Patients with a single failing tooth in the esthetic zone of maxilla (second premolar to
second premolar), and in need for implant replacement will be recruited.
During the first appointment, medical history and clinical and radiological evaluations
(OPG) will be recorded to verify the eligibility of each subject. If the sufficient bone
is present apical to the failing tooth, intraoral scan of the upper jaw will be obtained
prior to tooth extraction. Six to eight weeks following tooth extraction CBCT scan will
be obtained together with digital impression. The implant positions will be planned
according to the bone anatomy and future prosthetic reconstruction. Two groups of
treatment protocols will be randomized as following:
Group 1: Early implant placement + immediate provisionalisation; Group 2: Early implant
placement + conventional loading.
Implant surgery will be performed by two experienced surgeons. Full thickness triangular
flap will be elevated, and fully guided implant placement will be completed.
Under-preparation of implant bed in the soft bone will be utilized to obtain adequate
primary stability. During the surgery, primary implant stability will be monitored by the
means of insertion torque (IT) and resonance frequency analysis (RFA) Contour
augmentation will be done for all patients from both groups by means of locally collected
autogenous bone chips and deproteinized bovine bone particles, covered by a collagen
membrane. Depending on the group, healing cap or healing abutment will be selected, and
primary wound closure will be achieved.
Prosthetic rehabilitation:
All impressions will be taken digitally using intraoral scanner and appropriate implant
scanbody.
Titanium temporary abutments will be used for provisional restorations, and titanium base
abutments for the definitive restoration. Provisional restorations will be made of
polymethyl methacrylate (PMMA) (Telio®CAD, Ivoclar Vivadent, Schaan, Lichtenstein) in a
digital way. Digital scanning for final restorations and virtual design will be repeated
in the same manner. Full ceramic screw-retained crown will be fabricated in a digital way
and delivered to the patients.
Group 1:
Immediate screw-retained provisional restoration made of poly methyl methacrylate (PMMA)
will be delivered within the first 7 days after surgery. Three months later, final
screw-retained full ceramic crown will be fabricated and delivered.
Group 2:
Three months after the surgery, implant will be exposed and provisional screw-retained
PMMA restoration delivered. Three months later final screw-retained ceramic crown will be
fabricated.
Implant stability will be monitored through RFA. ISQ will be measured in both groups:
At the day of the implant placement
At the day of the provisional restoration placement
At the day of the definitive restoration placement
CBCT scan with a small field of view will be taken prior to implant placement,
immediately after implant placement, and 1 year after implant placement. Post-op CBCT
scans will be used for measurement of the facial bone wall thickness. Marginal bone level
will be monitored using periapical radiographs taken with paralleling technique, using
custom silicone holder fabricated for each patient. X-rays will be taken on the day of
the provisional restoration placement, final restoration placement, and one year after
final restoration.
Esthetic outcome for the peri-implant mucosa will be assessed from the photographs taken
at the definitive restoration delivery and 1 year follow-up visit, using pink esthetic
score (PES). Patient satisfaction regarding function and aesthetics (mucosa, crown and
overall) would be assessed using visual analogue scale (VAS). Quality of life would be
examined by OHIP-14 questionnaire. These Patient Reported Outcome Measures (VAS and
OHIP-14) would be recorded at 3 time points: before implant placement (baseline), 1 month
after definitive crown delivery and after 1 year of function.