The aim of this prospective randomized clinical study was to compare the clinical treatment outcome for single dental implants submitted to either immediate loading (IL) or delayed loading (DL) after 5 years of follow-up. Fifty patients with a missing maxillary tooth (15-25) were randomly allocated to either the IL or DL. The treatment procedures included implant installation in healed sites, temporary screw-retained crown and replacement with a permanent single implant crown. The two groups were evaluated with regard to implant survival, marginal bone level, papillae index, pink and white esthetic score (PES, WES). At the 5-year follow-up the implant survival rate was 100% and 95.8% for IL and DL, respectively. Implant success rate was 91.7% and 83.3% for IL and DL, respectively. The mean +/- SD marginal bone loss for IL and DL was -0.50 +/- 0.73 mm and -0.54 +/- 0.65 mm, respectively. (p = 0.782). Statistically significant less marginal bone loss was found non-smokers (p = 0.021). No statistically significant differences were found for IL and DL concerning papillae index PES and WES after 5 years. This study suggests that implant-supported single crowns in the maxillary aesthetic zone can present similar results with respect to either IL or DL after 5 years.

Purpose: To compare clinical and esthetic outcomes between immediately loaded single implants placed with and without a fully guided surgical procedure. Materials and Methods: Patients with a missing maxillary tooth (second premolar to second premolar) were considered for inclusion in this 1-year prospective nonrandomized study. Exclusion criteria were general health contraindications for oral surgery besides the need for bone grafting or ridge augmentation. One group received digital implant planning, fully guided surgery, and immediate loading (DIL). The other group received freehand surgery and immediate loading (IL). Outcome measures were implant survival, marginal bone loss, soft tissue changes, papilla index, pink and white esthetic scores (PES and WES, respectively), and patient-reported outcome measures (PROMs). Results: Two of 21 implants failed in the DIL group soon after placement, resulting in a 1-year implant survival rate of 90.5%, while no implants failed in the IL group. Significantly higher papilla index scores and lower soft tissue changes were found for the DIL group compared to the IL group. No differences were found after 1 year regarding marginal bone loss, PES, WES, or PROMs. Conclusion: Within the limitations of this study, immediate loading in combination with fully guided surgery might negatively affect implant survival. Immediate loading, fully guided surgery, and a digital workflow appear to have a positive effect on early soft tissue adaptation.

Today there are several treatment techniques available to replace a missing tooth. Since the beginning of the 1990s, it has become increasingly common to treat individual tooth loss with dental implants. Important patient factors are survival, success, functionality, aesthetics, oral health and quality of life.

The range of indications and possibilities for implant treatment has broadened compared to the originally proposed treatment indications. A variety of methods, components and materials are available today. Improvements of the implant surface have led to shorter healing periods, which has affected the overall treatment time. Methods for computer-assisted implant planning and surgical guides have been developed to improve treatment planning. Several techniques are involved in the manufacturing of implant-supported single crowns, from the traditional plaster models, wax, casting and porcelain veneering to 3D scanning, computer aided design and manufacturing. It is important that all these treatment modalities are evaluated in a systematic and scientific way to ensure that the treatment given is the best one possible according to the individual conditions that exist.

The general aim of this project was to evaluate the treatment outcome between different treatment modalities for single dental implants. Study I aims to retrospectively evaluate implant survival. Patient reported outcome measures, marginal bone loss (MBL), clinical and esthetic outcomes following conventional single implant treatment. The aim of study II, a prospective randomized clinical study, was to compare the overall treatment outcome following immediate loading (IL) and delayed loading (DL) of single implants. In study III the aim was to in a vitro setting evaluate the deviation in final dental implant position after the use of surgical guides fabricated from two different desktop 3D printers using a digital workflow. For study IV the aim was to, in a non-randomized study, compare clinical and aesthetic outcomes between immediately loaded single implants placed with and without a fully guided-surgery procedure (DIL). In study I a total of 85 implants were examined after a mean follow-up time of 7.51 years. The 5-year implant survival rate was98.4% (95% CI: 96.3% - 100%), with a crown survival rate of91.8% (95% CI: 86.3%-97.3%). Overall mean MBL was -0.13 mm. Final and initial total Pink esthetic score (PES) were 9.61 and 11.49 (P<.001) Mean White esthetic score (WES) was 6.48 at final follow-up. Visual analog scale (VAS) score for soft tissue and implant-supported crown aesthetics were 73.5 and 82.1 (maximum score 100). A oral health impact profile-14 (OHIP-14) 14 score of 16.11 was observed at the final follow-up. Study II and IV found implant survival rates of 100%, 96% and 90.5 % for IL, DL and DIL, respectively, after 1-year. No statistically significant differences were found for MBL, PES, WES and OHIP-14after 1-year. Statistically significant lower papilla index scores were found for the IL. Overall statistically significant improvement inPES, WES and OHIP-14 were found over time. In the DIL group a moderate correlation between aesthetics and deviation in fixture position was found. For Study III a statistically significant difference between stereolithography and direct light processing (DLP) was found fordeviation at entry point (P = .023) and the vertical implant position(P = .009). Overall lower deviations were found for the guides from the DLP printer, with the exception of deviation in horizontal implant position.The results from these studies suggest that good clinical results can be achieved with different treatment modalities for single implants. Positive advantages with immediate loading and guided surgery is primarily seen in the early faces of the treatment procedure only. Care needs to be exerted with technically complicated treatment procedures as the effect on implant survival should not be underestimated. Further studies have to be performed to evaluate guided surgery and immediate loading to identify possible factors effecting survival.

STATEMENT OF PROBLEM: Different factors influence the degree of deviation in dental implant position after computed tomography-guided surgery. The surgical guide-manufacturing process with desktop 3D printers is such a factor, but its accuracy has not been fully evaluated.

PURPOSE: The purpose of this in vitro study was to evaluate the deviation in final dental implant position after the use of surgical guides fabricated from 2 different desktop 3D printers using a digital workflow.

MATERIAL AND METHODS: Twenty 3D-printed resin models were prepared with missing maxillary premolar. After preoperative planning, 10 surgical guides were produced with a stereolithography printer and 10 with a digital light-processing (DLP) printer. A guided surgery was performed; 20 dental implants (3.8×12 mm) were installed, and a digital scan of the dental implants was made. Deviations between the planned and final position of the dental implants were evaluated for both the groups.

RESULTS: A statistically significant difference between stereolithography and DLP were found for deviation at entry point (P=.023) and the vertical implant position (P=.009). Overall lower deviations were found for the guides from the DLP printer, with the exception of deviation in horizontal implant position.

CONCLUSIONS: The tested desktop 3D printers were able to produce surgical guides with similar deviations with regard to the final dental implant position, but the DLP printer proved more accurate concerning deviations at entry point and vertical implant position.

Background: Immediate loading of single implants is generally considered a reliable procedure. Purpose: The objective of the present prospective randomized clinical study was to compare the overall treatment outcome following immediate loading (IL) and delayed loading (DL) of single implants after 1 year of follow-up. Materials and Methods: Patients with a missing maxillary tooth (15-25) were randomly assigned to IL or DL. The protocol included implant installation in healed sites, immediate loading, delayed loading, temporary screw-retained restoration, and replacement with a permanent single implant crown. Outcome measures were implant survival, marginal bone level, soft tissue changes, papillae index, pink, and white esthetic score (PES and WES), patient judged aesthetics, and oral health impact profile (OHiP-14). Results: Implant survival rate was 100% and 96% for IL and DL, respectively. Implant success rate was 96% and 88% for IL and DL, respectively. Statistically significant lower papilla index scores were found in the IL group at temporary crown and definitive crown placement. An overall statistically significant improvement after 12 months for PES, WES and OHIP-14 was found. Conclusion: This prospective randomized study showed that single implants in the maxilla can present satisfactory results with respect to either immediate loading or delayed loading after 12 months.

Purpose: The aims of this clinical study were to retrospectively evaluate implant survival, patient satisfaction, and radiographic, clinical, and esthetic outcomes following single-implant treatment. Materials and Methods: Eighty-seven patients, with a total of 126 implants (XiVE S, Dentsply Implants), who received single implant-retained crowns between 2004 and 2011 were retrospectively evaluated. Implant survival, marginal bone levels (MBL), changes in implant/mesial tooth vertical relationship, pink esthetic score (PES), white esthetic score (WES), patient assessment of the esthetics (visual analog scale), and oral health impact profile (OHIP-14) were evaluated. Results: Altogether, 59 patients with a total of 85 implants attended a final clinical and radiographic follow-up examination. The mean ages of males and females at implant placement were 19.78 and 22.58 years, respectively. The mean total follow-up time from the implant surgical date was 7.51 years. The 5-year implant clinical survival rate (CSR) was 98.4% (95% CI: 96.3%-100%), and crown CSR was 91.8% (95% CI: 86.3%-97.3%). The overall mean change in MBL was -0.19 mm. No significant differences were found between the different implant diameters (3.0, 3.4, and 3.8 mm) with regard to change in MBL. Mean increase in implant infraposition was 0.13 mm. With regard to esthetics, mean initial and final total PES were 9.61 and 11.49, respectively (P < .001). The mean WES was 6.48 at follow-up. Patients' mean assessment of soft tissue esthetics and implant-supported crown appearance were 73.5 and 82.1 (maximum score 100). At the follow-up examination, the additive OHIP-14 score was 16.11. Conclusion: This retrospective study of XiVE S implants found excellent survival rates and showed good clinical outcomes concerning patient-centered findings, esthetics, and marginal bone preservation. In context, it is important to stress that this study consisted of mostly young patients with agenesis who were treated by experienced clinicians.

PURPOSE: The aim of the present study was to morphometrically analyze the mandibular canal through the mandibular ramus by cone beam computed tomography (CBCT) and to relate the findings to performing sagittal split ramus osteotomy. METHODS: CBCT of 200 patients were analyzed. Five parameters were measured at the axial scan, from the mandibular foramen to 21 mm below it (3-mm intervals). The canal was classified according to the position within the bone marrow space. Variations were evaluated according to age, sex, side, and number of mandibular teeth. RESULTS/CONCLUSIONS: The following measurements increased gradually towards the most inferior level of measurement: the total thickness of the mandibular ramus through the center of the mandibular canal, the width of the bone marrow space (both buccal and lingual), and the narrowest width from the mandibular canal inner cortical to the mandibular ramus external cortical. The inner diameter of the mandibular canal slightly decreased to the same direction. Concerning the mandibular canal position within the bone marrow space, the percentage of the separate type increased towards the most inferior level of measurement, and the contact and fusion types decreased. Age, number of teeth, and sex had no significant influence on the total thickness of the mandibular ramus and on the narrowest width from the mandibular canal inner cortical to the mandibular ramus external cortical.

This article presents three cases of single labially tilted implants restored with screw-retained single crowns. Individualized abutments with an angled screw channel were used to avoid an unesthetic vestibular access channel. This individualized abutment allows the dentist and dental technician to use the screw-retained restorations where a cemented reconstruction would otherwise have been needed.

Objective: To determine the longest upright and tilted implant that can be placed in posterior mandibular teeth (second premolars [2PM], first molars [1M], and second molars [2M]) in case of immediate implant placement (IIP), respecting a safe distance from the inferior alveolar canal (IAC) and the submandibular fossa, using cone beam computed tomography (CBCT) scans. Method and Materials: In CBCT scans of 118 subjects, the following were measured: distance from the tooth apex to the IAC (DTC), lateromedial width of the mandible, classification of mandibular cross-sectional morphology, upright and tilted implant placement simulation, tilting angle that allowed placement of the longest implant. Results: The DTC has shown to be greater for 1M, shorter for 2PM, and even shorter for 2M. Between 70% and 88% of all 2PM, 1M, and 2M present less than 6 mm of DTC. The cross-sectional morphology of the mandible had a tendency to be classified as "undercut" in more posterior regions. For both 4.0- and 5.0-mm implants, more posterior regions resulted in a greater difference in length between the upright and tilted implants. The tilting angle was greater for the more posterior regions. Most of the relationships between age/sex and the morphometric parameters were weak. Conclusion: Lingual concavity is a common clinical finding at the posterior mandibular region, and its occurrence varies according to the tooth type. The great majority of the 2PM, 1M, and 2M present limited available bone between the root apex and the IAC, which stresses the need for careful attention when IIP is planned in this area.

PURPOSE: To compare digital and conventional impression techniques in a randomized clinical trial; specifically, procedure times, patient-centered outcomes, and clinical evaluation of the restorations. MATERIALS AND METHODS: Forty-eight patients in need of tooth-supported single crowns and/or fixed partial prostheses up to six units were randomly allocated to one of the impression techniques. The procedure times, dentists' and patients' assessments using a visual analog scale (VAS), and clinical evaluation of the restorations were compared between the two groups. RESULTS: The mean total procedure times for digital and conventional impression technique were 14:33 ± 5:27 and 20:42 ± 5:42, respectively (p < 0.0001). Mean impression times were 7:33 ± 3.37 and 11:33 ± 1.56, respectively (p < 0.0001). Mean VAS scores for the dentist's assessment of difficulty (0 to 100; very difficult = 100) were 24.00 ± 18.02 and 48.02 ± 21.21, respectively (p < 0.0001). Mean VAS scores for the patients' assessment of discomfort (0 to 100; very discomforting = 100) was 6.50 ± 5.87 and 44.86 ± 27.13, respectively (p < 0.0001). Occlusal contacts showed a better result for the digital technique. CONCLUSION: The results of this study demonstrated that the digital technique was more efficient and convenient than the conventional impression technique.