Aesthetic and radiographic outcomes using the root membrane technique in immediate adjacent implant placement: A retrospective clinical study with a 5- to 9-year follow-up.

PURPOSE: The root membrane technique was designed to preserve the buccal portion of the root in situ, preventing postextraction bundle bone loss and overlying soft tissue recession. Nevertheless, maintenance of the aesthetic gingival architecture around two or multiple adjacent implants, particularly in the anterior maxilla, remains a challenge, notably regarding the gingival contour and the interimplant papillae. The present study aimed to evaluate the clinical, aesthetic and radiographic outcomes for immediate adjacent implants placed using the root membrane technique in the anterior maxilla in a sample with a 5- to 9-year follow-up. MATERIALS AND METHODS: A retrospective clinical study was designed using the medical records of two private dental practices. A total of 40 patients who were treated using the root membrane technique for at least two adjacent implants and single-crown restorations between January 2010 and February 2019 were selected (100 implants). The clinical and radiographic data were analysed to assess implant survival/success, marginal bone loss and the pink aesthetic score. RESULTS: The cumulative survival rate after a mean follow-up period of 81.5 ± 30.5 months was 99.0% (implant-based) and 97.5% (patient-based), respectively. Between 1 and 5 years (n = 99), the mean marginal bone loss changed from 0.39 ± 0.07 mm to 0.36 ± 0.07 mm and subsequently to 0.37 ± 0.07 mm at the 7-year follow-up (n = 71) and 0.33 ± 0.07 mm at the 9-year follow-up (n = 14). The improvement from 1 year was significant at all the follow-up time points (P = 0.000). The mean global pink aesthetic score increased from baseline (11.33 ± 1.03) to 3 months after placement of the final restoration (11.73 ± 0.95) and the final observation (12.01 ± 0.87). This was a significant increase (P = 0.000 baseline to 3 months, 3 months to final observation and baseline to final observation). CONCLUSIONS: In this non-controlled retrospective study, adjacent implants placed using the root membrane technique achieved a satisfactory survival and success rate. The variation in marginal bone loss showed a significant positive trend from 1 year to 5 and 7 years. The overall pink aesthetic scores improved significantly between sequential observation periods. CONFLICT-OF-INTEREST STATEMENT: Dr Leitão-Almeida receives personal fees (for sponsored lectures) and non-financial support from MegaGen (Daegu, South Korea) outside of the submitted work; the other authors declare no conflicts of interests relating to this study.

The Root Membrane Technique: A Retrospective Clinical Study With Up to 10 Years of Follow-Up.

PURPOSE: Immediate implant placement in conjunction with intentional root retention is a recently introduced technique, but the majority of existing documentation is limited to short-term reports with low level of evidence. Hence, the aim of this study was to document the long-term clinical and radiographic results of the root membrane technique. METHODS: This retrospective study reports on clinical results of the root membrane technique for periodontal ligament-mediated immediate implant placement with up to 10 years of follow-up from 3 private dental practices. Anterior implants placed with immediate loading from January 2006 to December 2016 were assessed. Kaplan-Meier estimators were computed for reporting of implant success and survival. RESULTS: A sample of 182 patients (82 men and 100 women, age range: 18-83 years) received 250 immediate implants (230 maxilla, 20 mandible) after the root membrane concept and followed-up for a mean of 49.94 months (±32.5). Overall, 5 implant failures were recorded for a 10-year cumulative patient-level implant survival rate of 96.5%. Considering mechanical and biological complications, the 10-year cumulative implant success rate was 87.9%. CONCLUSIONS: Within the limits of the retrospective design, the root membrane technique showed long-term success rates comparable to those of conventional immediate implants.

The Root Membrane Technique: Human Histologic Evidence after Five Years of Function.

BACKGROUND: The "root membrane" (RM) is a technique that has become popular among implantologists for placement of immediate implants in the anterior maxilla. PURPOSE: To present histologic evidence of an immediate implant placed in the human anterior maxilla, according to the RM technique, and retrieved after five years. METHODS: A fixture, along with the surrounding tissues, was retrieved from the anterior maxilla of a 68-year-old patient, who had been treated five years earlier with immediate implant placement and RM technique. The specimen was processed for histologic/histomorphometric evaluation. RESULTS: The buccal bone plate was maintained without any resorption; a healthy periodontal ligament was evidenced. The implant showed osseointegration, with a high percentage of bone-to-implant contact (BIC = 76.2%). With regard to the space between the RM and the implant, the apical and medial thirds were filled with compact, mature bone; the coronal third was colonized by noninfiltrated connective tissue. CONCLUSIONS: The RM technique appears to be effective in preventing bone resorption of the buccal bone plate of the human anterior maxilla, five years after the placement of an immediate implant.

Long-Term Esthetic Evaluation of the Roll Flap Technique in the Implant Rehabilitation of Patients with Agenesis of Maxillary Lateral Incisors: 10-Year Follow-Up.

PURPOSE: The use of the roll pedicle flap has been recommended by various authors, but there are no studies evaluating the stability of the augmented soft tissue in the long term. The aim of this retrospective study was to evaluate the stability of peri-implant soft tissue augmented with the roll flap technique in patients with congenitally missing maxillary lateral incisors after 10 years of function. MATERIALS AND METHODS: Patients with congenitally missing maxillary lateral incisors restored with dental implants in the period between 2000 and 2002 were invited for reexamination after 10 years. The esthetic of the peri-implant soft tissue was evaluated with Furhauser's pink esthetic score (PES). RESULTS: The peri-implant soft tissue of 21 implants in 17 patients was evaluated at the 10-year follow-up. No implants were lost within the duration. The PES score was slightly improved from 11.43 ± 1.504 at baseline to 11.70 ± 1.793 at the 10-year follow-up examination without a statistically significant difference (P > .05). CONCLUSION: Within the limitations of this study, the roll flap technique was found to be a sustainable method for the achievement of durable peri-implant esthetics in the anterior maxillary region, especially in terms of variables related to tissue contour and appearance.

A Step-by-Step Description of PDL-Mediated Ridge Preservation for Immediate Implant Rehabilitation in the Esthetic Region.

The aim of this study was to present in detail the clinical steps of the root-membrane technique. This technique combines the benefits of conventional root submergence via intentional maintenance of a root fragment for ridge preservation with those of immediate implant placement for functional rehabilitation of the treated site. A case study of a tooth diagnosed with a horizontal root fracture is used to illustrate this technique step by step. The clinical application of the root-membrane technique not only allowed for immediate placement in a site with compromised buccal plate but also facilitated excellent clinical stability of soft tissue contours during the 3 years of follow-up.

Immediate implant placement in the esthetic zone utilizing the "root-membrane" technique: clinical results up to 5 years postloading.

PURPOSE: To clinically evaluate immediate implant placement with simultaneous intentional retention of the buccal aspect of the root and to report longitudinal data on survival of implants placed with the use of this novel technique. MATERIALS AND METHODS: A retrospective case series of implants placed with the root-membrane technique in the maxillary anterior region of adult patients was conducted. Clinical and radiographic analysis was performed to assess implant success and to evaluate the survival of the retained root fragment based on predetermined criteria. A Kaplan-Meier method analysis was used to estimate the 5-year success rate of implants placed with this technique. RESULTS: Data from 46 patients (median follow-up time, 40 months; range, 24 to 60 months) were evaluated. Each patient contributed one implant site in this study. All implants successfully maintained osseointegration at the end of the follow-up period for a 100% cumulative survival rate, based on clinical and radiographic criteria. Radiographic examination revealed good crestal bone stability with mean crestal bone loss on the mesial and distal aspects of the implants estimated to be 0.18 ± 0.09 mm and 0.21 ± 0.09 mm, respectively. The only complication noted in this patient cohort was apical root resorption of a single retained root fragment that did not interfere with the osseointegration of the implant. CONCLUSION: The intentional retention of the buccal aspect of the root with its periodontal apparatus during immediate implant placement can lead to predictable and sustainable osseointegration of implants placed in the maxillary anterior region of healthy adults.