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Abstract
This study aimed to investigate the factors that could be associated with the risk of labial cortical bone wall perforation with immediate implant placement (IIP) in the maxillary aesthetic zone, in a cone-beam computed tomography (CBCT) virtual study. CBCT exams from 126 qualified subjects (756 teeth) were included. Implants were virtually positioned in two different positions: in the long axis of the tooth (prosthetically-driven position) and in an ideal position in relation to adjacent anatomical structures (bone-driven position). Two different implant diameters were planned for each tooth position, namely, 3.75 and 4.3 mm for central incisors and canines, and 3.0 and 3.3 mm for lateral incisors. The incidence of perforation was nearly 80% and 5% for prosthetically- and bone-driven position, respectively. Factors associated with a higher risk of cortical bone wall perforation (bone-driven position), according to logistic regression analysis, were women, wider implants, Sagittal Root Position class IV, and decrease of the labial concavity angle. Perforation of the labial cortical bone wall can be greatly minimized when the implant is placed in a bone-driven position compared to a prosthetically-driven position. It is important to preoperatively evaluate the morphological features of the implant site for risk assessment and to individualize the treatment plan.
Highlights
According to the first well-established protocol for the modern dental implants, implants were surgically placed in the jaws only after a 3–6-month period after tooth extraction, to ensure satisfactory remodeling and healing of the alveolar bone in order to optimize osseointegration of the implant [1]
It has been widely accepted that dental implants can be inserted into the alveolar socket immediately after extraction of teeth, with survival rates comparable to the ones observed for implants placed in pristine or healed sites [2,3]
From the 574 cone-beam computed tomography (CBCT) exams of the maxilla performed at the aforementioned oral radiology company during the last quarter of 2014, 414 exams were initially excluded either due to one or more missing teeth in the focused area, from patients that had a history of or were under orthodontic treatment, or due to the presence of anterior maxillary teeth with misalignment
Summary
According to the first well-established protocol for the modern dental implants, implants were surgically placed in the jaws only after a 3–6-month period after tooth extraction, to ensure satisfactory remodeling and healing of the alveolar bone in order to optimize osseointegration of the implant [1]. It has been widely accepted that dental implants can be inserted into the alveolar socket immediately after extraction of teeth, with survival rates comparable to the ones observed for implants placed in pristine or healed sites [2,3]. The issue is especially important if the implants planned to be placed immediately after extraction are positioned in the same position as the tooth that previously occupied the socket [7], the so-called prosthetically-driven position, as it is advocated that the implant should be anchored by a minimum amount of bone apical to the socket in order to achieve primary stability [8,9]
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