Molar Septum Expansion with Osseodensification for Immediate Implant Placement, Retrospective Multicenter Study with Up-to-5-Year Follow-Up, Introducing a New Molar Socket Classification

Comparison of accuracy of immediate implant placement between planned and actual position in pre-extractive versus conventional method - A prospective study

This study aims to evaluate the accuracy of immediate implants in mandibular molars between the conventional method and the pre-extractive inter-radicular method.

MATERIALS AND METHODS

A total of 20 patients were equally divided into two groups. Implants were placed using the conventional method (Group A) and pre-extractive inte-rradicular method (Group B). Coronal, apical and angular deviation between planned and placed implants were evaluated by superimposing preoperative and postoperative three-dimensional (3D) STL models in Geomagic Freeform software. The data were subjected to an unpaired Student t-test.

RESULTS

Results revealed that the coronal, apical and angular deviation were lower in the pre-extractive inter-radicular drilling method than in the conventional method, which was statistically significant. Apical deviation was greater than coronal deviation in both the sagittal and coronal planes. It was also found that the mean deviation was greater in the sagittal plane (mesio-distal axis) than in the coronal plane (bucco-lingual axis).

CONCLUSION

Comparison of the two methods revealed significant changes between the planned and actual positions of implant. When stringent steps were followed, the degree of deviation was found to be less in the pre-extractive inter-radicular approach, proving it to be more accurate than the conventional method. However, large-scale research studies are required to extrapolate our findings.

Three-dimensional radiographic assessment of immediate implant placement in the posterior mandible: A novel parameter-based classification

OBJECTIVES

To assess the implant position (IP), the interradicular septum width (ISW) and radiographic bone to implant contact (BIC), when simulating an immediate implant placement in first and second mandibular molars.

STUDY DESIGN

75 patients (150 sites) were studied using cone beam computed tomography scans (CBCT) and computer aided design software. Implants were placed in a prosthetically driven position; subsequently, IP and BIC were digitally calculated. Linear ISW was also analyzed at 2, 4 and 6mm apically to the highest septal bony peak. Multiple linear regressions were performed to assess relationships between BIC and the different predictive variables. Additionally, the receiver operating characteristics (ROC) curve was used to create a model for BIC based on the ISW at 2mm.

RESULTS

BIC in implants replacing first molars was the highest at the septal (S) position when compared to those in septal-mesial (S-M) position (p-value 0.001). As for the second molar, the highest percentage of BIC was recorded at the septal (S) position, followed by those in S-M and mesial (M) positions (p<0.001).

CONCLUSION

According to the proposed classification, clinician must consider the ISW and IP when placing immediate implant in the first and second mandibular molar sites. When tackling first molars, S position is predominant, while S-M position is the most common in the second molars. ISW at 2mm should be at least respectively 2mm and 2.5mm at the first and second molar sites to achieve 50% of BIC.

Immediate implant placement in single mandibular molar with chronic periapical periodontitis

INTRODUCTION

The present study aims to assess and compare the clinical outcomes of immediate implant placement in the mandibular molar region with or without the presence of chronic periapical periodontitis.

MATERIALS AND METHODS

Employing a case-control design, this study encompassed a cohort of patients necessitating implant surgery to supplant a single, failed mandibular molar. Participants exhibiting periapical lesions measuring between > 4 mm and < 8 mm were assigned to the test group, while those without periapical lesions to the control group. Subsequent to flap surgery and tooth extraction, extraction sockets were debrided thoroughly, and implants were immediately implanted (baseline). Permanent restorative procedures were carried out three months post-operation, with follow-up conducted one year post-surgery. During the study period, parameters including implant survival rate, Cone Beam Computer Tomography (CBCT) data, implant stability quotient (ISQ), insertional torque values (ITV), and potential complications were closely monitored.

RESULTS

Throughout the yearlong observation period subsequent to implant placement, both groups exhibited a 100% implant survival rate. None of the participants experienced any complications. Both groups demonstrated significant decreases in the height and width of the alveolar bone (P < 0.05). However, there were no statistically discernible differences between corresponding areas in the two groups (P > 0.05). The differences in ITV between the test group (37.94 ± 2.12 N•cm) and the control group (38.55 ± 2.71 N•cm) were not statistically significant at baseline (P > 0.05). A significant rise in ISQ was noted within the same group between baseline and three months post-operation (P < 0.05), while no significant variations in ISQ changes were noted between the two groups (P > 0.05).

CONCLUSION

Given the constraints of this investigation, the preliminary clinical outcomes of immediate implant placement in the mandibular molar region with chronic periapical periodontitis do not significantly differ from those observed in instances devoid of chronic periapical periodontitis.

Cone-Beam Computed Tomography (CBCT)-Based Assessment of the Alveolar Bone Anatomy of the Maxillary and Mandibular Molars: Implication for Immediate Implant Placement

Purpose This study aims to examine specific aspects of socket morphology, including buccal and palatal/lingual bone width, interradicular bone (IRB) width, and assessments of root apices and furcation proximity to the vital structures of the maxillary and mandibular first and second molars using cone-beam computed tomography (CBCT). Materials and methods The study involved the analysis of 400 maxillary and mandibular first and second molars. Various measurements were taken to assess socket morphology, including mesiodistal (MD) and buccolingual (BL) width, buccal and lingual bone thickness at 2 mm apical to the alveolar crest, IRB width at 2 mm from the furcation, and the distance between the root apices and furcation to vital structures, such as the floor of the maxillary sinus (FMS) and inferior alveolar nerve (IAN). Results The mesiobuccal (MB) root of the second molar commonly intruded into the sinus, followed by the palatal root of the maxillary first molar. The mean FMS-F distance was 7.17 + 3.98 mm, and it was 7.2 + 2.72 mm for maxillary first and second molars, respectively. The mean IRB width was 2.77 + 0.96 and 2.29 + 0.74 mm for the first and second molars. The mandibular second molar had the shortest distance to the IAN in comparison to the first molar. For maxillary teeth, 7% of the first and 4% of the second molars presented alveolar anatomy adequate for immediate implant placement, compared to 84% and 50% of mandibular first and second molars. Conclusion Understanding the local alveolar bone anatomy of molars and its relationship to vital structures is crucial for the effective planning of implant treatments.

Effects of Osseodensification on Primary Stability of Cylindrical and Conical Implants-An Ex Vivo Study

Primary stability is an important factor for dental implant success. In the past years, a new method for bone site preparation was introduced, named osseodensification (OD). OD produces a condensation of the trabecular portion of the bone, increasing bone-to-implant contact and primary stability. This study aims to compare the effect of OD in cylindrical and conical implants to conventional instrumentation. A total of forty implants, divided into four groups, were placed in porcine tibia: cylindrical conventional (1a), cylindrical OD (1b), conical conventional (2a) and conical OD (2b). Each implant was measured for implant stability quotient (ISQ), insertion torque (IT) and removal torque (RT). Group 2b showed the higher values for each of the evaluated parameters; groups 1b and 2b showed better results than 1a and 2a, respectively. Regarding the IT and RT, group 1b achieved higher values than group 2a, but not for ISQ. The inter-group comparison showed significant difference between groups 1a vs 2a, 1a vs 2b and 1b vs 2b for ISQ and 1a vs 1b and 1a vs 2b for RT analysis. OD resulted in improved ISQ, IT and RT of both cylindrical and conical implants.

Single-rooted extraction socket classification: A systematic review and proposal of a new classification system based on morphologic and patient-related factors

Taxonomy and classification of a disease contributes to facilitating the diagnosis and treatment planning process and simplifies communication between clinicians. The aim of this study was to provide a critical appraisal based on a systematic review of the single-rooted extraction socket (ES) classifications and subsequently, introduce a new classification system combining the cornerstones of the previously proposed systems and based on the latest consensus in implant dentistry. Following the systematic search process in PubMed, EMBASE, and SCOPUS databases 13 ES classifications were detected. The most repeated hard and soft tissue factors in the previous classifications were buccal bone dehiscence, interproximal bone, gingival recession, and soft tissue phenotype. However, there was minimal attention to patient-related factors such as systemic conditions and smoking. Therefore, a new classification system based on the combination of patient-related factors, clinical and radiographical parameters was proposed. This divides an ES into three types. Class I and II sockets are candidates for receiving immediate implant placement and conversely, a class III socket includes a compromised condition that requires multiple-stage reconstruction mostly suitable for standard delayed implant placement with alveolar ridge preservation. Within the limitations of this study, the new classification system not only provides comprehensive inclusion of various crucial parameters in implant placement (such as prediction of future implant position and osteotomy difficulty, etc.) but also, in contrast to the previously introduced systems, is able to classify the ES prior to extraction and also, takes into the account the patient-related factors as the class modifiers following the extraction.

[Autotransplantation of a horizontally oriented fragment of the root of a removed tooth to preserve alveolar tissues]

THE AIM OF THESTUDY

To develop a method to contain atrophy of the alveolar bone and surrounding soft tissues in the area of many cortical teeth in the first 3 months after removal for subsequent installation of a dental implant.

MATERIALS AND METHODS

A description of a method for containing atrophy of the alveolar bone and surrounding soft tissues after removal of the first molar of the mandible 3 months after tooth extraction is presented. The method consists in closing the mouth of the well with a horizontally oriented fragment of the root of the removed tooth with a preserved section of the ligamentous apparatus. An X-ray assessment of bone restoration in the lumen of the well was carried out according to the Hounsfield coefficient and an assessment of the condition of soft tissues in the area of surgery 3 months after removal. For histological assessment of bone maturity, bone was taken from the implantation area 14 weeks after tooth extraction.

RESULTS

The technique allowed to preserve the quality of soft tissues close to the original; on three-dimensional X-ray images in the lumen of the well, bone restoration sufficient for the installation of a dental implant is diagnosed, the zonal value of the Hounsfield coefficient is more than 300 units; histologically, a well-developed network of coarse-fibrous trabeculae is determined with the beginning of reconstruction into lamellar bone, regeneration of the alveolar process occurs by intramembranous ossification.

CONCLUSION

The proposed technique contributes to the preservation of the qualities of the marginal gum in the healing zone after tooth extraction and the formation of sufficient bone maturity in the lumen of the well.

Medical Application of Functional Biomaterials-The Future Is Now

We live in unprecedented times [...].

Criteria for the Classification of the Interradicular Septum Shape in Maxillary Molars with Clinical Importance for Prosthetic-Driven Immediate Implant Placement

The aim of this study was to use cone-beam computed tomography (CBCT) to evaluate the morphometric properties of the interradicular septum (IRS) in the maxillary molar region that may be indicative for prosthetic-driven implant placement. Following the repetitive algorithm based on the visual identification of IRS shapes, we described the following IRS shapes: arrow, boat, drop, and palatal and buccal convergence. The incidence of IRS shapes showed significant differences for the first and second maxillary molars (the highest frequency for the arrow shape, and the lowest for the drop shape) with no significant difference between the molars. The most prominent width indicative for implant placement was observed in the palatal convergence shape, whereas the height criteria were the most satisfying in the buccal convergence-shaped IRS for both molars. Apart from the parameters in the coronal view, the image analysis in the axial view revealed that IRS surface area, required for the implant placement, was the most prominent in the palatal convergence shape for the first, and boat shape for the second molars. Our results showed the benefits of CBCT diagnostics in posterior maxilla morphometric analysis. IRS shape classification may be helpful in achieving more rapid and accurate planning for interventions in this region.

Effects of Osseodensification on Immediate Implant Placement: Retrospective Analysis of 211 Implants

Osseodensification is a new method of bone instrumentation for dental implant placement that preserves bulk bone and increases primary implant stability, and may accelerate the implant rehabilitation treatment period and provide higher success and survival rates than conventional methods. The aim of this retrospective study was to evaluate and discuss results obtained on immediate implant placement with immediate and delayed loading protocols under Osseodensification bone instrumentation. This study included private practice patients that required dental implant rehabilitation, between February 2017 and October 2019. All implants were placed under Osseodensification and had to be in function for at least 12 months to be included on the study. A total of 211 implants were included in the study, with a 98.1% total survival rate (97.9% in the maxilla and 98.5% in the mandible). For immediate implants with immediate load, 99.2% survival rate was achieved, and 100% survival rate for immediate implant placement without immediate load cases. A total of four implants were lost during this period, and all of them were lost within two months after placement. Within the limitations of this study, it can be concluded that Osseodensification bone instrumentation provided similar or better results on survival rates than conventional bone instrumentation.

Assessment of Maxillary Molars Interradicular Septum Morphological Characteristics as Criteria for Ideal Immediate Implant Placement—The Advantages of Cone Beam Computed Tomography Analysis

The aim of this study was to evaluate the interradicular septum bone morphometric characteristics using cone beam computed tomography (CBCT) images, as well as to establish quantitative shortcuts to allow clinicians to make a faster and more reliable plan for immediate implant placement in the maxillary molars area. This retrospective quantitative study was conducted on CBCT images obtained from 100 patients. The morphometric analysis of the maxillary molars region was based on the parameters obtained on the sagittal and axial slices. The analysis performed on sagittal slices showed that the first maxillary molars had a wider interradicular septum when compared to the second molars, but the septum height in the first molars was significantly below the height in the second maxillary molars. The axial CBCT slices analysis showed that both interradicular septum perimeter and surface area were significantly more pronounced in the first than in the second maxillary molars. The interradicular furcation angle significantly correlated with the surface area (positively) and septum height (negatively) for both molars. The results of this study may recommend CBCT image analysis as a useful tool in predefining the circumstances that can allow for substantially better planning of immediate implant placement procedures in the region of maxillary molars.

Morphological Characteristics of Maxillary Molars Interradicular Septum and Clinical Implications - What do We Know So Far?

The interradicular septum describes area in the root furcation that separate alveoli of multi-rooted teeth. The shape and dimension depend of the topography of the extraction socket, the geometry of residual root and anatomy of molars alveoli. The clinical implications of this anatomic structure may be used in oral surgery resection procedures, periodontology and implantology. There is an opinion from the surgical and prosthodontic side that center of interradicular septum may be adequate place for immediate implantation. The aim of this study was to investigate morphological characteristics and clinical implications of upper molars interradicular septum. The studies showed that interradicular septum is important for success of resection surgery procedures: hemi-section, bisection and root amputation. It’s reported that furcation involvement in periodontal disease is clinical sign for severe bone loss. By reviewing the available literature for immediate implantation, it’s reported the clinical implications for diagnostical plan (pre-intervention), presurgical (pre-instrumentation) and intraoperative evaluation of interradicular septum for immediate implantation. The cone beam computed tomography analyze study presented mean values of septum height and wide for hypothetical plan of immediate implant placement. The presurgical studies evaluate how to assure preservation of septum and safe implant position in center of septum. The research showed varies therapy modalities that can be used, and how to choose right therapy according the socket type and initial septum width classification. According to observation of studies results, other researches should be considered for CBCT anatomical structure analyze and measures of interradicular septum for immediate implantation planning.