Maintaining Tissue Architecture in Immediate Implant Placement Following Extraction of Natural Teeth Using Custom Healing Screw

Abstract

The aim of this study was to compare the conventional healing screw with custom healing screw in terms of maintenance of soft tissue architecture. Twenty-four patients who underwent single tooth extraction and single immediate implant placement were included in the study. Twelve patients were treated with conventional healing screw after immediate implant placement (control group) and 12 were treated with screwretained custom healing screw (test group). After minimally traumatic tooth extraction, a temporary abutment was fabricated utilizing flowable composite, which adapted to the socket architecture, to serve as a customized healing screw. In order to evaluate soft tissue remodeling in all cases, digital impressions were made before tooth extraction, at implant insertion, at 6 months after insertion, and after placement of the final restorations. After 6 months of the Osseo integrated period, the custom healing screw served successfully as a tooth profile for peri-implant tissue. In cases of implants with conventional healing screw, soft tissue remodeling around the implants is observed, in contrast to cases of custom healing abutments. Correct design of a healing abutment is important for maintaining the emergence contour in cases of immediate implant placement. In our study, a considerable difference was observed between the standard healing screw and customized healing screw. The selection between provisional restoration and customized healing abutment is only based on esthetic considerations.

Effect of customized healing abutments on the peri‐implant linear and volumetric tissue changes at maxillary immediate implant sites: A 1‐year prospective randomized clinical trial

“…The use of customized healing abutments, when an implant is inserted in a fresh extraction socket, has been described as a beneficial solution that permits to personalize the peri-implant tissues architecture. [15][16][17][18]24,25 This study demonstrated that, in the first month of treatment, the use of customized healing abutments is favorable in preventing linear and volumetric peri-implant tissue loss (Figure 5). CA group exhibited approximately half less the volumetric dimensional variation than CM group (À12.98 ± 14.53 mm 3 and À25.20 ± 17.44 mm 3 ; p = 0.049, respectively).…”

“…22,23 On the other hand, the use of customized healing abutments in IIP is a growing subject but almost limited to description of techniques and case reports in terms of scientific evidence. [15][16][17][18]24,25 Recently, an RCT from Perez and colleagues, 26 comparing customized healing abutments and standard healing abutments at IIP sites, showed favorable results in terms of papilla presence and marginal bone loss at the sites treated with customized abutments, when compared with the standard healing abutments sites. In our investigation, all the experimental sites were carefully selected and classified as type 1 extraction sockets.…”

“…Some authors revealed that the use of customized healing abutments could maintain peri-implant soft tissue contour, eliminate the need for a reopening surgery, and retain the bone graft particles as a mechanical barrier. 17,26 Additionally, this solution could customize the emergency profile without placing a provisional restoration, which could lead to implant failure if adequate primary stability was not acquired. 18 Despite the results previously mentioned, both groups developed a completely different behavior after that first month healing period (Figure 4).…”

“…14 Recently, studies evaluating the use of customized healing abutments/screws have been performed aiming to assess possible advantages associated with this treatment modality. [15][16][17][18] The utilization of a CAD/CAM technique to fabricate a perfectly adapted polymethyl methacrylate (PMMA) healing abutment aims to reproduce the precise contours of the cervical root area and maintain the soft tissue contours during osseointegration and the healing of the peri-implant mucosa. Also, they seem to provide a predictable outcome while reducing the number of surgeries, postoperative discomfort, morbidity related to open-flap technique, and the length of treatment.…”

Immediate implant in the posterior region combined with alveolar ridge preservation and sealing socket abutment: A retrospective 3D radiographic analysis

“…To cope with this anatomical consideration several authors have proposed using a customized abutment to seal the large molar socket after the immediate implant placement, and maintaining the original outline of soft tissues 21‐26 . For instance, the Sealing Socket Abutment (SSA) technique introduced by Finelle et al 2017 uses an individualized chairside‐fabricated abutment following tooth extraction to seal the surgical area and to protect the bone grafting material from the oral cavity exposure as well.…”