Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial.

OBJECTIVE: To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS: Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS: The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION: The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE: These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

Is the facial bone wall critical to achieving esthetic outcomes in immediate implant placement with immediate restoration? A systematic review.

BACKGROUND: Rehabilitation in the anterior region requires specific conditions for success, such as the presence of papilla, emergence profile, and balance between pink and white esthetic. OBJECTIVES: This systematic review aimed to evaluate the esthetic risk associated with immediate implant placement with immediate restoration in the anterior superior area, where the facial bone plate may be absent or deficient. MATERIAL AND METHODS: The search was done in PubMed, Embase, Cochrane, Lilacs, Scopus, Scielo, and Google Scholar databases. The investigation involved clinical studies and observational studies published between January 2012 and July 2023. Studies were excluded if there was less than 12-month follow-up, no immediate restoration or facial defect, heavy smokers, or systemic disease. The risk of bias was assessed using the ROBINS-I and Modified-Cochrane RoB tools. RESULTS: Twelve studies were included in this systematic review. The thinner the facial plate, the higher the alveolus's risk of gingival recession or shrinkage. There was an increased interproximal recession when the thin phenotype was associated with flap surgery. An increase in pink esthetic score (PES) was reached when immediate implant placement (IIP) and immediate restoration were done. Soft tissue augmentation achieved more gingival-level stability. Regardless of the initial phenotype, an esthetic outcome was delivered. The risk of bias was high in 1 study and moderate in 3 studies. CONCLUSION: It is possible to conclude that esthetic results and increased final PES or patient satisfaction index in IIP treatments associated with immediate restoration could be obtained even in buccal bone wall defects or gingival recession, regardless of their extension.

Effect of lateral static load on immediately restored implants: histologic and radiographic evaluation in dogs.

OBJECTIVES: The aim of this study was to evaluate the effect of lateral static load in immediately restored implants in the canine mandible. MATERIAL AND METHODS: In 7 mongrel dogs, all premolars and the first molars were extracted bilaterally in the mandible. Two months after the extractions, 6 implants with sandblasted acid-etched surfaces were placed in each animal, 3 on each side. Randomly, two implants per side were immediately restored with an orthodontic expansion device that promoted lateral excessive static load (test group) or load (control) while the third implant of each side, remained submerged (unloaded group). These loaded devices were cleaned daily with chlorhexidine 0.12%, during the 4 months of study, when the animals were sacrificed and biopsies removed for histometric study. Intra-oral periapicals were made using positioners at the beginning and at the end of the study. RESULTS: Five implants from test group were lost in 3 dogs. Radiographically, there was a marginal bone loss of 3.68 ± 0.74 mm for the test group, 1.63 ± 0.2 mm for the control group and 0.45 ± 0.5 mm for the unloaded group. Histometrically, the percentage of bone-to-implant contact (BIC%) was 35.52 ± 7.32%, for the test group, 63.16 ± 5.16% for the control group and 42.33 ± 2.14% for the unloaded group. CONCLUSION: In conclusion, the excessive lateral static load negatively affected the behavior of peri-implant bone around immediate restored implants.