Influence of Extraction Socket Class on Success of Post Extraction Implant:A Clinical Study.

*Rawaa Younus Al-Rawee. M.Sc., MOMS.RCPSG.

*Bashar A. Tawfeeq. F.I.C.M.S., Consultant MaxFacs.

**Ali M. A. Alkhayat. F.B.M.S. MaxFacs.

*Bassam F. Yaseen. F.B.M.S., Consultant MaxFacs.

* Department of Oral and Maxillofacial Surgery, Al-Sallam Teaching hospital, Iraq.

** Department of Oral and Maxillofacial Surgery, Al-Jamhoury Teaching hospital, Iraq.

Running title: Post-extraction dental implant.

Abstract

Aim of Study: To evaluate the effect of a fresh extraction socket type onthe success rate of immediate dental implants. Materials and Methods:131 patients were chosen for immediate post-extraction implant surgery during the period from (2007-2011). Super line Dentium implant system were used; (Korean made), we compared the effect of extraction socket type on both complicationsand success rate in both gender types (male andfemale). Results: SPSS Statistical analysis system was used. Descriptive analysis show 409 dental implants distributed in that 200 female and 209 male. Five implants were lost from total 409 implants placed in fresh extraction socket. In comparison of success rate and complications among extraction socket type with or without use of bone substitute in male versus female group show no significant differences. Discussion: good success rate with post extraction dental implant treatment in all different extraction socket typeswith the aid of selection of special protocol of treatment in each case alone.

Keywords: post extraction implants, extraction socket classification, immediate dental implants.

INTRODUCTION

Endosseous dental implants are used for the replacement of various types of tooth loss(1). Dental implant treatment based on the phenomenon of osseointegration(2), however, the success rates vary according to bone condition at the implant site(3). Poor bone quantity or inadequate bone height is one of the major causes of implant failure(4).The challenge facing todays` clinicians is to determine when to perform the immediate or the late procedure of dental implantology following tooth extraction, in an effort to maximize the regenerative and esthetic treatment outcomes(5,6).Following tooth loss, a natural process of alveolar bone resorption occurs(7,8,9).Insufficient amount of supporting bone can restrictadequate placement of endosseous dental implants(10,11).

Bucco-lingual ridge collapse and significant ridge atrophy may continue up to 12 months post-extraction(12). Such alveolar bone changes often result in esthetic compromises in the area of tooth extraction and/or inadequate bone for ideal implant conditionfor implant placement in anyposition(13). The interproximal bone levels of adjacent teeth may also be affected(14). Recognition of these potentially clinically significant alveolar changes after tooth removal has led to use of variousmaterials and techniques to help effect alveolar bone regeneration and to ameliorate ridge shrinkage(15).Immediate implants are implants that are placed into a prepared fresh extraction socket. Short-term animal and human studies have shown these implants to be comparable to implants placed into healed bone(16). The advantages of the procedure include fewer surgical sessions, elimination of the waiting period for socket healing, shortened edentulous time period, reduced overall cost(17), as well as preservation of bone height and width(18).

Residual extraction site morphology is an important determinant of immediate implant success and can complicate implant positioning(19,20), these important aspects are axial inclinations (slope), root curvature of the extracted tooth (dilacerations), and location of the socket apex(19), the extraction site must be large enough to accommodate an appropriately selected commercial dental implant(16).When these factors are found to be clinically unfavorable, considerable thought should be given to decide whether or not to proceed with immediate implants.Residual socket morphology varies from nearly ideal to severely compromise. As with many clinical situations, the decision to proceed with immediate implants will depend on the surgeon’s ability and clinical experience (21).

Aim of Study:To evaluate the effect of fresh extraction socket type on immediate post extraction implant.

MATERIALS AND METHODS

One hundred thirty one patients were chosen for immediate implant surgery during the period from (2007-2011) with four hundred and nine implants inserted in a fresh extraction socket. Superline Dentium endosseous dental implant system, was used.Surgical sites examined following extraction to evaluate and record the extraction socket class, also to detect weather the use of bone substitute to close the defect of the extraction socketwas needed or not, and complications seen that occur at the follow up period after loading(at least 6 months). Thepatients'age was between (20-55) years old.

Dental extraction (atraumatic extraction) achieved by the use of periotome, the socket examined to classify the defect by use of Meltzer classification to specify the treatment parameters for osseous defectand placement of the fixture immediately after preparation of socket. Successand failure rate were recorded.

Meltzer classification(22): Class I. The fresh extraction defect resides completely, by the osteotomy bony housing with all walls intact.Class II. The defect has three of the four walls intact; the fourth wall presented with dehiscence or fenestration. Class III. The site is characterized by two walls are defective; the other two of the four walls are intact.Class IV. The socket defect is one of the inadequate height present; we exclude these cases from the data.We usually use bone substitute to close the defect in the class I,II and IIIextraction sockets.

We compare the effect of extraction socket class on both failureand success rate in both malesand females patients.

Results

SPSS Statistical analysis system used. Table (1) shows the descriptive analysis of success and failure rate for post extraction immediate dental implant of male (209)and female (200)groups.

Data divided according to extraction socket class, as Class I with and without bone substitute (Male and Female), Class II and Class III both with bone substitute used to close the defect in the socket after placement of implant, also in both groups, malesand females had been isolated, it shows that, the highest percentage (70.17%) in the class I socket without the use of bone substitute,and shows class III socket is the lowest percentage (4.4%) from the total 409 implants used, Table (2).

Five implants were lost from total 409 implants placed in fresh extraction sockets, this gave excellent success rate which is (98.77%)Table(1).In comparison of success rate andfailure ratewith extraction socket class with or without the use of bone substitute in male gender show no significantdifferences.Table (3, 4).

DISCUSSION

The advantages of placement of dental implant in a fresh extraction socket are multiple, includes, less surgical sessions, elimination of the waiting period for socket healing with shorter overall treatment time, reduced overall treatment cost in comparison to the standard treatment method, as well as greaterpreservation of alveolar bone height and width in the immediate type of dental implantation, in due, lead to selection of larger height and width of inserted dental implant.

Residual extraction dental socket morphology is an important determinant of immediate implant success and can complicate implant positioning(19,20).The important aspects are axial inclinations, root curvature of the extracted tooth (dilacerations), and location of the socket apex(19). The extraction site must be large enough to accommodate an appropriately selected commercial dental implant(16).Residual socket morphology varies from ideal to severely compromised, as with many clinical situations, the decision to proceed with immediate implants will depend on the surgeon’s ability and clinical experience.

Five implants only completely failed with success rate of (98.77%). No significant results shown for the effect ofclass of extraction socket on success rate with immediate dental implantation with fine years follow up. The success rate can be attributed to intimate adherence to case selection criteria for immediate dental implant procedure(23).

REFERENCES

[1] Kyung-Ah Park, Cheol-WoongJeong, Gyeong-Ho Ryoo,.”Survival Analysis of Wide-Diameter Implants in Maxillary and Mandibular Molar regions”.J. Korean Acad. Periodonto. Vol. 37, No. 4, PP. 825-838, 2007.

[2] Jaffin RA, Berman CL. “The Excessive Loss of Brånemark Fixtures in type IV Bone,A 5-year analysis”. J. Periodontol,62(1):2-4.Jan.;1991.

[3] Flávio DN, Dennis F, Sérgio RB, Célio JP, Alfredo JFN. “Short implants-An Analysis of Longitudinal Studies”. Int. J. Oral Maxillofacial Implants; 21:86-93.2006.

[4] Davarpanah M, et al. “Wide-Diameter Implants NewConcepts”Int. J. Periodontics Restorative Dent.; 21:149-159.2001.

[5] Paul A. Fugazzotto.”A Literature Review and Proposed Hierarchy of Treatment Selection”. J. Periodontol; 76(5):821-31.May 2005.

[6] Atwood, D.A. “Some Clinical Factors related to Rate of Resorption of Residual Ridges”. J. Prosthet. Dent.86(2):119-125.Aug.2001.

[7] Becker, W.et al.“The Use of e-PTFE Barrier Membranes for Bone Promotion around Titanium Implants Placed into Extraction Sockets: a prospective multicenter study”. Int. J. Oral Maxillofacial Implants. 9(1):31-40.Jan-Feb.1994.

[8] Lekovic, V.et al.“A Bone Regenerative Approach to Alveolar Ridge Maintenance Following Tooth Extraction.Report of 10 cases”. J. Periodontol. 68(6):563-70.Jun 1997.

[9] Jaim Pietrokovski,andMaury Massler, “Residual Ridge Remodeling After Tooth Extraction in Monkeys”. J. Prosthet. Dent.26(2): 119-29.Aug 2015.

[10] Jahangiri, L.et al.“Current Perspectives in Residual Ridge Remodeling and its Clinical Implications: a review”J. Prosthet. Dent. 80(2):224-37.Aug 1998.

[11] Ofer Moses, SanduPitaru, ZviArtzi, Carlos E..” Healing of Dehiscence-Type Defects in Implants Placed Together with Different Barrier Membranes: a Comparative Clinical Study”: Clin. Oral Impl. Res. 16; 210–219, 2005.

[12] Scheer P., Boyne P.J. “Maintenance of Alveolar Bone Through Implantation of Bone Graft Substitutes in Tooth Extraction Sockets”. J. American Dental Association, 114(5):594-7. June 1987.

[13] Mathai JK, Chandra S, Nair KV, Namblar KK. “Tricalcium Phosphate Ceramic as Immediate Root Implants for The Maintenance of Alveolar Bone in Partially Edentulous Mandibular Jaws. A Clinical Study”.Australian Dental J., 34:421-426, 1989.

[14] Bahat O, Deeb C, Golden T, Komomyckyj O.,“Preservation of Ridges Utilizing Hydroxyapatite”. Int. J. periodontics and Restorative Dent, 7(6):35-41.1987.

[15] Gauthier O.et al,“A New Injectable Calcium Phosphate Biomaterial for Immediate Bone Filling of Extraction Sockets”.J. Periodontol, 70(4):375-83.1999.

[16] Douglass GL., Merin RL. “The Immediate Dental Implant”. J. California Dental Association,30(5):362-5, 368-74.May,2002.

[17] Cornelini R., et al. “Immediate One-Stage Postextraction Implant: a Human Clinical and Histologic Case Report”. Int. J. Oral Maxillofac Implants, 15:432-437.2000.

[18] Wheeler SL, Vogel RE, Cassellini R. “Tissue Preservation and Maintenance of Optimum Esthetics”. International J. Oral Maxillofacial Implants,15(2): 2:265-71. Mar-Apr2000.

[19] Fugazzotto P.A. “Simplified Technique for Immediate Implant Insertion into Extraction Sockets: Report of Technique and Preliminary Results”. Implant Dentistry,11(1):79-82.Fbruary,2002.

[20] Cavicchia F, Bravi F. “Case Reports Offer a Challenge to Treatment Strategies for Immediate Implants”. International J. Periodontics and Restorative Dentistry, 19(1):66-81, Feb.1999.

[21] Matthew D. McNutt, B.A., Chun-Han Chou, B.S. “Current Trends in Immediate Osseous Dental Implant Case Selection Criteria”J. of DentalEducation. Volume 67, number 8,August 2003.

[22] Saadoun AP, Landsberg CJ. “Treatment Classifications and Sequencing for Post Extraction Implant Therapy”. Practical Periodontics Aesthetic Dental, 9(8):933-41.Oct. 1997.

[23]Dr. med. Dent. Peter Gehrke. “Indications, Guidelines and Risk Factors of Early and Immediate Implant Placement: A Literature Review”, (1998).

1