Bone dimensional changes after flapless immediate implant placement with and without bone grafting: Randomized clinical trial

Abstract

Introduction: Immediate implant in postextraction sockets requires managing the postextraction alveolar resorption. This randomized clinical trial examined vertical and horizontal changes 1-year following flapless immediate implant with and without xenograft at sites with thin labial plate.Methods: Forty patients with hopeless teeth in maxillary esthetic zone were randomly assigned to receiving either one immediate implant without bone graft (control) or with bone graft (intervention). Cone beam computed tomography (CBCT) scans were obtained pre-extraction and 1-year postoperatively to measure thickness and dimensional changes of the labial bone.Results: Cone beam computed tomography measurements revealed that a xenograft, when compared to no xenograft, led to 0.2 mm increased fill of the horizontal gap (95% confidence interval (CI): À1.1, 0.7). In both groups, there was a significant reduction in the labio-palatal bone width after 1 year compared to baseline (P ≤ 0.05). There was no significant difference (P > 0.05) between the xenograft when compared to no xenograft regarding the labio-palatal bone collapse % at 0 mm (À0.2, 95% CI: À4.8, 4.5) and 2 mm apical to the labial crest (1.9, 95% CI: À1.8, 5.6). While at 5 mm the ridge was significantly reduced (P ≤ 0.05) in the no xenograft when compared to xenograft (4.5, 95% CI: 0.7, 8.2). The xenograft when compared to no xenograft, led to 1.1 mm less vertical bone changes (95% CI: 0.4, 1.9). Both groups revealed significant positive correlation between labio-palatal socket dimension and bone formed labial to the implant (P ≤ 0.05). [Correction added on 7 February 2023, after first online publication: In the 8th line of this section, the word "collapse" was changed to "ridge" in this version.] Conclusion: This investigation suggested that immediate implants with or without grafting the labial gap preserved alveolar bone dimension and that bone formation labial to the implant was related to initial labio-palatal socket dimension.

Hard and soft tissue alterations using dual‐zone concept versus connective tissue graft at maxillary immediate implant placement: A 1‐year randomized clinical and volumetric trial

“…It has been previously proven that a thin labial plate of bone is not a critical factor for the existence or absence of new bone formation labial to the implant, while the labio‐palatal socket dimension could be a decisive factor (Fettouh, Ghallab, Ghaffar, et al., 2023; Jiang et al., 2020). Previous studies highlighted the importance of using a CTG in the presence of thin bone phenotypes (Fernandes et al., 2023; Seyssens et al., 2021).…”

“…Accordingly, the present trial observed that sites treated with CTG and DZ showed an acceptable mean amount of bone formed labial to the implant (2.28 ± 1.33 mm and 2.22 ± 1.04 mm, respectively) with no significant difference between them. This might be accredited to their similar baseline socket dimensions (Fettouh, Ghallab, Ghaffar, et al., 2023). These findings were in line with Jiang et al.…”

“…The amount of bone formed labial to the implant was measured at three levels below the labial bone crest; 0 mm, 2 mm, and 5 mm on the CBCT after 1 year in both studied groups. To perform radiographic measurements and comparisons and to ensure standardization and reproducibility of the CBCT images, superimposition of DICOM file sets of each patient was done using Fusion module software (OnDemand3D ver, 1.0.9, Cybermed) (Fettouh, Ghallab, Ghaffar, et al., 2023), which allowed subvoxel accuracy (Koerich De Paula et al., 2016). To measure the horizontal labio‐palatal bone width, the palatal surface of the implant was used as a reference point.…”

“…Several surgical techniques have been proposed over the years to preserve the soft and hard tissues in the esthetic zone, commencing with proper 3D implant positioning (Evans & Chen, 2008), flapless approach (Garcia Sanchez et al., 2021; Raes et al., 2011), following the addition of bone graft (Fettouh, Ghallab, Ghaffar, et al., 2023; Zaki et al., 2021), the application of a connective tissue graft (CTG) (Garcia Sanchez et al., 2021; Seyssens et al., 2021), the socket shield technique (Elaskary, Abdelrahman, et al., 2023; Hürzeler et al., 2010; Salama et al., 2007), or the use of customized healing abutment (Pitman et al., 2022). Furthermore, the innovation of new techniques such as vestibular socket therapy (Elaskary et al., 2020), dual‐zone concept (DZ) (Chu et al., 2012), and immediate dentoalveolar restoration (Da Rosa et al., 2013) was introduced to counteract the peri‐implant tissue reduction.…”

The facial–coronal ridge crest alterations after single immediate implant placement and provisionalization with thin buccal plate phenotype in anterior maxilla: A radiographic case‐series study

“…19 The diminished bone volume may still contribute to the collapse of the facial profile 21,22 or even an obvious mid-facial gingival recession if an implant is buccally positioned. 13,23 The quantitative ridge remodeling, particularly the alterations of the facial-coronal ridge crest, after IIPP with grafting procedures and the potential influencing factors, such as socket width, 24 buccal plate thickness, 25,26 implant diameter, 27 implant position 28,29 and gap width, 25,30,31 still needs further investigation.…”