OBJECTIVE: To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up.
METHODS: Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites.
RESULTS: The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14).
CONCLUSIONS: The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up.
CONCLUSIONS: These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.

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.

BACKGROUND: Immediate implant restoration by prefabricated prosthesis has multiple benefits. However, the design and insertion workflow of the prosthesis may influence the seating.
OBJECTIVE: Evaluation of seating accuracy of prefabricated interim prosthesis of different designs and insertion workflows for immediate restoration of implants placed via static computer-assisted implant surgery (sCAIS).
METHODS: A maxillary model without incisors was used to plan for two implants at the lateral incisor locations. According to the planned implants, sCAIS surgical template and a four-unit interim prosthesis were designed. Four prostheses were fabricated based on the design and insertion workflow. The first prosthesis involved complete fabrication (CF) of the interim prosthesis, where the interim prosthesis is fabricated for laboratory attachment to abutments. The other three prostheses were produced by partial fabrication (PF), where the interim prosthesis shell was produced with internal spacing between the fitting surface and the abutments. The PF prostheses were cemented on abutments attached to the inserted implants. Three different PF prosthesis designs were included with different levels of internal spacing: 100 μm (PF.1), 200 μm (PF.2), and 300 μm (PF.3). A total of 15 surgical models received implants on which each prosthesis was seated and scanned by a laboratory scanner. The vertical, horizontal, and proximal contact errors were measured.
RESULTS: Although all prostheses were seated on every model, the CF prostheses had greater vertical error, followed by PF.1, PF.2, and PF.3 prostheses, respectively. A similar pattern was observed for proximal contact error, where PF.3 was most superior. PF.3 prostheses had the least horizontal error than the other prostheses.
CONCLUSIONS: All interim prostheses experienced errors at the vertical, horizontal, and proximal surfaces, which can be attributed to deviations of the inserted implants. The PF of interim prosthesis with increased internal spacing for intraoral insertion appeared to reduce seating errors.

BACKGROUND: Rehabilitation in the anterior region requires specific conditions for success, such as the presence of papilla, emergence profile, and balance between pink and white esthetic.
OBJECTIVE: This systematic review aimed to evaluate the esthetic risk associated with immediate implant placement with immediate restoration in the anterior superior area, where the facial bone plate may be absent or deficient.
METHODS: The search was done in PubMed, Embase, Cochrane, Lilacs, Scopus, Scielo, and Google Scholar databases. The investigation involved clinical studies and observational studies published between January 2012 and July 2023. Studies were excluded if there was less than 12-month follow-up, no immediate restoration or facial defect, heavy smokers, or systemic disease. The risk of bias was assessed using the ROBINS-I and Modified-Cochrane RoB tools.
RESULTS: Twelve studies were included in this systematic review. The thinner the facial plate, the higher the alveolus\'s risk of gingival recession or shrinkage. There was an increased interproximal recession when the thin phenotype was associated with flap surgery. An increase in pink esthetic score (PES) was reached when immediate implant placement (IIP) and immediate restoration were done. Soft tissue augmentation achieved more gingival-level stability. Regardless of the initial phenotype, an esthetic outcome was delivered. The risk of bias was high in 1 study and moderate in 3 studies.
CONCLUSIONS: It is possible to conclude that esthetic results and increased final PES or patient satisfaction index in IIP treatments associated with immediate restoration could be obtained even in buccal bone wall defects or gingival recession, regardless of their extension.

As the field of implant dentistry continues to evolve, new techniques and technologies arise that can provide great benefits to the partial or completely edentulous patient. The purpose of this article is to review the history, definition, and rationale of immediate loading of dental implants with the goal of providing evidence-based recommendations for implementation into clinical practice. Relevant literature is summarized and includes discussion regarding prerequisites for immediate loading/restoration of an endosseous implant. Surgical techniques and methodologies to prevent implant failure in immediate-load cases are discussed as well. The greatest success has been demonstrated with 4 or more mandibular implants. Although there is support in the literature demonstrating successful outcomes in immediate functional loading of single implants, the opinion of the author is to opt for a nonfunctional load that does not have any occlusal contacts when considering immediate loading of a single dental implant.

BACKGROUND: Restoring the mandibular anterior teeth by implants can be difficult due to potential complications arising from using prosthetic implant connections that are larger than the incisors at the cementoenamel junction level.
METHODS: This retrospective study is aimed at determining the survival and esthetic outcomes of anterior mandible implants immediately placed and restored in patients diagnosed with stages 3-4 periodontitis. The study included 75 implants that were inserted along with guided bone regeneration in 42 patients. Over a follow-up period of 3 to 8 years (mean of 6.95 ± 1.78 years), the study evaluated esthetic, marginal bone loss (MBL), and biological and prosthetic complications.
RESULTS: No failures were recorded during the follow-up period; after eight years, the survival rate was 100%. Patient\'s age and gender did not have a statistically significant impact on MBL, but smokers had a greater MBL than non-smokers at the 8-year (2.98 mm vs. 1.23 mm, respectively, p = 0.016) time-point. At 3 years, only 13.3% of the implants had mesial papillae, 36.0% had distal papillae, and 16.0% had the cervical metallic part of the abutment exposed. Peri-implantitis was diagnosed in 20.7% of the patients at the 8-year follow-up time.
CONCLUSIONS: Based on the limitations of this study, immediate placement and restoration of the mandibular incisors can be a feasible procedure, but only a few implants achieved the complete restoration of the papillae.

OBJECTIVE: To assess marginal bone level change (MBLc), clinical outcomes for soft tissue, and survival rates for immediately restored implants with simultaneous guided bone regeneration (GBR).
METHODS: Electronic and manual searches were conducted in PubMed/MEDLINE, EMBASE, and CENTRAL for studies that investigated immediately restored implants in simultaneously grafted sites with a mean follow-up of over 12 months. MBLc was the primary outcome. Soft tissue clinical parameters and implant survival rate (ISR) were the secondary outcomes.
RESULTS: Twenty-five studies (5 randomized controlled trials, 6 prospective studies, 2 retrospective studies, and 12 case series) were included, from which 692 immediately restored implants were analyzed. For studies that investigated bone grafts in the gap between the implant and the peripheral bone wall, the weighted mean MBLc was -0.73 ± 1.52 mm (range: -1.50 to 0.26 mm) for 475 implants. Pink esthetic score (PES) was improved in eight studies and the weighted cumulative ISR was 98.99% (Median: 100%) in 622 implants. Mean MBLc was -1.19 ± 0.26 mm for 30 implants in studies that reported gap with dehiscence and/or fenestration augmentation. Weighted cumulative ISR was 97.25% in 70 implants. A meta-analysis was not possible due to the lack of studies with an eligible control group. Therefore, the data should be interpreted with caution.
CONCLUSIONS: Less marginal bone loss and more predictable soft tissue parameters can be achieved for immediately restored implants with simultaneous peri-implant gap filling compared with gap with dehiscence/fenestration grafting. Increased ISR for implants with gap filling was observed. However, more evidence is needed to confirm whether immediate provisional prostheses should be utilized when bone defects are simultaneously augmented around the implants.

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.

To assess implant success and survival of immediately placed and restored progressive-type implants in the esthetic zone.
A total of n = 21 patients (21 implants) had received an immediate placement of a tapered, two-part implant with a progressive thread design (PL) for a single tooth replacement in the anterior maxilla. An immediate \'non full-functional loaded\' restoration was provided upon adequate primary stability on a final patient-specific abutment (one abutment-one time concept). The final restoration was provided at 12 weeks (baseline). Implant survival and success (e.g. bleeding on probing-BOP, probing pocket depth-PD, mucosal recession-MR, pink esthetic score-PES) as well as patient- reported outcomes (PROM`S) were recorded at 6 and 12 months.
An adequate primary implant stability (i.e. insertion torque > 35 Ncm) was obtained at all but one sites. At 12 months, implant survival (n = 20 patients) amounted to 100%. Non-significant changes to baseline were noted for mean BOP (2.5 ± 28.2%), PD (- 0.26 ± 0.73 mm), and MR (0.0 ± 0.4 mm) values. PES values amounted to 12.9 ± 1.14 and 13.2 ± 0.84 at 6 and 12 months. Technical and mechanical complications were not observed. Patients expressed an overall high satisfaction.
The presented immediacy protocol was associated with high survival and success rates on the short-term.

BACKGROUND: Flapless immediate implant placement and provisionalization (FIIPP) in the aesthetic zone is still controversial. Especially, an initial buccal crest thickness (BCT) of ≤1 mm is thought to be disruptive for the final buccal crest stability jeopardizing the aesthetic outcome.
OBJECTIVE: To radiographically assess the BCT and buccal crest height (BCH) after 1 year and to calculate the correlation between initial and final achieved BCT.
METHODS: The study was designed as a prospective study on FIIPP. Only patients were included in whom one maxillary incisor was considered as lost. In six centers, 100 consecutive patients received FIIPP. Implants were placed in a maximal palatal position of the socket, thereby creating a buccal space of at least 2 mm, which was subsequently filled with a bovine bone substitute. Files of preoperative (T0), peroperative (T1) and 1-year postoperative (T3) cone beam computed tomogram (CBCT) scans were imported into the Maxillim™ software to analyze the changes in BCT-BCH over time.
RESULTS: Preoperatively, 85% of the cases showed a BCT ≤1 mm, in 25% of the patients also a small buccal defect (≤5 mm) was present. Mean BCT at the level of the implant-shoulder increased from 0.6 mm at baseline to 3.3 mm immediate postoperatively and compacted to 2.4 mm after 1 year. Mean BCH improved from 0.7 to 3.1 mm peroperatively, and resorbed to 1.7 mm after 1 year. The Pearson correlation of 0.38 between initial and final BCT was significant (p = 0.01) and therefore is valued as moderate. If only patients (75%) with an intact alveolus were included in the analysis, still a \"moderate correlation\" of 0.32 (p = 0.01) was calculated.
CONCLUSIONS: A \"moderate correlation\" was shown for the hypothesis that \"thinner preoperative BCT\'s deliver thinner BCT\'s\" 1 year after performing FIIPP.