Bone Volume Assessment Around Immediate Dental Implant in the Esthetic Area with Immediate Tooth-Like Single Crown Provisionalization: A Laser and Computed Tomography 1-Year Retrospective Study.

PURPOSE: To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas. MATERIALS AND METHODS: Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P < .01. RESULTS: No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value < .0001 from the baseline (0.983 ± 0.172 cm3) to the 1-year survey (0.865 ± 0.156 cm3). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value < .0001) was registered for only the bone tissues (from 0.434 ± 0.075 to 0.355 ± 0.061 cm3). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 ± 0.067) appeared to be significantly different from the overall volume loss (-0.118 ± 0.083 cm3). A shrinkage in width (-0.5 ± 0.7 mm) was found from baseline (12.6 ± 0.6 mm) to the 1-year follow-up (12.1 ± 0.9 mm). Marginal bone levels were 0.97 ± 0.70 mm and 0.39 ± 0.78 mm, respectively, at the mesial and distal aspects of the implants. CONCLUSIONS: The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery.

Bone assessment around the delayed dental implant with and without preformed anatomical caps: A 1-year retrospective case-control study.

PURPOSES: To investigate the amount of first-year peri­implant bone loss and the development of the papillae when delayed dental implants loaded with anatomic cover screw and those underwent conventional healing protocol were compared. METHODS: Edentulous healed sites had undergone delayed implants placement. In the anatomical cap group, patients were treated with a guided tissue healing, tooth-like cross-linkable acrylic resin caps had been immediately screwed on dental implants. The marginal loss of the alveolar bone height 1 year after surgery and Jemt's papillae index were obtained. Non-parametric statistics were performed with a level of significance of 1% RESULTS: Forty patients were included in the present retrospective analysis. After a follow-up of 1 year, none of the 40 included implants showed a failure. The Jemt's papilla index was 1.76±0.44 and 1.34±0.50 respectively for guided tissue healing and conventional healing group, without any significant difference. Within the first year of survey a bone loss of -1.27±0.26 mm for conventional healing treatment showed a statistically significant difference (p-value<0.0001) when it was compared to the negligible of the other group (-0.06±0.31 mm). CONCLUSIONS: A guided healing procedure with preformed caps seemed to give better outcomes regarding marginal bone loss and papilla index than those of conventional abutments.

The Assessment of Different Gingival Management Materials for Immediate Implant Treatment in the Esthetic Zone: A Clinical and Biochemical Study.

PURPOSE: To observe the effect of different prosthetic materials (polymethyl methacrylate [PMMA] and flowable composite [FC]) on marginal bone loss, pink esthetic score (PES), and cytokine levels (receptor activator of nuclear factor kappa-Β ligand [RANKL] and osteoprotegerin [OPG]). MATERIALS AND METHODS: A total of 46 patients (31 women, 15 men) were treated with immediate implant therapy after tooth extraction. For standardization, only the maxillary premolar tooth of each patient was restored, and also, both of the adjacent teeth were present in the dental arch. Provisional crowns were prepared before the surgery on patient models with two different materials (24 PMMA, 22 FC). Following the surgical procedure, provisional crowns were adjusted on polyetheretherketone (PEEK) abutments as nonfunctional in centric and eccentric movements. After the surgery, patients were evaluated monthly for 3 months. At each follow-up, periapical radiography was obtained by the parallel technique, and peri-implant crevicular fluid (PICF) was collected. Pink esthetic scoring was done. MBL was calculated for the mesial and distal sides separately. Cytokine levels were analyzed from PICF. Statistical analyses (Shapiro-Wilk, Mann-Whitney U, independent-samples t test, Wilcoxon t test, paired-samples t test, and Friedman two-way analysis of variance with Bonferroni correction) were completed (α = .05). RESULTS: PES was increased significantly within groups (P < .01). However, there was no statistically significant difference between groups. According to the Mann-Whitney U test, no significant difference was found for the MBL (P > .05). When the RANKL/OPG values were evaluated within the group by using the Friedmann two-way analysis of variance test, no significant difference was found (P > .05). CONCLUSION: Similar pink esthetics, cytokine levels, and bone loss can be achieved using a protocol including immediate implants, particle grafts, soft tissue graft, PEEK abutments, and provisional restorations fabricated using PMMA and FC.

Prosthetic Rehabilitation of Edentulous Patients With Implants Based on Facial Profile Assessment: A Case Report.

PURPOSE: To introduce a user-friendly protocol for implant-retained prosthetic rehabilitation of fully edentulous patients based on facial profile and the cephalometric intermaxillary relationship. MATERIALS AND METHODS: The prosthetic rehabilitation of edentulous patients with implants based on facial profile assessment protocol commences with a clinical and cephalometric analysis, followed by a preliminary projection to obtain a harmonious interarch relationship, eventually stabilized by the preplanned prosthesis. The protocol is divided into the following 5 phases: esthetic evaluation; cephalometric-occlusal assessment; surgery; provisionalization; and definitive prosthesis. Evaluation of patient's satisfaction from the treatment provided was performed through a preoperative and postoperative visual analogue scale scores. RESULTS: The patient was granted immediate function and superior esthetics at day 1 of the treatment. These results were re-evaluated on an interval of 18 months and continued to be stable. The overall treatment time was significantly reduced. CONCLUSION: Our recommended protocol gives the clinician a chance to grasp results beyond the offered by traditional protocols by using a wider perspective of rehabilitation, involving the patient's facial profile, thus fulfilling the integration of both occlusal and cephalometric parameters in a unified surgical-prosthetic approach.

Esthetic Assessment of Implants Placed into Fresh Extraction Sockets for Single-Tooth Replacements Using a Flapless Approach.

BACKGROUND: To validate the concept of immediate implant placement and nonfunctional loading for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria. PURPOSE: This study analyzed procedural results as graded by the pink esthetic score and white esthetic score (PES/WES). METHODS: Thirty-nine suitable patients (mean follow-up 44.82 ± 28 months) were evaluated. RESULTS: Thirty-eight implants fulfilled stringent criteria for successful osseointegration: absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 15.50 ± 2.67 (range: 10-20). The mean total PES of 7.92 ± 1.60 (range: 5-10) indicated favorable overall peri-implant soft-tissue conditions. Root convexity and texture (1.63 ± 0.54) and curvature of the facial mucosa (1.68 ± 0.47) and distal papilla (1.66 ± 0.48) had the highest mean values, whereas acceptable levels of facial tissue (1.53 ± 0.73) and mesial papilla (1.42 ± 0.64) were the most difficult to fully achieve. The mean mesial and distal bone loss at data collection was, was 1.19 ± 0.54 and 1.15 ± 0.51, respectively. Periodontal disease severity (advanced chronic and aggressive periodontitis) was significantly associated with a low total PES (p = .048). CONCLUSIONS: Objective PES/WES assessment validated immediate anterior maxillary single-tooth replacement and restoration as being a successful and esthetically predictable treatment modality in sites where the buccal bone had been preserved during the extraction at 1 year of follow-up.

Quality assessment of systematic reviews regarding immediate placement of dental implants into infected sites: An overview.

STATEMENT OF PROBLEM: With the increased number of published systematic reviews and in view of their wide clinical applicability, these studies must be carefully assessed before professionals begin to use their recommendations in daily practice, and above all, the methodological quality of this study design must be considered. In implant dentistry, one topic that has been arousing particular interest is the immediate placement of dental implants into infected sites. PURPOSE: The purpose of this systematic review was to determine the methodological quality of systematic reviews that evaluated the immediate placement of dental implants into infected sites. MATERIAL AND METHODS: A systematic search was performed by 2 independent reviewers of PubMed, LILACS, and ISI Web of Knowledge up to March 2016. All selected articles were published in the English language. Systematic reviews of original papers that assessed the immediate placement of dental implants into infected sites were eligible for the overview. Narrative reviews, randomized clinical trials, and case reports were excluded. Methodological quality assessment was performed using A Measurement Tool to Assess Systematic Reviews. RESULTS: Of the 5 selected systematic reviews, 3 were low methodological quality and 2 were assessed as moderate. None were high methodological quality. The first systematic review of the topic was published in 2010, and the most recent, published in 2015, was the only one that performed meta-analysis. CONCLUSIONS: The systematic reviews that assessed the immediate placement of dental implants into infected sites were assessed as low or moderate methodological quality. The topic focus remains controversial because the implant survival rate, the main outcome considered for the implant placement prognosis, presents contradictory results.

A Non-Invasive and Accurate Measurement of Gingival Thickness Using Cone-Beam Computerized Imaging for the Assessment of Planning Immediate Implant in the Esthetic Zone-A Pig Jaw Model.

INTRODUCTION: The objective of the study is to compare the accuracy of the measurement of gingival thickness using cone-beam computerized tomography (CBCT) with direct clinical measurement on a pig jaw model, aiming to provide an alternate and precise method to aid assessment of the gingival biotype before immediate implant placement at the esthetic zone. MATERIALS AND METHODS: Four pig mandibles were categorized separately into 14 different zones with each prominent tooth cusp as one. A high-resolution CBCT image was taken. Measurement of gingival thickness was performed using computer software and was compared with direct clinical measurements. RESULTS: Intraclass correlation coefficient between clinical and CBCT measurements were 0.995 (pig 1), 0.945 (pig 2), 0.966 (pig 3), and 0.932 (pig 4), which indicated a good match between 2 measuring methods. Independent t test showed no significant difference between 2 independent investigators in all aspect of measurements (P > 0.05). CONCLUSION: Measuring gingival thickness using CBCT is a predictable and accurate method to assess the gingival biotype of a patient, so as to predict the suitability of immediate implantation.

Preoperative assessment of labial bone perforation for virtual immediate implant surgery in the maxillary esthetic zone: A computer simulation study.

BACKGROUND: In this computer simulation study, the authors investigated the frequency distribution of labial bone perforation (LBP) between various sagittal root position (SRP) classes with respect to the anterior maxillary osseous housing and evaluated the associated factors correlated with a higher risk of LBP when performing a virtual immediate implant surgery in the esthetic zone. METHODS: The authors analyzed cone-beam computed tomography (CBCT) images from 285 qualified study participants (1,449 teeth) to determine the probability of LBP when associated with selected variables, such as tooth type, SRP class, and morphologic parameters. The authors examined associated factors and analyzed the adjusted odds ratios by means of multiple logistic regression analysis. RESULTS: The overall probability of LBP was 81.7%, which presented statistically significant differences between each specific tooth type and SRP class (all P<.001). After adjusting for other factors, the authors found that the maxillary central incisor was 2.37 times more likely to have LBP than the canine. SRP class I was 4.9 times more likely to be associated with LBP when compared with SRP class IV. CONCLUSIONS: When a clinician performs an immediate implant in the anterior esthetic zone, he or she should be aware that the specific tooth type, SRP class, and morphologic features of fossa concavities are associated with a risk of experiencing LBP. PRACTICAL IMPLICATIONS: Presurgical cross-sectional images can be analyzed to identify anatomic features relative to LBP in the maxillary esthetic region, and this can avoid unpleasant complications, specifically when performing immediate implant procedures.

Computer-guided versus free-hand placement of immediately loaded dental implants: 1-year post-loading results of a multicentre randomised controlled trial.

PURPOSE: To compare planning and patient rehabilitation using a 3D dental planning software and dedicated surgical guides with conventional rehabilitation of partially or fully edentulous patients using flapless or mini-flap procedures and immediate loading. MATERIALS AND METHODS: Fifty-one fully or partially edentulous patients requiring at least 2 implants to be restored with a single prosthesis, having at least 7 mm of bone height and 4 mm in bone width, had their implant rehabilitation planned on three-dimensional (3D) cone beam computed tomography (CBCT) scans using a dedicated software. Afterwards they were randomised according to a parallel group study design into two arms: computer-guided implant placement aided with templates (computer-guided group) versus conventional implant placement without templates (conventional group) in three different centres. Implants were to be placed flapless and loaded immediately; if inserted with a torque over 35 Ncm with reinforced provisional prostheses, then replaced, after 4 months, by definitive prostheses. Outcome measures, assessed by masked assessors were: prosthesis and implant failures, complications, peri-implant bone level changes, number of treatment sessions, duration of treatment, post-surgical pain and swelling, consumption of pain killers, treatment time, time required to solve complications, additional treatment cost, patient satisfaction. Patients were followed up to 1 year after loading. RESULTS: Twenty-six patients were randomised to the conventional treatment and 25 to computerguided rehabilitation. No patient dropped out. One provisional prosthesis failed, since one of the two supporting implants failed 11 days after implantation in the conventional group (P = 1.0). Four patients of the conventionally loaded groups experienced one complication each, versus five patients (6 complications) in the computer-guided group (P = 0.726). There were no statistically significant differences between the two groups for any of the tested outcomes with the exception of more postoperative surgical pain (P = 0.002) and swelling (P = 0.024) at conventionally treated patients. CONCLUSIONS: When treatment planning was made on 3D CBTC scan using a dedicated software, no statistically significant differences were observed between computer-guided and a free-hand rehabilitations, with the exception of more postoperative pain and swelling at sites treated freehand because more frequently flaps were elevated.

Modified indexing technique for the immediate interim restoration of a dental implant.

Because of the functional and esthetic requirements of patients, different techniques have been proposed to reduce the time between dental implant placement and interim restoration fabrication. This article describes a modified indexing technique by using a surgical template for open-tray impression and definitive cast development during immediate loading procedures. This technique does not use a complete impression of the oral cavity and, therefore, is more comfortable, less time consuming, and less expensive. It also allows the fabrication of interim restorations with the optimal shape for developing an adequate emergence profile.

Patient-related and financial outcomes analysis of conventional full-arch rehabilitation versus the All-on-4 concept: a cohort study.

BACKGROUND: Patient-related variables such as cost of treatment, length of the treatment period, and comfort provided by the interim prosthesis when treatment planning for full-arch rehabilitation are often neglected in dental publications. METHODS: Two patient cohorts were followed up longitudinally in this study: the "All-on-4 treatment concept group" and the "historical group." The number of implants, total treatment time, number of surgical procedures, number of sinus grafts, necessity for immediate provisional implants, adjusted cost associated for treatment in each group, and the quality of interim prosthesis were compared. RESULTS: The total adjusted cost for patients receiving All-on-4 treatment concept averaged at $42,422 ± 3860 (&OV0556;31,392 ± 2856), whereas the mean total adjusted cost for the historical group was $57,944 ± 20,198 (&OV0556;42,879 ± 2113) (P = 0.01). The difference in cost had a mean value of $7307 (&OV0556;5407) per jaw. Factors associated with complexity of treatment and patient comfort, such as the quality of interim prosthesis, number of surgeries, and duration of treatment time, all significantly favored the All-on-4 treatment concept group in comparison with conventional treatment modalities. CONCLUSIONS: When implant rehabilitation of the total jaw is sought, the All-on-4 treatment concept should be considered the least costly and least time consuming treatment option.