Guided immediate implant with and without using a mixture of autogenous and xeno bone grafts in the dental esthetic zone. A randomized clinical trial

Abstract

Purpose: This in vivo study aims to assess the pink esthetic score in the anterior maxilla after computer-guided immediate implant installation and fully digital immediate temporalization with and without grafting the jumping gap with a mixture of 1:1 autogenous and xenograft particulates.

Materials and methods: Twenty-four patients with non-restorable upper anterior teeth in the aesthetic zone have undergone a traumatic extraction for the non-restorable tooth followed by immediate implant placement using a 3D-printed surgical guide according to prosthetically driven implant placement. The patients were divided into two groups. The study group received the dental implant after grafting the jumping gap with 1:1 autogenous and xenograft particulates, while the control group received the dental implant without grafting the jumping gap. Each patient received a digitally fabricated, immediate, nonfunctional temporary prosthesis. The esthetic outcome was compared between the two groups using the pink esthetic score at implant insertion and after 6 months of follow-up. Statistical comparisons were carried out between the studied groups using the Mann-Whitney U test.

Results: Immediately postoperatively, there was no statistically significant difference between the median PES in the two groups (P-value = 0.746). After six months, the study group showed a statistically significantly higher median PES than the control group (P-value = 0.048).

Conclusions: Grafting the jumping distance in the immediate implant protocol helps achieve a better esthetic outcome.

Clinical relevance: The use of immediate guided implant placement along with grafting the jumping gap followed by immediate digital temporalization guarantees a better esthetic outcome while preserving time, cost, and the number of clinical visits.

Trial registration: The study was registered on clinicaltrials.gov with registration number NCT04096209. (19/9/2019).

Keywords: CAD-CAM; Esthetics; Immediate implants; Immediate loading; Implants; Surgical guides; Temporary prosthesis.

Fig. 1

Virtual designing of the temporary prosthesis

Fig. 2

Implant planning according to the prosthetically driven implant placement protocol

Fig. 3

Design of the implant placement surgical guide

Fig. 4

Atraumatic extraction of an endodontically treated remaining root using a large endodontic manual file

Fig. 5

Immediate postoperative view after placing the 3D-printed temporary restoration

Fig. 6

A bone mixture of 50% xenograft to 50% autogenous bone was used to graft the jumping gap in the study group

Fig. 7

Immediate implant placement without grafting the jumping gap in the control group

Fig. 8

Box plot representing median and range values for Pink esthetic score in the two groups (Circle represents outlier)