These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.

Objectives To evaluate the survival rate, the orobuccal bone resorption and stability of peri‐implant hard and soft tissues following immediate implant placement of wide diameter implants in molar extraction sites and peri‐implant defect grafting with autogenous bone (AB) or biphasic bone graft material (BBGM) with 1‐ to 3‐year follow‐up examinations. Material and Methods Fifty wide diameter implants were placed in 50 patients immediately into molar extraction sockets by a flapless approach. Peri‐implant defect augmentation was performed randomized with either AB or BBGM. Primary outcome variable was implant survival. Marginal bone level changes, orobuccal width of the alveolar crest, probing depths, and implant success were considered as secondary parameters. Results One implant of the BBGM group was lost, 1 patient withdrew from the study (drop‐out). The remaining 48 patients were still in function at a follow‐up period up to 31 months after implant insertion. Interproximal marginal bone level regenerated from −7.5 mm to the level of the implant shoulder (AB + 0.38 mm, BBGM + 0.1 mm) at final follow‐up. The width of the alveolar crest changed by −0.08 mm (AB) and +0.72 mm (BBGM) at 1 mm, −0.36 mm (AB) and +0.27 mm (BBGM) at 3 mm, −0.36 mm (AB) and +0.31 mm (BBGM) at 6 mm apical to implant shoulder level. Success rate was 87.5% in the AB and 56.3% in the BBGM group (p = .058). Conclusions Medium‐term results prove a high survival rate, a favorable amount of bone generation in both groups and a low amount of orobuccal resorption in immediate molar implant insertion.

Background : The main problem in periimplantitis is often the combination of severe periimplant bone loss with a contaminated implant surface and an insufficient soft tissue situation. Classic surgical concepts with at crestal access to the bony defect and debridement of the surface most often lead to partial defect regeneration and a soft tissue recession. An incision above the pathologic bony lesion is contrary to basic surgical treatment rules.Aim/Hypothesis : To overcome this problem a technique was developed which allows to clean the implant surface, reconstruct the bony defect and improve soft tissue quantity without cutting the papilla complex. This pilot study evaluates implants with severe periimplantitis treated with this modified approach.Material and Methods : A total of 11 implants in 9 patients (6 females, 3 males, 7 non-smokers, 2 smokers) were included. All implants ( 2Straumann Bone Level, 2 NobelActive, 1 Frialit II, 2 OsseoSpeed, 2 OsseoSpeed Profile, 2 NobelPerfect; 5 incisor, 1 canine, 1 premolar and 4 molar implants) were treated according to the same treatment protocol-horizontal mucosal incision 5 mm apical to marginal mucosa, supraperiostal preparation in apical direction, cutting through periosteum at level of the implant apex, subperiosteal flap elevation in coronal direction, exploration and cleaning of the periimplant defect, thorough debridement of the implant surface with the Er-YAG laser (Morita), subperiosteal grafting with connective tissue, grafting of the bony defect with autogenous bone chips from the mandibular ramus, bilayered suturing of periosteum and mucosa. During this pilot study implant survival, marginal bone levels, periimplant probing depths, recession and tissue thickness were evaluated.Results : All implants were still in function at the final examination. Mean follow-up period was 7.3 months (range, 5 to 12 months). Interproximal, oral and buccal marginal bone levels increased significantly in relation to the implant shoulder from pre-operative examination to final examination. No signs of suppuration or periimplant infection were present. Probing depths and recession decreased significantly, while the soft tissue thickness improved from pre-operative examination to final examination. Conclusion and ClinicalImplications : Marginal bone levels and soft tissue results suggest feasibility for the regeneration of severe periimplant hard and soft tissue deficiencies by this new treatment approach. With the use of this concept the simultaneous implant surface cleansing and improvement of hard and soft tissue seems to be possible and unfavorable postoperative exposition of titanium surface can be prevented.

Background : The majority of the implants on the market has a flat prosthetic shoulder which does not correspond to the vertical height differences of the extraction socket walls. An implant with a sloped marginal shoulder, the Astra Tech OsseoSpeed Profile (Astra Tech AB, Mölndal, Sweden), has been developed 10 years ago to optimize implant placement in extraction sites and support the marginal bone circumferentially.Aim/Hypothesis : The study examined the clinical performance of OsseoSpeed Profile implants in a one-stage procedure with immediate insertion and provisionalization in the esthetic zone within a follow-up of up to 8 year.Material and Methods : Of 21 OsseoSpeed Profile implants were inserted in 16 patients. All implants were placed immediately into extraction sockets in the esthetic zone. Facial bony defects (4 total, 9 partial losses of the facial lamella) were reconstructed immediately with autogenous bone chips without raising a flap. All patients received immediate provisional restorations. Primary outcome variables were implant survival, marginal bone levels and Pink Esthetic Score.Results : Mean follow-up was 99 months (range 82 to 107 months). One implant was lost early at 2.5 months. Two patients with 2 implants did not continue the follow-up after prosthesis delivery respectively the 3-year follow-up (drop-out). Cumulative survival rate according to Kaplan-Meier was 94.7%. Marginal bone levels remained at the level of the implant shoulder (0.01 ± 0.68, range, −0.9 to 2.2 mm) at the final follow-up. In 72% of the implant sites the gingival esthetics was stable or even improved from the pre-operative examination (mean 10.6 ± 2.3) to the final follow-up (mean 11.9 ± 1.5). The width of the attached mucosa and the gingival biotype correlated with the marginal bone levels and the gingival esthetics. Conclusion and Clinical Implications: Results of survival rate, marginal bone and esthetic stability suggest proof of principle for immediate insertion and provisionalization of Astra OsseoSpeed Profile implants in the long-term observation.

Background : A wider implant design might improve the congruence between a molar extraction socket and the dental implant and may lead to less orobuccal bone resorption. Therefore, this study examined and compared the clinical performance of OsseoSpeedô EV 5.4S implants immediately inserted in molar extraction sites using two different grafting materials with a follow-up period of 6-36 months.Aim/Hypothesis : The aim of this prospective study is to evaluate the survival rate and stability of periimplant hard and soft tissue following immediate implant placement of OsseoSpeed EV 5.4S implants in molar extraction sites and periimplant defect grafting with autogenous bone or alloplastic bone graft material.Material and Methods : 50 implants were inserted. The periimplant defect augmentation was performed randomized with either autogenous bone (AK) or with a biphasic bone graft material (Symbios) (SY). Primary outcome variable was implant survival, secondary outcome variables were marginal bone level changes, orobuccal width of the alveolar crest, periimplant probing depths and implant success.Results : One implant of the SY group was lost. 49 patients were followed in average for 21 months. Survival rate was 100% in the AK and 96% in the SY group. Interproximal bone level regenerated from −7.5 mm to the level of the implant shoulder at final follow-up AK: 0.1 mm; SY: −0.2 mm). The width of the alveolar crest changed by −0.5 mm (AK) and; 0.8 mm (SY) 1 mm apical to implant shoulder, −0.5 mm (AK) and; 0.7 mm (SY) 3 mm apical, −0.4 mm (AK) and; 0.8 mm (SY) 6 mm apical to this level. 8 implants (3 AK, 5 SY) showed a decrease of the interproximal marginal bone to more than 1 mm or probing depth more than 5 mm. Conclusion and Clinical Implications :The results prove a high survival rate, a favorable defect regeneration and a low amount of orobuccal resorption in immediate molar implant insertion without differences for the bone graft material.