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.

Effect of three different grafting materials on immediate implant placement using vestibular socket therapy in class II extraction sockets in the maxillary esthetic zone: a randomized controlled clinical trial.

BACKGROUND: This study compared the effectiveness of three bone grafting materials used for treating class II fresh extraction sockets in the esthetic zone with immediate implant placement using Vestibular Socket Therapy (VST) to evaluate the pink esthetic score (PES), peri-implant mucosal levels (PML), and facial bone thickness (FBT). METHODS: Twenty-four surgical sites in the maxillary anterior region presented with type II socket defects received immediate implants and simultaneous bone grafting with either a collagen plug soaked in blood, demineralized bone matrix Grafton, or a particulate mixture of 2/3 autogenous bone chips and 1/3 deproteinized bovine bone mineral MinerOss X. The outcome measures were evaluated at 6 and 12 months. The study was registered on www. CLINICALTRIAL: gov (12/07/2021 - ID: NCT04957654). RESULTS: Twenty-two cases (91.6%) showed a total PES score of > 10, without a significant difference between all groups. The vertical height soft tissue changes showed significant improvement in the Collagen plug and Grafton groups at 6 and 12 months, while MinerOss X showed no significant difference at 6 and 12 months compared to baseline. Radiographically, FBT was 0.72 ± 0.20, 0.44 ± 0.12, and 0.95 ± 0.37 at baseline, which significantly increased to 1.61 ± 0.88, 1.48 ± 1.20 and 2.31 ± 0.86 at 12 months for all three groups, respectively. CONCLUSION: The use of a particulate bone graft mixture significantly increases the FBT compared to collagen plugs and DBM-Grafton when performing VST during immediate implant placement in compromised Class II extraction sockets.

Immediate Implant Placement in Intact Fresh Extraction Sockets Using Vestibular Socket Therapy Versus Partial Extraction Therapy in the Esthetic Zone: A Randomized Clinical Trial.

PURPOSE: This randomized clinical trial aimed to assess esthetic and soft and hard tissue outcomes 6 months after immediate implant placement using vestibular socket therapy (VST) (test) versus partial extraction therapy (comparator) in intact thin-walled fresh extraction sockets in the esthetic zone. MATERIALS AND METHODS: Twenty-four patients with hopeless maxillary anterior teeth requiring immediate implant placement were randomly assigned to two equal groups to receive either VST or partial extraction therapy. Definitive restorations were delivered after 3 months. Pink esthetic scores (PESs) and vertical soft tissue alterations in millimeters were measured 6 months after restoration using intraoral digital scans of the distal papilla, midfacial gingival margin, and mesial papilla. Facial bone thickness was measured using CBCT scans at baseline and after 6 months. Implant survival and peri-implant pocket depth were assessed. RESULTS: Both groups showed 100% implant survival after 6 months. The overall PESs after 6 months were 12.67 (± 1.3) in the VST group, while the partial extraction therapy group score was 13.17 (± 1.19), with no significant difference between them (P = .02). The mean (± SD) vertical soft tissue measurements for the VST group were 0.08 (± 0.55), 0.01 (± 0.73), and -0.03 (± 0.52) mm, and for the partial extraction therapy group, they were -0.24 (± 0.25) mm, -0.20 (± 0.10) mm, and -0.34 (± 0.13) mm for the mesial papilla, midfacial gingival margin, and distal papilla, respectively. No significant differences were observed between the groups at any of the reference points (P ± .05). Both techniques demonstrated a significant gain in millimeters of labial bone thickness after 6 months compared to baseline (P ± .05). Regarding VST, the apical, middle, and crestal mean bone gain was 1.68 (±± 2.73), 1.62 (±± 1.35), and 1.33 (±± 1.22) mm, respectively, while partial extraction therapy showed 0.58 (± 0.62), 1.27 (± 1.22), and 1.53 (± 1.24) mm, respectively, with no significant difference detected between them (P ≥ .05). Additionally, the mean (± SD) peri-implant pocket depth after 6 months for VST was 2.16 (± 0.44) and 2.08 (± 1.02) mm for partial extraction therapy with no significant difference between them (P = .79). CONCLUSION: This investigation suggests that both VST and partial extraction therapy preserved alveolar bone structure and peri-implant tissues following immediate implants. The novel VST might be considered a predictable alternative treatment approach for immediate implant placement in intact thin-walled fresh extraction sockets in the esthetic zone. Int J Oral Maxillofac Implants 2023;38:468-478. doi: 10.11607/jomi.9973.

A novel atraumatic extraction technique using vestibular socket therapy for immediate implant placement: a randomized controlled clinical trial.

PURPOSE: This randomized controlled clinical trial compared soft tissue changes following a novel vestibular atraumatic extraction technique (test group) versus the conventional incisal atraumatic extraction approach (control group) while implementing the vestibular socket therapy for immediate implant placement. METHODS: Thirty patients with hopeless maxillary anterior teeth requiring atraumatic extraction were randomly assigned into two equal groups to receive either test or control. Vertical soft tissue alterations in mm were measured at baseline and 12 months post-restoration using intraoral digital scans at three reference points, distal papilla, mid-facial gingival margin, and mesial papilla, as well as pink esthetic scores (PESs) after 12 months. RESULTS: Vestibular extraction technique showed significant soft tissue improvement and creeping when compared to incisal extraction (P < 0.05). The test group showed soft tissue measurements with a mean (± SD) of 0.26 (± 0.58), 0.39 (± 0.64), and 0.05 (± 0.37) mm for the mesial papilla, mid-facial gingival margin, and distal papilla respectively. While the incisal extraction technique demonstrated gingival recession at the distal papilla, mid-facial gingival margin, and mesial papilla of - 0.37 (± 0.54) mm, - 0.32 (± 0.68) mm, and - 0.39 (± 0.59) mm respectively. The overall PESs after 12 months were 12.67 (± 1.59) in vestibular extraction group, while incisal extraction group was 11.40 (± 1.40), with significant difference between them (P = 0.03). CONCLUSION: This investigation suggests that both studied techniques were successful in the atraumatic extraction of hopeless severely damaged teeth. The novel vestibular extraction technique might be considered an alternative reliable atraumatic extraction approach compared to the conventional incisal extraction when performing the vestibular socket protocol for immediate implant placement with soft tissue enhancement.

Immediate implant placement utilizing vestibular socket therapy versus early implant placement with contour augmentation for rehabilitation of compromised extraction sockets in the esthetic zone: A randomized controlled clinical trial.

OBJECTIVE: The present randomized controlled trial compares for the first time the vestibular socket therapy (VST) to the contour augmentation technique in the management of compromised fresh extraction sockets in the maxillary esthetic zone, regarding mid-facial soft tissue changes (primary outcome), mesial and distal papillae dimensions, horizontal soft tissue changes and labial bone plate thickness at apical, middle and coronal levels (secondary outcomes) over 1-year. MATERIALS AND METHODS: Forty participants with single nonrestorable maxillary teeth in the esthetic zone were randomized into two groups; VST (test; n = 20) utilizing vestibular access for guided bone regeneration (GBR) with immediate implant placement, or contour augmentation (control; n = 20) undergoing an initial healing period followed by implant placement with GBR through a conventional access flap. RESULTS: All implants were successfully osseo-integrated, except for one implant in the test group. VST showed significantly less mid-facial soft tissue changes of -0.53 ± 1.17 mm versus -1.87 ± 0.69 mm in the control group (p < 0.001). Similarly, changes in mesial papilla (test = -0.64 ± 0.95 mm, control = -1.20 ± 0.81 mm), distal papilla (test = -0.56 ± 1.17 mm, control = -1.26 ± 0.63 mm), horizontal soft-tissue (test = -0.82 ± 0.95 mm, control = -1.84 ± 0.88 mm; p < 0.05) were significantly less in VST. Intra-group comparisons demonstrated a significant increase in labial bone thickness, with no differences between groups. Regression analysis revealed a significant correlation between VST as well as increased coronal bone thickness with the reduction in mid-facial soft-tissue changes. CONCLUSION: The VST showed less soft-tissue changes and could represent an innovative technique for implant placement in the maxillary esthetic zone. Both techniques showed a high implant survival rate and increased bone thickness after 12 months.

Does Grafting the Jumping Gap in Immediately Placed Anterior Implants Using Vestibular Socket Therapy Influence the Labial Bone Thickness?

PURPOSE: There is no consensus in the literature on whether grafting the jumping gap (the distance between the inner surface of the labial bone plate and the implant surface) in immediately placed implants influences the thickness of the labial bone plate. This study aimed to compare the efficacy of particulate bone graft filling material and spontaneous bone healing following blood clot formation when placing immediate implants in the esthetic zone. METHODS: A double-blind randomized controlled clinical trial was conducted in a private practice on patients scheduled for immediate implant placement using the vestibular socket therapy between November and December 2019. Participants were assigned to 2 groups. In Group 1, the jumping gap was filled with a mixture of 75% autogenous bone chips and 25% deproteinized bovine bone mineral (DBBM). In Group 2, the gap was unfilled. The regenerated facial bone thickness was evaluated using CBCT. Measurements were taken at baseline before tooth extraction and 12 months postoperatively. The Mann Whitney U test was used for between group comparisons and Wilcoxon signed-rank test for within-group comparisons. RESULTS: Twenty-two patients (8 men and 14 women; mean age, 45.22 years) were randomly assigned to Group 1 or Group 2, with 11 patients each. A statistically significant difference in bone thickness was found between groups (P = .008). The mean (SD) overall bone thickness was 2.95 (0.97) mm for the particulate bone group compared to 1.45 (0.92) mm preoperatively. While, for the unfilled group, the mean (SD) overall bone thickness was 1.98 (0.56) mm compared to 0.79 (0.49) mm preoperatively. CONCLUSIONS: The results suggested that grafting the jumping gap with particulate bone graft when implementing the vestibular socket therapy enhanced the thickness of the labial bone plate of immediately placed implants in the esthetic zone.

Vestibular socket therapy with immediate implant placement for managing compromised fresh extraction sockets: A prospective single-arm clinical study.

PURPOSE: To assess hard and soft tissues regenerated around immediate implants placed in compromised fresh extraction sockets using vestibular socket therapy 2 years postoperatively. MATERIALS AND METHODS: Twenty-seven compromised fresh extraction sockets were managed using vestibular socket therapy and immediate implant placement. After immediate implant placement, a cortical bone shield was stabilised through a vestibular incision. The socket defect was filled with particulate bone graft. Labial plate thickness and bone height were evaluated 1 and 2 years postoperatively using CBCT. The pink aesthetic score and probing depth were recorded after 6 months, 1 year and 2 years. A Friedman test was used to study changes in the reported outcomes over time, with the level of statistical significance set at P ≤ 0.05. RESULTS: All implants recorded a 100.0% survival rate. A statistically significant increase in bone height (0.93 mm, P = 0.004) and apical (0.12 mm, P = 0.026), midfacial (1.26 mm, P < 0.001) and crestal (0.86 mm, P < 0.001) bone thickness was observed after 2 years. The changes in pink aesthetic score and probing depth were not significant: the pink aesthetic score was 12.48 ± 1.45 and the mean PD was 2.37 ± 0.79 mm mesially, 2.11 ± 0.70 mm facially, 2.07 ± 1.04 mm distally and 1.00 ± 0.00 mm palatally after 2 years. CONCLUSION: Combining immediate implant placement with vestibular socket therapy to manage compromised fresh extraction sockets offers promising radiographic, aesthetic and periodontal results while minimising the treatment time and number of surgical procedures required.

Vestibular Socket Therapy: A Novel Approach for Implant Placement in Defective Fresh Extraction Sockets With or Without Active Socket Infection (One-Arm Cohort Study).

PURPOSE: This study aimed to assess the radiographic, esthetic, and periodontal outcomes after 1 year of implant placement in compromised fresh extraction sockets in the esthetic zone using vestibular socket therapy. MATERIALS AND METHODS: Implants were placed in type 2 sockets using vestibular socket therapy, which includes immediate implant placement, vestibular incision, and cortical bone shield stabilization, along with filling the socket gap with particulate bone graft, then sealing the socket orifice with a customized healing abutment in one visit. A 6-day protocol of antimicrobial therapy for treating sockets with active infection was also described. Assessment included measuring bone height and labial plate thickness at three levels at baseline and after 1 year, in addition to pink esthetic score and periodontal parameters (modified sulcus Bleeding Index and peri-implant probing depth) after 1 year. SPSS was used to calculate descriptive statistics of outcome measures. RESULTS: All 16 implants used in the study showed success. There was a significant increase of bone height and bone thickness at the middle and crestal thirds (mean [SD] gain = 6.08 [3.07], 1.65 [0.91], and 1.18 [1.51]). The mean (SD) pink esthetic score was 12.63 (1.71), the mean (SD) modified sulcus Bleeding Index was 1.19 (0.40), and the mean (SD) peri-implant probing depth was 1.97 (0.46) mm. CONCLUSION: Vestibular socket therapy was successfully used in compromised sockets with optimum radiographic, esthetic, and periodontal outcomes in addition to minimizing treatment time and number of surgical interventions. The 6-day protocol was able to eliminate infection and prepare sockets for implant placement.

A Novel Method for Immediate Implant Placement in Defective Fresh Extraction Sites.

PURPOSE: This study assessed a novel treatment protocol for immediate implant placement in defective fresh extraction sockets. MATERIALS AND METHODS: A single-arm clinical study was conducted including 12 fresh extraction sockets divided into two groups: those with intact and those with a deficient facial plate of bone. Hopeless teeth were atraumatically extracted, a vestibular access horizontal incision was made 3 to 4 mm apical to the mucogingival junction, a mucoperiosteal tunnel was created from the labial orifice of the socket, a slowly resorbing membrane shield was stabilized under the tunnel, implants were placed using a surgical guide, and a subepithelial connective tissue graft was harvested and secured over the membrane shield. Definitive restorations were delivered at 3 months postoperatively. Cone beam computed tomography (CBCT) scans were taken at baseline and after 6 and 13 months to measure facial bone thickness and height. Pink esthetic score (PES) was recorded at 6 and 13 months. RESULTS: At 6 months, the mean ± SD facial bone thickness was 1.88 ± 0.73 mm for sockets with intact facial bone compared to 0.76 ± 0.42 at baseline and 2.34 ± 0.78 mm for sockets with deficient facial bone compared with 0 ± 0 at baseline, whereas at 13 months, the thickness was 1.84 ± 0.74 and 2.18 ± 0.73 mm, respectively. The facial bone crest coincided with the implant platform in sockets with an intact facial bone plate and those with a deficient facial bone plate at 6 months, whereas at 13 months, the distance for sockets with a deficient facial bone plate increased to 0.20 ± 0.13 mm. The mean PES at 6 and 13 months was 11.33 for both groups out of a maximum score of 14. CONCLUSION: The proposed technique provided a minimally invasive treatment with predictable esthetic outcome allowing immediate implant placement in sockets with intact and with deficient facial plates.