Immediate Placement Of Dental Implants Research Articles

Immediate Placement of Dental Implants in the Esthetic Zone: A Systematic Review and Pooled Analysis

Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri-implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single-tooth implants in the esthetic zone. MEDLINE, EMBASE, and CENTRAL databases were searched for publications up to June 2013. Studies reporting on implant survival, changes in hard and soft peri-implant tissues, esthetic outcome, and patient satisfaction were considered. A pooled analysis was performed to identify factors associated with survival and peri-implant tissue changes after immediate implant placement. Thirty-four studies were considered eligible. Immediate placement of single-tooth implants in the esthetic zone was accompanied by excellent 1-year implant survival (97.1%, 95% confidence interval [CI]: 0.958 to 0.980). Mean marginal peri-implant bone loss was 0.81 ± 0.48 mm, mean loss of interproximal peri-implant mucosa level was 0.38 ± 0.23 mm, and mean loss of peri-implant midfacial mucosa level was 0.54 ± 0.39 mm. Regression analysis revealed that delayed provisionalization (odds ratio [OR] 58.03, 95% CI: 8.05 to 418.41, P <0.000), use of a flap (OR 19.87, 95% CI: 10.21 to 38.66, P <0.000), and use of a connective tissue graft (OR 4.56, 95% CI: 1.72 to 12.08, P <0.002) were associated with marginal peri-implant bone-level change >0.50 mm. Because of underreporting, esthetic results and patient outcome did not allow for reliable analysis. Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short-term treatment outcome in terms of implant survival and minimal change of peri-implant soft and hard tissue dimensions.

Immediate, non-submerged, root-analogue direct laser metal sintering (DLMS) implants: a 1-year prospective study on 15 patients

This study evaluated the 1-year survival and success rate of root-analogue direct laser metal sintering (DLMS) implants, placed into the extraction sockets of 15 patients. DLMS is a technology which allows solids with complex geometry to be fabricated by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model; the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer-by-layer, the desired object. Cone-beam computed tomography (CBCT) acquisition and 3D image conversion, combined with the DLMS process, allow the fabrication of custom-made, root-analogue implants (RAIs). CBCT images of 15 non-restorable premolars (eight maxilla; seven mandible) were acquired and transformed into 3D models: from these, custom-made, root-analogue DLMS implants with integral abutment were fabricated. Immediately after tooth extraction, the RAIs were placed in the sockets and restored with a single crown. One year after implant placement, clinical and radiographic parameters were assessed: success criteria included absence of pain, suppuration, and exudation; absence of implant mobility and absence of continuous peri-implant radiolucency; distance between the implant shoulder and the first visible bone-to-implant contact <1.5 mm from initial surgery; and absence of prosthetic complications. At the 1-year follow-up, no implants were lost, for a survival rate of 100 %. All implants were stable, with no signs of infection. The good conditions of the peri-implant tissues were confirmed by the radiographic examination, with a mean DIB of 0.7 mm (±0.2). The possibility of fabricating custom-made, RAI DLMS implants opens new interesting horizons for immediate placement of dental implants.

Expandable Micro-motor Bur, design of a new device for least invasive extraction of broken teeth roots

BackgroundExtraction of a broken tooth root is often a traumatic experience for both the practitioner and the patient. To extract broken roots, generally invasive approaches as open window surgeries or mucoperiosteal flap and/or removal of buccal bone are performed.Presentation of the hypothesisExpandable micro-motor bur (EMB) is a hypothetical design of a dental instrument proposed for removal of broken teeth roots that cannot be extracted by the routine closed methods and in which common instrumentations cannot afford to accomplish. Implication of EMB would introduce a new technique in removal of broken teeth roots in which surgical trauma is minimized and so post-extraction disorders. It would eliminate surgical invasion to the surrounding tissues; and also it would eliminate profound hand forces by the practitioner, consequently reduces stress for both the practitioner and the patient. It would eliminate high risk aftermaths such as operative morbidity (due to bone loss), maxillary sinus exposure and probable need for additional surgery as are indicative of some conventional open access approaches.Testing the hypothesisFurther studies are needed to confirm its effect in clinical cases. The effectiveness of EMB should be verified firstly by animal experiments. The likelihood of its negative influence on nearby vascular and nerve system should be well evaluated.Implications of the hypothesisImplication of EMB would be of interest to both patients and the surgeon due to the following main achievements: a) no need for mucoperiosteal flap, hence preservation of soft tissue, b) no need for osteotomy, hence retention of buccal bone, c) less risk of sinus exposure, d) minimum chance of post operative infections due to eliminated surgeries in soft tissues and bones and e) in terms of esthetics, it will have a special meaning for immediate placement of dental implants. EMB’s structural components include Bur head, Spacers and Bur base. A micro motor would power its spin. In contrast to conventional surgical approaches, EMB procedure is conservative. It is anticipated that EMB would provide less traumatic and least post-operative complications in extraction of broken teeth roots.

Immediate placement of dental implants in the mandible

This case describes extraction of teeth in the mandibular arch, i.e., 41 42 43 44 45 51 52 53 54 55 56 57 58 (grade two mobility), followed by immediate placement of four dental implants (3i biomet), two in the 45 55 region and two dental implants in 12 21 region. A prefabricated provisional mandibular denture was immediately placed. The purpose of immediate placement was to aid the patient resume his professional duties the next day itself along with esthetic and functional comfort, psychological well-being and most importantly preserving the remaining tissue in a healthy condition.

Immediate Implant Placement After Extraction of Mandibular molars : Report of 3 cases

Immediate dental implant placement has been an acceptable procedure for at least the past two decades. Commonly, immediate implants have been reserved for the single rooted anterior tooth and single or bi-rooted premolar tooth. Perhaps the most important aspect of any implant surgery in accordance with the successful procedure is implant stability and bone to implant contact (BIC). Removal of molar teeth provides a challenging and intriguing dilemma due to multiple root morphology. In the case of extraction and immediate placement of dental implants preserving alveolar bone proper, particularly that of the labial and lingual plates of bone is essential in providing the optimal environment for maximizing BIC and implant stability. Also, the position of the final restoration must be considered, in relation to intra and inter arch position, occlusion, function and esthetics. Thus, minimal alveolar bone removal should be considered and attained to aid in the above factors in order to provide an acceptable surgical site for successful placement of the dental implant. Finally, and perhaps most importantly when considering immediate molar implant placement, removal of the intra-alveolar septum should be avoided to aid in increasing BIC and allowing the attainment of initial implant stability at the time of placement.

Ten-year Evolution Utilizing Computer-Assisted Reconstruction for Giant Ameloblastoma

The authors describe our current practice of computer-aided virtual planned and pre-executed surgeries using microvascular free tissue transfer with immediate placement of implants and dental prosthetics. All patients with ameloblastomas treated at New York University (NYU) Medical Center during a 10-year period from September 2001 to December 2011 were identified. Of the 38 (36 mandible/2 maxilla) patients that were treated in this time period, 20 were identified with advanced disease (giant ameloblastoma) requiring aggressive resection. Reconstruction of the resultant defects utilized microvascular free tissue transfer with an osseocutaneous fibular flap in all 20 of these patients. Of the patients reconstructed with free vascularized tissue transfer, 35% (7/20) developed complications. There were two complete flap failures with consequent contralateral fibula flap placement. Sixteen patients to date have undergone placement of endosteal implants for complete dental rehabilitation, nine of which received immediate placement of the implants at the time of the free flap reconstruction. The three most recent patients received immediate placement of dental implants at the time of microvascular free tissue transfer as well as concurrent placement of dental prosthesis. To our knowledge, this patient cohort represents the largest series of comprehensive computer aided free-flap reconstruction with dental restoration for giant type ameloblastoma.

Post-Extractive Implants: Outcome of 40 Cases

In the last two decades, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results with a two-stage surgical procedure. Recently immediate loading has become an emerging technique as it has been documented to be a successful and time saving procedure. As regard the possibility of immediate/early loading of implants placed in fresh extraction sockets few reports are available. In addition they are based on limited series with short follow-up. Thus we decided to perform a retrospective study on a series of post-extractive implants. A total of 40 two-piece implants (FMD srl, Rome, Italy) were inserted in post extractive sockets, 22 in females and 18 in males. The median age was 52 ± 11 (min-max 24–69 years). Twenty-one implants were inserted in upper jaw and 19 in mandible. Fixtures replaced 7 incisors, 3 cuspids, 12 premolars and 18 molars. Implant' length was x ≤ 10 mm, 10,30 ≤ x ≤ 12.30, equal to 13 mm and x ≥14 mm in 6,14,9, and 11 cases, respectively. Implant' diameter was narrower than 3.5 mm, equal to 3.8 mm and wider than 4.0 mm in 1,7, and 32 cases, respectively. There were 28, 2 and 10 Elisir, I-fix, and Shiner implant types, respectively. No implant on single tooth rehabilitations, was lost, survival rate = 100%. Then peri-implant bone resorption (i.e. delta IAJ) was used to investigate SCR. Seven fixtures have a crestal bone resorption greater than 1.5 mm (SCR = 82.5%). Statistical analysis demonstrated that there was a difference between surgeons (p= 0.005). In conclusion FMD implants are reliable devices for oral rehabilitation with a very high SCR and SVR.

Factors Affecting Survival and Usefulness of Implants Placed in Vascularized Free Composite Grafts Used in Post–Head and Neck Cancer Reconstruction

Bone-containing vascularized grafts have been used successfully to reconstruct post-cancer surgical defects. Dental implants can be placed in these bone-containing grafts to allow implant-supported prosthodontic reconstruction of these patients. The aim of this study was to evaluate the survival of dental implants used in the rehabilitation of subjects treated with bone-containing vascularized grafts to compare usability of implants placed at the time of reconstruction and after healing. A cross-sectional study was undertaken to examine survival rates of implants placed in vascularized bone-containing grafts either immediately at the time of surgical reconstruction or after 3 months healing. Other factors such as graft type, whether radiation therapy was given, and implant type were recorded. A total of 41 patients had 145 implants placed in 47 vascularized bone-containing flaps. Increased failure rate of implants was seen in immediately placed implants. There was also a significant increase in the number of osseointegrated implants that were prosthodontically unusable or sub-optimally placed in the immediate placement group. Radiation therapy was associated with a significant increase in failure rate. Modern implant surfaces appeared to perform better than machined/turned surfaces. Graft donor site did not influence implant survival. This study demonstrated the difficulties encountered with immediate placement of dental implants at the time of post-cancer reconstructive surgery.

A novel root analogue dental implant using CT scan and CAD/CAM: selective laser melting technology

Direct laser metal forming (DLMF) is a new technique which allows solids with complex geometry to be produced by annealing metal powder microparticles in a focused laser beam, according to a computer-generated three-dimensional (3D) model. For dental implants, the fabrication process involves the laser-induced fusion of titanium microparticles, in order to build, layer by layer, the desired object. Modern computed tomography (CT) acquisition and 3D image conversion, combined with the DLMF process, allows the fabrication of custom-made, root-analogue implants (RAI), perfect copies of the radicular units that need replacing. This report demonstrates the successful clinical use of a custom-made, root-analogue DLMF implant. CT images of the residual non-restorable root of a right maxillary premolar were acquired and modified with specific software into a 3D model. From this model, a custom-made, root-analogue, DLMF implant was fabricated. Immediately after tooth extraction, the root-analogue implant was placed in the extraction socket and restored with a single crown. At the 1-year follow-up examination, the custom-made implant showed almost perfect functional and aesthetic integration. The possibility of fabricating custom-made, root-analogue DLMF implants opens new interesting perspectives for immediate placement of dental implants.

Histologic and Histomorphometric Assessment of Implants and Periapical Tissues When Placed in the Sockets of Extracted Teeth, Teeth With Periapical Lesions, and Healed Lesions: A Canine Study

Eighteen canine mandibular premolars were divided into 3 groups. In group 1, implants were inserted in periapical lesions. In group 2, implants were inserted when lesions were radiographically healed. In group 3 (control), implants were inserted immediately after extraction. There was no significant difference in average bone implant contact between the 3 groups. Considering the limitations of this study, immediate placement of dental implants in tooth sockets with periapical lesions should be proposed only under special circumstances.

Immediate Placement of Dental Implants Into Fresh Extraction Socket in the Maxillary Anterior Region: A Case Report

The loss of the buccal alveolar plate following tooth extraction in the maxillary anterior may lead to palatal implant positioning with esthetic complications. Immediate placement of dental implants has been suggested because it may preclude dramatic postextraction bone loss. In this report, the harmony of soft and hard tissue was achieved by immediate implant placement with bone augmentation in an esthetically challenging situation.

Immediate Placement and Temporization of Implants: Three- to Five-year Retrospective Results

The immediate placement of dental implants in esthetic areas is a primary challenge for modern implantology. The underlying treatment goal is to preserve the natural periodontal architecture; in recent years, however, a concurrent goal has been to reduce the period between implant placement in the fresh extraction socket and delivery of the definitive restoration, but adequate long-term data are still lacking on the efficacy of this technique. A 3- to 5-year retrospective analysis of 282 dental implants immediately placed into extraction sockets, and temporized with nonoccluding provisional prostheses has been undertaken. All recorded outcomes and complications, as well as a proposed protocol for management of immediate function, are discussed.

Spiral Family Implants Inserted in Postextraction Bone Sites

In the last 2 decades, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results with a 2-stage surgical procedure. Recently, immediate loading has become an emerging technique as it has been documented to be a successful and a time saving procedure. As regard, few reports are available for the possibility of immediate/early loading of implants placed in fresh extraction sockets. In addition, they are based on limited series with short follow-up. Thus, we decided to perform a retrospective study on a series of postextractive spiral family implants (SFIs). In the period May 2004 to November 2007, 133 SFIs were inserted in fresh extraction sockets. The mean follow-up was 12 months. Several host-, surgery-, and implant-related factors were investigated and Kaplan-Meier algorithm and Cox regression were used to detect those variables associated with the clinical outcome. Because only 7 of 133 implants were lost (i.e., survival rate, 94.7%) and no statistical differences were detected among the studied variables, no, or reduced, marginal bone loss was considered as an indicator of success rate to evaluate the effect of several host-, surgery-, and implants-related factors. Also, in this case no variable has impact on clinical outcome. It was demonstrated that postextractive SFIs have a high survival and success rate that are similar to those reported in previous studies of 2-stage procedures or in immediate loading implants inserted in healed bone.

Immediate Loaded Dental Implants

In the last two decades, several investigators have reported immediate placement of dental implants into extraction sockets achieving excellent results with a two-stage surgical procedure. Recently, immediate loading (IL) has become an emerging technique because it has been documented to be a successful and time-saving procedure. Regarding the possibility of immediate/early loading of implants placed in fresh extraction sockets, few reports are available. In addition, they are based on limited series with short follow up. Thus, we decided to perform a retrospective study on a large series of postextractive IL implants. From January 1995 to October 2004, 416 IL fixtures were placed immediately after extraction and 658 IL fixtures in healed sites. The mean follow up is 3 years. Multiple implant systems were used. Because only eight of 1,074 implants were lost (i.e., survival rate, 99.3%) and no statistical differences were detected among the studied variables, no or reduced marginal bone loss was considered as an indicator of success rate to evaluate the effect of several host-, surgery-, and implant-related factors. A general linear model was then performed to detect those variables statistically associated with marginal bone loss. Only eight of 1,074 implants were lost (i.e., survival rate, 99.3%) and no differences were detected among the studied variables. On the contrary, the general linear model showed that younger age (cutoff, 55 years) and harder bone are related to a lower delta insertion abutment junction (or marginal bone loss) and thus a better outcome. We demonstrated that postextractive IL implants have a high survival rate and success rate that are similar to those reported in previous studies of two-stage procedures or in IL implants inserted in healed bone. Poor bone quality and older age correlate with a slight higher bone resorption.

Immediate placement of anatomically shaped dental implants.

Immediate placement of dental implants into tooth extraction sites is an effective treatment option. When immediate placement procedures are performed with a round implant, a void is often evident between the implant and the orifice of the socket. Previous treatment focused on the use of membranes or special closure techniques to induce bone growth into the void. Anatomically shaped dental implants provide a predictable alternative to previous filling techniques since the anatomical implants decrease or completely fill the void at the socket opening. This article describes a surgical technique developed for the immediate placement of these implants in extraction sites.

Localized Ridge Maintenance Using Bone Membrane

The immediate placement of a dental implant into a fresh extraction socket has been limited in many instances by the quantity of bone that remains after the extraction. This article presents two clinical cases that demonstrate successful regeneration of alveolar ridges in which there was extensive loss of the buccal plate of bone. This lack of alveolar process impeded the immediate placement of dental implants into fresh extraction sockets. The surgical technique performed in these cases was based on the principles of guided bone regeneration using a demineralized freeze-dried bone membrane. The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissues. Bone formation took place for the placement of endosseous dental implants 8 months after the procedures were initiated. These human clinical cases confirm positive results of previous animal findings.

Surgical treatment of fractures of the edentulous mandible

Purpose This retrospective study presents treatment alternatives for fractures of the edentulous mandible. Methods A chart review of 34 patients with fractures of the edentulous mandible was performed. Patients were followed with clinical and radiographic examinations. Results Five different treatment groups were used, ranging from closed treatment to bone graft augmentation and immediate placement of dental implants. Twenty-five patients showed good bony union. Frequent complications were encountered, including psuedarthrosis, fractured plates, and persistent dysesthesia. Augmentation was more stable when implants were placed simultaneously. Conclusion Treatment needs to be based on the type and location of the fracture and the degree of atrophy. Augmentation in combination with implants appears to be a good treatment for fractures of the edentulous mandible.