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      Survival rates and bone loss after immediate loading of implants in fresh extraction sockets (single gaps). A clinical prospective study with 4 year follow-up

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          Abstract

          Background

          The aim of this prospective study was to report the outcome of treatment with implants inserted after tooth extraction and immediately loaded.

          Material and Methods

          Fifty-six patients with single tooth loss were treated with 116 IPX Galimplant® implants with internal connections and a sandblasted, acid-etched surface. All implants were placed after tooth extraction using a flapless approach without bone regeneration, and they were then immediately loaded with cemented acrylic prostheses. After a period of three months, definitive cemented ceramic prostheses were placed. Patients were examined throughout a total of 4 years of follow-up. Marginal bone loss and survival rates were evaluated using digital periapical radiographs, taking into account clinical variables such as age, gender, smoking, history of periodontitis, etiology of extraction, placement site, diameter, and implant length. The Mann-Whitney U and Kruskal-Wallis non-parametric tests were used to compare differences between subgroups created based on the different clinical variables identified.

          Results

          Clinical results indicate an implant survival and success rate of 97.4%. Three implants were lost. Of the 116 immediate acrylic single crowns initially placed, 113 were replaced with definitive ceramic crowns after 3 months. A total of 77.8% of implants were inserted in the maxilla, while 22.2% were inserted in the mandible. No further complications were reported after the follow-up period (4 years). The mean marginal bone loss was 0.67 mm ± 0.40 mm. No differences were found among the subgroups of study patients.

          Conclusions

          This study indicates that dental implants that are inserted after tooth extraction and immediately loaded may constitute a successful and predictable alternative implant treatment.

          Key words:Dental implants, post-extraction implants, fresh sockets, immediate loading, immediate prostheses, implant dentistry.

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          Most cited references29

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          A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year.

          Niklaus P Lang, Lui Pun, Ka Lau … (2012)
          Type I immediate implant placement has gained popularity because it may reduce treatment time, number of surgeries and post-extraction bone loss. However, this is potentially challenged by inadequate keratinized mucosa for flap adaptation and difficulties in achieving primary stability. Moreover, it has been proven that post-extraction bone loss is an inevitable biological process, which affects treatment outcomes. To estimate survival and success rates of implants and the implant-supported prostheses, the prevalence of biological, technical and aesthetic complications, and the magnitude of soft and hard tissue changes following implant placement immediately into fresh extraction sockets. An electronic search in MEDLINE (PubMed) and the Cochrane Library from 1991 to July 2010 was performed to include prospective studies on immediate implants with a mean follow-up time of at least 1 year. The survival rates were computed using the STATA statistical software. Weighted means of soft and hard tissue changes were obtained by the inverse variance method. A total of 46 prospective studies, with a mean follow-up time of 2.08 years, were included. The annual failure rate of immediate implants was 0.82% (95% CI: 0.48-1.39%), translating into the 2-year survival rate of 98.4% (97.3-99%). Among the five factors analysed (reasons for extraction, antibiotic use, position of implant [anterior vs. posterior, maxilla vs. mandible), type of loading], only the regimen of antibiotic use affected the survival rate significantly. Lower failure rates were found in groups that were provided with a course of post-operative antibiotics. The success of implant therapy was difficult to assess due to scarce reporting on biological, technical and aesthetic complications. Soft tissue changes occurred mostly in the first 3 months after the provision of restoration, and then stabilized towards end of the first year. Marginal bone loss predominantly took place in the first year after implant placement, with a magnitude generally less than 1 mm. Controversy on hard tissue preservation with platform-switching technique remained unsolved. Despite the high survival rate observed, more long-term studies are necessary to determine the success of implant treatment provided immediately after tooth extraction. Special attention has to be given to aesthetic outcomes. © 2011 John Wiley & Sons A/S.
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            Smoking and dental implants: A systematic review and meta-analysis.

            Bruno Chrcanovic, Tomas Albrektsson, Ann Wennerberg (2015)
            Recent studies implicate smoking as a significant factor in the failure of dental implants. This review aims to test the null hypothesis of no difference in the implant failure rates, risk of postoperative infection, and marginal bone loss for smokers versus non-smokers, against the alternative hypothesis of a difference.
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              Factors influencing ridge alterations following immediate implant placement into extraction sockets.

              Bjarni E Pjetursson, Jorge Ferrús, Denis Cecchinato … (2009)
              To identify factors that may influence ridge alterations occurring at the buccal aspect of the extraction site following immediate implant placement. In 93 subjects, single-tooth implants were placed immediately into extraction sockets in the maxilla (tooth locations 15-25). A series of measurements describing the extraction site were made immediately after implant installation and at re-entry, 16 weeks later. The implant sites were stratified according to four factors: (i) implant location (anterior/posterior), (ii) cause of tooth extraction (periodontitis/non-periodontitis), (iii) thickness of the buccal bone walls ( 1 mm) and (iv) the dimension of the horizontal buccal gap ( 1 mm). (i) The location where the implant was placed (anterior/posterior) as well as (ii) the thickness of the buccal bone crest and (iii) the size of the horizontal buccal gap significantly influenced the amount of hard tissue alteration that occurred during a 4-month period of healing. At implant sites in the premolar segment, the fill of the horizontal gap was more pronounced than in the incisor-canine segment, while the vertical crest reduction was significantly smaller. Furthermore, at sites where the buccal bone wall was thick (>1 mm) and where the horizontal gap was large (>1 mm), the degree of gap fill was substantial. The thickness of the buccal bone wall as well as the dimension of the horizontal gap influenced the hard tissue alterations that occur following immediate implant placement into extraction sockets.
              Article 0 comments Cited 53 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Med Oral Patol Oral Cir Bucal
                Journal ID (iso-abbrev): Med Oral Patol Oral Cir Bucal
                Journal ID (publisher-id): Medicina Oral S.L.
                Title: Medicina Oral, Patología Oral y Cirugía Bucal
                Publisher: Medicina Oral S.L.
                ISSN (Print): 1698-4447
                ISSN (Electronic): 1698-6946
                Publication date (Print): March 2018
                Publication date (Electronic): 25 February 2018
                Volume: 23
                Issue: 2
                Pages: e230-e236
                Affiliations
                [1 ]Professor of Comprehensive Dentistry for Adults and Gerodontology. Faculty of Dentistry. University of Seville
                [2 ]Clinical Professor of Comprehensive Dentistry for Adults and Gerodontology. Faculty of Dentistry. University of Seville
                [3 ]Associate Professor of Comprehensive Dentistry for Adults and Gerodontology. Faculty of Dentistry. University of Seville
                [4 ]Associate Professor of Comprehensive Dentistry for Special Patients. Faculty of Dentistry. University of Seville
                Author notes
                Faculty of Dentistry University of Seville C/ Avicena s/n 41009-Sevilla Spain , E-mail: evelasco@ 123456us.es

                Conflict of interest statement: The authors have declared that no conflict of interest exist.

                Article
                Publisher ID: 21651
                DOI: 10.4317/medoral.21651
                PMC ID: 5911350
                PubMed ID: 29476669
                SO-VID: 953a9bcc-c6ee-4f15-a992-7a12175100b1
                Copyright © Copyright: © 2018 Medicina Oral S.L.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date accepted : 25 January 2018
                Date received : 21 September 2016
                Categories
                Subject: Research
                Subject: Oral Surgery

                ScienceOpen disciplines: Surgery
                Data availability:
                ScienceOpen disciplines: Surgery

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