Filiep Raes

Immediate and conventional single implant treatment in the anterior maxilla: 1‐year results of a case series on hard and soft tissue response and aesthetics

AIM The main objective of this clinical study was to document midfacial soft tissue dynamics following single immediate implant treatment (IIT) and conventional implant treatment (CIT) in the anterior maxilla when performed by experienced clinicians in well-selected patients. MATERIAL AND METHODS Appropriate bone volume and ideal soft tissue levels were considered requirements for implant therapy. Additional prerequisites for IIT were intact socket walls and a thick gingival biotype. CIT included standard flap elevation whereas IIT was either performed with a flap or flapless procedure. All implants were provisionally restored using cemented acrylic crowns. Bone levels, papillae and midfacial soft tissue levels were monitored at regular intervals. The aesthetic outcome was assessed after 1 year using the pink aesthetic score (PES) and white aesthetic score (WES). RESULTS Sixteen patients (10 men, six women; mean age 45) received an immediate implant and 23 patients (12 men, 11 women; mean age 40) had conventional implant surgery. One immediate implant failed in the early healing phase. The mean bone level from the implant-abutment interface was 0.85mm for IIT and 0.65mm for CIT after 1 year (p=0.144). Mesial papillae remained stable over time. Minute loss of distal papillae occurred following IIT (-0.38mm) and a tendency for re-growth was found following CIT (0.60mm). Midfacial soft tissues remained stable over time following IIT with only 7% showing advanced recession (>1mm). Flapless surgery induced less midfacial recession than flap surgery (p=0.023). Significant midfacial recession occurred following CIT (-1mm). Overall, 24% were aesthetic failures (PES<8 and/or WES<6) and 8% showed an (almost) perfect outcome (PES12 and WES9). The remainder (68%) demonstrated acceptable aesthetics. CONCLUSIONS Immediate implants demonstrated fairly stable midfacial soft tissue levels with only a minority of cases showing advanced recession. Irrespective of the timing of implant placement, aesthetic failures seem to be rather common and only a strict minority may show perfection.

Clinical, aesthetic and patient-related outcome of immediately loaded single implants in the anterior maxilla: a prospective study in extraction sockets, healed ridges and grafted sites

PURPOSE The objective of this prospective clinical study was to document the overall treatment outcome of immediately loaded single Astra Tech Osseospeed™ (Astra Tech AB, Mölndal, Sweden) implants placed in extraction sockets, healed ridges, and grafted sites. MATERIALS AND METHODS Forty-eight patients in need of a single implant in the anterior maxilla (15-25) were recruited. Patients were allocated to a conventional implant treatment (CIT) or immediate implant treatment (IIT) group on the basis of specific criteria. If the buccal bone plate was damaged or missing upon tooth removal, patients were allocated to a grafted implant treatment (GIT) group. Irrespective of the treatment concept, implants were immediately provisionalized. Hard and soft tissue alterations, aesthetic parameters (pink and white esthetic scores, [PES and WES]) and patients opinion (Oral Health Impact Profile [OHIP-14] questionnaires) were registered at different time points. RESULTS After 1 year of function, the overall implant survival rate was 98% with one failure following IIT. The mean bone level to the implant-abutment interface was 0.65 (SD 0.79), 0.85 (SD 0.64), and 0.56 mm (SD 0.44) for CIT, IIT, and GIT. Complete papilla loss was rare following either strategy. Mean midfacial recession amounted to 1.00 (SD 1.15), 0.12 (SD 0.78), and 0.49 mm (SD 0.82) for CIT, IIT, and GIT, respectively. The aesthetic outcome showed a mean PES of 10.30 (SD 1.89) and mean WES of 7.11 (SD 2.14), all patients considered. Patients satisfaction showed a significant improvement after 1 year of function on all seven domains (p < .001). CONCLUSIONS This prospective study showed that single implants clinically and aesthetically perform well under immediate non-occlusal loading conditions in the premaxilla. In this context, it is of pivotal importance to stress that patients were carefully selected for IIT and GIT.

Immediate Provisionalization of Dental Implants Placed in Healed Alveolar Ridges and Extraction Sockets: : A 5-year Prospective Evaluation

PURPOSE This 5-year prospective multicenter study compared implant survival and success, peri-implant health and soft tissue responses, crestal bone level stability, and complication rates following immediate loading of single OsseoSpeed implants placed in anterior maxillary healed ridges or extraction sockets. MATERIALS AND METHODS Individuals requiring anterior tooth replacement with single implants were treated and immediately provisionalized. Definitive all-ceramic crowns were placed at 12 weeks. Implant survival, bone levels, soft tissue levels, and peri-implant health were monitored for 5 years. RESULTS One hundred thirteen patients received implants in fresh sockets (55) and healed ridges (58). After 5 years, 45 and 49 patients remained for evaluation, respectively. During the first year, three implants failed in the extraction socket group (94.6% survival) and one implant failed in the healed ridge group (98.3% survival); this difference was not significant. No further implant failures were recorded. After 5 years, the interproximal crestal bone levels were located a mean of 0.43 ± 0.63 mm and 0.38 ± 0.62 mm from the reference points of implants in sockets and healed ridges (not a significant difference). In both groups, papillae increased over time and peri-implant mucosal zenith positions were stable from the time of definitive crown placement in sockets and healed ridges. Compared to flap surgery for implants in healed ridges, flapless surgery resulted in increased peri-implant mucosal tissue dimension (average, 0.78 ± 1.34 mm vs 0.19 ± 0.79 mm). CONCLUSION After 5 years, the bone and soft tissue parameters that characterize implant success and contribute to dental implant esthetics were similar following the immediate provisionalization of implants in sockets and healed ridges. The overall tissue responses and reported implant survival support the immediate provisionalization of dental implants in situations involving healed ridges and, under ideal circumstances, extraction sockets.

A Case-Control Study Assessing Oral-Health-Related Quality of Life After Immediately Loaded Single Implants in Healed Alveolar Ridges Or Extraction Sockets

INTRODUCTION Tooth loss reduces oral-health-related quality of life (OHRQoL) as assessed with the 14-item Oral Health Impact Profile questionnaire (OHIP-14). OBJECTIVES This prospective multicenter case-control study sought to (i) establish OHRQoL in patients requiring a single implant in the anterior maxilla and to (ii) compare these changes following implant placement and immediate provisionalization in extraction sockets with healed alveolar ridges up to 1 year. MATERIAL AND METHODS Ninety-six patients were enrolled in the study with 102 single implants (OsseoSpeed AstraTech) provisionalized immediately after placement in sockets or after placement in healed ridges. A final crown was cemented after 12 weeks. OHIP-14 was registered before surgery (baseline), after 1 (provisional crown), 6 and 12 months (final crown). Repeated measures ANOVA was performed for the seven conceptual OHIP Domains, the treatment group (extraction site socket vs. healed alveolar ridge) and time as within subjects variables. RESULTS Two implants failed, 1/48 (2.1%) in the extraction group (n=46 patients) and 1/54 (1.8%) in the healed ridge group (n=50 patients). From 82 patients (87.5%), OHIP-14 was available at all time points. The overall OHIP-14 based on the mean of the seven domains increases between baseline and 6 months and remained stable afterward for the total study group and both treatment groups. Comparison between extraction and healed groups revealed no significant difference at baseline but the healed group showed a significantly higher improvement for functional limitation, physical disability, physical pain and psychological discomfort (P<0.05). Between baseline and 1 year in the healed bone group, all seven domains improved significantly compared with only three domains in the extraction group. However, the overall OHIP-14 score between groups was not substantially different. Hence, both treatment modalities lead to similar OHRQoL improvement. CONCLUSION Patients in need of a single-tooth replacement have limited OHRQoL problems as reflected by the OHIP-14 score but improvements in several domains related to oral health were evaluated when implants were placed and provisionalized in healed bone and extraction sites.

Reliability of Circumferential Bone Level Assessment around Single Implants in Healed Ridges and Extraction Sockets Using Cone Beam CT

PURPOSE Cone beam computerized tomography (CBCT) provides three-dimensional information and could absolutely be useful for evaluating circumferential implant bone levels. However, the accuracy and precision of the technique has not been described. The aim of the study was to assess the accuracy and precision of CBCT (i-CAT®, Imaging Sciences International®, Hatfield, PA, USA) using periapical radiographs (PA) as a reference and to evaluate the circumferential bone level on CBCT around immediately loaded single implants placed in healed ridges (CIT, conventional implant treatment) and extraction sockets (IIT, immediate implant placement). MATERIALS AND METHODS PA and CBCT radiographs were obtained from 26 single Astra Tech Osseospeed™ implants (Astra Tech AB, Mölndal, Sweden) 1 year after loading in respectively healed ridges (CIT) or extraction socket (IIT). For accuracy analysis, the three mesial and three distal interproximal levels obtained by CBCT were pooled to enable a comparison with PA. Precision was analyzed by intra- and interexaminer reliability calculation from mesial and distal sites on CBCT. The circumferential bone level considered all eight positions assessed on CBCT. RESULTS Accuracy of CBCT was low (R = 0.325/p = .019) given the fact that bone level of the total group was 0.70 mm (standard deviation [SD] 0.78, range 0.00-3.20) on PA and 0.23 mm (SD 0.27, 0.00-1.20) on CBCT (p < .001) with only 42% of the measurements showing deviation within 0.2 mm. However, intra- and interexaminer reliability were favorable (R ≥ 0.611/p < .001, ≥ 83%). The mean circumferential bone level on CBCT was 0.21 mm (SD 0.30) and 0.26 mm (SD 0.18) for IIT and CIT, respectively. The impact of the treatment strategy was not significant. CONCLUSION PA should be the standard technique to assess interproximal bone level but correlates poorly with the CBCT measurements. However, the precision of CBCT was high. CBCT requires further improvements of hardware and/or software. Within the limitations of the study, there is an indication that the buccal bone 1 year after implant treatment is evenly preserved when implants are immediately loaded in extraction sockets or in healed bone.

Immediate provisionalization of dental implants in grafted alveolar ridges in the esthetic zone: a 5-year evaluation.

This clinical study assessed at 5 years both implant survival and peri-implant tissue architecture of immediately provisionalized implants placed 4 to 6 months following augmentation with demineralized bovine bone allograft and collagen membrane. Of 23 implants in 19 patients, one implant failed prior to loading (95.6% survival). Implant tissue relationships were stable following implant placement; marginal bone level changes from implant placement to 5 years (mean ± SD: -0.18 ± 0.79 mm, range: -1.6 to 1.4 mm, P = .51), the mesial and distal papilla length changes (mesial mean ± SD: 1.14 ± 0.92 mm, P < .001; distal mean ± SD: 0.74 ± 1.46 mm, P = .04), and the unchanged mucosal zenith location (mean ± SD: 0.24 ± 0.93 mm, P = .15) were recorded. There were no major surgical complications during the 5-year period. When augmentation is required, subsequent dental implant placement in the anterior maxilla may be achieved using immediate placement and provisionalization protocol to attain osseointegration success and stable peri-implant tissue responses.

Immediate Loading of Single Implants: A 2-Year Prospective Multicenter Study.

The aim of this prospective multicenter study was to evaluate the outcomes of single implants subjected to immediate functional loading. Inclusion criteria were single-tooth placement in postextraction sockets or fully healed sites, and sufficient bone height and width to place an implant of at least 3.5 × 10.0 mm. All implants were functionally loaded immediately after placement and followed for 2 years. Outcome measures were implant survival, complications, and peri-implant marginal bone loss (MBL). A total of 57 implants (38 maxilla, 19 mandible) were placed in 46 patients (23 men, 23 women, aged 18-73 years). Of these, 10 implants were placed in postextraction sockets. One implant failed, in a healed site, giving a patient-based overall 2-year survival rate of 97.6%. The incidence of biologic complications was 1.8%; prosthetic complications amounted to 7.5%. The peri-implant MBL was 0.37 ± 0.22 mm (healed sites: 0.4 mm ± 0.22; postextraction sockets: 0.3 mm ± 0.22). The immediate functional loading of single implants seems to represent a safe and successful procedure. Long-term follow-up studies on a larger sample of patients are needed to confirm these results.

Immediate functional loadingof single implants: a multicenter study with 4 years offollow-up

Background. In the current scientific literature there are only few studies on the immediate functional loading of single implants. The aim of the present present study was to evaluate the 4-year survival rate, complication rate and peri-implant marginal bone loss (PIMBL) of immediately loaded single implants inserted in healed ridges and fresh post-extraction sites. Methods. Six centers were involved in this prospective study. The surgical and prosthetic protocol was defined in detail, before the start of recruiting patients. Recruitment of patients and performance of surgeries took place between February 2012 and February 2013. Criteria for inclusion were single-tooth gaps in healed ridges and fresh post-extraction sockets. All the fixtures (Anyridge®, Megagen Corporation, Gyeongbuk, South Korea) were functionally loaded immediately after insertion and followed for a period of 4 years. Outcome measures were implant survival, complications and PIMBL. Results. Forty-six patients (18‒73 years of age) were selected. In total, 57 fixtures were placed (10 in fresh post-extraction sockets). After 4 years of functional loading, only one fixture was lost; therefore, high survival rates (97.6% patient-based; 98.1% implant-based) were reported. In addition, a limited incidence of biologic (4.8% patient-based; 3.8% implant-based) and prosthetic (9.7% patient-based; 7.6% implant-based) complications was reported. The overall 4-year PIMBL amounted to 0.38±0.21 mm (healed ridges: 0.4±0.21 mm; fresh post-extraction sockets: 0.33±0.20 mm). Conclusion. Loading single implants immediately seems to be a highly successful treatment modality. However, long-term data are needed to confirm these positive outcomes.

Clinical outcome after 8 to 10 years of immediately restored single implants placed in extraction sockets and healed ridges

Recent systematic reviews point to the scarcity of single implants followed up longer than 5 years, and the incidence of biologic/technical complications is underreported. This prospective follow-up study documents 8- to 10-year clinical outcomes of immediately restored single implants in extraction sockets (immediate implant treatment [IIT]) and healed bone (conventional implant treatment [CIT]). Patients received a single, chemically modified, moderately rough titanium implant and a provisional crown on the day of surgery in the anterior maxilla (second premolar to second premolar). Provisional crowns were replaced by permanent crowns after 10 weeks. Implant survival, complications, crestal bone changes, plaque score, probing depth, and bleeding on probing were regularly recorded up to 10 years of follow-up. Of 16 patients who underwent IIT, 11 could be evaluated after 8 years. Of the 23 patients who received an implant in healed bone, 18 were finally evaluated. One implant failed in the IIT group at 12 weeks; all implants survived in the CIT group; 38% of the patients experienced at least one complication; 10% had one or more biologic complications, whereas 31% experienced one or more technical complications. There were no significant changes in crestal bone level from 1 to ≥ 8 years of follow-up for either group or between IIT and CIT at any time point (P ≥ .129). Only 6.9% (2 of 29) implants demonstrated progressive bone loss > 2 mm combined with pockets ≥ 6 mm. Immediately restored single implants in extraction sockets and healed ridges demonstrate good long-term outcomes in terms of implant survival, crestal bone loss, and peri-implant health. However, biologic and especially technical complications are common.

A long-term prospective cohort study on immediately restored single tooth implants inserted in extraction sockets and healed ridges : CBCT analyses, soft tissue alterations, aesthetic ratings, and patient-reported outcomes

BACKGROUND Although many studies have been published on single implants, long-term data remain scarce. PURPOSE To evaluate immediately restored single implants after at least 8 years of follow-up in terms of buccal bone, soft tissue alterations, aesthetic ratings, and patient-reported outcomes. MATERIALS AND METHODS This prospective cohort study included patients who were consecutively treated with an immediately restored single implant installed in an extraction socket (IIT) or a healed ridge (CIT) in the anterior maxilla. Biomaterials were never used. CBCTs were taken at study termination, soft tissue alterations, and Pink Esthetic Score were evaluated between 1 year and study termination using standardized clinical images. Patient satisfaction was also registered. RESULTS About 11/16 initially treated patients in the IIT cohort (10 men, 6 women; mean age 45) and 18/23 initially treated patients in the CIT cohort (12 men, 11 women; mean age 40) could be evaluated after more than 8 years. A buccal bone wall less than 2 mm was found at all implant sites. A thin buccal bone wall less than 1 mm was found at 42% of the implant sites. In the CIT cohort, 8 patients had a missing buccal bone in the crestal area, although bone was present at the time of surgery. Alveolar process deficiency significantly deteriorated (P ≤ .046), whereas vertical soft tissue levels and PES remained stable over time in both cohorts. Patients expressed high overall satisfaction. CONCLUSIONS Substantial dimensional changes may be expected at the buccal aspect of single implants inserted in the premaxilla. As a result, contour augmentation procedures at the time of implant placement should be considered to counteract these bone alterations, even when implants are fully embedded in bone upon insertion.