title: A prospective clinical study of non-submerged immediate implants: clinical outcomes and esthetic results. Facial alveolar bone wall width - a cone-beam computed tomography study in Asians. Bone healing following immediate versus delayed placement of titanium implants into extraction sockets: a prospective clinical study. The clinical use of deproteinized bovine bone mineral on bone regeneration in conjunction with immediate implant installation. Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study. Immediate restoration of implants placed into fresh extraction sockets for single-tooth replacement: a prospective clinical study. Esthetic outcomes of immediate implant placements. Immediate provisionalisation of single post-extractive implants versus implants placed in healed sites in the anterior maxilla: 1-year results from a multicentre controlled cohort study. Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year follow-up. Immediate provisional for single-tooth implant replacement with Brånemark system: preliminary report. Behaviour of the buccal crestal bone levels after immediate placement of implants subjected to immediate loading. Soft and hard tissue assessment of immediate implant placement: a case series. Dimensional changes of peri-implant soft tissue over 2 years with single-implant crowns in the anterior maxilla.
abstract: OBJECTIVES To evaluate healing of marginal defects in immediate transmucosal implants  grafted with anorganic bovine bone , and to assess mucosal and radiographic outcomes 3 - 4 years following restoration . MATERIAL AND METHODS Thirty immediate transmucosal implants in maxillary anterior extraction sites of 30 patients r and omly  received BioOss ( N=10 ; BG ) , BioOss and resorbable collagen membrane ( N=10 ; BG+M ) or no graft ( N=10 ; control ) . RESULTS Vertical defect height ( VDH ) reductions of 81.2+/-5 % , 70.5+/-17.4 % and 68.2+/-16.6 % , and horizontal defect depth ( HDD ) reductions of 71.7+/-34.3 % , 81.7+/-33.7 % and 55+/-28.4 % were observed for BG , BG+M and control groups , respectively , with no significant inter-group differences . Horizontal resorption was significantly greater in control group ( 48.3+/-9.5 % ) when compared with BG ( 15.8+/-16.9 % ) and BG+M ( 20+/-21.9 % ) groups ( P=0.000 ) . Ten sites ( 33.3 % ) exhibited recession of the mucosa after 6 months ; eight ( 26.7 % ) had an unsatisfactory esthetic result post-restoration due to recession . Mucosal recession was significantly associated ( P=0.032 ) with buccally positioned implants ( HDD 1.1+/-0.3 mm ) when compared with lingually positioned implants ( HDD 2.3+/-0.6 mm ) . In 19 patients followed for a mean of 4.0+/-0.7 years , marginal mucosa and bone levels remained stable following restoration . CONCLUSION BioOss significantly reduced horizontal resorption of buccal bone . There is a risk of mucosal recession and adverse soft tissue esthetics with immediate implant placement . However , this risk may be reduced by avoiding a buccal position of the implant in the extraction socket BACKGROUND The width of the facial alveolar bone wall is crucial for long-term successful esthetic outcomes of implants immediately placed into extraction sockets . A threshold of 2 mm is recommended to minimize buccal vertical bone resorption . AIM To assess the width of the facial alveolar bone wall using cone-beam computed tomography images ( CBCT ) . MATERIAL AND METHODS Retrospective CBCT images were acquired from a representative sample of Asians using the i-CAT classic system with a 0.4-mm voxel size . At r and om , 200 CBCT images were selected according to predefined criteria . The DICOM file was imported into the i-CAT Vision software . In the panoramic screen , the middle of each tooth was selected , and in the sagittal window , the middle cross section was selected for performing the measurements using a computer . The vertical distance from the alveolar crest ( BC ) - cemento-enamel junction ( CEJ ) was measured . The width of the facial alveolar bone wall was measured at three locations : 1 , 3 , and 5 mm apical to BC . Descriptive statistics , frequency analyses , and multi-level comparisons were performed . RESULTS The sample consisted of 74 men and 126 women ( mean age of 37.2 years ; range 17 - 82 years ) . A total of 3618 teeth were assessed . There was no significant difference between the values of right and left sides , or between genders . However , statistically significant differences were observed between age groups at all levels . The distance from CEJ to BC varied from 0.4 to 4 mm , with an overall tendency to increase with age . The mean width of the facial alveolar bone wall at anterior teeth was 0.9 mm and increased toward posterior regions . Rarely , a width of 2 mm was yielded ( 0.6 - 1.8 % for anterior teeth , 0.7 - 30.8 % for posterior teeth ) . At a 5-mm distance from BC , minimal widths of facial alveolar bone were identified for the anterior teeth . The frequency of dehiscence ranged from 9.9 % to 51.6 % for anterior and 3.1 % to 53.6 % for posterior teeth , respectively . CONCLUSION A thin facial alveolar bone wall was usually present in both jaws . Hence , for most patients , adjunctive bone augmentation may be needed when installing implants in areas of esthetic concern PURPOSE The aim of this study was to compare bone healing and crestal bone changes following immediate ( I m ) versus delayed ( De ) placement of  titanium dental implants with acid-etched surfaces ( Osseotite ) in extraction sockets . MATERIAL S AND METHODS Forty-six patients were r and omly allocated to the I m or De group ( n = 23 per group ) and received 1 implant at the incisor , canine , or premolar region of the maxilla or the m and ible . The implants were placed an average of 10 days following tooth extraction in the I m group and approximately 3 months after extraction in the De group . The widths ( parallel and perpendicular to the implant ) and the depth of marginal bone defects around the implants were measured clinical ly just after placement and 3 months later at the abutment surgery . The crestal bone changes mesially and distally to the implants were evaluated radiographically by linear measurements . RESULTS The survival rates were 91 % in the I m group and 96 % in the De group . In the I m group , the mean reductions in parallel width , perpendicular width , and depth of the largest defect of each implant amounted to 48 % ( from 4.4 to 2.3 mm ) , 59 % ( from 2.2 to 0.9 mm ) , and 48 % ( from 6.9 to 3.6 mm ) , respectively . The corresponding mean reductions in the De group amounted to 39 % ( from 3.1 to 1.9 mm ) , 77 % ( from 1.3 to 0.3 mm ) , and 34 % ( from 4.4 to 2.9 mm ) . The reduction over time was statistically significant in both groups ( P < .04 ) . For both groups , a higher degree of bone healing was achieved in the infrabony defects ( > 60 % for depth ) than in dehiscence-type defects ( approximately 25 % ) . Furthermore , 70 % of the 3-wall infrabony defects with a parallel width of up to 5 mm , a depth of maximum 4 mm , and a perpendicular width of maximum 2 mm had a capacity of spontaneous healing within a period of 3 months . DISCUSSION AND CONCLUSION New bone formation occurs in infrabony defects associated with immediately placed implants in extraction sockets Twenty-one  c.p . titanium screw-shaped implants were immediately installed after extraction and thorough curettage of the alveoli in 15 patients .  Granules of deproteinized bovine bone of 0.25 - 1.0 mm diameter were used to fill the remaining defect when the distance of the defect wall to the implant surface was > 3 mm . Dimensional measurements of the defect height and width were made with a pocket probe . Fourteen sites in the upper jaw and 7 sites in the lower jaw were thus treated . The mean defect depth varied between 7 mm vestibularly and 10 mm mesially . The mucoperiosteal flaps were hermetically closed . At re-entry , the particles were packed and firmly attached but still distinguishable from the surrounding bone . Of the 21 sites treated , 5 sites had an exposure of the implant cover screw during the healing period . An exposure of the granular material occurred in 4 sites , but loss of granules in only 3 . Even in these sites no signs of infection or inflammation of the soft tissues were observed . At re-entry after 6 months , 10 sites were completely and 9 partially filled . For the partial fills , the mean remaining defect height was 1.6 mm ( range : 0.6 - 3.0 mm ) . Two sites showed an increased defect of respectively 2.4 and 4.8 mm . No fixtures were lost . The present results indicate that deproteinized bovine bone is a safe filling material to fill remaining defects around implants installed in fresh extraction sockets PURPOSE This 1-year prospect i ve study evaluated the implant success rate , peri-implant tissue response , and esthetic outcome of immediately placed and provisionalized maxillary anterior single implants .  MATERIAL S AND METHODS Thirty-five patients ( 8 men , 27 women ) with a mean age of 36.5 years ( range 18 to 65 ) were included in this study .  Thirty-five threaded , hydroxyapatite-coated implants were placed and provisionalized immediately after each failing tooth had been removed . The definitive restoration was placed 6 months later . The patients were evaluated clinical ly and radiographically at implant placement and at 3 , 6 , and 12 months after implant placement . RESULTS At 12 months , all implants remained osseointegrated . The mean marginal bone change from the time of implant placement to 12 months was -0.26 + /- 0.40 mm mesially and -0.22 + /- 0.28 mm distally . No significant differences in the Plaque Index scores were noted at different time intervals . The mean midfacial gingival level and mesial and distal papilla level changes from pretreatment to 12 months were -0.55 + /- 0.53 mm , -0.53 + /- 0.39 mm , and -0.39 + /- 0.40 mm , respectively . All patients were very satisfied with the esthetic outcome and none had noticed any changes at the gingival level . DISCUSSION Although marginal bone and gingival level changes were statistically significant from pretreatment to 12 months of follow-up , they were well within clinical expectations . CONCLUSION The results of this study suggest that favorable implant success rates , peri-implant tissue responses , and esthetic outcomes can be achieved with immediately placed and provisionalized maxillary anterior single implants The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns . A series of 22 cases with a 12-month follow-up is presented . Twenty-two patients ( 15 women and 7 men ; mean age 39 years ) who needed a single tooth replaced because of vertical or horizontal root fracture , caries , endodontic lesions , or periodontal disease were treated with immediate post extraction implant placement .  The implant was then restored with a screw-retained prosthetic restoration within 24 hours . Radiographic assessment s were made at baseline and 12 months after implant placement . Clinical parameters , such as plaque score , mucositis score , probing attachment level , mucosal margin position , variation of gingival level , and variation of papilla position , were also measured at baseline and after 12 months of follow-up . At 12 months , no implants had failed . Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline . The mean variation of gingival level , compared to the neighboring teeth , was -0.75 mm . Probing attachment levels were 0.79 , 0.45 , and 0.54 mm at proximal , buccal , and lingual sites , respectively . The values for the mucosal margin position were 2.9 , 2.2 , and 2.4 mm at proximal , buccal , and lingual sites , respectively . Regarding variation of papilla position , according to Jemt 's index , 27 papillae presented with a score of 2 ( 61 % ) and 17 with a score of 3 ( 39 % ) . An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13 % . Furthermore , mucositis ( score 2 ) was not observed at any of the peri-implant units . Primary implant stability did not significantly increase over time . The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure . The success rate and radiographic and clinical results were comparable to those obtained following the st and ard protocol . Within the limits of the present investigation , immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth . However , long-term clinical trials are needed to confirm the present results BACKGROUND Single-rooted teeth deemed not restorable via conventional means may be c and i date s for implant placement at the time of tooth extraction .  Immediate implant placements are believed to preserve soft and hard tissue form and contours , reduce the need for augmentation procedures , minimize surgical exposure of the patient , reduce treatment time and improve esthetic outcomes . METHOD This retrospective review analyzed the  esthetic outcomes of 42 non-adjacent single-unit implant restorations completed using an immediate implant surgical placement protocol .  RESULTS The mean time in function was 18.9 months ( range 6 - 50 months ) and the majority of implants placed had a restorative platform diameter of 4.1 and 4.8 mm . A highly significant change in crown height due to marginal tissue recession of 0.9 + /- 0.78 mm ( P=0.000 ) was recorded for all sites , with no difference seen between implant systems ( P=0.837 ) . Thin tissue biotype showed slightly greater recession than thick tissue biotype ( 1 + /- 0.9 vs. 0.7 + /- 0.57 mm , respectively ) ; however , this difference was not statistically significant ( P=0.187 ) . Implants with a buccal shoulder position showed three times more recession than implants with a lingual shoulder position ( 1.8 + /- 0.83 vs. 0.6 + /- 0.55 mm , respectively ) with the difference being highly statistically significant ( P=0.000 ) . CONCLUSIONS Immediate implant placement requires very careful case selection and high surgical skill levels if esthetic outcomes are to be achieved . Long-term prospect i ve studies on tissue stability and esthetic outcomes are needed PURPOSE The purpose of the study was to compare the clinical and aesthetic outcome of single post-extractive implants versus implants placed in a preserved socket after 4 months of healing in the anterior maxilla . All of the implants were immediately non-occlusally loaded . MATERIAL S AND METHODS A total of 50 patients were treated in the two groups of study . The Delayed Group had a maxillary tooth ( premolar , canine , lateral or central incisor ) removed , with immediate socket grafting , followed by implant placement and provisionalisation 4 months later . The Immediate Group had immediate implant placement and provisionalisation . Outcome measures were implant failures , biological and biomechanical complications , peri-implant radiographic bone level changes , and gingival aesthetics . RESULTS At the 12-month follow-up , two implants failed in the Immediate Group ( 8 % ) versus one in the Delayed Group ( 4 % ) , with a comparable rate of implant failure ( P = 0.55 ) . No complications occurred for either group . The 12-month peri-implant bone resorption was similar in both groups ( P = 0.23 ) : 0.71 mm ( 95 % CI 0.45 , 0.97 ) in the Immediate Group versus 0.60 mm ( 95 % CI 0.38 , 0.82 ) in the Delayed Group . The mean difference in bone resorption was 0.13 mm ( 95 % CI -0.21 , 0.47 ) . An ideal gingival marginal level was reached most frequently in the Delayed Group ( 83.3 % versus 52.1 % , P = 0.04 ) . Rates of full closure of the papilla were similar between the two groups ( 82.6 % for the Immediate Group versus 62.5 % for the Delayed Group , P = 0.12 ) . CONCLUSIONS Given the limitation that this was not a r and omised controlled trial , there were no differences in complications or crestal bone response at immediate post-extractive implants when compared to delayed implants . A delayed protocol might be considered in the aesthetic zone due to the gingival recession that occurs after post-extractive implant placement PURPOSE This is a follow-up of an earlier 1-year prospect i ve study on implant success rates and the peri-implant response after immediate placement and provisionalization of single implants in the esthetic zone . The effects of gingival biotype on the peri-implant tissues were also evaluated . MATERIAL S AND METHODS Thirty-five patients were evaluated clinical ly and radiographically at presurgical examination ( T0 ) , immediately after  immediate implant placement and provisionalization  ( T1 ) , 1 year after implant surgery  ( T2 ) , and the latest follow-up appointment ( T3 ) . Data were analyzed using t tests and repeated- measures analysis of variance at the significance level of alpha = .05 . RESULTS After a mean follow-up time of 4 years ( range , 2 to 8.2 years ) , all implants remained in function . At T3 , the mean mesial and distal marginal bone level changes were significantly greater than those observed at T2 . At T3 , the mean mesial and distal papilla level changes were significantly smaller than those observed at T2 , whereas the mean facial gingival level change was significantly greater than that observed at T2 . Sites with a thick gingival biotype exhibited significantly smaller changes in facial gingival levels than sites with a thin gingival biotype at both T2 and T3 . CONCLUSIONS Favorable implant success rates and peri-implant tissue responses can be achieved with this procedure . While the results suggest the possibility of spontaneous papilla regeneration over time following this procedure , continuing recession of the facial gingival tissue was also observed . The effect of gingival biotype on peri-implant tissue response seemed to be limited only to facial gingival recession and did not influence interproximal papilla or proximal marginal bone levels BACKGROUND The success of osseointegrated implants ad modum Brånemark for single-tooth restorations is documented . Future developments should aim at improving the benefits to patients by decreasing treatment time , minimizing surgical stages , and maximizing esthetic outcomes . Using knowledge from studies of immediate implant placement , one-stage , immediate loading protocol s , the authors developed the immediate provisional . PURPOSE The purpose of this study was to develop a protocol to provide an immediate solution for restoring a single missing tooth in the esthetic zone . The protocol should be simple , predictable , cost effective , and allow the use of other techniques to improve esthetic outcome . MATERIAL S AND METHOD This prospect i ve clinical study included 24 patients treated from August 1999 to October 2000 .  Single-tooth implant replacement was done according to immediate provisional protocol . Thirteen of the 24 patients had immediate implant placement after tooth extraction .  All implants were placed in the esthetic zone . During surgery , emphasis was placed on obtaining primary stability by achieving bicortical anchorage and maximum insertion torque of at least 40 Ncm . CeraOne ( Nobel Biocare ) abutments were used , and provisional crowns were fabricated immediately before wound closure . The occlusion was protected by adjacent teeth . RESULTS Within the follow-up period of between 1 month and 15 months , all fixtures in the 24 patients were stable . Crestal bone loss greater than one thread-width was not detected . The esthetic result was considered satisfactory by all patients . CONCLUSIONS The implant placement and restoration protocol used in this study showed promising initial results for both the immediate implant and healed extraction site groups . The desirable goals of patient satisfaction , excellent esthetic outcomes , and no increase in treatment cost were achieved in this protocol . Further studies to eluci date the potential of the immediate provisional protocol are justified The aim of this study was to measure changes in buccal alveolar crestal bone levels after immediate placement and loading of dental implants with Morse taper prosthetic abutments  after tooth extraction . This study followed the STROBE guidelines regarding prospect i ve cohort studies . The sample comprised 12 patients with a mean age of 45 years , in whom a central or upper lateral incisor was indicated for extraction . Prior to extraction , computed tomography ( CT ) analysis was carried out to assess the presence of the buccal bone crest . CT scans were performed at 24 h and at 6 months after immediate implant placement and immediate loading . The distance from the most apical point of the implant platform to the buccal bone crest was assessed at the two time points . The buccal bone crest height was evaluated at three points in the mesio-distal direction : ( 1 ) the centre point of the alveolus , ( 2 ) 1 mm mesial to the centre point , and ( 3 ) 1 mm distal to the centre point . The values obtained were subjected to statistical analysis , comparing the distances from the bone crest to the implant platform for the two time points . After 6 months there was a statistically significant , non-uniform reduction in height at the level of the crest of the buccal bone in the cervical direction . It is concluded that the buccal bone crest of the immediate implants that replaced the maxillary incisors underwent apical resorption when subjected to immediate loading OBJECTIVES The aim of this prospect i ve study was to evaluate clinical ly and radiographically the success and esthetic result of immediate implant placement at the time of extraction . MATERIAL AND METHODS Twelve patients with 14 titanium screw-shaped implants ( 13 - 16 mm length and 4.3 or 5 mm diameters ) were placed in the extraction sockets . Defects after implant placement were recorded , and then filled up with deproteinized bovine bone mineral , bioabsorbable collagen membrane , and absorbable pins . The defect was again re-evaluated at second-stage surgery . Clinical and radiographic parameters of the peri-implant conditions were assessed at the moment of prosthesis placement and at 1-year follow-up . RESULTS The cumulative implant survival and success rate was 100 % after a 1-year observation period . Analysis of the esthetic result showed that the mean pink esthetic score ( PES ) was 11.1 ( SD 1.35 ) at 1-year follow-up . At 1 year , 64.3 % papillae had a score of 2 and the remaining 35.7 % score 3 according to the Jemt ( 1997 ) papillary index . Optimal value of width of the keratinized mucosa was recorded in 13 ( 92.9 % ) implant cases in both periods of follow-up . At 1-year follow-up , the linear distance between implant-shoulder to the bone peaks remains stable with a mean of 2.62+/-0.2 mm at the mesial and 2.9+/-0.58 mm at the distal aspect . CONCLUSION Careful evaluation of potential extraction sites before immediate implant installation promotes optimal implant esthetics OBJECTIVE To compare the peri-implant soft tissue dimensions after insertion of  single-implant crowns in the anterior maxilla . MATERIAL S AND METHODS Twenty patients were accepted according to well-defined inclusion criteria and r and omized to porcelain-fused-to-metal ( PFM ) or all-ceramic groups . Follow-up was at : Baseline ( B ) , Crown Insertion ( CI ) , 1-year ( 1Y ) , and 2-year ( 2Y ) . The following parameters were statistically analysed : distance implant shoulder to marginal peri-implant mucosa ( DIM ) , papilla height ( PH ) , width of keratinized mucosa ( KM ) , crestal bone level ( CBL ) , full mouth plaque score ( FMPS ) , full mouth bleeding score ( FMBS ) , and probing pocket depth . RESULTS Between groups measurements for DIM , PH , KM , CBL , FMPS , and FMBS showed no statistically significant differences except the distal CBLs to adjacent tooth . DIM ( mid-facial ) decreased from B to CI remaining stable at 1Y and 2Y ( p-value 0.0014 ) . DIM mesial and distal aspects significantly increased from B to CI showing signs of stability at the 2Y . PH between B and CI increased at the mesial site and at the distal site , thereafter , peri-implant soft tissues were stable at the 2Y . CONCLUSION The insertion of an implant crown affects the peri-implant mucosa morphology by an apical displacement at the mid-facial aspect and coronal at mesial and distal sites
target: Conclusion It can be concluded that bone remodeling occurs after tooth extraction and immediate implant installation
background: Purpose The objective of this systematic review was to assess the three-dimensional changes in bone tissue after immediate installation of a single implant in a fresh extraction socket in the anterior maxilla .