A Modified Socket-Shield Technique: Simplifying the Root Sectioning Process.

Socket wall resorption leading to a loss of surrounding bone following tooth extraction has been documented in the dental literature. The use of various socket-shield techniques has been suggested as a solution to this issue. In these approaches, the tooth root is sectioned in two, and the coronal two-thirds of the buccal root is preserved in the socket. This allows the periodontium along with the bundle and buccal bone to remain intact, thus preventing or minimizing bone remodeling. According to the literature, this procedure is highly technique sensitive, especially when it comes to sectioning the root. Additionally, the procedure requires significant time, and several complications may occur, such as fenestration or luxation of the remaining root, requiring its complete extraction. This case report presents a modified socket-shield technique using a trephine bur guided by a computer-designed surgical guide to simplify root sectioning, thus reducing surgical time while increasing predictability of the outcome.

Tissue engineering innovations to enhance osseointegration in immediate dental implant loading: A narrative review.

The demand for efficient and accelerated osseointegration in dental implantology has led to the exploration of innovative tissue engineering strategies. Immediate implant loading reduces treatment duration and necessitates robust osseointegration to ensure long-term implant success. This review article discusses the current studies of tissue engineering innovations for enhancing osseointegration in immediate dental implant loading in the recent decade. Keywords "tissue engineering," "osseointegration," "immediate implant loading," and related terms were systematically searched. The review highlights the potential of bioactive materials and growth factor delivery systems in promoting osteogenic activity and accelerating bone regeneration. The in vivo experiment demonstrates significantly improved osseointegration in the experimental group compared to traditional immediate loading techniques, as evidenced by histological analyses and biomechanical assessments. It is possible to revolutionize the treatment outcomes and patient satisfaction in dental implants by integrating bioactive materials and growth factors.

Five-Year Clinical, Radiographic, and Cone-Beam Follow-Up of Socket Shield Technique in Two Cases Treated with a Split Mouth Design.

The two presented cases of socket shield technique were done following a split mouth protocol in two patients, each received an immediate implant inserted conventionally on maxillary one side and another implant inserted applying the socket shield technique on the contralateral side. The outcomes including soft and hard tissue changes were compared clinically and radiographically. The four implants were followed for 5 years, and the outcomes were successful.

Single immediate implant placement in the maxillary aesthetic zone with and without connective tissue grafting: Results of a 5-year randomized controlled trial.

AIM: To assess the 5-year effects of grafting connective tissue while undertaking single immediate implant placement and provisionalization at the mid-buccal mucosa level (MBML). Secondary outcomes were buccal bone wall thickness (BBT), marginal bone level (MBL) and patient satisfaction. MATERIALS AND METHODS: Sixty patients with a single failing tooth in the maxillary anterior region were provided with an immediately placed and provisionalized implant. At implant placement, the patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). The alveolar socket classification was mainly Type 2A. Data were collected before removing the failing tooth (T0 ), and at 1 (T1 ), 12 (T12 ) and 60 (T60 ) months after final crown placement. The primary outcome was the change in MBML compared with the pre-operative situation. Additionally, the change in BBT, MBL, aesthetics (using the Pink Aesthetic Score-White Aesthetic Score), soft-tissue peri-implant parameters and patient satisfaction were assessed. RESULTS: At the 5-year follow-up, 27 patients could be analysed from each group. In each group, one implant was lost during the osseointegration period, within 3 months of placement, resulting in an implant survival rate of 96.7% in both groups. MBML change at T60 was -0.6 (-1.1 to -0.1) mm in the control group and 0.1 (-0.4 to 0.5) mm in the test group (p = .008). BBT and MBL, aesthetics, soft-tissue peri-implant parameters and patient satisfaction showed stable results and satisfied patients, without clinically relevant differences between the groups. CONCLUSIONS: This 5-year follow-up study shows that grafting connective tissue when replacing a single failing tooth with immediately placed and provisionalized implant results in favourable peri-implant tissues and fewer MBML changes.

A randomized, multicenter, double-blinded parallel study to evaluate the safety and performance of zoledronate-coated versus uncoated dental implants in partially edentulous patients.

OBJECTIVE: To evaluate patient safety, implants survival and implant stability of the bisphosphonate (zoledronate) as a coating on dental implants in patients requiring oral rehabilitation in the posterior maxilla. MATERIALS AND METHODS: In this multicenter, double-blind, randomized controlled study, 62 patients were randomized to receive either zoledronate-coated or uncoated control implants in the premolar or molar area of the maxilla, using a one stage-protocol. Due to dropouts and exclusion 49 patients completed the study. The implants were examined by resonance frequency analysis (RFA) using an implant stability quotient (ISQ) scale at the time of insertion, and at 8 weeks, and after 12 weeks prior to prosthetic restoration. Radiographs were taken prior to surgery, directly after insertion, and during the follow-up at 12 weeks, 6 months, and 1 year to analyze changes in marginal bone levels (MBL). Finally, all complications and adverse effects (AE) were observed and recorded. RESULTS: Out of 62 included patients, 49 patients completed the study. No AE were reported by patients receiving zoledronate-coated implants. There was no statistically significant difference between the zoledronate-coated or uncoated implant groups when comparing ISQ levels at insertion and after 12 weeks of healing, the mean of the ISQ values demonstrated a change of 4.64 (95% confidence interval: 15.46; 5.79, p = 0.43) between the two groups. At 8- and 12-weeks, ISQ values remained stable (range 62-70). Radiographic analysis showed no statistically significant difference in MBL between the two implant groups after 1 year of loading neither at the mesial side (p = 0.99) or the distal side (p = 0.97). MBL for coated implants were 0.57 mm at the mesial side and 0.46 mm at the distal side. For the uncoated implants, MBL was 0.48 mm at the mesial side and 0.47 mm at the distal side. CONCLUSION: The zoledronate-coated dental implants are safe to use in a one-stage surgery protocol in patients requiring oral rehabilitation in the posterior maxilla, after 1 year of loading. There were no statically significant changes in implant stability and marginal bone levels measured by intraoral radiographs in comparison to uncoated control implants.

The bone shielding versus dual-zone concept in treating thin-walled fresh extraction sockets with immediate implant placement: Soft and hard tissue changes. A randomized clinical trial.

OBJECTIVES: To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual-zone (DZ) technique versus the bone shielding concept in patients with intact thin-walled sockets in the esthetic zone. MATERIAL AND METHODS: This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco-palatal ridge dimensional changes were measured and assessed using intra-oral digital scans at baseline and 1 year post-procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year. RESULTS: The bone shielding group provided bucco-palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco-palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco-palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively. CONCLUSION: The bone shielding concept might offer a reliable alternative for restoring thin-walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization." CLINICAL TRIAL REGISTRATION: NCT05381467.

Modified Technique to Rehabilitate American Society of Anesthesiology-III Patient, Through Flapless Procedure With Computed Tomography-Guided Surgery.

PURPOSE: The aim was to evaluate the safety and effectiveness of a computed tomography-guided surgery implant placement with a flapless technique and immediate functional loading in an American Society of Anesthesiology-III patient. METHODS: This technical note involved a 64-year-old American Society of Anesthesiology-III patient. Her hopeless teeth were extracted and a restorative evaluation was provided as a prosthetic reference. The surgical procedure was based on the flapless technique that let us to use local anesthesia. The authors used an All-on-4 concept restoration for maxilla and conventional fixed prosthesis procedures for jaw rehabilitation. The authors placed 4 tilted implants in the upper maxilla and 6 right implants in the jaw. Implants were loaded with a provisional prosthesis on the same day of surgery. Five months later, provisional restoration was removed; the authors placed into the ceramic crowns 2 Procera Implant Bridge (Nobel Biocare) frameworks, developed through computer-aided design/computer-aided manufacturing technology. CONCLUSIONS: Computed tomography-guided surgery is a minimally invasive technique that allows, through a flapless approach, safer and more predictable procedures. In this technical note, the authors achieved accurate implant placement and precise fit of restoration with natural looking appearance; this patient-oriented-treatment led to a reduced healing time with better compliance.

First-in-Human Pilot Study to Assess Methodology for Using a Mineral-Organic Bone Adhesive for Optimization of Primary Stability and Implant Success for Implants Glued into Immediate Extraction Sockets and Immediately Temporized: Pilot Study.

PURPOSE: To assess the handling properties and clinical function of a new class of material, a so-called mineral-organic bone adhesive (Tetranite; TN), which as yet has no precedent in orthopedic or oral and maxillofacial surgery, for clinically unstable implants placed in immediate extraction sockets and immediately temporized in the anterior maxilla. MATERIALS AND METHODS: A cohort of up to 15 patients requiring between one and four immediate dental implants placed into maxillary extraction sockets from canine to canine were eligible for inclusion. Implants had to be unstable with an insertion torque of < 15 Ncm. Implants were then stabilized using TN, which was allowed to set before reassessing stability using both torque and resonance frequency measurements. Implant stability quotients (ISQs) taken after TN setting were compared to ISQs taken prior to its application, and the implants had to demonstrate resistance to a forward torque of 20 Ncm to be considered stable. ISQs were monitored at 1 week and 1, 3, 7, and 12 months postplacement. In addition, peri-implant tissue health was monitored, adverse events were recorded, and implant success was determined at 1 year postplacement. RESULTS: Eleven patients received a total of 14 implants. Three out of the first six implants failed within 1 month (50%), and thus a protocol amendment was made to remove steps considered potentially destructive to the bonding process. As a result of these amendments, only one further failure was experienced for the next eight implants placed (12.5%). Mean ISQ data averaged for buccolingual and mesiodistal measurements demonstrated a baseline value before TN application of 59.1 Ncm (SD: ± 9.7; range: 40.5 to 73.0). After final setting of the TN, mean ISQ measured 71.9 Ncm (± 6.5; 56.0 to 80.0). At 3 months, just prior to restoration placement, mean ISQ measured 71.0 Ncm (± 6.6; 57.0 to 78.0). Thereafter, the mean ISQ continued to increase at both the 7- and 12-month follow-ups with scores of 78.9 (± 4.6; 72.0 to 84.5) and 80.3 (± 3.8; 74.5 to 85.0), respectively. The surviving 10 implants went on to be fully restored and remained in function beyond the end of the study period to yield a final success rate of 71.4%. CONCLUSIONS: The purpose of a first-in-human study is to demonstrate an extrapolation of preclinical data into the controlled human clinical arena. It is an opportunity to learn what does and does not translate well from experimental data. In that regard, the current pilot study can be deemed a complete success. The implant survival rate of 71.4%, while disappointing, should be considered in light of the protocol amendments identified, the user handling experience learned, and the opportunity to modify the material to better perform in the human patient, as all represent important lessons learned. The notable increase in ISQ sheds light on the nature by which the glue was substituted for bone to yield a stable implant by the end of the study period.

Comparison of Soft Tissue Volumetric Changes and Pink Esthetics After Immediate Implant Placement with Socket Shield and Conventional Techniques: A Randomized Controlled Trial.

PURPOSE: To compare volumetric changes in buccal soft tissue and pink esthetic scores after immediate implant placement performed with a socket shield technique (SST) or the conventional technique (CT). MATERIALS AND METHODS: This parallel-arm, randomized controlled trial included 22 participants requiring replacement of a single maxillary incisor with an immediate implant. Immediate implants were placed via either the SST or the CT, with patients randomly allocated to one of the two groups. All implants underwent an immediate loading protocol. Definitive crowns were placed 6 months after implant placement. Scans of casts were recorded with a digital white light scanner before implant placement and at the end of 12 months. Volumetric changes to soft tissues on the buccal aspect were assessed by superimposition of the scanned cast. Esthetic evaluation of the soft tissue was done by evaluating the pink esthetic score (PES) before implant placement and 6 and 12 months after implant placement. Statistical analysis of the data was performed using statistical software (Stata 16.0, StataCorp). RESULTS: The mean volumetric change in buccal soft tissues at the end of 12 months in the SST group was -0.1520 ± 0.86 mm, and in the CT group, it was -0.643 ± 0.35 mm. The difference was statistically significant (P = .001). Higher PES was observed in the SST group at all time intervals. The difference was statistically significant at 6 months (P = .001) and 12 months (P = .007). CONCLUSIONS: The results of this study showed less volumetric changes in buccal soft tissues and higher PES when the SST is used rather than the CT.

Simultaneous implant placement and restoration with guided bone regeneration in the mandibular anterior region.

BACKGROUND: Restoring the mandibular anterior teeth by implants can be difficult due to potential complications arising from using prosthetic implant connections that are larger than the incisors at the cementoenamel junction level. METHODS: This retrospective study is aimed at determining the survival and esthetic outcomes of anterior mandible implants immediately placed and restored in patients diagnosed with stages 3-4 periodontitis. The study included 75 implants that were inserted along with guided bone regeneration in 42 patients. Over a follow-up period of 3 to 8 years (mean of 6.95 ± 1.78 years), the study evaluated esthetic, marginal bone loss (MBL), and biological and prosthetic complications. RESULTS: No failures were recorded during the follow-up period; after eight years, the survival rate was 100%. Patient's age and gender did not have a statistically significant impact on MBL, but smokers had a greater MBL than non-smokers at the 8-year (2.98 mm vs. 1.23 mm, respectively, p = 0.016) time-point. At 3 years, only 13.3% of the implants had mesial papillae, 36.0% had distal papillae, and 16.0% had the cervical metallic part of the abutment exposed. Peri-implantitis was diagnosed in 20.7% of the patients at the 8-year follow-up time. CONCLUSIONS: Based on the limitations of this study, immediate placement and restoration of the mandibular incisors can be a feasible procedure, but only a few implants achieved the complete restoration of the papillae.

EAO Position Paper: Immediate Implant Placement: Managing Hard and Soft Tissue Stability from Diagnosis to Prosthetic Treatment.

In this position paper, the state of the art in immediate implant placement (IIP) at incisor-cuspid-premolar sites is described. The literature supports that the following prerequisites need to be simultaneously met for a predictable outcome: (1) there must be no acute infection; (2) there must be apical and palatal/lingual bone for implant anchorage; (3) the tooth must be inside the bone envelope; (4) the alveolar socket must have a favorable morphology (type I, IIa, IIb avoiding wide dehiscences); (5) there must be no midfacial recession; (6) the right implant must be selected; and (7) the surgeon needs to be experienced and skilled. A preoperative CBCT is required for IIP because multiple aforementioned prerequisites (2, 3, and 4) can only be assessed on the basis of 3D imaging. The final prerequisite relates to the importance of a perfect implant position, preferably leaving a horizontal gap of at least 2 mm between the implant shoulder and buccal bone wall. Guided surgery is preferred over free-hand surgery to accomplish this. Flapless surgery, socket grafting, connective tissue graft (CTG), and immediate provisionalization have been shown to contribute to hard and/or soft tissue stability. When the previously mentioned prerequisites are fulfilled, IIP may be considered over alternative treatment concepts (eg, early implant placement [EIP] and delayed implant placement [DIP]) based on time gain, minimal invasiveness, and similar outcomes in the literature. Given very strict selection criteria, clinicians should primarily screen patients for IIP before considering other treatment options with wider indications. Int J Prosthodont 2023;36:533-545.

Success rate of immediately loaded implants in the posterior zone.

Dental implants are considered an ideal treatment for a missing single tooth. Immediate loading of implants can hasten the procedure, providing comfort to the patients. Recently, immediate loading of implants has gained much importance as it helps hasten the procedure and provides more comfort to patients. A previous systematic review published 5 years ago compared the success rates between immediate and conventional loading. There are several factors that influence the success rate of implants that were not discussed in detail in the previous review. Hence, the present systematic review is done to report differences in the outcomes from single implant restorations of missing teeth in the posterior region in patients who were subjected to immediate loading and conventional loading. A follow up for 1 year was done. Electronic databases of Medline, Scopus, and Web of Science were searched for publications in the English Language during May 2021. The search results yielded 306 articles, out of which 225 were excluded based on title and abstract screening. Screening of the remaining 81 full text articles yielded 14 original research articles that satisfied the predefined inclusion criteria. Meta analysis was not possible due to the heterogeneity of the data. The overall success rate of the immediate loading of a single implant is 94.31%. Implants in the maxillary region had a higher survival rate than those in the mandibular region. The age range between 18 and 80 years showed good prognosis and outcomes in older individuals. Good oral hygiene was emphasized for all patients to prevent any secondary conditions or delays in healing.

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.

Comparative Evaluation of Survival Rates and Marginal Bone Levels of Nonsplinted Immediately Loaded Interforaminal Mandibular Implant-Retained Overdentures: A Randomized Controlled Clinical Trial with 5-Year Results.

PURPOSE: Τo evaluate and compare the marginal bone loss (MBL), survival rates, and periodontal parameters of immediately loaded implants with either Dolder bar or Locator attachments placed in the interforaminal region of edentulous mandibles. MATERIALS AND METHODS: A total of included 19 patients with edentulous mandibles each received two implants in the interforaminal area of the symphysis. Randomly allocated Dolder bar or Locator attachments were then attached immediately, and both clips and a framework were fastened to the denture by the dental laboratory within 24 hours. RESULTS: A total of 28 subjects with 56 implants were treated in accordance with the immediate-loading study protocol. Of these, 9 patients were lost to follow-up; 1 patient reported a serious illness and 8 patients moved and couldn't be reached. The 19 subjects not lost to follow-up (11 women and 8 men; average age: 68 years) were included. Every patient received either two Locator abutments and were assigned to group A (7 patients; 36.8%) or two multiunit abutments and were assigned to group B (12 patients; 63.2%). No implant failure was detected for either group, and therefore the survival rate for both groups was 100% after 5 years. After 5 years without any symptoms, 2 implants from group A and 7 implants from group B showed > 2 mm of MBL, which makes the group A success rate 85.7% and the group B success rate 70.8%. Modified sulcular bleeding index (mSBI) did not differ significantly at any of the measurement intervals. However, the modified plaque index (mPI) of group B was significantly higher than group A at the 60-month follow-up. CONCLUSION: It can be concluded that either splinting or not splinting the immediately loaded interforaminal implants to retain mandibular overdentures (OVDs) does not affect marginal bone levels after 5 years and immediate loading of nonsplinted implants with Locator attachments can be safely preferred to retain mandibular OVDs.

Peri-implant Outcomes from Customized Healing Abutments Using Immediate Implants: A Systematic Review.

PURPOSE: To evaluate the peri-implant outcomes of customized healing abutments (CstHA) placed on dental implants inserted in fresh tooth extraction sockets. MATERIALS AND METHODS: The study was registered on PROSPERO: CRD42022304320. A systematic search in PubMed, Scopus, and Web of Science was conducted between April 2022 and October 2022 to identify clinical studies involving immediate implant surgery associated with CstHA placement. The Joanna Briggs Institute Critical Appraisal and RoB2 tool were performed for the risk of bias analysis. RESULTS: A total of 12 studies were included, most of them with low risk of bias. Four studies compared CstHA vs conventional healing abutments (CnvtHA), two compared CstHA vs cover screw and collagen matrix (CMa), and six were clinical case series. For the CstHA vs CnvtHA comparison, favorable results were observed for CstHA considering papilla maintenance and probing depth, yet the mean marginal bone level was statistically similar between CstHA and CnvtHA. CstHA showed advantages when compared to CMa for total bone volume, papilla height, and midfacial mucosa maintenance. Significantly less horizonal bone loss was reported when using CstHA compared with CMa. Horizontal and vertical bone loss was observed in a few (or no) sites in the case series using CstHA. CONCLUSIONS: CstHA provides favorable peri-implant response because in general it does not result in a significant loss of soft and hard tissues.

The Effect of Topical Application of Hyaluronic Acid on the Stability of Immediate Loaded Dental Implants in the Posterior Maxilla: Clinical and Animal Study.

Objective: To assess the effect of topically applied hyaluronic acid (HA) on the stability of immediately loaded implants in the posterior maxilla. Materials and Methods: For the clinical study, a total of 20 implants were placed in 14 patients seeking the replacement of missing single or multiple posterior maxillary teeth. The patients were randomly divided into two groups. In the clinical control group (CC group), 10 implants were placed and immediately loaded, while in the clinical study group (CS group), 10 implants were coated with HA immediately before placement and immediately loaded. All patients had implant stability clinically evaluated at implant placement time (T0) and 1 (T1), 3 (T3), and 6 (T6) months after loading. Peri-implant pocket depth and modified sulcus bleeding index were evaluated clinically at 6 months in all patients. Bone density was evaluated radiographically after 3 months. All the clinical and radiographic data were subjected to statistical analysis. For the animal study, a total of 12 implants were placed in the tibiae of six rabbits. For each rabbit, 1 implant without any applied HA was placed in the left tibia (AC group), and 1 implant coated with HA was placed in the right tibia (AS group). The rabbits were euthanized at 21 and 45 days after implant insertion. Results: There were no significant statistical differences between the two groups regarding implant stability, peri-implant pocket depth, modified sulcus bleeding index, or bone density from the palatal and apical aspects. However, there was a significant statistical difference in the bone density from the buccal aspect in favor of the study group. The animal study showed that the newly formed bone in the right tibiae showed improved quantity and quality of bone, as it had denser bone trabeculae and smaller marrow spaces compared to the left tibiae. Conclusion: In the clinical study, the application of hyaluronic acid had a superior effect on the buccal bone density around immediately loaded implants. In the animal study, hyaluronic acid had a synergistic effect on the quality and quantity of bone formation around dental implants.

10-year Historical Prospective Cohort Study of Calcium Phosphate-Blasted Acid-Etched Titanium Implants Placed in Different Ridges.

Purpose: To evaluate the survival rate and marginal bone level (MBL) of calcium phosphate-blasted acid-etched titanium implants placed in a cohort of patients with different ridges after a follow-up period of at least 10 years. Materials and Methods: A total of 61 patients with a minimum implant follow-up of 10 years were selected for this historical prospective, best clinical practice cohort study. Between 2009 and 2012, 121 titanium implants were placed using a flap, flapless, or postextractive technique. The implant placement timing was performed according to pre-extractive diagnosis and divided into immediate (immediately after tooth extraction with an absence of infection), early (within 2 to 3 months with an acute periapical lesion), delayed (6 to 12 months from extraction with a large periapical infection), or late (> 12 months from extraction with healed edentulous ridges). All implants were loaded after 3 months with provisional and definitive cemented restorations. Periapical radiographs were taken before implant insertion and at 3, 6, 12, 24, 36, 48, 96, and 120 months (T3, T6, T12, T24, T36, T48, T96, and T120, respectively). The MBL was calculated in single blind by an additional examiner. Linear logistic regression was performed to analyze statistically significant differences in relation to different operative variables at all evaluation times. Multilevel mixed logistic regression was made to evaluate the factors associated to MBL at 10 years (T120). Results: After 10 years, 47 patients and 92 implant restorations were analyzed, showing that 88 implants (95.6%) survived and 4 implants (4.4%) failed. The cumulative drop-out rate was 22.1%. Loosening and/or mobility was observed in a total of 9 abutments (9.7%) during the observational time. No other complications were reported. Implants placed with a flapless technique revealed a similar MBL to those placed with a flap technique. No significant differences were observed between the surgical techniques at T96 and T120. Immediate and early implants revealed a more stable MBL than both delayed and late implants up to T48. At longer evaluation times (T96 and T120), the MBL values were not statistically significant (P > .05). Narrower diameter implants (3.5 mm) revealed a higher bone loss when compared to the 4.1-mm- and 5.0-mm-diameters, especially in the first year from implant insertion (from T3 to T12) and at longer follow-up (T36 and T48). After that, the difference was reduced. Multilevel analysis showed that none of these variables appear to significantly influence MBL at 120 months. Conclusions: MBL was not influenced by surgical technique or implant placement timing after 10 years. Maintaining a strict occlusal and hygiene control created the conditions to preserve bone integrity and achieve a high implant survival rate.

Critical review on bone grafting during immediate implant placement.

In the last 20 years, immediate implant placement has been proposed as a predictable protocol to replace failing teeth. The research conducted in preclinical and clinical studies have focused on soft and hard tissue changes following tooth extraction and immediate implant placement. Different approaches for hard and soft tissue grafting together with provisional restorations have been proposed to compensate tissue alterations. This review analyzed some relevant clinical and preclinical literature focusing on the impact of bone grafting procedures on immediate implant placement in terms of hard and soft tissue changes, aesthetic results, and patient-related outcomes.

Facial Contour Preservation of Anterior Immediate Single-Tooth Replacement With the Socket Shield Technique Versus Connective Tissue Graft: A Case Report.

The socket shield technique and subepithelial connective tissue graft following immediate implant placement with provisionalization had been advocated for peri-implant facial contour and gingival architecture preservation. This case report used three-dimensional volumetric analysis to longitudinally assess the peri-implant facial contour change before and after these procedures. The results demonstrated comparable and acceptable preservation of peri-implant facial contour between the two procedures after 2 years of function.

Immediate Tooth Replacement in the Esthetic Zone with the Socket Shield Technique and a Novel Body-Shift Implant: A Pilot Study with Up to 3 Years of Follow-up.

Successful rehabilitation of the anterior maxilla remains a challenge, primarily due to postextraction ridge collapse, which can lead to gingival recession and a nonesthetic appearance. The socket shield technique presents a viable alternative for immediate dental implant placement in the esthetic zone. This pilot study aimed to evaluate the survival, complication rates, and marginal bone loss around body-shift implants placed in fresh extraction sockets with the socket shield technique to replace maxillary incisors. After socket shield preparation, 14 hopeless incisors were extracted and immediately replaced by a body-shift implant (Inverta, Southern Implants) at baseline. Patients were followed up for 12 to 39 months (mean: 18.1 ± 8.2 months). The average age was 52.3 ± 16.9 years, and the survival rate was 100%. One socket shield presented minimal internal exposure that was successfully treated with a connective tissue graft. The mean PES score was 12.9 ± 1.2. Mean interproximal marginal bone loss was -0.4 ± 0.5 mm. Body-shift implants can be a promising alternative for immediate tooth replacement combined with the socket shield technique. The superior esthetic outcomes remained stable, suggesting that the extra space created by the narrow cervical portion of the implant is beneficial for preserving the alveolar bone and limiting internal shield exposure.