Immediate implant placement or wait for socket preservation: results from a 1 year long controlled trial.

Molar replacement with 7 mm-wide diameter implants: to place the implant immediately or to wait 4 months after socket preservation? 1 year after loading results from a randomised controlled trial

By: Tallarico M, Xhanari E, Pisano M, Gatti F, Meloni SM.


Purpose

 To test the hypothesis that there is no difference in clinical, radiographic and aesthetic outcomes positioning single post-extractive 7 mm-diameter implants or waiting 4 months after molar extraction and socket preservation procedure.


Materials & Methods

Subjects and Outcomes of the study

Period : Between June and December 2014. (The last follow-up was in September 2016)

Patients : Both group A and group B both have 12 patients

(Age : Mean 53.9 years(from 37 years to 67 years)

Implant: Total 24 TSIII SA Ultra-Wide

Group classification

– Group A(n=12) : implant installation in fresh extraction sockets grafted with cortico-cancellous heterologous bone and porcine derma

– Group B(n=12) : delayed implant installation 4months after tooth extraction and socket preservation using the same materials

The primary outcome measures : the success rates of the implants and prostheses and the occurrence of any surgical and prosthetic complications during the entire follow-up.

Secondary outcome measures : peri-implant marginal bone level (MBL) changes, resonance frequency analysis (ISQ) and pink esthetic score (PES) values at implant placement (baseline) up to 1 year after loading.

 Study design : Randomized controlled trial of parallel group


Results

 Twelve patients were randomised to group A and 12 to group B. No patient dropped out within 1 year after loading. No implant and prosthesis failed and no complications occurred during the entire follow-up.

One year after loading, statistically significant higher mean MBL loss was experienced in group A (0.63 mm 0.31 mm) compared to group B (0.23 mm 0.06 mm); difference 0.41 mm (95% CI 0.17-0.53; P = 0.001). Six months after implant placement, mean ISQ value was 78.8 2.8 for group A and 79.9 3.6 for group B, showing no statistically significant difference between groups (difference 1.1; 95% CI: 0.04 to 2.96; P = 0.422). One year after loading, mean PES was 10.6 1.8 [range: 8 to13] in group A and 12.2 1.2 [range: 11 to 14] in group B. The difference was statistically significant (1.6 2.7; 95% CI -0.55-2.55; P = 0.019) with better results for group B.

Table 1. Main patient and implant characteristics

  Group A (n=12)
Immediate post-extractive implants
Group B (n=12)
Delayed implants
Number of female patients (n=16) 7 (58.3%) 9 (75.0%)
Number of male patients (n=8) 5 (41.7%) 3 (25.0%)
Age at insertion (range) 51.6 (37-67) 56.2 (42-67)
Total number of smokers (10 cigarettes per day) 0 (0%) 0 (0%)
Total number of mandibular implants 6 (50%) 6 (50%)
8.5mm long implants 3 (25%) 1 (8.3%)
10mm long implants 9 (75%) 9 (75%)
11.5mm long implants 0 (0%) 2 (16.7%)
Implants in first molar position 10 (83.3%) 11 (91.7%)
Implants in second molar position 2 (16.7%) 1 (8.3%)

Table 2. Outcomes comparison between groups at one year after loading

  Group A (n=12)
Immediate post-extractive implants
Group B (n=12)
Delayed implants
Difference Difference
Peri-implant marginal bone loss,
mm SD (95% CI)
0.63 0.31 (0.42-0.78)* 0.23 0.06 (0.17-0.23) 0.41 (0.17-0.53) 0.001**
Pink aesthetic score 10.6 0.31 (9.99-12.01) 12.2 1.2 (11.32-12.68) 1.6 (-0.55-2.55) 0.019**

*One patient became pregnant and has not undergone the 1-year radiograph.  **Statistically significant difference.


Conclusion

 Within the limitations of this study, both procedures achieved successful results over the 1-year follow-up period, but waiting 4 months after tooth extraction and socket preservation procedure was associated with less marginal bone loss and a better aesthetic outcome.

 

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