Immediate non-occlusal loading of immediate post-extractive versus delayed placement of single implants in preserved sockets of the anterior maxilla: 4-month post-loading results from a pragmatic multicentre randomised controlled trial.
ABSTRACT To compare the effectiveness of immediate post-extractive single implants with delayed implants placed in preserved sockets after 4 months of healing. Implants that achieved an insertion torque of at least 35 Ncm were immediately non-occlusally loaded.
Just after tooth extraction and in the presence of a loss of the buccal plate bone less than 4 mm, compared to the palatal wall, 106 patients requiring a single immediate postextractive implant in the maxilla from second premolar to second premolar were randomly allocated to immediate implant placement (immediate group; 54 patients) or to socket preservation using anorganic bovine bone covered by a resorbable collagen barrier (delayed group; 52 patients) according to a parallel group design at three different centres. Bone-to-implant gaps were to be filled with anorganic bovine bone, however this was not done in 17 patients (corresponding to 40% of those who should have been grafted). Four months after socket preservation, delayed implants were placed. Implants placed with an insertion torque >35 Ncm were immediately loaded with non-occluding provisional single crowns, replaced, after 4 months, by definitive crowns. Outcome measures were implant failures, complications, aesthetics assessed using the pink esthetic score (PES), and patient satisfaction, recorded by blinded assessors. All patients were followed up to 4 months after loading.
Nineteen (35%) implants were not immediately loaded in the immediate group versus 39 (75%) implants in the delayed placement group because an insertion torque >35 Ncm could not be obtained. No patient dropped out. Two implants failed in the immediate group (4%) versus none in the delayed group. More minor complications occurred in the immediate group (8) than the in the delayed group (1) and this was statistically significant (P = 0.032). At delivery of definitive crowns, 4 months after loading, aesthetics were scored as 12.8 and 12.6 in the immediate and delayed groups, respectively. There was no statistically significant difference (P = 0.5). Patients of both groups were equally satisfied.
There were more complications at immediate post-extractive implants when compared to delayed implants. The aesthetic outcome appears to be similar for both groups and it seems more difficult to obtain a high insertion torque in sockets preserved with anorganic bovine bone.
SourceAvailable from: Bruno Chrcanovic[Show abstract] [Hide abstract]
ABSTRACT: Objectives: The purpose of the present review was to test the null hypothesis of no difference in the implant failure rates, postoperative infection and marginal bone loss for the insertion of dental implants in fresh extraction sockets compared to the insertion in healed sites, against the alternative hypothesis of a difference. Methods: An electronic search was undertaken in July 2014. Eligibility criteria included clinical human studies, either randomized or not. Results: The search strategy resulted in 73 publications, with 8241 implants inserted in sockets (330 failures, 4.00%), and 19410 in healed sites (599 failures, 3.09%). The difference between the procedures significantly affected the failure rates (RR 1.58, 95%CI 1.27-1.95, P<0.0001). The difference was not statistically significant when studies evaluating implants inserted in maxillae or in mandibles were pooled, or when the studies using implants to rehabilitate patients with full-arch prostheses were pooled; however, it was significant for the studies that rehabilitated patients with implant-supported single crowns and for the controlled studies. There was no apparent significant effect of implants inserted in fresh extraction sockets on the occurrence of postoperative infection or on the magnitude of marginal bone loss. Conclusion: It is suggested that the insertion of implants in fresh extraction sockets affects the failure rates. However, it does not affect the marginal bone loss or the occurrence of postoperative infection. The results should be interpreted with caution due to the potential for biases and to the presence of uncontrolled confounding factors in the included studies, most of them not randomized.Journal of Dentistry 01/2015; 43(1):16-41. DOI:10.1016/j.jdent.2014.11.007 · 2.84 Impact Factor
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ABSTRACT: Purpose: The aim of this prospective multicentre study was to evaluate the clinical outcome of immediately loaded single implants. Materials and methods: Patients were recruited at six clinical centres. Inclusion criteria were singletooth replacement in fully healed sites or post-extraction sockets with adequate bone height and width, to place an implant of at least 3.5 mm in diameter and 10.0 mm in length. All implants (AnyRidge, MegaGen, Gyeongbuk, South Korea) were functionally loaded immediately after placement. After 3 months, final crowns were delivered. All implants were followed for 1 year. Outcome measures were: implant stability; complications; peri-implant marginal bone level changes; probing pocket depth. Results: Fifty-seven implants (38 in the maxilla and 19 in the mandible) were placed in 46 patients (23 males, 23 females, aged between 18 to 73 years). Ten implants were placed in post-extraction sockets. Two patients (two implants) withdrew from the study and were classified as drop-outs. At the end of the study, only one implant was lost in a healed site. All the surviving implants were stable, giving an overall 1-year survival rate of 97.7% (patient-based). A few complications (one patient experienced swelling after surgery, two had loosened abutments and another patient had a ceramic crown fracture) were encountered. After 1 year of functional loading, the patients had lost an average of 0.32 mm (± 0.22) of peri-implant marginal bone; the mean probing pocket depth (PPD) was 2.16 mm (± 0.68). Conclusions: Within its limit (limited number of patients treated and self-evaluation of the outcomes), this study supports the concept that immediate functional loading of single dental implants can be a successful treatment procedure, with satisfactory clinical outcomes. Conflict-of-interest statement: MegaGen Implant Co., Gyeongbuk, South Korea, the manufacturer of the implants used in this investigation, partially supported this study by donating the implants and prosthetic components; however, the research data belonged to the authors and by no means did Megagen interfere with the conduct of the study or the publication of the results.