Comparison of Immediate Implantation into the Socket with and without Periapical Pathology: Systematic Review and Meta-Analysis.

Background and Objectives: The present systematic review and meta-analysis were conducted to evaluate and compare the long-term clinical outcomes of immediate implants placed into fresh sockets with and without periapical pathology. Materials and Methods: After the search and review of the literature in the electronic databases, 109 publications were achieved. The titles and abstracts of 66 publications were screened. After the evaluation of the full text of 22 publications, based on the inclusion criteria, six controlled clinical studies were included in this systematic review and meta-analysis. Results: The statistical calculation showed no heterogeneity among the studies included. The implant survival was 99.6% in the test (socket with periapical pathology) and control (socket without periapical pathology) groups of all the clinical trials. The results of the meta-analysis showed no statistically significant difference between test and control groups regarding the marginal bone level and the width of keratinized mucosa in all the studies. Other parameters indicating plaque level, bleeding on probing, and gingival recession also did not differ between test and control groups at the final follow-up in nearly all studies. Conclusions: Within the limitation of this systemic review and meta-analysis, the obtained data suggest that implants immediately placed into the extraction sockets of teeth exhibiting periapical pathology can be successfully osseointegrated for an extended period.

A randomized controlled trial of immediate implant placement comparing hydroxyapatite nano-coated and uncoated sandblasted/acid-etched implants using a digital surgical guide.

PURPOSE: This study evaluated the implant stability, volumetric changes, and patient-reported outcome measures (PROMs) of hydroxyapatite (HA) nano-coated sandblasted/acid-etched (SLA) implants compared to uncoated SLA implants. METHODS: Forty patients were recruited and randomly allocated to HA nano-coated SLA group (test, n = 20) and uncoated SLA group (control, n = 20) using single-blinded/block randomization. Implants were immediately placed in maxillary posterior region using a digital surgical guide. Insertion torque and implant stability quotient (ISQ) were measured at implant surgery and 1, 2, 3, and 4 months postoperatively. Intraoral scans, PROMs and soft tissue inflammation data were collected, and multivariable linear regression analysis of ISQ was performed. RESULTS: In total, 48 implants (test; n = 24, control; n = 24) in 37 patients (test; n = 19, control; n = 18) were analyzed. Despite no significant between-group difference at surgery, the test group showed higher ISQ values than the control group at 2 (76.53 ± 4.17 vs. 71.32 ± 4.79, p < 0.01), 3 (77.45 ± 4.41 vs. 73.85 ± 4.69, p < 0.05), and 4 months (79.08 ± 2.96 vs. 73.43 ± 3.52, p < 0.0001) postoperatively. There were no significant differences in linear and volumetric changes, PROMs, and soft tissue inflammation analysis between two groups. The ISQ at implant surgery was influenced by age and diabetes mellitus (DM) at the implant level and DM and predicted total bone-to-implant contact area at the patient level. CONCLUSION: HA nano-coated SLA implants promoted favorable immediate implants stability during early osseointegration phase compared to uncoated SLA implants, but displayed similar dimensional changes, PROMs, and soft tissue inflammation outcomes. TRIAL REGISTRATION: Clinical Research Information Service (CRIS), KCT0006364. Registered 21 July 2021, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24221&search_page=L .

Design and Biomechanical Analysis of Customized Angled Abutment Based on Tooth Inclination Angle for Immediate Implant Placement on Maxillary Anterior Region.

PURPOSE: Finite element analysis and an in vitro experiment were employed to investigate the loading effects of angled abutments, comparing various customized angled abutments derived from the average angle of incisors in patients with a commercial 15°∆ angled abutment, on both the implant and surrounding bone. METHODS: Four customized angled abutment models (21.9°∆, 24.15°∆, 20.22°∆, 33°∆) were developed using cone-beam computed tomography (CBCT) images of incisor inclination from various age groups of patients. 3D maxillary bone models were created from CBCT images of four individual patients. Finite element analysis and in-vitro strain gauge experiments were conducted, applying 100N or 50N of axial or oblique force, to assess the differences in stress/strain between the customized and the commercial 15°∆ angled abutments in both the implants and surrounding bone. RESULTS: Under axial loading, the stress values in the dental implant and surrounding bone were elevated due to the relatively higher angles of the customized angled abutments (21.9°∆, 24.15°∆, 20.22°∆, 33°∆) when compared to the commercial 15°∆ angled abutment; however, under oblique loading the commercial 15°∆angled abutment exhibited higher stress values in both the implant and surrounding bone. For in vitro experiment, there is no statically difference in bone strain between the customized (21.9°∆) and the commercial 15°∆ angled abutments in axial loading. Nevertheless, in oblique loading using a commercial 15°∆ angled abutment induced the higher bone strains. CONCLUSION: Customized angled abutments offer lower stress/strain under oblique loads but higher stress/strain under axial loads compared to commercial ones. Therefore, in the design and application of angled abutments, careful consideration of the occlusal load direction is paramount for achieving biomechanical success of dental implant.

Preserving Peri-Implant Soft Tissue Health: A Case Report on Immediate Implant Placement Using the Socket Shield Technique.

Alveolar bone resorption is a natural occurrence following tooth extraction, complicating the process of prosthetic rehabilitation with implants. Techniques such as socket preservation, atraumatic extraction, and immediate implant placement are employed to reduce the dimensional changes associated with extraction. The socket shield technique (SST) is effective in preserving the alveolar ridge's contour, enhancing the aesthetic results of rehabilitation by maintaining the integrity of the bundle bone complex even when the buccal bone is less than 1mm.  This case report presents a 23-year-old female patient with a fractured upper central incisor. The socket shield technique was chosen based on the clinical findings from the cone beam computed tomography (CBCT) scan. Immediate temporization was provided to preserve soft tissue integration. A comparison of the initial and subsequent cone beam computed tomography (CBCT) scans, along with clinical observations, suggests that the socket shield technique is a viable method for preserving both hard and soft tissue structures in the anterior dental region, thereby improving aesthetic outcomes.

Comparative Assessment of Crestal Bone Levels in Immediate Versus Delayed Implant Placement With and Without Bone Graft.

Background Presently, modern regenerative and surgical techniques for immediate implant placement in prepared sockets with soft tissue grafts and bone substitutes have helped eliminate concerns about bone deficiency. This also allowed the placement of dental implants based on prosthodontic needs. Aim  The present study aimed to comparatively assess dental implant healing following immediate implant placement with or without bone graft and dental implant healing after delayed implant placement with or without bone graft. Methods The study included 120 study subjects that were divided into two groups. Group I for immediate implant placement with or without bone graft (n=60) and Group II for delayed implant placement with or without bone graft (n=60). These two groups were further divided into subgroups. Group I subjects were further divided into two subgroups, where Group A (n=30) subjects underwent immediate implant placement with bone graft and Group B (n=30) subjects were given immediate implant placement without bone graft. Group II participants were further divided into two subgroups, where Group C (n=30) subjects underwent delayed implant placement with bone graft and Group D (n=30) subjects underwent delayed implant placement without bone graft. In the two groups, crestal bone levels were compared radiographically preoperatively and postoperatively at the immediate postoperative time, three months, and six months. Results More reduction in the crestal bone level was seen in the immediate implant placement group at three and six months postoperatively compared to the delayed implant placement group. A non-significant reduction in crestal bone levels was seen in the immediate implant placement with bone graft group with p>0.05 at three and six months compared to immediate implant placement without bone graft. Similar, non-significant crestal bone loss was seen in the delayed implant placement with bone graft group at three and six months compared to delayed implant placement with bone graft. Conclusions  This study concluded that healing of crestal bone in the delayed implant placement group with or without bone graft is better in comparison to the immediate implant placement group with or without bone graft.

Immediate Implant Placement with Immediate Restorations after Dental Avulsions Due to Endotracheal Intubation in a Patient with Severe Chronic Periodontal Disease.

We report the case of a 61-year-old woman who was referred to the Oral Surgery and Implantology Unit of the University Hospitals of Geneva to take care of edentulous sites after the dental avulsions of teeth 11 and 21 following traumatic shock due to endotracheal intubation under general anesthesia. The dental history revealed that the patient had a history of generalized chronic periodontitis that had been treated several years earlier. The treatment consisted, for the first time to our knowledge, of the immediate insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure and immediate restorations.

Efficacy of Oral Magnesium on Bone Regeneration and Implant Stability in Immediate Dental Implants: A Randomized Controlled Trial.

PURPOSE: The successful osseointegration around immediate implants requires high quality and quantity of osteogenesis around them. The role of magnesium as a boneenhancing mineral, and as an adjunctive analgesic has been well documented in orthopedic literature. However, there is a paucity of literature in its role in successful osseointegration around immediate implants. This randomized controlled trial sought to assess the promising impact of magnesium on osseointegration by examining various aspects of implant stability, correlating them with serum bone markers, and establishing a foundation for future research on its potential as a potent analgesic. MATERIALS AND METHODS: Immediate implant placement was done after the extraction of the indicated mandibular molar tooth, and all the patients were segregated into 2 groups (Placebo- Lactose, and Magnesium citrate). Bone regenerate in the peri-implant area was assessed radiographically immediate post-operatively, on the 6th week and 12 weeks. Implant stability was measured immediate post-operatively, at the 4th week and 12th week. Serum parameters were procured pre-operatively and post-operatively for serum calcium, serum alkaline phosphatase (ALP), and serum parathyroid hormone at the 8th week, and serum vitamin D3 levels preoperatively. RESULTS: 54 immediate implants placed showed the demographics and baseline serum, clinical, and radiographic parameters were comparable in both groups. Analysis of Implant Stability Quotient at 12th week showed statistically significant difference in intervention group both on intergroup and intragroup analysis. Radiodensity measurement showed a statistically significant difference in both intragroup and intergroup analysis in the intervention group at the 6th and 12th week. In bone gap analysis, the difference in mean change in the horizontal bone gap (HG) at 6 weeks was non-significant while the difference in HG at the 12th week was significant in the intervention group. On intragroup analysis, mean change HG at 6 weeks and 12 weeks both were significant only in intervention group. Intergroup analysis of vertical bone gap (VG) 12 and VG 12-0 (mean difference in the vertical bone gap from 12th week-day 0) showed a statistically significant difference in the intervention group. On intragroup analysis, VG 12 was significantly better in the intervention group. On serum analysis, ALP post-operatively was found to be significantly raised (P=0.013) in intervention group. Numerical rating Scale (NRS) analysis showed a significant decrease in post-op day 5 and 7, (P=0.017) and (P=0.002) respectively. CONCLUSION: The oral magnesium citrate supplementation after immediate implant placement helps in enhancing the stability of the immediate implants, along with improved radiodensity around them which was found to be statistically significant. It also helps in reducing the horizontal, and vertical gap around the implant and has significant analgesic potential.

The influence of immediate occlusal loading on micro/nano-structure of peri-implant jaw bone in rats.

PURPOSE: The objective of the present study was to ascertain the effect of immediate occlusal loading after implant placement on osseointegration and the micro/nanostructure of the surrounding bone. METHODS: After extraction of a rat maxillary right second molar, an implant was placed immediately with initial fixation (2 N< ). The implants were placed to avoid occlusal loading due to mastication, and in the loaded group, a superstructure was fabricated and subjected to occlusal loading. Bone morphometry, collagen fiber anisotropy, and biological apatite (BAp) crystallite alignment were quantitatively evaluated in both groups after extraction and fixation of the jaw bone at Days 7 and 21 after surgery. RESULTS: Osseointegration was observed in both groups. Bone morphometry showed significant differences in bone volume, trabecular number, trabecular thickness and bone mineral density (BMD) at Days 21 postoperatively (P < 0.05). A significant difference was also found in the trabecular separation at Days 7 postoperatively (P < 0.05). In the evaluation of collagen fiber anisotropy, collagen fiber bundles running differently from the existing bone were observed in both groups. In terms of BAp crystallite alignment, a specific structure was observed in the reconstructed new bone after implantation, and preferential orientation of BAp crystallite alignment was observed in the longitudinal direction of the implants in the Day 21 postoperative loaded group. CONCLUSION: When sufficient initial fixation is achieved at the time of dental implant placement, then the applied masticatory load may contribute to rapidly achieving not only bone volume, but also adequate bone quality after implant placement.

Long-term survival rates of tapered self-tapping bone-level implants after immediate placement: a positional effective rationale.

BACKGROUND: Immediate implant placement has gained popularity due to its several advantages. However, immediate placement has its challenges, including concerns about primary stability and bone formation around the implant. The aim of the present study is to evaluate the clinical outcomes of tapered, sand-blasted, and acid-etched internal submerged dental implants in various regions of the jaw bones and to provide a positional rationale for immediate implant placement. METHODS: Between 2009 and 2018, a single surgeon at Seoul National University Dental Hospital in Seoul, Korea, immediately inserted 49 dental implants with tapered bone-level design after extraction, in a total of 34 patients. The clinical outcomes were collected and evaluated, focusing on location of implant placement and marginal bone loss (MBL), with consideration of other parameters such as implant diameter and length. RESULTS: Of 49 immediately installed Luna® (Shinhung Co., Seoul, Korea) dental implants, 23 were placed in the mandible, and 26 were set in the maxilla. The mean age of patients at the time of installation was 65.91 years, ranging from 40 to 86 years. The average follow-up period was 7.43 years, with a range of 5 to 14 years. After a 5-year retrospective evaluation of tapered, sand-blasted, and acid-etched internal submerged dental implants for immediate implant placement, the cumulative survival rate was 93.88%, with 100% survival rate in the mandible and premolar region of both the maxilla and mandible. CONCLUSIONS: After a 5-year evaluation, tapered, sand-blasted, and acid-etched internal submerged dental implants demonstrated good efficacy for immediate placement in various locations within the dental arches, exhibiting effective clinical performance.

Accuracy analysis of robotic-assisted immediate implant placement: A retrospective case series.

OBJECTIVES: This study aimed to investigate the accuracy of a robotic computer-assisted implant surgery (r-CAIS) for immediate implant placement. METHODS: Patients requiring immediate implant placement in the maxillary anterior region were enrolled for r-CAIS. Before surgery, the patients underwent a cone beam computed tomography (CBCT) scan with a positioning marker. Virtual implant placement position and drilling sequences were planned. Following spatial registration and calibration, the implants were placed with the robotic system under supervision. A postoperative CBCT was taken to control the actual implant positions. The DICOM data of the virtually planned and the actually placed implant were superimposed and registered through the accuracy verification software of the robotic system. The accuracy was calculated automatically. The deviation at the mesial-distal, labial-palatal, and apico-coronal directions were recorded. RESULTS: Fifteen patients with 20 implants were included. No adverse surgical events or postoperative complications were reported. The global platform, apex, and angular deviation were 0.75 ± 0.20 mm (95 % CI: 0.65 to 0.84 mm), 0.70 ± 0.27 mm (95 % CI: 0.57 to 0.82 mm), and 1.17 ± 0.73° (95 % CI: 0.83 to 1.51°), respectively. Moreover, the vertical platform and apex deviation were 0.50 ± 0.31 mm, (95 % CI: 0.35 to 0.64 mm) and 0.48 ± 0.32 mm, (95 % CI: 0.33 to 0.63 mm), respectively. All the placed implant positions were further labial and apical than the planned ones, respectively. CONCLUSIONS: High accuracy of immediate implant placement was achieved with the robotic system. CLINICAL SIGNIFICANCE: Our study provided evidence to support the potential of the robotic system in implant placement, even in challenging scenarios.

Immediate implant placement in a dialysis patient. A case report.

Implant-supported rehabilitation in high-risk patients poses significant challenges for the dental team. The presence of comorbidities and increased infection risk can, for example, lead to a higher risk of implant loss. For the therapy to be completed with as few complications as possible, special anamnesis, detailed diagnostics, and a risk analysis based on those findings are indispensable. The aim of all considerations is to keep the risk of infection for the patient with a disease history to a minimum and to strive for an appropriate functional and esthetic therapeutic success. Particularly in the esthetic zone, in addition to the general health risks of the surgical procedure, esthetic aspects are increasingly taken into account in planning. The present article describes the implant-prosthetic replacement of a single anterior tooth in a dialysis patient. Several aspects (regular dialysis, missing buccal lamella, high smile line, functional risk) increased the risk of complications in this case.

Immediate versus early loading of immediately placed bone-level tapered dental implants with hydrophilic surface in full arch maxillary rehabilitation: A pilot randomized clinical trial with 2-year follow-up.

This study aimed to compare implant stabilities between the immediate and early loaded, immediately placed bone-level tapered dental implants in the maxilla and to evaluate marginal bone loss (MBL), oral health-related quality of life (OHRQoL), and patient satisfaction at a 2-year follow-up. A pilot, prospective, randomized, controlled clinical trial was conducted on 24 maxillary failing dentition patients. The bone-level tapered implants of 12 patients were immediately loaded with temporary restorations, while the other 12 patients did not receive any kind of temporization. Implant-supported screw-retained complete porcelain-fused-to-metal prostheses were delivered to all patients in the seventh postoperative week. The insertion torque values of implants assigned to the immediate and early loading groups were 33.0 ± 4.87 and 29.26 ± 8.31 Ncm, respectively. The dynamics of implant stability changes from implant placement up to a 2-year follow-up were similar for both groups (Penguin®, p = 0.268; Ostell®, p = 0.552), while the MBL was at submillimeter level. The cumulative implant survival rate was 91.80% for immediately loaded implants and 97.22% for early loaded implants, without significant difference (p = 0.162). The total score on the Oral Health Impact Profile questionnaire significantly decreased over time in both groups, indicating improvement in OHRQoL (p < 0.001), and the high level of patient satisfaction remained after 2 years of function regardless of a loading protocol. Both loading protocols, immediate and early, of six immediately placed bone-level tapered dental implants are an adequate treatment choice for fixed rehabilitation of the maxillary failing dentition.

The Socket Shield Technique: Stability of the Buccal Peri-implant Bone after Partial Root Removal - A Prospective Case Series of 20 patients, with 18 Months Follow-up.

OBJECTIVE: This study aims to collect data on implant survival, bone volume maintenance, and complications associated with the socket shield technique. BACKGROUND DATA: The socket shield technique was introduced in 2010. Since then, several systematic reviews have been published, showing good clinical outcomes. The behaviour of the buccal bone plate is so far not completely understood. METHODS: The study involved the placement of 23 implants using the socket shield technique in 20 patients. AstraTech EV implants were used, and no bone substitutes or connective tissue grafts were applied. Patients were monitored for 18 months, recording implant survival, volumetric bone analysis on CBCT scans, interproximal bone levels, bone sounding, pink esthetic scores, and complications. Prosthetic procedures were also described, including temporary and final restorations. RESULTS: A 95.7% cumulative 18-month implant survival rate was obtained using the socket shield technique, with a significant but limited reduction in buccal bone thickness (BBT) after implant placement. One implant did not integrate and two shields were partially exposed. The mean pink esthetic score, 1 year after loading was 12.93 ± 1.22. CONCLUSION: The study suggests that the socket shield technique can result in limited reduction of the buccal bone volume, with a high implant survival rate. Re-entry studies are recommended to investigate the causes of bone resorption.

Dynamic analyses of a soft tissue-implant interface: Biological responses to immediate versus delayed dental implants.

AIM: To qualitatively and quantitatively evaluate the formation and maturation of peri-implant soft tissues around 'immediate' and 'delayed' implants. MATERIALS AND METHODS: Miniaturized titanium implants were placed in either maxillary first molar (mxM1) fresh extraction sockets or healed mxM1 sites in mice. Peri-implant soft tissues were evaluated at multiple timepoints to assess the molecular mechanisms of attachment and the efficacy of the soft tissue as a barrier. A healthy junctional epithelium (JE) served as positive control. RESULTS: No differences were observed in the rate of soft-tissue integration of immediate versus delayed implants; however, overall, mucosal integration took at least twice as long as osseointegration in this model. Qualitative assessment of Vimentin expression over the time course of soft-tissue integration indicated an initially disorganized peri-implant connective tissue envelope that gradually matured with time. Quantitative analyses showed significantly less total collagen in peri-implant connective tissues compared to connective tissue around teeth around implants. Quantitative analyses also showed a gradual increase in expression of hemidesmosomal attachment proteins in the peri-implant epithelium (PIE), which was accompanied by a significant inflammatory marker reduction. CONCLUSIONS: Within the timeframe examined, quantitative analyses showed that connective tissue maturation never reached that observed around teeth. Hemidesmosomal attachment protein expression levels were also significantly reduced compared to those in an intact JE, although quantitative analyses indicated that macrophage density in the peri-implant environment was reduced over time, suggesting an improvement in PIE barrier functions. Perhaps most unexpectedly, maturation of the peri-implant soft tissues was a significantly slower process than osseointegration.

Five decades of research on immediate implant therapy: A modern bibliometric network analysis via Altmetric and level of evidence mapping.

AIM: To conduct a bibliometric network analysis to explore the research landscape of immediate implant placement (IIP) and provide insights into its trends and contributors. MATERIALS AND METHODS: The Scopus database was utilized as the bibliographic source, and a search strategy was implemented to identify relevant research articles. Various bibliometric parameters were extracted, including publication year, journal, authors, citations, and funding. The analysis involved examining authorship patterns, international collaborations, level of evidence, Altmetric data, and funding analysis. RESULTS: We identified a steady annual growth rate of 6.49% in IIP research. The top three countries contributing to research output were the USA, Italy, and China. Prolific authors were identified based on publication and citation metrics. International collaborations among different countries were observed. The level of evidence analysis revealed that over 30% of the articles fell into higher levels of evidence (levels 1 and 2). Altmetric data analysis indicated no significant correlations between citation counts and Altmetric Attention Score (AAS), and conversely a significant association with Mendeley readers count. Funding and open access did not significantly impact the bibliometric indices of the papers. CONCLUSIONS: The focus of research on IIP has been evolving as indicated by an exponential growth rate in this study. Only approximately 16% of the articles fit into level 1 evidence, therefore, emphasizing on higher quality level research study shortage in this field. Modern indices can be used as new bibliometric indicators as they also cover social media and online attention scores.

Accuracy of open-sleeved vs. closed-sleeved static computer-assisted implant systems in immediate maxillary molar implant placement: An in vitro study.

OBJECTIVES: The objective of this study is (1) to compare the accuracy of an open-sleeved static computer-assisted implant system (sCAIS) with a closed-sleeve sCAIS and free-hand approach in immediate implant placement (IIP) of maxillary molar sites and (2) to investigate the influence of socket morphology on these approaches. MATERIALS AND METHODS: Ninety partially edentulous duplicated maxillary models simulating three different molar sockets (type A, B, and C based on Smith and Tarnow's classification) were investigated. Three modalities, including sCAIS with open-sleeves, sCAIS with closed-sleeves, and free-hand approach, were applied separately to 30 models with 120 sockets. A customized Python script automatically measured the deviations between the virtual and actual implant positions for all 360 implants. RESULTS: The 3D deviations of sCAIS were significantly influenced by the socket and sleeve types. Both guided groups exhibited significantly less deviation than the free-hand approach. Type A and C sockets resulted in better implant positions than type B socket sites. In type B sockets, the open-sleeve group achieved significantly less deviation compared to the closed-sleeve group, with respect to apical global (1.34 ± 0.53 vs. 1.84 ± 0.59 mm), coronal horizontal (0.68 ± 0.36 vs. 0.93 ± 0.34 mm), apical horizontal (1.21 ± 0.59 vs. 1.74 ± 0.63 mm), and angular (3.30 ± 1.41 vs. 4.41 ± 1.96°) deviations. CONCLUSIONS: Guided implant surgery significantly reduces deviations during molar IIP compared to free-hand procedures. Furthermore, the use of open-sleeve sCAIS appears to be more effective in minimizing deviations in type B sockets when compared with the closed-sleeve guided system.

The Use of a New Safe Angle Concept for Immediate Implant Placement in the Anterior Maxilla: A Cross-Sectional CBCT Study

PURPOSE: To introduce a new method for labiopalatal positioning and angulation of immediately placed dental implants in the anterior maxilla with relation to the type of abutment used (straight/angled abutment). MATERIALS AND METHODS: CBCT scans from the database of a private practice were searched for patients who received immediate implants in the anterior maxilla. After superimposition of the initial and postoperative scans, the incisor root angle (IRA), incisor implant angle (IIA), and the difference between these angles were measured. An assessment was then made about whether the implant position would be within the safe angle or not. Age, sex, tooth/implant site, and type of prosthetic abutment (straight/angled) were retrieved from the patients' records. RESULTS: A total of 74 patients with 95 immediate implants altogether were selected for analysis. In regard to the type of abutment, 76 (80%) were straight, and 19 abutments (20%) were angled. Regardless of abutment type, 72 implants (75.8%) were placed within the safe angle, while 23 implants (24.2%) were placed outside it. All 19 implants with angled abutments were placed outside the safe angle. There were statistically significant associations between placement within the safe angle and type of abutment (P < .001; OR = 19), IRA (P < .001; effect size = 0.904), difference between IIA and IRA (P < .001; effect size = 1.209), and sex (P < .001; OR = 2.995). There was no statistically significant association between placement within the safe angle and IIA (P = .757, effect size = 0.063), site (P = .200; effect size = 0.184 ), or age (P = .387; effect size = 0.208). There was a statistically significant association between the type of abutment and the IRA (P = .001; effect size = 0.762) as well as the difference between IIA and IRA (P < .001; effect size = 1.056). CONCLUSIONS: The safe angle concept can be used as a reliable planning tool to determine the correct implant positioning for immediate implant placement in the anterior maxilla. Applying the safe angle concept will reduce the need for angled abutments for prosthetic correction.

Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

PURPOSE: There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period. METHODS: The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria. RESULTS: The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%. CONCLUSION: No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.

Comparing the Long-term Success Rates of Immediate Implant Placement vs. Delayed Implant Placement in Patients with Periodontally Compromised Teeth.

Background: This study aims to compare the long-term success rates of immediate implant placement and delayed implant placement in patients with periodontally compromised teeth. Materials and Methods: A total of 30 patients presenting with periodontally compromised teeth requiring extraction and subsequent implant placement were enrolled in this retrospective study. Patients were divided into two groups based on the timing of implant placement: Group A (immediate implant placement) and Group B (delayed implant placement). Implants were placed according to standard protocols. Patient records were reviewed for implant survival, peri-implant bone loss, and prosthetic complications. Data were statistically analyzed using appropriate tests. Results: The mean follow-up period was 5 years. In Group A, the implant survival rate was 90%, while in Group B, it was 83%. The mean peri-implant bone loss was 1.5 mm in Group A and 2.2 mm in Group B. Prosthetic complications were observed in three cases in Group A and five cases in Group B. The differences in implant survival and bone loss between the two groups were not statistically significant (P > 0.05). Conclusion: Both immediate implant placement and delayed implant placement demonstrated comparable long-term success rates in patients with periodontally compromised teeth.

Clinical outcomes of 3-5 years follow-up of immediate implant placement in posterior teeth: a prospective study.

BACKGROUND: Immediate implant placement in posterior teeth has become popular in recent years. However, only a few studies focused on evaluating the long-term success of immediate implant placement. PURPOSE: To analyze the clinical outcomes of immediate implant placement in the posterior region with conventional loading with 3-5 years follow-up following the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. METHOD: The study was done in 25 bone-level implants (Straumann® SLActive® bone level tapered implant, Straumann®, Basel, Switzerland) in 19 patients who underwent immediate implant placement in a posterior tooth with conventional loading with 3-5 years follow-up. The overall success and survival of these placements were evaluated following the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference using chart records, clinical examination, radiographic evaluation, and outcomes measurement. Patient satisfaction was evaluated by using a numeric rating scale. The biological and technical status, modified Pink Esthetic Score (mPES), complications, and marginal bone change were also evaluated. The analysis was done using SPSS version 21 (SPSS Inc., Chicago, IL, USA). The data were analyzed using a paired samples t-test. RESULTS: It was found that 24 out of the 25 (96%) dental implants survived for an average of 57 ± 8.07 months. All of the 24 surviving dental implants were considered an operational success. The average mPES was 9.75 ± 0.44. The major prosthetic complications seen were: (1) proximal contact loss (41.67%), (2) loosening of the screw (8.33%), and (3) cement debonding (4.17%). CONCLUSIONS: Immediate implant placement in a posterior tooth with conventional loading yields a predictable result with some complications. The most prominent complications were proximal contact loss, followed by loosening of the screw and cement debonding. The implant survival rate was 96% at a mean time follow-up of 4 years and 9 months.