title: Immediate non-occlusal loading of immediate post-extractive versus delayed placement of single implants in preserved sockets of the anterior maxilla: 4-month post-loading results from a pragmatic multicentre randomised controlled trial.
abstract: OBJECTIVE
  To compare the effectiveness of immediate post-extractive single implants with delayed implants placed in preserved sockets after 4 months of healing. Implants that achieved an insertion torque of at least 35 Ncm were immediately non-occlusally loaded.
  
  
  METHODS
  Just after tooth extraction and in the presence of a loss of the buccal plate bone less than 4 mm, compared to the palatal wall, 106 patients requiring a single immediate postextractive implant in the maxilla from second premolar to second premolar were randomly allocated to immediate implant placement (immediate group; 54 patients) or to socket preservation using anorganic bovine bone covered by a resorbable collagen barrier (delayed group; 52 patients) according to a parallel group design at three different centres. Bone-to-implant gaps were to be filled with anorganic bovine bone, however this was not done in 17 patients (corresponding to 40% of those who should have been grafted). Four months after socket preservation, delayed implants were placed. Implants placed with an insertion torque >35 Ncm were immediately loaded with non-occluding provisional single crowns, replaced, after 4 months, by definitive crowns. Outcome measures were implant failures, complications, aesthetics assessed using the pink esthetic score (PES), and patient satisfaction, recorded by blinded assessors. All patients were followed up to 4 months after loading.
  
  
  RESULTS
  Nineteen (35%) implants were not immediately loaded in the immediate group versus 39 (75%) implants in the delayed placement group because an insertion torque >35 Ncm could not be obtained. No patient dropped out. Two implants failed in the immediate group (4%) versus none in the delayed group. More minor complications occurred in the immediate group (8) than the in the delayed group (1) and this was statistically significant (P = 0.032). At delivery of definitive crowns, 4 months after loading, aesthetics were scored as 12.8 and 12.6 in the immediate and delayed groups, respectively. There was no statistically significant difference (P = 0.5). Patients of both groups were equally satisfied.
  
  
  CONCLUSIONS
  There were more complications at immediate post-extractive implants when compared to delayed implants. The aesthetic outcome appears to be similar for both groups and it seems more difficult to obtain a high insertion torque in sockets preserved with anorganic bovine bone.
authors.affiliation: Department of Peridontology and Implantalogy, University of Bologna, Bologna, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Felice
authors.forename: Elisa
authors.initials: E
authors.lastname: Soardi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Piattelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Pistilli
authors.forename: Michele
authors.initials: M
authors.lastname: Jacotti
authors.forename: Marco
authors.initials: M
authors.lastname: Esposito
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D000540:Alveolar Ridge Augmentation / Q000379:methods; D001857:Bone Matrix / Q000637:transplantation; D018786:Bone Substitutes / Q000627:therapeutic use; D003094:Collagen; D003442:Crowns; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008567:Membranes, Artificial; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use; D017060:Patient Satisfaction; D011183:Postoperative Complications; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery*; D019415:Torque; D016896:Treatment Outcome
chemical_list: C106416:Bio-Gide; C077540:Bio-Oss; D018786:Bone Substitutes; D008567:Membranes, Artificial; D008903:Minerals; D003094:Collagen