Clinical outcomes of retention of the buccal root section combined with immediate implant placement: A systematic review of longitudinal studies

Abstract

Introduction: Immediate implant placement in conjunction with partial extraction therapy has been shown to result in functional osseo-and dento-integration with partial preservation of the periodontal ligament (PDL) in humans. Strategic buccal root retention for PDL preservation is a biologically driven procedure that maintains alveolar ridge dimensions and esthetics, while allowing for implant placement. The aim of this study was to conduct a systematic review of longitudinal clinical outcomes of PDL-mediated ridge preservation in conjunction with implant placement in adults, compared with conventional immediate implant placement with total extractions. The primary outcome for this study was marginal bone level (MBL) changes after strategic buccal root retention implant placement techniques.Materials and Methods: To address a predefined PICOS question, a systematic search of randomized clinical trials and cohort studies with at least 10 participants per group and a minimum 12-month follow-up was conducted. A two-phase systematic selection strategy, data extraction, and risk of bias assessment, was performed independently and in duplicate. Randomized trials were quantitatively analyzed in a meta-analysis.Results: Ten human studies fulfilled the predefined criteria and were included; three clinical trials and seven cohort studies, for a total of 506 patients and 587 implants. PDL-mediated implant placement of single-rooted periodontally healthy teeth was found to reduce marginal peri-implant bone loss and buccal plate changes as compared to conventional immediate implants across studies, while implant survival and success rates were comparable between the two procedures. A meta-analysis found that bone changes were significantly less when retention of the buccal root section was performed as compared to total extractions (standardized mean difference: [À4.53, À0.11]); the three clinical trials were, however, largely heterogeneous (I 2 : 93.1%; Q = 28.98, p < 0.001). Conclusion:Strategic retention of the buccal root section has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases of single-rooted teeth.

Effects of socket‐shield therapy on inter‐implant papilla preservation between upper central and lateral incisors: A case series with 3–5 year follow‐up

“…17 Previous clinical studies have consistently reported superior periimplant bone maintenance and higher PES in cases of immediate single implant placement utilizing the socket shield (SS) technique compared to conventionally inserted implants. [18][19][20][21][22][23] The SS technique involves the retention of the facial root fragment during extraction and removal of the palatal portion of the root and apex. Subsequently, the implant is placed lingual to the retained root fragment during the same or subsequent session.…”

Complication Management in Periodontal Ligament-Mediated Implant Placement with Total Extraction of the Root: A Case Report with 4 Years Follow-up

“…19,20 Importantly, a recent clinical study provided evidence that the root-membrane (RM) technique for PDL-mediated implant placement is non-inferior to no extraction based on volumetric and radiographic data 21 , whereas a recent systematic review of longitudinal studies concluded that strategic retention of the buccal root has a benefit in terms of dimensional ridge stability over conventional immediate implantation when implemented in carefully selected cases. 22 Collectively, this emerging body of evidence is on the verge of supporting PDL-mediated implant placement techniques as mainstream treatment modalities. Nonetheless, because of the recency of these techniques, little is known about the possible complications arising from their application and their management.…”