A prospective randomized split-mouth trial comparing immediate versus early anterior implant placement with customized healing abutments: 12-month marginal bone loss, stability, and esthetic outcome
The clinically meaningful esthetic advantages of IIP support its preferential use in the anterior zone when anatomical conditions permit and when combined with guided protocols and customized healing abutments, IIP and EIP yield comparable 12-month marginal bone outcomes.
Abstract
Objectives To compare 12-month marginal bone loss (MBL) between immediate implant placement (IIP) and early implant placement (EIP) in the anterior region. Secondary objectives included the evaluation of implant stability (ISQ), esthetic outcomes (PES–WES), and peri-implant health (probing depth and bleeding index) when using customized healing abutments. Methods A prospective, randomized, split-mouth clinical trial was conducted involving 12 patients, with a total of 24 implant sites. The protocol was approved by the institutional review board (IRB2023-H0113D-P-0494), registered at ClinicalTrials.gov (NCT0698551). Each patient received one IIP and one contralateral EIP via fully guided surgery. Chairside-fabricated customized healing abutments were utilized, and definitive restorations were delivered at 3 months. Outcomes were recorded at 3, 6, and 12 months. MBL was assessed via standardized CBCT, implant stability via resonance-frequency analysis, and esthetics through Pink/White Esthetic Scores. Mixed-effects models were used for statistical analysis (α = 0.05). Results IIP demonstrated significantly lower early MBL at 3 months (mean difference: −0.30 mm, 95% CI: −0.52 to −0.08; p = 0.012) and 6 months (mean difference: −0.22 mm, 95% CI: −0.39 to −0.05; p = 0.016), and higher ISQ at 3 months (mean difference: 2.49, 95% CI: 0.49–4.49; p = 0.017) compared to EIP. However, no significant differences were observed in MBL (mean difference: −0.01 mm, 95% CI: −0.08 to 0.06; p = 0.618) or ISQ (mean difference: 0.20, 95% CI: −1.62 to 2.02; p = 0.823) at the 12-month primary endpoint. Regarding esthetics, total PES favored IIP at 6 months (mean difference: 2.09, 95% CI: 1.48–2.70; p < 0.001) and 12 months (mean difference: 1.50, 95% CI: 0.92–2.08; p < 0.001). WES was similar at 6 months (mean difference: 0.42, 95% CI: −0.31 to 1.15; p = 0.234) but favored IIP at 12 months (mean difference: 1.00, 95% CI: 0.50–1.50; p = 0.002). Peri-implant health parameters improved over time in both groups with no implant losses. Conclusions When combined with guided protocols and customized healing abutments, IIP and EIP yield comparable 12-month marginal bone outcomes. IIP provides an advantage in accelerated early stability and superior soft-tissue esthetic scores (PES) compared to EIP. The clinically meaningful esthetic advantages of IIP support its preferential use in the anterior zone when anatomical conditions permit.
AIM
To compare the clinical outcomes of digitally assisted immediate implant placement in the posterior mandible using immediate (Type A) and delayed (Type C) loading protocols.
METHODS
Eighty-two patients requiring five-unit fixed partial dentures supported by three implants were consecutively enrolled. All cases were planned using a fully digital workflow integrating CBCT, intraoral scanning, and static computer-guided surgery. Only implants achieving adequate primary stability (insertion torque ≥25 Ncm and/or ISQ ≥60) were included. Patients were assigned to either immediate or delayed loading protocols. Implant survival, marginal bone loss (MBL), plaque index (PI), bleeding on probing (BOP), and probing depth (PD) were evaluated over variable follow-up periods according to the timing of patient enrollment and treatment completion.
RESULTS
A total of 246 implants were placed, yielding an overall survival rate of 97.5% with no significant differences between loading protocols. Mean MBL was 0.7 mm and remained comparable between groups. Peri-implant parameters, including PI, BOP, and PD, were stable throughout follow-up. Regression analysis identified restorative angles >30° as the only significant predictor of increased MBL.
CONCLUSION
Digitally guided immediate implant placement in the posterior mandible demonstrated high survival rates and favorable peri-implant outcomes with both Type A and Type C loading protocols.
CLINICAL SIGNIFICANCE
Type A loading may provide a predictable and time-efficient alternative to conventional delayed loading without compromising clinical outcomes.
Mohammed A. Elsawy, Mohammed T. Khater, Islam Kandil et al.· E -journal of dentistry· 0 citations
Immediate implants placed 6 mm below the mid-buccal gingival level showed significantly less short-term marginal bone loss than immediate implants placed 4 mm below the gingiva after a period of 1 year.
Jonas Alkimavicius, Manish Rathi, Ula Linkeviciute et al.· Journal of Prosthodontics· 0 citations
The 39.1% early failure rate within the first 12 months was followed by stable marginal bone levels through 36 months in implants that achieved successful osseointegration, underlining the need for peri-implant maintenance.
M. Jennes, Z. Mao, Ece Atay et al.· International Journal of Imp...· 0 citations
OBJECTIVES
This randomized clinical study aimed to assess implant placement accuracy and radiographic outcomes of computer-guided versus freehand ridge split and expansion with simultaneously inserted implants in patients with horizontally deficient maxillary anterior ridges over a 2-year follow-up period.
METHODS
Twenty-two volunteers were randomly allocated (1:1) to either a computer-guided or a freehand group. The primary outcome was implant placement accuracy. Secondary outcomes included postoperative complications, marginal bone loss, horizontal ridge width changes, and peri-implant defect resolution. All parameters were evaluated radiographically at baseline, immediately after surgery, and at 3, 6, 12, and 24 months.
RESULTS
The computer-guided group demonstrated lower angular deviation versus the freehand group (1.45 ± 0.43° vs. 10.02 ± 3.24°; p < 0.001) and entry point deviation (0.54 ± 0.19 mm vs. 2.16 ± 0.31 mm; p < 0.001). Depth deviation showed a non-significant difference. Three, six, and twelve months after surgery, the freehand group exhibited higher marginal bone loss (1.02 ± 0.13, 1.57 ± 0.13, 1.58 ± 0.13, and 1.73 ± 0.17 mm, respectively) than the computer-guided group (0.27 ± 0.13, 0.35 ± 0.13, 0.36 ± 0.13, and 0.39 ± 0.15 mm, p < 0.001). The computer-guided approach also was associated with minimal ridge collapse and enhanced peri-implant defect fill.
CONCLUSIONS
The present preliminary findings suggest that computer-guided ridge split and expansion were associated with improved implant placement accuracy and peri-implant hard tissue preservation compared with the conventional freehand approach over 2 years. Both techniques achieved successful implant outcomes without major complications. However, these observations should be interpreted cautiously as preliminary evidence requiring external validation, given the limited sample size, single-operator design, and mid-term follow-up duration. Multicenter studies with larger cohorts and longer follow-up are required before confirming definitive clinical superiority.
CLINICAL SIGNIFICANCE
The present preliminary findings suggest that integrating the digital workflow into ridge split and expansion may enhance surgical precision and peri-implant hard tissue stability in narrow maxillary ridges. Nevertheless, the potential advantages of the guided approach require confirmation through larger, well-designed clinical trials before recommending widespread, routine clinical implementation.
CLINICAL TRIAL REGISTRATION
The study was prospectively registered in the ClinicalTrials.gov registry (Identifier: NCT06135506) on 11/11/2023 under the title "Artificial Intelligence/Computer Guided Ridge Splitting for Treating Horizontal Ridge Defects."
CLINICALTRIALS
gov PRS: Record Summary NCT06135506.
Asmaa Allam, N. Hatata, Walid S. Salem et al.· E -journal of dentistry· 0 citations
Marginal bone preservation around osseointegrated dental implants continues to represent a critical challenge in modern implant dentistry. To address this issue, subcrestal implant placement along the apico-coronal axis has been proposed as a reliable clinical strategy aimed at reducing the risk of implant thread exposure within the oral environment. In the present study, 38 healthy patients were treated with either bone-level implants (BLG-Control) or implants positioned 2 mm subcrestally (SCG-Test). All implants featured an internal conical connection and a platform-switching design. In addition, implants in the test group were restored using an immediate tissue-level abutment following the one-time abutment (OTA) protocol. Marginal bone modifications (MBMs) were evaluated through standardized radiographic examinations performed at surgery (T0), implant loading (T1), and after 6 (T2), 12 (T3), 24 (T4), and 36 (T5) months of functional loading. MBMs, meaning the overall changes in the radiographic bone structure over time, were categorized as bone loss (BL) when occurring apical to the implant neck, and as bone remodeling (BR) when detected coronally to the implant neck. Clinical parameters, including probing pocket depth (PPD), bleeding on probing (BoP), and plaque index (PI), were also recorded and analyzed throughout the follow-up period. At the 36-month evaluation, mean MBM values were 0.61 mm for the test group and 0.58 mm for the control group. After three years of follow-up, the test group demonstrated a mean PPD of 2.03 mm, compared with 2.78 mm in the control group. Bleeding on probing was recorded at 13% in the test group and 11% in the control group, while plaque index values were 11% and 5%, respectively. Within the limitations of the present investigation, implants placed 2 mm subcrestally and characterized by an internal conical connection combined with platform switching demonstrated favorable clinical and radiographic outcomes over a short- to medium-term observation period of three years. When compared with equicrestally positioned implants, the subcrestal approach seemed to favor the peri-implant hard tissue conditions while reducing the possibility of marginal bone loss below the implant neck. However, one should bear in mind that this clinical behavior applies specifically to the investigated implant design and should be interpreted within the limitations of the present study.
M. Mensi, E. Scotti, S. Calza et al.· Applied Sciences· 0 citations
OBJECTIVES
To evaluate the clinical and radiographic outcomes of implant restorations with two different angulated screw channel abutments in the esthetic area.
MATERIALS AND METHODS
Patients with implant restorations using angulated screw channel abutments (AS or ASC group) were encompassed. Sixty-seven restorations (34 in AS and 33 in ASC) in 54 patients (27 in AS and 27 in ASC) were analyzed. Survival rates, mechanical complications, and biological parameters were recorded. Esthetic outcomes were assessed using the Pink and White Esthetic Score (PES/WES) and patient satisfaction via Visual Analog Scale (VAS). Radiographic analysis evaluated marginal bone loss (MBL), buccal bone thickness (BBT), and prosthesis design.
RESULTS
No implant loss occurred during a mean follow-up of 23.79 ± 7.63 months. The AS group showed severe mechanical complications requiring remaking (11.8% vs. 0%) and a numerically higher mechanical complication rate (26.5% vs. 15.2%); however, neither difference was statistically significant (P > 0.05). The AS group also had significantly greater PD (P = 0.041) and BOP% (P = 0.047). Both groups achieved favorable esthetics and satisfaction.
CONCLUSIONS
Both abutment types are feasible for the anterior maxilla, providing good esthetics, satisfaction, and bone stability. The AS group experienced severe mechanical complications, which may warrant closer clinical attention.
CLINICAL SIGNIFICANCE
The ASC abutment showed favorable numeric trends in mechanical complications and peri‑implant soft tissue health. If using the AS abutment, closer attention to the restoration's cervical region is advised from our observations.
Jingyao Gong, Se-Jin Lee, Fangyuan Cai et al.· E -journal of dentistry· 0 citations