Flapless early implant placement into the uncalcified provisional matrix-Does it lead to osseointegration of the implant? A preclinical study.

AIM: To test whether early implant placement into the extraction socket containing an uncalcified provisional matrix leads to successful osseointegration and stable marginal bone levels. MATERIALS AND METHODS: In six mongrel dogs, the mandibular molars were extracted. Three weeks later, early implant placement was performed according to three experimental protocols: (i) flapless implant placement with preservation of the provisional matrix; (ii) flap elevation, socket debridement and implant placement; and (iii) flap elevation, socket debridement, implant placement and guided bone regeneration (GBR). One untreated extraction socket served as a control group. Data analyses were based on histologic slides 3 months after implant placement. RESULTS: There were no differences in bone-to-implant contact between the three experimental groups (66.97%, 58.89% and 60.89%, respectively) (inter-group comparison p = .42). Marginal bone levels, first bone-to-implant contact as well as the thickness of the connective tissue did not reveal any significant differences between the groups (p = .85, .60 and .65, respectively). CONCLUSIONS: Flapless early implant placement into posterior extraction sockets was as effective as an open flap approach in conjunction with GBR. Mineralization of the socket seems to occur irrespective of the presence of dental implants or biomaterials.

Alveolar ridge preservation versus early implant placement in single non-molar sites: A systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analyses was to evaluate the outcomes of alveolar ridge preservation (ARP) following extraction of non-molar teeth in comparison to early implant placement (EIP) in terms of clinical and radiographic changes, need for additional augmentation at the time of implant placement, patient-reported outcomes, and implant failure rate. METHODS: Electronic databases were searched to identify randomized and non-randomized studies that compared ARP to EIP. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Data were analyzed using a statistical software program. RESULTS: A total of 106 studies were identified, of which five studies with 198 non-molar extraction sockets in 198 participants were included. Overall meta-analysis showed significant differences in changes in midfacial mucosal margin (mean difference (MD) -0.09; 95% confidence interval (CI) -0.17 to -0.01; p = .03) and ridge width (MD -1.70; 95% CI -3.19 to -0.20; p = .03) in favor of ARP. The use of ARP was also associated with less need for additional augmentation at implant placement, but the difference was not statistically significant. CONCLUSIONS: Within the limitation of this review, ARP following extraction of non-molar teeth has short-term positive effects on soft tissue contour, mucosal margin and thickness, and alveolar ridge width and height. It can also simplify future implant treatment by minimizing the need for additional augmentation.

Early implant placement versus ridge preservation and delayed implant placement: Analysis of profilometric, clinician- and patient-reported outcomes from a two-centre RCT.

OBJECTIVES: To compare early implant placement (EP) to alveolar ridge preservation and delayed implant placement (ARP/DP) in terms of contour changes, along with clinician- and patient-reported outcome measures (PROMs) until the delivery of the implant-supported restoration. MATERIALS AND METHODS: Patients with a failing single tooth in the maxilla or mandible were recruited in two centres. After tooth extraction, patients were randomly assigned (1:1) to either EP or ARP/DP. At abutment connection and crown delivery, the buccal contour changes at 3 mm below the mucosal margin (primary outcome) along with clinician- (ease of treatment) and patient-reported outcomes were assessed using numeric rating scales and OHIP-14. RESULTS: A total of 46 patients were analysed. The mean buccal contour at abutment connection decreased by -1.2 ± 0.6 mm in group EP and -1.6 ± 0.8 mm in group ARP/DP (estimated mean difference; 0.45 [95%CI, -0.02; 0.94]; p = .061) with no significant differences between the groups. ARP/DP was consistently easier than EP across all stages of the surgery (estimated mean difference; 2.0 [95%CI, 1.3; 2.7] p < .001): during flap elevation (EP: 4.8 vs. ARP/DP: 1.6), implant placement (EP: 5.7 vs. ARP/DP: 2.2) and wound closure (EP: 3.4 vs. ARP/DP: 1.6). Both interventions improved quality of life but patients who underwent ARP/DP were significantly more satisfied at the time of crown delivery (ARP/DP: 9.6 vs. EP: 9.1, p = .02). CONCLUSIONS: EP and ARP/DP show no significant differences in buccal contour changes, aesthetics and patient-reported outcomes. However, ARP/DP is an easier procedure at all stages of the surgery compared to EP and could therefore be the preferred therapy for less experienced clinicians.

The fusion of keratinized epithelium, an indication of early implant placement in the aesthetic area: an animal study.

BACKGROUND: In the period of the early implant placement, the socket is mainly occupied by provisional matrix (PM). Keratinized epithelium (KE) is critical for primary wound closure. Although both KE and PM are important, the detailed relationship among migrating KE, PM formation and indication of the early implant placement is still unclear. OBJECTIVE: This research aimed to locate a healing stage of KE with highest osteogenic PM formation after tooth extraction, which could be treated as the optimal time point for early implant placement. MATERIAL AND METHODS: Mice were sacrificed on days 1, 2, 3, 4 and 6 after incisor extraction. Clinical, histological, and immunohistochemical evaluations of the extraction sockets were performed, and statistical analyses were conducted. We then inserted implants into the PM with the greatest bioactivity and observed its osseointegration pattern for 3, 10, 17 and 30 days. RESULT: When KE fusion was reached, sockets were dominated by PM with the greatest expression of osteocalcin (OC, P < 0.05) and high levels of CD34 and Runx2. OC and Runx2 expression were positively correlated with KE coverage (P < 0.05). When the implant was inserted at 4 days' healing, the PM maintained its osteogenic ability, and osseointegration proceeded perfectly. CONCLUSION: The migration of KE was correlated with the formation of highly osteogenic and angiogenic PM. And the fusion of KE could be treated as an indication for early implant placement.

Early implant placement with or without alveolar ridge preservation in single tooth gaps renders similar esthetic, clinical and patient-reported outcome measures: One-year results of a randomized clinical trial.

OBJECTIVES: To test whether early implant placement with alveolar ridge preservation (ARP) results in different esthetic, clinical and patient-reported outcome measures (PROMs) compared with early implant placement without ARP. MATERIAL AND METHODS: Seventy-five patients requiring single tooth extraction in the anterior maxilla were recruited. Following tooth extraction, the patients were randomly allocated to three groups: (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen matrix (CM) (n = 25), (b) ARP using DBBM-C covered with a palatal graft (PG) (n = 25) and (c) spontaneous healing (control) (n = 25). Eight weeks after tooth extraction, a CBCT was taken and early implant placement was performed in all patients. Esthetic, clinical and PROMs were evaluated one year post-loading. RESULTS: A total of 70 patients were available for re-examination at one year post-loading. The median mid-facial mucosal margin change amounted to -0.02 mm (IQR -0.27-0.46) in the CM group, -0.13 mm (IQR -0.44-0.25) in the PG group and -0.14 mm (IQR -0.29-0.07) in the control group, with no significant differences between the groups. Mean PES scores amounted to 7.0 ± 1.4 in the CM group, 7.1 ± 1.5 in the PG group and 7.3 ± 1.7 in the control group without significant differences between the groups. Plaque, bleeding on probing and probing depth did not differ between treatment groups. PROMs in general revealed no significant differences between the groups. CONCLUSION: Early implant placement with ARP using either a collagen matrix or a palatal graft rendered similar esthetic, clinical and PROMs to early implant placement without ARP. When a failing tooth can be replaced with an implant within 2 months after tooth extraction, the added value of ARP might be clinically negligible.

Is the timing of implant placement and loading influencing esthetic outcomes in single-tooth implants?-A systematic review.

OBJECTIVES: To address the following question: "Is the timing of implant placement and/or loading influencing the esthetic outcomes of implant-supported single crowns?" MATERIAL AND METHODS: A literature screening was performed in four electronic databases until June 2020. Randomized controlled clinical trials with a minimum of 10 patients and 1 year of follow-up and reporting on dimensional changes of the peri-implant mucosa (midfacial recession, papilla level) and esthetic indexes were included. Cochrane Risk of Bias Tool was used, and comparable trials were subjected to meta-analyses. RESULTS: Out of 8549 articles, 72 full-text articles were assessed for eligibility and 18 were included. Nine trials evaluated the timing of implant placement, and nine trials evaluated the timing of loading. The included trials comparing immediate implant placement to delayed implant placement evaluating the midfacial recession reported heterogeneous findings. No differences were found at 1 and 2-years, when comparing midfacial recession and papilla level between immediate and early implant placement. In immediate and delayed implant placement, when comparing conventional and immediate loading, the midfacial mucosal margin change was not statistically significant at the 1-year follow-up. When evaluating the timing of implant placement and/or loading the included trials found no differences in the Pink Esthetic score, White Esthetic score, and Papilla Index between groups. CONCLUSIONS: Both immediate and early implant placement protocols presented stable treatment results in terms of esthetic outcomes at the 1-, 2-, and 10-years follow-up. Loading protocols did not seem to influence esthetic outcomes in short- and medium-term follow-ups.

Early implant placement in ridge preserved extraction sockets: A pre-clinical in vivo study.

OBJECTIVES: The aim was to analyse the outcomes of early implant placement after 6 and 12 weeks of healing in ridge preserved sites in a canine model. MATERIALS AND METHODS: Implants were placed in second maxillary incisors sites in 9 dogs 6 weeks after grafting of the sockets with 90% deproteinized bovine bone mineral in 10% collagen matrix (DBBMC) and closure with resorbable type I/III porcine collagen matrix (PCM). The implants were randomly assigned to 6 (T6) and 12 (T12) weeks of healing. RESULTS: The percentage of bone-to-implant contact (%BIC), old bone, new bone and residual DBBMC was similar between T6 and T12. In relation to the implant shoulder (IS), the original bone crest (IS-ROB) was more apical on the buccal than the palatal side. The regenerated bone crest (IS-C) and IS-ROB were similar between groups. However, the distance from IS to first bone-to implant contact (IS-fBIC) was significantly less in T12 compared with T6 (p = .022; Wilcoxon signed-rank test). The bucco-palatal ridge dimensions between T6 and T12 were similar. CONCLUSIONS: This study confirms that implants can successfully be placed early in ridge preserved maxillary second incisor sites and are osseointegrated by 6 weeks. There were significantly lower IS-fBIC values at 12 weeks than at 6 weeks on the buccal aspect. The original buccal bone crest underwent greater corono-apical resorption than the palatal crest. The %BIC, relative proportions of mineralized tissues and dimensions of the alveolar ridge demonstrated stability between 6 and 12 weeks of healing.

Explorative randomized controlled study comparing soft tissue thickness, contour changes, and soft tissue handling of two ridge preservation techniques and spontaneous healing two months after tooth extraction.

OBJECTIVES: To compare two ridge preservation techniques and spontaneous healing in terms of soft tissue thickness, contour changes, and soft tissue handling two months after tooth extraction. METHODS: Thirty-six patients were included with buccal bone plate dehiscences of up to 50% after single-tooth extraction in the esthetic zone. They were randomly assigned to receive one of three procedures: a deproteinized bovine bone mineral with 10% collagen (DBBM-C) covered with a collagen matrix (DBBM-C/CM), DBBM-C alone, or spontaneous healing (SH). Two months later, the status of soft tissue healing was assessed, and the thickness of the mucosa was measured at the center of the site. Thereafter, implants were placed and the need for further guided bone regeneration (GBR) to cover exposed implant surfaces was assessed. RESULTS: Thirty-six patients were evaluated at the day of implant placement. An invagination of the soft tissues was recorded in 41.7% (n = 12), 53.8% (n = 13), and 90.9% (n = 11) of the sites in groups DBBM-C/CM, DBBM-C, and SH, respectively. The median thickness of the mucosa measured was 3.0 mm in group DBBM-C/CM, 2.1 mm in group DBBM-C, and 1.5 mm in group SH. Additional GBR was necessary in 66.7% (n = 12), 53.8% (n = 13), and 90.9% (n = 11) of the sites in groups DBBM-C/CM, DBBM-C, and SH, respectively. CONCLUSIONS: The present explorative study revealed slight tendencies for more favorable soft tissue conditions with less invaginations as well as increased soft tissue volume and thickness in groups having received an alveolar ridge preservation procedure compared to spontaneously healed sites at 8 weeks of healing.

Alveolar ridge preservation and early implant placement at maxillary central incisor sites: A prospective case series study.

PURPOSE: To assess whether alveolar ridge preservation (ARP) with 90% deproteinized bovine bone mineral in a 10% collagen matrix (DBBMC) and resorbable type I/III porcine collagen matrix (CM) maintains sufficient bone volume for early implant placement 8-10 weeks after extraction of maxillary central incisors. MATERIALS AND METHODS: In this case series study of 10 consecutively enrolled patients, sockets of maxillary single central incisors requiring extraction and early implant placement were grafted with DBBMC/CM. Ridge dimensions were measured pre-extraction and just prior to implant placement. RESULTS: Alveolar ridge preservation maintained sufficient bone volume for implants to be placed in all sites. Compared to pre-extraction, there was a significant reduction in the orofacial dimensions of the ridge (1.4 ± 1.07 mm; 13.2% reduction) and bone (0.7 ± 0.67 mm; 9.3%) at the coronal midfacial region. A significant reduction in apicocoronal height of the crestal bone at midfacial (1.2 ± 0.78 mm) and palatal aspects was observed. On CBCT, a statistically significant reduction in alveolar ridge area occurred (10.9 ± 13.42 mm2 ; 12.2% reduction). To optimize aesthetic outcomes, 9/10 sites required additional low volume grafting at the coronal region, whereas one site required more extensive grafting due to a facial bone dehiscence. At 1-year, the implant survival rate was 100% and median Pink Esthetic Score (PES) was 10 (range 9-13). CONCLUSIONS: ARP using DBBMC/CM maintains sufficient bone volume for early implant placement 8.9 ± 0.97 weeks later, with a 100% survival rate 1 year after restoration.

The influence of collagen membrane and autogenous bone chips on bone augmentation in the anterior maxilla: a preclinical study.

OBJECTIVES: To evaluate the effect of a resorbable collagen membrane and autogenous bone chips combined with deproteinized bovine bone mineral (DBBM) on the healing of buccal dehiscence-type defects. MATERIAL AND METHODS: The second incisors and the first premolars were extracted in the maxilla of eight mongrels. Reduced diameter, bone-level implants were placed 5 weeks later. Standardized buccal dehiscence-type defects were created and grafted at implant surgery. According to an allocation algorithm, the graft composition of each of the four maxillary sites was DBBM + membrane (group D + M), autogenous bone chips + DBBM + membrane (group A + D + M), DBBM alone (group D) or autogenous bone chips + DBBM (group A + D). Four animals were sacrificed after 3 weeks of healing and four animals after 12 weeks. Histological and histomorphometric analyses were performed on oro-facial sections. RESULTS: The pattern of bone formation and resorption within the grafted area showed high variability among the same group and healing time. The histomorphometric analysis of the 3-week specimens showed a positive effect of autogenous bone chips on both implant osseointegration and bone formation into the grafted region (P < 0.05). The presence of the collagen membrane correlated with greater bone formation around the DBBM particles and greater bone formation in the grafted region after 12 weeks of healing (P < 0.05). The oro-facial width of the augmented region at the level of the implant shoulder was significantly reduced in cases where damage of the protection splints occurred in the first week of healing (P < 0.05). CONCLUSIONS: The addition of autogenous bone chips and the presence of the collagen membrane increased bone formation around DBBM particles. Wound protection from mechanical noxa during early healing may be critical for bone formation within the grafted area.

Impact of placement and restoration timing on single-implant esthetic outcome - a randomized clinical trial.

AIM: The objective of this randomized clinical trial was to investigate the influence of the time of implant placement (immediate vs. early) and the time of restoration (immediate vs. early) on esthetic outcome in maxillary anterior single implants. MATERIAL AND METHODS: Forty-eight patients with a single failing incisor in the maxilla and a natural contralateral site were randomly distributed into four groups. Treatment variations affected the time of implant placement (immediate or early) as well as the time of restoration (immediate or early) - in detail, group 1a with immediate implant placement and immediate temporary restoration, group 1b with immediate implant placement and early restoration, group 2a with early implant placement and immediate temporary restoration, and group 2b with early implant placement and early restoration. All patients received the final prosthetic restoration 10-12 weeks after implant placement. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES after Fürhauser. For statistical analysis, the Kruskal-Wallis test and Dunn's post hoc test were applied. Interobserver reliability was evaluated by Krippendorff's alpha. RESULTS: The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 1a), 7.93 (SD 3.21, group 1b), 6.62 (SD 3.24, group 2a), and 8.10 (SD 3.25, group 2b). The differences between groups 2a and 1a and between groups 2a and 2b were statistically significant (P = 0.015 and P = 0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity. CONCLUSIONS: Immediate implant placement and restoration appear to be a viable alternative to early implant placement if an experienced surgeon is entrusted with the implantation procedure.

Achieving Predictable Esthetics With Early Implant Placement and Soft Tissue Modeling: A Case Report and Literature Review.

In the modern era, patients are increasingly concerned about dental esthetics. Edentulism can significantly impact the appearance, occlusion, and self-esteem of the patient. Treatment options like removable dentures, fixed crown and bridge prostheses, and resin-retained bridges are available to replace missing teeth. Implant therapy is popular due to its high success rates and long-term durability. However, its efficacy can be compromised by errors in treatment planning, surgery, tissue care, and infections. Thus, meticulous planning and execution are crucial. Clinicians must have the expertise to manage difficulties during surgery and maintain stable soft tissue. The stability of tissues around osseointegrated implants affects long-term clinical stability and esthetics. Early implant placement is recommended for missing teeth in the esthetic zone, aiming to place implants in anatomically and functionally correct positions for durable and esthetic results. Patients with high cosmetic demands, thin gingival biotypes, and high smile lines pose challenges. Assessing Pink and White esthetics guides treatment planning. Advantages of early implant placement include simplified procedures and reduced post-surgical complications. Soft tissue molding is achieved using customized healing abutments and temporizing with fiber-reinforced resin-bonded prostheses. Customized healing abutments preserve socket width, prevent soft tissue collapse, and promote natural contouring, eliminating the need for secondary surgeries and aiding spontaneous healing. This case report outlines a comprehensive approach to achieving predictable esthetics through early implant placement and soft tissue modeling in a patient with a traumatically avulsed maxillary central incisor.

Alveolar ridge changes 1-year after early implant placement, with or without alveolar ridge preservation at single-implant sites in the aesthetic region: A secondary analysis of radiographic and profilometric outcomes from a randomized controlled trial.

OBJECTIVES: To assess both the radiographic and profilometric outcomes of early implant placement with or without alveolar ridge preservation (ARP) (using two different ARP techniques) after 1 year of loading. MATERIALS AND METHODS: Seventy-five patients with a failing single tooth in the anterior maxilla were randomly allocated to three groups (1:1:1): (a) ARP using demineralized bovine bone mineral containing 10% collagen (DBBM-C) covered by a collagen matrix (CM), (b) ARP using DBBM-C covered with a palatal graft (PG), and (c) unassisted socket healing (control). Eight weeks after tooth extraction, early implant placement was performed in all patients. Cone-beam computed tomography (CBCT) and impressions were taken 8 weeks after tooth extraction (ARP/unassisted healing) prior to implant placement and 1-year post-loading. Radiographic and profilometric outcomes were evaluated. RESULTS: Out of the 70 patients available for re-examination at 1-year post-loading, 55 datasets could be assessed (ARP-CM 19; ARP-PG 17; Control 19). The need for additional guided bone regeneration (GBR) at implant placement amounted to 31.6% (ARP-CM), 29.4% (ARP-PG), and 68.4% (unassisted healing). Adjusted models revealed that residual buccal bone height and additional GBR at implant placement significantly influenced the magnitude of the alveolar changes at 1 year (p < 0.05). In patients with ARP (group ARP-CM or ARP-PG) without additional GBR, the presence of bone convexity amounted to 36.0% (9/25) at 1-year post-loading. For patients that received ARP and additional GBR at implant placement, the frequency of bone convexity increased to 72.7% (8/11) (p = 0.042). Regarding profilometric measurements, a tendency toward agreement with radiographic outcomes was observed. CONCLUSIONS: Early implant placement with ARP can attenuate alveolar ridge changes at 1-year post loading by minimizing both radiographic and profilometric alterations. However, early implant placement with simultaneous GBR consistently yields superior radiographic and profilometric outcomes, regardless of whether ARP is performed.

Pre- and Postoperative Evaluation of Immediate and Early Implant Placement in Esthetic Areas with Pre-Extraction Facial Dehiscence: A Retrospective Clinical Study.

The clinical requirement for a good esthetic result for immediate implant placement is the absence of dehiscence in the anterior facial alveolar bone. In the presence of dehiscence, it is recommended to use a connective tissue graft in addition to immediate implant placement or to change to early implant placement. However, the literature focusing on dehiscence is scarce, and the influence of different placement times and combined use of connective tissue graft on postoperative esthetics in cases with dehiscence is unclear. Therefore, we quantitatively evaluated the pre-extraction dehiscence morphology and postoperative changes in the facial tissue of implants in three groups: immediate implant placement (Group I), immediate implant placement with connective tissue graft (Group IC), and early implant placement (Group E). To this end, 52 implants were obtained (20 in Group I, 16 in Group IC, and 16 in Group E). A wider dehiscence increases the risk of soft tissue regression, which was one reason for choosing early implant placement. A combination of immediate implant placement and connective tissue graft, or early implant placement, tended to result in less soft tissue regression due to the thicker postoperative facial soft tissue volume.

Comparison of quality of bone and insertion torque values of early implants placed at 6 and 8 weeks in sockets preserved with advanced platelet-rich fibrin: A randomized controlled trial.

Aim: Successful functional and esthetic rehabilitation of edentulous jaws with implants depends on the optimal timing of placement, surgical protocol, materials used, cost-effectiveness, and satisfying patient needs. Increasing demand for shorter treatment times necessitates the immediate placement protocol. However, researchers have demonstrateda higher failure rate. A-PRF (Advanced platelet-rich fibrin) has exhibited accelerated bone regeneration potential. Early implant placement with a limited healing period, along with A-PRF, can be beneficial over conventional and immediate implant placement. Settings and Design: This prospective randomized clinical trial aims to assess the outcome of early implant placement in sockets preserved using A-PRF at six weeks and eight weeks of post-extraction. Two groups of 10 participantseach were formed. All patients underwent atraumatic extraction and socket preservation using A-PRF. Materials and Methods: A Partial-thickness pedicle graft was raised, and the extraction socket wasclosed. Implants wereplaced in at six and eight weeks of post-extraction in group A group B, respectively. The histomorphometric analysisassessedthe bone quality present at the timeof surgery. The insertion torque values were recorded during implant placement. Statistical Analysis Used: The obtained data were statistically analyzed using parametric tests, namely independent T-test for intergroup comparison. Results: T-test for torque values indicated a significantly higher torque value at eight weeks. The meanhistomorphometric value showeda significantly higher percentage of bone formation at eight weeks than at six weeks (P = 0.03). Conclusion: Within the study's limitations, early implant placement in extraction sockets preserved with A-PRF had significantly higher insertion torque values and predictable bone at eight weeks compared to six weeks.

Early implant placement and peri-implant augmentation with a porcine-derived acellular dermal matrix and synthetic bone in the aesthetic area: a 2-year follow-up prospective cohort study.

The aim of this study was to evaluate the 2-year follow-up results of early implant placement with simultaneous peri-implant augmentation using an acellular dermal matrix (ADM) and a synthetic bone substitute in the aesthetic zone. Twenty subjects were enrolled in this study, they were either males (eight) or females (12), with a mean age of 47.8±4.45 years and each patient was treated with one implant. Simultaneous contour augmentation with guided bone regeneration was performed using synthetic bone particles (maxresorb®) and an ADM (mucoderm®). Keratinized mucosa width (KMW) and gingival thickness (GT) were assessed at baseline, 1, 3, 6, 12 and 24 months. Marginal bone loss, probing pocket depth, bleeding on probing and plaque index were also recorded. GT and KMW increased between baseline and 1 month, slightly decreased between 1 month and 12 months (P<0.001) and remained stable between 12 and 24 months (P<0.001). After 2 years, mean marginal bone loss level was 0.51 ± 0.63mm, with no probing pocket depth values >5mm and no concomitant signs of inflammation registered. Pink aesthetic score was 8.3. Combining an ADM and guided bone regeneration with early implant placement revealed a significant increase of 1.9mm for GT and 1.6mm for KMW after 2 years, showing good patient satisfaction regarding the aesthetic outcomes of soft tissues and prosthetic crown.

A 5-year cohort study on early implant placement with guided bone regeneration or alveolar ridge preservation with connective tissue graft.

PURPOSE: To assess on the one hand the 5-year outcome of early implant placement with guided bone regeneration (EIP/GBR) and on the other hand of alveolar ridge preservation with late implant placement and connective tissue graft (ARP/CTG). MATERIALS AND METHODS: Patients who had been treated with a single implant in the anterior maxilla in 2014 were selected for reevaluation in 2019. In the EIP/GBR cohort, implants were installed 4 to 8 weeks following extraction and the buccal contour was overbuilt by means of GBR. In the ARP/CTG cohort, collagen-enriched deproteinized bovine bone mineral was applied at the time of extraction and implants were installed 5 months later. All ARP/CTG cases received a buccal CTG 3 months after implant installation to reestablish buccal convexity. Primary outcomes were the pink esthetic score (PES) (Belser et al 2009) and the mucosal scarring index (MSI) (Wessels et al 2019). Clinical and radiographical parameters were secondary outcomes. RESULTS: Eighteen patients (9 females; mean age 52) in the EIP/GBR cohort, and 20 patients (9 females; mean age 38) in the ARP/CTG cohort were evaluated. PES was 6.28 following EIP/GBR. A (nearly) perfect aesthetic outcome defined as PES ≥8 was found in 3/18 cases. Perfect root convexity / soft tissue color and texture seemed most difficult to achieve. PES was 7.80 following ARP/CTG. A (nearly) perfect aesthetic outcome was found in 11/20 cases. MSI was 2.94 following EIP/GBR with 14/18 cases showing scarring. MSI yielded 0.50 following ARP/CTG with 6/20 cases showing scarring. In both cohorts, all implants survived, and none had developed periimplantitis. However, implants in the ARP/CTG cohort demonstrated a 5.4 times higher risk for periimplant mucositis than implants in the EIP/GBR cohort at 5 years follow-up. CONCLUSION: EIP/GBR and ARP/CTG showed acceptable long-term outcomes. The aesthetic outcome was particularly favorable following ARP/CTG, yet this should be interpreted with caution due to selection bias and because soft tissue grafting was not performed in the EIP/GBR cohort. Randomized controlled trial (RCTs) comparing EIP with ARP are required to assess the need for soft tissue grafting and to evaluate clinical, aesthetic, volumetric, and patient-reported outcomes. Only on the basis of such studies clinical recommendations can be made.

Extraction Socket Management Utilizing Platelet Rich Fibrin: A Proof-of-Principle Study of the "Accelerated-Early Implant Placement" Concept.

Dental implants are widely accepted as the golden standard for the rehabilitation of an edentulous site following the extraction of a tooth. The ideal time for implant placement is dependent on the time required for partial or complete tissue healing and the adequacy of socket dimensions. The use of autologous growth factors is a promising new concept that aids clinicians in minimizing treatment time and increasing patient satisfaction. The purpose of this paper is to introduce a protocol for "accelerated-early" implant placement. In this protocol, platelet rich fibrin is employed to accelerate soft and hard tissue healing and to provide a better-healed recipient site for accelerated, early implant placement. Histological analysis revealed that at 6 weeks postextraction, the application of our approach resulted in delicate newly formed bone showing intense osteoblastic activity surrounded by connective tissue as well as areas of mineralized tissue. The present study is a proof-of-principle study of the acceleration of the physiologic postextraction healing sequelae with the use of autologous growth factors. The accelerated-early implant placement concept is a bioengineered protocol that may aid clinicians to achieve increased primary stability, by placing implants in ridges in an advanced stage of bone healing, while offering patients the benefits associated with early implant placement. Controlled studies are warranted to verify the reproducibility of this treatment concept and identify specific indications where the use of the presented technique can lead to significant clinical results.

Early peri-implant bone loss: a prospective cohort study.

The aim of this study was to measure the early peri-implant bone level changes before the completion of an implant-abutment connection and to evaluate the influence of demographic, biologically relevant, anatomical, and implant-specific variables on these changes. A prospective cohort study design was used. STROBE guidelines were followed. The sample comprised 493 implants placed using a two-stage surgical procedure. Random allocation was used to determine the implant placement depth. Peri-apical radiographs taken at implant insertion and at the second surgery 2 months later were matched. Kappa statistics were used to compute intra- and inter-examiner reliability. The statistical analysis was performed at the implant level. Two-way analysis of variance (ANOVA) with the Bonferroni adjusted post hoc test was used to evaluate the influence of variables. One-way ANOVA with Tukey's range test and unpaired Student t-tests were used to analyze significant variables. Early marginal bone remodelling was -0.86 mm. The timing of implant placement (P=0.00) and the depth of implant placement (P≤0.05) significantly influenced early bone remodelling. Relevant radiographic early bone loss was found, but implants initially positioned below the alveolar crest and inserted ≥3 months after tooth extraction showed statistically significant higher marginal bone loss during the healing phase.

Full mouth rehabilitation with implant-supported prostheses for severe periodontitis: a case report.

Oral rehabilitation for a patient with severe loss of alveolar bone and soft tissue resulting from severe periodontitis presents a challenge to clinicians. Replacing loosening natural teeth with fixed prostheses supported by dental implants often requires either gingival surgery or bone grafting. The outcome of the bone grafting is sometimes unpredictable and requires longer healing time and/ or multiple surgeries. The presence of periodontal inflammation and periapical lesions often delay the placement of bone grafts as well as dental implants. Here we present a clinical case of a patient undergone full mouth reconstruction with implant-supported fixed prostheses. We demonstrated that early placement of implants (three weeks after extractions) with minimal bone grafting may be an alternative to conventional bone grafting followed by implant placement. We believe that primary stability during implant placement may contribute to our success. In addition, composite resin gingival material may be indicated in cases of large fixed implant prostheses as an alternative to pink porcelain.