Late implant placement following ridge preservation versus early implant placement: A pilot randomized clinical trial for periodontally compromised non‐molar extraction sites

Assessment of soft and hard tissue changes following micro crestal flap-Alveolar ridge preservation and augmentation at molar extraction sites in patients with stage III/IV periodontitis: A randomized controlled trial

AIM

This study aimed to assess hard and soft tissue contour changes following micro crestal flap-alveolar ridge preservation (MCF-ARP) and natural healing (NH) in periodontally compromised molar extraction sites and to analyse the feasibility and need for bone augmentation during implant therapy.

MATERIALS AND METHODS

Fifty-six patients with 70 sites were randomized into two groups at the site level (35 sites from 31 patients in the test group and 35 sites from 29 patients in the control group). Among whom, four patients contributed one tooth to the control group and one tooth to the test group. Hard tissue indicators were measured using cone beam computed tomography performed before tooth extraction and 6 months after surgery. Soft tissue contour changes were assessed using intraoral scanning performed before and immediately after surgery and also 2 weeks and 1, 3 and 6 months after surgery.

RESULTS

Six months after surgery, the MCF-ARP group showed less resorption in buccal bone height (p = .032) and greater augmentation in central bone height (p = .001) and ridge width (p = .009). The mean, vertical and horizontal collapse of buccal soft tissue contour in the MCF-ARP group were 0.95 mm (p = .010), 0.61 mm (p = .019) and 0.56 mm (p = .013) less than that in the NH group, respectively. There were significantly (p = .007) fewer sites in the MCF-ARP group than in the NH group (0% vs. 26.7%) for staged bone augmentation and more sites that could be treated with simple implant procedure in the MCF-ARP group than in the NH group (71.9% vs. 56.6%).

CONCLUSIONS

Compared with NH, MCF-ARP reduced bone resorption in periodontally compromised molar extraction sites and maintained the buccal soft tissue contour. MCF-ARP reduces the need for complex bone augmentation procedures in implant therapy.

TRIAL REGISTRATION

Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on 4 February 2022, Version 1.0.

Early implant placement versus ridge preservation and delayed implant placement: Analysis of profilometric, clinician- and patient-reported outcomes from a two-centre RCT

OBJECTIVES

To compare early implant placement (EP) to alveolar ridge preservation and delayed implant placement (ARP/DP) in terms of contour changes, along with clinician- and patient-reported outcome measures (PROMs) until the delivery of the implant-supported restoration.

MATERIALS AND METHODS

Patients with a failing single tooth in the maxilla or mandible were recruited in two centres. After tooth extraction, patients were randomly assigned (1:1) to either EP or ARP/DP. At abutment connection and crown delivery, the buccal contour changes at 3 mm below the mucosal margin (primary outcome) along with clinician- (ease of treatment) and patient-reported outcomes were assessed using numeric rating scales and OHIP-14.

RESULTS

A total of 46 patients were analysed. The mean buccal contour at abutment connection decreased by -1.2 ± 0.6 mm in group EP and -1.6 ± 0.8 mm in group ARP/DP (estimated mean difference; 0.45 [95%CI, -0.02; 0.94]; p = .061) with no significant differences between the groups. ARP/DP was consistently easier than EP across all stages of the surgery (estimated mean difference; 2.0 [95%CI, 1.3; 2.7] p < .001): during flap elevation (EP: 4.8 vs. ARP/DP: 1.6), implant placement (EP: 5.7 vs. ARP/DP: 2.2) and wound closure (EP: 3.4 vs. ARP/DP: 1.6). Both interventions improved quality of life but patients who underwent ARP/DP were significantly more satisfied at the time of crown delivery (ARP/DP: 9.6 vs. EP: 9.1, p = .02).

CONCLUSIONS

EP and ARP/DP show no significant differences in buccal contour changes, aesthetics and patient-reported outcomes. However, ARP/DP is an easier procedure at all stages of the surgery compared to EP and could therefore be the preferred therapy for less experienced clinicians.

Alveolar ridge preservation versus early implant placement in single non-molar sites: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analyses was to evaluate the outcomes of alveolar ridge preservation (ARP) following extraction of non-molar teeth in comparison to early implant placement (EIP) in terms of clinical and radiographic changes, need for additional augmentation at the time of implant placement, patient-reported outcomes, and implant failure rate.

METHODS

Electronic databases were searched to identify randomized and non-randomized studies that compared ARP to EIP. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program.

RESULTS

A total of 106 studies were identified, of which five studies with 198 non-molar extraction sockets in 198 participants were included. Overall meta-analysis showed significant differences in changes in midfacial mucosal margin (mean difference (MD) -0.09; 95% confidence interval (CI) -0.17 to -0.01; p = .03) and ridge width (MD -1.70; 95% CI -3.19 to -0.20; p = .03) in favor of ARP. The use of ARP was also associated with less need for additional augmentation at implant placement, but the difference was not statistically significant.

CONCLUSIONS

Within the limitation of this review, ARP following extraction of non-molar teeth has short-term positive effects on soft tissue contour, mucosal margin and thickness, and alveolar ridge width and height. It can also simplify future implant treatment by minimizing the need for additional augmentation.

Horizontal ridge augmentation in the maxillary aesthetic region using the autogenous circular cortical-lamina anchoring technique: A case series study

AIM

This case series aimed to evaluate the effectiveness of the autologous circular cortical lamina-anchoring (CCA) technique for horizontal bone augmentation in the maxillary aesthetic region.

MATERIALS AND METHODS

A total of 25 patients with 28 implants underwent horizontal bone augmentation using CCA followed by implant placement and crown delivery. The primary outcome measures were alveolar ridge width (ARW) and buccal bone thickness (BBT), whereas the secondary outcome measures included marginal bone loss (MBL), mid-facial mucosal margin loss (MML), clinical assessment of peri-implant and aesthetic parameters, patient-reported outcome measures (PROMs), and implant survival rates.

RESULTS

All 25 patients with 28 implants completed the treatment, no dropouts occurred. After CCA, the mean ARW at 1, 2, and 4 mm below the alveolar crest significantly increased from 2.38 ± 0.48, 2.85 ± 0.51, and 3.21 ± 0.53 mm to 6.80 ± 0.48, 6.99 ± 0.50, and 8.08 ± 0.52 mm, respectively. At the 3-year follow-up, the mean BBT0, BBT2, and BBT4 slightly decreased from 2.51 ± 0.26, 2.63 ± 0.31, and 2.75 ± 0.29 mm to 2.43 ± 0.27, 2.51 ± 0.30, and 2.64 ± 0.28 mm, respectively. Although the overall MBL was <0.15 mm, the results were statistically significant. The mean MML at the 3-year follow-up was 0.02 mm. All implant sites showed acceptable peri-implant and aesthetic outcomes. Incisions healed without complications, and no significant differences in PROMs observed at any time point. The 3-year follow-up showed a 100% implant survival rate.

CONCLUSION

The autologous CCA technique is a useful method for increasing ARW and maintaining BBT in the maxillary aesthetic region.

Efficacy of Alveolar Ridge Preservation in Periodontally Compromised Molar Extraction Sites: A Systematic Review and Meta-Analysis

AIM

To investigate the efficacy of alveolar ridge preservation (ARP) in periodontally compromised molar extraction sites.

METHODS

An electronic search was performed on 10th November 2023 across five databases, seeking randomised/non-randomised controlled trials (RCTs/NCTs) that included a minimum follow-up duration of four months. The RoB2 and Robins-I tools assessed the risk of bias for the included studies. Data on alveolar ridge dimensional and volumetric changes, keratinized mucosal width, and need for additional bone augmentation for implant placement were collected. Subsequently, a meta-analysis was carried out to derive the pooled estimates.

RESULTS

Six studies were incorporated in the present review, and a total of 135 molar extraction sockets in 130 subjects were included in the meta-analysis. ARP was undertaken in 68 sites, and 67 sites healed spontaneously. The follow-up time ranged from 4 to 6 months. The meta-analysis of both RCTs and NCTs showed significant differences in mid-buccal ridge width changes at 1 mm level below ridge crest with a mean difference (MD) of 3.80 (95% CI: 1.67-5.94), mid-buccal ridge height changes (MD: 2.18; 95% CI: 1.25-3.12) and volumetric changes (MD: 263.59; 95% CI: 138.44-388.74) in favour of ARP, while the certainty of evidence is graded low to very low. Moreover, ARP appeared to reduce the need for additional sinus and bone augmentation procedures at implant placement with low certainty of evidence.

CONCLUSIONS

Within the limitations of this study, alveolar ridge preservation in periodontally compromised extraction sites may, to some extent, preserve the ridge vertically and horizontally with reference to spontaneous healing. However, it could not eliminate the need for additional augmentation for implant placement. Further, longitudinal studies with large sample sizes and refined protocols are needed.

Alveolar ridge preservation: Complications and cost-effectiveness

Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.

Surgical interventions for implant placement in the anterior maxilla: A systematic scoping review with evidence mapping

OBJECTIVES

Simplification and standardization of interventions are critical challenges to improving performance in implant dentistry. This study aimed to systematically identify and schematically present the evidence base of the implant dentistry surgical interventions for the anterior maxilla as a basis for further development and standardization.

METHODS

Electronic searches were conducted in PubMed, Embase and Cochrane CENTRAL. Primary clinical studies reporting surgical interventions in the anterior maxilla, with a sample size of at least ten patients, were included. Bibliometric information and study details were extracted. Descriptive analysis and a mind map approach were used to describe the documentation of different surgical interventions.

RESULTS

Two hundred and seventy-two studies reporting on 9001 patients were included. Within the past two decades, the number of literatures on implant placement in the anterior maxilla has increased dramatically (7 studies before 2005, 151 studies after 2016). Overall, the evidence map identified six primary operations and 33 variations. For hopeless tooth extraction, immediate implant placement was the most frequently reported (141 studies, 4670 patients); flapless implant placement with hard tissue augmentation and immediate provisionalization was the most commonly reported variation (33 studies, 987 patients). Type 3/4 implant placement (62 studies, 1902 patients) and implant site augmentation (33 studies, 788 patients) were frequently reported for missing teeth. Geographical differences were observed, with type 2 placement studies almost exclusively from Europe.

CONCLUSIONS

Research on immediate implant placement was the most reported surgical intervention in the anterior maxilla. Hard tissue augmentation was frequently reported simultaneously with or before implant placement. Immediate provisionalization was mainly used for type 1 implant placement. The finding that six primary operations with 33 variations have been reported indicates the need for additional research to simplify and consolidate the surgical approach.

Primary flap closure in alveolar ridge preservation for periodontally damaged extraction socket: A randomized clinical trial

INTRODUCTION

The effect of primary wound closure (PC) on alveolar ridge preservation (ARP) in periodontally damaged sockets has yet to be fully discovered.

METHODS

Periodontally damaged sockets were allocated to one of the following groups: (1) ARP with PC (group PC), and (2) ARP without PC (group secondary wound closure [SC]). Following tooth extraction and flap elevation, granule-type xenogeneic bone substitute material and a collagen barrier were applied. Ridge change was evaluated using cone-beam computed tomographic (CBCT) scans immediately after ARP and at 4 months. Core biopsy specimens were examined histomorphometrically.

RESULTS

A total of 28 patients were included in the analysis (13 in group PC, 15 in group SC). Histomorphometrically, the percentage of newly formed bone was 26.2 ± 17.7% and 24.6 ± 18.4% in groups PC and SC, respectively (independent t-test, degree of freedom [df] = 25, p > 0.05). Horizontal ridge changes on CBCT were -4.9 ± 3.1 mm and - 4.2 ± 2.5 mm in groups PC and SC at the 1 mm level below the ridge crest, respectively (independent t-test, df = 26, p > 0.05). Approximately half of the sites required additional bone augmentation at implant placement.

CONCLUSIONS

ARP with/without PC yielded similar new bone formation and radiographic ridge change. This clinical trial was not registered prior to participant recruitment and randomization (https://cris.nih.go.kr/cris/search/detailSearch.do/19718).

Alveolar ridge preservation in extraction sockets of periodontally compromised teeth: a systematic review and meta-analysis

OBJECTIVES

Alveolar ridge preservation (ARP) procedures can limit bone changes following tooth extraction. However, the role of ARP in periodontally compromised socket lacks strong scientific evidence. The aim of this systematic review and meta-analysis was to evaluate the outcomes of ARP following extraction of periodontally compromised teeth in comparison to extraction alone in terms of hard tissue changes, need for additional augmentation at the time of implant placement and patient-reported outcomes.

MATERIAL AND METHODS

Electronic databases were searched to identify randomized controlled trials (RCTs) that compared ARP in periodontally compromised sockets to spontaneous socket healing. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool.

RESULTS

Five studies with 134 extraction sockets in 126 participants were included. Of these, ARP was performed in 77 sites, while the remaining sites were intentionally left to heal without any ARP treatment. The follow-up time varied between six and 12 months. Overall meta-analysis showed significant differences in changes in ridge height (mean difference (MD) -0.95; 95% confidence interval (CI) -1.43 to -0.47; P = 0.0001) and bone volume (MD -38.70; 95% CI -52.17 to -25.24; P < 0.0001) in favour of ARP. The use of ARP following extraction of periodontally compromised tooth was also associated with significantly less need for additional bone grafting at the time of implant placement.

CONCLUSIONS

Within the limitation of this review, ARP following extraction of periodontally compromised teeth may have short-term positive effects on alveolar ridge height and bone volume and minimize the need for additional augmentation procedures. However, the evidence is of very low to low certainty.

The long-term impact of alveolar ridge preservation with xenograft bone mineral on peri-implant health after 5 years in function: A retrospective cohort study of 108 patients assessed clinically and radiologically

Objectives

When teeth are lost, dental implants contribute to improved oral function and quality of life. Limitations in dental implant placement arising from poor bone anatomy may be circumvented via alveolar ridge preservation (ARP). The aim is to evaluate the long‐term impact of ARP on peri‐implant health and the relationship with common risk indicators such as smoking and history of periodontitis.

Materials and Methods

One hundred and eight patients were enrolled in this retrospective cohort study with 308 implants. Of these, ∼41% were placed in bone sites that had previously received ARP with deproteinized bovine bone mineral xenograft. Association between baseline variables: ARP, age, gender, number of implants per patient, anatomical site, smoking, and previous history of grade III/IV periodontitis, and outcome variables: mucositis, peri‐implantitis, implant loss, full‐mouth plaque score (FMPS), full‐mouth bleeding score, and marginal bone loss (MBL) was evaluated using both univariate and multivariate models.

Results

After 5 years, the overall survival rate was 93.7%. The occurrence of peri‐implantitis was 21.3% and the extent of MBL was ~2.2 mm. Both peri‐implantitis occurrence and MBL were comparable between ARP⁺ and ARP⁻. Smoking is associated with higher FMPS and MBL.

Conclusions

The findings indicate that peri‐implant health can be maintained around dental implants for up to 5 years in ARP⁺ sites using Bio‐Oss®. Smoking is a major risk indicator for peri‐implantitis, whereas the association between history of periodontitis and the risk of peri‐implantitis, based on this specific, well‐maintained cohort and the specific implants used, remains inconclusive.

Patient's perception of timing concepts in implant dentistry: A systematic review

Protocols for implant dentistry, most frequently include periods until healing of the extraction sockets and osseointegration of the implant. Deductional thinking imply that patients would prefer if treatment time in implant dentistry were reduced.

AIM

What is the patient perception of immediate or early implant placement or loading in comparison with traditional, delayed placement, and/or loading assessed by patient-reported outcome measures, as evidenced in randomized controlled clinical trials or prospective controlled studies?

MATERIAL AND METHODS

A systematic review was performed following the PRISMA guidelines with a literature search up to June 30. All hits were imported into Rayyan online software and analyzed by two authors for eligibility. Cochrane RoB2.0 and Newcastle-Ottawa Scale were used to evaluate risk of bias in the individual studies.

RESULTS

Of the initially 1439 articles, 76 underwent full-text analysis and finally 40 articles, representing 35 cohort studies, were included. The quality evaluation demonstrated some concerns among most of the studies.

CONCLUSION

a) There is no strong evidence to support that the time for implant placement or loading of implant-supported single or short-span reconstructions or overdentures influence patients´ discomfort, satisfaction with function or esthetics or overall satisfaction with the implant treatment. b) There is some evidence that studies including edentulous patients rehabilitated with implant-supported full-arch FDPs demonstrate more satisfied patients with immediate than for the early or delayed loaded implant reconstructions after short time, but the difference is not clear one year after treatment.

Early implant placement with or without alveolar ridge preservation in single tooth gaps renders similar esthetic, clinical and patient-reported outcome measures: One-year results of a randomized clinical trial

Objectives

To test whether early implant placement with alveolar ridge preservation (ARP) results in different esthetic, clinical and patient‐reported outcome measures (PROMs) compared with early implant placement without ARP.

Material and methods

Seventy‐five patients requiring single tooth extraction in the anterior maxilla were recruited. Following tooth extraction, the patients were randomly allocated to three groups: (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM‐C) covered by a collagen matrix (CM) (n = 25), (b) ARP using DBBM‐C covered with a palatal graft (PG) (n = 25) and (c) spontaneous healing (control) (n = 25). Eight weeks after tooth extraction, a CBCT was taken and early implant placement was performed in all patients. Esthetic, clinical and PROMs were evaluated one year post‐loading.

Results

A total of 70 patients were available for re‐examination at one year post‐loading. The median mid‐facial mucosal margin change amounted to −0.02 mm (IQR −0.27–0.46) in the CM group, −0.13 mm (IQR −0.44–0.25) in the PG group and −0.14 mm (IQR −0.29–0.07) in the control group, with no significant differences between the groups. Mean PES scores amounted to 7.0 ± 1.4 in the CM group, 7.1 ± 1.5 in the PG group and 7.3 ± 1.7 in the control group without significant differences between the groups. Plaque, bleeding on probing and probing depth did not differ between treatment groups. PROMs in general revealed no significant differences between the groups.

Conclusion

Early implant placement with ARP using either a collagen matrix or a palatal graft rendered similar esthetic, clinical and PROMs to early implant placement without ARP. When a failing tooth can be replaced with an implant within 2 months after tooth extraction, the added value of ARP might be clinically negligible.

A case series of profilometric changes in two implant placement protocols at periodontally compromised non-molar sites

Information regarding profilometric changes at a soft tissue level following implant placement with different protocols is insufficient. Therefore, this study aimed to comparatively investigate the profilometric tissue changes with respect to late implant placement following alveolar ridge preservation (LP/ARP) and early implantation (EP) in periodontally compromised non-molar extraction sites. Sixteen patients were randomly assigned to the following groups: implant placement 4 months post-ARP (group LP/ARP) and tooth extraction and implant placement 4–8 weeks post-extraction (group EP). Dental impressions were obtained immediately after final prosthesis insertion and at 3, 6, and 12 months. At the time of implant placement, bone augmentation was performed in the majority of the patients. Profilometric changes of the tissue contour were minimal between the final prosthesis insertion and 12 months in the mid-facial area (0.04–0.35 mm in group LP/ARP, 0.04–0.19 mm in group EP). The overall tissue volume increased in both groups (1.70 mm³ in group LP/ARP, 0.96 mm³ in group EP). In conclusion, LP/ARP and EP led to similar stability of the peri-implant tissue contour between the final prosthesis insertion and at 12 months. Moreover, the change of peri-implant tissue on the soft tissue level was minimal in both modalities.

Soft tissue contour and radiographic evaluation of ridge preservation in early implant placement: A randomized controlled clinical trial

Objectives

To compare two ridge preservation techniques and spontaneous healing in terms of hard and soft tissue changes 2 months after tooth extraction.

Material and methods

The study was designed as a randomized controlled trial and included 75 patients. After single tooth extraction in the maxillary incisor/premolar area, patients were randomly allocated to one of the following groups: (a) ridge preservation with a xenogeneic bone substitute covered with a collagen matrix (CM‐group), (b) ridge preservation with a xenogeneic bone substitute covered with a free palatal graft (PG‐group) or (c) spontaneous healing (control). Eight weeks after tooth extraction, implants were placed and clinical, profilometric and radiographic evaluations were performed. In addition, the need for further guided bone regeneration (GBR) at implant placement was assessed. The differences between the treatment groups were compared with the One‐way ANOVA or Kruskal–Wallis test with the corresponding post hoc analysis. The proportions of the categorical parameters were compared with the Fisher´s exact test.

Results

Seventy‐five patients underwent early implant placement 8 weeks after tooth extraction and were evaluated. CM‐group (−0.9 SD 0.6 mm) and PG‐group (−1.0 SD 0.8 mm) showed less horizontal bone resorption compared to the control group (−3.2 SD 2.1 mm) (p < .001). Moreover, the necessity of GBR at implant placement was significantly less in CM‐group (32%) and PG‐group (24%) when compared to control group (72%) (p = .001). Patients in CM‐group experienced less pain than PG‐group, one week after tooth extraction (p = .042). No significant differences were found regarding graft evaluation, post‐operative complications, and soft tissue contour.

Conclusions

Ridge preservation using a xenogeneic bone substitute covered with a collagen matrix or a palatal graft, results in less bone resorption and fewer GBR procedures at early implant placement compared to spontaneous healing.