Immediate and Early Placement of Dental Implants Healing ... course presentations...Immediate...
Transcript of Immediate and Early Placement of Dental Implants Healing ... course presentations...Immediate...
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Immediate and Early Placement of Dental Implants
Healing with Immediate Implants
David Wilson, DDS
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Protocols for Implant Placement
Type I: Implant placement immediately following tooth extraction and as part of the same surgical procedure
Type 2: Complete soft tissue coverage (typically 4-8wks)
Type 3: Substantial clinical and/or radiographic bone fill of the socket (typically 12-16 weeks)
Type 4: Healed site (typically more than 16 weeks)
Consensus Statements and Recommended Clinical Procedures Regarding the Placement of Implants in Extraction Sockets. Hammerle C, Chen S, Wilson T. Quintessence vol 19, supplement 2004
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Evaluation for Implant Timing
Overall patient treatmentEsthetic expectations of the patientSoft tissue quality, quantity, and morphologyBone quality, quantity, and morphologyPresence of pathologyCondition of adjacent teeth and supporting structures
Consensus Statements and Recommended Clinical Procedures Regarding the Placement of Implants in Extraction Sockets. Hammerle C, Chen S, Wilson T. Quintessence vol 19, supplement 2004
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Immediate Implant Loading: within 1week of placement
Early Implant Loading: 1 week - 2 months
Conventional Loading: > 2 months
The Effectiveness of Immediate, Early, and Conventional Loading of Dental Implants: A Cochrane Systematic Review of Randomized Controlled Clinical Trials. Esposito M, Gabriella M, Willings M, Coulthard P, Worthington H. Ing J Oral Maxillofac
Implants 2007;22:893-904
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Reduced treatment time
Reduced number of surgeries
Psychological
Advantages of Immediate Implants
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Cannot assure patient that implant will be placed that day
Potentially higher failure rates
Potential Lack of KT
Disadvantages of Immediate Implants
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Insertion torque < 30 N/cmPoor bone qualityOcclusion (ej deep overbite)Active infectionLack of KTParafunctional habits< 10mm bone height < 3-4mm apical bone for immediate implants
The Effectiveness of Immediate, Early, and Conventional Loading of Dental Implants: A Cochrane Systematic Review of Randomized Controlled Clinical Trials. Esposito M, Gabriella M, Willings M, Coulthard P, Worthington H. Ing J Oral Maxillofac
Implants 2007;22:893-904
Immediate Loading: Contraindications
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Extraction socket repair 1. Hemorrhage!
2.Clot formation!
3. Inflammatory reaction-> recruitment of cells!
4. 48-72 hrs granulation tissue starts to replace clot!
5. 4 days- epithelium proliferates, immature CT!
6. 7 days- granulation tissue completely replaces clot, osteoid evident at the base of socket!
7. 2-3 weeks (3 to 4 wks after ext)- CT replaces granulation tissue, osteoid mineralizes coronally !
8. 6 weeks- epithelialization complete, bone fills more than 2/3 of socket!
Boyne 1966, Amler 1969, Darby 2009!
pearldentalclinic.co.uk!
Courtesy of Dr. Prokopets
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Immediate Implants: Prevent Bone Resorption?
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004)18 pts with a total of 21 teeth scheduled for extraction
All received immediate implants with flap elevation
Gap not filled / no membranes placed
4 months re-entry, gap measuredHard-tissue alterations following immediate implant placement in extraction sites. Botticelli D, Berglundh T, Lindhe J. J Clin
Periodontol 2004;31:820-828
Immediate Implants: Prevent Bone Resorption?
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Horizontal bone resorption about 56%
70% of total horizontal bone resorption was attributed to buccal bone
Vertical resorption:buccal: 0.3lingual: 0.6mesial: 0.2distal: 0.5
Hard-tissue alterations following immediate implant placement in extraction sites. Botticelli D, Berglundh T, Lindhe J. J Clin Periodontol 2004;31:820-828
Gaps filled with bone from inside of the defects, but substantial ridge resorption noted
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5 Beagles
Sectioned teeth and removed one root on each side
Control: socket left to heal
Test: SLA implant placed
Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. Araujo M, Sukekava F, Wennstrom J, Lindhe J. J Clin Periodontol 2005;32:645-652
Immediate Implants: Prevent Bone Resorption?
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Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. Araujo M, Sukekava F, Wennstrom J, Lindhe J. J Clin Periodontol 2005;32:645-652
Bony resorption was the same with or without immediate implant placement
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Multi-center study (4 centers)
Very strict inclusion criteria (ideal cases for Type I placement)
Conical or Straight implants placed (randomized)
Measurements taken at placement and re-entry (16wks)
A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Sanz M, Cecchinato D, Ferrus J, Pjetursson E, Lang N, Lindhe J. Clin Oral Impl
Res 2010;21:13-21
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Submerged healing protocol
Measurements taken to nearest half millimeter with a caliper by calibrated examiner (not the surgeon)
No difference in bony resorption (36% buccal /14% palatal)
Type I placement does not prevent bone resorption
A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Sanz M, Cecchinato D, Ferrus J, Pjetursson E, Lang N, Lindhe J. Clin Oral Impl
Res 2010;21:13-21
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Although B-L width changed, M-D dimensions did not (adjacent teeth were kept)
A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Sanz M, Cecchinato D, Ferrus J, Pjetursson E, Lang N, Lindhe J. Clin Oral Impl
Res 2010;21:13-21
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Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. Grunder U. Int J Periodontics Restorative Dent
2011;31:9-17
Immediate Implants: CTG at time of placement
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Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. Grunder U. Int J Periodontics Restorative Dent
2011;31:9-17
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24 pts treated consecutively with immediate implants in anterior maxilla
12 without CT graft / 12 with CT graft
Healing abutment placed at time of Sx and removable prosthesis delivered
Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. Grunder U. Int J Periodontics Restorative Dent
2011;31:9-17
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Bucco-lingual volume measured before tx and 6months after Sx
No CT graft group: avg loss 1.1mm (range 0.23-2.0mm)
CT graft group: avg gain 0.34mm (range 0.0-1.5mm)
Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. Grunder U. Int J Periodontics Restorative Dent
2011;31:9-17
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No bone defect around tooth to be extracted
Soft tissue level that would still be in harmony with the gingival level of the adjacent teeth AFTER some shrinkage in the apical direction
Thick Biotype
Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. Grunder U. Int J Periodontics Restorative Dent
2011;31:9-17
Recommendations for case selection in esthetically demanding patients
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Araujo 2005
Immediate Implants: Graft Gap?
Covani 2004
Gaps < 2mm fill spontaneously
Paolantonio 2001
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Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
Tarnow 2011
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Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
No primary flap closure
No bone grafting
No membrane
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Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
Straight healing abutment placed
4.2mm buccal gap
Allowed 5 months healing time
Biopsied 10 months after placement
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Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
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Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
3.2mm wide buccal plate
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Immediate Implants: Fill Gap?
Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
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Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J
Periodontics Restorative Dent 2011;31:515-521
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Tarnow 2014
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Flapless postextraction socket implant placement in the estheetic zone: Part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Tarnow D, Chu S, Salama M, Stappert C,
Salama H, Garber D, Sarnachiaro G, Sarnachiaro E, Luis S, Saito H. Int I Periodontics Restorative Dent 2014;34:323-331
Immediate Implants: Graft Gap?
Aim: evaluate horizontal changes of ridge after flapless extraction and immediate implant placement with and without grafting, with and without a provisional
49pts, 70% Central Incisors
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Facial-palatal changes evaluated form FMB and apical to labial bone crest
Teeth without endo lesions, dehiscences, recession, PD...
Flapless postextraction socket implant placement in the estheetic zone: Part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Tarnow D, Chu S, Salama M, Stappert C,
Salama H, Garber D, Sarnachiaro G, Sarnachiaro E, Luis S, Saito H. Int I Periodontics Restorative Dent 2014;34:323-331
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Minimum torque 35 N/cm
Flapless postextraction socket implant placement in the estheetic zone: Part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Tarnow D, Chu S, Salama M, Stappert C,
Salama H, Garber D, Sarnachiaro G, Sarnachiaro E, Luis S, Saito H. Int I Periodontics Restorative Dent 2014;34:323-331
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Maryland
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Casts were measured 6 months to 4 yrs after final delivery
Average 0.5mm less thickness at all points compared to contralateral natural teeth
Immediate Provisionalization does not prevent resorption
Flapless postextraction socket implant placement in the estheetic zone: Part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Tarnow D, Chu S, Salama M, Stappert C,
Salama H, Garber D, Sarnachiaro G, Sarnachiaro E, Luis S, Saito H. Int I Periodontics Restorative Dent 2014;34:323-331
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Immediate Placement and Provisionalization of Maxillary Anterior Single Implants: 1-Year Prospective Study. Kan J, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-39
Immediate Provisionalization
35 pts / 35 implants
100% survival at 1-yr
Mesial and Distal papilla -0.55mm and -0.53 respectively after 1-yr
Mesial and Distal bone change -0.26 and -0.22 respectively at 1-yr
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Immediate Placement and Provisionalization of Maxillary Anterior Single Implants: 1-Year Prospective Study. Kan J, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-39
Immediate Provisionalization
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Immediate Placement and Provisionalization of Maxillary Anterior Single Implants: 1-Year Prospective Study. Kan J, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-39
Midfacial change in position of gingiva -0.53
No pt noticed change at the gingival margin
All pts satisfied with the esthetic outcome
Immediate Provisionalization
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Immediate Placement and Provisionalization of Maxillary Anterior Single Implants: 1-Year Prospective Study. Kan J, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-39
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Immediate Placement and Provisionalization of Maxillary Anterior Single Implants: 1-Year Prospective Study. Kan J, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-39
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Comparison of Radiographic and Clinical Outcomes Following Immediate Provisionalization of single-tooth dental implats palced in healed alveolar ridges and extraction sockets. Cooper L, Raes F, Reside G, Soliva J, Giner L, Wiltfang J, Kern M, De
Bruyn H. Int J Oral Maxillofac Implants 2010;25:1222-1232
Prospective multi-center study, 1-yr follow-up
Measured Rx bone levels, soft tissue levels
139 pts / 157 implants in maxilla
58 implants healed ridges / 55 immediate / 23 needed bone grafting prior to DI placement / 11 DI lack primary stability
Healed Ridge vs Immediate Implant
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Comparison of Radiographic and Clinical Outcomes Following Immediate Provisionalization of single-tooth dental implats palced in healed alveolar ridges and extraction sockets. Cooper L, Raes F, Reside G, Soliva J, Giner L, Wiltfang J, Kern M, De
Bruyn H. Int J Oral Maxillofac Implants 2010;25:1222-1232
3 immediate implants failed (5.2%)
1 failed in healed ridge (1.5%)
Zenith stable or moved incisally after definitive placement in 84% of immediate implants and in 87% of implants in healed ridges after 1 year
All implants immediately provisionalized
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Comparison of Radiographic and Clinical Outcomes Following Immediate Provisionalization of single-tooth dental implats palced in healed alveolar ridges and extraction sockets. Cooper L, Raes F, Reside G, Soliva J, Giner L, Wiltfang J, Kern M, De
Bruyn H. Int J Oral Maxillofac Implants 2010;25:1222-1232
Responses of local bone and soft tissues at immediately loaded implants in extraction sockets or healed ridges were similar
1-year results suggest that clinical management of esthetically critical soft tissue may be predictably achieved in both indications
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Esthetic outcomes of immediate implant placements. Evans, C, Chen S. Clin Oral Implants Res 2008;19:73-80
42 implants immediately placed, mean follow-up 19mo
Retrospective study
Not immediately provisionalized (delayed provisionalization)
Maxilla and mandible
100% survival rate
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Esthetic outcomes of immediate implant placements. Evans, C, Chen S. Clin Oral Implants Res 2008;19:73-80
Highly SS change in crown height due to rec of 0.9mm for all sites, with no difference between implant systems
Thin biotype (probe seen through gingiva) more recession than thick (0.9 vs 0.7), NSSD
Implants with buccal shoulder position 3x more recession than lingual position (1.8 vs 0.6mm)
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Finite Element Anaylsis
Increased length and diameter of implant decreased stress and strain on alveolar crest
Stress and strain increased on horizontal loading vs vertical loading
Diameter had a more significant effect than length to relieve crestal stress and strain concentration
Effect of Diameter and Length on Stress Distribution of the Alveolar Crest around Immediate Loading Implants. Ding X, Liao S, Zhu X, Zhang X, Zhang L, Clin Implant Dent Relat Res vol 11, num 4, 2009
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Immediate Loading: Increased BIC
4 patients with 1 extra implant placed
Group A: immediate loading (non-functional)Group B: implants submerged
4 weeks: 1 of each group trephined out8 weeks: the other implants removed
Bone formation around immediately loaded and submerged dental implants with a modified sandblasted and acid-etched surface after 4 and 8 weeks: a human histologic and morphometric analysis. Degidi M,
Piatelli A, Shibil J, Perrotti V, Iezzi G. Int J Oral Maxillofac Implants 2009;24:896-901Wednesday, September 24, 14
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Immediate Loading: Increased BIC
Immediate Loading group: 4wks BIC 65.6%; 8wks 76.2%
Submerged group: 4wks 54.7%; 8wks 62.3%
Bone formation around immediately loaded and submerged dental implants with a modified sandblasted and acid-etched surface after 4 and 8 weeks: a human histologic and morphometric analysis. Degidi M,
Piatelli A, Shibil J, Perrotti V, Iezzi G. Int J Oral Maxillofac Implants 2009;24:896-901Wednesday, September 24, 14
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Outcome based on prosthesis failures, implant failures, and marginal bone levels measured on intraoral xrays
11 trials including 300pts:6 immediate vs conventional3 early vs conventional2 immediate vs early
NSSD between different loading protocols
The Effectiveness of Immediate, Early, and Conventional Loading of Dental Implants: A Cochrane Systematic Review of Randomized Controlled Clinical Trials. Esposito M, Gabriella M, Willings M, Coulthard P, Worthington H. Ing J Oral Maxillofac
Implants 2007;22:893-904
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Correlation between placement torque and survival of single-tooth implants. Ottoni J, Fagundes Z, Mansini R, Melo A. Int J Oral Maxillofac Implants 2005;20:769-776
When Immediate Loading Fails...
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10/23 immediately loaded implants failed
Single implants in anterior sites
9/10 failed implants had < 20 N/cm torque
No diet specifications given to paitents
Correlation between placement torque and survival of single-tooth implants. Ottoni J, Fagundes Z, Mansini R, Melo A. Int J Oral Maxillofac Implants 2005;20:769-776
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47 consecutive cases treated (10 I, 5 C, 30 PM)
Single implants placed after flapless extractions
Gap grafted with porcine bone and collagen membrane
Clinical exams and standard PAs taken at baseline, 1, 3, and 5 years
Smokers >10cigs/day and all diabetics excluded from study
Tissue Stability of Implants Placed in Fresh Extraction Sockets: A 5-Year Prospective Single-Cohort Study. Covani U, Canullo L, Toti P, Alfonsi F, Barone A. J Periodontol 2014;85:e323-e332
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Facial wall present after extraction
Implants submerged (no healing abutment/immediate load)
All implants restored 4-5 months later
Pre-med with atb and continued 4 days after sx
Tissue Stability of Implants Placed in Fresh Extraction Sockets: A 5-Year Prospective Single-Cohort Study. Covani U, Canullo L, Toti P, Alfonsi F, Barone A. J Periodontol 2014;85:e323-e332
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Survival rate at 5 years: 95.7% (1 removed at 7 and other 16mo)
Marginal Bone loss: SS1yr: -0.7
3yrs: -0.955yrs: -1.1
NSSD in width of KT (-0.2mm over 5yrs)
Tissue Stability of Implants Placed in Fresh Extraction Sockets: A 5-Year Prospective Single-Cohort Study. Covani U, Canullo L, Toti P, Alfonsi F, Barone A. J Periodontol 2014;85:e323-e332
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Facial Soft Tissue Level: 1yr: +0.71 5yr: +0.56 (decreased)
Patient satisfaction: 74% satisfied regarding overall implant tx73% satisfied regarding peri-implant soft tissue81% judged positively the finished crown appearanceNSSD at any point in time
Tissue Stability of Implants Placed in Fresh Extraction Sockets: A 5-Year Prospective Single-Cohort Study. Covani U, Canullo L, Toti P, Alfonsi F, Barone A. J Periodontol 2014;85:e323-e332
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Systematic Review 1991-2010
46 prospective studies, mean follow-up 2 years
Factors analyzed: reason for extraction, antibiotic use, position of implant (ant vs post, max vs man), type of loading
Only SS dif was for antibiotc use (POT atb lowered failures)
2-year survival rate 98.4%A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least
1 year. Lang N, Pun L, Yee K, Yan K, Wong M. Clin Oral Impl Res 23/Suppl 5, 2012, 39-66
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Most soft tissue changes occurred in first 3 months, and stabilized towards end of first year
Marginal bone loss mostly took place within first year of implant placement, usually being less than 1mm
A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Lang N, Pun L, Yee K, Yan K, Wong M. Clin Oral Impl Res 23/Suppl 5, 2012, 39-66
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275 implants immediately loaded in extraction sockets, 197 in periodontally infected sites (I, C, PM)
Marginal bone levels measured at baseline, 12, 24 and 48 months (digital PAs)
Immediate Loading of Dental Implats Placed in Periodontally Infected and Non-Infected Sites: A 4-Year Follow-Up Clinical Study. Crespi R, Cappare P, Gherlone E. J Periodontol 2010;81:1140-1146
Immediate Loading in Periodontally Infected Sites
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At 4 yrs: infected group 98.9% survival (2 implants lost within 1st month), non-infected group 100% survival
NSSD between MBL at 4yrs (both lost 0.79mm)
Immediate Loading of Dental Implats Placed in Periodontally Infected and Non-Infected Sites: A 4-Year Follow-Up Clinical Study. Crespi R, Cappare P, Gherlone E. J Periodontol 2010;81:1140-1146
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Summary
Type 1, 2, 3, and 4 DI placement have equal survival rates
More literature necessary for Type 2
SEVERAL CONTRAINDICATIONS FOR TYPE I PLACEMENT
More long-term studies needed for success of Type I Placement
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References
1. Consensus Statements and Recommended Clinical Procedures Regarding the Placement of Implants in Extraction Sockets. Hammerle C, Chen S, Wilson T. Quintessence vol 19, supplement 20042. The Effectiveness of Immediate, Early, and Conventional Loading of Dental Implants: A Cochrane Systematic Review of Randomized Controlled Clinical Trials. Esposito M, Gabriella M, Willings M, Coulthard P, Worthington H. Ing J Oral Maxillofac Implants 2007;22:893-9043. Hard-tissue alterations following immediate implant placement in extraction sites. Botticelli D, Berglundh T, Lindhe J. J Clin Periodontol 2004;31:820-8284. Ridge alterations following implant placement in fresh extraction sockets: an experimental study in the dog. Araujo M, Sukekava F, Wennstrom J, Lindhe J. J Clin Periodontol 2005;32:645-6525. A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Sanz M, Cecchinato D, Ferrus J, Pjetursson E, Lang N, Lindhe J. Clin Oral Impl Res 2010;21:13-216. Crestal ridge width changes when placing implants at the time of tooth extraction with and without soft tissue augmentation after a healing period of 6 months: report of 24 consecutive cases. Grunder U. Int J Periodontics Restorative Dent 2011;31:9-177. Human Histologic Verification of Osseointegration of an Immediate Implant Placed into a Fresh Extraction Socket With Excessive Gap Distance Without Primary Flap Closure, Graft, or Membrane: A Case Report. Tarnow D, Chu S. Int J Periodontics Restorative Dent 2011;31:515-521
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References
8. Flapless postextraction socket implant placement in the estheetic zone: Part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Tarnow D, Chu S, Salama M, Stappert C, Salama H, Garber D, Sarnachiaro G, Sarnachiaro E, Luis S, Saito H. Int I Periodontics Restorative Dent 2014;34:323-3319. Immediate Placement and Provisionalization of Maxillary Anterior Single Implants: 1-Year Prospective Study. Kan J, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-3910. Comparison of Radiographic and Clinical Outcomes Following Immediate Provisionalization of single-tooth dental implats palced in healed alveolar ridges and extraction sockets. Cooper L, Raes F, Reside G, Soliva J, Giner L, Wiltfang J, Kern M, De Bruyn H. Int J Oral Maxillofac Implants 2010;25:1222-123211. Esthetic outcomes of immediate implant placements. Evans, C, Chen S. Clin Oral Implants Res 2008;19:73-8012. Effect of Diameter and Length on Stress Distribution of the Alveolar Crest around Immediate Loading Implants. Ding X, Liao S, Zhu X, Zhang X, Zhang L, Clin Implant Dent Relat Res vol 11, num 4, 200913. Correlation between placement torque and survival of single-tooth implants. Ottoni J, Fagundes Z, Mansini R, Melo A. Int J Oral Maxillofac Implants 2005;20:769-77614. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Lang N, Pun L, Yee K, Yan K, Wong M. Clin Oral Impl Res 23/Suppl 5, 2012, 39-6615. Immediate Loading of Dental Implats Placed in Periodontally Infected and Non-Infected Sites: A 4-Year Follow-Up Clinical Study. Crespi R, Cappare P, Gherlone E. J Periodontol 2010;81:1140-1146
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References
16. Bone formation around immediately loaded and submerged dental implants with a modified sandblasted and acid-etched surface after 4 and 8 weeks: a human histologic and morphometric analysis. Degidi M, Piatelli A, Shibil J, Perrotti V, Iezzi G. Int J Oral Maxillofac Implants 2009;24:896-901
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