Comparison Between Immediate and Delayed Single Wide Implants Placed in the Molar Region: A Clinical Retrospective Study with a Follow up of 1 – 10 years
Eduardo José de Moraes, OMS, MSc 1, Nathalia Benevides de Moraes MSc2 & Luis Eduardo Benevides de Moraes OMS 3
Implants placed post extraction have proven to be a successful, predictable treatment modality with reduced morbidity and treatment time. Placement of an implant into a fresh alveolus will usually result in a gap and bone defects that it seems reasonable to combine a bone reconstructive procedure. The use of a wide-body implant allows for higher mechanical and increased bone-implant contact. In the other hand a molar .extraction followed by immediate installation results in large periimplant defects, reduced bone anchorage area and problems to closure the extraction site.
The aim of the present study was to compare immediate (Im) versus delayed (De) implants with wide diameter placed in the molar region to confirm the predictability and performance of this type of implant
Materials and Methods:
A retrospective study was made of subjects treated with immediate or delayed dental implants installed in fresh sockets and healed sites of molar regions in the maxilla or the mandible. The reasons for tooth extraction included root fractures, periodontally compromised teeth, endodontic failures, and advanced caries lesions The exclusion criteria for the study were: 1. The patient was not able to give his/her informed consent to participate. 2. Health conditions that did not permit the surgical procedure 3. Patients with systemic contraindications to surgery. 4. Uncontrolled diabetes. 5. Under treatment with bisphosphonates. 6. Abuse of alcohol or drugs 7. Health or psychiatric problems. 8. Irradiated patients. A protocol was prepared in which patient age, sex, implant length, diameter, and use of bone graft were recorded. After a period of 4 months to mandible and 6 months to maxillae, the second-stage surgery was performed for implant exposure and radiographs were obtained to document healing status. The Implant survival criteria were defined by Albretksson et al and Buser et al, followed by the reverse torque test (10 N.cm)
Between July, 2004 to October, 2013 hundred-ten patients (61women, 49 men) with mean age of 53 years (range, 25 to 80 years) were submitted to implant surgery. A total of 118 wide implants of three different implants systems were placed (34 in the maxilla and 84 in the mandible). The implants were allocated to the immediate (Im) group (70 implants) or the healed sites (De) group (48 implants). In all immediate implants, bone grafts materials were used to fill the gaps between the implant and remaining bony walls. The patients were followed up in minimum period of 12 months and the survival rates were 95 % with a total of 6 implants lost, two implants in the Im group (1.7%) and four implants in the De group (3.4%).
Conclusion and implications:
Within limitations of this study the single implants with wide diameter when placed in fresh sockets has been shown similar results to implants placed in mature bone after 12 months of follow-up. Some authors considers that high torque promote critical pressure leading to microfractures specially in healed sites of mandible bone. A mechanical study demonstrated that the increase of implant diameter make possible a reduction in the insertion torque to obtain a good primary stability that is important to the success of implants placed in fresh sockets
1. Moraes, EJ and Genovese F R. Comparison Between Immediate and Delayed Laser Surface Implants with Switching Platform: A Clinical Retrospective Study Journal of Oral Implantology,
Vol ,XXXIX/Nr Three /2013. .
2. Rosenquist B. A comparison of various methods of soft tissue management following the immediate placement of implants into extraction sockets. Int J Oral Maxillofac Implants 1997;12:43–51.
3. Norton, M. Editorial : Primary Stability Versus Viable Constraint – A Need to Redefine. Int J Oral Maxillofac Implants 2013;28: 19-218.
4.Tarnow, P.D., Emtiaz, S., Classi, A. Immediate loading of threaded implants at stage 1 surgery in edentulous arches: Ten consecutive cases reports with 1 to 5 year data. Int J Oral Maxillofac Implants 1997;12: 319-324.
5. Trisi, P, . Todisco, M., Consolo,U., Travaglini, D. High versus low implant insertion torque: A histological, histomorphometric and biomechanical study in the sheep model. Int J Oral Maxillofac Implants 2011;26: 837-949