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Background Anatomically formed healing abutments were suggested in literature to address many of the issues associated with immediate posterior implant insertion such as large extraction sockets that are extremely hard to seal without reflecting the mucoperiosteal flap, extraction sockets anatomy that are not suitable for regular healing abutment placement, and potentially high occlusal stresses when planning a temporary implant supported prothesis to improve the conditioning of supra implant tissue architecture and the emergence profile of the implant supported restorations. Purpose To clinically evaluate the peri-implant soft tissue profile of single posterior implant retained restorations and to assess patient related outcomes of the implant restorations that were conditioned immediately by CAD-CAM socket sealing abutments (SSA) versus those conditioned by Titanium (Ti) standard healing abutments (SHA). Methods Twenty participants received twenty-two single maxillary immediate implants after flapless minimally invasive tooth extraction and 3D guided implant placement in the posterior area (premolar and molar) and allocated randomly into two groups ( n  = 11), the intervention group: patients received PEEK SSA and the control group: the patients received Ti SHA. Modified Pink Esthetic Score (PES) was evaluated at 3 observation periods: Baseline T0 (immediate after implant supported crown insertion), 6 months T1 and 1 year of clinical performance T2. Patient satisfaction was assessed one week and one year after crown insertion using visual analogue scale (VAS). Results At base line, after six as well as 12 months, SSA group showed statistically significant higher total modified PES scores than SHA group ( P -value < 0.001). At the 2 clinical observation periods (baseline and after one year), SSA group showed statistically significantly higher overall satisfaction score than SHA group ( P -value < 0.001). Conclusion After one year of clinical observation period, CAD-CAM PEEK socket sealing abutments together with flapless minimally invasive tooth extraction and 3D guided implant placement provided superior outcomes compared to Ti SHA in terms of peri-implant soft tissue profile. Trial registration This study was registered on clinicaltrials.gov with ID no. NCT05276765 on 03/03/2022.

Background Implant placement in the posterior maxilla is challenging, so modifications of the surgical techniques were introduced to overcome these challenges. The undersized drilling technique uses a final drill smaller than the diameter of the implant. The single drilling technique is a simplified method where the osteotomy is made using a single drill without sequential widening. This study was directed to evaluate the peri-implant bone behavior of the undersized drilling technique versus the single drilling technique of immediately loaded dental implants inserted in the posterior maxilla. Patients and methods 32 patients were selected for prosthetic replacement of a missing maxillary posterior single tooth by an immediately loaded dental implant and divided randomly into two equal groups. In Group I: 16 patients received 16 implants using the undersized drilling technique, while in Group II: 16 patients received 16 implants using the single drilling technique. Insertion torque, implant stability, modified sulcus bleeding index (mBI), peri-implant probing depth, bone density, and marginal bone height were evaluated for both groups. Statistical analysis was made for clinical and radiographic data. Results 32 implants were inserted in the posterior maxilla. During a 12-month follow-up, every dental implant was successful with no complications. Both techniques showed high insertion torque (≥ 35 Ncm) and primary stability (> 70 ISQ) with no significant difference between the two groups ( P  > 0.05). Also, there were no significant differences between the study groups regarding peri-implant soft tissue health, bone density, and marginal bone loss ( P  > 0.05). Conclusion Both techniques revealed comparable, promising clinical and radiographic outcomes over a 12-month post-loading follow-up period when the immediate loading protocol was used in the posterior maxilla, where bone density is poor, but preparing the implant bed using the single drilling technique offers several merits for both the patient and clinician. In addition to avoiding excessive heat generation, mechanical damage, and high frictional forces during drilling procedures, surgical operations, and surgical site exposure take less time. Trial registration Clinical-Trials.gov PRS ( https://register.clinicaltrials.gov ) had this study registered under the identifier number. NCT06770231 on 01/01/2025.

Background Immediate implant placement (IIP) in compromised extraction sockets poses significant challenges in maintaining the contour and level of mucosal tissues. This study compares the efficacy of vestibular socket therapy (VST) combined with acellular dermal matrix (ADM) versus connective tissue grafts (CTG) in IIP within the esthetic zone. Methods Twenty participants requiring extraction in the maxillary esthetic zone were randomized into two groups: ADM and CTG ( n  = 10 each). Both groups underwent VST with bone grafting and dental implant placement. Clinical outcomes were evaluated at baseline, 6 months, and 12 months, measuring soft-tissue level and thicknesses, and the radiographic facial alveolar bone thicknesses and height. Results Both groups resulted in statistically significant increase in coronal mucosal thickness, facial bone height and thickness over time. CTG showed statistically significant increase at apical mucosal thickness over time, whereas the ADM group had a significantly higher facial bone height after 12 months. No significant differences were observed between groups in mucosal thickness and level at any time point and both groups achieved 100% implant survival. Conclusion ADM and CTG are both effective for soft tissue augmentation and hard-tissue maintenance in IIP within compromised extraction sockets after 12 months. CTG may offer advantages in apical mucosal thickness, while ADM was associated with greater bone height. Clinical relevance Both ADM and CTG effectively enhance soft tissue and maintain hard-tissue levels, with CTG providing better apical mucosal thickness and ADM resulting in greater facial bone height after 12 months. These insights help clinicians to customize treatment plans based on individual goals and patient needs.

Background The purpose of this study was to test how musical flow using baroque (BM) and classical era music (CM) as a non-pharmacological therapy can control anxiety and pain levels among patients undergoing IPI (Immediate post-extraction implants). Methods 78 patients who required an IPI were enrolled in this randomized clinical trial. Each patient was assigned to one of the three experimental groups with a simple randomization: Group I ( n  = 26) listened to BM; Group II ( n  = 27) listened to CM; and Group III ( n  = 25) did not listen to music and was the control group (C). The physiological dependent variables analyzed were systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (SpO2). The psychological dependent variable analyzed was modified dental anxiety scale (MDAS) and visual analogue scale (VAS), measured before and after surgery. In all cases, the level of statistical significance was set at p  < 0.01. Results Statistically significant differences were found in the SBP decrease in the CM group ( p  = 0.001, CI = 1.9716–6.5840) and the BM group ( p  = 0.003, CI = 1.4450–6.4396). Anxiety levels during the intervention decreased in both groups that listened to music: BM group ( p  = 0.002, CI = 0.645–2.662) and CM group ( p  = 0.000, CI = 1.523–3.884). Conclusions Patients undergoing IPI placement surgery can register lower levels of SBP when listening to BM and CM than patients who were not exposed to the musical flow, improving their anxiety levels.

IntroductionSoft-tissue defect is commonly seen in immediate maxillary posterior implantation because of tooth extraction wound and tension from bone graft. Bone graft materials exposure has a significant detrimental influence on bone augmentation. However, previous studies lack sufficient evidence to guide wound closure after immediate posterior implantation. This study aims to use 3D integration technology to evaluate the effect of porcine collagen matrix versus rotated pedicle palatal connective tissue flap (RPPCTF) on the soft-tissue closure after the immediate maxillary posterior implantation.Methods and analysisThis is a single-centre, evaluator-blinded, randomised, two-arm parallel-group controlled trial. A total of 54 patients requiring immediate implant placement in the first upper molar extraction sockets will be recruited. The patients will be randomly assigned to two groups: one group will receive the porcine collagen matrix and the other group will receive RPPCTF on the soft-tissue closure after the immediate posterior implantation. The primary outcome is the soft-tissue volume change. Secondary outcomes include width of keratinised gingiva, healing status of soft tissue, marginal bone level and operation time.Ethics and disseminationThe study protocol has been approved by the Ethics Committee of Shanghai Stomatological Hospital (SHSHIRB-2022016). The project has been registered on the ClinicalTrials.gov website and National Medical Research Registration and Filing Information System. Written informed consent was obtained from all the participants. The results of this study will be reported in a peer-reviewed journal.Trial registration numberChiCTR2300067770.

Background Distally inclining posterior implants may be technically challenging in certain situations. The presence of a posterior cantilever can also exert unfavorable forces on supporting implants. The aim of the present study was to evaluate and compare peri-implant soft and hard tissues around 4 mandibular interforaminal implants having tilted posterior implants with posterior cantilevers, versus vertical implants, 2 in the interforaminal region and 2 in the first molar regions, without posterior cantilevers. All implants supported full-arch fixed detachable restorations opposing complete dentures. Material and methods A total of 80 implants were placed flapless in the mandibles of 20 edentulous participants. Four implants were placed for every participant, who were randomly assigned into 2 equal groups. Axial group implants were vertically aligned, with 2 implants in the interforaminal area and 2 in the molar area. Tilted group implants have 2 anterior axial and 2 posterior distally inclined implants. Interim screw-retained prostheses converted from pre-existing dentures were immediately fabricated and loaded on the same day of surgery. After awaiting period of 3 months, all participants received fixed detachable metal acrylic resin definitive restorations. A follow-up protocol of 3, 6, and 12 months was scheduled to assess the modified gingival index, modified plaque index, peri-implant probing depth, implant stability, and marginal bone level and bone density changes. Results No statistically significant differences ( P  > .05) were found in the modified gingival index, modified plaque index, peri-implant probing depth, implant stability, bone density, and marginal bone level between the axial and tilted implant groups after the 1-year follow-up period. Conclusion Placing 4 flapless immediately loaded implants in mandibular edentulous patients that supported full-arch fixed restorations provided high implant and prosthodontic success rates whether posterior implants were tilted with posterior cantilevers or vertically aligned without posterior cantilevers. Trial registration: Pan African Clinical Trial Registry database, PACTR201907776166846. Registered 3 July 2019, www.pactr.org .

Purpose To evaluate early versus conventional loading in immediate implants for molars. This study aims to answer the following PICO (Patient, Intervention, Comparison, and Outcome) question: In patients over 18 years of age, does early loading of immediately placed implants in molar areas result in a similar implant survival rate and marginal bone loss as conventional loading? Methods Twenty-seven patients (15 women and 12 men) received a total of 30 implants immediately after molar extraction. The surgical treatment protocol entailed atraumatic tooth extraction without flap elevation. Non-invasive quantitative analyses were used to assess implant stability. After an uneventful healing period, the 30 implants were restored with screw-retained monolithic zirconia prosthesis, half of which after 6 weeks (G1) and the other half after 3 months (G2). Results Regarding the survival rate, the Kaplan–Meier and log-rank test showed that there was no statistically significant difference between both groups ( p  = 1). Implant stability quotient at the prosthetic phase of both groups (6 weeks in G1 and 3 months in G2) revealed no statistically significant difference (G1 RFA74.4 (SD 5.54) − DCA 79.07 (SD 5.75))/G2 RFA 73.67 (SD 5.7), − DCA78.93 (SD 4.48). Conclusions Early loading of immediately placed implants in molar sites is considered a predictable treatment modality provided that ideal implant position and adequate insertion torque are achieved.

Background The current trial evaluated the midfacial gingival margin changes, volumetric, radiographic and clinical alterations 1-year following immediate implant placement with customized healing abutment (IIP + CHA) either solely, or in combination with xenograft (IIP + Bonegraft) or with connective tissue grafting (IIP + CTG) at sites with thin labial bone in the esthetic zone. Methods Thirty-nine non-restorable maxillary teeth indicated for extraction in the esthetic zone were included. Participants were randomly assigned into three equal group; IIP + Bonegraft (Control), IIP + CTG and IIP + CHA. Midfacial gingival margin changes(mm) as primary outcome, labial soft tissue contour change(mm), interdental tissue height changes and total volume(mm 3 ) were assessed. Amount of bone labial to the implant and crestal bone level changes were also recorded. All outcomes were measured 1-year post-operative. Results The midfacial gingival margin changes demonstrated a significant difference ( P  ≤ 0.05) between the groups showing -0.98, -0.74 and -1.54 mm in sites treated with IIP + Bone graft, IIP + CTG and IIP + CHA respectively after1-year. While labial soft tissue contour change (mm), total volume (mm 3 ) and distal interdental tissue height changes (mm) revealed a significant difference after one-year between the studied groups, yet mesial interdental tissue height changes showed no difference ( P  > 0.05). Both IIP + Bone graft and IIP + CHA groups revealed a significant positive correlation between the total volume loss (mm 3 ) after 1 year and mid-facial gingival margin changes ( P  ≤ 0.05). However, no significant correlation was observed in the IIP + CTG group ( P  = 0.63). CBCT measurements showed a significant difference in crestal bone changes between the three groups ( P  ≤ 0.05), yet, there was no significant difference regarding mean amount of bone labial to the implant( P  > 0.05). Conclusions This investigation suggests that the mere presence of CTG simultaneous with IIP in the anterior maxilla reduced the midfacial gingival margin alterations (mm), besides, CTG decreased the overall volume loss (mm 3 ) by 5-folds compared to the other studied groups after one year. Meanwhile, using CHA alone with IIP failed to maintain the peri-implant soft tissues contour. Trial registration The current trial was retrospectively registered at Clinical trials.gov (ID: NCT05975515, Date: 27-July-2023).

Purpose This study evaluated the implant stability, volumetric changes, and patient-reported outcome measures (PROMs) of hydroxyapatite (HA) nano-coated sandblasted/acid-etched (SLA) implants compared to uncoated SLA implants. Methods Forty patients were recruited and randomly allocated to HA nano-coated SLA group (test, n  = 20) and uncoated SLA group (control, n  = 20) using single-blinded/block randomization. Implants were immediately placed in maxillary posterior region using a digital surgical guide. Insertion torque and implant stability quotient (ISQ) were measured at implant surgery and 1, 2, 3, and 4 months postoperatively. Intraoral scans, PROMs and soft tissue inflammation data were collected, and multivariable linear regression analysis of ISQ was performed. Results In total, 48 implants (test; n  = 24, control; n  = 24) in 37 patients (test; n  = 19, control; n  = 18) were analyzed. Despite no significant between-group difference at surgery, the test group showed higher ISQ values than the control group at 2 (76.53 ± 4.17 vs. 71.32 ± 4.79, p  < 0.01), 3 (77.45 ± 4.41 vs. 73.85 ± 4.69, p  < 0.05), and 4 months (79.08 ± 2.96 vs. 73.43 ± 3.52, p  < 0.0001) postoperatively. There were no significant differences in linear and volumetric changes, PROMs, and soft tissue inflammation analysis between two groups. The ISQ at implant surgery was influenced by age and diabetes mellitus (DM) at the implant level and DM and predicted total bone-to-implant contact area at the patient level. Conclusion HA nano-coated SLA implants promoted favorable immediate implants stability during early osseointegration phase compared to uncoated SLA implants, but displayed similar dimensional changes, PROMs, and soft tissue inflammation outcomes. Trial registration Clinical Research Information Service (CRIS), KCT0006364. Registered 21 July 2021, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24221&search_page=L .

DesignThis paper is a single-centre, double-blinded, prospective randomised control trial, comparing immediate vs delayed implant placement clinically and radiographically in patients with chronic periodontitis, specifically assessing the molar region. Seventy-four patients were recruited to the study over a one-year period, all of whom returned for follow up throughout the study.Study selectionThe study adhered to the principles outlined in the Declaration of Helsinki and obtained ethical approval from the affiliated University Hospital of Qingdao. Written consent was gained from patients in line with the CONSORT guidance. The patients were recruited from the Department of Oral and Maxillofacial Surgery at the University of Qingdao between January 2019 and January 2020. The study included anyone above the age of 18, who had a molar with chronic apical periodontitis and lesions of less than 8 mm. Exclusions included pregnancy, uncontrolled diabetes, smokers, bisphosphonate use, history of head/neck tumours, coagulation disorders, and acute infections of adjacent teeth/tissue.Data extraction and synthesisOf the patients who met the inclusion criteria, all were randomly numbered by a stomatologist and placed into either the control group or the experimental group by a computerised system (Microsoft Excel). This study looked at the placement of 74 implants in 74 patients, including 40 female and 34 male patients in total. The delayed implant placement allowed for healing of 3 months in the mandible and 6 months in the maxilla. The width of the implants placed was 6 mm and the lengths were between 7 mm and 12 mm. The periodontal probing depth, modified sulcus bleeding index, and modified plaque index were all clinically examined. In terms of other parameters assessed, CBCT was used to look at alveolar bone mass. All surgery and implant placement was carried out by the same surgeon and the clinical measurements were all taken by one dentist.ResultsThe results showed no significant difference in implant stability quotient immediately and 6 months post-surgery (0.110 and 0.066, respectively), when comparing the experimental and control group. Similarly, there was no significant difference in PD, mSBI or mPI between the groups. On assessment of CBCT scans however there was a significant difference between the two groups in the buccal horizontal marginal bone loss (P = 0.003), lingually there was not. Vertical bone loss also showed no significant difference in comparison. At one-year post-implant placement, there was a survival rate of 100% in both groups assessed. IBM SPSS statistics was used for statistical analysis. Multiple tests including the Shapirowilk test, the student t-test and the Mann-Whitney U-test were carried out on the data and all statistical tests were two tailed. Statistical significance was set at <0.05 throughout study of results.ConclusionThe conclusion of this study suggests that immediate implant placement in chronic periodontitis patients, specifically in the molar region, may be clinically viable. With flap surgery and complete removal of inflammatory granulation tissue, the study suggests no significant disadvantage to alveolar bone healing or osseointegration. The various limiting factors of this study should be taken into consideration, and it must be highlighted that longer and larger studies are necessary to allow for more accurate understanding of the long-term outcomes.