Immediate, Early (6 Weeks) and Delayed (4 Months) Single Post- Extractive Implants: 3-Year Post-Loading Data From a Randomised Controlled Trial

Abstract

Randomised controlled trial PURPOSE. To compare the clinical outcome of single implants placed immediately after tooth extraction with those placed 6 weeks after tooth extraction (early placement), and those placed 4 months after extraction and socket healing (delayed placement). MATERIALS AND METHODS.Two hundred and ten patients requiring one single implant-supported crown to replace a tooth to be extracted were randomised into 3 groups of 70 patients each to receive immediate, early (at 6 weeks), or delayed (after 4 months of healing) post-extraction implants, according to a parallel-group design. When needed, patients from the immediate and early groups had bone substitute grafts in the extraction socket, covered with a resorbable membrane, at implant placement. Sockets randomised to delayed implants were grafted in the same manner if poorly preserved, or in the "aesthetic" areas (from second upper premolar to second upper premolar). Implants inserted with at least 25 Ncm torque were left to heal unloaded for 4 months, whereas those inserted with less than 25 Ncm were left to heal unloaded for 6 months. Temporary crowns were delivered, and were to be replaced by definitive ones after 4 months. Outcome measures were crown and implant failures; complications; peri-implant marginal bone level changes; aesthetics, as assessed using the pink aesthetic score (PES); and patient satisfaction, recorded by blinded assessors. Patients were followed-up for 3 years post-loading. RESULTS.Three years after loading, drop-outs were: five (7.1%) patients from the immediate, nine (12.9%) from the early, and eight (11.4%) from the delayed group. Five implants (9.2%) failed in the immediate, four (6.6%) in the early, and one (1.6%) in the delayed group (P [Freeman-Halton] = 0.282). Apart from the crowns that failed due to implant losses, no other definitive crown had to be remade. Complications affected eleven patients from the immediate group, 12 from the early, and eight from the delayed group (P [chi-square test] = 0.596). Mean peri-implant marginal bone loss after 3 years was -0.33 ± 0.22 mm at immediate, -0.43 ± 0.26 mm at early, and -0.49 ± 0.30 at delayed implants; (P [Kruskal Wallis test] <0.001); there were significant pairwise differences between immediate and early (0.10 mm; CI 95% -0.02; 0.22; P [Dunn-Bonferroni post-hoc] = 0.0391) and immediate and delayed implants (0.16 mm; CI 95% 0.04; 0.27; P [Dunn-Bonferroni post-hoc] = 0.0004), but no difference between early and delayed implants (0.06 ± 0.05 mm; CI 95% -0.06; 0.18; P [Dunn-Bonferroni post-hoc] = 0.6015). Three years after loading, the mean overall PES were 12.25, 11.98 and 11.17 in the immediate, early and delayed groups, respectively (P [Kruskal Wallis test] <0.001); there were significant pairwise differences between immediate and delayed (1.08 ± 0.27 mm; CI 95% 0.45; 1.72; P [Dunn-Bonferroni post-hoc] = 0.0006), and early and delayed implants (0.81 ± 0.27 mm; CI 95% 0.17; 1.46; P [Dunn-Bonferroni post-hoc] = 0.0099), but no difference between immediate and ea...

The peri‐implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

“…Full‐text assessment was performed for 327 articles. Based on the predetermined inclusion criteria, 121 articles were included 14–20,22,23,30–141 . The reason for exclusion of the other 196 articles is available in the Appendix (Table S1).…”

Survival Rates and Factors Affecting the Outcome Following Immediate and Delayed Implant Placement: A Retrospective Study

“…Implant treatment protocols have shown both failures and complications. A randomized clinical trial that compared the clinical outcomes of single implants placed immediately after an extraction, with implants inserted at 6 weeks (immediate-delayed) or at 4 months demonstrated no significant differences with respect to failure rates, complications and patient satisfaction [ 24 ]. Immediate and immediate–delayed implants resulted in better esthetic results than delayed implants when the total esthetic score was used [ 24 ].…”

“…A randomized clinical trial that compared the clinical outcomes of single implants placed immediately after an extraction, with implants inserted at 6 weeks (immediate-delayed) or at 4 months demonstrated no significant differences with respect to failure rates, complications and patient satisfaction [ 24 ]. Immediate and immediate–delayed implants resulted in better esthetic results than delayed implants when the total esthetic score was used [ 24 ]. In contrast, a randomized clinical trial that included patients in need of a single implant in the anterior and premolar areas reported higher radiographic bone loss, deeper probing depths and more frequent inadequate pink esthetic scores in subjects that received immediate implants than those subjects who received one at 12 weeks [ 25 ].…”

Comparison Between Single Early-Loaded Implants With Sandblasted Acidetched (Sa) Surface Versus Sa Surface Modified With Ph Buffering Agent (Soi): Four-Month Data From a Split-Mouth, Multicentre Randomized Controlled Trial

“…Different surgical approaches have been attempted to provide immediate aesthetic and functional rehabilitation [4][5][6] . Although a Cochrane systematic review has failed to find any convincing evidence of a clinically significant difference in implant and prosthesis failures associated with different implant loading times 6 , as compared with the conventional procedure, immediate implant placement into fresh extraction sockets has been associated with a higher incidence of implant failures [6][7][8][9][10] . Hence, over the years different implant macro and micro designs have been introduced in the attempt to increase the bone-to-implant contact during healing time, making osseointegration faster.…”