Immediate placement and loading of single NobelActive™ implants in the esthetic zone: one-year clinical and radiographic results

Background: Since the 1969 when Brånemark introduced the concept of osseointegration, the traditional protocols have been modified and clinical procedures, such as immediate or early implant placement and immediate or early loading, have been proposed to decrease the overall treatment time and to optimize functional and esthetic results. Aim: to assess the clinical, radiographic and esthetic outcomes of immediate loaded post-extractive implant to replace single-teeth in the esthetic zone. Material and Methods: A total of 24 consecutive patients requiring single-tooth extraction in the maxillary or mandibular anterior or premolar zones were treated with 25 immediate placement and loading of a single NobelActive™ implant. The treatment involved minimal flap elevation, tooth extraction, immediate implant placement, peri-implant marginal defect filled up with grafting material, insertion of the definitive abutment and the temporary crown within 24 h. The final prosthetic restoration was

Background: Since the 1969 when Branemark introduced the concept of osseointegration, the traditional protocols havebeen modified and clinical procedures, such as immediate or early implant placement and immediate or early loading, have been proposed to decrease the overall treatment time and to optimize functional and esthetic results. Aim/Hypothesis: To assess the clinical, radiographic and esthetic outcomes of immediate loaded post-extractive implant to replace single-teeth in the esthetic zone. Material and methods: A total of 24 consecutive patients requiring single-tooth extraction in the maxillary or mandibular anterior or premolar zones were treated with 25 immediate placement and loading of a single NobelActiveTM implant. The treatment involved minimal flap elevation, tooth extraction, immediate implant placement, peri-implant marginal defect filled up with grafting material, insertion of the definitive abutment and the temporary crown within 24 h. The final prosthetic restoration was performed after a mean period of 6 months. Clinical and radiographic examination was completed at 6 and 12 months to assess implant success, radiographic bone loss and periodontal parameters. The modified Pink and White Esthetic Score (PES/WES) were used to evaluate the esthetic outcome. The data were analyzed using the Wilcoxon signed ranch test. Bonferroni’s correction was used to take into account multiple comparisons. A value of P < 0.05 was considered as statistically significant. Results: Two implants had failed at 1 month of follow-up, resulting in an implant success rate of 91.67%. Periapical radiographs at 12 months showed minimal crestal bone loss, with mean bone loss of 0.38 mm and 0.28 mm respectively at the mesial and distal aspect. The aesthetic evaluation showed a mean total PES/WES score of 17.1. Conclusions and clinical implications: The study included a one-stage procedure for immediate replacing single teeth with implant-supported fixed prosthesis. For the patient this strategy seems to be attractive because the protocol decreases treatment time, minimizes the number of surgical/restorative procedures and eliminates the need for a removable partial denture in the early stages of healing, providing immediate functional and esthetic comfort. Within the limitations of the present study, that includes few patients and short follow-up period, it is possible to suggest that, if a careful selection of the patient and strict clinical protocol are observed, the immediate placement and loading of a single NobelActiveTM implant in a fresh socket may be considered a valuable and predictable option in terms of implant success and hard and soft tissue remodeling.