Immediate and Delayed Implant Placement Into Extraction Sockets: A 5-Year Report

A Systematic Review on Immediate Implant Placement in Intact Versus Non-Intact Alveolar Sockets

Objectives: The primary objective of this systematic review was to compare IIP in intact versus non-intact sockets in terms of buccal bone thickness. Methods: Two independent reviewers carried out an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to June 2024. Randomized controlled trials (RCTs), cohort studies, and case series on intact and/or non-intact sockets were included for analysis. The primary outcome was buccal bone thickness (BBT). Secondary outcomes were vertical midfacial soft tissue level change, pink esthetic score (PES), implant survival and complications. This systematic review was conducted in accordance with the PRISMA guidelines. Results: After screening 1001 unique titles and conducting manual searches, 20 articles reporting on 525 implants (intact: 265; non-intact: 260) in the anterior maxilla with a follow-up of up to 120 months were selected. The overall study quality was low, especially for non-intact sockets since only two RCTs could be found, and none demonstrated a low risk of bias. Meta-analyses were not feasible due to a lack of direct comparisons, and heterogeneity in terms of surgical approach, soft tissue handling, and restorative approach. BBT ranged between 1.10 and 3.18 mm (intact) and 1.18 and 3 mm (non-intact). Vertical midfacial soft tissue level change ranged between -0.13 and -0.58 mm (intact) and -0.03 and -0.59 mm (non-intact). Pink esthetic scores ranged between 10.48 and 12.80 (intact) and 9.25 and 12.43 (non-intact). Implant survival exceeded 90% in all studies and was 100% in the vast majority of the studies. Conclusions: This systematic review suggests a similar outcome of IIP in intact and non-intact sockets. However, the overall low study quality, a lack of direct comparisons, and heterogeneity rendered the comparison highly biased. Future studies should be conducted to establish an evidence-based treatment approach for IIP in non-intact sockets.

Immediate implant placement in the premolar maxillary area: a cone-beam computed tomography study

PURPOSE

This research aimed to investigate potential factors associated with the risk of perforation of the labial bone plate, nasal floor, or maxillary sinus floor during immediate implant placement (IIP) in the maxillary premolar area, utilizing a cone-beam computed tomography (CBCT) virtual study.

METHODS

CBCT exams from 179 eligible participants, encompassing 716 teeth, were included. Implants were virtually positioned in 2 orientations: along the long axis of the tooth (the prosthetically-driven position) and in an optimal position relative to adjacent anatomical structures (the bone-driven position). Binary logistic regression analysis was employed to assess potential associations between perforation or invasion and various covariates, including sex, age, tooth region, the distance from the tooth apex to the nasal floor or maxillary sinus floor, the angle between the prosthetically- and bone-driven positions (implant-line A angle [ILAA]), and the labial concavity angle (LCA).

RESULTS

The mean ILAA was 18.3°±8.0°, and the angle was significantly larger for the second premolar compared to the first premolar. The mean minimum implant length was 13.0±2.1 mm, with a bone anchorage of 4 mm. The incidence of perforation was 84.1% for the prosthetically-driven position and 40.5% for the bone-driven position. Factors associated with a higher risk of cortical bone wall perforation or invasion of the 2-mm safety margin from surrounding anatomical structures (in the bone-driven position) included female sex, older age, shorter distance from the tooth apex to the nasal cavity/maxillary sinus, and smaller LCA.

CONCLUSIONS

A high prevalence of cortical bone wall perforation or invasion of the 2-mm safety margin is anticipated when performing IIP in the maxillary premolar region.

Navigating Esthetic Challenges: Immediate Implant Placement and Comprehensive Restorative Solutions-A Clinical Case With 2-Year Follow-Up Study

Introduction: The esthetics of immediate implant dentistry can be challenging. Clinical considerations for immediate implant placement have demonstrated long-term success rates comparable to traditional delayed implant protocols. However, it is a sensitive technique that requires proper treatment planning as well as meticulous execution to be predictable and successful in the long term. Methods: This clinical situation demands extensive knowledge of soft and hard tissue management for atraumatic tooth extraction followed by implant therapy, along with an understanding of the available materials to meet esthetic needs. This case report features a female patient with the chief complaint of needing to replace an anterior crown due to loss of retention. After a comprehensive oral assessment and cone beam computed tomography (CBCT) radiographic examination, it was determined that the crown on Tooth #9 was fractured at the subgingival level. Furthermore, gingival zenith positions displayed differences at the keratinized mucosa level in Teeth #7, #8, and #9, and the metal marginal areas of the porcelain-fused-to-metal (PFM) crowns in the anterior area of Teeth #5, #7, #8, #9, and #10 were apparent. The procedure involved atraumatic extraction of Tooth #9, followed by immediate implant placement. Crowns on Teeth #5, #7, #8, and #10 were replaced, and veneers on Teeth #6 and #11 were fabricated using press lithium disilicate-reinforced ceramic. Connective tissue graft (CTG) was contoured before final implant restorations. Results: The final implant crown was restored using a prefabricated abutment with a titanium base and lithium disilicate ceramic dental material. A well-planned combined treatment, including atraumatic tooth extractions for immediate implants and ideal contouring of soft tissues, can significantly impact the outcome of esthetic restorations. Conclusions: Single immediate implant-supported crowns in the esthetic zone were able to fulfill the patient's esthetic expectations.

Jumping gap in immediate implant placement in the esthetic zone: A virtual implant planning using cone-beam computed tomography

PURPOSE

A jumping gap (JG) refers to the implant's future buccal wall; this study aims to estimate the jumping gap dimension in relation to virtual implant placement and subsequently link the implant diameter and implant position with the anatomical site.

METHODS

This observational study was conducted to analyze the maxillary teeth in the esthetic zone from cone-beam computed tomography (CBCT) scans using OnDemand software. The horizontal jumping gap dimension of each tooth was assessed by subtracting the calculated virtual implant diameter from the socket dimensions.

RESULTS

A total of 253 anterior and premolar maxillary teeth were analyzed from 52 CBCT scans. The estimated JG dimensions were 1.23 ± 0.59 mm, 1.80 ± 0.64 mm, 3.02 ± 0.69 mm, for central incisors, lateral incisors and canines respectively, 3.70 ± 0.68 mm for the first premolars showing the highest horizontal gap and 3.19 ± 0.88 mm for second premolars. The incisors showed the smallest horizontal gap compared to the canines and premolars.

CONCLUSIONS

In terms of JG, immediate implant placement is more favorable at the canine and premolar sites. By contrast, the incisors sites should be handled with extreme caution, where the use of narrower implants is advisable when necessary.

Survival Rate of Immediate Implants in Periodontally Compromised Patients: A Systematic Review

Background

Immediate implant placement into a fresh extraction socket has been developed as a consistent treatment, allowing for a reduction in the duration of time necessary for prosthetic rehabilitation. The study will evaluate the clinical and radiologic outcomes of implants placed immediately for a 10-year follow-up period.

Aim

The aim of this systematic review is to evaluate the durability of the immediate implant in periodontally compromised individual placement.

Methods

Studies reporting clinical and radiologic implant outcomes from periodontally compromised individuals who were treated and followed periodontal and implant maintenance for ≥5 years were considered eligible for the review. Screening of the articles, data extraction, and quality assessment were conducted independently and in duplicate.

Results

There were 99 papers, and of them, 55 were excluded after title/abstract assessment. The full texts of 28 potentially eligible publications were screened, but only seven studies met the inclusion criteria.

Conclusions

The study confirms that immediate implant therapy is safe, effective, and predictable for successful osseointegration and long-term functioning in periodontally compromised individuals, with minimal differences in clinical and radiographic outcomes.

Immediate implant placement in the anterior mandible: a cone beam computed tomography study

BACKGROUND

The placement of implants into the alveolar socket right after tooth extraction is called immediate implant placement (IIP). This approach has its particularities depending on which region of the jaws is involved. The anterior mandible region is peculiar due to the presence of mandibular incisors, which have the shortest roots among all permanent teeth.

PURPOSE

This study aimed to investigate the factors that could be associated with the risk of either cortical bone wall perforation or invasion of the 2 mm secure distance from the surrounding anatomical structures (defined as unsafe implant placement), with IIP in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study.

MATERIALS AND METHODS

CBCT exams from 239 eligible subjects were investigated. Implants were virtually placed in two distinct positions: prosthetically-driven (along the long axis of the existing tooth) and bone-driven position (according to the available bone and with regard to nearby anatomical structures). Correlation between several variables was tested, and binary logistic regression analysis in order to assess of the possible associations between covariates and unsafe placement was performed.

RESULTS

Safe placing implants was significantly higher for the bone-driven in comparison to the prosthetically-driven position (22.2% vs. 3.3%, respectively), and the 2-mm secure distance from anatomical structures was not possible to respect in the majority of cases (77.6% vs. 82.9%, respectively). Covariates associated with a higher risk of unsafe placement were tooth region (CI in relation to IL and CA), decrease of labial concavity angle (LCA), decrease of mandible basal bone height (MBBH), and decrease in mandibular bone thickness at the tooth apex level (MBT0).

CONCLUSION

The possibility of safely placing immediate implants in the anterior mandible is significantly higher for bone-driven than in prosthetically driven position. Presurgical virtual planning with CBCT is a great tool for minimizing the risk of implant unsafe placement with regards to the anatomical conditions in the mandible.

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.

Do dental implants installed in different types of bone (I, II, III, IV) have different success rates? A systematic review and meta-analysis

Purpose

The objective of this systematic review and meta-analysis was to evaluate the survival rate of implants installed in bone type IV (Lekholm and Zarb, 1995) compared to that of implants installed in bone types I, II, and III.

Material and methods

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA) and was registered in the PROSPERO International Database of Systematic Reviews (CRD42021229775). The PubMed/MEDLINE, Scopus, and Cochrane databases were searched through July 2021. The PICO question was: "Dental implants installed in type IV bone have a lower success rate when compared to implants installed in type I bone, II and III?". The established inclusion criteria were: 1) controlled and randomized clinical trials (RCT), 2) prospective and retrospective studies with at least 10 participants with dental implants, and 3) patients with dental implants installed in bone tissue types I, II, III, and IV (Lekholm and Zarb, 1985). The minimum followup duration was 1 year.

Results

After searching the identified databases, 117 articles were selected for full reading and 68 were excluded. Thus, 49 studies were included for qualitative and quantitative analyses. The total number of participants included was 12,056, with a mean age of 41.56 years and 29,905 implants installed. Bone types I, II, and III exhibit a lower implant failure rate when compared to bone type IV.

Conclusion

Dental implants installed in bone types I, II, and III showed significantly higher survival rates than those installed in type IV. The bone type I success rate was not significantly different than that of type II; however, the success rate of bone type I and II was higher than that of type III.

An Evaluation of the Efficacy and Acceptability of Basal Implants in Traumatically Deficient Ridges of the Maxilla and the Mandible

Background and objective Rehabilitation of edentulous jaw areas is a complex procedure that has witnessed numerous advancements in technique and materials for better functional and aesthetic outcomes over the years. Dental implants have emerged as a cutting-edge, cost-effective, and non-invasive alternative to traditional removable partial dentures (RPDs), fixed partial dentures (FPDs), and full dentures. In this study, the basal implant was tested in traumatically deficient ridges on the mandible and the maxilla to determine its effectiveness and acceptability. Materials and methods The purpose of this research was to determine whether basal implants might be successfully used to restore traumatized ridges in the maxilla and mandible. Eleven individuals aged 20-55 years participated in the trial, and a total of 30 implants were used. All patients were evaluated for pain, soft tissue health around the basal implant, and patient satisfaction, with follow-ups on the third day and at three and six months postoperatively. Results The mean pain score measured using the visual analog scale (VAS) of patients during follow-ups was 2.00 ±1.15 on the third day, 0.40 ±0.84 at three months, and 0.00 ±0.00 at six months postoperatively. The mean gingival index score of patients was 1.30 ±0.48 on the third day, 0.10 ±0.31 at three months, and 0.00 ±0.00 at six months postoperatively. The mean patient satisfaction score was 34.77±5.54 on the third day, 41.11 ±6.27 at three months, and 40.7 7±10.91 at six months postoperatively. The mean immediate postoperative marginal bone level was 12.33 ±2.26 mm, and it was 10.85 ±2.29 mm after six months postoperatively. The mean preoperative crestal bone level was 10.76 ±1.77 mm and it was 9.70 ±1.79 mm after six months postoperatively. Conclusion Due to the fact that basal implantology does not involve extensive augmentation procedures necessary for the placement of conventional implants, it plays an important role in the rehabilitation of edentulous maxillary and mandibular arches, especially in traumatic, moderate to severely atrophic maxillary and mandibular arches.

Controversies in the dental implant treatment planning for anterior maxillary aesthetic zone - A review

The anterior maxillary region being an aesthetic zone remains critical in decision-making when it comes to replacing a tooth. Treatment planning to place dental implants in aesthetic zone like anterior maxilla needs paramount attention in order to provide best of the treatment outcomes from aesthetic point of view. As the field of dental implants tend to evolve continuously, newer concepts with inadequate research come into practise on regular basis. In this article, some of the controversies regarding dental implant placement and treatment process related to anterior maxillary aesthetic zone are discussed with literature to support evidence.

Tooth preservation vs. extraction and implant placement in periodontally compromised patients: A systematic review and analysis of studies

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.

Combined Effect of Platelet-Rich Fibrin Matrix (PRFM) and Demineralized Freeze-Dried Bone Allograft (DFDBA) in Immediate Implant Placement: A Single-Arm Clinical Trial

Introduction

Placement of immediate implants in contrast to delayed implant placement may be favorable. The factors contributing to this are shortened overall treatment time, aid in ideal orientation and fixture placement, bone preservation following extraction, and achieving optimal aesthetics involving soft tissue. However, the gap distance between the surface of the implant and the buccal bony wall during implant placement is critical for subsequent bone healing in a fresh extraction socket. Considering that as the gap broadens, the amount of bone-to-implant contact (BIC) decreases, causing an apical shift of the highest bone-implant contact. Incorporating a bone substitute material (BSM) within the fixture-socket gap preserves alveolar ridge volume by minimizing socket remodeling and encouraging de-novo bone formation.

Aim and objectives

To evaluate the efficacy of platelet-rich fibrin matrix (PRFM) and demineralized freeze-dried bone allograft (DFDBA) in fresh extraction socket with simultaneous implant placement.

Methods

Implants were immediately placed in 12 patients following a two-stage submerged protocol. The combination of PRFM and DFDBA was used to fill the gap between the implant body and the surrounding socket wall. The final restoration was placed after 3 months following implant placement. The full mouth plaque, gingival bleeding index, and gingival esthetics scores were assessed at baseline, 3, and 6 months. The crestal changes were evaluated using intraoral periapical radiographs (IOPA) at baseline, 3, and 6 months. Cone beam computed tomography (CBCT) images were obtained at baseline and 6 months after implant loading to analyze the buccolingual changes.

Results

At 6 months follow-up, the coronal bone remodeling detected on CBCT revealed a minimal (0.1 mm) narrowing of the alveolar ridge in a buccolingual direction, with a mean bone loss of 0.10+0.09, which was statistically non-significant (p > 0.05). Implant success was 100% at 6 months after loading as determined by Akbrektsson’s criteria for implant success.

Conclusions

The adjunctive use of PRFM with DFDBA following immediate implant placement yielded a significant reduction in bone resorption and maintenance of buccolingual dimensions.

Success and patient satisfaction of immediately loaded zirconia implants with fixed restorations one year after loading

Background

There is limited evidence for the use of zirconium dioxide implants in immediate implant placement as well as for related immediate loading protocols. The aim of this retrospective study was to investigate the survival rate, success and patient satisfaction of immediately placed zirconia implants compared to delayed placed implants.

Methods

The study included 58 partially edentulous patients who were treated between 2013 and 2015 with immediate and delayed transgingival healing zirconium dioxide implants (SDS, Kreuzlingen/ Switzerland). In addition to survival and success rate, marginal bone loss was assessed using radiographs and soft tissue was evaluated using Pink Esthetic Score. Oral health-related quality of life was investigated prospectively using a modified OHIP questionnaire.

Results

The cumulative survival rate of all implants included was 92% with 88% classified as full success. No significant difference was found between the bone levels of immediately and delayed placed and immediately and delayed loaded implants. The mean Pink Esthetic Score after final prosthetic rehabilitation was 12.2/14 points indicating excellent esthetic clinical results. Analysis of the OHIP questionnaire showed a mean value of 0.54/100 points reflecting a high patient satisfaction.

Conclusions

Immediate and delayed placed as well as loaded zirconium dioxide implants showed excellent results regarding implant success and survival in this study. Zirconium dioxide implants may ensure excellent esthetic results and high patient satisfaction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02231-0.

Dental Implants Inserted in Fresh Extraction Sockets versus Healed Sites: A Systematic Review and Meta-Analysis

The present review aimed to evaluate the difference of dental implant failure rates and marginal bone loss (MBL) between implants inserted in fresh extraction sockets or healed sites. Electronic search was undertaken in three databases, plus manual search of journals, including studies randomized or not. Meta-analyses were performed besides meta-regressions, in order to verify how the odds ratio (OR) and MBL were associated with follow-up time. The review included 163 publications. Altogether, there were 17,278 and 38,738 implants placed in fresh extraction sockets and healed sites, respectively. Pairwise meta-analyses showed that implants in sockets had a higher failure risk in comparison to healed sites: OR 1.349, all studies included; OR 2.070, only prospective non-RCTs; OR 2.487, only RCTs (all p < 0.001). The difference in implant failure between the groups was statistically significant in the maxilla (OR 1.616, p = 0.029), but not in the mandible (OR 2.192, p = 0.075). The MBL mean difference (MD) between the groups was −0.053 mm (p = 0.089). There was an estimated decrease of 0.003 in OR (p = 0.284) and an increase of 0.006 mm (p = 0.036) in the MBL MD between groups for every additional month of follow-up. In conclusion, implants placed in fresh extraction sockets present higher risk of failure than implants placed in healed sites.

Implants placed into alveoli with periapical lesions: an experimental study in dogs

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.

Studies on the Performance of Molar Porous Root-Analogue Implant by Finite Element Model Simulation and Verification of a Case Report

PURPOSE

The aim of this study was to evaluate the effect of porous layer thickness in a 3-dimensionally printed 1-piece molar porous root-analogue implant (RAI) on the biomechanical properties of the peri-implant bone and the clinical efficacy of one such implant in a patient.

MATERIALS AND METHODS

Three RAIs with different superficial porous layer thicknesses (0.5 mm, 1 mm, and fully porous) were designed and assembled using a mandible model and then solidified to obtain 3 finite elements models, denoted A, B, and C. Finite element analysis was performed to analyze the stress on the solid and porous structures of the RAIs and the stress and strain experienced by the bone surrounding the implant. RAIs were fabricated by selective laser melting. An unrepairable molar in a single patient was selected for replacement. An RAI was designed and prepared and then implanted into the alveolar bone immediately after minimally invasive extraction of the damaged tooth. Definitive restorations were placed after a 3-month period of uninterrupted healing.

RESULTS

The stress concentration observed in the 3 types of RAI was principally between the solid and porous interface contact points, with maximum stress on the solid and porous structures smaller than that of the respective yield strength. The introduction of a porous structure on the surface of the RAIs increased peri-implant bone stress, which increased with thickness of the porous layer. The 3-dimensionally printed porous RAI exhibited excellent initial stability immediately after implantation. After continual observation for 6 months, it was found that bone surrounding the root had infiltrated into the RAI, achieving good osseointegration.

CONCLUSIONS

Stress shielding can be reduced by decreasing the elastic modulus of the implant, with the interface between implant and bone allowing more appropriate stress conduction. A 1-piece porous RAI fabricated using 3-dimensional printing establishes a new indication for immediate implantation after extraction.

A 22-Year Follow Up of Immediate Implant Placement without Bone Augmentation: A Case Series Study

PURPOSE

To retrospectively evaluate the treatment outcome of immediate implants placed in fresh extraction sockets without bone augmentation after 22 years of function.

MATERIALS AND METHODS

The study group received implant therapy in 1997, including surgical placement and prosthodontic rehabilitation. The mean age of the subjects at the time of implant placement was 40 ± 5.54 years. A total of 35 subjects received 36 implants in fresh extraction sockets without bone augmentation. Definitive prostheses were placed 4 to 6 months after implant placement. Implant treatment outcomes were evaluated using clinical and radiographic parameters obtained during follow-up visits at 1, 5, 10, 15, 20, and 22 years after prosthetic loading.

RESULTS

Among the 35 treated subjects, five patients moved out of the country and could not be evaluated at the follow-up times. A total of 29 subjects were included in the study with a drop-out rate of 14.1%. Of these, one patient lost the implant during the osseointegration period before prosthodontic treatment. No other implant failure or complication during the rest of the follow-up period was reported, thus giving a cumulative survival rate of 97.2% during the 22-year follow-up. The change in marginal bone level was less than 2 mm in most subjects at the 22-year examination. The mean bone loss from baseline to 22-year follow-up was 1.61 mm, and the mean bone level at the 22-year follow-up examination was situated at 2.13 ± 0.023 mm from the implant platform, which was used as the reference point.

CONCLUSIONS

Immediate implant placement in extraction sockets exhibits excellent prognosis even when bone augmentation is not performed.

A clinical and radiographical comparison of buccolingual crestal bone changes after immediate and delayed implant placement

Aim

The study aims to clinically and radiographically compare the bucco-lingual crestal bone changes after immediate and delayed placement of implants.

Methods

Two groups that consisted of fifty implants were considered for this study. In group A the implants were placed immediately post extraction, whereas, in group B implants placement were delayed by four to six weeks. All the implants were submerged within the alveoli confines. Bone grafts were only placed if the jumping distance was more than 1.5 mm. Barrier membrane was not placed in any of the cases. Bucco-lingual width was measured at the time of implant placement and during abutment placement after four to six weeks. Primary flap closure was ensured in all the cases.

Results

Thirty-one implants were placed in the mandible and nineteen were placed in the maxilla. All the implants achieved osseointegration. Immediate implant group showed a mean width of 8.80 mm (SD2.280) at the time of implant placement whereas, 7.60 mm (SD 1.871) after six months. Delayed implant group showed a mean width of 8.40 mm (SD1.673) at the time of implant placement, and 7.40 mm (SD 1.658) after six months. Intragroup showed statistically significant data (P<0.05). When the intergroup comparison of group 1 and group 2 was made at implant placement day and abutment placement day, it was found to be statistically non-significant.

Conclusion

This study suggests that circumferential defect heals on itself without any guided bone regeneration in both the groups. The data suggests that the healing in both the group were equally good. The equally good results suggest placing the implant immediately post extraction. This saves the cost, time and most importantly the need for an extra surgery.

Evaluation of peri-implant condition in periodontally compromised patients

Aims:

The aim of the study is to evaluate the profile of peri-implant tissues in periodontally compromised patients.

Settings and Design:

In vivo – cross sectional study design.

Materials and Methods:

Fifty-eight implants were evaluated, clinically and radiographically, installed in seven individuals treated by the same team of professionals, during the years 1997 and 2005 in a private dental clinic in Vitória, ES, Brazil; that time of data collection, all implants were at least 10 years of functional loading. The variables related to the dental implants evaluated were: visible Plaque Index, Gingival Bleeding Index (GBI), probing pocket depth, bleeding on probing, and bone level, to relate them to the classification of dental implants.

Statistical Analysis Used:

The Chi-square and Kruskal–Wallis test were adopted.

Results:

The total of 58 implants were classified: 11 (18.9%) as healthy and 12 (20.7%) as clinically stable. The other 35 implants (60.4%) had some type of peri-implant inflammation, 20 of them (34.5%) were diagnosed with peri-implant mucositis and 15 (25.9%) with peri-implantitis. Among the variables studied, the results showed statistically significant differences for implant location (P = 0.001) and GBI (P = 0.03). Most of the maxillary implants (85.7%) were classified for some type of peri-implant disease. For the implants which resulted in Score 1 for GBI, most of them (75.0%) were also classified for some type of peri-implant disease.

Conclusions:

Dental implants placed in periodontally compromised patients may have high long-term survival rates. However, most implants were classified with some type of peri-implant inflammation.

Outcome of early dental implant placement versus other dental implant placement protocols: A systematic review and meta-analysis

BACKGROUND

The aim of this systematic review and meta-analysis was to compare the clinical efficacy of the early dental implant placement protocol with immediate and delayed dental implant placement protocols.

METHODS

An electronic and manual search of literature was made to identify clinical studies comparing early implant placement with immediate or delayed placement. Data from the included studies were pooled and quantitative analyses were performed for the implant outcomes reported as the number of failed implants (primary outcome variable) and for changes in peri-implant marginal bone level, peri-implant probing depth, and peri-implant soft tissue level (secondary outcome variables).

RESULTS

Twelve studies met the inclusion criteria. Significant difference in risk of implant failure was found neither between the early and immediate placement protocols (risk difference = -0.018; 95% confidence interval [CI] = -0.06, 0.025; P = 0.416) nor between early and delayed placement protocols (risk difference = -0.008; 95% CI = -0.044, 0.028; P = 0.670). Pooled data of changes in peri-implant marginal bone level demonstrated significantly less marginal bone loss for implants placed using the early placement protocol compared with those placed in fresh extraction sockets (P = 0.001; weighted mean difference = -0.14 mm; 95% CI = -0.22, -0.05). No significant differences were found between the protocols for the other variables.

CONCLUSIONS

The available evidence supports the clinical efficacy of the early implant placement protocol. Present findings indicate that the early implant placement protocol results in implant outcomes similar to immediate and delayed placement protocols and a superior stability of peri-implant hard tissue compared with immediate implant placement.

Implant placement and loading protocols in partially edentulous patients: A systematic review

OBJECTIVES

To systematically review the evidence for the clinical outcome of fixed implant prostheses treated with different combinations of implant placement and loading protocols in partially edentulous patients.

MATERIALS AND METHODS

An electronic search was performed in Medline, Embase, and Central to identify studies investigating the outcome of implants subjected to immediate placement + immediate restoration/loading (Type 1A), immediate placement + early loading (Type 1B), immediate placement + conventional loading (Type 1C), early placement + immediate restoration/loading (Type 2-3A), early placement + early loading (Type 2-3B), early placement + conventional loading (Type 2-3C), late placement + immediate restoration/loading (Type 4A), late placement + early loading (Type 4B), late placement + conventional loading (Type 4C) with implant-supported fixed dental prostheses (IFDPs) in partially edentulous patients. Only human studies with at least 10 cases and a minimum follow-up time of 12 months, reporting on solid-screw-type implants with rough surfaces and an intra-osseous diameter between 3 and 6 mm, were included. A cumulative survival rate for each type of the implant placement and loading protocols was weighted by the duration of follow-up and number of implants.

RESULTS

The search provided 5,248 titles from which 2,362 abstracts and 449 full-text articles were screened. A total of 69 publications that comprised 23 comparative studies (15 randomized controlled trials, 7 controlled clinical trials) and 47 noncomparative studies (34 prospective cohort studies, 13 retrospective cohort studies) were included for analysis. Considerable heterogeneity in study design was found, and therefore, a meta-analysis of controlled studies was not possible. The weighted cumulative survival rate of each type of placement and loading protocol was 98.4% (Type 1A), 98.2% (Type 1B), 96.0% (Type 1C), 100% (Type 2-3B), 96.3% (Type 2-3C), 97.9% (Type 4A), 98.3% (Type 4B), and 97.7% (Type 4C). Type 1C, Type 2-3C, Type 4B, and Type 4C were scientifically and clinically validated (SCV). Type 1A, Type 1B, and Type 4A were clinically documented (CD), and Type 2-3A and Type 2-3B were clinically insufficiently documented (CID).

CONCLUSIONS

Evaluating outcomes in oral implantology by combining the placement and loading protocols are paramount. The selected loading protocol appears to influence the outcome of immediate implant placement.

Autologous platelet-rich fibrin: can it secure a better healing?

OBJECTIVE

The aim of this study was to evaluate the efficacy of platelet-rich fibrin (PRF) in the healing of impacted mandibular third molar (M3) extraction sockets.

STUDY DESIGN

This study included 30 patients with bilaterally symmetric impacted M3 (N = 60) requiring transalveolar extraction. All patients were assigned numbers randomly; left-sided M3 patients with odd numbers and right-sided patients with even numbers were categorized into group A (test group), and the other side of the mouth was classified as "group B" (control group). Group A M3 extraction sockets received PRF, whereas group B sockets were closed without PRF. Patients were evaluated for pain and swelling on postoperative days 1, 3, 7, and 14. Bone healing was compared on postoperative weeks 8 and 16. Analysis of variance (ANOVA) and Tukey's multiple comparison tests were applied for statistical analysis.

RESULTS

A total of 30 patients, ages 18 to 40 years, participated in this study. The overall postoperative pain score (visual analogue scale [VAS]) and facial swelling percentages were lower for group A compared with group B (P < .05). Early bone healing was also evident on postoperative radiographs obtained at weeks 8 and 16 in group A (P < .001).

CONCLUSIONS

The use of autologous PRF aids in earlier and better wound healing in a controlled manner.

Immediate Versus Delayed Loading of Postextraction Implants: A Long-Term Retrospective Cohort Study

PURPOSE

To compare the long-term clinical and radiographic outcomes between immediate loading (IL) and conventional loading of implants placed immediately in fresh extraction sockets.

MATERIALS AND METHODS

Demographic data, implant details, and periapical radiographs of patients were collected. The long-term marginal bone level remodeling and implant survival rate were calculated.

RESULTS

Twenty-one patients (mean age 52.55 ± 14.61 years) with 35 implants immediately inserted into postextraction sites (22 immediate loaded and 13 delayed loaded) were analyzed. The mean follow-up duration was 6 years (range 2-11 years). The implant cumulative survival rate was 96.5%. At the longest follow-up, the mean crestal bone level averaged 0.144 ± 0.705 for IL and 0.161 ± 0.877 for delayed loading, respectively. The mean implant aesthetic score was 7.

CONCLUSIONS

IL does not negatively influence the long-term prognosis of implants inserted into fresh extraction sockets.

Is Bone Graft or Guided Bone Regeneration Needed When Placing Immediate Dental Implants? A Systematic Review

AIMS

To systematically review the effect and type of bone graft and guided bone regeneration around immediate implants on hard and soft tissue changes.

METHODS

Three electronic databases were searched up to June 2015. Outcomes consisted of hard and soft tissue dimensional changes.

RESULTS

Eight studies were included according to inclusion criteria. Immediate implants with bone grafting had superior soft tissue stability and preserved horizontal ridge dimension and buccal plate thickness, when compared to no grafting. The use of a barrier alone significantly decreased buccal plate resorption and the remaining defects around the implants, and the use of both bone graft and membrane aided in soft tissue preservation. The optimal type of bone graft material was a combination of cortical autogenous and synthetic particulate when compared to each separately, whereas no difference was found between demineralized allograft and hydroxyapatite in decreasing bone loss.

CONCLUSIONS

Quantitative data analysis was not possible due to heterogeneity of the included studies. Further randomized clinical trials with homogenous samples and proper controls are needed to support the results of this report.

Rehabilitation of Postextractive Socket in the Premaxilla: A 12-Year Study on 27 Titanium Plasma Spray Resorbable Calcium Phosphate Coated Single Implants

OBJECTIVES

The purpose of this study was to evaluate the peri-implant bone tissue level on postextractive resorbable calcium phosphate coated single implants placed in premaxillary sites grafted with autologous bone, anorganic bovine bone (ABB), platelet-rich plasma (PRP), and keratinized epithelial connective graft over 12 years.

MATERIALS AND METHODS

A total of 27 patients received a postextractive single implant in premaxillary sites grafted with ABB and PRP. Two months later, a keratinized epithelial connective graft was applied and the implants loaded. Clinical and radiographical evaluations were performed at baseline, 6 and 18 months, 4 and 6 years after the implant insertion, and then every 2 years up to the 12th year.

RESULTS

After 12 years, a total of 22 implants (81.48%), were available for the final data analysis; the implants achieved a 100% cumulative survival rate, and only a mild degree of periodontal tissue inflammation was recorded. The radiographic evaluation revealed a physiological marginal bone remodeling over the follow-up.

CONCLUSION

Although a good preservation of the residual bone tissue in postextraction implant sites treated with keratinized epithelial connective tissue grafts was observed, the low number of treated cases does not allow us to propose this experimental protocol to all cases of bone defects but it certainly represents a new option. Further studies on a greater number of patients and using implants with different surface characteristics should be conducted for a better understanding of the indications of the proposed treatment.

Comparison of immediate implant placement in infected and non-infected extraction sockets: a systematic review and meta-analysis

OBJECTIVE

This review aimed to investigate the feasibility of immediate implant placement in infected extraction sockets.

MATERIAL AND METHODS

We performed electronic and manual searches up to March 2017 to obtain data from randomized controlled trials (RCTs) and nonrandomized controlled clinical trials (CCTs). Using a fixed-effects model to assess the difference in survival rate (primary outcome), we evaluated the risk difference for immediate implant placement in infected and non-infected sites. We estimated the weighted mean differences (WMDs) of the change in marginal bone loss (MBL), probing depth (PD), modified bleeding index (mBI), marginal gingival level (MGL) and width of keratinized gingiva (WKG) at baseline and latest follow-up.

RESULTS

In total, five studies (0 RCT, five CCTs) were included in the systematic review and three studies were included in the meta-analysis. The risk difference for immediate implant placement in an infected extraction socket compared with that in a non-infected socket was -0.02. WMDs for MBL, PD, mBI, MGL and WKG between the two groups were 0.32, 0.12, 0.07, -0.06, 0.20 and 0.51, respectively. No statistical differences were observed between the two groups, except for the change in WKG.

CONCLUSIONS

Implants can be placed in infected extraction sockets after thorough socket debridement. For aesthetics, WKG should be considered when performing immediate implant placement in infected sites.

Hydroxyapatite-coated implant: Clinical prognosis assessment via a retrospective follow-up study for the average of 3 years

PURPOSE

This research evaluated clinical outcomes of two types of hydroxyapatite (HA)-coated implants: OT (Osstem TS III-HA, Osstem implant Co., Busan, Korea) and ZM (Zimmer TSV-HA, Zimmer dental, Carlsbad, USA).

MATERIALS AND METHODS

The research was conducted on 303 implants (89 of OT, 214 of ZM), which were placed from January 16, 2010 to December 20, 2012. The prognosis was evaluated in terms of success rates, survival rates, annual marginal bone loss, and implant stability quotients (ISQ). The samples were classified into immediate, early, conventional, and delayed groups according to the loading time.

RESULTS

Overall, there were no significant differences between OT and ZM in success rates, survival rates, and annual marginal bone loss, except for the result of secondary stability. OT showed 77.83 ± 8.23 ISQ, which was marginally higher than 76.09 ± 6.90 ISQ of ZM (P<.05). In terms of healing periods, only immediate loading showed statistically significant differences (P<.05). Differences between OT and ZM were observed in terms of two indices, the annual marginal bone loss (0.17 ± 0.58 mm/year < 0.45 ± 0.80 mm/year) and secondary stability (84.36 ± 3.80 ISQ > 82.48 ± 3.69 ISQ) (P<.05). OT and ZM did not have any statistically significant differences in early, conventional, and delayed loading (P>.05).

CONCLUSION

OT (97.75%) and ZM (98.50%) showed relatively good outcomes in terms of survival rates. In general, OT and ZM did not show statistically significant differences in most indices (P>.05), although OT performed marginally better than ZM in the immediate loading and 1-stage surgery (P<.05).

Aesthetics and Survival of Immediately Restored Implants in Partially Edentulous Anterior Maxillary Patients

This retrospective study was undertaken to determine survival rates and aesthetic outcomes of immediate placement of multiple implants at anterior maxilla sites. One hundred and eighteen implants placed in 39 patients (21 women and 18 men; average age 58.3 years) were immediately restored (24–72 h after placement). Aesthetic assessment, radiographic bone loss, and biological and prosthetic complications were evaluated. Data collection between 12 and 84 months (mean 32.2 ± 18) after final prosthetic installation revealed that no implants were lost, and that 106/118 (89.8%) implants had no more than 1.5 mm of bone loss by the end of the first year and an additional 0.2 mm for each successive year. The marginal bone loss was higher for extractions due to periodontitis compared to extractions due to caries (mean mesial loss of 1.37 mm vs. 1.01 mm, respectively, and mean distal loss of 1.37 mm and 0.99 mm, respectively, p = 0.001). The mesial papilla was present in 83/118 implants (70.3%), while the distal papilla was present in 76/118 implants (64.4%). The cervical metallic part of the abutment was exposed in 16/118 (13.5%) implants. There was a higher ratio of recessions and missing papillae in patients in whom the extractions were performed due to periodontal reasons. Within the limitations of the present study, aesthetic and radiographic parameters support immediate restoration of partially edentulous maxillae.

Evaluation of dimensional behavior of peri-implant tissues in implants immediately exposed or submerged in fresh extraction and healed sites: a histological study in dogs

Background

The aim of this study was to compare histologically the dimensional behavior of peri-implant tissues during osseointegration of immediately exposed or submerged implant placement in fresh extraction and healed sites.

Methods

Four fresh extraction and four delayed implant sites were placed in each hemimandible of five dogs at the bone crest level. In 2 implants of each side were installed a healing abutment (exposed) and two cover screw (submerged) and formed four groups: implant installed in fresh extraction submerged (group 1), implants in fresh extraction immediately exposed (group 2), implants installed in healed site submerged (group 3), and implants in healed site immediately exposed (group 4). After 12 weeks of healing period, histomorphometric analyses of the specimens were carried out to measure the crestal bone level values and the tissue thickness in the implant shoulder portion.

Results

The measure of crestal bone level showed some higher values for implants installed in fresh extraction sites in the buccal aspect: 1.88 ± 0.42 mm for group 1 and 2.33 ± 0.33 mm for group 2, with statistical significance among all four groups tested (P < 0.001). For peri-implant tissue thickness, a significative higher statistical difference (P < 0.001) for implants installed in healed sites (groups 3 and 4) was found.

Conclusions

Within the limitations of the present animal study, our findings suggest that the implants placed in fresh extraction or healed site and with regards to the moment of exposition (immediately or no) are important factors to the amount of peri-implant tissues after remodeling over a period of 12 weeks. The null hypothesis was rejected.

Feline Dental Implants: Long-Term Follow-up of Two Cases

Dental implants have become an option for replacement of lost canine teeth in cats. Although cats appear to manage well after a canine extraction, complications such as lip entrapment can occur after maxillary canine tooth extraction. Even cats with a complicated crown fracture of the maxillary canine tooth that have had root canal therapy can develop lip entrapment. This can lead to painful lip ulcers and potential need for further dental treatment. Canine tooth replacement with a dental implant and prosthodontic crown is, in the authors' experience, a predictable option that can be offered to clients who would like to replace a lost canine tooth. This report will discuss 2 long-term cases of maxillary canines replaced by dental implants/crowns.

Immediate Loading of Tapered Implants Placed in Postextraction Sockets and Healed Sites

OBJECTIVE

The aim of the present study was to compare the survival, stability, and complications of immediately loaded implants placed in postextraction sockets and healed sites.

METHODS

Over a 2-year period, all patients presenting with partial or complete edentulism of the maxilla and/or mandible (healed site group, at least 4 months of healing after tooth extraction) or in need of replacement of nonrecoverable failing teeth (postextraction group) were considered for inclusion in this study. Tapered implants featuring a nanostructured calcium-incorporated surface were placed and loaded immediately. The prosthetic restorations comprised single crowns, fixed partial dentures, and fixed full arches. Primary outcomes were implant survival, stability, and complications. Implant stability was assessed at placement and at each follow-up evaluation (1 week, 3 months, and 1 year after placement): implants with an insertion torque (IT) <45 N·cm and/or with an implant stability quotient (ISQ) <70 were considered failed for immediate loading. A statistical analysis was performed.

RESULTS

Thirty implants were placed in postextraction sockets of 17 patients, and 32 implants were placed in healed sites of 22 patients. There were no statistically significant differences in ISQ values between the 2 groups, at each assessment. In total, 60 implants (96.8%) had an IT ≥45 and an ISQ ≥70 at placement and at each follow-up control: all these implants were successfully loaded. Only 2 implants (1 in a postextraction socket and 1 in a healed site, 3.2%) could not achieve an IT ≥45 N·cm and/or an ISQ ≥70 at placement or over time: accordingly, these were considered failed for stability, as they could not be subjected to immediate loading. One of these 2 implants, in a healed site of a posterior maxilla, had to be removed, yielding an overall 1-year implant survival rate of 98.4%. No complications were reported. No significant differences were reported between the 2 groups with respect to implant failures and complications.

CONCLUSION

Immediately loaded implants placed in postextraction sockets and healed sites had similar high survival and stability, with no reported complications. Further long-term studies on larger samples of patients are needed to confirm these results.

Osteomyelitis of the Mandible after Dental Implants in an Immunocompetent Patient

Dental implants are now broadly used to replace missing teeth, and the presence of infectious complications is rising. Dental implant therapy as a local risk factor for the onset of osteomyelitis and its management have not been widely explored. Here, we report an unusual case of mandibular suppurative osteomyelitis caused by Streptococcus intermedius in a healthy and immunocompetent patient secondary to mandibular implants. We describe how surgery combined with systemic application of antibiotics allowed conservation of the dental implants in the mandibular bone, discuss the probable source of contamination, and present the follow-up of the osteomyelitis.

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.

Dental Implants and Incisor Bridge Placement in a Dog

Veterinary dentistry has tended to follow the trends and advancements in the human dental field. As for any procedure performed on a patient, whether human or animal, an informed decision is based on the available evidence regarding treatment options. This is certainly true for the more involved treatments in veterinary dentistry which can include the disciplines of endodontics and dental implantology. A number of published case reports have been accepted by the specialty that endodontic therapy is indeed a predictable and a valuable service that can be offered to pet owners. Oral implantology has become an accepted and predictable procedure in the human dental field and can now be offered to pet owners if performed by suitable trained veterinary clinicians. The success rate for endosseous implant osseointegration is very high in humans. Success rates are also very high in animals used for implantology research. Canine studies have shown good bone-to-implant contact of around 73% in osseointegrated endosseous implants based on histological sections. Radiographic and histological findings demonstrate stable alveolar crestal bone levels after loading endosseous implants for up to 12 months in a dog model. This article discusses use of dental implants in the rostral mandible of a companion dog to replace periodontally diseased incisors, their restoration, to return the animal to full dental function and 3-year follow-up.

Esthetic Assessment of Implants Placed into Fresh Extraction Sockets for Single-Tooth Replacements Using a Flapless Approach

BACKGROUND

To validate the concept of immediate implant placement and nonfunctional loading for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria.

PURPOSE

This study analyzed procedural results as graded by the pink esthetic score and white esthetic score (PES/WES).

METHODS

Thirty-nine suitable patients (mean follow-up 44.82 ± 28 months) were evaluated.

RESULTS

Thirty-eight implants fulfilled stringent criteria for successful osseointegration: absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 15.50 ± 2.67 (range: 10-20). The mean total PES of 7.92 ± 1.60 (range: 5-10) indicated favorable overall peri-implant soft-tissue conditions. Root convexity and texture (1.63 ± 0.54) and curvature of the facial mucosa (1.68 ± 0.47) and distal papilla (1.66 ± 0.48) had the highest mean values, whereas acceptable levels of facial tissue (1.53 ± 0.73) and mesial papilla (1.42 ± 0.64) were the most difficult to fully achieve. The mean mesial and distal bone loss at data collection was, was 1.19 ± 0.54 and 1.15 ± 0.51, respectively. Periodontal disease severity (advanced chronic and aggressive periodontitis) was significantly associated with a low total PES (p = .048).

CONCLUSIONS

Objective PES/WES assessment validated immediate anterior maxillary single-tooth replacement and restoration as being a successful and esthetically predictable treatment modality in sites where the buccal bone had been preserved during the extraction at 1 year of follow-up.

Immediate dental implant placement into infected vs. non-infected sockets: a meta-analysis

OBJECTIVE

This meta-analysis was aimed at assessing whether immediate dental implant placement into infected vs. non-infected sites produced different effects on implant failure risk and marginal bone loss.

MATERIAL AND METHODS

Relevant studies were identified by searching articles in PubMed, Web of Knowledge, and the Cochrane Library through February 2015 and by reviewing the reference lists of the retrieved articles. When an intervention led to dichotomous outcomes, the outcomes were expressed as risk ratios, whereas continuous outcomes were expressed as mean differences in millimeters; each had a 95% confidence interval. Study-specific estimates were combined using fixed-effects models.

RESULTS

A total of 1743 articles were identified following the search process. Seven studies were finally included in the meta-analysis, which comprised a total of 1586 implants and 25 failures. Compared to the immediate insertion of a dental implant into a non-infected site, the insertion of an implant into an infected site showed 116% increase in the risk of implant failure, which had borderline statistical significance (risk ratio = 2.16, 95% confidence interval: 0.97, 4.80, P = 0.058; heterogeneity: I²  = 0.0%, P_{heterogeneity}  = 0.997). With regard to marginal bone loss, we observed no statistically significant difference between insertions into infected vs. non-infected sites (mean difference = -0.04, 95% confidence interval: -0.09, 0.02, P = 0.173, heterogeneity: I²  = 0.0%, P_{heterogeneity}  = 0.765).

CONCLUSION

This meta-analysis suggests that immediately placing a dental implant into an infected site may increase the risk of implant failure. Given the presence of uncontrolled confounders in the studies that were assessed, the results should be interpreted with caution.

Extraction Socket Management Utilizing Platelet Rich Fibrin: A Proof-of-Principle Study of the "Accelerated-Early Implant Placement" Concept

Dental implants are widely accepted as the golden standard for the rehabilitation of an edentulous site following the extraction of a tooth. The ideal time for implant placement is dependent on the time required for partial or complete tissue healing and the adequacy of socket dimensions. The use of autologous growth factors is a promising new concept that aids clinicians in minimizing treatment time and increasing patient satisfaction. The purpose of this paper is to introduce a protocol for "accelerated-early" implant placement. In this protocol, platelet rich fibrin is employed to accelerate soft and hard tissue healing and to provide a better-healed recipient site for accelerated, early implant placement. Histological analysis revealed that at 6 weeks postextraction, the application of our approach resulted in delicate newly formed bone showing intense osteoblastic activity surrounded by connective tissue as well as areas of mineralized tissue. The present study is a proof-of-principle study of the acceleration of the physiologic postextraction healing sequelae with the use of autologous growth factors. The accelerated-early implant placement concept is a bioengineered protocol that may aid clinicians to achieve increased primary stability, by placing implants in ridges in an advanced stage of bone healing, while offering patients the benefits associated with early implant placement. Controlled studies are warranted to verify the reproducibility of this treatment concept and identify specific indications where the use of the presented technique can lead to significant clinical results.

Clinical evaluation of implant survival based on size and site of placement: A retrospective study of immediate implants at single rooted teeth sites

Objectives

This retrospective clinical study sought to evaluate the survival of immediate implants placed at maxillary and mandibular single-rooted tooth extraction sites and to determine the relationship among implant size, placement site, and implant survival.

Methods

Between January 2010 and June 2011, 85 patients (33 males, 52 females; mean age: 45 years) underwent immediate implant placement after extraction of single-rooted teeth. All implants were restored between 12 and 14 weeks after implant placement. The implant survival and its relationship with implant size and implantation site were evaluated by odds ratios (ORs).

Results

Implants were placed at the following sites: upper central incisor (UCI, n = 35), upper lateral incisor (ULI, n = 27), upper second premolar (U2ndP, n = 36), lower incisor (LI, n = 53), and lower premolar (LP, n = 22). Implants of the following sizes were used: 5 × 10 mm (n = 24), 5 × 8 mm (n = 21), 4.3 × 10 mm (n = 77), 4.3 × 8 mm (n = 36), 3.5 × 10 mm (n = 12), and 3.5 × 8 mm (n = 3). After a mean follow-up time of 47 months, the overall implant survival rate was 96%. Survival rate was highest at the LI site (98.1%) and lowest at the ULI site (92.6%). All of the 5-mm implants survived (100%), as did most of the 4.3 × 10 mm implants (96.1%). Implants of 4.3 × 8 mm and 3.5 × 10 mm were the least successful (91.7%). Mandibular implants had a better survival rate (97.3%) than maxillary implants (94.9%). There was no significant OR of increased survival for any particular implant size or site.

Conclusions

Immediate implant placement in fresh extraction sockets can give predictable clinical outcomes, regardless of the implant size and site of placement.

Differences in Healing Patterns of the Bone-Implant Interface between Immediately and Delayed-Placed Titanium Implants in Mouse Maxillae

BACKGROUND

There are no available data on the healing process at the bone-implant interface after immediate implant placement.

PURPOSE

This study aimed to establish an animal experimental model of titanium implants placed in mouse maxillae and compare the healing pattern of the bone-implant interface after immediate implant placement with that after delayed implant placement.

MATERIALS AND METHODS

Maxillary first molars (M1) from 4-week-old mice were extracted and replaced with the implant following drilling (immediate-placement group). In contrast, M1 from 2-week-old mice were extracted, followed by drilling and implantation after 4 weeks (delayed-placement group). The decalcified samples at 0-28 days after implantation were processed by immunohistochemistry, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay, and tartrate-resistant acid phosphatase histochemistry. The elements and bone volume of undecalcified samples were quantitatively analyzed by an electron probe microanalyzer.

RESULTS

Osseointegration was completed by 28 days after the procedure in both groups. There were no differences in contact area, bone loss at the cervical area, or rate of calcification at the bone-implant interface between the two groups.

CONCLUSIONS

This study found no significant differences in the chronological healing process at the bone-implant interface between the two groups at the cellular level.

Long-term Survival of Straumann Dental Implants with TPS Surfaces: A Retrospective Study with a Follow-up of 12 to 23 Years

PURPOSE

The aim of this study was to evaluate the long-term dental implant survival rates of Straumann dental implants in a university hospital environment over 12 to 23 years.

MATERIALS AND METHODS

A total of 388 Straumann dental implants with titanium-sprayed surfaces (TPS) were inserted in 92 patients between 1988 and 1999 in the Department of Oral and Maxillofacial Surgery of the University Hospital Schleswig-Holstein in Kiel, and they were reevaluated with standardized clinical and radiological exams. Kaplan-Meier analyses were performed for individual factors. Cox proportional hazard regression analysis was used to detect the factors influencing long-term implant failure.

RESULTS

The long-term implant survival rate was 88.03% after an observation time of 12.2 to 23.5 years. Cox regression revealed statistically significant influences of the International Team for Implantology (ITI) implantation type (p = .00354) and tobacco smoking (p = .01264) on implant failure. A proportion 82.8% of the patients with implant losses had a medical history of periodontitis. Peri-implantitis was diagnosed in 9.7% of the remaining implants in the long-term survey.

CONCLUSIONS

This study emphasized the long-term rehabilitation capabilities of Straumann dental implants in complex cases. The survival rates after several years constitute important information for patients, as well as for clinicians, in deciding about different concepts of tooth replacement. Patient-related and technical factors - determined before implant placement - could help to predict the risk of implant loss.