The influence of connective tissue grafting on the reconstruction of a missing facial bone wall using immediate implant placement and simultaneous bone reconstruction: a retrospective long-term cohort study.

PURPOSE: This retrospective cohort study evaluates the influence of connective tissue grafts (CTG) on bone regeneration at implant sites with total loss of the buccal bone wall treated with flapless immediate implant placement (IIP) and reconstruction with autogenous bone chips (AB) within a follow-up of up to 13 years. METHODS: Sixty implants were inserted in 55 patients in sites with total loss of the buccal bone wall between 2008 and 2021. The implants were inserted and the buccal gaps were grafted by AB. A subgroup of 34 sites was grafted additionally with CTG using tunnel technique. Primary outcome was the vertical bone regeneration in height and thickness. Secondary outcome parameters were interproximal marginal bone level, recession, soft tissue esthetics (PES), width of keratinized mucosa (KMW) and probing depths (PPD). RESULTS: Mean follow-up period was 60.8 months. In 55 sites a complete vertical bone regeneration was documented. The mean buccal bone level increased by 10.6 mm significantly. The thickness of the buccal bone wall ranged between 1.7 and 1.9 mm, and was significantly thicker in sites without CTG. Interproximal marginal bone level was at implant shoulder level. The mean recession improved significantly by 1.2 mm. In sites with CTG, recessions and PES improved significantly more. CONCLUSIONS: Additional CTG in extraction sites with total buccal bone loss followed by IIP with simultaneous AB grafting led to improved PES and recession, but also to a thinner buccal bone wall compared to sites grafted just with AB.

Efficacy of autogenous platelet concentrates in immediate implant therapy: A systematic review and meta-analysis of prospective controlled clinical trials.

PURPOSE: To provide an overview of the outcomes of the use of autogenous platelet concentrates in immediate implant placement. MATERIALS AND METHODS: Based on an a priori protocol, a systematic search was performed of the National Library of Medicine (MEDLINE via PubMed), Embase and Scopus databases. Randomised and non-randomised controlled clinical trials on immediate implant placement including at least one study arm with use of platelet-rich fibrin or platelet-rich plasma as a gap filler between immediately placed implants and the alveolar bone were included. A random-effects meta-analysis model was built to assess the primary outcomes of marginal bone loss and probing pocket depths between test (platelet concentrates) and control (no graft or other graft materials) groups. A risk of bias assessment was performed and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the certainty of evidence. RESULTS: A total of 20 trials (595 immediate implants placed in 454 individuals) were included in the meta-analytic model. Based on the data from studies with a minimum post-prosthetic loading period of 6 months after immediate implant placement, overall, the application of platelet concentrates was associated with significantly lower marginal bone loss and probing pocket depth compared to the control groups (mean difference -0.36 mm; P < 0.01 and mean difference -0.47 mm; P < 0.01, respectively). No additional benefit of application of platelet concentrates was detected regarding primary stability of immediate implants. Subgroup analysis revealed significantly lower marginal bone loss with xenogeneic bone alone compared to platelet concentrates alone as grafting material in immediate implant placement (mean difference 0.66 mm; P < 0.01). Evidence on soft tissue outcomes and aesthetic parameters was scarce. CONCLUSIONS: A low level of certainty based on the Grading of Recommendations Assessment, Development and Evaluation approach indicates superior outcomes in terms of marginal bone loss and probing pocket depth in immediate implant placement with the use of platelet concentrates versus no graft. Future research should be tailored towards a standardised protocol for preparation of platelet concentrates and inclusion of soft tissue and aesthetic outcomes as well.

Evaluation of Crestal Bone Levels using Simvastatin as an Adjuvant Around Immediate Implants - A Clinico Radiographic Study.

Objective: Simvastatin was used as an adjuvant medication in this clinico-radiographic investigation to assess the impact on crestal bone levels around immediate implantation. Materials and Methods: A randomized controlled trial with 50 patients who needed an implant placed right away was done. Simvastatin was used as an adjuvant in groups ((Group A), whereas group (Group B)) served as the control group for the participants. At baseline and during follow-up visits, clinical measures such as probing depth (PD) and bleeding on probing (BOP) were measured. At baseline and 12 weeks, radiographic measurements of crestal bone levels were taken. Results: At 12 weeks, Group A demonstrated a significantly lower PD and BOP than did Group B. Furthermore, at 12 weeks, Group A showed greater crestal bone preservation than did Group B. The results of the statistical analysis showed that the two groups were significantly different. Conclusion: The results of this study indicate that simvastatin use as an adjuvant medication after immediate implant insertion contributes to better clinical outcomes and greater crestal bone preservation. Simvastatin may be helpful in increasing bone regeneration, decreasing inflammation, and soft tissue healing. These findings demonstrate how simvastatin may be used as an additional therapy to enhance the effectiveness of rapid implant implantation operations.

Relationship between soft tissue dimensions and tomographic radial root position classification system for immediate implant installation.

The aim of this study was to evaluate the relationship between soft tissue dimensions and radial root position (RRP) classification for immediate implant placement on maxillary anterior teeth. Maxillary anterior teeth (n = 420) were analyzed in the radial plane of cone beam computed tomography (CBCT) scans. Each tooth was classified according to its RRP: class I, (IA, IB); class II (IIA, IIB) class III; class IV, and class V. Soft tissue thickness at different landmarks, supracrestal soft tissue height, and crestal bone thickness were measured in CBCT. Keratinized tissue width was clinically measured. Gingival phenotype (thick or thin) was evaluated by transparency of the periodontal probe and at the landmark 2 mm from the gingival margin in CBCT. Class I tooth position accounted for 31.7%, class II for 45%, class III for 13.3%, class IV for 0.5%, and class V for 9.5%. The gingival phenotype was associated with RRP (χ2 test, p < 0.05). Soft tissue dimensions were significantly different over RRP classes (ANOVA and Tukey tests, p < 0.05). Types IA and IIA presented both thick soft and hard tissues. When planning immediate implants in the anterior maxilla, soft tissue dimensions evaluation should be incorporated into RRP classification to increase the accuracy and predictability of treatment outcomes.

Bone formation in large/moderate gap after immediate implantation in response to different treatments: a pre-clinical study in the canine posterior mandible.

OBJECTIVES: This study aims to investigate different treatments on new bone formation around immediate implants in the canine posterior mandible with varying sized mesial-distal gap. MATERIALS AND METHODS: The 4th premolar and the 1st molar of six Labrador dogs were extracted from the mandible, and 4 dental implants were placed 1 mm below the level of the buccal bone crest. Moderate/large mesial-distal gaps between the implants and the sockets were treated with one of four methods and divided into the following groups: (1) the blank group, (2) the collagen membrane (CM) group, (3) the deproteinized bovine bone mineral (DBBM) group, and (4) the DBBM + CM group. Sequential fluorescent labeling was performed at 4, 8, and 10 weeks after the operation. After 12 weeks, the dogs were euthanized, and specimens were collected for micro-CT scanning and histological analysis. RESULTS: The survival rate of immediate implant was 100%. Micro-CT showed significant differences in bone mineral density (BMD) and bone volume fraction (BVF) among groups (P = 0.040, P = 0.009); other indicators were not significantly different among groups. Histological analysis showed the proportion of new bone formation and bone-to-implant contact were not significantly different among groups. No significant difference in bone reduction height around dental implant among four groups and varied mesial-distal gap size. CONCLUSION: Owing to the restricted sample size, this pilot study lacks conclusive findings. Within the limitation, this study demonstrated that although DBBM significantly increase BMD and BVF, the use of DBBM/CM didn't significantly improve bone formation and healing in extraction sockets around the implants in both moderate and large mesial-distal gap. CLINICAL RELEVANCE: The use of deproteinized bovine bone in conjunction with collagen is a common practice in immediate implantation procedures in the posterior mandible. However, there is a lack of conclusive evidence regarding the timing and circumstances under which they should be employed.

Jumping gap in immediate implant placement in the esthetic zone: A virtual implant planning using cone-beam computed tomography.

PURPOSE: A jumping gap (JG) refers to the implant's future buccal wall; this study aims to estimate the jumping gap dimension in relation to virtual implant placement and subsequently link the implant diameter and implant position with the anatomical site. METHODS: This observational study was conducted to analyze the maxillary teeth in the esthetic zone from cone-beam computed tomography (CBCT) scans using OnDemand software. The horizontal jumping gap dimension of each tooth was assessed by subtracting the calculated virtual implant diameter from the socket dimensions. RESULTS: A total of 253 anterior and premolar maxillary teeth were analyzed from 52 CBCT scans. The estimated JG dimensions were 1.23 ± 0.59 mm, 1.80 ± 0.64 mm, 3.02 ± 0.69 mm, for central incisors, lateral incisors and canines respectively, 3.70 ± 0.68 mm for the first premolars showing the highest horizontal gap and 3.19 ± 0.88 mm for second premolars. The incisors showed the smallest horizontal gap compared to the canines and premolars. CONCLUSIONS: In terms of JG, immediate implant placement is more favorable at the canine and premolar sites. By contrast, the incisors sites should be handled with extreme caution, where the use of narrower implants is advisable when necessary.

Assessment of crestal bone loss and periodontal parameters of polymer infiltrated ceramic network versus lithium disilicate implant hybrid abutment crowns in the esthetic zone (A randomized clinical trial).

BACKGROUND: Lithium disilicate can be reliable when restoring implants in the esthetic zone. However, it has a high elastic modulus. This might increase the amount of forces transmitted to the crestal bone. AIM OF THE STUDY: To evaluate the crestal bone loss and peri-implant periodontal parameters of polymer infiltrated ceramic network compared to lithium disilicate implant-supported hybrid abutment crowns after 12 months of follow-up. METHODOLOGY: 44 patients were enrolled. They were randomly assigned into two groups (n = 22). The first group received 22 implants restored with polymer-infiltrated ceramic network (Vitaenamic) hybrid abutment crowns. The second group received 22 implants restored with lithium disilicate (e.max) hybrid abutment crowns over immediately placed implants in the esthetic zone. Periapical radiographs were taken immediately after prosthetic placement and 1 year later utilizing a parallel technique, to assess crestal bone loss. Periodontal parameters were assessed after 1 year. RESULTS: Regarding crestal bone loss, a comparison between group I (Vitaenamic) and group II (e.max) was made by using an Independent t-test, which showed an insignificant difference between them (p > 0.05). A comparison between groups I and II revealed insignificant differences regarding periodontal parameters (probing depth, bleeding on probing, visible plaque, and suppuration). CONCLUSIONS: Regarding bone stability and periodontal parameters, polymer infiltrated ceramic network and lithium disilicate hybrid abutment crowns showed comparable results. Both materials showed clinically acceptable hard and soft tissue responses.

Comparison of crestal bone loss and papilla fill after conventional and immediate implant placement: A 12 month clinical and radiographic prospective study.

Background: The problem of missing teeth persists in all age groups. The main objective of implants in dentistry is to provide a restoration that reconstructs the shape and restores esthetics and functions of edentulous areas. The objectives of this study are to compare the crestal bone level changes and papillary fill after placement of implants in fresh extraction socket, i.e. immediate implant placement, and healed extraction socket, i.e. delayed or conventional implant placement, and to assess other clinical parameters such as modified plaque index (mPI), modified gingival index (mGI) and gingival biotype in between the groups and within the groups. Methods: 18 patients were recruited in the study out of which 9 patients received implants as per immediate implant placement protocol (group 1) and 9 patients received implants as per conventional implant placement protocol (group 2). All patients were evaluated for gingival biotype, mPI and mGI and papillary fill was assessed as per Jemt's papilla score as clinical parameters. Implant site was assessed for radiographic bone loss using Image J software. Statistical analysis was performed using independent t test, paired t test and chi square test. Results: At the end of 1 year, results showed that crestal bone loss was seen more in the immediate group than the conventional group. Conventional implants showed better papillary fill than implants placed in fresh extraction sockets. Plaque scores were assessed as per modified plaque index, which showed better results in the conventional group. Modified gingival index was used to assess gingival status which showed better results in the immediate group one year later. Conclusions: Findings from the study suggest that crestal bone loss was found to be increased in the immediate group than the conventional group and papillary fill was better in the conventional group than the immediate group.Registration: CTRI ( CTRI/2019/09/021340).

Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial.

PURPOSE: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates. MATERIALS AND METHODS: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test. RESULTS: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048). CONCLUSIONS: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome. CLINICAL RELEVANCE: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits. TRIAL REGISTRATION: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

An immediate implant approach to replace failing maxillary anterior dentition due to orthodontically induced severe root resorption.

Incomplete orthodontic therapy can lead to severe root resorption, resulting in mobile and non-restorable teeth. This clinical report presents the diagnosis, treatment planning and oral rehabilitation of a young woman with failing dentition in the anterior maxilla due to orthodontically induced root resorption. The patient's chief complaint was mobile maxillary anterior teeth 2 years after discontinuing orthodontic treatment. Radiographic and clinical evaluations revealed a missing right first premolar and left premolars and grade III mobility from the right canine to the left lateral incisor. Due to a hopeless prognosis, extraction of the maxillary anterior teeth was planned, followed by grafting procedures. Four implants were immediately placed in the fresh sockets of the canine and central sites, and a removable provisional appliance was delivered to contour the soft tissues involved. The final restorations consisted of two three-unit layered zirconia implant-supported fixed dental prostheses. Well-planned immediate implant therapy and zirconia restorations can successfully replace mobile teeth with severe root resorption caused by external surface resorption from incomplete orthodontic treatment. Combining grafting procedures during implant placement can replace hard tissue lost due to extractions, whereas provisional restorations can re-establish optimal tissue architecture in the aesthetic zone. The present case offers insight into effective strategies for treating non-compliant or uncooperative patients with failing dentition due to orthodontically induced root resorption.

Immediate Loading of Implants with Fixed Rehabilitations in Geriatric Edentulous Patients; Biological Complications.

BACKGROUND: This study aimed to report the outcomes of the immediate loading of implants with fixed rehabilitations in edentulous geriatric patients. METHODS: Edentulous geriatric patients were diagnosed with an oral examination, radiographic evaluation, and intermaxillary relations and treated with fixed rehabilitation over several implants. After immediate surgery, the implants were immediately loaded with a fully fixed prosthesis. RESULTS: Twenty-four patients (20 females and 4 males) were treated using a total 210 implants. All patients (100%) had a previous history of periodontitis. Eleven patients (45.8%) were smokers. Eleven patients (45.8%) suffered from chronic medical diseases (i.e., diabetes, cardiovascular diseases). The study's clinical follow-up period extended for three years, during which thirty-three fixed prostheses were installed over the implants in 24 patients. The average marginal bone loss measured was 1.33 ± 0.17 mm. The success rate of the implants and prosthodontics being placed in this study yielded 98.5% and 97%, respectively. One patient (4.2%) showed some kind of technical complications. Eleven patients (45.8%) showed mucositis, and 25 implants (11.9%) in 10 patients (41.7%) were associated with peri-implantitis. CONCLUSIONS: This study shows that the treatment of edentulous geriatric patients by immediate loading of implants with fixed rehabilitations is a clinically successful protocol but with a high prevalence of peri-implant diseases.

Assessment of the Effect of Phototherapy and PRP on the Immediate Implants: An Original Research.

Immediate implants have been gaining popularity in recent times. There are many adjuvant techniques that are followed before implant placement, which have recently shown hopeful results. For this reason, the current comparative study analyzes the effectiveness of platelet-rich plasma (PRP) and photofunctionalization (PF) at a tertiary care dental hospital. In the current clinical trial, 30 subjects were grouped equally to receive immediate dental implants, with one group in which pretreatment of the extraction site was done with the auto-PRP and PF, while the control group received no pretreatment. For 12 months after the placement of the implant, the subjects were observed for alterations in the parameters. The variables analyzed were survival, esthetics, biological integration, and finally the success of the implants in each group. Values were noted and compared using the appropriate statistical tools, while keeping the level of significance at P < 0.05. For the variables of esthetics and survival, no substantial differences were observed in the PRP and PF groups. There was no difference between these experimental groups and the control group. However, there were significant differences for the biological variable as there was more marginal bone loss in the experimental groups. On the whole, the success was greater for the experimental groups than the control group, though not significant. The pretreatment protocols using PRP and PF have shown to improve some characteristics of the immediate implants in the anterior regions. However, further studies are suggested.

Delayed and Immediately Loaded Implants Placed in Fresh Extraction Socket - A Clinical and Radiological Study.

Purpose: To present the outcomes of immediately loaded single implants placed in the anterior region compared to conventional protocol. Methodology: 10 patients requiring single anterior tooth extraction was randomised either into immediate or delayed loaded group. Implants were positioned immediately after extraction and prosthesis was providing for the immediately loaded group. The cases were followed up for a period of 9 months at regular 3-month interval after the placement of definitive crowns. The parameters taken were probing depth, pain score and crestal marginal bone loss. Results: A total of 10 AD1N-Touareg Spiral tapered Implant with spiral tap, 5 immediately loaded and 5 delayed loaded were evaluated. For immediate loaded cases, there was 0.93 ± 0.04 mm bone lost after 3 months, 1.26 ± 0.21 mm after 6 months and 1.72 ± 0.13 mm after 9 months. For delayed loading, there was 0.90 ± 0.02 mm bone lost after 3 months, 1.26 ± 0.15 mm after 6 months and 1.80 ± 0.07 mm after 9 months. Pain and probing depth showed gradual reduction in both the groups during the course of treatment. Conclusion: In the present study, the success rate and radiographic results of immediate loading of implants in freshly extracted sockets in the anterior region where comparable to those obtained from delayed groups.

Efficacy of Two Different Hydrodynamic Sinus Lift Systems for Atraumatic Elevation in Immediate Implant Placement.

Purpose: To evaluate the efficacy of two hydrodynamic sinus lifting procedures and to successfully place immediate implants in maxillary posterior sites that have a compromised native bone as a result of periodontal or endodontic disease. Patients and Methods: A total of 26 patient sites were enrolled with 13 sites each in the Minimally Invasive Antral Membrane Balloon Elevation (MIAMBE) and Drill Integrated Hydrodynamics for the transcrestal sinus floor elevation (DIHSFE) groups who received transcrestal sinus floor elevation followed by immediate implant placement. Clinical parameters such as sinus membrane perforations, nasal bleeding, postoperative sinusitis, VAS scores at Day-7 for pain and discomfort, primary implant stability and time taken were evaluated. Results: The DIHSFE had greater sinus membrane perforations and incidence of nasal bleeding when compared with MIAMBE with (p = 0.066) and (p = 0.141). Post-operative sinusitis was evident in both the groups with (p = 0.619). The mean VAS score was statistically significant between both the groups (p ≤ 0.005). The insertion torque values, and mean time taken for surgical procedure was not statistically significant between groups. Conclusion: The present study highlighted that MIAMBE is superior to DIHSFE in its ability to cause less severe patient morbidities and post-operative complications.

Cone Beam Computed Tomography (CBCT) Evaluation of Alveolar Bone Thickness and Root Angulation in Anterior Maxilla for Planning Immediate Implant Placement.

OBJECTIVE:  This retrospective study aimed to measure the labial, palatal, mesial, and distal bone thickness around maxillary central and lateral incisors and canines and height from crest to apex, using cone beam computed tomography (CBCT) images and compare the results based on gender. The second objective of the study was to measure root angulation on CBCT images and its relation with the labial cortical thicknesses.  Material and Methods: After the Institutional Review Board (IRB) approval, a total of 140 CBCT volumes were included in this study according to the set criteria. On each scan, right-side maxillary central, lateral incisors, and canine were selected for the measurements. All the measurements were done at three levels at the alveolar crest (L1), mid-root (L2), and apical region (L3) for each tooth.  Results: The Student's t-test was performed to compare the result of buccal, palatal, mesial, and distal bone thickness, angulation, and height of all subjects. Buccal alveolar bone thickness was minimum at the mid-root region, and the palatal bone thickness was minimum at the crestal region. The mesial bone thickness was minimum at the mid-root level, and distal bone thickness was minimum at the crest level. The available bone height was maximum at the lateral incisor and equal for the central incisor and canine. The canine was the most angulated tooth. CONCLUSION:  Cone beam computed tomography is a reliable imaging modality to evaluate pre-surgical immediate implant sites and measure alveolar bone thickness. The canine was the most angulated tooth with more buccal alveolar bone thickness.

Factors Associated with Esthetic Outcomes of Flapless Immediate Placed and Loaded Implants in the Maxillary Incisor Region-Three-Year Results of a Prospective Case Series.

Flapless immediate implant placement and provisionalization (FIIPP) is often associated with an increased risk of buccal soft-tissue recession. This study aims to assess the 3-year esthetic outcome. In 100 consecutive patients, one maxillary incisor, with or without a pre-extraction buccal bone defect (≤5 mm), was replaced by an implant installed in a maximal palatal position (buccal gap ≥2 mm). The created gaps were filled with bovine bone substitute. Patient satisfaction (PS), pink esthetic scores (PES/modPES), and white esthetic score (WES) were calculated at different time points. A multilevel regression analysis (MRA) was performed to analyze which factors may be associated with the esthetics. After three years, PS scored 8.9 ± 0.84 on a scale of 10 (n = 83), and the soft-tissue esthetics were high (PES = 12.2; modPES = 8.5), as was the WES (8.2), showing no decrease from one year. Buccal bone defect size and smoking could not be associated with the soft-tissue outcome; however, implant location, gap size, and emergence profiles could. Performing FIIPP, the final crown (WES) scored highest when it was cemented, the soft tissue (PES/modPES) in central-incisor positions, and all (WES/PES/modPES) with concave emergence profiles.

Outcomes of immediate dental implants in vascularised bone flaps for mandibular reconstruction.

BACKGROUND: The aim of this study is to assess the outcomes of immediate implant placement for dental rehabilitation following mandibular reconstruction with vascularised bone flaps in a single Australian tertiary cancer centre. METHODS: A retrospective analysis of patients who underwent immediate dental implant or delayed placement in vascularised bone flaps was performed. Primary outcome measures assessed included the number of implants placed, operative time, complication rates, time to radiotherapy initiation, dental rehabilitation rates and time to dental rehabilitation. RESULTS: In total, 187 dental implants were placed in 52 patients, of which 34 patients underwent immediate implant placement and 18 had delayed implant placement. There were no significant differences in the postoperative complication rate (32% immediate vs. 33% delayed, P = 0.89) or time to postoperative radiotherapy (median 42 days immediate vs. 47 days delayed, P = 0.24). Dental rehabilitation was achieved in 62% of the immediate cohort versus 78% of the delayed cohort. The time to be fitted with a dental prosthesis was significantly shorter in the immediate cohort (median 150 days immediate vs. 843 days delayed, P = 0.002). CONCLUSIONS: The placement of immediate dental implants at the time of primary reconstruction of the mandible is a safe procedure and facilitates timely dental rehabilitation.

Bone dimensional changes after flapless immediate implant placement with and without bone grafting: Randomized clinical trial.

INTRODUCTION: Immediate implant in postextraction sockets requires managing the postextraction alveolar resorption. This randomized clinical trial examined vertical and horizontal changes 1-year following flapless immediate implant with and without xenograft at sites with thin labial plate. METHODS: Forty patients with hopeless teeth in maxillary esthetic zone were randomly assigned to receiving either one immediate implant without bone graft (control) or with bone graft (intervention). Cone beam computed tomography (CBCT) scans were obtained pre-extraction and 1-year postoperatively to measure thickness and dimensional changes of the labial bone. RESULTS: Cone beam computed tomography measurements revealed that a xenograft, when compared to no xenograft, led to 0.2 mm increased fill of the horizontal gap (95% confidence interval (CI): -1.1, 0.7). In both groups, there was a significant reduction in the labio-palatal bone width after 1 year compared to baseline (P ≤ 0.05). There was no significant difference (P > 0.05) between the xenograft when compared to no xenograft regarding the labio-palatal bone collapse % at 0 mm (-0.2, 95% CI: -4.8, 4.5) and 2 mm apical to the labial crest (1.9, 95% CI: -1.8, 5.6). While at 5 mm the ridge was significantly reduced (P ≤ 0.05) in the no xenograft when compared to xenograft (4.5, 95% CI: 0.7, 8.2). The xenograft when compared to no xenograft, led to 1.1 mm less vertical bone changes (95% CI: 0.4, 1.9). Both groups revealed significant positive correlation between labio-palatal socket dimension and bone formed labial to the implant (P ≤ 0.05). [Correction added on 7 February 2023, after first online publication: In the 8th line of this section, the word "collapse" was changed to "ridge" in this version.] CONCLUSION: This investigation suggested that immediate implants with or without grafting the labial gap preserved alveolar bone dimension and that bone formation labial to the implant was related to initial labio-palatal socket dimension.

Immediate implant positioning using tooth-derived bone substitute material for alveolar ridge preservation: Preliminary results at 6 months.

OBJECTIVES: In the present study we evaluated the effectiveness of the use of a novel autologous bone substitute derived directly from processing the extracted tooth in the upper premolar area to preserve a suitable esthetic score and functionality. MATERIAL AND METHODS: Fourteen bone-level implants with platform switching were inserted in 12 patients immediately after atraumatic extraction of premolars for restorative or endodontic reasons. The implant buccal bone gap was filled using autologous tooth extracted-derived material. Clinical and radiographic parameters, including Pink Esthetic Score (PES) were evaluated at 6 months. RESULTS: A total of 10 patients accounting for 11 implants were included. PES showed a suitable esthetic result, and all the implant-prosthetic rehabilitation reported full satisfaction for masticatory function, phonetics, and aesthetics. Bone levels were stable and not affected by implant location, lesion type, or bone quality. CONCLUSION: Radiographically the autologous bone substitute used appears stable in the surgical site and there is good continuity between the autologous bone and the graft. No adverse effects such as periodontal inflammation, infection, or graft rejection was reported.

Bone preservation or augmentation simultaneous with or prior to dental implant placement: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years.

AIM: To evaluate outcome measures and methods of assessment in clinical studies on bone augmentation/preservation procedures for the placement of dental implants. MATERIALS AND METHODS: A systematic search was performed on three databases from January 2011 to April 2021 to identify clinical studies reporting on any type of bone augmentation/preservation procedure. The outcomes that have been used to assess efficacy or performance in each study were registered and assigned to different domains (group of outcomes). The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. RESULTS: Seven-hundred and eighty-three publications were included. Only 81.8% of the papers had a clear definition of their primary outcome. The rate of complications (59.3%), implant survival (58.2%), 3D radiographic bone gain/change (30%), marginal bone level (MBL; 29%), and histological outcomes (25.5%) were the most frequently reported outcome domains. The most commonly used primary outcome was 3D radiographic bone gain/change (25.8%), followed by implant survival (13.0%). Patient-reported outcome measures (PROMs) were reported in 15.7% of studies. Differences in the reported outcomes were observed among different types of bone preservation/augmentation interventions (i.e., alveolar ridge preservation, immediate implants, horizontal and/or vertical ridge augmentation, and sinus floor augmentation). CONCLUSION: Within the past decade, great heterogeneity was observed among the outcomes considered in studies evaluating bone preservation/augmentation procedures. Three-dimensional radiographic bone gain/change was the most routinely reported main outcome variable, while PROMs were rarely reported.