Preventive Antibiotic Therapy in the Placement of Immediate Implants: A Systematic Review

Immediate implants present a high risk of early failure. To avoid this, preventive antibiotics (PAs) are prescribed; however, their inappropriate administration leads to antimicrobial resistance. The present study aims to clarify whether the prescription of PAs reduces the rate of early failure of immediate implants and to establish guidelines to avoid the overprescription of these drugs. An electronic search of the MEDLINE database (via PubMed), Web of Science, Scopus, LILACS and OpenGrey was carried out. The criteria described in the PRISMA® statement were used. The search was temporarily restricted from 2010 to 2021. The risk of bias was analysed using the SIGN Methodological Assessment Checklist for Systematic Reviews and Meta-Analyses and the JBI Prevalence Critical Appraisal Tool. After searching, eight studies were included that met the established criteria. With the limitations of this study, it can be stated that antibiotic prescription in immediate implants reduces the early failure rate. Preoperative administration of 2–3 g amoxicillin one hour before surgery followed by 500 mg/8 h for five to seven days is recommended. It is considered prudent to avoid the use of clindamycin in favour of azithromycin, clarithromycin or metronidazole in penicillin allergy patients until further studies are conducted.

Prevalence of favourable anatomy for palatal emergence of an immediate implant in the maxillary central incisor post-extraction site.

The purpose of this study was to determine the prevalence of favourable anatomy for palatal emergence of an immediate flapless implant in the maxillary central incisor post-extraction site. Implants were virtually placed into maxillary central incisor sites using 3D implant planning software. Following a strict implant placement criteria to keep a safety distance to the buccal plate and other anatomical structures, sockets where assessed to determine their suitability for a palatally emerging implant. From 321 patients included in this study, 62.3% presented a suitable socket anatomy for an immediate implant to be placed with the angulation for a screw retained crown. In 29% of the cases, the implants had to be labially tilted to keep a minimum distance to the buccal plate. 8.7% were unsuitable for immediate implants due to anatomic limitations. The position and angulation for an implant in the maxillary central incisor socket should be carefully assessed preoperatively with 3D images, as many sites will not be candidates for a palatal emergence and thus, a screw retained restoration.

Molar Septum Expansion with Osseodensification for Immediate Implant Placement, Retrospective Multicenter Study with Up-to-5-Year Follow-Up, Introducing a New Molar Socket Classification

The ideal positioning of immediate implants in molar extraction sockets often requires the osteotomy to be in the interradicular septum, which can be challenging in some cases, with traditional site preparation techniques. Patients who had undergone molar tooth extraction and immediate implant placement at five different centers, and followed up between August 2015 and September 2020, were evaluated. Inclusion criteria were use of the osseodensification technique for implant site preparation. The primary outcome was septum width measurement pre-instrumentation and osteotomy diameter post expansion. Clinical outcomes, such as implant insertion torque (ISQ) and implant survival rate, were also collected. A total of 131 patients, who received 145 immediate implants, were included. The mean overall septum width at baseline was 3.3 mm and the mean osteotomy diameter post instrumentation was 4.65 mm. A total of ten implants failed: seven within the healing period and three after loading; resulting in a cumulative implant survival rate of 93.1%. This retrospective study showed that osseodensification is a predictable method for immediate implant placement with interradicular septum expansion in molar extraction sockets. Furthermore, it allowed the introduction of a new molar socket classification. In the future, well-designed controlled clinical studies are needed to confirm these results and further explore the potential advantages of this technique.

Primary stability and PES/WES evaluation for immediate implants in the aesthetic zone: a pilot clinical double-blind randomized study

The use of immediate implants in the aesthetic area is a technique widely used in modern implantology. The characteristics of the patient, the implant, and the surgical procedure used may influence the final results. The aim was to assess whether the implant design affects primary (P.S.) and secondary stability (S.S.), bone level (B.L.), and PES/WES evaluation. Twenty implants with two different designs (n = 10) were immediately placed and randomly located in the upper anterior maxilla with no grafting material. Implant-Stability-Quotient (ISQ), B.L., and Pink-Esthetic-Score/White-Esthetic-Score (PES/WES) were evaluated. Shapiro–Wilk normality test was performed to determine the sample normality, as the data did not follow a normal distribution, the Wilcoxon-Mann–Whitney test was applied (p < 0.05). ISQ was determined at placement (PS): control 59.1 (C.I.54.8–63.3); experimental 62.2(C.I.60.1–64.2) and three months after placement (SS): control 62.2.1 (C.I.53.3–71.0); experimental 67.2(C.I.65.8–68.5). The BL was measured at three months after placement: control 0.38 mm (C.I.− 0.06 to + 0.83); experimental 0.76 mm (C.I.0.33–1.19) and at 12 months post-loading: control 0.07 mm (C.I.− 0.50–0.65); experimental 0.90 mm (C.I.0.38–1.42). PES/WES values were evaluated for the control group: 15 (C.I.12.68–17.32), and for the experimental group 15.20 (C.I.11.99–18.41). No significant differences were shown between both implant designs. A good grade of osseointegration and primary/secondary stability was achieved, as well as proper maintenance of crestal bone and adequate PES/WES scores. The criteria for selection for the ideal patient for immediate implant placement is essential.ClinicalTrials Protocol ID: NCT04343833.

A radiological study method of vertical alveolar resorptions using immediate dental implants

Dental extraction is followed by decreases in alveolar volume, vertically and horizontally. This retrospective study measured vertical alveolar resorption after insertion of immediate implants, using OPG, without CBCT or additional radiographs. Patients were randomly split in two groups A (57 implants) and B (47 implants). Measurements were made by two independent observers. The types of implants were: Exacta (Biaggini Medical Devices), Nova, Dentix Millenium and Surcam. The method was based on the size of the implant and another common element of the two radiographs. It used an optimal radiologic exposure. It can be generalized to other studies. Similar results measured in the two groups showed that alveolar remodeling does not depend on the type of the implant. Half of the alveoli did not have any resorption. Another quarter showed barely perceptible clinical resorption (1-2 mm). In the last quarter were registered all the notable resorptions that were associated with various factors (temporary mobile prosthesis, surgical flap, medication and some health problems, smoking, etc.) showing real situations, not ideal conditions. Maximum resorption was unique (7.63 mm).

Immediate Implants with Early Loading Accompanying Autogenous Bone Grafting in a Maxilla with Periodontal Destruction: A Case Report

In the case of multiple hopeless teeth and severe bone loss, a conventional healing protocol of 3–4 months has been recommended to prevent the possibility of infection or unpredictable resorption of grafted bone during consolidation of the extraction socket. The use of a provisional denture is inevitable in the case of delayed implant placement, which is a common risk factor for wound dehiscence after a bone graft. Although autogenous bone is still the gold standard for bone grafting because of its excellent biocompatibility and osteogenic potential, there has been controversy in the unpredictable resorption of autogenous bone grafting. We present a case of successful maxillary rehabilitation without the use of provisional dentures by immediate implant placement, with early loading accompanying an extensive autogenous bone graft.

Effect of Platelet Concentrates on Marginal Bone Loss of Immediate Implant Procedures: A Systematic Review and Meta-Analysis

Background: To evaluate marginal bone loss (MBL) in immediate implant procedures (IIP) placed in conjunction with platelet concentrates (PCs) compared to IIP without PCs. Methods: A search was performed in four databases. Clinical trials evaluating MBL of IIP placed with and without PCs were included. The random effects model was conducted for meta-analysis. Results: Eight clinical trials that evaluated MBL in millimeters were included. A total of 148 patients and 232 immediate implants were evaluated. The meta-analysis showed a statistically significant reduction on MBL of IIP placed with PCs when compared to the non-PCs group at 6 months (p < 0.00001) and 12 months (p < 0.00001) follow-ups. No statistically significant differences were observed on MBL of IIP when compared PCs + bone graft group vs. only bone grafting at 6 months (p = 0.51), and a significant higher MBL of IIP placed with PCs + bone graft when compared to only bone grafting at 12 months was found (p = 0.03). Conclusions: MBL of IIP at 6 and 12 months follow-ups is lower when PCs are applied in comparison to not placing PCs, which may lead to more predictable implant treatments in the medium term. However, MBL seems not to diminish when PCs + bone graft are applied when compared to only bone grafting.