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Background: Immediate implant placement (IIP) into fresh extraction socket is a favorable treatment option. If successfully managed, it reduces the overall treatment time, and increases patient's satisfaction. Surgical and restorative factors affect IIP success rates. In this systematic review we evaluate the effect of guided bone regeneration (GBR) at the time of IIP on crestal bone level (CBL) changes after at least 12-months of functional loading., Methods: Reviewers conducted an independent search of the National Center for Biotechnology Information PubMed, Medline, and the Cochrane Collaboration Library from 1966 to January 2017 following the inclusion criteria. A hand search of bibliographies of reviews and clinical trials related to IIP was also performed. This study looked into CBL changes around IIP primarily and further extracted the data to conduct three meta-analysis of "IIP using GBR versus IIP without GBR", "IIP using bone graft alone versus IIP using bone graft with membrane" and "IIP using GBR versus conventional implant placement" which were further subdivided to provide more detailed information for each. Four reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms., Results: The electronic search identified 714 potential studies and the hand search retrieved 55 studies. Crestal bone level (CBL) changes were determined in three meta-analyses. The results revealed a mean difference in CBL changes of 0.175 ± 0.180 mm  in favor of IIP without GBR when compared with implant with GBR. However, IIP with bone graft and membrane showed better results when compared with IIP with bone graft alone [CBL changes of 0.532 ± 0.572 mm]. CBL preservation was noted in IIP with GBR versus conventional implant placement [CBL changes of - 0.001 ± 0.049 mm]., Conclusions: Meta-analyses showed minimal difference in CBL around IIP with bone graft versus without bone graft and with IIP with GBR compared with conventional implant placement. However, IIP with bone graft and membrane reported better CBL preservation compared with IIP with bone graft alone. Nonetheless, these results should be interpreted with caution because of moderate heterogeneity between studies., (© 2019 American Academy of Periodontology.)

Introduction: Implants that lack keratinized tissue (KT) have been associated with increased plaque accumulation, gingival inflammation or hue of metal showing through the tissue. Free gingival grafts (FGGs) are a predictable treatment for minimal or lack of KT. FGGs can increase the zone of KT around teeth and implants alike. Despite predictability of FGGs, stabilizing the graft around implants can be challenging, but is critical for success. Little information is available regarding ways to stabilize FGGs around implants. Acrylic or composite stents are a viable option for obtaining graft stability and support during the healing process., Case Presentation: This case report highlights the practicality of using acrylic or composite stents for FGG stabilization with successful outcomes. Two patients presented with dental implants, with minimal or lack of KT requiring soft tissue augmentation. FGGs were harvested from the palate and fitted around implant carriers allowing stabilization and adequate suturing. Custom-made acrylic or composite stabilization stents were fabricated to fit around implant carriers, which were screwed into the implant platform, and hollowed out internally to provide space for the graft. Postoperative visits showed healthy, stable zones of KT in both cases., Conclusion: The customized acrylic or composite stents allowed stabilization of the FGGs with successful outcome., (© 2019 American Academy of Periodontology.)

Background: Immediate implant placement (IIP) is predictable but can lead to esthetic challenges, including midfacial recession (MFR) and papillary height (PH) loss. The aim of this systematic review is to examine the effect of IIP on MFR and PH after at least 12 months of functional loading., Methods: Literature review of the Cochrane and MEDLINE electronic databases and hand search up to January 2016 identified eligible studies. Four reviewers independently assessed data quality and methodology., Results: A total of 106 articles satisfied the inclusion criteria. Twelve studies qualified for three meta-analyses. MFR was slightly less in conventional implant placement (CIP) than in IIP, but the result was not statistically significant (mean difference [MD] -0.064 mm; P = 0.687). Similarly, there was better PH maintenance in CIPs, with statistical significance for distal PH (DPH) only (cumulative PH: MD -0.396, P = 0.010; DPH: MD -0.765, P <0.001; mesial PH [MPH]: MD -0.285, P = 0.256). MFR was slightly less in IIP with thick versus thin biotypes, but not statistically significantly different (MD -0.373, P = 0.243). Pooled data showed statistically significantly less MFR and better PH maintenance in IIP with thick biotype (MFR: MD -0.478, P <0.001; cumulative PH: MD -0.287, P <0.001; MPH: MD -0.288, P <0.001; DPH: MD -0.310, P <0.001). Non-significantly less MFR (MD 0.253, P = 0.384) and significantly better PH maintenance were found in IIP with immediate provisionalization versus conventional restoration (MD -0.519, P = 0.028)., Conclusions: IIP in thick biotype and with immediate provisionalization had less MFR and better PH than IIP in thin biotype or with delayed restoration. However, these findings should be interpreted with caution due to high heterogeneity, which was calculated using comprehensive meta-analysis statistical software that took into account sample size and different treatment groups, and limited qualified studies.

Background: Immediate implant placement (IIP) is a successful treatment and has the advantages of reducing time and increasing patient satisfaction. However, achieving predictable esthetic results with IIP presents a challenge because of naturally occurring bone loss postextraction. Therefore, the focused question of this systematic review is: What is the effect of IIP on crestal bone level (CBL) changes after at least 12 months of functional loading?, Methods: Extensive literature review of the Cochrane and MEDLINE electronic databases and a manual search up to November 2012 identified eligible studies. Two reviewers independently assessed the study data and methodologic quality using data extraction and assessment forms., Results: Electronic and manual searches identified 648 relevant publications. A total of 57 articles satisfied the inclusion criteria. Sixteen studies had test and control groups; therefore, meta-analyses could be performed. The results demonstrated better CBL preservation around IIP compared with implant placement in healed/native bone at 12 months [CBL difference of -0.242 (95% confidence interval [CI], -0.403 to -0.080; P = 0.003)]. Similarly, platform switching around IIP showed better results compared with non-platform switching (CBL difference of -0.770 [95% CI, -1.153 to -0.387; P <0.001]). There was no difference in mean CBL changes with regard to one-stage or two-stage IIP protocol (-0.017 [95% CI, -0.249 to 0.216; P = 0.85]) or the use of immediate or delayed immediate implant loading (0.002 [95% CI, -0.269 to 0.272; P = 0.99])., Conclusions: Meta-analyses showed less CBL loss around IIP compared with implant placement in healed bone. Platform-switched implants showed greater crestal bone preservation than non-platform-switched implants. There was no significant difference in CBL with one- versus two-stage placement or use of immediate versus delayed IIP loading. Although there were statistically significant differences favoring IIP, the small differences may not be clinically relevant. Although IIP showed favorable outcomes for CBL changes, these results should be interpreted with caution because of high heterogeneity among studies.

This report describes the use of the combination of 2 technologies (Cone-beam computed tomography and Optical 3-dimensional scan) to maximize accuracy of implant placement in an area where previous implants failed and had to be removed. This report also stresses the increased efficiency of combining technologies to fabricate stereolithographic surgical guide which, when used intraoperatively, can improve precision of placement.

Introduction: Peri‐implant infections can occur any time postloading. Although management of peri‐implant infections has been described extensively in the literature, no consensus exists on the best approach to its treatment. Infections and bone loss can also occur around implants prior to loading, leading to early implant loss. Little has been reported on the management of peri‐implant infections occurring prior to loading. This report describes the identification as well as the surgical and restorative management of infection and bone loss around a preloaded dental implant. Case Presentation: A 52‐year‐old systemically healthy, non‐smoking white female had severe inflammation with bleeding on probing and bone loss around implant #28 (Universal Numbering System) 7 weeks after placement and augmentation with autogenous and deproteinized bovine bone and a resorbable collagen membrane (RCM). Surgical exposure revealed a deep bony crater around the entire implant. The implant was cleaned for 4 to 5 minutes with a tetracycline and saline slurry. Guided bone regeneration was performed with demineralized freeze‐dried bone allograft and an RCM. Azithromycin, ibuprofen 800 mg three times daily, and 0.12% chlorhexidine gluconate rinse were given post‐surgery. Postoperative healing was uneventful. Nearly complete bone fill was noted at 1 year of observation when implants were permanently restored. A combination of screw‐ and cement‐retained restorations were placed. Tissues remained healthy 5.5 years postloading with maximum 3‐mm probing depth and no changes in bone levels. Conclusions: This case shows that it is possible to arrest early peri‐implant infection, regenerate bone, and maintain health over 5.5 years postloading. Early detection and multidisciplinary care resulted in long‐term success. [ABSTRACT FROM AUTHOR]