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P61
Crestal Bone Changes After Immediate Placement in Molar Extraction Sites With 8-9mm Diameter Osseointegrated Implants: 3-year Follow-up
Thursday, March 1 / 5:40 - 5:50 pm / Monitor 2

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Crestal Bone Changes After Immediate Placement in Molar Extraction Sites with 8-9mm Diameter Osseointegrated Implants: 3 year follow-up

 

Eshaghzadeh, E,; Tetradis, S; Aghaloo, T; Moy, P; Pi-Anfruns, J

 

After a dental extraction, the alveolar socket undergoes a healing process that translates into vertical and horizontal bone loss. To minimize the remodeling process and prepare the site for future dental implants, socket grafting has been recommended. However, grafting procedures are costly, extend the treatment time and have associated risks. In order to reduce time and costs, extraction and immediate implant placement has been recommended. Furthermore, wide implants minimized discrepancy between the socket shape and the implant and may not require grafting at the time of placement. Short-term studies of 8-9mm diameter implants have demonstrated a survival rate of 95.7% and stable bone conditions, irrespective of loading or surgical protocol.

 

The aim of this prospective clinical study is to evaluate the success of immediate molar replacement with 8-9mm diameter dental implants.

 

This study was approved by UCLA’s Institutional Review Board (IRB #11-002634 and 12-000121). 

Patients who needed the extraction of the 1st or 2nd molars received an 8 or 9mm diameter implant at the time of extraction (Max® implant, Keystone Dental Inc., Burlington, MA.). All implants were placed as a one-stage protocol and allowed to heal for 2 months. All implants were restored as single units with a screw-retained PFM crown. At the time of crown delivery, a jig was fabricated in order to obtain standardized periapical x-rays, utilizing the parallel-cone technique, in subsequent follow-ups after delivery of the final restoration. Crestal bone height was measured utilizing digital software, and the changes in crestal bone height between follow-ups were analyzed. All crowns were screw-retained PFM crowns.

 

•To date, 60 patients (63 implants placed) have been enrolled in the study.
•Digital software analysis displayed no signficant difference of crestal bone height from the time of crown delivery until the 3-year follow-up (average of 0.04 mm decrease).
•All implants restored to date have received a single screw-retained porcelain fused to metal crown. To date, no prosthetic complications have been recorded.
•One implant in the mandible group failed to osseointegrate before the fabrication of the final restoration. In addition, only one implant has failed to survive at 18 months after crown delivery.
•No other surgical complications have been encountered to date. As reported by 90% of the patients treated to date, post-operative pain was managed with over the counter medication, even though prescription pain medication was given. No post-operative hematoma was noted for any patient.

 

•Advantages of immediate implant placement following extraction: one-stage procedure, overall reduced treatment time and reduced treatment costs4.
•However, placement in posterior areas has several risks.
•The posterior region of the maxilla and mandible is considered a high risk zone for implant placement
•poorer bone quality and to higher occlusal forces5.
•Furthermore, the maxillary sinus and the mandibular nerve limit the bone quantity in many cases.
•To avoid advanced surgical procedures, such as mandibular nerve transposition or maxillary sinus augmentation, placement of short implants is recommended6. If short implants are the choice, a wide diameter is preferred to maintain the bone-to-implant contact and provide good initial stability.
•The ongoing present study has demonstrated so far excellent success rates for the 8-9mm wide implants. Furthermore, overall bone conditions have been shown to remain stable with no significant change over a 3 year period.

 

Within the limitations of this study, 8-9mm diameter implants placed immediately after extraction have shown to be an alternative solution to avoid grafting procedures and reduce treatment time and costs in the posterior area.

 

1. HammerleCH, Araujo MG, Simion M. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res 2012;23 Suppl 5:80-82.

2. StrubJR, Jurdzik BA, Tuna T. Prognosis of immediately loaded implants and their restorations: a systematic literature review. J Oral Rehabil 2012;39:704-717.

3. Kim YK, Kim JH, Yi YJ, Yun PY, Kim SG, Oh JS, et al. A retrospective case report series of clinical outcomes with moderately rough, wide-diameter 8-mm implants in the posterior maxilla. Int J Periodontics Restorative Dent 2013;33:e95-100.
4.PolizziG, Grunder U, Goené R, Hatano N, Henry P, Jackson WJ, et al. Immediate and delayedimplantplacementintoextraction sockets: a 5-year report. ClinicalImplantDentistry and RelatedResearch. 2000;2(2):93–9.
5.MuftuA, Chapman RJ. Replacing posterior teethwithfreestandingimplants: four-yearprosthodonticresults of a prospectivestudy. J Am DentAssoc. 1998 Aug;129(8):1097–102.

6. RenouardF, Nisand D. Impact of implantlength and diameteronsurvivalrates. Clin Oral Implants Res. Blackwell Publishing Ltd; 2006 Oct;17 Suppl 2(S2):35–51.

7.VandewegheS, De Ferrerre R, Tschakaloff A, De Bruyn H. A Wide-BodyImplant as anAlternativeforSinusLiftorBoneGrafting. YJOMS. ElsevierInc; 2011 Jun 1;69(6):e67–e74. 

 

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