RESUMEN
PURPOSE: To evaluate the role of different healing abutment designs in compensating for the buccolingual volumetric tissue change that occurs following flapless single-tooth immediate extraction placement in the molar area. MATERIALS AND METHODS: Patients in need of extraction and replacement of a first or second molar in the mandible or maxilla were consecutively recruited. Immediately after extraction and implant placement, an abutment was connected. Five different types of abutments were randomly selected to be used for each case. The study population was divided into five categories according to abutment design: 5-mm diameter healing abutment (group 1); 6-mm diameter healing abutment (group 2); 7.5-mm diameter healing abutment (group 3); provisional restoration (group 4); and customized healing abutment (group 5). The buccopalatal dimension (BPD) was measured on the study casts at 1, 3, and 5 mm apical to the free gingival margin, and horizontal volumetric changes were compared between baseline and 2, 4, and 6 months. RESULTS: A total of 267 implants were inserted in 246 patients. The breakdown of placed implants for each group was as follows: 67 implants in group 1; 64 in group 2; 71 in group 3; 33 in group 4; and 32 in group 5. Changes in the mean horizontal ridge dimension were as follows. After 6 months in group 1, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 4.21 ± 0.158, 3.38 ± 0. 178 and 2.35 ± 0.178 mm. In group 2, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 3.16 ± 0.198, 2.56 ± 0.198, and 1.62 ± 0.198 mm. In group 3, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 2.53 ± 0.138, 2.16 ± 0.144, and 1.56 ± 0.144 mm. In group 4, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 1.11 ± 0.179, 1.23 ± 0.179, and 1.12 ± 0.179 mm. In group 5, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 0.25 ± 0.225, 0.30 ± 0.225, and 0.19 ± 0.225 mm. Mixed-effect regression and post hoc means comparisons were used to model the impact of the restoration technique, height of measurement, and time on BPD using a significance reference level of .05. Statistical analysis showed that the type of abutment, the height of measurement, and the time significantly influenced the BPD and that there were complex interaction effects between these variables. CONCLUSION: The observed volumetric soft tissue changes in the 6-month short-term follow-up appeared to vary based on the use of different healing abutment sizes that were connected to implants placed immediately after tooth extraction in the molar area. In particular, the use of a customized healing abutment resulted in preservation of the original horizontal dimension of the molar soft tissue.
Asunto(s)
Implantes Dentales de Diente Único , Implantes Dentales , Carga Inmediata del Implante Dental , Humanos , Diente Molar/cirugía , Extracción Dental/efectos adversos , Alveolo Dental/cirugíaRESUMEN
STATEMENT OF PROBLEM: Adjusting an interim screw-retained crown made of acrylic resin for maintenance of peri-implant soft tissues after immediate implant insertion requires accuracy and time. Assessments of these factors by using digital techniques are sparse. PURPOSE: The purpose of this clinical study was to describe a technique to fabricate an acrylic resin interim crown by using the data acquired from a cone beam computed tomography (CBCT) scan. The 3D tomography files were converted to a standard tessellation language (STL) file format used to print or to mill the interim crown with a technique called digital immediate tooth restoration (DITR). Additionally, the chair time spent during the prosthetic phase was evaluated in comparison with a protocol in which a standard interim crown (SIC) was fabricated with an indirect-direct technique. MATERIAL AND METHODS: Patients who needed to replace a single nonrestorable tooth were treated from February to June 2018 with an immediately placed implant and an acrylic resin screw-retained interim prosthesis that was connected to the implant immediately after placement of the implant. The participants were divided into 2 groups according to the acrylic resin interim crown fabrication technique: group DITR and group SIC. The average time to finalize the prostheses was compared between the groups. The total chair time (TCT) taken for the adaptation of the interim crown was noted and distinguished in 3 different times corresponding to each phase of adaptation of the interim restoration of the interproximal contact areas (CT1), adaption of the postextractive alveolar bone walls (CT2), and adaption of the occlusal contacts (CT3). For each time, the number of changes (N-CT1, N-CT2, N-CT3, and TN) needed to complete each prosthetic phase was also marked and observed. Generalized linear mixed models and generalized linear models were used for data analysis. All the sites were definitively restored with a screw-retained crown after 6 months of healing, and the participants were provided with standard hygiene recall appointments for the next year. RESULTS: A total of 82 crowns at sites distributed across the mandible and the maxilla were included in the study. Thirty-five were restored with an SIC and 47 with a DITR interim crown. None of the implants were lost during the 18-month follow-up period. The analysis of the chair times registered for the adaptation of the interim crown to the implant healing abutment and to the neighboring teeth between the 2 groups showed a reduction if a DITR interim crown was used (average CT1 of 15 ±14 seconds, CT2 of 2 ±5 seconds, CT3 of 59 ±19 seconds, and TCT of 76 ±28 seconds for group DITR and average CT1 of 135 ±27 seconds, CT2 of 185 ±30 seconds, CT3 of 73 ±16 seconds, and TCT of 394 ±61 seconds for group SIC). The number of corrections to finalize the interim crown adaptations was lower for the group DITR (0.81 ±0.74 for N-CT1, 0.19 ±0.39 for N-CT2, and 2.81 ±0.74 for N-CT3) when compared with the number of corrections needed for the group SIC (4.37 ±0.81 for N-CT1, 5.57 ±0.77 for N-CT2, and 3.86 ±0.64 for N-CT3). CONCLUSIONS: The data from CBCT scans led to interim acrylic resin crowns that needed fewer adjustments with the immediate implant placement and interim restoration approach, reducing chair time.
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Implantes Dentales de Diente Único , Implantes Dentales , Tomografía Computarizada de Haz Cónico Espiral , Resinas Acrílicas , Coronas , Prótesis Dental de Soporte Implantado , Humanos , MaxilarRESUMEN
This article aims to evaluate the effect of anatomically designed, single-unit provisional restorations on soft tissue preservation following immediate implant placement. Patients in need of a single-tooth replacement in the esthetic area were recruited for this study. An immediate provisional restoration with a transmucosal area anatomically designed to support the soft tissue was used for every patient. The horizontal volumetric tissue changes and the presence and amount of vertical recession were measured at baseline (T0) and after 1 month (T1), 3 months (T2), and 6 months (T3). Sixty-three patients received 66 implants that were placed into fresh extraction sites. The average follow-up time was 48 months (range: 24 to 60 months). All implant restorations were successful, and the cumulative implant survival rate and success of restorations was 100%. After 6 months, the mean horizontal ridge measured midbuccally had increased by 0.10 ± 0.10 mm at 1 mm from the free gingival margin, had decreased by 0.09 ± 0.10 mm at 3 mm, and had decreased by 0.20 ± 0.10 mm at 5 mm. In addition, the mean recession at the midbuccal surfaces was 0.04 ± 0.37 mm. Measurements were made clinically and compared to measurements made on the casts. According to the results of this study, the use of customized anatomically designed immediate provisional restorations following single-tooth extraction and immediate implant placement appeared to minimize the loss of tissue volume that results from postextraction bone remodeling, thus optimizing the final esthetic result.
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Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Estética Dental , Humanos , Estudios Prospectivos , Conservación de Tejido , Extracción Dental , Resultado del TratamientoRESUMEN
PURPOSE: The goal of this study was to evaluate the cumulative survival rate and marginal bone loss (MBL) of extra-short (5- and 6-mm-long) and short (6.5-mm-long) implants inserted into severely atrophic, partially edentulous posterior maxillae and mandibles that were immediately restored with provisional fixed dental prostheses. MATERIALS AND METHODS: Between October 2013 and December 2017, partially edentulous patients with severe vertical bone atrophy in the posterior area in need of replacement of premolars and/or molars with fixed prostheses were enrolled in the study. Analysis of cumulative survival rate and MBL was determined with respect to implant length at the longest, biannual follow-up period (38 ± 10 months; range: 25 to 48 months). RESULTS: Fifty-five patients were included in the study. A total of 62 extra-short (5 and 6 mm), 15 short (6.5 mm), and 69 standard-length (≥ 10 mm) implants were immediately placed and loaded. Cumulative survival rates were similar for all implants (99.3%). One mandibular extra-short implant failed and was removed but was replaced 2 months later with another implant of the same length and diameter and successfully reloaded. Implant length did not impart any significant differences in MBL, though the presence or absence of platform switching was influential. CONCLUSION: The cumulative survival rate and MBL reported in this study encourage the use of short and extra-short implants to immediately restore with fixed prostheses partially edentulous patients with severe vertical bone atrophy in posterior areas. Thus, it could be an alternative treatment to vertical bone augmentation.
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Aumento de la Cresta Alveolar , Implantes Dentales , Atrofia , Implantación Dental Endoósea , Diseño de Prótesis Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Estudios de Seguimiento , Humanos , Mandíbula/cirugía , Maxilar/cirugíaRESUMEN
PURPOSE: The aim of this study was to evaluate the buccopalatal volumetric tissue change that occurs following flapless single-tooth immediate extraction placement in the esthetic area and to analyze the role of four different variables. MATERIALS AND METHODS: Patients in need of a single-tooth replacement in the anterior maxillary or mandibular area (premolar to premolar) were recruited for the study. Patients were treated using four different therapeutic modalities: group 1 (healing abutment), group 2 (healing abutment + bone graft), group 3 (provisional restoration), and group 4 (provisional + bone graft). Alginate impressions were taken the day of implant insertion before tooth extraction (T0), at 1 month (T1), at 3 months (T2), and at 6 months (T3). Buccopalatal dimension (BPD) was measured on the study casts at 1, 3, and 5 mm apical to the free gingival margin and compared between T0 and T1 and T2 and T3. RESULTS: Seventy-seven patients were included in the study, 29 men and 48 women with a mean age of 54 years (range: 24 to 76 years), and 80 implants were inserted. Thirteen implants were inserted in group 1, 13 in group 2, 20 in group 3, and 34 in group 4. The BPD contraction was more evident for group 1, smaller in group 2 and group 3, and minimal in group 4. Repeated measures analysis of variance (ANOVA) and post hoc tests were used. The data analyzed were considered statistically significant with a level of α = .05. The interaction effect P value was numerically zero. CONCLUSION: The results of this study seem to indicate that volumetric tissue changes after immediate extraction placement in the esthetic area can be minimized if a provisional is immediately connected and a bone graft is inserted simultaneously.
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Trasplante Óseo , Implantes Dentales de Diente Único , Restauración Dental Permanente/métodos , Estética Dental , Extracción Dental , Adulto , Anciano , Diente Premolar , Prótesis Dental de Soporte Implantado , Estética , Femenino , Humanos , Masculino , Maxilar , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
The aim of this study was to investigate the survival rate of implants immediately placed in fresh extraction sockets of molars in the maxilla and mandible with a single-stage procedure. A total of 102 patients were treated, and 107 implants (53 in the maxilla and 54 in the mandible) were placed in a fresh molar extraction socket and connected to a healing abutment. After a mean follow-up of 3 years (range: 1 to 6 years) 1 implant failed, for a cumulative success rate of 99.06% (98.11% for the mandible and 100% for the maxilla). The results of this study support placement of an implant immediately after the extraction of a molar, applying a single-stage procedure.
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Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental/métodos , Diente Molar/cirugía , Alveolo Dental/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diente Molar/diagnóstico por imagen , Estudios Retrospectivos , Tasa de Supervivencia , Extracción Dental , Alveolo Dental/diagnóstico por imagen , Torque , Resultado del TratamientoRESUMEN
The crestal bone level around an immediately loaded contemporary hybrid implant with a multisurface topography was examined 8 weeks after implant placement and loading. Histologic analysis showed tight contact between the implant surface and surrounding bone, and demonstrated radiographic and histologic features of successful osseointegration. Very high bone-toimplant contact without epithelial downgrowth was noted. The buccal and lingual bone levels coincided with the original bone relationship to the implant shoulder at the time of implant placement, with no signs of resorption.
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Implantes Dentales de Diente Único , Carga Inmediata del Implante Dental , Diente Molar , Oseointegración/fisiología , Humanos , Masculino , Mandíbula , Persona de Mediana EdadRESUMEN
This prospective study evaluated the survival rate of immediately loaded anatomically tapered implants with a dual acid-etched, microtextured surface. Patients in a private practice were recruited for placement of 3i T3 tapered implants in single, multiple, and full-arch applications in the mandible and maxilla, in both fresh extraction and healed placement sites. Ninety patients were treated, and 240 implants were placed and immediately loaded: 124 in the maxilla and 116 in the mandible. One hundred twelve definitive prostheses were delivered between 4 and 6 months after implant placement. Over the course of 2 to 12 months of follow-up (mean: 4.8 months), five implants failed in the maxilla and no implants failed in the mandible, a survival rate of 96% for the maxilla and 100% for the mandible. The cumulative survival rate was 98%.