Immediate versus delayed loading of dental implants placed in fresh extraction sockets in the maxillary esthetic zone: a clinical comparative study. Prospective evaluation of immediate and delayed provisional single tooth restorations. Instant provisionalization of immediate single-tooth implants is essential to optimize esthetic treatment outcome. Clinical and radiographic evaluation of implant-retained mandibular overdentures with immediate loading. Immediate implant placement with transmucosal healing in areas of aesthetic priority. A multicentre randomized-controlled clinical trial I. Surgical outcomes. Immediate versus early loading of two implants placed with a flapless technique supporting mandibular bar-retained overdentures: a single-blinded, randomised controlled clinical trial. Vertical bone augmentation versus 7-mm-long implants in posterior atrophic mandibles. Results of a randomised controlled clinical trial of up to 4 months after loading. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: a prospective clinical study. Immediate non-occlusal loading of single implants in the aesthetic zone: a randomized clinical trial.
The aim of this study was to report a clinical comparative assessment of crestal bone level change around single implants in fresh extraction sockets in the esthetic zone of the maxilla either immediately loaded or loaded after a delay.
                Forty patients were included in a prospective, randomized study. All patients required 1 tooth extraction (ie, 1 tooth with a hopeless prognosis) and were randomized into either the test group or the control group. Implants were positioned immediately after tooth extraction and were loaded immediately in the test group (20 implants) and after 3 months in the control group (20 implants). The implant site was prepared, with at least 4 mm of sound apical bone below the implant apex, and the coronal margin of the implant was placed at the buccal level of the bone crest. All implants were 13 mm long; 30 implants had a diameter of 5 mm, and 10 had a diameter of 3.75 mm. Radiographic examinations were made at baseline, at 6 months, and at 24 months. To compare the mean values between test and control group, a paired t test was performed (considered statistically significant at P < .05).
                After a 24-month follow-up period, a cumulative survival rate of 100% was reported for all implants. The control group resulted in a mean mesial bone loss of 1.16 +/- 0.32 mm and a mean distal bone loss of 1.17 +/- 0.41 (mean bone loss, 1.16 +/- 0.51 mm). The test group resulted in a mesial bone loss of 0.93 +/- 0.51 mm and a distal bone loss of 1.1 +/- 0.27 mm (mean bone loss, 1.02 +/- 0.53 mm). No statistically significant difference between control and test groups (P > .05) was found.
                The success rate and radiographic results of immediate restorations of dental implants placed in fresh extraction sockets were comparable to those obtained in delayed loading group. The purpose of this study was 2-fold: to determine whether there is a significant difference in the hard and soft tissue response comparing immediate with delayed implant placement after tooth removal, with immediate provisionalization, in maxillary anterior sites; and to determine and compare the crestal bone levels as the primary endpoint variable for implants placed and immediately temporized in extraction sites, to implants placed into extraction sites after the extraction site has been grafted and healed for 4 months, all immediately restored with an anatomic provisional restoration. This aim was to be evaluated by measuring crestal bone levels on standardized digital radiographs of the implants, using implant threads as a monitor of magnification and a pre-extraction reference. Secondary endpoint variables include soft tissue measures compared with method.
                A total of 76 patients were recruited and randomized into treatment groups. Group 1 had a maxillary tooth (premolar, canine, lateral or central incisor) removed, with immediate socket grafting, followed by implant placement and provisionalization 4 months later with a single tooth. Group 2 had immediate implant placement and provisionalization. Standardized radiograph holders were used to expose digital radiographs every 6 months from baseline to up to 2 years restored. Soft tissue measures were made from standardized reference points. Data collected were analyzed by a statistician to test the hypotheses.
                A total of 55 patients completed their follow-up. Twenty-one patients were lost to follow-up because of implant loss (n = 5), 1 treated out of protocol because of labial bone loss found at the time of tooth removal (n = 1), geographic relocation (n = 11), dropped for noncompliance (n = 3), or medical problems (n = 1). The analyses showed no significant differences between groups in implant integration or crestal interdental bone movement on either the implant or the adjacent tooth. The bone level on the implants did move from the baseline levels during the first 6 months but not thereafter. There were no differences (P > .05) observed when comparing the interactions between groups, tooth locations, or time. There was a significant (P < .05) difference in the position of the facial gingival margin with a more apical position of the facial gingival margin in the delayed group compared with the immediate group during the course of the study.
                Crestal bone response to immediate or delayed placement of an implant into an extraction site in the maxillary anterior region with immediate provisionalization is similar regarding hard tissue changes. Support of the gingival margin with a provisional at the time of tooth extraction and implant placement preserved 1 mm more facial gingival margin position compared with the delayed group. The decision to use either method must consider the movement of the facial gingival margin, which, in a critical esthetic patient may require soft tissue support from a provisional restoration or similar type of anatomical healing abutment. The immediate single-tooth implant has become a viable treatment option. However, the impact of the restorative procedure on esthetics is currently unclear. The goal of this study was to compare the soft tissue outline at immediate implants following two restorative protocols: immediate connection of a temporary crown or submerged healing during which a removable partial denture is used.
                A 1-year single-blind randomized clinical study was performed in 49 patients. Twenty-four patients were assigned to the immediate restoration group and 25 to the delayed restoration group. Clinical and radiographic evaluations of soft and hard tissues were carried out after 3, 6 and 12 months.
                Implant survival, bone remodeling, probing depth and bleeding tendency were not influenced by the restorative protocol. Delayed restoration resulted in initial papilla loss taking up to 1 year to attain comparable height as for immediate restoration. Midfacial recession was systematically 2.5-3 times higher following delayed restoration pointing to a 0.75 mm additional loss in comparison with immediate restoration after 1 year.
                If the primary implant stability permits it, immediate single-tooth implants should be instantly provisionalized in the interest of optimal midfacial esthetics. The aim of this study was to evaluate and compare immediate-loaded implant-retained mandibular overdentures and delayed-loaded implant-retained mandibular overdentures.
                Ten completely edentulous male patients received 40 dental implants. Patients were randomly divided into 2 equal groups, 5 patients each. Patients of both groups received conventional maxillary complete denture and had stage 1 surgery for placing 4 dental implant fixtures, 2 on each side anterior to the mental foramina. Group A: One-stage surgical procedure and immediate loading. Patients in this group received mandibular bar-retained overdenture supported by 4 endosseous implants loaded immediately after implant placement. Group B: The original 2-stage concept and delayed loading. Patients in this group received mandibular bar-retained overdenture supported by 4 endosseous implants that remained submerged for a period of 4 months before loading. The patients were evaluated clinically and radiographically immediately after overdenture delivery and after 6 months, 12 months, 18 months, and 24 months.
                The results of clinical evaluation showed no statistical significant difference between the 2 groups regarding the effect of treatment. The radiographic assessment showed no statistical significant difference in mesial and distal alveolar bone loss at the different intervals of the follow-up period, except at the 12-month period, where immediately loaded implants showed a decrease in the amount of alveolar bone loss mesially and distally compared to delayed loaded implants.
                The results suggest that immediate-loaded implants provide promising results compared to delayed-loaded implants and can be a possible alternative procedure in implant dentistry. To compare the clinical outcomes of standard, cylindrical, screw-shaped to novel tapered, transmucosal (Straumann Dental implants immediately placed into extraction sockets. Material and methods: In this randomized-controlled clinical trial, outcomes were evaluated over a 3-year observation period. This report deals with the need for bone augmentation, healing events, implant stability and patient-centred outcomes up to 3 months only. Nine centres contributed a total of 208 immediate implant placements. All surgical and post-surgical procedures and the evaluation parameters were discussed with representatives of all centres during a calibration meeting. Following careful luxation of the designated tooth, allocation of the devices was randomly performed by a central study registrar. The allocated SLA titanium implant was installed at the bottom or in the palatal wall of the extraction socket until primary stability was reached. If the extraction socket was >or=1 mm larger than the implant, guided bone regeneration was performed simultaneously (Bio Oss and BioGide. The flaps were then sutured. During non-submerged transmucosal healing, everything was done to prevent infection. At surgery, the need for augmentation and the degree of wound closure was verified. Implant stability was assessed clinically and by means of resonance frequency analysis (RFA) at surgery and after 3 months. Wound healing was evaluated after 1, 2, 6 and 12 weeks post-operatively.
                The demographic data did not show any differences between the patients receiving either standard cylindrical or tapered implants. All implants yielded uneventful healing with 15% wound dehiscences after 1 week. After 2 weeks, 93%, after 6 weeks 96%, and after 12 weeks 100% of the flaps were closed. Ninety percent of both implant designs required bone augmentation. Immediately after implantation, RFA values were 55.8 and 56.7 and at 3 months 59.4 and 61.1 for cylindrical and tapered implants, respectively. Patient-centred outcomes did not differ between the two implant designs. However, a clear preference of the surgeon's perception for the appropriateness of the novel-tapered implant was evident.
                This RCT has demonstrated that tapered or standard cylindrical implants yielded clinically equivalent short-term outcomes after immediate implant placement into the extraction socket. To evaluate the efficacy of immediate loading versus early loading at 6 weeks of bar-retained mandibular overdentures supported by two implants placed with a flapless technique.
                Sixty patients were randomised: 30 to the immediately loaded group and 30 to the early loaded group. To be immediately loaded, implants had to be inserted with a minimum torque > 48 Ncm. Outcome measures were prosthesis and implant failures, biological and biomechanical complications, patient satisfaction, and Implant Stability Quotient (ISQ) assessed with a resonance frequency analysis instrument.
                Sixty implants were placed in each group. Flaps had to be raised in nine patients to check drill direction or to better visualise the area after multiple teeth extraction. Two implants in two patients did not reach the planned insertion torque and were immediately replaced by larger diameters ones. After 1 year no drop out occurred and two early loaded implants failed in two patients. There were no statistically significant differences between groups for prosthesis failures, implant losses, complications, and mean ISQ values; however, patients in the immediately loaded group were significantly more satisfied than those loaded early. When comparing mean ISQ values taken 6 weeks after placement with 1-year data within each group, values decreased significantly.
                Mandibular overdentures can be successfully loaded the same day of implant placement with a minimally invasive surgery, increasing patient satisfaction while decreasing treatment time and patient discomfort. No apparent advantages were seen when loading the overdentures at 6 weeks. To evaluate whether 7-mm-long implants could be a suitable alternative to longer implants placed in vertically augmented bone for the treatment of atrophic posterior mandibles.
                Sixty partially edentulous patients having 7 to 8 mm of residual crestal height and at least 5.5 mm thickness measured on a computed tomography scan above the mandibular canal were randomised to receive either two to three submerged 7-mm-long NanoTite External Hex implants (Biomet 3i) or 10-mm or longer implants (30 patients per group) placed in vertically augmented bone. Bone was augmented with anorganic bovine bone blocks (Bio-Oss) using a sandwich technique and resorbable barriers. The grafts were left healing for 5 months before placing the implants, which were submerged. Four months after implant placement, provisional acrylic prostheses were delivered. Definitive screw-retained metal-ceramic prostheses were delivered 4 months later. Outcome measures were: prosthesis and implant failures, any complications, and time needed to fully recover mental nerve sensitivity. All patients were followed up to the delivery of the final restorations (4 months after loading).
                No patient dropped out. In two patients of the augmented group, there was not enough space to place 10-mm or longer implants as planned and 7-mm-long implants were used instead. The most likely reason for this is that the Bio-Oss blocks fractured in many pieces at placement. One prosthesis could not be placed when planned in the 7-mm group versus three prostheses in the augmented group, because of failure of one implant in each patient. The difference was not statistically significant. All implants were successfully replaced and final prostheses delivered. Four complications (wound dehiscence) occurred during graft healing in the augmented group (one possibly associated with the failure of one implant) versus none in the 7-mm-long implant group. The difference was not statistically significant. No patient suffered from permanent paraesthesia of the alveolar inferior nerve; however, sensitivity was recovered significantly faster in the short implant group.
                The early results of this study suggest that, when the residual bone height over the mandibular canal is between 7 and 8 mm, 7-mm short implants might be a preferable choice since the treatment is faster, cheaper and associated with less morbidity than vertical bone augmentation. These preliminary results must be confirmed by follow-ups of 5 years or more in order to monitor the performance of short implants over time. The aim of this study was to compare bone healing and crestal bone changes following immediate (Im) versus delayed (De) placement of titanium dental implants with acid-etched surfaces (Osseotite) in extraction sockets.
                Forty-six patients were randomly allocated to the Im or De group (n = 23 per group) and received 1 implant at the incisor, canine, or premolar region of the maxilla or the mandible. The implants were placed an average of 10 days following tooth extraction in the Im group and approximately 3 months after extraction in the De group. The widths (parallel and perpendicular to the implant) and the depth of marginal bone defects around the implants were measured clinically just after placement and 3 months later at the abutment surgery. The crestal bone changes mesially and distally to the implants were evaluated radiographically by linear measurements.
                The survival rates were 91% in the Im group and 96% in the De group. In the Im group, the mean reductions in parallel width, perpendicular width, and depth of the largest defect of each implant amounted to 48% (from 4.4 to 2.3 mm), 59% (from 2.2 to 0.9 mm), and 48% (from 6.9 to 3.6 mm), respectively. The corresponding mean reductions in the De group amounted to 39% (from 3.1 to 1.9 mm), 77% (from 1.3 to 0.3 mm), and 34% (from 4.4 to 2.9 mm). The reduction over time was statistically significant in both groups (P < .04). For both groups, a higher degree of bone healing was achieved in the infrabony defects (> 60% for depth) than in dehiscence-type defects (approximately 25%). Furthermore, 70% of the 3-wall infrabony defects with a parallel width of up to 5 mm, a depth of maximum 4 mm, and a perpendicular width of maximum 2 mm had a capacity of spontaneous healing within a period of 3 months.
                New bone formation occurs in infrabony defects associated with immediately placed implants in extraction sockets. this study compared the outcome of immediate non-occlusal loading with conventional loading for single implants in the maxillary aesthetic zone. It was hypothesized that immediate non-occlusal loading is not inferior to conventional loading.
                sixty-two patients with a missing maxillary anterior tooth were randomly assigned to be treated with an implant that was either restored with a non-occluding temporary crown within 24 h after implant placement (the "immediate group") or was restored according to a two-stage procedure after 3 months (the "conventional group"). All implants were installed in healed sites. Follow-up visits were conducted after 6 and 18 months post-implant placement. Outcome measures were radiographic marginal bone-level changes, survival, soft tissue aspects (probing depth, plaque, bleeding, soft tissue level), aesthetics and patient satisfaction.
                no significant differences were found between both study groups regarding marginal bone loss (immediate group 0.91 ± 0.61 mm, conventional group 0.90 ± 0.57 mm), survival (immediate group 96.8%: one implant lost, conventional group 100%), soft tissue aspects, aesthetic outcome and patient satisfaction.
                within the limitations of this study (sample size, follow-up duration), it was demonstrated that, for single implants in the anterior maxilla, the outcome of immediate non-occlusal loading was not less favourable than conventional loading.
There is insufficient evidence to determine possible advantages or disadvantages of immediate, immediate-delayed or delayed implants, therefore these preliminary conclusions are based on few underpowered trials often judged to be at high risk of bias. There is a suggestion that immediate and immediate-delayed implants may be at higher risks of implant failures and complications than delayed implants on the other hand the aesthetic outcome might be better when placing implants just after teeth extraction. There is not enough reliable evidence supporting or refuting the need for augmentation procedures at immediate implants placed in fresh extraction sockets or whether any of the augmentation techniques is superior to the others.