Restoration Of Single-tooth Implants Research Articles

Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level.

The objective of this study was to assess marginal bone level around single implants inserted in fresh extraction sockets in the anterior maxillary region and instantly restored with computer-aided design/computer-aided manufacturing customized temporary crowns cemented on the final abutment. A total of 20 patients (15 females and 5 males, with a mean age of 30 years), where 20 were placed in fresh extraction sockets. After raising a full-thickness flap, atraumatic extraction was performed the implant site was prepared and fixtures were stabilized on the palatal bone wall. The implant location was immediately transmitted to the prepared master model using the pick-up impression coping seated in the surgical guide template. Prefabricated abutments were used as the final abutment on the master model, scanned and the crown was planned using computer-aided manufacturing customized software. Later on 8th weeks, abutments were torqued as per the manufacturer's recommendation, and the final crowns were cemented. Using personalized intraoral radiographs marginal bone level was evaluated mesially and distally to the implant shoulder as a reference at implant placement, 8 weeks, 1, 3, 5, and 10 years after loading. Wholly implants were osteo-integrated positively after 10 years of practical loading, but only 18 were available for clinical and radiological follow-up, and 2 patients with two implants were excluded from the study due to relocation abroad without any implant failure. The average marginal bone loss (MBL) in the current report was 0.16 ± 0.167 mm at crown cementation, 0.275 ± 0.171 mm after 1 year, 0.265 ± 0.171 mm after 3 years, 0.213 ± 0.185 mm after 5 years, and 0.217 ± 0.194 mm at 10 years. The strategy of inserting and not removing the final abutment at the time of implant placement facilitates the establishment of adequate attachment of both soft and hard tissues to the abutment surface, ensuring uninterrupted organization of tissue architecture and offers advantages in helping maintain soft tissue maturation and preventing marginal bone level. Immediately loaded implants in freshly extracted sockets lead to a significant reduction in marginal ridge resorption. The use of a temporary crown on a prefabricated abutment, exclusive of successive abutment manipulation, proved effective in preserving the primarily founding blood clot and served as a prototype for shaping the soft tissue around the previously wounded gum. How to cite this article: Berberi A, El Zoghbi A, Aad G, et al. Immediate Loading Using the Digitalized Customized Restoration of Single-tooth Implants Placed in Fresh Extraction Sockets in the Aesthetic Anterior Maxilla: A 10-Year Prospective Study of Marginal Bone Level. J Contemp Dent Pract 2024;25(3):213-220.

Establishing Clinically Acceptable PES/WES Threshold for Single- Tooth Implant Restoration.

Determining the esthetic success of single-tooth implant restorations (STIR) requires an objective tool such as one devised by Belser et al., 2009 - pink esthetic scores and white esthetic scores (PES/WES). This study aimed to utilized PES/WES to establish threshold scores based on (1) detectability and (2) acceptability of a STIR by lay person perception, (3) to study the difference in the ability of laypeople and dentists in detecting the presence of STIR, and (4) to study the pink and white deficiencies in relation to the detectability of the presence of STIR. A total of 38 calibrated photographs of STIR in the anterior region were scored with PES/WES by 3 prosthodontists. Next, 100 laypeople and 60 dentists were instructed to identify the STIR among the anterior teeth and provide reasoning behind the identification (based on pink and white esthetic criteria). The acceptance of the STIR was recorded. Receiver Operating Characteristics (ROC) analysis was utilized to determine the threshold scores. At the PES/WES score of 17, 71% of laypeople could not correctly identify the STIR, and at the PES/WES score of 12, 80% of laypeople accepted the implant. Out of 3,800 occasions, laypeople correctly identified the STIR 1,770 (46.58%) of those occasions. Among the correctly identified STIR, 751 (42.43%) of those occasions were identified with pink deficiencies and 1019 (57.57%) of those occasions were with white deficiencies. Out of 2,280 occasions, dentists correctly identified STIR 1869 (81.98%) of those occasions. The PES/WES score of 12 indicates the clinically acceptable threshold, while the score of 17 indicates the detectable threshold for an exceptional esthetic outcome. Laypeople tend to accept the implant despite its detectability. For both laypeople and dentists, root convexity/soft tissue color and texture are the most focused criteria of PES/WES, followed by overall white deficiencies that remain influential. Compared to laypeople, dentists tend to have a higher ability to detect STIR.

Comparison of functional and esthetic outcomes in digital versus analog rehabilitation of one-piece screw-retained implant crowns placed at second stage surgery.

Analog and digital impressions are established procedures for restoration of single-tooth implants. In this study, single-tooth implants were restored with definitive restorations during second-stage surgery. Analog and digital workflows were compared. Eighty single-tooth implants were examined in total. In 40 implants, an index was taken immediately after implant placement using composite resin to fabricate the final crowns (analog workflow). For the other 40 single-tooth implants, intraoral intraoperative scans were performed (digital workflow) during primary surgery. The custom-fabricated screw-retained crowns were placed during second-stage surgery. Photographs and examinations for the scores were taken at the time of the follow-up visit, 1-4 years after placement of the crowns. The number of treatment appointments required was recorded and the modified pink esthetic score (PES) was determined. Additionally, the functional implant prosthetic score (FIPS) was measured. The mean PES was 12.15/14 for the digital workflow and 11.95/14 for the analog workflow. The most common deficit was incomplete papillae for both workflows. Three treatment appointments were required for both workflows: (1) Scan and/or impressions making and patient consent, (2) implant placement, and (3) second-stage surgery with crown insertion. The FIPS was 9.1/10 for the digital workflow group and 9.2 /10 for the analog workflow group. Common deficits presented as missing papillae as well as open approximal contacts. The FIPS was not significantly different between workflows (p = 0.679). The PES also did not show a statistically significant difference for both workflows (p = 0.654), however the analog workflow showed better values for the papillae (p < 0.05). A significant difference was also found in the other PES values, with the digital workflow showing better results here (p < 0.05). A chronological analysis of the results of the digital technique showed that the cases treated last had significantly better values than the cases treated first. According to the results of this study, both workflows allowed placement of the definitive crowns on single-tooth implants during second-stage surgery. Both workflows were found to be equivalent in terms of esthetic results in this study, although the digital workflow demonstrated a learning curve. This article is protected by copyright. All rights reserved.

Editorial: Developing a Consensus: Abutment/Crown Design for Single-Tooth Implant Restorations

Editorial: Developing a Consensus: Abutment/Crown Design for Single-Tooth Implant Restorations

Single-Tooth Implant Restorations in Fresh Extraction Sockets of the Maxillary Esthetic Zone: Two-Year Results of a Prospective Cohort Study.

In this prospective study, 15 patients received 15 variable-thread tapered implants placed in fresh extraction sites in the maxillary esthetic zone and immediately were provisionalized out of occlusion. Of the 15 patients, 11 completed their 2-year follow-up. At 2 years, the success and cumulative survival rates were both 100%, and the mean bone level gain was 0.83 mm. Soft tissue assessment showed no zero esthetic scores, improved papilla indices, and low bleeding on probing and plaque accumulation. Overall, the study implants showed excellent hard tissue, soft tissue, and esthetic outcomes, indicating a healthy tissue response in single-tooth extraction sites in the maxillary esthetic zone.

Soft and Hard Tissue Changes Following Immediate Placement or Immediate Restoration of Single-Tooth Implants in the Esthetic Zone: A Systematic Review and Meta-Analysis.

This systematic review aimed to compare immediate protocols with conventional protocols of single-tooth implants in terms of changes in the surrounding hard and soft tissue in the esthetic area. Electronic and manual searches were performed in PubMed, EMBASE, Cochrane, and other data systems for research articles published between January 2001 and December 2014. Only randomized controlled trials (RCTs) reporting on hard and or soft tissue characteristics following a single-tooth implant were included. Based on the protocol used in each study, the included studies were categorized into three groups to assess the relationships between the factors and related esthetic indexes. Variables such as marginal bone level changes (mesial, distal, and mean bone level), peri-implant soft tissue changes (papilla level, midbuccal mucosa, and probing depth), and other esthetic indices were taken into consideration. The data were analyzed using RevMan version 5.3, Stata 12, and GRADEpro 3.6.1 software. A total of 13 RCTs met the inclusion criteria. Four studies examined immediate implant placement, five studies examined immediate implant restoration, and four studies examined immediate loading. Comparing the bone level changes following immediate and conventional restoration, no significant differences were found in the bone level of the mesial site (standard mean difference [SMD] = -0.04 mm; 95% confidence interval [CI]: -0.25 to 0.17 mm), the distal site (SMD = -0.15 mm; 95% CI: -0.38 to 0.09 mm), and the mean bone level changes (SMD = 0.05 mm; 95% CI: -0.18 to 0.27 mm). The difference in the marginal bone level changes between immediate and conventional loading was also not statistically significant (SMD = -0.05 mm; 95% CI: -0.15 to 0.06 mm for the mesial site and SMD = -0.02 mm; 95% CI: -0.09 to 0.05 mm for the distal site). Soft tissue changes following immediate and conventional restoration reported no significant differences in the papillae level of the mesial site (SMD = 0.18 mm; 95% CI: -0.00 to 0.37 mm), the papillae level of the distal site (SMD = -0.12 mm; 95% CI: -0.34 to 0.09 mm), and the midbuccal mucosa (SMD = -0.22 mm; 95% CI: -1.29 to 0.85 mm). Within the limitations, it can be concluded that immediately placed, restored, or loaded single-tooth implants in the esthetic zone result in similar hard and soft tissue changes compared with conventional protocols.

Are Predoctoral Students Able to Provide Single Tooth Implant Restorations in the Maxillary Esthetic Zone?

The objective of this study was to assess the ability of the University of Illinois at Chicago College of Dentistry (UIC-COD) predoctoral students to provide single tooth implant (STI) prostheses in the maxillary esthetic zone. The patient's esthetic satisfaction and the correlation between prosthodontists' and patients' perspectives were examined. Twenty-seven patients were recruited for recall examinations at the UIC-COD predoctoral implant program and underwent clinical and radiographic examination with clinical photographs of the implant sites. The patients completed a semantic differential scale questionnaire. The collected information was formulated into a PowerPoint presentation for two Diplomate of the American Board of Prosthodontists to use the Pink/White Esthetic Score (PES/WES) to evaluate the esthetic outcome. Descriptive analyses, Cohen kappa test, and Spearman rank correlation coefficient test were performed. The average PES/WES were above 6.0 (out of 10). The median for the patient satisfaction and esthetic outcome questionnaires were 10 and 9, respectively, on a scale with 10=highest. There was a medium and positive correlation between prosthodontists' and patients' perspectives in esthetic outcome. This study found that, with strict guidance and proper selection criteria, predoctoral students were able to provide esthetically acceptable STI prostheses in the maxillary esthetic zone and patients were satisfied with the treatment provided.

Immediate Placement and Restoration of Dental Implants in the Esthetic Region: Clinical Case Series

The objective of this study was to assess the hard and soft tissue changes following immediate placement and provisional restoration of single-tooth implants in the aesthetic zone. Thirteen patients with immediately placed and restored implants were included in this study. All participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, and connection of a screw-retained provisional restoration. Three months following implant placement, the temporary crowns were replaced by the definitive restorations. Implant survival rates, and hard and soft tissue changes were measured using periapical X-rays and photographs. The range of the observation period was between 12 and 37 months with a mean period of 23.2 ± 7.6 months. At the time of follow-up, all implants were present with no complications. Radiographic evaluation revealed a mean mesial bone gain of 1.20 ± 1.01 mm and a mean distal bone gain of 0.80 ± 1.14 mm, which reached statistical significance. The mean mid-buccal recession was 0.20 ± 0.78 mm, whereas the mesial and distal papillae height loss was 0.50 ± 1.26 mm and 0.30 ± 0.82 mm, respectively. The changes in the soft tissues did not reach statistical significance. Notwithstanding the limitation of a small sample size, this study shows that immediate implant placement and provisional restoration in the maxillary aesthetic zone can result in favorable treatment outcomes with regards to soft and hard tissues changes over a follow-up period of 23.2 ± 7.6 months. Most clinical trials investigating immediate implant placement and immediate restoration in the maxillary anterior zone have focused on implant survival and implant success, with particular emphasis on radiographically assessed hard tissues changes. However, this study assesses the soft tissue changes associated with this procedure, which is an important area of study given the esthetic demands of implant therapy in the maxillary anterior region.

Clinical evaluation of immediate implants using different types of bone augmentation materials

BackgroundThe immediate placement of implants into fresh extraction socket has proven to be a safe and predictable procedure. However, there is lack of scientific evidence regarding the healing pattern and osseointegration associated with immediate implants especially with different grafting materials. MethodsA total of 30 patients male or female, with a mean age of 23.1 years ± 6.0 in the age group of 18–38 years, each having at least one tooth indicated for extraction (either maxillary or mandibular anterior teeth) were selected and randomly divided in to two groups. 30 Implants (Xive® friadent, Germany) were placed into fresh extraction sockets during this study. Two types of graft materials namely Dembone® (freeze-dried bone allograft) for group A and G-Bone® (modified hydroxyapatite) for group B were used. After implant placement all implants were evaluated clinically and radiographically at baseline, 3 months, 6 months, 9 months and 12 months. All clinical and radiographic parameters were subjected to statistical analysis. Intragroup comparisons were made with paired ‘t’ test and intergroup comparisons with unpaired ‘t’ test (P > 0.05 NS, ≤0.05 S, ≤0.01 HS). ResultDuring the 1-year interval, no implant was lost and the mean bone level at the implants was maintained or even improved. ConclusionImmediate restoration of single tooth implants placed in fresh extraction sockets could be considered a valuable option to replace a missing tooth. The graft materials used in both groups have been found to be equally effective.

Dental Student Perceptions of Predoctoral Implant Education and Plans for Providing Implant Treatment

This study aims to identify dental students' perceptions of pre-patient care laboratory exercises (PCLEs) and clinical experiences that influence their future plans for providing implant care. One of two questionnaires was administered to dental student classes at one dental school (D2: Survey 1; D3 and D4: Survey 2). Future plans as graduates to provide implant diagnosis and treatment planning (DxTP), restoration of single-tooth implants (STIs), and implant-retained overdentures (IODs) were cross-sectionally assessed along with potential influences such as PCLE, clinical experiences, gender, and class. The majority of students planned to provide implant services after graduation (DxTP 68.9 percent; STI 61.2 percent; IOD 62.1 percent). Bivariately, males reflected more preparedness from PCLEs than females (p=.002) and the D2 students more than D3 and D4 students (p<.001). Multivariate models revealed the perceived preparedness from PCLEs generally had the strongest association with future plans for performing implant therapy. However, this varied by gender and class. These findings indicate that PCLEs are important for their influence on students' future plans to provide implant therapy. However, further studies are needed to validate actual PCLEs and clinical implant practices (both longitudinally and for other schools) and to determine educational interventions to optimize the provision of implant care.

Prosthodontic considerations designed to optimize outcomes for single‐tooth implants. A review of the literature

The aim of this study was to review the literature on the restoration of single-tooth implants, and to develop evidence-based conclusions to optimize aesthetic, biologic and patient-related outcomes. An electronic and hand search was conducted using the search terms 'dental implants, single-tooth; dental restoration, temporary; dental impression materials; dental impression technique; dental prosthesis, implant-supported; dental prosthesis design; dental abutments; dental occlusion; maintenance; survival; and survival analysis'. Resultant titles were screened, and full text was obtained where relevant. The authors selected the most appropriate articles, giving preference to systematic reviews and long-term, patient-based outcome data. Thirty-nine articles were selected and critiqued by the authors. There was strong suggestion by several authors that peri-implant soft tissue aesthetics can be sculpted through provisional restoration contour, but there are no clinical outcome studies to define or support this claim. Laboratory studies demonstrate that pick-up type impression copings in conjunction with elastomeric impressions are the most accurate means for transferring implant position to a dental cast. Laboratory and finite-element analysis studies suggest implants with an internal-type connection show improved stress distribution, but supportive clinical data are lacking. The authors of this review favour a screw-retained prosthesis for retrievability. Clinical and histological studies show that gold, titanium and zirconia ceramic abutment materials exhibit excellent biological responses, although there is insufficient data on the clinical service provided by zirconia as an implant-substructure material. The literature does not associate any particular occlusal scheme with superior clinical outcomes. Implant-borne single crowns offer comparable clinical service to tooth-borne fixed dental prostheses. However, single-tooth implant restorations are associated with an increased incidence of biological and technical complications.

Immediate temporary restoration of single-tooth implants: Prospective clinical study

The goal of this study is to assess the survival, marginal bone loss and complications around single-tooth implants on which immediate provisionalization was carried out. 78 implants were placed in 57 patients: 56 after extraction and 22 in healed sockets. Immediately after surgery provisional crows were delivered without contacts in both centric and excursive jaw movements. The final crowns were inserted between 3 to 6 months later. During the study there were 3 x-rays taken per patient. The marginal bone loss was measured and complications were recorded. The statistical analysis of the data was carried out with the STATA 10® software. The mean duration of the study was 92 weeks. Survival rate was 98.7% (1 failure out of 78 implants). The mean mesial bone loss was 0.2 ± 0.4 mm and the mean distal bone loss was 0.2 ± 0.4 mm. No statistically significant differences were found between immediate or delayed implants. 67 implants showed a bone loss less than 1 mm, and 36 did not show any bone loss at all. The main complications were the uncementing of the crowns (11 crowns), the presence of cement remnants (10 crowns) and the development of apical lesions around implants (6 implants). With the limitations of this study, it can be concluded by saying that immediate restoration with single-tooth implants and provisional crowns may be considered as a predictable technique.

Immediate restoration of implants placed into fresh extraction sockets for single-tooth replacement: A prospective clinical study

The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns. A series of 22 cases with a 12-month follow-up is presented. Twenty-two patients (15 women and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical or horizontal root fracture, caries, endodontic lesions, or periodontal disease were treated with immediate postextraction implant placement. The implant was then restored with a screw-retained prosthetic restoration within 24 hours. Radiographic assessments were made at baseline and 12 months after implant placement. Clinical parameters, such as plaque score, mucositis score, probing attachment level, mucosal margin position, variation of gingival level, and variation of papilla position, were also measured at baseline and after 12 months of follow-up. At 12 months, no implants had failed. Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline. The mean variation of gingival level, compared to the neighboring teeth, was −0.75 mm. Probing attachment levels were 0.79, 0.45, and 0.54 mm at proximal, buccal, and lingual sites, respectively. The values for the mucosal margin position were 2.9, 2.2, and 2.4 mm at proximal, buccal, and lingual sites, respectively. Regarding variation of papilla position, according to Jemt's index, 27 papillae presented with a score of 2 (61%) and 17 with a score of 3 (39%). An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13%. Furthermore, mucositis (score 2) was not observed at any of the peri-implant units. Primary implant stability did not significantly increase over time. The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure. The success rate and radiographic and clinical results were comparable to those obtained following the standard protocol. Within the limits of the present investigation, immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth. However, long-term clinical trials are needed to confirm the present results.—Reprinted with permission of Quintessence Publishing.

Single-Tooth Implant Restorations in the Esthetic Zone With PureForm Ceramic Crowns: 3 Case Reports

The anterior maxillary jaw is frequently called the "esthetic zone" because of its high visibility and influence on facial appearance. Implant placement and single-tooth restoration in this region can present some esthetic challenges for the clinician. The underlying titanium abutment, for example, can diminish porcelain translucency and result in a darkened prosthesis. Subsequent changes in soft-tissue margins can also result in the visibility of titanium at the gingival crevice. In recent years, all-ceramic restorations have gained popularity in response to increasing patient demands for improved esthetics. This article describes the clinical use of a new, tooth-shaped, ceramic coping system in the restoration of single teeth in the esthetic zones of 3 patients. Four tapered screw implants were placed in the locations of the central incisors (n = 3) and bicuspid (n = 1). Conventional ceramic protocols were used to fabricate all-ceramic crowns that were cemented onto small core abutments attached to the implants. All prostheses restored the biomechanical needs of the patients and achieved excellent esthetic results.

A New Approach to Esthetic Single-Tooth Implant Restorations

A New Approach to Esthetic Single-Tooth Implant Restorations