meta-analysis. J Prosthet Dent 2018; 120:658-667. [DOI: 10.1016/j.prosdent.2017.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 12/13/2017] [Accepted: 12/13/2017] [Indexed: 01/11/2023]
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Application of Immediate Dentoalveolar Restoration in Alveolus Compromised with Loss of Immediate Implant in Esthetic Area. Case Rep Dent 2018; 2018:1672170. [PMID: 30034886 PMCID: PMC6033297 DOI: 10.1155/2018/1672170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 04/10/2018] [Indexed: 11/19/2022] Open
Abstract
In the reported clinical case, the immediate dentoalveolar restoration (IDR) technique was applied to reconstruct the buccal bone wall, with autogenous graft of the maxillary tuberosity, which had been lost due to a root fracture, and to provide the necessary bone substrate for the installation of an implant and its provisioning. One of the greatest risks inherent in the survival of immediate implants is the maintenance of their stability during the healing period. In this case, due to a mechanical trauma in sports activity in the first postoperative month, there was a total failure in the osseointegration process, confirmed by tomographic examination of both the implant and the bone graft. The deleterious effects of this accident were compensated with a new approach and reapplication of IDR technique using a smaller-diameter implant and with conical macrogeometry in conjunction with the new bone reconstruction under the same compromised alveolus; associated, after the period of osseointegration, with the maneuvers of volume increase of the gingival tissue by subepithelial connective tissue graft. The tomographic result demonstrated the success of the surgical procedures, and the clinical/photographic analysis obtained showed the stability of the gingival margin without compromising the esthetic result of the prosthetic restoration.
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Testori T, Weinstein T, Scutellà F, Wang HL, Zucchelli G. Implant placement in the esthetic area: criteria for positioning single and multiple implants. Periodontol 2000 2018; 77:176-196. [PMID: 29484714 DOI: 10.1111/prd.12211] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient expectations from implant treatment have changed over the years and esthetics plays an important role in defining what is now called success of rehabilitation. Of the many factors that influence the outcome of the rehabilitation, the two main ones are the bone and soft-tissue deficiencies at the intended implant site. Many surgical approaches are described in terms of timing of implant placement and management of regenerative procedures. The aim of this article is to discuss the different implant placement alternatives in the esthetic area, in particular: (i) the timing of implant placement/regenerative procedures/skeletal growth/altered passive eruption; (ii) the correct three-dimensional position of the fixture between the cuspids and in the premolar area; (iii) multiple missing teeth in the esthetic area with single tooth/pontic or cantilevered options/prosthetic compensation; (iv) placement of implants into infected sites; and (v) the influence of abutment and crown morphology on implant position. Combining our long-standing clinical experience and the pertinent literature, the following conclusions can be drawn: Immediate implant placement can be a successful procedure in terms of esthetics but it is technique sensitive and requires an experienced team. Immediate placement is less traumatic to the patient as fewer surgical procedures are involved and patients tend to prefer this clinical approach with regards to quality of life. The diagnostic phase is of utmost importance, with not only bone and soft tissue deficiencies being addressed but also: skeletal growth, dental/implant soft tissue parameters such as altered passive eruption and the morphology of the roots adjacent to the edentulous area. Post-extraction immediate loading is feasible in infected sites. The correct position of the fixture should follow widely accepted guidelines but the abutment morphologies play a role in the vestibular/palatal position of the implant. The long axis of the implant, aiming at the incisal edge of the future restorations, is the most appropriate implant position when a shoulder-less abutment is used and allows a restorative crown morphology with a cervical contour resembling a natural tooth. The use of a shoulder-less abutment gives more space for the tissue to grow compared with the traditional abutment with shoulder finish line.
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