Immediate implant placement in fresh extraction sockets

Comprehensive analysis of the maxillary esthetic zone for immediate implant placement using cone beam computed tomography: A study of 352 maxillary images

STATEMENT OF PROBLEM

Previous studies have examined the maxillary esthetic zone for immediate implant placement, but these studies had small sample sizes and did not investigate multiple parameters.

PURPOSE

The purpose of this cross-sectional study was to use cone beam computed tomography (CBCT) to evaluate the sagittal root position (SRP), alveolar bone concavity, labial bone perforation (LBP), and tooth-ridge angle in the maxillary anterior teeth region.

MATERIAL AND METHODS

A total of 352 CBCT images of patients (180 men and 172 women) who visited the dental hospital between 2018 and 2023 were analyzed. The sample included 2112 anterior maxillary teeth. SRP, alveolar bone concavity, tooth ridge angle, and LBP were assessed using virtual implant simulation. The data were analyzed by using chi-squared and kappa tests to analyze distributions and agreement, respectively, dependent and independent t-tests to assess sex and tooth-specific differences, and the Spearman correlation test to explore potential correlations (α<.05).

RESULTS

The CBCT images revealed that the majority of SRP were in Class I (85.4%), with smaller percentages in Class II (12.5%) and Class IV (2.3%); Class III was the least common (1%). The canine exhibited the most significant alveolar bone concavity angle average (149.14 ±6.35 degrees), followed by the lateral incisor (142.32 ±8.7 degrees). The canines had the highest occurrence of LBP (63.1%) (P<.01). Women had a higher frequency of labial bone perforation and deeper alveolar bone concavities than men (P<.01).

CONCLUSIONS

The findings of this study indicate that careful assessment and planning are necessary for immediate implant placement in the maxillary anterior region. The significant occurrence of LBP highlights the importance of thorough planning and evaluation to avoid surgical mishaps and complications which may necessitate bone grafting and result in added costs and time. Special attention should be given to women and the canine area.

Case report and literature review: autonomous robotic system assisted palatal implantation at an anterior teeth site compromised by periapical cyst

Background

Immediate implant placement (IIP), which preserves gingival height and papilla shape while simultaneously accelerating the implant treatment period, has become a popular method due to its commendable clinical outcomes. Nonetheless, deploying immediate implants demands specific preconditions concerning the remaining alveolar bone. This poses a challenge to the accuracy of implant surgery.

Case presentation

In this report, we present the case of a 60-year-old woman with a left upper anterior tooth crown dislodged for over a month. Cone beam computed tomography (CBCT) revealed the absence of a labial bone wall on tooth 22, a remaining 1 mm bone wall on the labial side of the root apex, and a 17.2 mm*8.9 mm*4.7 mm shadow in the periapical region of the root apices of teeth 21 and 22, with the narrowest width on the sagittal plane being approximately 5 mm. After the surgeon removed the cyst, they completed the subsequent implantation surgery using an autonomous robot in a challenging aesthetic area. This method circumvented the potential exposure of the screw thread on the labial implant surface, assured initial implant stability.

Conclusion

Five months after the operation, the dental crown was restored. The implant remained stable, with yielding notable clinical results. To the best of our knowledge, this clinical case is the first to report the feasibility and precision of immediate implantation in anterior teeth site with periapical cyst removal, performed by an autonomous robotic surgical system. Autonomous robots exhibit exceptional accuracy by accurately controlling axial and angular errors. It can improve the accuracy of implant surgery, which may become a key technology for changing implant surgery. However, further clinical trials are still needed to provide a basis for the rapid development of robotic surgery field.

Nasopalatine duct cyst as a delayed consequence of dental implant placement in the anterior maxilla: A case report

Dental implants are now the best treatment method to replace missing teeth. However, complications may necessitate further therapeutic interventions because of anatomic limitations and mistakes during surgical procedures. In this case report, a nasopalatine duct cyst (NPDC) due to implant placement was studied. After clinical and radiographic evaluation, unilocular radiolucency with disturbance to the nasopalatine canal was observed. Following that, flap elevation was performed. Subsequently, the cyst was enucleated, and the bone defect was filled with xenograft and further covered with a resorbable membrane. Histopathology results confirmed NPDC as the definite diagnosis. After six months, the defect was completely resolved.

Flap versus Flapless Immediate Implants with Bone Augmentation: A Novel Study

Background

This study aimed to equate implants placed using a traditional flap elevation technique with implants placed using a flapless process regarding bone healing and success in clinical conditions.

Materials and Methods

Sixty subjects were included in this research work. The participants were randomly divided into two groups. Patients in group A underwent implant placement with the flap elevation technique. Similarly, group B patients underwent implant placement without flap reflection. Parameters such as plaque index, wound healing index, crestal bone loss, and radiograph were considered to estimate the effectiveness of the two techniques.

Results

Plaque indexes were improved in both groups. The modified gingival index also improved in all the phases of healing. The flapless method showed a better crestal bone.

Conclusion

It can be concluded that this study showed that with the right augmentation techniques, implants could be successfully performed immediate extraction sockets, both with and without elevation of the mucoperiosteal flap.

Clinical Effect and Aesthetic Evaluation of Minimally Invasive Implant Therapy

Objective

To explore the clinical effect and aesthetic evaluation of minimally invasive implant in the treatment of dentition defect.

Methods

From April 2020 to May 2021, 60 patients who received implant restoration were collected as the research objects. Randomly divided into minimally invasive surgery group (30 patients) and routine surgery group (30 patients). The postoperative antibiotic use time, pain disappearance time, swelling degree, and pain degree of the two groups were compared. Follow-up for one year, record and compare the success rate of implants and aesthetic evaluation of restoration between the two groups. The evaluation of patients' satisfaction with restoration was collected and compared.

Results

The operation time and antibiotic use time of patients in minimally invasive surgery group were significantly shorter than those in conventional surgery group, and the swelling degree rating was significantly better than that in conventional surgery group, with statistical significance (P < 0.05). The number of patients with no pain (0 degree) and mild pain (degree) in minimally invasive surgery group was significantly higher than that in routine surgery group, and the difference was statistically significant (P < 0.05). One year after the repair, the success rate of implants in minimally invasive surgery group was 100.00% compared with that in routine surgery group (93.33%), and the difference was not statistically significant (P > 0.05). The aesthetic effect scores of patients in minimally invasive surgery group were higher than those in routine surgery group in seven items: proximal gingival papilla, distal gingival papilla, labial gingival margin curvature, labial gingival margin height, root convexity, soft tissue color, and soft tissue texture, with statistical significance (P < 0.05). The satisfaction scores of the patients in minimally invasive surgery group in chewing function, comfort, aesthetics, retention function, and language function were higher than those in conventional surgery group, and the differences were statistically significant (P < 0.05).

Conclusion

Minimally invasive implant can achieve the same effect as conventional implant, and it has the advantages of lower postoperative swelling, shorter pain time, better aesthetic effect, and higher satisfaction after restoration.

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.