Implants In Fresh Extraction Sockets Research Articles

Survival analysis of dental implants placed in a private practice. A multicenter prospective cohort study.

This prospective cohort study aimed to assess the predictability and survival rates of dental implant treatment in edentulous patients while identifying potential factors contributing to implant failure. A total of 80 outpatients, receiving 166 dental implants between September 2015 and November 2017 in two private dental clinics, were included in this study. Patient and implant characteristics, surgical procedures, primary stability, prosthetic rehabilitation, failure analysis, and survival rates were analyzed. The majority of patients (53.75%) received a single implant for treating single-gap edentulism, with 6.25% requiring implants for fully edentulous jaws. Most implants (66.87%) were Avinent Ocean IC implants with specific design features. Surgical placement primarily occurred in healed pristine bone (78.31%), immediate implants in fresh extraction sockets (19.88%), and bone regeneration was simultaneous in 15.66% of cases. While 54.82% of implants achieved primary stability over 35Ncm, none exceeded 45Ncm, and only 4.82% failed to attain primary stability. Prosthetic rehabilitation revealed that 13.25% received immediate loading prostheses. During follow-up, four implants failed, resulting in a 2.41% failure rate, with bruxism (HR: 96.62; P< 0.001) and absence of primary stability (HR: 23.54; P< 0.001) significantly associated with implant failure. The cumulative survival rate at 24 months was 97.44%. This study demonstrates the high predictability and survival rates of dental implant treatment in edentulous patients, consistent with established standards. Factors such as bruxism and primary stability may impact early implant failure. Dental implants remain a reliable treatment option, boasting a 97.44% cumulative survival rate at 24 months. Further research is required to explore implant failure indicators and multifactorial influences. Key words:Dental implants, survival, edentulous patients.

Evaluation of Accuracy in Computer Guided Versus Free Hand Immediate Implant Placement in Fresh Extraction Sockets: a Randomized Controlled Clinical Trial

Background: The aim of this study was to compare between computer guided and free hand immediate implant placement in fresh extraction sockets in terms of accuracy of implant positioning.Methods: This is a randomized controlled clinical study, which used CBCT imaging and flapless surgical technique to place implants in fresh extraction sockets. Accuracy measurements were done using BluSky®1software. A total of 22 patients were recruited according to inclusion and exclusion criteria. Results: The mean values at the implant shoulder for implants inserted using computer surgical guides and those inserted using free hand technique in the mesiodistal direction were 0.69 and 1.43mm, respectively. While in the buccolingual direction they were 0.96 and 1.34mm, respectively. At the implant apex in the mesiodistal direction, they were 1.26 and 2.35mm, respectively. While in the buccolingual direction, they were 1.64 and 1.70mm, respectively. For the angular deviation they were 1.57 and 3.18mm respectively in the mesiodistal direction. Whilein the buccolingual direction were 1.29 and 7.76mm, respectively.Conclusions: Accuracy of computer guided immediate implant insertion surpasses the freehand technique in the buccolingual direction in terms of placing Immediate Implants in fresh extraction sockets in maxillary estheticregion and thus the prosthetic aspect.

Peri-implant tissue alteration around tissue-level and bone-level implants in fresh extraction sockets: a histomorphometric study in dogs.

BackgroundTo compare tissue alteration in fresh extraction sockets between bone-level and tissue-level implants with different neck designs.MethodsBilateral premolars of 6 adult Labrador dogs were extracted, and 24 bone-level and tissue-level implants with two different neck designs were immediately placed. At the same time, buccal bony wall thickness in fresh extraction sockets was also recorded. The Straumann® Bone Level (BL) and Standard Plus (SP) implants were positioned at two insertion depths: 1mm below and flush with the alveolar crest. All animals were sacrificed 6 months after the implant placement. Undecalcified block sections were obtained for histological measurement. Vertical bone resorption and biological widths were documented. Statistical analysis consisted of two sample t-test and Wilcoxon sign-rank test.ResultsAll implants were histologically osseointegrated. There was no significant difference between BL implants and SP implants in vertical bone resorption regardless of the insertion depths (P>0.05). Meanwhile, significant difference was found in lingual biological width between BL (3.16 mm) and SP (2.43 mm) implants when placed 1mm below the alveolar crest (P<0.05).ConclusionsWithin the limits, it seemed that different implant neck designs had little effect on bone remodeling in fresh extraction sockets. However, longer biological width was found in bone-level implants.

A Challenging Approach: Implant Placement in Fresh Extraction Socket with Buccal Plate Defect Using a Novel Technique

As Dental implants have emerged to be one of the best means of rehabilitating a missing tooth, there have been various new advancements taking place in implant dentistry in recent years. It is extremely important to preserve the facial bone and the soft tissue, especially in the esthetic zone. Various such procedures maintain the width of the soft tissue and underlying bone in the esthetic areas. Conventionally it was advisable to wait for at least 3 months after the implant placement, before prosthetically rehabilitating the patient. However, with recent advances, we can provide the patient with immediate implants. This review aims to discuss a technique, which discusses on how we are able to place dental implants in fresh extraction sockets, with a buccal plate defect incorporating a novel surgical method along with usage of both hard and soft tissue grafts, which will enable us to achieve pleasing esthetics for the patient, without causing future facial bone resorption.

Immediate Provisionalization of Single Narrow Implants in Fresh Extraction Sockets and Healed Sites: Clinical and Radiographic Outcomes of 2 Years Follow-up.

The purpose of this clinical study was to evaluate, through clinical and radiographic parameters, the 2-year implant survival and success rates of single, narrow, immediately loaded implants (3.1-mm diameter) placed in fresh extraction sockets or healed sites in the anterior region. A total of 16 patients were treated with 16 narrow single implants in fresh extraction sockets and healed sites, and restored immediately with temporary crowns. After 3 months, the implants were finally restored with screw-retained or cemented lithium disilicate crowns. Implant success and survival rates were both 100% due to stable marginal bone levels and shallow probing pocket depths after 2 years of follow-up. Within the limits of this clinical study, narrow 3.1-mm dental implants can be used successfully as a minimally invasive alternative in healed sites with a thin bone crest and in the presence of a reduced interdental space. Provided that stability of soft and hard peri-implant tissues were obtained in postextraction sites of mandibular incisors and maxillary lateral incisors with immediate provisional restoration, the 2-year results can be successfully maintained over time.

A 22-Year Follow Up of Immediate Implant Placement without Bone Augmentation: A Case Series Study.

To retrospectively evaluate the treatment outcome of immediate implants placed in fresh extraction sockets without bone augmentation after 22 years of function. The study group received implant therapy in 1997, including surgical placement and prosthodontic rehabilitation. The mean age of the subjects at the time of implant placement was 40 ± 5.54 years. A total of 35 subjects received 36 implants in fresh extraction sockets without bone augmentation. Definitive prostheses were placed 4 to 6 months after implant placement. Implant treatment outcomes were evaluated using clinical and radiographic parameters obtained during follow-up visits at 1, 5, 10, 15, 20, and 22 years after prosthetic loading. Among the 35 treated subjects, five patients moved out of the country and could not be evaluated at the follow-up times. A total of 29 subjects were included in the study with a drop-out rate of 14.1%. Of these, one patient lost the implant during the osseointegration period before prosthodontic treatment. No other implant failure or complication during the rest of the follow-up period was reported, thus giving a cumulative survival rate of 97.2% during the 22-year follow-up. The change in marginal bone level was less than 2 mm in most subjects at the 22-year examination. The mean bone loss from baseline to 22-year follow-up was 1.61 mm, and the mean bone level at the 22-year follow-up examination was situated at 2.13 ± 0.023 mm from the implant platform, which was used as the reference point. Immediate implant placement in extraction sockets exhibits excellent prognosis even when bone augmentation is not performed.

A Retrospective Study on Insertion Torque and Implant Stability Quotient (ISQ) as Stability Parameters for Immediate Loading of Implants in Fresh Extraction Sockets

Background To date, insertion torque value (ITV) and implant stability quotient (ISQ) obtained by the Osstell instrument are common clinical methods to assess the initial stability of an implant for a predictable loading procedure. The aim of this current study is to evaluate the ITV and ISQ as stability parameters as part of the decision-making protocol in the adoption of immediate loading in fresh extraction sockets. Materials and Methods A total of 41 tapered implants were allocated into two groups: the test group (n = 11; 3 males and 8 females; mean age: 62.8 ± 10.7) which received 18 implants as type 1 fresh extraction sockets after teeth removal and the control group (n = 7; 4 males and 3 females; mean age: 65.4 ± 9.7) which received 23 implants placed in healed sockets for a period of at least 3 months. Both the ITV and ISQ data were recorded at the time of insertion (t0). Since ITV (test group) and ITV/ISQ (control group) values were useful for the immediate loading protocol, a screw-retained temporary crown was immediately loaded. ISQ values were recorded after a healing period of 4 months (t1). Results ITV mean values at t0 in test and control groups were, respectively, 48.61 ± 15.39 and 70.47 ± 14.71, whereas ISQ mean values were 57.55 ± 1.93 and 72.86 ± 5.25, respectively, showing a statistically significant difference (p value < 0.001). ISQ mean values at t1 in either the test or the control group were 68.68 ± 4.20 and 74.54 ± 4.17, not showing a statistical difference. The implant survival rate was 100% in both groups, and no surgical and prosthetic complications were reported during the study. Conclusion In conclusion, this study remarked the presence of a residual gap that influenced the ISQ during implant insertion in fresh extraction sockets making this parameter not sufficient for a conclusive decision in the immediate loading, whereas the ITV alone showed to be the best parameter for a final substantial decision.

Does The Placement Of A Free Connective Tissue Graft In Conjunction With Immediately Placed Dental Implants In Fresh Extraction Sockets Preserve The Labial Marginal Bone Level? A Randomized Controlled Clinical Trial

Background: The beneficial effects of simultaneous soft tissue augmentation along with immediate post-extraction implant placement in the esthetic zone have been clearly demonstrated regarding the preservation and maintenance of soft tissue architecture. However, the potential of soft tissue augmentation to preserve the vertical height of thin labial bone plates is not fully evident. Research question: Is it necessary to apply a soft tissue graft with immediate implants in the esthetic zone if preservation of the height of a thin labial plate is desired? Methods: Twenty patients with single hopeless teeth in the esthetic zone having thin facial bone plates (<2mm) were equally and randomly divided into 2 groups; (A) who received immediate implants only (control) and (B) who received immediate implants and connective tissue graft secured over the implant in split-thickness facial and palatal pouches (test). Amount of vertical marginal bone loss from the facial plate was measured over 6 months. Results: A statistically-significant difference (at P ≤ 0.05) existed between the mean values of vertical bone loss of both groups. The amount of vertical bone loss was limited more in the test group (B). Conclusion: Simultaneous soft tissue augmentation with immediate implants in the esthetic zone demonstrated beneficial effects regarding the preservation of the vertical level of thin labial plates.

The “ring-shaped” autologous fibrin matrix: A technical note

The use of platelet-rich fibrin has gained importance as an autologous scaffold for tissue regeneration. One of its features is, when placing implants in fresh extraction sockets, to function as a selective scaffold and also as a barrier in order to correct marginal bone defects and/or to avoid collapse of surrounding soft tissue. However, its handling and placement require specific manipulation skills, to avoid unintentional slipping and dislodging during the suture procedure. In order to avoid these problems and to allow easier and faster use of the PRF matrix, a simple device for providing a self-stabilized fibrin plug has been developed. This plug surrounds, as an elastic ring, the transmucosal extension of the prosthetic components for conical internal connection implants, thus enhancing the effectiveness of the fibrin matrix expected performance.

Immediate loading of tantalum‐based implants in fresh extraction sockets. Long‐term outcomes

Immediate loading of tantalum‐based implants in fresh extraction sockets. Long‐term outcomes

Immediate Postextraction Screw-Retained Partial and Full-Arch Rehabilitation: A 3-Year Follow-up Retrospective Clinical Study.

The aim of this study was to document the performance of a novel technique (OnlyOne), involving immediate restoration of postextraction implants supporting a partial or full-arch restoration. A retrospective analysis of patients with at least 3 years of follow-up was performed. Implants were tilted mesiodistally and vestibulopalatally according to the available bone. Prosthetically guided definitive abutments were connected at surgery and never disconnected. Anorganic bovine bone grafting was done to preserve the buccal bone and the ridge contour. Patients received a screw-retained provisional prosthesis within 24 hours of surgery and a final screw-retained prosthesis within 1 year. Prostheses emerged from natural soft tissue. Clinical and radiographic evaluation was routinely performed. A total of 70 patients received 153 implants in fresh extraction sockets. The mean follow-up was 38.0 ± 3.0 months (range 36 to 51 months). One implant failed at the 3-year follow-up. Implant survival was 99.3%. Marginal bone level change averaged -0.68 ± 1.2 mm at the last radiographic control. Immediate placement and restoration of implants designed for high primary stability with a definitive abutment placed at surgery and final screw-retained prosthesis with no artificial gingiva is a viable procedure with excellent medium-term outcomes.

Osseointegration of Implant Placed in Extraction Socket and Augmented with Alloplastic Bone Substitutes and Subepithelial Connective Tissue Graft in Comparison to Those Augmented with Alloplastic Bone Substitutes Only (A Randomized Controlled Clinical Trial)

Background: The objective of this study was to assess the osseointegration around endosseous dental implants inserted in fresh extraction sockets using β-Tricalcium phosphate bone graft with and without subepithelial connective tissue graft.Methods: Twenty patients were enrolled in this study and allocated randomly to control group (Ten fresh extraction sockets were implanted by immediate dental implants and grafted by s-tricalcium phosphate) or test group (Ten fresh extraction sockets were implanted by immediate dental implants and grafted by s- tricalcium phosphate with a subepithelial connective tissue graft). The clinical parameters were monitored at 6,9 and 12 months post-implantation while the radiographic evaluation was conducted immediately after implant insertion(baseline),6 and 12 months postoperative. The implant stability was monitored using periotest at baseline,6 and 12 months after implantation. Results: All implants in both groups were well osseointegrated resulting in a 100% cumulative success rate after one year follow up. There were no significant differences between the studied groups regarding clinical and radiographically parameters throughout the study period. However, the patients in test groups displayed better assessments regarding pocket depth, periotest value, keratinized mucosa and marginal bone level than patients within the control group.Conclusion: The using of subepithelial connective tissue graft as a membrane with β-Tricalcium phosphate bone graft could improve osseointegration around dental implants in fresh extraction sockets.

STUDY OF THE EFFECT OF THE COMBINATION OF PLATELET-RICH FIBRIN (PRF) AND ALLOGENOUS BONE GRAFT AROUND IMMEDIATE IMPLANTS

INTRODUCTION: Following the immediate implant placement, there is a gap called jumping space which increases the risk of implant failure. OBJECTIVES: The aim of the study was to evaluate the clinical and radiographic efficiency of platelet-rich fibrin membrane (PRF) combined with bone graft surrounding immediate implants in fresh extraction sockets. MATERIALS AND METHODS: A clinical and radiographic study was carried out on ten fresh extraction sockets with age range from 20 to 50 years. Sockets were occupied by immediate endosseous implant and grafted with allogenous bone graft and PRF. After placement all implants were evaluated clinically after 6 months (modified sulcus bleeding index, probing pocket depth and degree of mobility) and radiographically to evaluate marginal bone loss. RESULTS: There was less pain, edema, bleeding and probing depth in the study group than in the control group but the difference among them was not statistically significant (P > 0.05). There was significantly more bone density and less marginal bone loss in the study group than in the control group on the sixth postoperative month (P < 0.05). CONCLUSIONS: It is clear that PRF is biocompatible and can improve both soft tissue healing and bone regeneration after immediate implant placement. KEYWORDS: Immediate implant, PRF, bone graft.

The Efficacy of Immediate Implant Placement in Extraction Sockets for Alveolar Bone Preservation

The aim of this study was to determine the efficacy of immediate implant placement with alveolar bone augmentation on socket preservation following atraumatic tooth extraction and comparing it with a tooth alveolar socket that was allowed to heal in a conventional way.Twenty medically fit patients (8 males and 12 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of mandibular premolar teeth were divided randomly and equally into 2 groups. In Group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In Group II, the immediate implant was placed and the gap between the implant and the inner buccal plate surface of the socket wall was filled with lyophilized bovine bone granules and the wound was covered with pericardium membrane. The patients were followed up clinically and radiologically for regular reviews at 1 week, 3 months, and 9 months postoperative. Cone beam computerized tomography images of the alveolar ridge and socket were analyzed to determine the structural changes of the alveolar ridge. Resonance frequency analysis was measured at 9 months for Group II to assess the degree of secondary stability of the implants by using Osstell machine.A significant difference of bone resorption of 1.49 mm (confidence interval, CI 95%, 0.63-2.35) was observed within the control group at 3 months, and 1.84 mm (P ≤ 0.05) at 9 months intervals. No significant changes of bone resorption were observed in Group II. Comparison between groups showed a highly significant difference at 3 months; 2.56 mm (CI 95% 4.22-0.90) and at 9 months intervals; 3.2 mm (CI 95%, 4.70-1.62) P ≤ 0.001 between Group I and II. High resonance frequency analysis values were observed at 9 months postoperative in Group II.In conclusion, the insertion of immediate implants in fresh extraction sockets together with grafting the circumferential gap between the bony socket wall and the implant surface with bovine bone granules was able to preserve a greater amount of alveolar ridge volume when compared with an extraction socket that was left to heal in a conventional way.

Implant stability measurements using resonance frequency analysis and radiographic evaluation of crestal bone loss in indigenously developed implants placed in fresh extraction sockets

Objectives: This study aimed to measure the stability and crestal bone level changes of indigenously developed implants in fresh extraction sockets. Materials and Methods: Forty implants were placed immediately in fresh extraction sockets in 27 patients in the age group of 18–65 years. Clinical assessment of stability was made using resonance frequency analysis (RFA) at the time of placement of implant at 3, 6, and 12 months postoperatively, and radiographic crestal bone changes were evaluated using digital radiograph at 0, 6, and 12 months. The distance between the first visible bone-implant contact and implant shoulder was measured, and crestal bone loss was calculated. Results: The mean RFA values obtained were 48.08 ISQ at the time of placement and reached 66.32 ISQ after a follow-up period of 12 months. The mean radiographic bone loss was 0.67 mm at the end of 12 months. The results emphasized that there was no significant bone loss. Out of forty dental implants, two failed in the early phase. Thus, the survival rate of implants placed in fresh extraction socket was 95% at the end of 12 months. Conclusion: Immediate placed implants can attain adequate level of primary stability. These stability levels improve with time, reaching similar values irrespective of the initial stability. About 50% of mean crestal bone loss occurred during the first 6 months after implant placement suggesting several factors other than occlusal load affecting bone levels around implants. The present study also finds a negative correlation between the crestal bone loss and stability values in terms of ISQ at a statistically significant value. Clinical Relevance to Interdisciplinary Dentistry Dental implants represent one of the most successful treatment modalities in modern dentistry. A multidisciplinary approach comprising surgical, prosthetic, and periodontal treatment was done to achieve a satisfactory result. Achievement and maintenance of implant stability is the most critical factor for successful clinical outcome.

Review suggests higher failure rates for dental implants placed in fresh extraction sites

PubMed, Web of Science and Cochrane Oral Health Group Trials. Register databases supplemented by hand searching a range of dental implants-related journals. Randomised and non-randomised studies comparing implant failure rates in any group of patients receiving dental implants being inserted in fresh extraction sockets compared to the insertion in healed sites were considered. Study quality was assessed using the Newcastle-Ottawa scale (NOS). Implant failure (complete loss of implant) and postoperative infection were the dichotomous outcomes measures evaluated, with marginal bone loss as a continuous outcome. Seventy-three publications were included, five were randomised controlled trials, 26 clinical controlled trials and 42 retrospective studies. The 73 studies included a total of 8241 dental implants inserted in fresh extraction sockets, with 330 failures (4.00%), and 19,410 implants inserted in healed sites, with 599 failures. A random effects meta-analysis (73 studies) found the relative risk of implant failures in fresh socket sites compared to healed sites was RR= 1.58 (95% CI; 1.27 1.95) for the maxilla only RR= 1.61 (95% CI; 0.97 2.66); mandible only RR= 2.15 (95% CI; 0.62-7.47). For implants supporting single crown restoration RR= 2.05 (95% CI; 1.36-3.11) and RR= 1.42 (95% CI; 0.71- 2.83) for those with a full arch prosthesis.There were 31 controlled studies (CCTs) and randomised controlled studies (RCTs) that included 2021 implants inserted in fresh sockets with 96 failures (4.75%) and 2759 implants were inserted in healed sites with 49 failures (1.59%). The relative risk of implant failures in fresh socket sites compared to healed sites was RR= 2.27 (95% CI; 1.57-3.29). The results of the present review should be interpreted with caution due to the presence of uncontrolled confounding factors in the included studies, most of them not randomised trials. Within the limitations of the existing investigations, the present study suggests that the insertion of dental implants in fresh extraction sockets affects the implant failure rates.

Outcome after placement of tantalum porous engineered dental implants in fresh extraction sockets: a canine study.

This study evaluated the stability and histologic proof of osseoincorporation of Trabecular Metal (TM) dental implants, which feature a tantalum-based porous midsection. A total of 48 TM implants (test group) and Tapered Screw-Vent implants (control group) were immediately placed bilaterally into mandibular extraction sockets in dogs. Resonance frequency analysis was performed at weeks 0, 2, 4, and 12 after implant placement. Histologic and histomorphometric evaluations of the implant interface were performed. Changes in mean implant stability quotients (ISQ) revealed no statistical differences between the test and control groups. Histologic analysis showed bone ingrowth into the porous tantalum structure of all test group implants. Histomorphometric analysis revealed an increased percentage of bone-to-implant contact between 4 and 8 weeks in both test and control groups. The porous sections of the test group exhibited significantly more new bone inside the pores at week 12 in comparison to weeks 2 and 4. No correlation was observed between ISQ and histomorphometric parameters. In a canine immediate extraction socket model, both test and control implants demonstrated comparable implant stability and bone-to-implant contact. Bone ingrowth was evident within the tantalum porous section of the test implants during the early healing.

Bone morphology changes around two types of bone-level implants installed in fresh extraction sockets - a histomorphometric study in Beagle dogs

Minimizing crestal bone loss following immediate implant placement is considered the most challenging aspect in implant therapy. Implant surface topography and chemical modifications have been shown to influence the success of Osseointegration. The Straumann Bone Level implant, featuring SLActive surface, has been introduced with the aim of enhancing bone apposition. Similarly, the OsseoSpeed implants from Astra Tech claim to have an enhanced osseointegration. Because of the specific features in the implant design, both companies claim that crestal resorption is minimal with these implants. To evaluate the osseointegration and crestal bone level following immediate placement of Straumann Bone Level implant and OsseoSpeed implants in fresh extraction sockets in Beagle dogs. The distal roots of the second, third and fourth premolars were extracted in both sides of the mandible. The distal roots were removed using a dental elevator. A total of 60 fixtures were installed in 10 Beagle dogs. Two types of implants were used: Straumann Bone-Level implants, which were 8 × 3.3 mm in size, and Astra Tech OsseoSpeed 3.5 S MicroThread implants, which were 8 × 3.5 mm in size. The histomorphometrical evaluation was performed at the end of 4- and 12-week healing. The implant-bone contact and bone volume percentage were assessed. The bone-to-implant contact (BIC) and the bone volume did not show any significant changes for both types of implants. The OsseoSpeed™ implants showed 67.4% and 65.3% BIC, respectively, at 4 and 12 weeks compared with 71.7 and 73.1 for the Straumann Bone-Level implants. The bone volume around both types of implants did not differ significantly at both time periods. The crestal bone resorption was observed for both types of implants. The first BIC at buccal side and lingual side of the implants also did not differ significantly for both implant systems. This study showed that Straumann Bone Level and OsseoSpeed implants induced similar bone response after immediate implantation at 4 and 12 weeks. The immediate implant placement resulted in peri-implant crestal bone-level changes for both types of implants.

Preserving soft tissue after placing implants in fresh extraction sockets in the maxillary esthetic zone and a prosthetic template for interim crown fabrication: A prospective study

The technique of immediate implant placement is said to have success rates similar to those of implantation into a healed socket. An implant-supported restoration in an esthetic area must achieve a harmonious balance of functional, esthetic, and biologic imperatives to be considered effective. The purpose of this clinical study was to assess the height of the interproximal gingival papillae adjacent to immediate implants with immediate loading. The hypothesis was that specific positioning of the proximal contact areas ofthe interim crowns would facilitate the maintenance or regeneration of the interproximal papilla. Twenty-eight participants were provided implants (n=36) in the anterior maxillary area that were loaded with a specifically contoured interim crown immediately after tooth extraction. The proximal contact areas of the interim crowns were positioned 5 to 6 mm incisal to the interproximal bony crest by using a prosthetic template. Papilla height was classified according to a previously described papilla index. A comparison was made between the papilla height before the extraction, at interim crown placement after the implant placement, and at 6 and 12 months postoperatively. Parametric and nonparametric tests were used when appropriate (Kolmogorov-Smirnov). Significance was expressed at the α=.05 level. Cross tables were used to describe the changes in the papilla index score. During the 1-year follow-up, the score of the distal and mesial papilla indices increased significantly (repeated-measures Friedman exact test; P=.035 and P=.002). This prospective study indicated that the use of a prosthetic template for positioning an interim crown on immediately placed implants and for ensuring that the proximal contact areas of the crown with adjacent teeth are 5 to 6 mm incisal to the interproximal bony crest does not seem to hinder the maintenance or regeneration of the height of the interproximal papillae.

Implant–Buccal Plate Distance as Diagnostic Parameter: A Prospective Cohort Study on Implant Placement in Fresh Extraction Sockets

The aim of this study is to investigate contour changes around immediate implants in fresh extraction sockets when different grafting procedures are performed, based on the distance between the external implant collar and the bony surface on the buccal plate (I-BP). A secondary aim is to assess the esthetic outcome via the implant esthetic score (IAS). This prospective cohort study was performed in three centers. Suitable patients to undergo implant placement in fresh extraction sockets were selected. Periodontal biotype, horizontal and vertical peri-implant bone defects, and dehiscences were assessed. Depending on I-BP, two types of grafting procedures were performed. In group A (I-BP <4 mm), only the peri-implant gap was grafted during the surgical phase (internal grafting [IG]), whereas group B (I-BP ≥ 4 mm) received both internal and external grafting (IEG). Master casts of the sites, made before implant placement and after 1 year of loading, were optically scanned. A computerized analysis of the contour changes at the involved sites was performed by superimposing the scanned models. A total of 20 patients (eight males and 12 females) were recruited, and 20 non-submerged implants were placed in fresh extraction sockets. No implant failed during the observation period. The mean follow-up was 25 months (range: 12 to 37 months). After 1 year of loading, group A showed a slight decrease in mean buccal volume, whereas group B had an increase in volume (P = 0.02). IAS was higher for group B than group A. When implants are placed immediately after tooth extraction, I-BP may represent a useful diagnostic parameter in choosing the most appropriate grafting procedure (IG versus IEG). In clinical cases in which the distance between implant surface and the buccal plate is <4 mm, the combination of internal and external grafting (IEG) is recommended to maintain the volume and the contour of the ridge and achieve a successful esthetic outcome.