The impact on obesity-related quality of life and eating satisfaction in the early period after laparoscopic sleeve gastrectomy.

INTRODUCTION: Obesity impairs patients' quality of life (QoL). Laparoscopic sleeve gastrectomy (LSG) is a common procedure for patients with severe obesity; however, studies reporting changes in obesity-related QoL are limited. The aim of this study was to assess changes in obesity-related QoL and food tolerance in the early postoperative period. METHODS: We included 20 consecutive patients who underwent LSG between May 2021 and July 2023. We evaluated changes in obesity-related QoL 6 months after surgery using an obesity and weight loss QoL questionnaire (OWLQOL) and a weight related symptom measure (WRSM). Additionally, we assessed eating satisfaction and food tolerance after surgery. RESULTS: The percentages of total weight loss and excess weight loss were 28.5% and 79.1%, respectively. OWLQOL scores and WRSM changed from 36.5 to 73.0 points and from 44.0 to 15.0 points (p = .007, .007), respectively. The food tolerance score decreased from 25 to 21.2 points (p < .001), while eating satisfaction showed no significant change (p = .25). CONCLUSION: Obesity-related QoL is enhanced even in the early postoperative period, without sacrificing eating satisfaction. The findings of this study may provide valuable insights for patients when considering LSG.

New Proposal Strategy of Sentinel Lymph Node Navigation Surgery for Endoscopic Curability C-2: A Retrospective Study.

BACKGROUND/AIM: The purpose of this study was to evaluate the outcomes of the sentinel node navigation surgery (SNNS) followed by limited gastrectomy for early gastric cancer (EGC) with Endoscopic Curability C-2 (eCuraC-2). PATIENTS AND METHODS: Between 2001 and 2018, 33 patients were included in this study. Following sentinel node (SN) biopsy using indocyanine green combined with an infrared ray laparoscopic system, limited gastrectomy (LG) [wedge resection (WR), or segmental gastrectomy (SG)] was performed without extended lymphadenectomy. RESULTS: SN detection rate was 97% (32/33). The mean number of SNs per case was 7.8. Three patients (9.1%) with lymph node metastasis (LNM) had a positive SN identified by intraoperative pathological examination. When intraoperative pathologic examination showed SN to be LNM negative, 11 patients underwent WR, and seven were subjected to SG. Postoperative pathological examinations showed no false negatives for LNM, and four patients (12%) had residual cancer in their resected stomachs. Overall survival and disease-specific survival five years after SNNS were 87.9% and 100%, respectively. CONCLUSION: SNNS followed by LG with lymphatic basin resection may be one of the ideal procedures for patients with eCuraC-2 due to the accurate diagnosis of LNM and favorable disease-specific prognosis.

Proctoring System Enables Safe Induction of Robotic Gastrectomy: Short-term Outcomes of the First 10 Cases.

BACKGROUND/AIM: The Japan Society of Endoscopic Surgery (JSES) proctoring system was established to prevent serious pancreatic pressure injuries in Japan in 2019. To safely perform robotic gastrectomy (RG) in our hospital, which has no experience in robotic surgery, we conducted a clinical trial with the support of this proctoring system. PATIENTS AND METHODS: The present study was a single-center clinical prospective study. The primary endpoint was morbidity determined using Clavien-Dindo classification (C-D) Grade IIIa or higher. RESULTS: Ten patients, seven males and three females, were recruited in this study. RG was performed under the proctoring system of the JSES in the initial six cases and was completed independently for the remaining four patients. We successfully performed the initial ten cases without C-D classification grade IIIa or higher morbidities. CONCLUSION: This study underscores the significance of a proctoring system for introducing RG to facilities with limited experience in robotic surgery. Despite some limitations, this study demonstrated successful outcomes in the initial ten cases, emphasizing the benefits for both surgeons and patients. This study provides valuable insights into the safety of RG in small institutions and calls for further research in this area.

Preliminary studies of XANES and DFT calculation of Ru extraction by imino-diacetamide and related compounds.

We connected three research fields on Ru extraction, XANES, and DFT calculation and elucidate the sequence of distribution ratio (D) and their reactions. The magnitude order of the distribution ratio, D(Ru), from acids, HCl > H2SO4 > HNO3 > HClO4, by IDOA indicates to extract readily the stable Ru-Cl ions. The XANES signals, which suggests the electrical charge of Ru(III) extracted into the organic phase, supports the ion-pairing extraction of the anionic Ru-Cl complex with an extractant protonated. Ru(III) in other acids might be extracted by solvation of extractant, thus ion-pair extraction is stronger than solvation in Ru extraction. According to the D(Ru), the same extractant trend, NTAamide > MIDOA > IDOA, as the energy gap of HOMO and LUMO by DFT calculation is found, which suggests that DFT calculation can give the relative magnitude of each D(M) value when extractant and metal in an extraction are determined.

Appropriate concentration setting for the intraoperative administration of indocyanine green for fluorescence imaging to identify the sentinel lymph node in early gastric cancer: a clinical pilot study.

PURPOSE: Some prospective trials have demonstrated the feasibility of sentinel node (SN) biopsy in gastric cancer (GC) surgery. This study aimed to identify the appropriate concentration settings for the intraoperative injection of indocyanine green (ICG) for SN biopsy. METHODS: Before the clinical studies, porcine model experiments explored the optimal concentration of ICG injected intraoperatively. Next, nine GC patients were enrolled in the clinical research. ICG (0.5 ml) was injected intraoperatively into four quadrants of the submucosa around the tumor at various concentrations (0.5, 0.25, and 0.1 mg/ml). The lymphatic basin dissection method was applied to the ICG-positive lymphatic areas. The number and location of the lymphatic basins and positive nodes were recorded intraoperatively. RESULTS: In the porcine model, the visibility gradually became clear at an ICG concentration higher than 0.1 mg/ml. In the clinical study, the average number of detected lymphatic basins was 3.3, 1.7, and 1.7, respectively. The mean number of detected SNs was 14.7, 6.7, and 4.0, respectively. CONCLUSION: To improve the reproducibility of SN biopsy, it is essential to prepare the correct concentration setting of ICG. Under current conditions in which ICG is injected intraoperatively, a 0.1 mg/ml concentration setting of ICG may be necessary and sufficient for SN identification.

Long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases.

BACKGROUND: Trastuzumab-based chemotherapy is a standard treatment regimen for human epithelial growth factor 2 (HER2)-positive gastric cancer. This is a case of a patient who has survived 12 years after being diagnosed with advanced gastric cancer with multiple liver and lung metastases. CASE PRESENTATION: A woman in her 70s underwent total gastrectomy, cholecystectomy, and left hepatic lobectomy for gastric cancer with liver metastasis. One month after the surgery, multiple liver metastases appeared. After two courses of S-1 + CDDP chemotherapy, the liver metastases disappeared, and new lung metastases occurred. Because the primary tumor was HER2 positive, S-1 + CDDP + trastuzumab chemotherapy was performed. After one course of chemotherapy, the blood test showed pancytopenia, and CDDP was discontinued. S-1 + trastuzumab chemotherapy was then initiated, and as a result, the lung metastases disappeared. The patient is alive without recurrence 12 years after the surgery. CONCLUSIONS: We encountered a case of long-term survival after multidisciplinary treatments for HER2-positive advanced gastric cancer with multiple liver and lung metastases.

14 Years On: A Clinical Case Report of an 86-Year-Old Patient With Full Arch Implant-Supported Restorations With Auro Galvano Crown Attachments.

Oral reconstruction in fully edentulous patients can be challenging at times. Hence, it is important to offer the most suitable treatment option after a detailed clinical examination and treatment plan. This 14-year long-term follow-up report is the clinical case of a 71-year-old nonsmoker who visited the clinic in 2006 and opted for full-mouth reconstruction using Auro Galvano crown (AGC) attachments. Maintenance was performed twice a year for the past 14 years, and the clinical results were satisfactory, with no signs of inflammation or lack of retention of the superstructures. This was associated with a high level of patient satisfaction, as indicated by the Oral Health Impact Profile. Compared to the screw-retained implants over dentures, AGC attachments can be a viable and effective treatment option when restoring fully edentulous arches.

Use of 6-mm Short Implants in Japanese Patients: Clinical, Radiologic, and Patient Satisfaction Results in a Retrospective Study with a 2-Year Follow-up.

Implant therapy for tooth loss in the molar area is challenging due to the anatomical limitations, requiring bone augmentation procedures that are associated with high surgical complexity and long postsurgical recovery. Recently, many studies have demonstrated the usefulness of short implants. However, few studies have been performed in Japanese patients to evaluate peri-implant bone changes, changes in peri-implant epithelial tissue, and patient satisfaction. The present study included 16 patients (5 men, 11 women; mean age: 60 years) who received 26 short (6-mm) implants. Changes in peri-implant bone and epithelial tissue were measured radiographically at superstructure loading and after 2 years. Peri-implant pocket probing depth was measured at the epithelial tissue and compared at both time points. Patient satisfaction was graded using the Oral Health Impact Profile (OHIP-14) before treatment and at follow-up. The mean mesial and distal bone levels were -0.05 mm and 0.37 mm at loading, respectively, and were 0.33 mm and 0.53 mm after 2 years, respectively. Significant peri-implant bone formation for mesial and distal bone levels at both time points were determined by Wilcoxon signed-rank test. Mean probing depth increased slightly, from 3.03 mm at loading to 3.33 mm after 2 years, but no significant difference was found. The OHIP-14 found that patient satisfaction levels increased after 2 years. Using 6-mm short implants in sites with insufficient bone levels can be a highly beneficial treatment option for patients, as it avoids the need for bone augmentation. However, more long-term and detailed studies on the clinical outcomes for these implants are required.

The uptake characteristics of Prussian-blue nanoparticles for rare metal ions for recycling of precious metals from nuclear and electronic wastes.

We have examined the uptake mechanisms of platinum-group-metals (PGMs) and molybdenum (Mo) ions into Prussian blue nanoparticles (PBNPs) in a nitric acid solution for 24-h sorption test, using inductively coupled plasma atomic emission spectroscopy, powder XRD, and UV-Vis-NIR spectroscopy in combination with first-principles calculations, and revealed that the Ru4+ and Pd2+ ions are incorporated into PBNPs by substitution with Fe3+ and Fe2+ ions of the PB framework, respectively, whereas the Rh3+ ion is incorporated into PBNPs by substitution mainly with Fe3+ and minorly with Fe2+ ion, and Mo6+ ion is incorporated into PBNPs by substitution with both Fe2+ and Fe3+ ions, with maintaining the crystal structure before and after the sorption test. Assuming that the amount of Fe elusion is equal to that of PGMs/Mo substitution, the substitution efficiency is estimated to be 39.0% for Ru, 47.8% for Rh, 87% for Pd, and 17.1% for Mo6+. This implies that 0.13 g of Ru, 0.16 g of Rh, 0.30 g of Pd, and 0.107 g of Mo can be recovered by using 1 g PBNPs with a chemical form of KFe(III)[Fe(II)(CN)6].

The uptake mechanism of palladium ions into Prussian-blue nanoparticles in a nitric acid solution toward application for the recycling of precious metals from electronic and nuclear wastes.

We have investigated the uptake mechanism of palladium (Pd: one of the most important elements in industry used as a catalyst) ions into Prussian-blue nanoparticles (PBNPs) in a nitric acid solution via high-resolution electron transmission microscopy, inductively coupled plasma atomic emission spectroscopy, powder X-ray diffraction, and ultraviolet-visible-near infrared spectroscopy in combination with first principles calculations. Comparison of the structural and electronic properties of PBNPs between before and after a 24 h sorption test reveals that the Pd2+ ions incorporated into PBNPs by the substitution of Fe2+ ions of the PB framework while maintaining the crystal structure, and the substitution efficiency is estimated to be 87% per PB unit cell. This implies that 0.30 g of Pd can be recovered by using 1 g of PB having the chemical formula KFe(iii)[Fe(ii)(CN)6]. The present finding suggests that PB (or its analogues) can be applied to recycle noble and rare metals from electronic and nuclear wastes.

Hydrothermal-treatment desorption of cesium from clay minerals: The roles of organic acids and implications for soil decontamination.

The adsorption and desorption of cesium (Cs) on clays of contaminated soil in a rhizosphere zone can be greatly affected by various biogeochemical processes, the timespans of which are usually months to years. Herein, we present several representative scenarios of the binding of Cs on diverse sites of vermiculitized biotite by controlled Cs adsorption to particles of different sizes. We investigated whether and how the fixed Cs in the different scenarios is desorbed by ambient and hydrothermal treatments with several low-molecular-weight organic acids (LMWOAs). The results showed that the sorbed Cs was discriminatively retained in the un-collapsed, partially collapsed, and thoroughly collapsed structures of vermiculites. The desorption of the sorbed Cs by hydrothermal LMWOAs extractions was easily realized in the un-collapsed structure, but was limited or minimal in the partially collapsed and thoroughly collapsed structures. The Cs desorption varied in accord with the LMWOA species applied and increased with the acid concentration, temperature, and number of treating cycles. The analysis of Cs-desorbed specimens confirmed their partial destruction and interlayer expansion, suggesting that the underlying mechanism of Cs removal by LMWOAs involves not only acid dissolution and complexation but also the accelerated weathering of clays within a short time under hydrothermal conditions. Our findings contribute novel insights into the mobility, bioavailability, and fate of Cs in contaminated soils and its removal from these soils for environmental restorations.

Effects of Diluents on the Separation of Minor Actinides from Lanthanides with Tetradodecyl-1,10-phenanthroline-2,9-diamide from Nitric Acid Medium.

To investigate the effective separation of actinides (Ans) from lanthanides (Lns), single-stage batch extraction experiments were performed with a novel extractant, tetradodecyl-1,10-phenanthroline-2,9-diamide (TDdPTDA) with various diluents such as 3-nitrobenzotrifluoride (F-3), nitrobenzene, and n-dodecane for Am, Cm, and Lns. The extraction kinetics with TDdPTDA was rapid enough to perform continuous extraction experiments using mixer-settler extractors. The slopes of the distribution ratio versus the TDdPTDA concentration and the distribution ratio versus the nitric acid concentration were similar for F-3 and nitrobenzene systems, but different from the n-dodecane system. These differences were attributed to the characteristics of the diluents. This study revealed high distribution ratios of Am (DAm) and Cm (DCm) for TDdPTDA, with the high separation factors (SFs) of Am from Lns enough for their separation.

Selective removal of radiocesium from micaceous clay for post-accident soil decontamination by temperature-controlled Mg-leaching in a column.

The effective and efficient removal of radioactive Cs from contaminated soil is highly urgent for the nuclear post-accident remediation. In present study, we achieved rapid Cs desorption from both a typical micaceous clay (i.e., vermiculitized biotite, VB) and actually contaminated soil by high-speed ion exchange through temperature-controlled continuous leaching with Mg-solutions in a column reactor. Cs-sorbed VB was firstly employed as a soil surrogate to explore the macro-Cs desorption process and micro-mechanism in detail. Results showed that VB sandwiched the adsorbed Cs to its interlayers within collapsed structure (10.7 Å) and prevent Cs release even by abundant extraction with H2O at 250 °C or Mg2+ at 25 °C. However, Mg2+-extracted Cs desorption boosted significantly with elevating temperatures and 100 % of sorbed-Cs was removed from Cs-VB leached above 150 °C. Further structural and composition analysis of the leached specimen ensured that solvated Mg2+ preferentially entered into Cs+-collapsed interlayers at 150 °C than K+-interlayers above 200 °C, leading to prior complete Cs removal over K from VB at lower temperatures. By contrast, the Cs-contaminated soil reduced by ∼39 % but ∼82 % of its initial radioactivity after equally leaching with same volumes of Mg2+-solution at 150 and 200 °C, respectively. These temperature-controlled Cs desorption validated that radioactive Cs in actual soil indeed be tightly trapped by micaceous clays nearly in the Cs-K co-collapsed interlayers, to which its extraction by other cations can conditionally occur above enough high leaching temperatures. These superior features would inspire new insights for the design of novel practical technologies for treatment and decontamination of the nuclear post-accident soils.

Selective separation of cadmium(ii) from zinc(ii) by a novel hydrophobic ionic liquid including an N,N,N',N'-tetrakis(2-methylpyridyl)-1,2-phenylenediamine-4-amido structure: a hard-soft donor combined method.

A novel hydrophobic ionic liquid including an N,N,N',N'-tetrakis(2-methylpyridyl)-1,2-phenylenediamine-4-amido structure ((IL-1,2-tpbd)+NTf2-) was successfully synthesized. (IL-1,2-tpbd)+NTf2- combined one amido (O-hard donor) and four pyridine (N-soft donor) groups. Its Cd2+ and Zn2+ separation behavior in nitric acid solution was investigated as a function of the extraction time, effect of pH etc. by dissolving (IL-1,2-tpbd)+NTf2- in a room temperature ionic liquid, 1-hexyl-3-methylimidazolium bis(trifluoromethanesulfonyl)imide ((C6mim)+NTf2-). The extraction kinetics were fairly fast and could reach equilibrium within 4 h. When pHeq ≥ 1.8, the extraction percentage of Cd2+ and Zn2+ remained constant and the maximum separation factor was calculated as 12.78 at pHeq = 3.1; when pHeq < 1.8, the extraction percentage of Cd2+ and Zn2+ decreased drastically due to the protonation of the pyridine groups. Complete stripping of the extracted Cd2+ and Zn2+ from the ionic liquid phase into an aqueous phase was successfully achieved under highly acidic conditions ([HNO3] = 2 M) without adding any other metal complex forming agents. The extraction mechanism was summarized as a cation exchange due to the independence of nitrate ions in the extraction process. Additionally, the results of the slope analysis and UV-vis titration revealed the formation of a 1 : 2 complex. Furthermore, (IL-1,2-tpbd)+NTf2- showed a higher preference for Cd2+ even under the interference of various co-existing metal ions.

Effects of NH4+, K+, Mg2+, and Ca2+ on the Cesium Adsorption/Desorption in Binding Sites of Vermiculitized Biotite.

The reversibility of cesium adsorption in contaminated soil is largely dependent on its interaction with micaceous minerals, which may be greatly influenced by various cations. Herein, we systematically investigated the effects of NH4+, K+, Mg2+, and Ca2+ on the adsorption/desorption of Cs+ into different binding sites of vermiculitized biotite (VB). Original VB was initially saturated by NH4+, K+, or Mg2+; we then evaluated the adsorption of Cs+ on three treated VBs, and the desorption by extraction with NH4+, K+, Mg2+, or Ca2+ was further evaluated. Our structural analysis and Cs+ extractability determinations showed that NH4+ and K+ both collapsed the interlayers of VB, resulting in the dominant adsorption of Cs+ to external surface sites on which Cs+ was readily extracted by NH4+, K+, Mg2+, or Ca2+ irrespective of their species, whereas Mg2+ maintained the VB with expanded interlayers, leading to the overwhelming adsorption of Cs+ in collapsed interlayer sites on which the Cs+ desorption was difficult and varied significantly by the cations used in extraction. The order of Cs+ extraction ability from the collapsed interlayers was K+ ≫ Mg2+ ≈ Ca2+ ≫ NH4+. These results could provide important insights into Cs migration in soil and its decontamination for soil remediation.

Enhanced desorption of cesium from collapsed interlayer regions in vermiculite by hydrothermal treatment with divalent cations.

Adsorption of cesium (Cs) on phyllosilicates has been intensively investigated because natural soils have strong ability of immobilizing Cs within clay minerals resulting in difficulty of decontamination. The objectives of present study are to clarify how Cs fixation on vermiculite is influenced by structure change caused by Cs sorption at different loading levels and how Cs desorption is affected by various replacing cations induced at different treating temperature. As a result, more than 80% of Cs was readily desorbed from vermiculite with loading amount of 2% saturated Cs (5.49×10-3mmolg-1) after four cycles of treatment of 0.01M Mg2+/Ca2+ at room temperature, but less than 20% of Cs was desorbed from saturated vermiculite. These distinct desorption patterns were attributed to inhibition of Cs desorption by interlayer collapse of vermiculite, especially at high Cs loadings. In contrast, elevated temperature significantly facilitated divalent cations to efficiently desorb Cs from collapsed regions. After five cycles of treatment at 250°C with 0.01M Mg2+, ∼100% removal of saturated Cs was achieved. X-ray diffraction analysis results suggested that Cs desorption was completed through enhanced diffusion of Mg2+ cations into collapsed interlayer space under hydrothermal condition resulting in subsequent interlayer decollapse and readily release of Cs+.

Selective enhancing effect of metal ions on mutagenicity.

BACKGROUND: We investigated the enhancing effect of metal ions on several mutagens and examined their mechanism of action. We performed the Ames tests on six mutagens, i.e., 2-(2-furyl)-3-(5-nitro-2-furyl)acrylamide, 4-nitroquinoline 1-oxide (4NQO), quercetin, 2-aminoanthracene (2-AA), benzo[a]pyrene, and 3-amino-1,4-dimethyl-5H-pyrido-[4,3-b]indole, in the presence of five metal ions: Ca(II), Mg(II), Mn(II), Cu(II), and Zn(II). RESULTS: Cu(II) enhanced the mutagenicity of only 4NQO and reduced the mutagenicity of the other mutagens. Zn (II) enhanced the mutagenicity of only 2-AA. To clarify the mechanism underlying the enhancing effects of Cu(II), we examined the production of reactive oxygen species (ROS) and 8-oxoguanine (8-oxoG), a DNA damage marker, in human lung carcinoma A549 cells. Cu(II) induced a remarkable increase in intracellular ROS and 8-oxoG production in the presence of 4NQO. CONCLUSIONS: Our results suggest that the enhancing effect of Cu(II) and Zn(II) on the mutagenicity of specific mutagens is caused by an increase in ROS.

Structural chromosome aberrations cause swelling of the nucleus.

BACKGROUND: Carcinogens are known to cause swelling of the mammalian cell nucleus. However, the mechanism of the swelling and its toxicological significance have not been fully elucidated. Since nuclear swelling (NS hereafter) has been frequently observed in chromosomal aberration (CA hereafter) tests (in vitro), the relationship between NS and CAs was investigated in this study. RESULTS: In a short-term CA test using the fibroblast CHL cell line, the appearance of NS increased in a dose-dependent manner after exposure to six types of clastogens (mitomycin C, methyl methane sulfonate, 1-methyl-3-nitro-1-nitrosoguanidine, benzo[a]pyrene, cyclophosphamide monohydrate, and 9,10-dimethyl-2-benzanthracene), and a strong correlation was found between NS (%) and CAs (%) at each dosage. Therefore, we hypothesized that clastogens cause NS in cultured mammalian cells, since the mouse lymphoma L5178Y cell line is known to have a similar sensitivity to clastogens. Thus, we measured NS for 14 compounds (clastogens) that are known to induce structural CAs, 4 aneugens, and 12 non-mutagenes. Almost all clastogens caused NS of more than 5 %, which increased in a dose-dependent manner. Among the aneugens, colchicine, and diethylstilbestrol caused the same level of NS % as the clastogens, while carbendazim and trichlorfon caused a similar level of NS % as the clastogens only at higher levels of cytotoxicity. Almost all the non-mutagens caused less than 5 % NS. CONCLUSIONS: These results strongly suggest that NS is mainly caused by structural aberrations in the nucleus during interphase of the cell cycle.

Implant Vertical Fractures Provoked by Laboratory Procedures: A Finite Element Analysis Inspired from Clinical Cases.

PURPOSE: To investigate the causes for internal implant fractures, which is suggested to be one of the reasons for marginal bone loss. MATERIALS AND METHODS: From a 14-year database of 6051 implants, 10 single implant vertical fractures were identified and the abutments were all castable abutments. The abutments presented contamination and irregularities at the internal connecting areas. The hypothesis was that perfect fit was disturbed by laboratory polishing procedures, and finite element analysis (FEA) using overcorrected and undercorrected castable abutment models were created and tested against a perfect fit model. RESULTS: The results from the FEA presented that both overcorrected and undercorrected models presented nonuniform excessive plastic strain distribution in the neck portion of the implants where clinically an implant fracture was noted. CONCLUSIONS: The results suggested that laboratory procedures could induce plastic strain of the implant-abutment complex, which increases the risk of fracture.

Immediate Implant Placement and Loading of Single Implants in the Esthetic Zone: Clinical Outcome and Esthetic Evaluation in a Japanese Population.

This study evaluated the clinical outcomes of immediately loaded maxillary anterior single implants placed in fresh extraction sockets. A patient cohort that was treated 1.5 years earlier was recalled, and 18 patients (6 men, 12 women) with 21 implants were included. Clinical photographs and periapical radiographs were taken at follow-up and baseline to determine the bone loss and change in esthetics. No marginal bone loss was detected at follow-up (mean bone level ± standard deviation = 0.32 ± 0.82 mm). Immediate implant placement and loading resulted in predictable clinical and esthetic outcomes, with soft and hard tissue levels remaining stable over time.