Immediate implant placement with immediate or delayed provisionalization in the maxillary aesthetic zone: A 10-year randomized trial.

AIM: To compare the marginal bone level of immediately placed implants, with either immediate or delayed provisionalization (IP or DP), in the maxillary aesthetic zone after 10 years of function. MATERIALS AND METHODS: Participants with a failing tooth in the maxillary aesthetic zone were randomly assigned to immediate implant placement with either IP (n = 20) or DP (n = 20) after primary wound closure with a free gingival graft. The final restoration was placed 3 months after provisionalization. The primary outcome was change in marginal bone level. In addition, implant survival, restoration survival and success, peri-implant tissue health, mucosa levels, aesthetic indices, buccal bone thickness and patient satisfaction were evaluated. RESULTS: After 10 years, the mean mesial and distal changes in marginal bone level were -0.47 ± 0.45 mm and -0.49 ± 0.52 mm in the IP group and -0.58 ± 0.76 mm and -0.41 ± 0.72 mm in the DP group (p = .61; p = .71). The survival rate was 100% for the implants; for the restorations, it was 88.9% in the IP group and 87.5% in the DP group. Restoration success, according to modified USPHS criteria, was 77.8% in the IP group and 75.0% in the DP group. The prevalence of peri-implant mucositis was 38.9% and 35.7% and of peri-implantitis 0.0% and 6.3%, respectively, in the IP group and DP group (p = 1.0; p = .40). The Pink Esthetic Score and White Esthetic Score was 15.28 ± 2.32 in the IP group and 14.64 ± 2.74 in the DP group, both clinically acceptable (p = .48). The buccal bone thickness was lower in the DP group. Patient satisfaction was similar in both groups (p = .75). CONCLUSIONS: The mean marginal bone level changes after immediate implant placement with IP were similar to those after immediate placement with DP. CLINICAL TRIAL REGISTRATION: Registered in the National Trial Register (NL9340).

Immediate placement of single implants with or without immediate provisionalization in the maxillary aesthetic region: A 5-year comparative study.

AIM: To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in the aesthetic region after five years of function. MATERIALS AND METHODS: Forty patients with a failing tooth in the maxillary anterior region were randomly assigned immediate implant placement with immediate (Group A: n = 20) or delayed (Group B: n = 20) provisionalization. Definitive crown placement occurred three months after provisionalization. The primary outcomes were changes in marginal bone level. In addition, survival rates, buccal bone thickness, soft peri-implant tissues, aesthetics and patient-reported outcomes were assessed. RESULTS: After 5 years, the mean mesial and distal marginal bone level changes were 0.71 ± 0.68 mm and 0.71 ± 0.71 mm, respectively, in group A and 0.49 ± 0.52 mm and 0.54 ± 0.64 mm, respectively, in group B; the difference between the groups was not significant (p = .305 and p = .477, respectively). Implant and restoration survivals were 100%. No clinically relevant differences in buccal bone thickness or in mid-facial peri-implant mucosal level, aesthetic and patient outcomes were observed. CONCLUSIONS: The mean marginal bone level changes following immediate implant placement and provisionalization were comparable with immediate implant placement and delayed provisionalization. (www.isrctn.com: ISRCTN57251089 and www.trialregister.nl: NL8255).

Effect of frenotomy on breastfeeding and reflux: results from the BRIEF prospective longitudinal cohort study.

OBJECTIVES: To assess the Efficacy of Frenotomy with regard to Breastfeeding and Reflux Improvement (BRIEF) in infants with breastfeeding problems. MATERIALS AND METHODS: A cohort of 175 consecutive breastfeeding women with breastfeeding and reflux problems related to a tongue-tie or lip-tie fulfilling the inclusion criteria was longitudinally followed for 6 months. The effect of frenotomy on these problems was studied by a standardized oral assessment and completing the validated Breastfeeding Self-Efficacy Short Form (BSES-SF), nipple pain score (Visual Analogue Scale, VAS), and Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) questionnaires pre-frenotomy and at 1 week, 1 month, and 6 months' post frenotomy. RESULTS: All 175 women completed the 1-month follow-up and 146 women the 6 months' follow-up. Frenotomy resulted in a significant improvement of BSES-SF, nipple pain score, and I-GERQ-R after 1 week, which improvement maintained to be significant after 1 month for BSES-SF and I-GERQ-R, and after 6 months for I-GERQ-R. The improvements were irrespective of the type lip-tie or tongue-tie underlying the breast feeding and reflux problems. No post-operative complications were observed. About 60.7% of infants still was breastfed 6 months after treatment. CONCLUSIONS: Frenotomy is a safe procedure with no post-operative complications and resulting in significant improvement of breastfeeding self-efficacy, nipple pain, and gastro-oesophageal reflux problems. CLINICAL RELEVANCE: Frenotomy of a tongue-tie and or lip-tie can lead to improvement of breastfeeding and reflux problems irrespective of the type of tongue-tie or lip-tie and should be considered by clinicians as a proper tool to resolve these problems if non-interventional support did not help. INTERNATIONAL TRIAL REGISTER: ISRCTN64428423.

Feasibility of immediate placement of single-tooth implants in the aesthetic zone: a 1-year randomized controlled trial.

AIM: To assess whether outcome of immediate implant placement and immediate provisionalization after 1 year was non-inferior to immediate implant placement and delayed provisionalization regarding Marginal Bone Level (MBL). MATERIALS AND METHODS: Forty patients with a failing tooth in the aesthetic zone were randomly assigned for immediate implant placement with immediate (n = 20) or delayed (n = 20) provisionalization. Follow-up was at 1 month and after 1 year. The study was powered to detect a difference in MBL of <0.9 mm. Apart from MBL, soft tissue peri-implant parameters, aesthetic indexes and patient satisfaction were assessed. RESULTS: After 1 year, MBL changes were -0.75 ± 0.69 mesially and -0.68 ± 0.65 distally mm for the immediate group and -0.70 ± 0.64 and -0.68 ± 0.64 mm for the delayed group respectively (NS). Regarding differences in means, non-inferiority was observed after 1 year (mesially: Group A versus B: difference in mean 0.08 mm (95% CI -0.38 to 0.53, p = 0.71 distally: Group A versus B: difference in mean 0.09 mm (95% CI -0.37 to 0.56 mm, p = 0.66).No significant differences in the other outcome variables were observed. CONCLUSIONS: This study showed that immediate placement and immediate provisionalization was non-inferior to immediate placement with delayed provisionalization. In addition, although not powered for these outcome variables, no clinically relevant differences in other outcomes were observed (www.isrtcn.com: ISRCTN57251089).

Immediate single-tooth implant placement in bony defect sites: A 10-year randomized controlled trial.

BACKGROUND: It is unclear whether an intact buccal bony plate is a prerequisite for immediate implant placement in postextraction sockets. The aim of this 10-year randomized controlled trial was to compare peri-implant soft and hard tissue parameters, esthetic ratings of, and patient-reported satisfaction with immediate implant placement in postextraction sockets with buccal bony defects ≥5 mm in the esthetic zone versus delayed implant placement after alveolar ridge preservation. METHODS: Patients presenting a failing tooth in the esthetic region and a buccal bony defect ≥5 mm after an extraction were randomly assigned to immediate (Immediate Group, n = 20) or delayed (Delayed Group, n = 20) implant placement. The second-stage surgery and provisional restoration placement occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. During a 10-year follow-up period, marginal bone levels (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded. RESULTS: The mean marginal bone level change was -0.71 ± 0.59 mm and -0.36 ± 0.39 mm in the Immediate Group and the Delayed Group after 10 years (p = 0.063), respectively. The secondary outcomes were not significantly different between both groups. CONCLUSIONS: Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in postextraction sockets with buccal bony defects ≥5 mm, were not statistically different to those following delayed implant placement after ridge preservation in the esthetic zone. PLAIN LANGUAGE SUMMARY: Immediate implant placement in case of a failing tooth is a favorable treatment option for patients because it considerably shortens treatment time and the number of surgical treatments. The question is if an intact buccal bone wall is necessary for immediate implant placement. A 10-year study was performed in which 20 patients with a failing tooth in the frontal region of the upper jaw were treated with immediate implant placement and were compared with 20 patients in whom a more conventional treatment strategy was followed in which the failing tooth was first removed and the bone gap restored and the implant placed in a second step. After a 10-year follow-up period, it appeared that the bone around the implant was very stable, gums were healthy, and patients were very satisfied with the result. There was no difference between the two treatment procedures. Such results mean that professionals can discuss the procedure with the patient and apply the individual's preference.

Immediate single-tooth implant placement with simultaneous bone augmentation versus delayed implant placement after alveolar ridge preservation in bony defect sites in the esthetic region: A 5-year randomized controlled trial.

BACKGROUND: It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post-extraction sockets. The aim of this 5-year randomized controlled trial was therefore comparison of peri-implant soft and hard tissue parameters, esthetic ratings, and patient-reported satisfaction of immediate implant placement in post-extraction sockets with buccal bony defects of ≥ 5 mm in the esthetic zone, with delayed implant placement after ridge preservation. METHODS: Patients presenting a failing tooth in the esthetic region and a buccal bony defect of ≥ 5 mm after extraction were randomly assigned to immediate (Immediate group, n = 20) or delayed (Delayed group, n = 20) implant placement. Second-stage surgery and placement of a provisional restoration occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. The follow-up was 5 years. Marginal bone level (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient-reported satisfaction were recorded. RESULTS: Mean marginal bone level change was -0.71 ± 0.35 mm and -0.54 ± 0.41 mm in respectively the Immediate group and the Delayed group after 5 years (P = 0.202). This difference, and in other variables, was not significant. CONCLUSIONS: Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients' satisfaction following immediate implant placement, in combination with bone augmentation in post-extraction sockets with buccal bony defects of ≥ 5 mm, were comparable to those following delayed implant placement after ridge preservation in the esthetic zone.

Buccal bone thickness at dental implants in the maxillary anterior region with large bony defects at time of immediate implant placement: A 1-year cohort study.

BACKGROUND: There is lack of studies regarding preservation and possible changes in BBT at dental implants. PURPOSE: To assess, on cone beam computer tomograms, the presence of bone at the time of tooth extraction in the maxillary esthetic region and the mean buccal bone thickness 1 month and 1 year after final restoration placement in patients with large bony defects. MATERIAL AND METHODS: In a cohort study, patients were selected presenting a failing tooth with a large bony defect (test group [n = 20]: large bony defect, immediate placed implant and delayed provisionalization). Results were compared with a group in which patients presented a failing tooth without or with a small bony defect: (control group [n = 20]: without or small bony defect, immediate placed implant and delayed provisionalization). Cone beam computer tomograms were made preoperatively, and 1 month and 1 year after placement of the restoration, and buccal bone thickness was analyzed. RESULTS: In both groups approximately 1 mm of buccal bone thickness was present after 1 month and 1 year, without a significant difference between the groups. CONCLUSION: In patients with large bony defects at a failing tooth it was possible to create a bone layer buccally of the implant and this bone layer remained stable during a 1-year follow-up; there were no significant differences between thickness of buccal bone at 1 month and 1 year in patients with large buccal bony defects and patients without or with small bony defects.

Buccal bone thickness at dental implants in the aesthetic zone: A 1-year follow-up cone beam computed tomography study.

Sufficient buccal bone thickness (BBT) is important for an optimal aesthetic outcome of implant treatment in the aesthetic zone. The aim of the study was to assess BBT at dental implants placed in the aesthetic zone (incisor, canine or first premolar in the maxilla) (immediate or delayed, with or without immediate provisionalization) with cone beam computed tomography (CBCT) as a function of time. Eighty patients were divided into 4 groups according to size of the buccal bony defect (<5 or ≥5 mm) after removal of the tooth, and timing of implant placement and provisionalization. CBCTs were made 1 month and 1 year after placement of the implant crown. BBT varied from 0.79 mm to 2.12 mm at 1 month and from 0.71 mm to 2.04 mm at 1 year. Change of BBT between 1 month and 1 year was negligible. This study concluded that BBT at dental implants in the aesthetic zone appears to be stable for immediate and delayed placed implants after placement of the definitive crown, independent of the size of buccal bone defect prior to implant insertion and timing of provisionalization.

Immediate Single-Tooth Implant Placement in Bony Defects in the Esthetic Zone: A 1-Year Randomized Controlled Trial.

BACKGROUND: This study aims to assess, with regard to marginal bone level (MBL), whether the outcome of immediate implant placement in bony defects in the esthetic zone was non-inferior to delayed implant placement after 1 year. METHODS: Forty patients with a failing tooth in the esthetic zone and a labial bony defect of ≥5 mm after removal of a tooth were randomly assigned for immediate (n = 20) or delayed (n = 20) implant placement. Second-stage surgery and provisionalization occurred after 3 months of healing. Follow-up was at 1 month and 1 year after definitive crown placement. The study was powered to detect a difference in MBL of >0.9 mm. Buccal bone thickness, soft tissue peri-implant parameters, esthetic indices, and patient satisfaction were also assessed. RESULTS: One year after definitive crown placement, MBL loss was 0.56 ± 0.39 mm mesially and 0.74 ± 0.51 mm distally for the immediate placement group and 0.51 ± 0.43 mesially and 0.54 ± 0.45 distally mm for the delayed placement group, respectively (not significant). Regarding differences in means, non-inferiority was observed after 1 year (difference in mean for immediate versus delayed: mesially 0.04 mm [95% confidence interval (CI) = -0.22 to 0.30 mm, P = 0.40]; distally 0.21 mm [95% CI = -0.10 to 0.51 mm, P = 0.58]). No significant differences in the other outcome variables were observed. CONCLUSIONS: Immediate implant placement with delayed provisionalization was non-inferior to delayed implant placement with delayed provisionalization in labial bony defects of ≥5 mm regarding change in MBL. Although not powered for other outcome variables, no clinically relevant differences were observed in these variables.

Inter- and intraobserver reproducibility of buccal bone measurements at dental implants with cone beam computed tomography in the esthetic region.

BACKGROUND: Sufficient buccal bone is important for optimal esthetic results of implant treatment in the anterior region. It can be measured with cone beam computed tomography (CBCT), but background scattering and problems with standardization of the measurements are encountered. The aim was to develop a method for reliable, reproducible measurements on CBCTs. METHODS: Using a new method, buccal bone thickness was measured on ten CBCTs at six positions along the implant axis. Inter- and intraobserver reproducibility was assessed by repeated measurements by two examiners. RESULTS: Mean buccal bone thickness measured by observers 1 and 2 was 2.42 mm (sd: 0.50) and 2.41 mm (sd: 0.47), respectively. Interobserver intraclass correlation coefficient was 0.96 (95% CI 0.93 to 0.98). The mean buccal bone thickness of the first measurement and the second measurement of observer 1 was 2.42 mm (sd: 0.50) and 2.53 mm (sd: 0.49), respectively, with an intraobserver intraclass correlation coefficient of 0.93 (95% CI 0.88 to 0.96). The mean buccal bone thickness of the first measurement and the second measurement of observer 2 was 2.41 mm (sd: 0.47) and 2.52 mm (sd: 0.47), respectively, with an intraobserver intraclass correlation coefficient of 0.96 (95% CI 0.93 to 0.97). CONCLUSIONS: Applying the methods used in this study, CBCTs are suitable for reliable and reproducible measurements of buccal bone thickness at implants.

Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis.

BACKGROUND: Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri-implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single-tooth implants in the esthetic zone. METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched for publications up to June 2013. Studies reporting on implant survival, changes in hard and soft peri-implant tissues, esthetic outcome, and patient satisfaction were considered. A pooled analysis was performed to identify factors associated with survival and peri-implant tissue changes after immediate implant placement. RESULTS: Thirty-four studies were considered eligible. Immediate placement of single-tooth implants in the esthetic zone was accompanied by excellent 1-year implant survival (97.1%, 95% confidence interval [CI]: 0.958 to 0.980). Mean marginal peri-implant bone loss was 0.81 ± 0.48 mm, mean loss of interproximal peri-implant mucosa level was 0.38 ± 0.23 mm, and mean loss of peri-implant midfacial mucosa level was 0.54 ± 0.39 mm. Regression analysis revealed that delayed provisionalization (odds ratio [OR] 58.03, 95% CI: 8.05 to 418.41, P <0.000), use of a flap (OR 19.87, 95% CI: 10.21 to 38.66, P <0.000), and use of a connective tissue graft (OR 4.56, 95% CI: 1.72 to 12.08, P <0.002) were associated with marginal peri-implant bone-level change >0.50 mm. Because of underreporting, esthetic results and patient outcome did not allow for reliable analysis. CONCLUSION: Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short-term treatment outcome in terms of implant survival and minimal change of peri-implant soft and hard tissue dimensions.

Osteoporosis and edentulous jaws.

PURPOSE: To investigate the influence of (1) osteoporosis on resorption of edentulous and (2) whether osteoporosis enhances implant loss. MATERIALS AND METHODS: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for association of osteoporosis and bone resorption/loss of implants. Inclusion and exclusion criteria were defined and quality assessment of the remaining studies after exclusion was performed. The Cochrane approach for cohort studies was applied. RESULTS: Methodologic assessment of the eligible publications using the Cochrane approach resulted in the inclusion of 11 publications in the final evaluation. Most studies dealt with the association between the extent of resorption or atrophy of edentulous jaws and the systemic (femoral, lumbar spine, metacarpal) bone mineral content (BMC) or bone mineral density (BMD) status. Four studies reported a significant association between the extent of resorption and the skeletal BMC and/or BMD. Four studies evaluated the effect of endosseous implants on mandibular BMC or BMD changes and the association between systematic BMD statuses and loss of implants. These studies revealed no association between systemic BMD status, mandibular BMD status, bone quality, and implant loss. CONCLUSIONS: Although no firm conclusions could be drawn regarding the effect of osteoporosis on resorption of edentulous jaws, with or without implants, due to the different parameters applied in the various studies, the use of endosseous implants in osteoporosis patients is not contraindicated.