Effectiveness of Autologous Platelet Concentrates in the Sinus Lift Surgery: Findings from Systematic Reviews and Meta-Analyses.

Maxillary sinus augmentation is one of the most predictable procedures for the rehabilitation of the posterior maxilla. The current overview aimed to summarize the findings provided by systematic reviews (SRs) and meta-analyses on the effectiveness of autologous platelet concentrates (APCs) in sinus lift and to assess the methodological quality of the included SRs. Three electronic databases have been explored. SRs and meta-analyses addressing the effectiveness of APCs in sinus lift technique were included. Clinical, radiographic and histomorphometric findings were considered for APCs as solely grafting materials and APCs in combination with biomaterials. Outcomes were implant survival rate (ISR), implant stability (IS), implant failure (IF), postoperative complications, histomorphometric findings, radiographic bone gain, bone volume and bone density. The methodological quality of the included SRs was assessed using the updated version of "A Measurement Tool to Assess Systematic Review" (AMSTAR-2). Thirty SRs were included. The methodological quality of the included reviews ranged from critically low (3 studies) to high (9 studies). The included SRs showed favorable clinical outcomes, short-term new bone formation and no biological complications when APCs were used both as solely graft material or in combination with other biomaterials. However, no significant additional effects in the long-term period were observed. APCs did not add any further positive effects compared to the physiological healing derived by the natural blood clot. The current overview of SRs highlighted the need for high-quality SRs evaluating the role of APCs in sinus lift though network meta-analyses, in order to identify the most powerful material for sinus lift augmentation. The use of APCs improves the healing of soft tissues and the postoperative quality of life in the short-term period. Thus, its application can be recommended.

Efficacy of photobiomodulation using diode laser 650 nm combined with nano-cellulose and nano-amorphous calcium phosphate in bone healing of rabbit tibial defects assessed by H&E staining and computed tomography.

BACKGROUND: The purpose of the current study was to evaluate the effect of Diode LLLT 650 nm, TEMPO oxidized Nano-fibrillated cellulose mixed with Nano-Amorphous calcium phosphate, and their combination on bone healing in rabbit tibia using H&E staining and computed tomography. METHODS: Eighteen adult male New Zealand rabbits were selected, two circular bone defects were created in each tibia, resulting in four bony defects in each rabbit, representing the four tested groups; group A (negative control), group B (filled with mineralized nano-cellulose), group C (combination), group D (laser). Animals were euthanized after two weeks and one month, defects were assessed by CT for bone density, then histological samples were examined by H&E stain. RESULTS: In both evaluation periods, group D recorded the greatest mean area percent of new bone formation and bone density, followed by group A, while group C recorded the lowest value. Groups A and D showed full closure of the defects, while groups B and C showed partial defect closure with retained bone graft material. H&E and CT showed that Laser group had the best results of defects healing, bone density and new bone formation, followed by the negative control group. CONCLUSIONS: Diode laser 650nm photobiomodulation significantly improved bone defects healing. Mineralized nano-cellulose experimental bone substitute material showed a delayed effect in bone healing and graft material resorption. The combination of LLLT with the graft material had no positive outcome on bone defect healing.

The Effectiveness of Autologous Platelet Concentrates in the Clinical and Radiographic Healing after Endodontic Surgery: A Systematic Review.

Regenerative techniques are increasingly applied in endodontic surgery, but different materials may have varying impacts on soft and hard tissue healing. This systematic review aims to evaluate the effectiveness of autologous platelet concentrates (APCs) in clinical and radiographic healing after endodontic surgery. The data for this systematic review were processed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for improving the reporting of systematic reviews and meta-analyses. A literature search was conducted until October 2023 on PubMed, Scopus, and Cochrane Databases. Randomized controlled trials and controlled clinical trials addressing the use of APCs in patients who presented persistent periapical lesions and needed periapical surgery were included. Dual publications, narrative reviews, systematic reviews, case series, questionnaires, animal studies, case reports, letters to the editor, in vitro studies, and abstracts were excluded. In total, the search resulted in 14 papers. Clinical and radiographical findings were reported, showing that when APCs were used, patients exhibited less pain and swelling and a greater reduction of apical radiolucency after 12 months follow-up on average. However, the moderate/high risk of bias of included studies and their high heterogeneity, do not allow one to draw definitive conclusions on the effectiveness of APC after endodontic surgery.

Effect of crown stiffness and prosthetic screw absence on the stress distribution in implant-supported restoration: A 3D finite element analysis.

This in-silico investigation evaluated the mechanical impact of Morse tape implant-abutment interface and retention system (with and without screw) and restorative materials (composite block and monolithic zirconia) by means of a three-dimensional finite element analysis (3D-FEA). Four 3D models were designed for the lower first molar. A dental implant (4.5 × 10 mm B&B Dental Implant Company) was digitized (micro CT) and exported to computer-aided design (CAD) software. Non-uniform rational B-spline surfaces were reconstructed, generating a 3D volumetric model. Four different models were generated with the same Morse-type connection, but with a different locking system (with and without active screw) and a different crown material made of composite block and zirconia. The D2 bone type, which contains cortical and trabecular tissues, was designed using data from the database. The implants were juxtaposed inside the model after Boolean subtraction. Implant placement depth was simulated for the implant model precisely at crestal bone level. Each acquired model was then imported into the finite element analysis (FEA) software as STEP files. The Von Mises equivalent strains were calculated for the peri-implant bone and the Von Mises stress for the prosthetic structures. The highest strain values in bone tissue occurred in the peri-implant bone interface and were comparable in the four implant models (8.2918e-004-8.6622e-004 mm/mm). The stress peak in the zirconia crown (64.4 MPa) was higher than in the composite crown (52.2 MPa) regardless of the presence of the prosthetic screw. The abutment showed the lowest stress peaks (99.71-92.28 MPa) when the screw was present (126.63-114.25 MPa). Based on this linear analysis, it is suggested that the absence of prosthetic screw increases the stress inside the abutment and implant, without effect on the crown and around the bone tissue. Stiffer crowns concentrate more stress on its structure, reducing the amount of stress on the abutment.

Fluoride and Calcium Release from Alkasite and Glass Ionomer Restorative Dental Materials: In Vitro Study.

This study evaluated the effect of pH and temperature on the ion (F- and Ca2+) release of a resin-based material containing alkaline fillers and a self-setting high-viscous glass ionomer cement. Disks were prepared according to manufacturers' instructions for both materials: the EF group (Equia Forte HT filling, GC) and the CN group (Cention N, Ivoclar). Specimens were immersed in 50 mL buffer solution with three different pHs (4.8, 6.8, and 8.8), and stored at 0°, 18°, 37°, and 44 °C. After 24 h, 7 d, and 28 d, cumulative F- and Ca2+ releases were analyzed by chromatography and mass spectrometry, and pH was measured. Both materials showed minimal changes in pH with final values after 28 d of 5.17 ± 0.56 for CN and 5.12 ± 0.24 for EF. In all experimental conditions, the percentages of ion release were higher for EF than for CF. In particular, both materials showed a significant difference in temperature in F- release. Regardless of the pH values, the highest Ca2+ ion release was after 28 days, with a significant difference in temperature for CN and EF. Within the limit of this study, the temperature storage influenced ion release and the high-viscous glass ionomer showed the maximum values.

Stress distribution in resin-based CAD-CAM implant-supported crowns.

OBJECTIVE: This study aimed to evaluate the influence of new resin-based CAD-CAM implant-supported materials on posterior crown restoration stress and strain concentrations. METHODS: A previous 3D implant model was edited to receive a cement-retained posterior crown manufactured with different CAD/CAM materials (Estelite P Block, Estelite Block II or Estelite Layered Block). Each solid model was exported to the computer-aided engineering software and submitted to the finite element analysis of stress and strain. Material properties were assigned to each solid with isotropic and homogeneous behavior according to the manufacturer information. A vertical load of 600 N was applied in the occlusal region of the crown, via a simulated food bolus, and stress was calculated in Von Misses (σVM) for the implant, abutment and screw, Maximum (σMAX) Principal Stresses for the crown and microstrain for the bone. RESULTS: All simulated materials showed acceptable stresses levels with a similar stress pattern among the models. At the crown intaglio region and cement layer, however, differences were observed: Estelite P Block showed a lower tensile and shear stresses magnitude when compared to other resin-based materials with lower elastic modulus. SIGNIFICANCE: The stress effect of different resin-based CAD-CAM implant-supported crowns is predominant in the crown and cement layer, with Estelite P Block showing 7.4 % versus 9.3 % and 9.2 % for Estelite Block II and Estelite Layered Block of crown failure risk.

Odontogenic keratocystic can be misdiagnosed for a lateral periodontal cyst when the clinical and radiographical findings are similar.

Lateral periodontal cyst (LPC) and odontogenic keratocystic (OK) are two osteolytic lesions of the jaw with different local invasiveness and percentage of recurrence. The aim of this study was to highlight the attention on the differential diagnosis of these lesions that sometimes can have unexpected location and can lead doubts on diagnosis, therapy, and follow-up. A 34-year-old man presented to our department with a complaint of soft pain in the vestibular aspect of left mandibular second premolar and left mandibular first molar. Vital teeth in the left mandible, no mucosal swelling, and no drainage were observed. The CBCT showed a well circumscribed hypodensity area, extending between 3.5 and the apex of mesial root of 3.6. No displacement and no resorption of the roots were notified. Upon clinical and radiographical examination, a provisional diagnosis of LPC was made and enucleation of the lesion and histological examination were planned. Histologically, a cystic wall partially lined by a keratinizing squamous epithelium was observed. Surrounding and within the lesion, there was a chronic inflammatory infiltrate also of granulomatous type and with cholesterol clefts. Based on these findings, the diagnosis of odontogenic keratocystic was done. Radiolucent lesions in the premolar and canine region are frequently clinically and radiographically misdiagnosed. The identification of keratocyst in a location preoperatively favoring a lateral periodontal cyst should be suspected and biopsy must be considered in all cases to establish the nature of the lesion, the best surgical treatment, and the follow-up appointments.

Mechanical Behavior of Alkasite Posterior Restorations in Comparison to Polymeric Materials: A 3D-FEA Study.

The present investigation evaluated the effect of the combination of different dental filling materials in Class I cavities under occlusal loading using three-dimensional finite elements analysis (FEA). Six computer-generated and restored models of a lower molar were created in the CAD software and compared according to the biomechanical response during chewing load condition. Two adhesively bonded bulk restorative materials [bulk-fill resin composite (BF) or Alkasite (Alk)] were evaluated with or without the presence of a base material below (flowable resin composite or glass ionomer cement). A food bolus was placed on the occlusal surface mimicking the compressive occlusal load (600 N) during the static linear analysis. The maximum principal stress (tensile) was calculated as stress criteria in enamel, dentin and restoration. All models showed high stresses along the enamel/restoration margin with a similar stress trend for models restored with the same upper-layer material. Stress values up to 12.04 MPa (Alk) or up to 11.12 MPa (BF) were recorded at the enamel margins. The use of flexible polymeric or ionic base material in combination with bulk-fill resin composite or Alk did not reduce the stress magnitude in dentine and enamel. Class I cavities adhesively restored with bulk-fill resin composite showed lighter stress concentration as well as Alk. Therefore, adhesively bonded Alk restoration showed a promising mechanical behavior when used with different base materials or as a bulk restoration for posterior Class I cavity.

Effect of Biologically Oriented Preparation Technique on the Stress Concentration of Endodontically Treated Upper Central Incisor Restored with Zirconia Crown: 3D-FEA.

The aim of this study was to evaluate the effect of biologically oriented preparation technique on the stress concentration of endodontically treated upper central incisors restored with zirconia crown (yttria-stabilized zirconia polycrystalline ceramic) through finite element analysis (FEA). Four models of maxillary central incisors containing enamel, dentin, periodontal ligament, cortical and medullary bone were created in CAD. Each model received a polymeric core-build up with nanofilled dental resin composite. The evaluated models were SM-preparation in shoulder 90°; CM-chamfer preparation; BOPT-biologically oriented preparation technique and BOPTB-BOPT preparation 1 mm below the cement-enamel junction. All models received zirconia crowns (5Y-TZP), fiberglass post and 1 mm ferrule. The models were imported into the analysis software with parameters for mechanical structural testing using the maximum principal stress and the tensile strength as the analysis criteria. Then, load of 150 N was applied at the cingulum with 45° slope to the long axis of the tooth, with the fixed base for each model. The type of marginal preparation affected the stresses concentration in endodontically treated teeth and in the zirconia crown margin. Considering the stress magnitude only, BOPT is a viable option for anterior monolithic zirconia crowns; however, with the highest stress magnitude at the restoration margin.

The role of cortical zone level and prosthetic platform angle in dental implant mechanical response: A 3D finite element analysis.

OBJECTIVE: The aim of this study was to evaluate the influence of three different dental implant neck geometries, under a combined compressive/shear load using finite element analysis (FEA). The implant neck was positioned in D2 quality bone at the crestal level or 2 mm below. METHODS: One dental implant (4.2 × 9 mm) was digitized by reverse engineering techniques using micro CT and imported into Computer Aided Design (CAD) software. Non-uniform rational B-spline surfaces were reconstructed, generating a 3D volumetric model similar to the digitized implant. Three different models were generated with different implant neck configurations, namely 0°, 10° and 20°. D2 quality bone, composed of cortical and trabecular structure, was modeled using data from CT scans. The implants were included in the bone model using a Boolean operation. Two different fixture insertion depths were simulated for each implant: 2 mm below the crestal bone and exactly at the level of the crestal bone. The obtained models were imported to FEA software in STEP format. Von Mises equivalent strains were analyzed for the peri-implant D2 bone type, considering the magnitude and volume of the affected surrounding cortical and trabecular bone. The highest strain values in both cortical and trabecular tissue at the peri-implant bone interface were extracted and compared. RESULTS: All implant models were able to distribute the load at the bone-implant contact (BIC) with a similar strain pattern between the models. At the cervical region, however, differences were observed: the models with 10° and 20° implant neck configurations (Model B and C), showed a lower strain magnitude when compared to the straight neck (Model A). These values were significantly lower when the implants were situated at crestal bone levels. In the apical area, no differences in strain values were observed. SIGNIFICANCE: The implant neck configuration influenced the strain distribution and magnitude in the cortical bone and cancellous bone tissues. To reduce the strain values and improve the load dissipation in the bone tissue, implants with 10° and 20 neck configuration should be preferred instead of straight implant platforms.

Lower third molar inclusion associated with paraesthesia: A case report.

When lower third molar inclusion is associated with neurosensorial complications, the treatment of choice is its surgical avulsion. One of these complications, that may be the most alarming during a first medical examination, is hemi-lip paraesthesia, that can appear in the presence of several mandibular lesions. This is a report of a rare clinical case in which paraesthesia was linked to the closeness between the root block of the dental element and the mandibular canal, which houses the neurovascular trunk of the lower mandibular nerve. A 64 year-old male Caucasian patient, presented with the chief complaint of past periodic inflammatory events in the retromolar region of the oral cavity and hemi-lip paraesthesia. Upon local clinical and radiological examination, a lower left third molar with class 3 position C inclusion was incriminated. The medical history of the patient revealed well compensated diabetes mellitus type II, and pharmacologically controlled hypertension. The tooth was surgically removed using piezoelectric instruments. Before and after surgery, three types of tests (tactile, pain and thermal sensitivity) were carried out to delimit the area affected by paraesthesia. At 7 days, the area of hypoesthesia of the hemi-lip was significantly reduced. Further improvement in tactile and thermal sensitivity occurred in subsequent follow-up, at 1 and 3 months, postoperatively. This clinical case demonstrates that the surgical intervention performed with piezoelectric instruments prevented the damage of an important structure such as the lower mandibular nerve, and promoted regression of a contingent paraesthesia.

Loading stress distribution in posterior teeth restored by different core materials under fixed zirconia partial denture: A 3D-FEA study.

PURPOSE: To evaluate the effect of different substrate stiffness [sound dentin (SD), resin composite core (RC) or metal core (MC)] on the stress distribution of a zirconia posterior three-unit fixed partial denture (FPD). METHODS: The abutment teeth (first molar and first premolar) were modeled, containing 1.5 mm of axial reduction, and converging axial walls. A static structural analysis was performed using a finite element method and the maximum principal stress criterion to analyze the fixed partial denture (FPD) and the cement layers of both abutment teeth. The materials were considered isotropic, linear, elastic, homogeneous and with bonded contacts. An axial load (300 N) was applied to the occlusal surface of the second premolar. RESULTS: The region of the prosthetic connectors showed the highest tensile stress magnitude in the FPD structure depending on the substrate stiffness with different core materials. The highest stress peak was observed with the use of MC (116.4 MPa) compared to RC and SD. For the cement layer, RC showed the highest values in the molar abutment (14.7 MPa) and the highest values for the premolar abutment (14.4 MPa) compared to SD (14.1 and 13.4 MPa) and MC (13.8 and 13.3 MPa). Both metal core and resin composite core produced adequate stress concentration in the zirconia fixed partial denture during the load incidence. However, more flexible substrates, such as composite cores, can increase the tensile stress magnitude on the cement. CLINICAL SIGNIFICANCE: The present study shows that the choice of the cast core and metallic post by the resin composite core and fiberglass post did not improve the biomechanical behavior of the FPD. This choice must be performed based on clinical criteria (other) than mechanical.

The Use of Dermal Substitutes for Donor Site Closure After Radial Forearm Free Flap Harvesting.

OBJECTIVE: The aim of our study was to analyze the aesthetic and functional outcome in the radial forearm free flap donor site using a simple split thickness skin grafting (STSG) closure compared with the use of dermal scaffold supporting the STSG closure. METHODS: The study analyzed 18 patients, divided in 2 groups based on the donor site closure modality. In STSG group, a simple STSG was used to cover the defect. In the DS + STSG group, the defect was covered by the use of dermal substitute (MatriDerm) supporting the STSG. Groups were compared on the following outcome variable: scar status; hand function; circumferences at most proximal and most distal point of the graft. All patients were followed up 1, 6, and 12 months post-operative. RESULTS: Nine patients from STSG group showed a difference in circumference between the operated and contralateral limbs respectively of 2.9 mm proximal and 1.2 mm distal; in the 9 patients of DS + STGS group the difference was respectively of 1.2 mm proximal and 1.3 mm distal. Welch unequal variances t-test demonstrated statistical significance of the values with P < 0.004 (P < 0.5). The average VSS was 1.82 ±â€Š0.2 for STSG group and 1.75 ±â€Š0.2 for DS + STGS group. The DASH score was 21.8% in STSG group and 19.4% in DS + STGS group. CONCLUSION: Our study shows that patients treated with Matriderm + STSG obtained a better result both in esthetic and functional outcomes.

Perceived Job Insecurity and Depressive Symptoms among Italian Dentists: The Moderating Role of Fear of COVID-19.

Containment measures adopted to reduce the spread of coronavirus disease 2019 (COVID-19) have produced a general perception of job insecurity. Dentists have been highly affected by such measures, as they represent an easy source of contagion. As perceived job insecurity is associated with psychological distress and Italian dentists have been highly affected by the COVID-19 outbreak in terms of potential financial loss and the risk of being infected, this study aimed at assessing whether the fear of COVID-19 moderated the effect of perceived job insecurity on depressive symptoms. This cross-sectional online study has included 735 Italian dentists recruited during the lockdown and ranging in age from 27 to 70 years old (495 men and 240 women). A quantile regression model with an inference based on the median and with an interaction term between the fear of COVID-19 and perceived job insecurity has been used to estimate the hypothesized associations. The results indicated that both perceived job insecurity and fear of COVID-19 were positively associated with depressive symptoms, and that the effect of perceived job insecurity on depressive symptoms was weaker among those with a low fear of COVID-19. The findings may inform public health policies for dentists in relation to reducing the risk of developing negative mental health outcomes.

Treatment of periodontal pockets at the distal aspect of mandibular second molar after surgical removal of impacted third molar and application of L-PRF: a split-mouth randomized clinical trial.

OBJECTIVES: Presence of clinical attachment loss on the distal aspect to the second molar may be associated with malposition of the third molar. The aim of this study was to evaluate the reduction of clinical attachment loss at the distal aspect of the second molar after third molar extraction and application of leukocyte- and platelet-rich fibrin (L-PRF). METHOD AND MATERIALS: Eighteen subjects with a clinical attachment loss on the distal site to the second molar associated with impacted third molar in both sides of the jaw were recruited for the study. For each subject the teeth were randomly allocated in test and control groups. After surgical removal of the impacted third molar, the L-PRF was inserted in the fresh alveolar socket of test sites; in the control sites no graft was inserted after extraction. Full-mouth plaque score, full-mouth bleeding score, clinical attachment level (CAL), probing depth, and gingival recession were assessed at baseline and 6 months later. RESULTS: After 6 months, mean CAL change was 1.99 ± 1.18 mm in the test group and 1.15 ± 1.01 mm in the control group; probing depth change was 1.33 ± 0.87 mm in the test group and 0.50 ± 0.63 mm in the control group. Statistically significant differences (P < .05) were observed between groups in terms of CAL and probing depth changes. No differences were found in gingival recession changes. CONCLUSION: Within the limits of the present study, the sites treated by means of application of L-PRF after impacted third molar extraction showed better results in terms of CAL gain and probing depth reduction when compared with control sites.

Pre-treatment Neutrophil-to-Lymphocyte Ratio as a predictor for occult cervical metastasis in early stage (T1-T2 cN0) squamous cell carcinoma of the oral tongue.

BACKGROUND: Optimum management of clinically negative neck (cN0) remains controversial in early stage (T1-T2) squamous cell cancer of the oral tongue (OTSCC). The purpose of this study was to investigate the value of pre-treatment Neutrophil-to lymphocyte ratio (NLR) in predicting occult cervical metastasis in stage I and II OTSCC. METHODS: We carried out a retrospective chart review on 110 patients suffering from early stage OTSCC who were surgically treated with tumour excision and elective neck dissection (END). Our cohort was divided in pN+ and pN0 groups basing on histopathological examination after elective neck dissection. For each patient pre-treatment NLR was calculated. RESULTS: A statistically significant relationship between high levels of pre-treatment NLR and probability rate for neck occult metastases (0.000496 p-value) has been found. On our model the cut-off value was set for NLR >2.93. Above this level the probability to finding metastasis in a clinically negative neck increases exponentially. CONCLUSION: These preliminary results offer clinicians an easily obtainable tool to stratify patients based on risks of metastatic node in whom END could be indicated.

Influence of Leukocyte- and Platelet-Rich Fibrin (L-PRF) in the Healing of Simple Postextraction Sockets: A Split-Mouth Study.

The aim of this study was to evaluate the effects of leukocyte- and platelet-rich fibrin (L-PRF) on the pain and soft tissue healing after tooth extractions. Twenty-six patients (9 males and 17 females) were treated with multiple extractions (2 to 8), with a total of 108 extractions. This was an exploratory single blinded randomized clinical trial with a split-mouth design. The pain after the surgery was assessed in each patient by the VAS scale (1 to 10) at intervals of 24-48-72-96 hours. The soft tissue healing was clinically evaluated at 3, 7, 14, and 21 days after surgery by the same examiner surgeon, using the modified Healing Index (4 to 12). The mean value of postextraction pain was 3.2 ± 0.3 in the experimental sides and 4.1 ± 0.1 in the control sides. After 7 days from the extractions, the values of modified Healing Index in the experimental and control groups were, respectively, 4.8 ± 0.6 and 5.1 ± 0.9. The use of L-PRF in postextraction sockets filling can be proposed as a useful procedure in order to manage the postoperative pain and to promote the soft tissue healing process, reducing the early adverse effects of the inflammation.

Safe approach in "All-on-four" technique: a case report.

The "All-on-Four" concept is based on the placement of four implants in the anterior part of fully edentulous jaws to support a provisional, fixed, and immediately loaded full-arch prosthesis. Combining tilted and straight implants for supporting fixed prostheses can be considered a viable treatment modality resulting in a more simple and less time consuming procedure, in significantly less morbidity, in decreased financial costs and a more comfortable postsurgical period for the patients. The authors present a case report with mandibular atrophy and left mental foramina on the top of the residual crest.

Use of piezosurgery device in management of surgical dental implant complication: a case report.

An implant displacement into the maxillary sinus could be a complication of implant surgery in the upper jaw. In such cases, implant removal is needed to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure safer management of such complications because of clear surgical visibility and a selective ability to cut. The aim of this report is to present a case of an implant-related oral surgery complication that was resolved by means of a piezosurgery technique.

Aesthetics in oral implantology: biological, clinical, surgical, and prosthetic aspects.

OBJECTIVES: The aim of this study was to identify a correct clinical, surgical, and prosthetic management of endosseous implants replacing missing teeth in the anterior maxilla, achieving predictable aesthetic outcomes. Placement of immediate post-extraction implants without incisions or flap elevation is one of the surgical treatment options able to improve the healing and regenerative potentials of the fresh socket. MATERIALS: Fifty-five patients (33 men, 22 women), ranging in age from 19 to 57 years (mean 29), were selected for this study. All the patients were not smokers, no bruxers, presented stable soft tissue conditions, an acceptable occlusion, and the absence of pathologies that would contraindicate bone healing. Patients were treated with implants made by 2 manufacturers: Institute Straumann, Walderburg, Switzerland and Friadent, Mannheim, Germany. A total of 87 implants were placed immediately after each failing tooth had been removed. The temporary restoration was placed 3 months after implant placement, and the final restoration was placed 4 months from the surgical procedure. The patients were evaluated clinically and radiographically at implant placement, and 2, 4, 18, and 24 months post-insertion. RESULTS: At 24 months, only 3 implants were lost (2 in male patients;1 in female patient). All of these failed implants did not achieve osseointegration. The overall success rate was 96.6%, with an implant failure rate of 3.4%, all prior to restoration. CONCLUSIONS: The immediate placement in the anterior maxilla fresh extraction sockets without incisions or flaps elevation is a surgical option that can ensure ideal peri-implant tissues healing, preserving the presurgical gingival and bone aspects. For a predictable aesthetic result, the most important aspect seems to be the height and thickness of the buccal bone wall, which remain after immediate placement of the fixture.