Noha Ghallab

OBJECTIVES: To evaluate the ridge alterations and esthetic outcome 1 year after immediate implant placement using the dual-zone (DZ) technique versus the bone shielding concept in patients with intact thin-walled sockets in the esthetic zone.

MATERIAL AND METHODS: This randomized clinical trial included 26 patients with nonrestorable maxillary teeth in the esthetic zone who were randomly assigned to two groups (n = 13 each) to receive immediate implants using either the bone shielding concept or DZ. Definitive restorations were delivered after 2 months. Pink esthetic scores (PESs), vertical soft tissue alterations, and bucco-palatal ridge dimensional changes were measured and assessed using intra-oral digital scans at baseline and 1 year post-procedure. Labial bone thickness was measured using cone beam computed tomography scans at baseline and after 1 year.

RESULTS: The bone shielding group provided bucco-palatal ridge thickness stability after 1 year (9.43 mm) compared to baseline values (9.82 mm), while DZ showed a significant loss in the bucco-palatal ridge thickness after 1 year (7.83) compared to baseline values (9.49). No significant difference was reported in the baseline bucco-palatal ridge thickness between the two groups (p = 0.6). After 1 year, the bone shielding group demonstrated 0.38 mm ridge shrinkage which was statistically significant (p = 0.0002) compared to 1.67 mm ridge shrinkage in the DZ group. In addition, the average total PES in the bone shielding group was 12.04 versus 10.28 in the DZ group. No significant difference was reported in the mesial papilla length between the DZ and the bone shielding group after 1 year (p > 0.05). However, the midfacial gingival margin (p = 0.026) and distal papilla were significantly higher in the DZ group (p = 0.0025). There was no significant difference in the mean ± SD mm bone gain at the apical level between the two studied groups after 1 year (p = 0.06) showing 0.85 ± 0.23 and 0.64 ± 0.32 mm, respectively. However, the bone shielding concept showed a statistically significant more bone gain mm (p < 0.001) at the (0.56 ± 0.43) and crestal (0.03 ± 0.8) levels after 1 year compared to DZ which revealed 0.18 ± 0.5 and 0.38 ± 0.29 mm bone loss, respectively.

CONCLUSION: The bone shielding concept might offer a reliable alternative for restoring thin-walled sockets by minimizing postextraction ridge dimensional alterations effect following immediate implant placement in the esthetic zone. Nevertheless, the study suffers from confounding bias since there are two systematic differences between the groups, the barrier membrane type, and the level of bone filling. "This clinical trial was not registered prior to participant recruitment and randomization."

CLINICAL TRIAL REGISTRATION: NCT05381467.

PURPOSE: This randomized clinical trial aimed to assess esthetic and soft and hard tissue outcomes 6 months after immediate implant placement using vestibular socket therapy (VST) (test) versus partial extraction therapy (comparator) in intact thin-walled fresh extraction sockets in the esthetic zone.

MATERIALS AND METHODS: Twenty-four patients with hopeless maxillary anterior teeth requiring immediate implant placement were randomly assigned to two equal groups to receive either VST or partial extraction therapy. Definitive restorations were delivered after 3 months. Pink esthetic scores (PESs) and vertical soft tissue alterations in millimeters were measured 6 months after restoration using intraoral digital scans of the distal papilla, midfacial gingival margin, and mesial papilla. Facial bone thickness was measured using CBCT scans at baseline and after 6 months. Implant survival and peri-implant pocket depth were assessed.

RESULTS: Both groups showed 100% implant survival after 6 months. The overall PESs after 6 months were 12.67 (± 1.3) in the VST group, while the partial extraction therapy group score was 13.17 (± 1.19), with no significant difference between them ( = .02). The mean (± SD) vertical soft tissue measurements for the VST group were 0.08 (± 0.55), 0.01 (± 0.73), and -0.03 (± 0.52) mm, and for the partial extraction therapy group, they were -0.24 (± 0.25) mm, -0.20 (± 0.10) mm, and -0.34 (± 0.13) mm for the mesial papilla, midfacial gingival margin, and distal papilla, respectively. No significant differences were observed between the groups at any of the reference points ( ± .05). Both techniques demonstrated a significant gain in millimeters of labial bone thickness after 6 months compared to baseline (P ± .05). Regarding VST, the apical, middle, and crestal mean bone gain was 1.68 (±± 2.73), 1.62 (±± 1.35), and 1.33 (±± 1.22) mm, respectively, while partial extraction therapy showed 0.58 (± 0.62), 1.27 (± 1.22), and 1.53 (± 1.24) mm, respectively, with no significant difference detected between them ( ≥ .05). Additionally, the mean (± SD) peri-implant pocket depth after 6 months for VST was 2.16 (± 0.44) and 2.08 (± 1.02) mm for partial extraction therapy with no significant difference between them ( = .79).

CONCLUSION: This investigation suggests that both VST and partial extraction therapy preserved alveolar bone structure and peri-implant tissues following immediate implants. The novel VST might be considered a predictable alternative treatment approach for immediate implant placement in intact thin-walled fresh extraction sockets in the esthetic zone. Int J Oral Maxillofac Implants 2023;38:468-478. doi: 10.11607/jomi.9973.

The aim of this study was to evaluate the radiographic and clinical outcomes of patients undergoing sinus membrane elevation via a minimally invasive crestal approach utilizing the dental implant. Twenty patients having 1 or more missing posterior teeth were included. The maxillary sinus membrane was elevated using dental implant via a crestal approach in areas with insufficient residual bone. CBCT scans were used to measure the amount of newly formed bone, implant length inside the sinus, bucco-palatal sinus width, and bone thickness. Surgical and postsurgical complications along with implant survival were also measured. The mean (±SD) values for the newly formed bone after 1 year were 2.4 (±1.87) mm, while values for implant length inside the sinus were 4 (±1.49) mm. The results showed that percentage of implant length inside the sinus and the palatal bone thickness were statistically significant positive predictors of the newly formed bone. Higher percentage of implant length inside the sinus and increased palatal bone thickness were associated with larger amounts of newly formed bone. A high patient satisfaction was reported along with a 100% implant survival. The utilization of the novel dental implant approach for crestal sinus elevation demonstrated predictable clinical and radiographic outcomes. This novel technique is simple to both patients and clinicians, rendering it a promising and cost-efficient procedure.

INTRODUCTION: Immediate implant in postextraction sockets requires managing the postextraction alveolar resorption. This randomized clinical trial examined vertical and horizontal changes 1-year following flapless immediate implant with and without xenograft at sites with thin labial plate.

METHODS: Forty patients with hopeless teeth in maxillary esthetic zone were randomly assigned to receiving either one immediate implant without bone graft (control) or with bone graft (intervention). Cone beam computed tomography (CBCT) scans were obtained pre-extraction and 1-year postoperatively to measure thickness and dimensional changes of the labial bone.

RESULTS: Cone beam computed tomography measurements revealed that a xenograft, when compared to no xenograft, led to 0.2 mm increased fill of the horizontal gap (95% confidence interval (CI): -1.1, 0.7). In both groups, there was a significant reduction in the labio-palatal bone width after 1 year compared to baseline (P ≤ 0.05). There was no significant difference (P > 0.05) between the xenograft when compared to no xenograft regarding the labio-palatal bone collapse % at 0 mm (-0.2, 95% CI: -4.8, 4.5) and 2 mm apical to the labial crest (1.9, 95% CI: -1.8, 5.6). While at 5 mm the ridge was significantly reduced (P ≤ 0.05) in the no xenograft when compared to xenograft (4.5, 95% CI: 0.7, 8.2). The xenograft when compared to no xenograft, led to 1.1 mm less vertical bone changes (95% CI: 0.4, 1.9). Both groups revealed significant positive correlation between labio-palatal socket dimension and bone formed labial to the implant (P ≤ 0.05). [Correction added on 7 February 2023, after first online publication: In the 8th line of this section, the word "collapse" was changed to "ridge" in this version.] CONCLUSION: This investigation suggested that immediate implants with or without grafting the labial gap preserved alveolar bone dimension and that bone formation labial to the implant was related to initial labio-palatal socket dimension.

OBJECTIVES: To evaluate the esthetic outcome, as well as clinical, radiographic, and volumetric tissue alterations 1 year after immediate implant placement (IIP) with connective tissue grafting (CTG) versus dual-zone concept (DZ) at sites with thin labial bone in the esthetic zone.

MATERIALS AND METHODS: This randomized clinical trial included 30 patients treated with IIP simultaneous with either CTG or DZ (n = 15 each). Pink esthetic score (PES) was assessed 6 months after crown placement as the primary outcome. Amount of bone labial to the implant, labio-palatal ridge reduction, and crestal bone changes were measured via CBCT after 1 year. Volumetric analysis of linear labial soft tissue contour, interdental, and mid-facial soft tissue level changes, and total volume loss (mm) were measured after 1 year.

RESULTS: Similar PES was observed in the CTG (12.53 ± 1.13) and DZ (12.13 ± 1.55) groups, with no significant difference (p = 0.42). Likewise, there were no statistically significant differences found between the two groups in labio-palatal bone reduction (mm&%), interdental papillae, and mid-facial gingival levels (p > 0.05). However, the mean vertical crestal bone changes in the CTG and DZ groups were -1.1 ± 0.6 mm and 0.2 ± 1.0 mm, respectively, with a statistically significant difference (p = 0.0002). Moreover, CTG revealed less linear and total volume (mm) loss in the labial soft tissue which was statistically significant compared to DZ (p = 0.007).

CONCLUSION: Both groups demonstrated the same PES, nevertheless, volumetric analysis revealed twice total labial volume loss in DZ compared to CTG. It might be concluded that the use of CTG with IIP caused less horizontal reduction in the supra-implant complex compared to the DZ.

OBJECTIVES: The aim of this randomized clinical trial was to assess the alveolar ridge contour after soft tissue augmentation using subepithelial connective tissue graft (SCTG) buccal to fresh extraction sockets in patients with thin buccal bone, versus minimally-traumatic extraction followed by spontaneous healing solely.

MATERIALS AND METHODS: Forty non-restorable maxillary teeth in the esthetic zone were randomly assigned into two groups: minimally-traumatic extraction with SCTG (test) and minimally-traumatic extraction followed by spontaneous healing (control). The outcomes assessed included linear volumetric change of buccal soft tissue contour, vertical tissue loss, gingival thickness (GT), and interdental papilla (IDP) height after 6 months.

RESULTS: The SCTG group showed a significant improvement (P < 0.001) in all outcomes after 6 months. The SCTG group showed a statistically significant (P < 0.001) gain in the buccal soft tissue volumetric change compared to the control group. The SCTG group showed a statistically significant increase in GT (P < 0.001) and IDP height (P < 0.05) after 6 months compared to the control group.

CONCLUSIONS: The use of SCTG buccal to extraction sockets in the anterior maxilla might be considered as a predictable approach for preserving the alveolar ridge contour.

CLINICAL RELEVANCE: SCTG buccal to extraction sockets might counteract post-extraction hard and soft tissue alterations in the esthetic zone.

PURPOSE: This randomized controlled clinical trial compared soft tissue changes following a novel vestibular atraumatic extraction technique (test group) versus the conventional incisal atraumatic extraction approach (control group) while implementing the vestibular socket therapy for immediate implant placement.

METHODS: Thirty patients with hopeless maxillary anterior teeth requiring atraumatic extraction were randomly assigned into two equal groups to receive either test or control. Vertical soft tissue alterations in mm were measured at baseline and 12 months post-restoration using intraoral digital scans at three reference points, distal papilla, mid-facial gingival margin, and mesial papilla, as well as pink esthetic scores (PESs) after 12 months.

RESULTS: Vestibular extraction technique showed significant soft tissue improvement and creeping when compared to incisal extraction (P < 0.05). The test group showed soft tissue measurements with a mean (± SD) of 0.26 (± 0.58), 0.39 (± 0.64), and 0.05 (± 0.37) mm for the mesial papilla, mid-facial gingival margin, and distal papilla respectively. While the incisal extraction technique demonstrated gingival recession at the distal papilla, mid-facial gingival margin, and mesial papilla of - 0.37 (± 0.54) mm, - 0.32 (± 0.68) mm, and - 0.39 (± 0.59) mm respectively. The overall PESs after 12 months were 12.67 (± 1.59) in vestibular extraction group, while incisal extraction group was 11.40 (± 1.40), with significant difference between them (P = 0.03).

CONCLUSION: This investigation suggests that both studied techniques were successful in the atraumatic extraction of hopeless severely damaged teeth. The novel vestibular extraction technique might be considered an alternative reliable atraumatic extraction approach compared to the conventional incisal extraction when performing the vestibular socket protocol for immediate implant placement with soft tissue enhancement.