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PubMed2001

Replacement therapy and the immediate post-extraction dental implant.

Immediate postextraction implant placement often deals with two major problems: maintaining the initial stability of the implant(s) and preventing soft tissue ingrowth during the healing period. Both problems may lead to the loss of the implant(s). The objective of this clinical study was to evaluate the effectiveness, reliability, and placement of single-stage implants in extraction sockets in combination with a synthetic bone substitute. Hopeless teeth were extracted and one-stage cylindrical screw implants, hollow and solid, were inserted together with a composite polymer without using a membrane. Rehabilitation was performed three to six months postoperatively by placement of different types of prostheses. Excellent initial results were confirmed by the follow-up of 7 to 10 years. The hollow screw-type showed a higher failure rate when compared with the solid screw-type. One-stage implant osseointegration in extraction sockets is enhanced if used with this synthetic graft material, and the simplicity of the method does not jeopardize outcome and predictability. It provides the patient with the benefits of implant-supported restorations in a simple, quick, cost-effective, and secure manner.

Adult↗
PubMed1997

Guided tissue regeneration around dental implants in immediate extraction sockets: comparison of resorbable and nonresorbable membranes.

This study was performed to compare the efficacy of guided tissue regeneration (GTR) around dental implants immediately placed into extraction sockets by resorbable of nonresorbable membranes. Mandibular P2, P3, and P4 of four adult beagle dogs were extracted bilaterally, and buccal standard defects were created and measured. Eighteen commercially pure titanium Steri-Oss implant fixtures were placed into the fresh extraction sockets. Four implants were untreated controls, four implants received polytetrafluoroethylene (e-PTFE, Gore-Tex) membranes, five implants received collagen membranes (ParaGuide), and five implants received polyglactin 910 mesh (Vicryl). After 14 weeks, clinical measurements were taken and the dogs were sacrificed and all specimens retrieved for histologic and histomorphometric evaluation. The average gain in bone height was 2.1 mm for untreated control sites, 3.3 mm for Gore-Tex sites, 3.8 mm for collagen sites, and 1.3 mm for polyglactin 910 sites. The greatest gain in bone height and volume was seen for two sites that received Gore-Tex membranes and remained covered for the entire evaluation interval. The results of this study indicate that Gore-Tex and collagen membrane produced good results for GTR around implants immediately placed into extraction sockets. Since collagen membrane does not cause obvious infection and does not need the surgical reentry for membrane removal, it can be a valid alternative to Gore-Tex membrane to improve bone regeneration around dental implants, while polyglactin 910 mesh seems not suitable to be used as GTR membrane in immediate implantation for its high infection rate.

Animals↗
PubMed2002

Alveolar bone remodelling pattern of the rat incisor under different functional conditions as shown by minocycline administration.

Remodelling of the socket surrounding the continuously growing and erupting rat incisor was examined in teeth under normo, hyper and hypofunctional conditions. Cross-sections of the mandible were observed under fluorescence microscopy, where minocycline labelling evidenced bone remodelling. Animals had received minocycline (10 mg/day) during the experimental period. Control animals (from all three groups) received vehicle alone and samples from these animals were not fluorescent. Minocycline did not interfere with the eruption rates in any of the functional conditions studied. Normofunctional (impeded) incisors showed constant osteogenic activity in the alveolar bone facing the periodontal ligament in all regions of the incisor. Under hypofunctional (unimpeded) and hyperfunctional (impeded) conditions, osteogenesis in the region close to the alveolar crest was markedly increased in the mesial wall of the socket. The labial alveolar bone, facing the enamel-related periodontium, was almost entirely formed during the experimental period in all the groups, but in hyper and hypofunctional teeth the newly formed bone was thicker and contained a substantial amount formed before the experimental period. In the more apical regions of the socket no marked differences between the three functional conditions were found. The similar bone remodelling shown in hypo and hyperfunctional teeth might indicate that there are common factors causing this pattern. Consideration of possible factors appear to rule out the eruption rate, which is very different under these two functional conditions.

Animals↗
PubMedDate not supplied

Evaluation of titanium implants placed into simulated extraction sockets: a study in dogs.

The purpose of this study was to evaluate the effect of gap width on bone healing around implants placed into simulated extraction socket defects of varying widths in 10 mongrel dogs. All premolars were removed and the alveolar ridges were reduced to a width of 7 mm. Nine weeks later, a total of 80 implants, 10 mm long by 3.3 mm wide, were placed into osteotomy sites prepared to 3 different diameters in the coronal half, simulating extraction sockets. Three experimental sites, with gap sizes of 0.5 mm, 1.0 mm, and 1.4 mm, were created; the control sites had no gap. The depth of each defect was measured at the time of implant placement. All implants were stable at the time of placement. The dogs were euthanized 12 weeks after implant placement, and blocks containing the implants and adjacent bone were submitted for histologic evaluation. Clinically, all control and test sites healed, with complete bone fill in the defect. Percentages of bone-to-implant contact were measured histologically. As the gap widened, the amount of bone-to-implant contact decreased, and the point of the highest bone-to-implant contact shifted apically. These changes were statistically significant (P < .001). No statistically significant differences in bone-to-implant contact were found between the sites when the apical 4 mm of implants were compared. Within the limits of this study, the simulated extraction socket defects healed clinically, with complete bone fill, regardless of the initial gap size. However, the width of the gap at the time of implant placement had a significant impact on the histologic percentage and the height of bone-to-implant contact.

Analysis of Variance↗
PubMed2000

Foreign body granuloma following placement of hard tissue replacement material: a case report.

The placement of grafting material in extraction sites for ridge preservation is an increasingly common practice among clinicians. This is a case report of a patient presenting with a symptomatic, foreign body granuloma following the placement of hard tissue replacement (HTR) in extraction sockets. The surgical specimen revealed numerous histiocytes and foreign body type giant cells. The grafting material was surgically removed and the patient's symptoms were alleviated. Although biocompatibility of HTR has previously been shown, specific applications may be contraindicated or some patients may exhibit sensitivity to this material.

Alveolar Ridge Augmentation↗
PubMed2006

Replacement of a fractured upper central incisor with an implant-supported crown: a step-by-step approach to achieve acceptable esthetics.

Implant-supported restorations in the upper anterior segment need to meet biological, functional, and esthetic requirements to be successful. Bone availability and soft-tissue characteristics in the area of implant placement are crucial for achieving maximum success. This article describes the steps involved in replacing a fractured upper central incisor with an implant-supported crown. Using surgical techniques involving extraction socket preservation/augmentation and connective tissue grafting, ideal positioning of the implant was possible and gingival contours were idealized. With this multiple step treatment, the final restoration met biological and functional requirements and its esthetic results were maximized.

Bone Matrix↗
PubMed2002

The immediate dental implant.

Numerous clinical studies have shown that dental implants can be placed immediately in extraction sockets with success when sites are carefully selected. Dental implants have been placed at the time of extraction with a variety of techniques. All the techniques report survival rates of 94 percent to 100 percent over a varied healing period of three months to approximately seven years. this article will review clinical criteria for determining patient selection for immediate implants and the advantages and disadvantages of immediate implant placement.

Dental Implantation, Endosseous↗
PubMed2000

Evaluation of recombinant human bone morphogenetic protein-2 in oral applications including the use of endosseous implants: 3-year results of a pilot study in humans.

BACKGROUND: This study evaluated patients who had been treated with recombinant human bone morphogenetic protein-2 (rhBMP-2) loaded in an absorbable collagen sponge (ACS) in human extraction sites or in sites that required alveolar ridge augmentation. An earlier report on the same patients revealed that after 4 months, implantation of rhBMP-2/ACS was safe, as determined by clinical, radiographic, systemic, and immunological analyses. In this longer-term follow-up, eligible patients were restored with endosseous dental implants in the area treated with rhBMP-2/ACS and bone biopsy samples were taken for histological analysis of the treated human bone tissue. The primary objective was to monitor the long-term safety of patients treated with rhBMP-2/ACS. Another objective was to evaluate the dental implants placed in the sites treated with rhBMP-2. METHODS: Patient safety was evaluated by clinical examinations, periapical radiographs, and occurrence of adverse experiences. Dental implants were evaluated by radiographic and clinical examination. All 12 patients have been followed for 3 years. RESULTS: Two years following surgical implantation of rhBMP-2/ACS, no serious or unexpected adverse experiences occurred. The adverse experiences that did occur were mostly benign and compatible with the dental implant surgeries performed in these patients. No adverse experiences were deemed as related to the rhBMP-2/ACS. Furthermore, no safety concerns in the local area of rhBMP-2/ACS placement were noted, based on oral wound examinations. In the 10 patients (6 extraction socket patients and 4 augmentation patients) who received endosseous implants, all implants were clinically stable at all assessments and all 10 patients have been functionally restored. Histological evaluation of the human bone core biopsies revealed normal bone tissue formation identical to the surrounding native bone. Three-year follow-up clinical examinations revealed that all implants had stable marginal bone levels and healthy peri-implant tissues. CONCLUSIONS: These 3-year results demonstrate that rhBMP-2/ACS can be used safely in human patients. Human bone biopsies reveal normal bone formation in areas treated with rhBMP-2/ACS. Endosseous implants placed in these areas were all stable with no radiographic or clinical complications. The results from this study suggest that rhBMP-2/ACS (0.43 mg/ml) can be safely used in tooth extraction sites and in local ridge augmentation procedures and that endosseous dental implants placed in bony areas treated with rhBMP-2/ACS are stable and can be functionally restored without complication.

Alveolar Process↗
PubMed2003

Immediate replacement of single upper posterior teeth: a report of cases.

BACKGROUND: The immediate replacement of upper molar teeth with implants poses a significant challenge to the clinician because of its sinus involvement. PURPOSE: The purpose of this article is to report a protocol in which single molar teeth are replaced immediately with implants, minimizing the need for other surgical procedures. MATERIALS AND METHODS: This protocol has been employed in eight cases. Briefly, the teeth are extracted atraumatically, the sockets evaluated, an osteotomy performed following the direction of the socket, and a wide diameter implant placed using the socket walls and sinus floor to anchor it. A grafting material is placed when the space between implant and socket wall is considerably large. Three cases are reviewed here, and all eight are summarized. RESULTS: All cases have excellent soft and hard tissue healing after 6 months. Furthermore, the overall time needed to restore the cases has been considerably reduced and the need for sinus management eliminated. CONCLUSION: The cases presented support the use of the described protocol in the placement of implants in maxillary molar areas without any other sinus procedures.

Adult↗
PubMed2003

In vitro calibration and validation of a digital subtraction radiography system using scanned images.

OBJECTIVES: To calibrate and validate a digital subtraction radiography system using scanned images for quantification of alveolar bone changes by means of computer-assisted densitometric image analysis (CADIA) in vitro. MATERIALS AND METHODS: Noise levels were determined using 10 standardized periapical radiographs of the same lower molar region in a human dry skull. For validation of the system, radiographs were taken before and after bovine bone particles in measures with increments of 2 mg weighing from 2 to 20 mg were added into each socket of three dry skulls. Radiographs were developed and scanned into a computer with a flatbed scanner. After digitization, the images were subjected to alignment, normalization and subtraction. Appropriate regions of interest (ROIs) were selected and their CADIA values were calculated for the determination of noise levels, and correlations between the CADIA values and the actual bone mass were performed. RESULTS: When the threshold value was 7, the percentage of pixels deviating from the set threshold value was small (0-11.3%). There were statistically significant correlations between the actual bone mass and the CADIA value for anterior sockets (p<0.001, r2=0.89) and posterior sockets (p<0.001, r2=0.9). For pooled data of both anterior and posterior sockets, the correlation was also statistically significant (p<0.001, r2=0.88). CONCLUSIONS: A high and statistically significant correlation between the actual bone mass and CADIA value was obtained, which suggests that the system could be suitable for the detection of small alveolar bone changes.

Absorptiometry, Photon↗
PubMed2001

Immediate implant in fresh extraction socket of resected mandibular first molar: a preliminary clinical report.

This study presents a new technique that involves resection of the affected mesial root in a lower mandibular molar with immediate implant placement in its extraction socket. This technique offers a treatment option for mandibular molars affected by local periapical infection, bifurcation involvement, or buccolingual fractures. Extraction of such molars usually creates a large edentulous span and subsequent restorative problems. The patient is provided with a crown that is supported by an implant in the resected mesial root site and the retained distal root. The crown is esthetic and functional and easy to maintain. This technique was successfully applied on five patients.

Adult↗
PubMed1999

Localized ridge maintenance using bone membrane.

The immediate placement of a dental implant into a fresh extraction socket has been limited in many instances by the quantity of bone that remains after the extraction. This article presents two clinical cases that demonstrate successful regeneration of alveolar ridges in which there was extensive loss of the buccal plate of bone. This lack of alveolar process impeded the immediate placement of dental implants into fresh extraction sockets. The surgical technique performed in these cases was based on the principles of guided bone regeneration using a demineralized freeze-dried bone membrane. The bone membrane acted as an efficient barrier that excluded the nonosteogenic tissues. Bone formation took place for the placement of endosseous dental implants 8 months after the procedures were initiated. These human clinical cases confirm positive results of previous animal findings.

Adult↗
PubMed1999

Extraction sites--foundations for restorative excellence.

Preservation of the socket site architecture promotes better esthetics, easier prosthetic treatment, and restoration of the alveolar bone for implant or bridge replacement options. The purported simplicity of the simple extraction can be misleading if the bone housing or soft tissues have been ravaged by disease. This article provides guidelines for case selection, patient consultations, selection of appropriate materials, and a step-by-step methodology for completing successful extraction site therapy.

Alveolar Bone Loss↗
PubMed1999

Extraction site--foundation for restorative excellence.

Preservation of the socket site architecture promotes better esthetics, easier prosthetic treatment, and restoration of the alveolar bone for implant or bridge replacement options. The purported simplicity of the simple extraction can be misleading if the bone housing or soft tissues have been ravaged by disease. This article provides guidelines for case selection, patient consultations, selection of appropriate materials, and a step-by-step methodology for completing successful extraction site therapy.

Alveoloplasty↗
PubMed2006

Towards the limit of quantifying low-amplitude strains on bone and in coagulum around immediately loaded oral implants in extraction sockets.

The purpose of this study was to quantify strains in coagulum around immediately loaded oral implants in extraction sockets at the ex vivo level. Bilateral maxillary premolar teeth of two fresh human cadavers were extracted and psi 4.1 x 12 mm Straumann TE implants were placed in the sockets of first and second premolars by utilizing mesio-distal and palatal anchorage, respectively. Installation torque value (ITV) of each implant was measured by a custom-made torque wrench and resonance frequency analyses (RFAs) were undertaken to determine intraosseous stability. Upon abutment connection, a gold coping allowing the placement of a miniature load cell to contact the underlying solid abutment was fabricated. A linear strain gauge was connected to the coping at a distance for strain measurements in coagulum around the implant neck in the extraction socket. Linear strain gauges were also bonded on the labial marginal bone of each extraction socket. Strain measurements were performed at a sample rate of 10 kHz simultaneously monitored from a computer connected to data acquisition system and under a maximum load of 100 N on each implant with or without human coagulum in the extraction socket. Low-amplitude strains were measured around immediate implants. The increase in load increased strains on labial marginal cortical bone around implants (P < 0.05). Bone strains were higher on the implant loaded, when coagulum was present in the bone defects (P < 0.05). Strains within coagulum around mesiodistally anchored implants were higher than palatally anchored implants (P < 0.05). The type of implant on anchorage and presence of coagulum has an impact mechanotransduction to buccal marginal bone around immediate implants.

Blood Coagulation↗
PubMed2002

[Immediate post-extraction implant in infected site. An eight-year clinical and radiographic control].

The use of immediate post-extraction implants presents several advantages in term of reduction of surgical steps and time required to conclude the therapy. Particularly important is the possibility to minimize the bone loss that otherwise would occur in the physiologic healing of the alveolus. Many authors agree that an infected site is one of the main contraindications to use post-extraction implants. In spite of this, favourable results have been reported also in these conditions. In this study, an immediate post-extraction implant has been placed to substitute the maxillary left second premolar, extracted due to vertical root fracture. Suppuration with fistula in the vestibule was present. The residual wide bone defect at the end of the debridement of the surgical socket has made it necessary a regenerative procedure by means of e-PTFE membrane, at the same time of implant insertion. After 9 month-healing the membrane has been removed and the implant exposed to perform the prosthetic procedures. The clinical and radiographic control after 8 years prove that infection in the surgical site has not compromised the final success, even in the long-term observation, suggesting the need to re-evaluate the contraindications conventionally reported.

Adult↗
PubMed2005

Implant stability measurements for implants placed at the time of extraction: a cohort, prospective clinical trial.

BACKGROUND: Studies indicate that implants placed at the time of extraction have high success rates. Implants must be stable at the time of insertion. Presently there are no data indicating the degree of implant stability when implants are placed at the time of extraction. This study evaluated changes in stability of implants from implant placement to abutment connection utilizing resonance frequency analysis (RFA). The unit of measurement was the international stability quotient (ISQ). METHODS: Prior to treatment, patients were given medical history and dental evaluations. Periapical and panogram radiographs were taken. Fifty-two patients requiring extraction of one or two teeth and implant placement immediately after extraction were enrolled in this study. Under conscious sedation and local anesthesia or local anesthesia alone, teeth were atraumatically removed and the extraction sockets were debrided. A total of 73 dental implants (57 in the maxilla, 16 in the mandible) were placed. Using a one-stage approach, all implants were placed within the patient's alveolar envelope and were never placed directly into extraction sockets. All implants were placed into contained extraction sites. Bone augmentation procedures were not performed. After implant insertion, the RFA electronic transducer was attached to the head of the implant with the retaining screw. The device was attached to a computer designed to register RFA scores in ISQ units. RFA measurements were taken at implant placement and abutment connection. Bone qualities, quantity, implant length and width as well as site of placement were recorded. RESULTS: The average interval between implant insertion and abutment connection was 5.6 months (SD 2.05). Two implants were lost between implant insertion and 1 year. At 2 to 3 years, the cumulative survival was 97.2%. Resonance frequency measurements at implant placement showed a mean primary stability of 62.0 (SE 1.1; range 43 to 83 ISQ) and a mean secondary stability after 1 year of 64.0 (SE 1.2; range 40 to 98 ISQ) for all implants. The increase was marginally significant (generalized estimating equation z-statistic = 1.79; P value = 0.07). CONCLUSIONS: Implants placed at the time of extraction and inserted into native bone and not directly into extractions sockets have a high degree of initial stability as evidenced by RFA measurements. Implants with initial high ISQ levels revealed a slight drop in levels over time, while implants with levels lower than 60 had increases in levels between implant insertion and abutment connection. At 2 to 3 years the cumulative survival rate was 97.2%.

Bone Density↗
PubMed2002

Immediate implant in extraction socket with acellular dermal matrix graft and bioactive glass: a case report.

A buccal plate destroyed as a result of a longitudinal root fracture was completely restored by the use of a Frialit-2 implant placed in the alveolus of the fractured maxillary left first bicuspid. An acellular dermal matrix material was used as a membrane barrier to cover the implant, and a bioactive glass was used as grafting material. After 6 months, the defect around the implant was completely filled by mineralized tissue.

Adult↗