Soft Tissue Volume Changes After Immediate Implants With Two Different Techniques
Study Details
Study Description
Brief Summary
The aim is to comparatively evaluate the soft tissue volume changes that occur after tooth extraction and immediate dental implant placement using two different surgical techniques.
These techniques are: the Socket-Shield technique and conventional immediate placement.
The null hypothesis is that the Socket-Shield technique better maintains soft tissue volume after partial tooth extraction and immediate implant placement compared to the conventional technique.
From a sample of 30 patients, they will be divided into groups of 10 and will be randomized using the random.org program.
The volume of the soft tissues will be recorded by means of a hydrocolloid impression before tooth extraction and 6 months later.
The soft tissue dimensional changes produced will be digitally evaluated and statistically analyzed.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
After tooth extraction, the supporting tissues, bone and mucosa will undergo a loss of volume associated with the loss of the cementum-periodontal ligament-bone attachment complex.
This alteration in volume can affect aesthetic results, especially when the tooth involves the anterior area, where the alveolar bone is narrower.
To compensate for the lost volume loss, some authors promote delayed implant placement, which would facilitate soft tissue management after healing.
The conventional immediate implant placement technique proposes the use of bone regeneration biomaterials in the space between the implant wall and the residual vestibular bone. The aim of this technique is to compensate for this bone resorption, thus improving the aesthetic results. In the same sense of compensating for the resorption that will occur, some authors recommend the use of soft tissue grafts in the same operative act of extraction and placement of the immediate implant.
Some years ago, some authors presented the technique of partial extraction of the tooth as an alternative to the conventional technique of immediate implant placement after extraction with the aim of avoiding or minimising this resorption. The technique consists of leaving a piece of tooth (shield) inserted in the vestibular alveolar bone area so that the resorption process is slowed down.
The presence of bone between the dentine wall of the tooth fragment and the implant has been demonstrated in both animal and ex-vivo histological studies.
From a clinical point of view, the Socket-Shield or partial extraction technique has been shown to maintain the vestibular volume in post-extraction implants placed using this technique in both posterior and anterior areas with high aesthetic compromise, maintaining adequate clinical values and patient satisfaction.
On the other hand, a 2015 systematic review, comparing immediate and delayed implantation techniques, reports no significant differences between the two, especially at the soft tissue level, although it mentions a lack of quality in the RCTs analysed.
A 2017 randomized clinical trial compared the conventional immediate implant placement technique with the delayed or early implantation technique, advising against the former when aesthetics were compromised and limiting it to well-selected cases.
In contrast, another more recent randomized clinical trial found no aesthetic, clinical or radiographic differences between the two techniques, and reported similar levels of patient satisfaction.
Likewise, a higher rate of early failure has been found in the immediate implantation technique, mentioning the lack of randomised clinical studies comparing both techniques, especially in terms of soft tissue volume changes.
A recent randomised clinical study comparing the Socket-Shield technique with the conventional implant placement technique found better levels of marginal bone and pink aesthetic assessment in the former, considering it a safe and feasible technique in the anterior sector.
Given the lack of evidence in the literature, there is a palpable need for clinical studies to compare the best technique and/or timing of implant placement after tooth extraction.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Immediate Implant with SST (SST) Patients who will receive immediate implant placement using the Socket-Shield Technique. |
Procedure: Dental implant placement after tooth extraction
Immediate implant placement after partial or complete tooth extraction.
Other Names:
|
| Active Comparator: Immediate Implant with biomaterial (GAP) Patients who will receive immediate implant placement using bone biomaterials to fill the gap after complete extraction of the tooth. |
Procedure: Dental implant placement after tooth extraction
Immediate implant placement after partial or complete tooth extraction.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Soft tissue volume [6 months]
Soft tissue volume changes after tooth extraction
Secondary Outcome Measures
- Surgery pain perception by Numerical Rating Scale [Just after surgery]
Pain perception by the patient during surgical procedure, being 0 no pain at all, 1-3 mild discomfort, 4-7 moderate pain and 7-10 intense pain.
- Surgery satisfaction of the patient by Numerical Rating Scale [Just after surgery]
Patients satisfaction after surgery, being 0 not satisfied at all, and 10 very satisfied
- General satisfaction of the patient by Numerical Rating Scale [6 months after the beginning of treatment]
Patients general satisfaction 6 months after the beginning of treatment, being 0 not satisfied at all, and 10 very satisfied
- Esthetic satisfaction of the patient by Numerical Rating Scale [3 months after after crown placement]
Patients esthetic satisfaction 3 months after crown placement, being 0 not satisfied at all, and 10 very satisfied
- Function satisfaction of the patient by Numerical Rating Scale [3 months after after crown placement]
Patients function satisfaction 3 months after crown placement, being 0 not satisfied at all, and 10 very satisfied
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Patients requiring single tooth extraction in lateral or anterior areas of the upper jaw.
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Teeth that do not present alteration or loss of the vestibular bone table.
Exclusion Criteria:
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Patients in whom surgical intervention is contraindicated.
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Teeth with alteration or loss of the vestibular bone table.
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Teeth with marginal recession >2mm.
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Early or delayed failure of the implant placed with any of the three techniques.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Clínica Dental Esteve | Alicante | Spain | 03001 |
Sponsors and Collaborators
- Aula Dental Avanzada
Investigators
- Principal Investigator: Guillem Esteve-Pardo, Aula Dental Avanzada
Study Documents (Full-Text)
None provided.More Information
Publications
- Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol. 2005 Feb;32(2):212-8.
- Buser D, Chen ST, Weber HP, Belser UC. Early implant placement following single-tooth extraction in the esthetic zone: biologic rationale and surgical procedures. Int J Periodontics Restorative Dent. 2008 Oct;28(5):441-51.
- Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla--a systematic review. Int J Oral Maxillofac Implants. 2014;29 Suppl:186-215. doi: 10.11607/jomi.2014suppl.g3.3. Review.
- Cosyn J, De Lat L, Seyssens L, Doornewaard R, Deschepper E, Vervaeke S. The effectiveness of immediate implant placement for single tooth replacement compared to delayed implant placement: A systematic review and meta-analysis. J Clin Periodontol. 2019 Jun;46 Suppl 21:224-241. doi: 10.1111/jcpe.13054.
- Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The socket-shield technique: a proof-of-principle report. J Clin Periodontol. 2010 Sep;37(9):855-62. doi: 10.1111/j.1600-051X.2010.01595.x.
- Lee CT, Chiu TS, Chuang SK, Tarnow D, Stoupel J. Alterations of the bone dimension following immediate implant placement into extraction socket: systematic review and meta-analysis. J Clin Periodontol. 2014 Sep;41(9):914-26. doi: 10.1111/jcpe.12276. Epub 2014 Jul 23. Review.
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