“IMMEDIATE PLACEMENT OF IMPLANTS AT SINGLE ROOTED …

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“IMMEDIATE PLACEMENT OF IMPLANTS AT SINGLE ROOTED FRESH

EXTRACTION SOCKET” - A CLINICAL AND RADIOLOGICAL EVALUATION

By

Dr. SHYNU SAHIB

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka,

In partial fulfillment of the requirements for the degree of

MASTER OF DENTAL SURGERY

In ORAL AND MAXILLOFACIAL SURGERY

Under the guidance of

Dr. B C SIKKERIMATHM.D.S Professor and Head

DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,

P.M.N.M DENTAL COLLEGE AND HOSPITAL,

BAGALKOT-587101, KARNATAKA.

2015 - 2018

Scanned by CamScanner




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LIST OF ABBREVIATIONS

SL. NO ABBREVIATIONS

FULL FORM

1 IOPAR INTRA ORAL PERI APICAL

RADIOGRAPH

2 OPG ORTHOPANTAMOGRAM

3 OPD OUT PATIENT DEPARTMENT

4 BOP BLEEDING ON PROBING

LIST OF TABLES

SL.NO.

TABLE NAME

PAGE NO.

1.

Table 1: Age distribution 26

2.

Table 2: Gender distribution 27

3. Table 3: Site & Aetiology of tooth loss

27

4. Table: 4 Implant fixture size

28

5. Table 5: Clinical evaluation of implants at the time of

their placement

29

6. Table 6 – Evaluation 7 days after surgery

30

7. Table 7 – Evaluation at the time of 3 months after surgery

31

8. Table 8: Radiological evaluation of Mean Mesial Vertical

Crestal Bone resorption measurement

32

9. Table 9: Radiological evaluation of Mean Distal Vertical

Crestal Bone resorption measurement

33

LIST OF FIGURES

SL.NO.

GRAPH NAME

PAGE NO.

1.

Graph 1 showing age distribution 35

2.

Graph 2 showing Gender distribution 35

3. Graph 3 showing Aetiology of extraction

36

4. Graph 4 showing size of implants used

36

5 Graph 5 showing stability of implant

37

6. Graph 6 showing Mean modified plaque index

37

7. Graph 7 showing mean gingival index

38

8. Graph 8 showing Mean vertical crestal bone level in mesial

side

38

9. Graph 9 showing Mean vertical crestal bone level in distal

side

39

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ABSTRACT


EXTRACTION SOCKET” - A CLINICAL AND RADIOLOGICAL

EVALUATION

BACKGROUND AND OBJECTIVES:

The concept of immediate implant placement helps out in many ways like

preserving the alveolar bone, the trauma, relief to the patient from strenuous

appointments and moreover holds a psychological value. Apart from the conventional

methods, placement of implant immediately after the extraction of a poor prognosis

teeth can be done. The objective of the study is to evaluate the outcome of

immediately placed implants in fresh extraction sockets.

METHODS:

Ten patients reporting to the Department of oral and maxillofacial surgery for

extraction of single rooted teeth will be examined and evaluated for receiving an

immediate implant placement. Patients will be followed up at intervals of 1 week, 1

month, 3 months and 6 months. At follow up appointments bone integration will be

assessed with the help of radiovisiography and clinical assessment of the soft tissue

will be performed by measuring the probing depth around the implant, presence or

absence of bleeding on probing and suppuration.

RESULTS:

10 implants were placed in the maxilla (all anterior) while no implants in the

mandible. Clinical evaluation of the implants 3 months after surgery showed good

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periodontal status with absence of Plaque, Bleeding on Probing, Pus Discharge and

Clinical Mobility.No implant failure was observed (100% success rate) in the 3 month

of the pre- loading phase, after which, 8 patients (accounting for 10 implants)

received single unit fixed partial restoration.

INTERPRETATION AND CONCLUSION:

On conclusion we recommend the use of immediate implants as a viable therapeutic

option in improving success, reducing the treatment duration and patient

acceptance.Immediate implants must gain sufficient primary (mechanical) stability for

successful outcome.

KEY WORDS: Osseo integration, Primary stability, Crestal bone

INTRODUCTION

P.M.N.M. DENTAL COLLEGE & HOSPITAL, BAGALKOT 1

INTRODUCTION

This is an era in which dental implants are conquering the field of aesthetic

dentistry. As a result of it, the other routine prosthesis is in a way of fading.

A dental implant is an artificial replacement for a tooth root usually made

from titanium. Schmidt et al. (2001) defines an ideal bone implant material as having

a biocompatible chemical composition to avoid adverse tissue reaction, excellent

corrosion resistance in the physiologic limits, acceptable strength, a high resistance to

wear and a modulus of elasticity similar to that of bone to minimize bone resorption

around the implant1. There are many implant systems available and when

competently use, they all deliver a highly reliable form of treatment. Dental implants

are suitable for most adults with good general health. Loss of teeth in the aesthetic

zone is a traumatic experience with or without compromise in phonetics and function.

Hence in the aesthetic zone implant supported single tooth replacement is one of the

most challenging situations confronting the clinician. The concept of immediate

implant placement helps out in many ways like preserving the alveolar bone, the

trauma, relief to the patient from strenuous appointments and moreover holds a

psychological value2.

When it comes to the history of dental implants, it is quite

a long way back. In 1981, evidence of oldest dental implant was found in the Kalavak

Metropolis in Turkey, which is dated back to 550 B C.

But the introduction of Titanium implants took place after the accidental

discovery of osseointegration of Titanium by Branemark in early 1950s. Soon after

this, the evaluation of various types of dental implants came into the health care

INTRODUCTION


market. Different types like based on design attachment, mechanism, surface of

implant, types of material used.

Implants were usually used in a missing tooth region. Taking various

operative and technical considerations into actions, the width and length of implant

should be decided by clinician. Apart from the conventional methods, placement of

implant immediately after the extraction of a poor prognosis teeth can also be done.

This can offer minimum treatment time, psychological benefits and helps in avoiding

another surgical procedure and appointment for implant placement.

For this study, patients with poor prognosis of anterior single rooted teeth with

no other conservative management is possible are selected. Ten patients reporting to

the Department of Oral and Maxillofacial Surgery OPD are chosen. After the

extraction of teeth, for replacing, patients have option of removable prosthesis, fixed

prosthesis and implants. Implants can be used as delayed and immediate. In delayed

implants, after the extraction, patient have to wait till bone formation finishes. It may

take months together. Certain literature says about intermediate placement which is

done by placing implant after a period of 2 to 3 weeks from extraction. But this is not

been widely used because the results is less or equal to the immediate placement.

Immediate placement helps in single appointment work, holds psychological benefits,

it helps in preserving the alveolar bone. The present study aims to evaluate the clinical

and radiological outcome of immediate placement of implants.

OBJECTIVES


OBJECTIVES

The objective of the study is to evaluate the outcome of immediately placed

implants in fresh extraction sockets. It is done by regular assesment of

osseointegration as seen on routine radiographs and clinically by checking the

primary stability and bleeding on probing around the region of implant placed.

REVIEW OF LITERATURE

P.M.N.M. DENTAL COLLEGE & HOSPITAL, BAGALKOT

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Thomas G. Wilson and Daniel Buser (1998) done a study on Implants placed in

immediate extraction sites: A report of histologic and histometric analyses of human

biopsies. Five titanium plasma-sprayed implants were biopsied from a human

volunteer 6 months after placement. Four test implants had been placed in immediate

extraction sockets, while one implant was placed in a mature site and served as a

control. The histologic analysis demonstrated that all five implants achieved

osseointegration as demonstrated by light microscopy, whereas a varying degree of

bone-implant contact was observed. The authors concluded that osseointegration may

occur in immediate extraction sites in humans using titanium implants with a plasma-

sprayed surface. The horizontal component of the peri-implant defect was apparently

the most critical factor relating to the final amount of bone-implant contact3.

Paul A Fugazzotto (2002) performed a study to assess the success rate of immediate

implant placement following a modified trephine / osteotome approach. In his study a

technique is presented which utilizes a trephine with 3.0 mm diameter followed by an

osteotome to implode a core of maxillary posterior alveolar bone prior to immediate

implant placement. He concluded that implants can be uncovered by this technique

and it will be an ease for further restoration4.

Nemcovsky CE et al. (2002) conducted a study wherein, healing of marginal defects

around implants placed in fresh extraction sockets was measured. Two implant

placement protocols were compared: delayed-immediate sites primarily closed by a



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rotated palatal flap (RPF) at the time of tooth extraction and implantation after 4–6

weeks and immediate procedures (into fresh extraction sockets) primarily closed by a

rotated split palatal flap (RSPF). Height and width of the marginal defect were

measured at the time of implant placement and after 6–8 months, at second stage

surgery. Significant differences were found for mean percentage reduction of the

defect height and area only between the two implant subgroups within each group5.

Lars Schropp and et al (2003) carried out a prospective clinical study on bone

healing following immediate versus delayed placement of Titanium implants into

extraction sockets. The aim was to compare bone healing and crestal bone changes

following immediate vs delayed placement of titanium dental implants with acid

etched surfaces in extraction sockets. A total of 46 patients, 23 in each group were

randomly allocated and received 1 implant in premolar, canine and incisor region of

maxilla and mandible. The width and depth of marginal bone around implant was

measured clinically at the time of placement and crestal bone changes were evaluated

radiographically by linear measurements. The study has concluded that new bone

formation occurs in infrabony defects associated with immediately placed implants in

extraction sockets6.

Stephen T Chen et al (2004) studied the biologic basis, clinical procedures and

outcomes of immediately placed implants following tooth extraction. The aim of their

study was to review the current literature with regard to survival and success rates

along with clinical procedures and outcomes associated with immediate and delayed

implant placement. A MEDLINE search was conducted for studies published between

1990 and June 2003. From that 10 cases were included with detailed case reports.



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Studies reporting on success and survival rates were required to have follow up

periods of at least 12 months. The study concluded that short-term survival rates and

clinical outcomes of immediate and delayed implants were similar7.

Bianchi AE et al. (2004) evaluate the long-lasting efficacy of a combined surgical

protocol, using immediate implant and subepithelial connective tissue graft for single-

tooth replacement. In the time period from 1990 to 1998, 116 patients were

consecutively admitted for treatment with a total of 116 solid screw ITI-implants

supporting single crowns. Ninety-six patients underwent the proposed combined

treatment (test group), while 20 received only single immediate implants (control

group). The observation time extended from 1 up to 9 years. The 9-year cumulative

survival rate was 100% for both test and control groups8.

Luiz A Lima, Anita M Fuchs-Wehrle and et al (2004) done a study to analyze the

surface characteristics of implants influence their bone integration after simultaneous

placement of implant and GBR membrane. The purpose of this study was to evaluate

the influence of titanium surface characteristics on bone integration of implants, and

to describe the pattern of peri-impiant tissue healing after simultaneous implant

placement and guided bone regeneration. The fraction of implant-bone integration

was much higher in the pristine bone compared to that in the regenerated bone.

Titanium plasma sprayed surfaces positively influenced the fraction of

osseointegration in comparison to machined surfaces for both regenerated and pristine

bone. Furthermore, early membrane removal negatively affected the fraction of bone

defect fill9.



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Cangini F et al. (2005) use an enamel matrix derivative (EMD) and bioabsorbable

barrier membrane to enhance healing following the immediate placement of

transmucosal implants into extraction sockets was assessed. Thirty-two adult patients

scheduled for tooth replacement with dental implants agreed to participate. Following

the insertion of a transmucosal implant into the extraction site, the subjects were

assigned to one of two treatment alternatives of the remaining bone defects around the

implants. They were: 1) the residual bone defects were filled with EMD (EMD group)

or 2) the residual bone defects were covered with a bioabsorbable membrane

(membrane group). Flaps were then coronally positioned around implant cover

screws. At a 12-month follow-up, all of the implants were completely osseointegrated

and successfully functioning, showing a success rate of 100%. Authors concluded that

membrane group obtained more favorable results in terms of both the probing

attachment level and peri-implant position of soft tissues compared to the EMD

group. The use of a bioabsorbable membrane around immediately placed

transmucosal implants enhanced soft and hard tissue healing and might be an

advisable treatment choice particularly in areas with high esthetic demands10.

Cornelini R et al. (2005) evaluate the placement of immediate implants into fresh

extraction sockets. A series of 22 implants cases with a minimum of 12 months

follow- up done. Radiographic assessments were made at baseline to 12 months after

implant placement. Clinical parameters such as plaque score, mucositis score, probing

attachment level, mucosal margin position were measured at baseline to 12 months

after implants placement. Radiographic assessment revealed mean 0.5mm bone

resorption at 12 months. The success rate and radiographic and clinical results were

comparable to those obtained from conventional implants. The authors also describe



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the radiographic method of measuring marginal bone level around peri-implant

surface11.

Roberto Cornelini, Filippo Cangini and et al (2005) had done a study on immediate

restoration of implants placed into fresh extraction sockets for single-tooth

replacement:A prospective clinical study. The aim of the present clinical study was to

evaluate the placement of transmucosal implants into fresh extraction sockets and

their immediate restoration with temporary crowns. Twenty-two patients (15 women

and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical

or horizontal root fracture, caries, endodontic lesions, or periodontal disease were

treated with immediate postextraction implant placement. The implant was then

restored with a screw-retained prosthetic restoration within 24 hours. Radiographic

assessments were made at baseline and 12 months after implant placement. Clinical

parameters, such as plaque score, mucositis score, probing attachment level, mucosal

margin position, variation of gingival level, and variation of papilla position, were

also measured at baseline and after 12 months of follow-up. At 12 months, no

implants had failed. He concluded that within the limits of the present investi- gation,

immediate restoration of single-tooth implants placed in fresh extraction sockets can

be considered a valuable option to replace a missing tooth10.

Peter K Moy, Diana Medina and et al (2005)conducted a study to assess the failure

rates of dental implants and associated risk factors. They collected all the records of

implant cases from the year of 2003 to 1982 in a retrospective cohort study.they

considered all the patient data and procedure details for their study. They got a result

of increasing age, smoking, medically compromised conditions showed an increase in



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failure of implants compared to the normal counterparts. They concluded by quoting

that the overall dental implant failure is low and there is no absolute contraindications

for implant placement. Conditions that were found to be correlated with an increased

risk of failure should be considered during treatment planning and factored into the

informed consent process12.

W. Becker (2006) has conducted a study on treatment planning and surgical steps for

successful outcomes of immediate implant placement. In this study he stressed on

diagnosis and treatment planning and further follow up with radiographs for a

successful outcome. He concluded as the efficacy of immediate implant placement

has been established and shown to be predictable if reasonable guidelines are

followed. Thorough medical and dental histories, clinical photographs, OPG and

IOPA radiographs of the implant site are inevitable13.

Crespi R et al. (2008) did a study to evaluate the radiographic assessment of crestal

bone level changes around the implant placed in the fresh extraction socket. Forty

patients were included in the study. Radiographic assessments were made at baseline,

at 6 months ad at 24 months. After 24-month follow-up period, a cumulative survival

rate of 100% was reported for all implants. Radiographic assessment showed mean

bone loss at 24 months follow up was 1.02+/- 0.53mm bone14.

Botticelli D et al. (2008) evaluate the 5-year clinical outcome of the immediate

implants. One week after the cementation of the prosthesis, a clinical baseline

examination was carried out. Clinical measurements were performed of the following:

plaque, mucositis, probing pocket depth, and soft tissue position. The height of the



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keratinized mucosa was measured at the buccal/lingual aspects. Standardized intra-

oral radiographs were taken. The marginal level of bone to implant contact was

measured and bone level change over time was evaluated. The clinical/ radiographic

measurements were repeated on a yearly basis. Authors concluded that ‘immediate

implants that were loaded after 5–7 months had a high success rate. During the 5-year

interval, no implant was lost, and the mean bone level at the implants was maintained

or even improved15.

Cafiero C et al. (2008) in this cohort study assess the clinical and radiographic

outcomes of immediate transmucosal placement of implants into molar extraction

sockets. Following molar extraction, tapered implants with an endosseous diameter of

4.8mm and a shoulder diameter of 6.5mm were immediately placed into the sockets.

Peri-implant marginal defects were treated according to the principles of guided bone

regeneration (GBR) by means of deproteinized bovine bone mineral particles in

conjunction with a bioresrobable collagen membrane. Eighty-two patients (42 males

and 40 females) were enrolled and followed for 12 months. They contributed with 82

tapered implants. Extraction sites displayed sufficient residual bone volume to allow

primary stability of all implants. No post-surgical complications were observed. All

implants healed uneventfully yielding a survival rate of 100% and healthy soft tissue

conditions after 12 months16.

Stephen T Chen and Daniel Buser (2009)had conducted a study to evaluate clinical

outcomes of implant placed in postextraction sites. Bone augmentation procedures are

effective in promoting bone fill and defect resolution at implants in postextraction

sites, and are more successful with immediate and early placement than with late



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placement. The majority of studies reported survival rates of over 95%. Similar

survival rates were observed for immediate and early placement. Recession of the

facial mucosal margin is common with immediate placement. Risk indicators

included a thin tissue biotype, a facial malposition of the implant, and a thin or

damaged facial bone wall. They also said that early implant placement is associated

with a lower frequency of mucosal recession compared to immediate placement17.

Gökçen-Röhlig B et al. (2010) examine the clinical and radiographic results of

implants placed in fresh extraction sockets for 2 years of function. Ten patients were

presented a treatment protocol involving the extraction of their remaining mandibular

teeth and immediate placement of 4 implants (2 in fresh extraction sockets; test group

(n =20), 2 in mature bone; control group ( n = 20). Descriptive statistics for the

differences between baseline and follow-up values were assessed by chi-square test.

None of the implants lost osseointegration. Authors concluded that placement of

implants in fresh extraction sockets is a reliable treatment alternative18.

Peñarrocha-Diago MA et al. (2011) compare the success rates, after 1 year of

loading, for implants placed immediately after tooth extraction and in healed sites in

patients undergoing extraction of all residual teeth for rehabilitation with a fixed, full-

arch, implant-supported prosthesis. A retrospective case series study was conducted of

38 patients treated from June 2004 to June 2008 by extraction of all remaining teeth

and implant placement in both mature bone and at the extraction site in the same

procedure. After osteointegration, the implants were restored with fixed full-arch

prostheses. The marginal bone loss around the implants was measured after 1 year. A

total of 41 arches were restored in 30 patients, 23 in the maxilla and 18 in the



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mandible. A total of 292 implants were placed, 173 immediately and 119 in mature

bone. Of the 292 implants, 8 failed, 4 in the immediate group and 4 in the

nonimmediate group. The mean bone loss was 0.6 mm at 1 year of loading (0.63 ±

0.18 mm at the immediate implant sites and 0.58 ± 0.26 in mature bone). The mean

success rate was 96.9% overall, 97.7% for the immediate group, and 96.3% for the

nonimmediate group. Authors concluded that enhanced bone healing and remodeling

can take place in fresh extraction socket defects associated with immediately placed

implants. The results of the present study have demonstrated that immediate implant

osseointegration can be as, or more, successful than nonimmediate implantation

during the same healing period19.

Lang NP et al. (2011) estimate survival and success rates of implants and the

implant- supported prostheses, the prevalence of biological, technical and aesthetic

complications, and the magnitude of soft and hard tissue changes following implant

placement immediately into fresh extraction sockets. A study from 1991 to July 2010

was performed to include prospective studies on immediate implants with a mean

follow-up time of at least 1 year. A total of 46 prospective studies, with a mean

follow- up time of 2.08 years, were included. The annual failure rate of immediate

implants was 0.82% (95% CI: 0.48–1.39%), translating into the 2-year survival rate of

98.4% (97.3– 46 99%)20.

Col M Viswambaram, Maj Gen Vimal Arora and et al (2011) did a study for

clinical evaluation of immediate implants using different types of bone augmentation

materials. Two types of graft materials namely Dembone ( freeze dried bone allograft)



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and G Bone ( modified hydroxyapatite) were used in addition to the implant root

form. Then they did a followup for 1 year both clinically and radiographically. They

got a result that no implant was lost and the mean bone level at the implants was

maintained or even improved and they concluded that immediate restoration of single

tooth implants placed in fresh extraction sockets could be considered a valuable

option to replace a missing tooth and use of graft has a synergestic effect in the

prognosis21.

Hayacibara RM et al. (2012) evaluate the success rate of immediate dental implants

placement in mandibular molars within a follow-up period as long as 8 years.

Seventy- four mandibular molar implants after non-traumatic tooth extraction

between 2002 and 2008 were examined in the study. All implants were evaluated

radiographically immediately after prosthesis placement, 1 year after implantation,

and by the end of the experimental period, in 2010. All implants presented clinical

and radiographic stable conditions, that is, 100% success rate. Authors concluded that

immediate implant placement of mandibular molars proved to be a viable surgical

treatment given the high success rate up to 8 years after implantation22.

Atieh MA et al. (2012) evaluate immediate placement and immediate restoration of

strongly tapered wide-diameter implant in fresh mandibular molar extraction sockets.

Twenty-four 8- or 9-mm diameter implants were placed in either a fresh molar

extraction socket or a healed site. All the implants received provisional crowns within

48 h. The provisional crowns were replaced with full ceramic crowns after 8 weeks of

implant placement. The overall implant success rate after 1 year of service for the 24

implants in two treatment groups was 75%. Success rates were 83.3% and 66.7% for



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the delayed and immediate placement groups respectively, with no significant

difference observed between the two groups (P = 0.35)23.

Archana Singh, Aratee and et al (2012) performed a study on immediate implant

placement in fresh extraction socket with early loading. In this study they considered

immediate placement of implants in anterior fresh extraction sockets. As the anterior

region is of prime concern in case of aesthetics, the implant placement is one of the

most challenging situations confronting the clinician. They provided with the case

report of a 20-year-old male patient with fractured upper anterior teeth with poor

prognosis. Presurgical radiographic evaluation was carried out using periapical

radiographs and OPG for appropriate treatment planning. After that an endo osseous

implant was selected. They came to the conclusion that it is possible to achieve

greater efficiency in our efforts to give patient sound, timely and economical

treatment. Even though the procedure is technique sensitive, but it is clear that with

continued innovation we should be able to enhance the outcome24.

A Chandra Sekar, M Praveen and Aarti Saxena (2012) had done a study on

immediate implant placement to analyze the success rate of the procedure by

assessing the stability of implant and changes in the hard and soft tissues surrounding

the implant. The tooth was atraumatically extracted, the socket was prepared to the

required depth and a Biohorizon Implant was inserted followed a week later by

temporization by a bonded restoration. They concluded that atraumatic operating

technique and the immediate insertion of the Implant resulted in the preservation of

the hard and soft tissues at the extraction site25.



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Jordi Ortega-Martínez (2012) done a systematic review on immediate implants

following tooth extraction. The aim of this study is to review the current state of

immediate implants, with their pros and contras, and the clinical indications and

contraindications. Immediate implants have predictable results with several

advantages over delayed implant placement. However, technical complications have

been described regarding this technique. Also, biomaterials may be needed when the

jumping distance is greater than 1mm or any bone defect is present26.

Kirsten W Slagter and Laurens Den Hartog (2014)had done a research interest on

immediate placement of dental implants has shifted from implant survival toward

optimal preservation of soft and hard tissues. The aim of this study is to

systematically assess the condition of implant survival, peri-implant hard and soft

tissue changes, esthetic outcome, and patient satisfaction of immediately placed

single- tooth implants in the esthetic zone. A pooled analysis was performed to

identify factors associated with survival and peri-implant tissue changes after

immediate implant placement. Immediate placement with immediate

provisionalization of dental implants in the esthetic zone results in excellent short-

term treatment outcome in terms of implant survival and minimal change of peri-

implant soft and hard tissue dimensions27.

Sundar Ramalingam and et al (2015) conducted a retrospective study of immediate

implants at single rooted teeth sites for implant survival based on size and site of

placement. This study sought to evaluate the survival of immediate implants at the

maxillary and mandibular single rooted extraction sites. The study included 85



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patients from both genders. The implant survival and its relationship with size and site

are evaluated by odds ratio. They concluded their study as immediate implant

placement in fresh extraction sockets can give predictable clinical outcomes,

regardless of the implant size and site of placement28.

Mayank Singh, Lakshya Kumar and et al (2015) conducted a study on Immediate

dental implant placement with immediate loading following extraction of natural

teeth. In this study, extraction sockets were thoroughly debrided and inspected with

the help of periodontal probe for any defect or possible perforation of cortical plate.

Osteotomy sites were prepared with sequential order of drills, Implants were inserted

in the prepared osteotomy sites with insertion torque of 45 NCm, and adequate

primary stability was obtained. Provisionalization was done with laboratory fabricated

self-cure acrylic (Pyrax Polymers, Roorkee, India) crowns and a followup of 1 week,

1 month, 3 months and 6 months is done. They concluded that immediate implant

placement with immediate loading may be a viable treatment option for cases

requiring earliest restoration of teeth to be extracted. Careful selection of cases, proper

treatment plan and follow-up of surgical and prosthetic protocols are the keys to

success29.

Elise J Zuiderveild and Henry (2015) conducted a study on immediate placement

and provisionalization of an implant after removal of an impacted maxillary canine.

The objective of this report was to describe a surgical approach for removal of a

buccal or palatally located impacted secondary canine, combined with extraction of

the failing primary canine, and immediate placement and provisionalization of an

implant. A window technique was applied for surgical removal of the impacted



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canine. The alveolar crest was preserved. After extraction of the primary canine, the

implant was inserted with primary stability. It is concluded that under premise of

preservation of sufficient bone to achieve primary stability of the implant, removal of

the canines can be combined with immediate placement and provisionalization of the

implant30.

Ole T Jensen (2015) did a study on dental implants, immediate placement and as well

as loading of the implant. He believed in the principle that what happens after

extraction is patterned in the biology and cannot be substantially changed at the

baseline by any effort to replace teeth immediately with implants. Therefore treatment

must be compensatory, treatment should include conjuctive augmentation procedures,

often hard and soft tissues to account for loss of post extraction volume failure. In this

6 month study with a sequence of periapical radiographs of immediately placed

implants in the maxillary arch, he concluded that immediate function requires

adequate implant stability. Immediate function requires prosthetic stability,

particularly when multiple implants are loaded. Factors to consider for immediate

implants into extraction sites are thickness of socket walls, thickness of gingival

drape, optimal position of the implant, and patient factors such as hygiene and

smoking cessation31.

MATERIALS AND METHODS


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SOURCE OF THE DATA:

Ten patients who require extraction of single rooted tooth and willing for immediate

implant placement reporting to the Department of Oral and Maxillofacial Surgery,

P.M.N.M Dental College and Hospital, Bagalkot are considered for the study.

METHOD OF COLLECTION OF DATA:

Ten patients reporting to the Department of oral and maxillofacial surgery for

extraction of single rooted teeth will be examined and evaluated for receiving an

immediate implant placement. Patients will be explained about the procedure, its

benefits and the prognosis of the treatment. Extraction will be carried out with least

trauma and least cortical bone expansion as it is of prime importance in attaining

primary stability. Implant surfaces will be covered with sutures. Immediate IOPA

radiograph will be taken for assessing the placement depth and angulation of implant

into the bone. Patients will be followed up at intervals of 1 week, 1 month, 3 months

and 6 months. At follow up appointments bone integration will be assessed with the

help of radiovisiography and clinical assessment of the soft tissue will be performed

by measuring the probing depth around the implant, presence or absence of bleeding

on probing and suppuration.

INCLUSION CRITERIA:

! Mean age group of 20 to 50 years old



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! Patients willing for surgery

! Single rooted teeth which are indicated for extraction other than existing

pathology

! Traumatic single rooted teeth indicated for extraction

EXCLUSION CRITERIA:

! Chronic smokers

! Teeth with chronic periapical infections

! Patient with previous implant failure

! Patient with immunocompromised condition

INVESTIGATIONS:

I. Pre-operative and post-operative photographs

II. Routine blood investigations

III. IOPAR

STUDY METHOD:

It includes mainly following four steps:

• Patient selection

• Pre Operative assesment

• Extraction and immediate placement of implant

• Follow up of the Patients- Clinically and Radiographycally



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PATIENT SELECTION

Placement of implant immediately after extraction of teeth is a technique sensitive

procedure. Selection of the patient is an important step in it. A thorough history of the

patient is mandatory mainly to rule out certain tissue abusing habits and underlying

medical condition. A patient is selected by analyzing the inclusion and exclusion criteria.

Once it is fulfilled, a patient is taken and a detailed case history is taken and in the mean

time necessary investigations. like routine blood examination including bleeding time

and clotting time is done. Then IOPA radiograph of extracting teeth is taken. With the

help of IOPAR and clinical examination, the dimensions for the implant which has to be

placed is selected. Informed and written consents were obtained from the patient.

TREATMENT PLAN AND OPERATIVE PROCEDURE

Once the patient is taken for the procedure, a test dose for 2 % Local Anesthesia

with adrenaline is given subcutaneously.

Patient is painted with Betadine 10%. Local anesthesia is administered for extraction

of teeth. Extraction of teeth is carried out as least traumatic as possible. Pretty care

was taken to preserve the buccal cortical bone and moreover the expansion of socket

is also avoided. After the extraction, curettage is done to remove all the granulation

tissue and debris from the socket and a thorough Betadine irrigation is done to make it

a fresh socket.

By comparing also with the extracted root fragment, the ideal implant was chosen.

When it comes to the maxillary anterior region, the drilling direction is more of

palatally to get an adequate bone support. As there is no need of using a pilot drill,

directly sequential drills can be used. Drilling is carried out with the help of physio



21

dispenser with a circulating cold saline internal irrigation. Then the implant root form

can be taken for placement with the help of implant driver. After placement, more

precise tightening is done using a Torque Ratchet up to a maximum of 35 Newton.

Primary stability of the implant is achieved and one of the prime concern is to relieve

it from occlusal forces. Tight closure with Vicryl 3-0 round bodied suture is done.

After that the implant placed area is isolated with a Perio Pack.

Immediately after placement an IOPAR is adviced to record the placement and to

analyze implants position, angulation, and relation to adjacent structures.

INSTRUCTIONS GIVEN POST OPERATIVELY

• Bite down and maintain firm pressure on the gauze pack that was placed at the

end of your surgery, Do this for at least minutes.

• Do not rinse or spit for a minimum of 72 hours and longer if possible.

• Saliva should be swallowed.

• Do not brush the teeth in the area of surgery for 48 hours.

• Avoid excess physical activity and exercise.

• Do not smoke

• No force or any sort of pressure in the anterior region where implant is placed

• Eat soft foods and drink lots of fluids, do not drink through a straw for the first

24 hours.



22

FOLLOW UP OF PATIENTS AND METHOD OF

EVALUATION

Patients were followup on 1st week, one month, 3 months and 6

months. On the followup dates patients were instructed to report to Department

of Maxillofacial surgery OPD. A routine and thorough clinical examination is

carried out and an IOPAR in relation to that implant region is taken.

Clinically assessment of the soft tissue will be performed by measuring the

probing depth around the implant, presence or absence of bleeding on probing and

suppuration if any and bone integration will be assessed with the help of

radiovisiography.

CLINICAL EVALUATION

-During Placement we checked for

-Clinical mobility (using a probe)

-Perforation of Buccal or Lingual wall of socket (visual examination)

-After 1st stage surgery:

-Observing Infection (Pus Discharge), Pain, Soft Tissue Dehiscence

-At the time of 2nd stage surgery and 3 month after loading:

-Observing Modified Plaque Index, Gingival Index, Pus Discharge & Implant

Mobility at the time of loading.

Modified Plaque Index SCORE CRITERIA 0 No detection of plaque

1 Plaque only recognized by running a probe across the smooth marginal surface of the implant. Implants covered by plasma spray in this area always score 1

2 Plaque can be seen by naked eye 3 Abundance of soft matter



23

Gingival Index SCORE CRITERIA 0 Normal mucosa 1 Mild inflammation 2 Moderate inflammation (redness, oedema and glazing)

3 Severe inflammation (Marked redness, oedema, ulceration as shown by spontaneous bleeding)

Mobility scale was tested manually and graded according to clinical implant mobility index. SCORE CRITERIA 0 Absence of clinical mobility with 500gm in any direction 1 Slight detectable horizontal mobility 2 Moderate visible horizontal mobility upto .5mm 3 Severe horizontal movement greater than .5mm 4 Visible moderate to severe horizontal and any visible vertical movement

RADIOGRAPHIC EVALUATION

IOPA X-Rays were taken before implant placement for treatment planning,

immediately after implant placement, 1month, 3 months and 6 months after implant

placement, at the time of and 3 months after loading to asses crestal Bone Loss and

horizontal Defect Dimensions. A horizontal line tangential to the coronal border of

the implant was used as reference. Measurements from this line to the most coronal

height of the crestal bone on the proximal surfaces around the implant done to

evaluate the mesial and distal vertical crestal height of the bone. Horizontal defect

dimension of bone mesial and distal was measured by mesiodistal dimension between

the implant, measured at the level of implant shoulder and bone around the peri-

implant surface.

We have adopted the method described by Yoo et al. The length (mm) of the implant

was measured on the radiographs. Next the distance between the observed crestal

bone and implant-abutment interface was measured at the mesial and distal implant



24

surfaces. The actual implant length was known based on manufacturing standards. To

adjust the measurements for magnification error, the following equation

was used to determine the corrected crestal bone levels: Corrected crestal bone level= Measured crestal bone level x Actual implant length Measured implant length

IMPLANT SYSTEM

The implant system used in this study is Equinox Myriad™ , the Netherlands. The

implant system offer a wide range of high quality implants that provides improved

bone loading, quick healing period, good function, durability, longevity.

The Myriad™ implant form is based on the Anaform root shaped, tapered body

design which is the most proven and versatile shape for immediate and delayed

implantation.

The Bioprofile thread featured on all Myriad™ implants is an asymmetrical surface

extensive thread. Bioprofile™ essentially comprises one synchronized self tapping

thread composed of three distinct thread profiles that are adapted to three different

levels of bone biology.

All Myriad™ implants carry the unique Nanopore titanium anodic oxidation surface.

This calcium oxidized nano surface results in 11% calcium deposits saturating the

implant surface. Nanopore exhibits three dimensional interconnecting porosities

which is a characteristic that mimics the structure of human cancellous bone.

Myriad-Hybrid™ implants are available in four diameters D3.3, D3.8, D4.5 and D5.7

in lengths L8mm, L9.5mm, L11mm, L13mm and L15mm. The prosthetic platform is

consolidated to one size for common use of all prosthetic components.



25

Drilling Speed and Technique

Correct drilling reduces overheating and subsequent necrosis of surrounding bone.

The Myriad Smart Implants system envisaged for internal irrigation port. The drilling

must be without exerting excessive pressure. The advised speed for D3-D4 types bone

must be about 1500 rpm, for D1-D2 types 2000-2500 rpm. The use of "bone dancers"

technique with intermittent pressure for 1.2 seconds preferable.

Implant kit used in the study was Myriad Smart Direct-To-SiteTM implants.

It contains

1) Pilot Drill ( 2 mm)

2) Twist Drills with various length markings ( 3.3, 3.8, 4.5, 5.7)

3) Locator driver

4) Hexed driver

5) Torque Ratchet

6) Torque driver

STATISTICAL ANALYSIS

The data were entered and analyzed statistically. The Wilcoxon’s Signed Rank test

was used to get the results.

SAMPLE SIZE ESTIMATION


26

SAMPLE SIZE ESTIMATION

Analysis: A priori: Compute required sample size

Input: Tail(s) = One

Effect size dz = 0.80

α err prob = 0.10

Power (1-β err prob) = 0.85

Output: Noncentrality parameter δ = 2.5298221

Critical t = 1.3830287

Df = 9

Total sample size = 10

Actual power = 0.8702413

The sample size has been estimated using the software GPower v. 3.1.9.2

Considering the effect size to be measured (dz) at 80% for One-tailed hypothesis, power of

the study at 85% and the margin of the error at 10%, the total sample size needed is 10.

RESULTS


27

RESULTS

The objective of the study is to evaluate the outcome of immediately placed

implants in fresh extraction sockets. It is done by assesing the osseointegration by

checking the crestal bone level as seen on routine radiographs and clinically by

checking the primary stability and bleeding on probing around the region of implant

placed for a span of 6 months.

Table 1: shows the patients in this study who are in the age group ranging between 20

to 50 years with a mean age of 24 ± 4. It also shows that 75 % of the subjects were

between the ages of 21 and 30 years

Table 1: Age distribution

Age in years No of patients Percentage

0 – 10 years 0

11 – 20 years 0

21 – 30 years 7 75%

31 – 40 years 1 25%

41 – 50 years 0

Total 8 100%

MEAN ± SD 24 ± 4

Table 2: shows Sex distribution of the study group; 6 were male (75 %) and 2 were

female (25 %)

RESULTS


28

Table 2: Gender distribution

Gender Number Percentage

Male 6 75%

Female 2 25 %

Total 8 100%

Table3: shows the site of implant placement, the following observations were made;

10 implants were placed in the maxilla (all anterior) while no implants in the

mandible. It also demonstrates that in maxillary anteriors the chief cause of extraction

of teeth was trauma.

Table 3: Site & Aetiology of tooth loss

Aetiology Site in

Maxilla Caries

Trauma

Failed

endodontics

Root

stumps

Others

Central

incisor

- 5 1 1 1

Lateral

incisor

- 1 - 1 -

Canine - - - - -

Table 4: shows that the most common size (diameter X length) of implant fixture in

maxilla was 3.8 X 11 mm. Implant sizes were chosen depending on the dimensions of

the tooth/ root to be extracted and the bone available.

RESULTS


29

Table: 4 Implant fixture size

Site Size in mm

(Diameter X Length)

11 3.8 X 11

21 3.8 X 11

21 3.8 X 11

11 3.8 X 11

22 3.8 X 8

11 3.8 X 11

21 3.8 X 9.5

11 3.8 X 9.5

21 3.8 X 9.5

11 3.8 X 11

Table 5: represents Clinical evaluation of implants at the time of their placement.

Modified plaque index and Gingival index was measured around tooth before

extraction.

RESULTS


30

CLINICAL EVALUATION

Modified

Plaque

Index

Gingival

Index

Implant

Mobility

Score

Perforation

Buccal/Lingual

A 11 0 1 0 A

B 21 1 1 0 A

C 21 1 1 0 A

D 11 1 1 0 A

E 22 1 1 0 A

F 11 0 0 0 A

G 21 1 1 0 A

H 11 1 0 0 A

I 21 1 0 0 A

J 11 1 1 0 A

Table 6 represents clinical evaluation of the implant 7 days after surgery. No

Infection (pus discharge) was observed and post operative inflammation resolved by

the 7th day.

RESULTS


31

Table 6 – Evaluation 7 days after surgery

CLINICAL EVALUATION

Modified Plaque

Index

Gingival

Index

Implant

Mobility

Score

Pus

Discharge/

Bleeding

A 11 0 0 0 A

B 21 0 0 0 A

C 21 1 0 0 A

D 11 0 0 0 A

E 22 0 0 0 A

F 11 0 0 0 A

G 21 0 0 0 A

H 11 0 0 0 A

I 21 0 0 0 A

J 11 0 0 0 A

Table 7 represents clinical evaluation of the implants 3 months after surgery showed

good periodontal status with absence of Plaque, Bleeding on Probing, Pus Discharge,

Clinical Mobility

RESULTS


32

Table 7 – Evaluation at the time of 3 months after surgery

CLINICAL EVALUATION

Modified Plaque

Index

Gingival

Index

Implant

Mobility

Score

Pus

Discharge/

Fistula

A 11 1 0 0 A

B 21 1 0 0 A

C 21 1 0 0 A

D 11 0 0 0 A

E 22 0 0 0 A

F 11 0 0 0 A

G 21 0 0 0 A

H 11 0 0 0 A

I 21 0 0 0 A

J 11 0 0 0 A

Table 8: shows assessment of Vertical Crestal Bone resorption- Mesial. The

result in the present study shows that at the 6th month post operatively,

resorption of minimum of 0.30 mm to maximum 1.6 mm of bone; with mean vertical

bone resorption of 1.04 ± 0.97 mm with P<0.05 shows significant crestal bone loss.

RESULTS


33

Table 8: Radiological evaluation of Mean Mesial Vertical Crestal Bone

resorption measurement

RADIOLOGICAL EVALUATION

Vertical Crestal Bone Measurement - Mesial

Baseline At 1 week 1 month 3month 6 months

A

11

1 1 1.1 1.3 1.3

B 21 -.2 -.2 0 .3 .3

C 21 -2.3 -2 -.8 -.8 -.7

D 11 1.2 1.3 1.5 1.7 2.2

E 22 2.2 2.2 2.2 2.5 2.7

F 11 .6 .6 .6 .9 1.1

G 21 0 0 .3 .5 .5

H 11 0 0 0 .3 .5

I 21 .5 .6 .8 .8 1

J 11 1 1.1 1.3 1.3 1.5

Mean ± SD

.40 ± 1.1 .46 ± 1.1 .70 ± .9 .88 ± .9 1.04 ± .97

Mean bone loss from baseline to M6 is 0.5 ± 0.49

Table 9: shows assessment of Vertical Crestal Bone resorption- Distal. The

RESULTS


34

result in the present study shows that at the 6th month post operatively,

resorption of minimum of 0.4 mm to maximum 0.5 mm of bone; with mean vertical

bone resorption of 1.26 ± 0.85 mm with P<0.05 shows significant crestal bone loss

Table 9: Radiological evaluation of Mean Distal Vertical Crestal Bone

resorption measurement

RADIOLOGICAL EVALUATION

Vertical Crestal Bone Measurement - Distal

Baseline At 1 week 1 month 3 months 6 months

A

11 .8 .8 .9 1 1.2

B 21 -.5 -.5 -.3 0 0

C 21 1.9 2 2.1 2.3 2.4

D 11 1.8 1.9 2 2.3 2.3

E 22 1.7 1.7 2 2.2 2.2

F 11 .9 .9 .9 1.1 1.4

G 21 0 0 .2 .5 .5

H 11 0 0 0 .3 .3

I 21 .5 .5 .7 .8 1

J 11 .8 .8 1.1 1.3 1.3

Mean ± SD

.79 ± .82 .81 ± .85 .96 ± .85 1.18 ± .84 1.26 ± .85

Mean bone loss from baseline to M6 is 1.6 ± .64

RESULTS


35

No implant failure was observed (100% success rate) in the 3 month of

the pre- loading phase, after which, 8 patients (accounting for 10 implants) received

single unit fixed partial restoration. At last evaluation all prostheses were successful

and functioning.

RESULTS


36

Graph 1 showing age distribution

Graph 2 showing Gender distribution

RESULTS


37

Graph 3 showing Aetiology of extraction

Graph 4 showing size of implants used

RESULTS


38

Graph 5 showing stability of implant

Graph 6 showing Mean modified plaque index

RESULTS


39

Graph 7 showing mean gingival index

Graph 8 showing Mean vertical crestal bone level in mesial side

RESULTS


40

Graph 9 showing Mean vertical crestal bone level in distal side

DISCUSSION


41

DISCUSSION

Implants are the recent advance prosthesis in the field of dentistry. From its inception

onwards by Branemark, continuous researches were going on this field.

Immediate implant may be a good treatment option in the loss of anterior teeth. Its

success rate in maxilla is 90 – 100%24.

Immediate implant placement is most commonly indicated when tooth extraction is

due to trauma, endodontic lesion, root fracture, root resorption, root perforation,

unfavourable crown to root ratio (not due to periodontal loss) and bony walls of

alveolus are still intact. Contraindications includes presence of active infection,

insufficient bone (<3 mm) and wide and/or long gingival recession24.

Prior to extraction of tooth it was aesthetically evaluated to comprehensively assess

the potential implant placement site. A proper plan was made which included soft

tissue treatment protocol and set of well defined aesthetic goals. Under three

parameters the prospective implant site was evaluated to predict the peri-implant

aesthetic outcome these are tooth position and shape, form and bio-type of the

periodontium and position of osseous crest.

The initial stability of the implant is essential for early/immediate loading. The

minimum insertion screw has to be equal or superior to 32 N/cm and the micro

movement of the implant should not exceed 150 um. Bruxism and the lack of primary

stability of the implants are contraindications for the immediate loading. In this study,

primary stability was achieved and no need for bone augmentation because the

implant diameter closely matches the socket dimension.

Immediate/early placement of implant requires an understanding of the biology of the

DISCUSSION


42

recipient tissue, the surgical trauma, the wound healing process and occlusion. Wound

healing studies have demonstrated that early osteoid formation begins after 7 day,

mineralization commences at 21 days thus implant loading after 2-3 weeks may

therefore turn into a feasible protocol. In this study implant is loaded after 3 months

and during 6 months of follow-up there is minimum bone loss occurred[12][24].

Dental implants that are immediately placed and loaded into carefully selected

extraction socket have high survival rates comparable to implant placed in healed site.

Several studies (Garcia et al., 2009; Lops et al., 2008; Mangano et al., 2012) also have

reported 100% survival rates after immediate implant placement in the maxilla and

mandible with follow-up periods of up to 2 years. Results of the present study are

comparable to this. The significant positive influence of atraumatic extraction

techniques on immediate implant osseointegration and survival is well documented

(Blus and Szmukler-Moncler, 2010). In the present study, the surgeon was careful to

perform all dental extractions atraumatically[16][18][26].

A prospective multicentre study by Polizzi et al. (2000) reported survival rates for

immediate implants as high as 92.4% in the maxilla and 94.7% in the mandible. They

concluded that the severity of inflammation at the extracted site can significantly

influence immediate implant survival negatively26.

In this study, implants were placed in the maxillary aesthetic zone (canine to

canine region). No implants were placed in the canine region. All the implants placed

in the central incisor and lateral incisor region shown a 100 % survival rate with good

primary stability, lack of any signs of infection and minimal loss of vertical crestal

bone height which showed acceptable osseointegration

DISCUSSION


43

Studies have confirmed that immediate placement helps to produce excellent

preservation of alveolar bone height. Although in this study, we were needed to

achieve this result, our real goal is to show the potential to reduce time and improve

patient satisfaction by placing an implant in an extraction socket which reduces

further appointments and providing a fast prosthesis in aesthetic zone.

CONCLUSION


44

CONCLUSION

This study concluded that immediate placement of implants is an excellent treatment

modality in variety of situations. This procedure is technique sensitive because

prognosis depends on various factors preoperatively, intraoperatively and

postoperatively. It depends on age of the patient, aetiology of loss of teeth, presence

or absence of infections, codition of bone, habits of patient and general oral hygiene

of the patient are some of them.

In this study we have done placement of immediate implant after extraction of teeth in

the anterior aesthetic zone which is followed up for 6 months with loading done at 3

months post placement. All the prosthesis were success with no post operative

complications

Success of immediately placed implants mainly depend on primary stability achieved

at the time of placement. It should be approximately or equal to 30 N of torque. After

the placement, instructions which the patient have to follow also plays an important

role. A good oral hygiene and regular follow ups are mandatory.

PREVENTION IS BETTER THAN CURE. We all are familiar with this proverb.

Diseases of teeth are irreversible. It cannot be reverted back to the normal and whatever

treatment or prosthesis we undergo, it cannot match the natural one. Incase of poor

prognosis for routine treatments for restoring a teeth, implant is the advanced option

available in the field. Considering various factors which is mentioned in this study,

immediate placement of implants is one choice. Anterior aesthetic zone restored with

immediate implants have many merits with high success rate.

It is a must need for a higher number of sample for generalizing the conclusion of this

study and its credibility.

SUMMARY


SUMMARY

From more than past three decades implants are gaining its popularity and its usage is

becoming more common. Presently dental implants are in such a state that there are no

absolute contraindications for its usage. In this study we want to check the outcome,

acceptance and feasibility of implants in aesthetic zone. There has been studies conducted

related to this with immediate loading and delayed loading.

Ole T. Jensen in his study summarized as success of an immediately placed implant is

mainly depended on its primary stability. Immediate function requires prosthetic

stability, particularly when multiple implants are loaded. Factors to consider for

immediate implants into extraction sites are thickness of socket walls, thickness of

gingival drape, optimal position of the implant, and patient factors such as hygiene

and smoking cessation.

Mayank Singh in his study mentioned dental implant offers the most cost-effective

and long-term solution for replacement of missing teeth with high average life

expectancy, providing the patient with the best sense of security and well-being.

In this study we have done successful placement of immediate implant after extraction

of teeth in the anterior aesthetic zone which is followed up for 6 months with loading

done at 3 months post placement. On summarizing by combining with the results of

previous studies also its clear that the sole key to the success of immediate implants is

primary stability. Other factors which include age, oral hygiene, systemic and

recipient site conditions, maintainence by the patient also have a important role.

BIBLIOGRAPHY

P.M.N.M DENTAL COLLEGE & HOSPITAL, BAGALKOT

46

BIBLIOGRAPHY

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7) Chen ST. Immediate or early placement of implants following tooth

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14) Crespi R. Immediate versus delayed loading of dental implants placed in fresh

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up clinical study.

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sites: a 12-month prospective multicenter cohort study.

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sites.

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28) Sundar Ramalingam. Clinical evaluation of implant survival based on size and

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CONSENT FORM


PATIENT CONSENT FORM Name:

Age:

Gender :

Date

O.P. /I.P. No.-

Occupation:

I ______________________________________________________ the undersigned

give consent for operative procedure ________________________________ which

has been explained to me in my mother tongue by

Dr.____________________________.

The doctor has explained in detail in my mother tongue the need to take the

medication before, during and after the surgical procedure and post operative

complication, which may arise due to operation/procedure/anesthesia/drugs.

I after thoroughly thinking about the procedure/anesthesia/drugs with my

parents/guardian; I give my consent in full consciousness that in event of any

unforeseen complication I may be treated for the complication or shifted to ICU/any

hospital for further treatment and will not hold responsible for any damage, liabilities

and expenses incurred. I also give my consent for filming, video graphing and

photographing of the operative procedure for the purpose of medical education,

records, periodicals and articles. I have no objection to any work, research,

experiments carried out on my extracted tooth or any other tissue excised with the

understanding that my identity is kept confidential.


PROFORMA PROTOTYPE


DEPARTMENT OF ORAL, MAXILLO-FACIAL & RECONSTRUCTIVE SURGERY

P.M.N.M.DENTAL COLLEGE AND HOSPITAL, BAGALKOT-587101

KARNATAKA

CASE HISTORY PROFORMA


EXTRACTION SOCKET” - A CLINICAL AND RADIOLOGICAL

EVALUATION

(A)Patient Identification Data-

1. NAME-

2. AGE/SEX-

3. OPD NUMBER

4. DATE

5. ADDRESS-

6. OCCUPATION-

7. MARITAL STATUS-

8. RELIGION-

(B)Case history-

1. CHIEF COMPLAINT-

2. HISTORY OF PRESENT ILLNESS-

3. MEDICAL HISTORY-

4. DENTAL HISTORY-

PROFORMA PROTOTYPE


5. FAMILY HISTORY-

6. SOCIAL HISTORY-

7. PERSONAL HISTORY-

(a)Tobacco habits- 1) Form and frequency 2) Duration

(b)Alcohol consumption- 1) Form and Frequency 2) Duration

(c)Oral hygiene-

1) Mode (Toothbrush/Datun/Others) 1) Frequency 2) Duration

2) Tooth brushing Methods- Horizontal ( ) Vertical ( ) Circular ( )

3) Dental floss- ( )

4) Tooth Picks- ( )

5) Interproximal Brushes- ( )

6) Mouthwashes- ( )

(d)Habits-

1) Clenching ( )2) Tongue-thrusting ( ) 3) Mouth-Breathing ( ) 4) Pan-chewing ( ) 5)

Bruxism ( ) 6) Chronic biting of teeth and tongue ( )7) Others ( )

(C).CLINICAL EXAMINATION-

1. GENERAL EXAMINATION-

a) Gait-

b) Built

c) Nutritional status

d) Height/ Weight

e) Skin

f) Vital Signs-

g) Pallor

PROFORMA PROTOTYPE


h) Icterus

i) Cyanosis

j) Clubbing

k) Lymphadenopathy

1) Review of other system-

a) CNS-

b) CVS-

c) Respiratory system-

d) Renal system-

e) GIT-

2.EXTRAORAL EXAMINATION-

1. Profile- Convex ( ) Concave ( ) Straight ( )

2.Shape of head- Mesocephalic ( ) Dolichocephalic ( ) Brachycephalic ( )

3.Shape of face- Round ( ) Oval ( ) Square ( )

4. Size of head- Macrocephaly ( ) Microcephaly ( )

5.Facial Profile- Retrognathic ( ) Prognathic ( ) Mesiognathic ( )

6.Facial Divergence- Anterior ( ) Posterior ( ) Straight ( )

7. Lips- Competent ( ) Incompetent ( ) Everted ( )

8.Nasolabial sulcus- Normal ( ) Acute( ) Obtuse ( )

9.Mentolabial sulcus- Normal ( ) Deep ( ) Shallow ( )

10. Facial symmetry- Symmetrical ( ) Asymmetrical( )

11. Hair-

12.Skin-

13.Nose-

14. Eyes-

PROFORMA PROTOTYPE


15. Ears-

16. Maxilla-

17. Mandible-

18.TMJ-

1) Tenderness-

2) Clicking/Crepitus/Popping-

3) Jaw Deviation-

4) Mouth opening-

5) Lateral/Protrusive Movement-

6) Swelling-

19-Salivary Gland-

1) Flow of Saliva-

2) Colour-

3) Consistency-

4) Swelling-

5) Skin over Salivary gland-

3 .INTRA ORAL EXAMINATIONS-

(A)SOFT TISSUE EXAMINATION-

1. Buccal/Labial/Palatal/Vestibular/Pharyngeal Mucosa- 2. Floor of

Mouth/tongue/tonsil/uvula/frenum-

3. Gingival Status

4. Periodontal Status

(B).HARD TISSUE EXAMINATION-

1. Teeth Present-

PROFORMA PROTOTYPE


2. Missing teeth-

3. Carious teeth-

4. Restored teeth-

5. Loss of Proximal contact-

6. Tender on percussion-

7. Fractures-

8. Wasting Diseases of teeth-

9. Pathological migration –

10. Developmental disorders-

11. Calculus and Stains-

12. Occlusal Analysis-

a) Angles Classification-

b) Canine relationship-

c) Overbite and Overjet-

d) Openbite and Crossbite-

e) Crowding-

D) INVESTIGATIONS

a) CBC:

b) Hb:

c) BT:

d) CT:

e) RBS:

f) HIV:

g) HBsAg:

h) OTHERS:

PROFORMA PROTOTYPE


E) RADIOGRAPHIC INTERPRETATION:

F) DIAGNOSIS:

G) TREATMENT:

H) FOLLOW UP:

CLINICAL EVALUATION VISIT MODIFIED

PLAQUE SCORE

GINGIVAL INDEX

IMPLANT MOBILITY

PUS DISCHARGE/ BOP

1 WEEK 1 MONTH 3 MONTHS 6 MONTHS RADIOGRAPHIC EVALUATION CRESTAL BONE LOSS MESIAL DISTAL BASELINE 1 WEEK 1 MONTH 3 MONTHS 6 MONTHS


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PHOTOS

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CASE 1:

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CASE 2:

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CASE 3:

ANNEXURE


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CASE 4:

Documents

“IMMEDIATE PLACEMENT OF IMPLANTS AT SINGLE ROOTED …