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Objectives To compare the 1-year aesthetic results of flapless single implants, placed in fresh extraction sockets with bone replacement and immediate provisional restoration with or without a connective tissue graft (CTG). Material and methods The present study proposes a partially blinded multicentre parallel randomized controlled trial, where computer-generated tables were used for central randomization to allocate treatments. A total of 59 of the 60 patients screened by eight private practices in Northern Italy fulfilled the inclusion criteria. Immediate implants were placed in a fresh extraction socket with a non-functional immediate provisional restoration with (Test group) or without (Control group) a CTG. The primary outcome variable was the implant Crown Aesthetic Index (ICAI) at the 1-year follow-up. Results ICAI for the 59 randomized patients (Test group = 31, Control group = 28) at the 1-year follow-up was 4.69 (95% CI = 3.16-6.22) for the Test group and 3.45 (95% CI = 1.83-5.08) for the Control group, without statistically significant difference between the two groups (p = .086). One implant failure was recorded in each group, resulting in an implant survival rate of 96.8% [95% CI = 83.3-99.9] for the Test group and 96.4% [95% CI = 81.7-99.9] for the Control group. Other secondary outcome variables and complication rates were comparable across the two groups. Conclusions Within the limitations of the present clinical trial, the results suggested that the adjunct use of CTG is not mandatory to achieve successful aesthetic outcomes for a well-planned immediate implant placement with immediate non-functional provisional restoration in a fresh extraction socket.

After tooth extraction, a modeling and remodeling phase of bone and soft tissues occurs. It has been fully demonstrated that bone resorption as high as 50% can take place regarding ridge width and a variable amount concerning ridge height, making it difficult to perform implant surgery.Active members of the Italian Academy of Osseointegration (IAO) participated in this Consensus Conference, and three systematic reviews were conducted before the meeting to provide guidelines on alveolar ridge preservation procedures. The systematic reviews covered the following topics: (1) What material best preserves the dimensions of the ridge horizontally and vertically?; (2) what material favors the formation of the highest quantity of new bone?; (3) which technique would best seal the socket?; and (4) what effect does alveolar ridge preservation have on soft tissues?The main conclusions reached by the assembly were that alveolar ridge preservation is advisable after dental extraction, particularly in esthetic areas, in proximity of anatomical structures (ie, maxillary sinus, inferior alveolar nerve, and mental foramen), whenever the treatment plan requires delayed placement, and whenever patients ask to postpone implant insertion for various reasons. Socket debridement is advised before the use of a "regenerative material," and xenograft is considered the gold standard material to maintain ridge dimensions. Another indication is antibiotic therapy, which is recommended in the case of alveolar ridge preservation (amoxicillin 2 g 1 hour before the intervention and 1 g every 12 hours for 6 days). A membrane or autologous soft tissue should be used to seal the socket and protect the regenerative material, and the indicated reentry time (implant insertion) is 4 to 6 months.This Consensus Conference agreed that the adoption of alveolar ridge preservation can effectively prevent physiologic bone loss, especially in esthetic areas. It is recommended to cover the xenograft material with a membrane or autologous soft tissue, and antibiotic therapy is advisable.

To evaluate possible benefits of the adjunctive use of light-activated disinfection (LAD) in the treatment of peri-implantitis.Eighty patients with at least one implant affected by peri-implantitis defined as at least 3 mm of bone loss from the baseline radiographs in the presence of signs of infection (pus exudation and/or soft tissue swelling and/or soft tissue redness) were nonsurgically or surgically treated. A total of 50% were randomly allocated to receive an additional treatment of LAD (FotoSan) according to a parallel group design at four different centres. Only one implant per patient was considered. Outcome measures recorded up to 4 months after treatment were implant failures, complications, probing pocket depth (PPD) changes and number of re-treatment sessions recorded by blinded assessors. Patients were followed for 4 months after treatment.Five treated patients did not fit the original inclusion criteria, 4 because they were not affected by peri-implantitis (as defined in the present study) and one because the patient was treated with antibiotics, however they were included according to an intention-to-treat analysis concept. Nine patients of the LAD group were treated surgically versus 10 control patients. After 4 months, 1 patient dropped out from the LAD group and no implant failed. Fifteen implants had to be re-treated in the LAD group versus 16 implants in the control group, the difference was not significant. Three minor complications occurred: 2 in the LAD group and 1 in the control group. PPD significantly decreased in both groups, and at 4 months there was no significant differences between groups (difference -0.12 mm, 95% CI of difference -0.94 to 0.69, P = 0.77). There were significant differences between centres for number of re-treatments needed, PPD changes, plaque and marginal bleeding 4 months after treatment. The results did not change when removing the 5 patients who did not match the present inclusion criteria.The use of adjunctive LAD therapy with mechanical cleaning of implants affected by peri-implantitis did not improve any clinical outcomes up to 4 months after treatment, however longer follow-ups are needed to evaluate the possible effect of repeated LAD therapy over time.

OBJECTIVES: To evaluate whether the adjunctive use of a bone substitute at immediate single implants placed in fresh extraction sockets with a residual buccal bone-to-implant gap of at least 1 mm could improve the aesthetic outcome of guided bone regeneration (GBR). MATERIALS AND METHODS: Eighty patients requiring bone augmentation at a single immediate postextractive implant to improve the aesthetic outcome were randomly allocated to an augmentation procedure using a resorbable barrier alone (GBR group; 40 patients) or a bone substitute plus a resorbable barrier (GBR + BS group; 40 patients) according to a parallel group design at four different centres. Three to 4 months after implant placement/augmentation, implants were loaded with provisional or definitive single crowns. Outcome measures were implant failures, complications, aesthetics assessed using the pink esthetic score (PES), patient satisfaction and peri-implant marginal bone levels, recorded by blinded assessors. All patients were followed up to 1 year after loading. RESULTS: One patient dropped out from the GBR group. Seven (9%) implants failed: 2 (5%) in the GBR + BS group and 5 (12.5%) in the GBR group. Six minor complications occurred in the GBR + BS group versus 2 in the GBR group. These differences were not statistically significant. Just after implant placement/augmentation, mean bone levels were -0.21 mm at GBR + BS implants and -1.92 mm at GBR implants whereas at 1 year after loading they were -1.04 and -1.76, respectively. When comparing the two groups, GBR + BS implants had 0.70 mm more peri-implant marginal bone than GBR implants. Aesthetics was scored by a blinded assessor as statistically significantly better for the GBR + BS group. Patients were equally satisfied. There were no differences between centres regarding the clinical outcomes. CONCLUSIONS: The use of additional an organic bovine bone substitute (Endobon) with resorbable collagen barriers (OsseoGuard) in defects around post-extractive implant improves the aesthetic outcome, though single post-extractive implants might be at a higher risk for implant failures.