We report the case of a 61-year-old woman who was referred to the Oral Surgery and Implantology Unit of the University Hospitals of Geneva to take care of edentulous sites after the dental avulsions of teeth 11 and 21 following traumatic shock due to endotracheal intubation under general anesthesia. The dental history revealed that the patient had a history of generalized chronic periodontitis that had been treated several years earlier. The treatment consisted, for the first time to our knowledge, of the immediate insertion of implants at sites 11 and 21 with simultaneous bone augmentation in a single surgical procedure and immediate restorations.

A patient with extensive atrophy of the alveolar ridge in the posterior portion of the maxilla was selected to complete an experimental and clinical case of the robotic zygomatic implant to investigate the viability of an implant robotic system in clinical use.
The preoperative digital information was collected, and the implantation position and personalized optimization marks needed for robot surgery were designed in advance in a repair-oriented way. The resin models and marks of the patient\'s maxilla and mandible are all printed in 3D. Custom-made special precision drills and handpiece holders for robotic zygomatic implants were used to perform model experiments and compare the accuracy of the robotic zygomatic implant group (implant length = 52.5 mm, n = 10) with the alveolar implant group (implant length = 18 mm, n = 20). Based on the results of extraoral experiments, a clinical case of robotic surgery for zygomatic implant placement and immediate loading of implant-supported full arch prosthesis was carried out.
In the model experiment, the zygomatic implant group reported an entry point error of 0.78 ± 0.34 mm, an exit point error of 0.80 ± 0.25 mm, and an angle error of 1.33 ± 0.41degrees. In comparison, the alveolar implant group (control group) reported an entry point error of 0.81 ± 0.24 mm, an exit point error of 0.86 ± 0.32 mm, and an angle error of 1.71 ± 0.71 degrees. There was no significant difference between the two groups (p > 0.05). In clinical cases, the average entry point error of two zygomatic implants is 0.83 mm, the average exit point error is 1.10 mm and the angle error is 1.46 degrees.
The preoperative planning and surgical procedures developed in this study provide enough accuracy for robotic zygomatic implant surgery, and the overall deviation is small, which is not affected by the lateral wall deviation of maxillary sinus.

BACKGROUND: The aim of this retrospective study was to document the long-term clinical efficacy of a surgical-prosthetic technique (the flat one-bridge technique) involving the immediate restoration of both postextraction and nonpostextraction implants supporting full-arch restorations.
METHODS: Implants were placed by adapting the axis to the available bone. Flat definitive abutments were connected during surgery and never disconnected to compensate for eventual implant disparallelism. Bone grafting was performed when needed. The patients received a screw-retained provisional restoration within 48 h of surgery and a final screw-retained prosthesis within 1 year.
RESULTS: Sixty-six patients received 494 implants distributed in 75 prostheses. The median follow-up was 86 months (range 82-168 months). Only three implants had failed at the last follow-up. Implant survival was 99.6%.
CONCLUSIONS: The flat one-bridge prosthetic protocol is a viable procedure with excellent long-term outcomes. No difference in clinical success could be observed between postextractive and nonpostextractive implants.

Immediate implant placement (IIP) often is related to mid-buccal recession in literature. To draw conclusions about the behavior of the soft tissues following IIP, pre-operative aesthetic measurements have to be taken into account. The aim of analysis of these prospective clinical case series data was to elucidate whether the pre-operative buccal soft tissue level (STL) or gingival phenotype influence the 1-year pink aesthetic outcome after performing flapless immediate implant placement and provisionalization (FIIPP) maxillary incisor cases.
In 97 patients, a maxillary incisor was replaced performing FIIPP. STL and phenotype were analyzed on light-photographs made pre-operatively (T0), direct post-operatively (T1), after placement of the permanent crown (T2), and 1 year post-operatively (T3). To investigate if a pre-operative buccal soft tissue deficiency or excess influenced the total pink esthetic score (total-PES) per patient at T3, PES-3 was modified by adding a minus (\"-\") or plus (\"+\") in case of a STL-deficiency or excess, respectively.
Pre-operatively, 40% of the cases showed a mid-buccal recession (STL-deficiency), 19% STL-excess, while in 41% an equal level in comparison with the contra-lateral tooth was observed (STL-neutral). One year post-operatively, 79% (31/39) of the recession cases showed soft tissue gain, while STL-excess cases showed the highest rate of soft tissue reduction (94%; 17/18). This resulted in a decrease of soft tissue recessions and excesses (to 26% and 4%, respectively), and an increase of ideal STL (PES-3-score 2) to 70%. The 1-year aesthetic outcome was not statistically different (p = 0.577) between patients with a pre-operative soft tissue recession (mean T3 total-PES = 12.18) or STL excess (mean T3 total-PES = 11.94). Of the total population, 71 patients with a thin, and 26 with a thick phenotype were evaluated. No statistical difference (p = 0.08) was present in aesthetic outcome between the two phenotypes (thin mean T3 total-PES = 12.30, thick mean T3 total-PES = 11.65).
Regardless of phenotype, preoperative soft tissue recession, or excess, comparable high aesthetic outcomes were achieved 1 year post-operatively.
Ethical approval was obtained and registered on 20 October 2015 ( NTR5583/NL4170 ).

The replacement of missing teeth, especially in the anterior region, is an essential part of dental practice. Fiber-reinforced composite resin bridges are a conservative alternative to conventional fixed dental prostheses or implants. It is a minimally invasive, reversible technique that can be completed in a single visit. The two cases presented herein exemplify the treatment of root-fractured anterior teeth with a natural pontic immediately after extraction.

BACKGROUND: Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking.
OBJECTIVE: To analyze the aesthetic outcome after IIPP.
METHODS: One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used.
RESULTS: In the first year postsurgery, the mean total-WES and total-PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3.
CONCLUSIONS: Within the limitations of this 1-year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved.

BACKGROUND: The aim of this systematic review was to evaluate the survival rates of immediately loaded implants after at least five years. Besides implant failure, the amount of marginal bone loss around implants and the complication type were assessed.
METHODS: The electronic search was undertaken on Medline, Scopus, and Cochrane Central Register of Controlled Trials using key terms such as: \"immediate loading\", \"immediate function\", \"immediate restoration\", \"immediate temporization\", \"dental implants\", \"fully edentulous patients\", \"partially edentulous patients\". The search terms were combined using the Boolean operators AND, OR. The last electronic search was performed on 15 February 2018. Two authors independently screened the studies, extracted the data, and assessed the risk-of bias. The main outcomes recorded for each study were: implant and prosthesis success and survival, marginal bone level change, incidence and type of complications. Kaplan-Meier analysis was used to estimate cumulative survival rates.
RESULTS: Thirty-four prospective studies with at least five-year follow-up, published between 2007 and 2017 were included. A total of 5349 immediately loaded implants in 1738 patients were analyzed. The mean follow-up was 72.4 months (median 60 months, 95% confidence intervals (CI): 64.53, 80.25 months, range 60 to 147 months). The mean weighted implant survival was 97.4% (median 98.15%, 95% CI: 96.29%, 98.54%, range 83.80% to 100%). Cumulative survival rate of implants placed in the mandible was significantly higher than for the maxilla (p < 0.01). No significant difference in failure rate was found among the types of prosthesis employed (p = 0.27). The mean peri-implant bone level change at the end of the follow-up in each study ranged from 0.3 to 1.7 mm.
CONCLUSIONS: Immediate loading of implants appears to have long-term predictability and success rate under well-defined circumstances.

OBJECTIVE: To follow-up the radiographic bone level changes and the clinical outcomes of immediately provisionalized and conventionally restored implants with a hydrophilic surface following 5 years of function.
METHODS: This was a 5-year follow-up of a prospective, randomized, single-blind controlled study involving 16 of the 24 originally recruited patients in need of a single-tooth replacement in the esthetic area. Implants were either immediately provisionalized with a non-occluding temporary crown (test group, n = 7), or left without a crown (control group, n = 9). In both groups, the definitive restoration was placed 16 weeks after implant placement. Radiographic and clinical parameters were evaluated at 36, 48, and 60 months post-implant placement, together with implant survival and success rates. The esthetic outcomes were measured with the Papilla Fill Index (PFI) and the Pink Esthetic Score (PES).
RESULTS: At 60 months, similar peri-implant bone loss was observed in the test (-0.42 mm ±0.17 mm) and in the control (-0.37 mm ±0.35 mm) groups. A tendency for an improved esthetic outcome from implant loading to the subsequent follow-ups was noticed in both groups. Both groups presented with high levels of long-term implant survival and success.
CONCLUSIONS: This study supports non-functional immediate provisionalization as a viable long-term option for the management of single-tooth implants in the esthetic area. However, the small sample size does not allow statistical inference at 60 months of follow-up and future adequately powered studies are warranted.

Today, clinicians have a variety of treatment modalities available to address the increasing number of implant procedures performed each year. Single-stage implant surgery is now commonly used in implant dentistry. With patients\' demands for immediate restoration, the utilization of 1-piece implants is gaining acceptance. This article reports the results of tapered 1-piece implants (Zimmer Biomet) placed in a single practice over a 10-year period. A total of 33 1-piece dental implants were placed in 24 patients and provisionally restored out of occlusion at the time of surgery. All 33 implants were definitively restored with ceramometal crowns after 3 months of provisionalization. Implant survival and success rates were 100% after 2.6-10 years of follow-up. Only 1 minor complication of crestal bone remodeling occurred among the 33 implants placed. Adequately stabilized tapered 1-piece implants can be successfully restored out of occlusion at the time of implant placement and definitively loaded in occlusion 3 months without adversely affecting function or esthetics. Additional long-term controlled studies are recommended to further understand these findings.

OBJECTIVE: To compare the radiographic bone changes, clinical parameters and aesthetic outcomes of immediately provisionalised and conventionally restored implants at 12- and 24-months post-implant placement.
METHODS: In 24 patients, 24 bone level implants with a hydrophilic (SLActive) surface were placed in healed sites and they were either immediately provisionalised with a non-occluding temporary crown (test group) or left without a crown (control group). In both groups, the definitive restoration was placed 16 weeks after implant placement. Clinical and radiographic parameters were calculated at 12- and 24-months post-implant placement, together with implant success/survival rates according to three different sets of criteria. The aesthetic outcome was evaluated through the Papilla Fill Index and the Pink Aesthetic Score.
RESULTS: The mean marginal bone loss at 1 year was -0.73 mm (SD 0.83 mm) in the test group and -0.22 mm (SD 0.46 mm) in the control group (p > .05). Whilst 100% survival rate and positive aesthetic outcomes were recorded in both groups, three patients of the test group did not fulfil all success criteria.
CONCLUSIONS: Immediate provisionalisation may represent a viable option for the replacement of single missing teeth, with radiographic, clinical and aesthetic results comparable to those of conventionally loaded implants at 2 years of follow-up.