Variations in Soft and Hard Tissues following Immediate Implant Placement versus Delayed Implant Placement following Socket Preservation in the Maxillary Esthetic Region: A Randomized Controlled Clinical Trial

Abstract

Introduction. Although retrospective analysis has shown immediate placement of implants (IIP) in the maxillary esthetic zone showing promising outcomes compared to delayed placement of implants following socket preservation (DIP), a direct comparison in a prospective, well-designed randomized fashion with adequate power analysis between the two implant placement protocols is still lacking. This study is aimed at radiographically evaluating the effect of IIP after extraction as compared to implant placed in preserved sockets 4 months following extraction (DIP) in terms of changes in buccal plate thickness(CBT) after 6 months of healing and evaluation of pink esthetic score (PES) for assessment of soft tissue changes and patient-related outcome measures (PROMs) using visual analogue scale (VAS). Materials and Methods. 25 implants were placed immediately following extraction in the IIP group, and 25 implants were placed four months following socket preservation with demineralized bovine bone mineral (DBBM) and advanced platelet-rich fibrin (A-PRF) in the DIP group, control group, in the maxillary esthetic region. CBCT was taken preoperatively and 6 months postoperatively to assess the dimensional changes in the buccal bone plates(CBT). PES and PROMs for pain threshold and patient satisfaction using VAS were evaluated at the time of implant placement and 6 months postoperatively. Results. Significant differences in mean reduction in buccal plate thickness (CBT) were found in the test group (IIP) 0.2 ± 0.02 compared to the control group (DIP) which showed a mean reduction in CBT of 0.4 ± 0.1 ( p < 0.001 ) at the end of 6 months. Although there was no statistically significant difference in PES between the groups, there was a significant difference between the groups when individual values of PES were compared at p < 0.001 . Conclusion. The IIP group showed lesser reduction in CBT and a better PES which is an important clinical information which could be translated clinically in situations where implant placement is planned in the maxillary esthetic region. This trial is registered with CTRI/2019/06/019723.

Socket Preservation after Tooth Extraction: Particulate Autologous Bone vs. Deproteinized Bovine Bone

“…Socket preservation is a technique defined as alveolar ridge preservation within the bone envelope remaining after tooth extraction with the purpose of reducing bone resorption in order to perform a correct implant-supported prosthesis [ 21 ]. The need of socket preservation immediately after tooth extraction should be determined by the aesthetic, functional and risk-related viewpoint [ 13 , 21 ]: in the case of a treatment plan with implant-supported prosthodontics of the extracted tooth with risk of excessive resorption after tooth extraction and/or aesthetic impact of the tooth, socket preservation is suggested [ 22 ]. Alenazi et al underlined the need for socket preservation after tooth extraction in the case of future implant prosthesis in order to have correct bone volume [ 23 ].…”

Patient‐reported outcomes for bone regenerative procedures

“…However, even the recent bone regeneration studies do not use the patient's perception or PROMs as a primary outcome but as a secondary one. 29,[38][39][40][41] In the systematic review by Nibali and coworkers, 39,42 where the aim was to compare clinical, radiographic, and patient-reported outcomes when regenerative surgery at teeth was used, it was found that only very few studies reported PROMs and meta-analyses were impossible to perform. Another systematic review by Wittneben et al 42 examined patient-reported outcome measures focusing on the esthetics of implant-supported fixed dental prostheses and found corresponding results.…”

“…Patient‐reported outcome measures are used more frequently in recent studies compared to previous ones. However, even the recent bone regeneration studies do not use the patient's perception or PROMs as a primary outcome but as a secondary one 29,38–41 . In the systematic review by Nibali and coworkers, 39,42 where the aim was to compare clinical, radiographic, and patient‐reported outcomes when regenerative surgery at teeth was used, it was found that only very few studies reported PROMs and meta‐analyses were impossible to perform.…”

Platelet-Rich Fibrin in Oral Surgery and Implantology: A Narrative Review

“…These could be reduced by the use of PRF [ 23 ]. The application in the included studies was performed either with PRF as a sole filling material [ 44 , 45 , 46 , 47 , 48 , 49 ] or PRF in combination with bone graft materials and a collagen plug compared to spontaneous healing of the alveolus [ 49 , 50 , 51 ]. Eight out of 32 articles dealing with this topic were included in our analysis.…”

“…For this purpose, studied parameters were defined as dimensions of alveolar bone and its changes [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ], new bone formation [ 44 , 46 , 47 , 51 ], pain [ 49 , 50 , 51 ], swelling [ 51 ], soft tissue healing [ 48 , 49 , 51 , 52 , 53 ]. Follow-up for soft tissue healing was documented in the first postsurgical week [ 44 , 45 , 47 , 48 ] and for hard tissue healing between up to 6 months [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”