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Aim This systematic review was aimed at analysing bone dimensional alterations within the first year following immediate implant placement. Materials and methods The electronic search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE from January 1980 to October 2013. Quality assessment of selected articles was performed using Cochrane Collaboration's tool or Newcastle-Ottawa scale according to the design of each study. A meta-analysis was performed to estimate bone dimensional reduction. Weighted mean differences in bone dimension between baseline and follow-up measurement were calculated. Subgroup analysis and mete-regression were conducted to evaluate the effects of different variables. Results A total of 1348 articles were identified following the search process. Six studies were included in the present review. The weighted mean buccal horizontal bone dimensional reduction (BHDr) was 1.07 mm and buccal vertical bone dimensional reduction (BVDr) was 0.78 mm. The weighted mean palatal bone dimensional reduction was 0.62 mm horizontally (PHDr) and 0.50 mm vertically (PVDr). The initial thickness of the buccal alveolar plate (TB) of the socket was the only variable significantly correlated with BHDr and BVDr in meta-regression analysis. Conclusions The bone dimensions of immediate implant sites demonstrated approximately 0.5-1.0 mm reduction in vertical and horizontal aspects 4-12 months following surgery. The results should be interpreted with care because of the data heterogeneity. The correlation of the socket buccal wall thickness, and other variables, with dimensional changes of the bony ridge should be investigated further in controlled clinical trials.

Aim We conducted a randomized controlled trial to compare the effect of flapless (FLS) or flap-involving (F) immediate placement and provisionalization of single-tooth implants in the esthetic zone. Materials and Methods Thirty-nine patients were randomized following extraction of a non-restorable tooth to a FLS or F group. All implants were immediately placed and provisionalized. We monitored prospectively changes in the peri-implant mucosal margin, the interproximal bone and buccal horizontal ridge at 3, 6 and 12 months. Results At 3 months post-surgery, the mean±SD [median (inter-quartile range)] mesio-buccal peri-implant gingival margin recession from the pre-surgical soft tissue position amounted to 0.11±0.32 mm [0 (0, 0.5)] in the FLS treatment arm vs.0.43±37 mm [0.5 (0,0.5)] in the F treatment arm (p=0.02); corresponding values at the disto-buccal surface were 0.11±32 mm [0 (0, 0)] in the FLS arm vs. 0.48±0.44 mm [0.5 (0,1)] in the F arm (p=0.01). No other significant differences in soft- or hard tissue remodeling between the treatment arms were observed at 3, 6 or 12 months. Conclusions Flapless and a flap-involving immediate implant placement and provisionalization in the esthetic zone resulted in comparable remodeling of the peri-implant mucosa, interproximal bone and buccal ridge at 6 and 12 months. This article is protected by copyright. All rights reserved.

Context: The maxillary sinus elevation procedure has become an important pre-prosthetic surgical procedure for the creation of bone volume in the edentulous posterior maxilla for the placement of dental implants. Research and clinical experience over the past 30 years has increased the predictability of this procedure as well as reduced patient morbidity. Evidence Acquisition: Data on grafting materials and implant survival rates comes from 10 published evidence-based reviews that include all relevant published data from 1980 to 2012. Supporting clinical material comes from the experience of the authors. Evidence synthesis: The evidence-based reviews report and compare the implant survival rates utilizing various grafting materials, implant surfaces, and the use or non-use of barrier membranes over the lateral window. Clinical studies report on complication rates utilizing piezoelectric surgery and compare them to complication rates with rotary instrumentation. Conclusions: The conclusions of all the evidence-based reviews indicate that the utilization of bone replacement grafts, rough-surfaced implants, and barrier membranes result in the most positive outcomes when considering implant survival. Further, the utilization of piezoelectric surgery, rather than rotary diamond burs, for lateral window preparation and membrane separation leads to a dramatic reduction in the occurrence of the intraoperative complications of bleeding and membrane perforation.

Immediate implantation, despite many advantages, carries a risk of gingival recession, papilla loss, collapse of ridge contour, and other esthetic complications. Soft tissue graft placement combined with immediate implantation may be used to reduce these concerns. This review aims to systematically analyze clinical esthetic outcomes of the immediate implant combined with soft tissue graft (IMITG).The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic reviews were used. The electronic search was conducted using MEDLINE (PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from January 1980 to October 2014. Quality assessments of selected articles were performed. Mid-buccal gingival level, interproximal gingival level, facial gingival thickness, gingival ridge dimension, and width of keratinized gingiva were the esthetic outcomes reviewed. Weighted mean difference of mid-buccal gingival level (WDBGL), papilla index score (WDPIS), and width of keratinized gingiva (WDKG) between initial and last measurements were calculated. Other esthetic outcomes were assessed by the descriptive analysis.Ten studies with a minimum of 6-month follow-up were included, and reported esthetic outcomes were analyzed. Mid-buccal gingival level (WDBGL, 0.07 mm; 95% confidence interval [CI] = -0.44 to 0.59; P = 0.12) and interproximal gingival level did not significantly change after IMITG (WDPIS in the mesial site, 0.31; 95% CI = -0.01 to 0.64; P = 0.06; and WDPIS in the distal site, 0.29; 95% CI = -0.06 to 0.65; P = 0.11). Width of keratinized gingiva significantly increased after IMITG (WDKG, 1.27 mm; 95% CI = -0.08 to 2.46; P = 0.04). Facial gingival thickness and gingival ridge dimension could be increased after IMITG.Because of the heterogeneity and limited number of selected studies, no conclusive statement could be made regarding the benefit of IMITG on esthetic outcomes. More randomized controlled trials are needed to provide definite clinical evidence.

Purpose: Immediate implantation has become one of the therapeutic options for replacement of a hopeless tooth. In the case of a tooth with a periapical lesion, this approach remains controversial. The aims of this article were to systematically review the evidence on immediate implants in sites with periapical lesions with reference to: (1) survival rates, (2) changes in crestal bone levels and marginal tissues, (3) complication rates, and (4) comparison of clinical outcomes with other implant treatments. Materials and Methods: An electronic search was conducted in MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE for articles published between January 1990 and August 2013. Publications were screened, and data extraction and quality assessment were performed. Implant survival rates were calculated using predicted Kaplan-Meier survival analysis. Crestal bone level changes, soft tissue outcomes, complications, and procedure characteristics were analyzed descriptively. Results: Initially, 301 articles were identified. Three prospective controlled trials of immediate implant placement in sites with periapical lesions with a follow-up period of at least 1 year were selected for the survival analysis. The predicted cumulative 5-year survival rate of immediate implants in sites with periapical lesions was 96.23%. Bone and gingival level changes were comparable to those of implants placed in sites without periapical pathology. The complication rates, reported in only one study, were 15.4% (2/13) in sites with periapical lesions and 6.7% (1/15) in healthy sites. Conclusion: Limited evidence suggests that immediate implant placement in sites with periapical lesions leads to clinical outcomes comparable to those of immediate implants in healthy sites. Additional prospective controlled trials with large sample sizes and long-term follow-up are needed to further investigate these results

The authors revisited the 1999 International Workshop postulate of robust serum antibody responses to infecting agents in localized aggressive periodontitis (LAgP) and weak responses in generalized aggressive periodontitis (GAgP). Antibody responses were further examined in localized and generalized chronic periodontitis (LCP and GCP).The study includes 119 patients (60 males and 59 females, aged 11 to 76 years), 18 with LAgP, 37 with GAgP, 37 with LCP, and 27 with GCP. Multiple subgingival plaque samples/patient (1,057 in total) were analyzed with respect to 11 bacterial species using checkerboard DNA-DNA hybridizations, and serum immunoglobulin (Ig)G levels were measured against the same bacteria using checkerboard immunoblotting. Further, infection ratios (antibody level over the average bacterial colonization by the homologous species) were computed for each patient. Comparisons of bacterial colonization, serum IgG levels, and infection ratios were made across the diagnostic categories using multivariable linear regression models adjusting for age and race/ethnicity.There were no statistically significant differences in serum IgG levels to Aggregatibacter actinomycetemcomitans among the four diagnostic categories. IgG levels to several species, including Porphyromonas gingivalis, Treponema denticola, and Campylobacter rectus, were highest in patients with GAgP and significantly different from LCP and GCP, but not from LAgP. Comparisons based on infection ratios showed no statistically significant differences for any species between GAgP and LAgP.This study provides evidence against the 1999 Workshop's postulate of weak serum antibody responses in patients with GAgP and shows that serum IgG responses in GAgP are comparable to those in LAgP, but higher than in GCP or LCP for several species.