Influence of Abutment Angulation on Implant Failure in Immediately Placed and Restored Implants in the Esthetic Zone Using Computer Aided Surgical Guides: RCT
Condition: Immediate Dental Implants
Study type: Interventional

Summary: 
      patients with fractured teeth in the esthetic area requiring immediate restoration will be
      recruited to the study. Immediate implants will be placed and patients will be restored
      either with straight or angled abutments. Implant failure will be measured.
    

Detailed description: 
      A: General operative procedures:

      The study will be explained in details to the eligible participants with all possible
      alternative treatment options and possible risk.

      If a patient accepts the treatment, informed consent will be signed. Standard extra oral and
      intraoral examination will be carried out. Diagnostic charts will be filled including medical
      and past dental history.

      The patient will choose a sealed envelope to determine the allocation group. Preliminary
      impressions will be taken. The tooth to be extracted will be trimmed from the cast and an
      ideal wax up will be done.

      A hard vacuum stent 2 mm thickness will be constructed over the cast with the wax up for
      fabrication of the temporary crown later.

      The patient will be imaged a cone beam computerized topography (CBCT). The acquired DICOM
      image will be assessed on blue sky software ®. All the cases must have adequate buccolingual
      bone, if not the patient will be excluded from the study.

      The co-supervisor (MW) will inform the principle investigator (HF) with the allocation group.

      The principle investigator (HF) will plan the case. The implants will be planned apical to
      socket depth to engage apical bone for better primary stability. Final implant position 3
      dimensionally will be according to allocation group to allow for placement of either straight
      or angled abutment.

      The guide will be exported from the software and printed.

      Intra operative procedures:

      Patients will administrate a prophylactic antibiotic 3 days ahead the surgery. The procedure
      will be carried out under local anesthesia under sterile conditions.

      The remaining tooth will be extracted atraumatically using periotome for better bone
      preservation.

      After tooth extraction, the socket will be curettaged and irrigated with copious saline till
      fresh bleeding from the socket is observed.

      Surgical guide will be placed and checked for stability and drilling will be performed
      following instructions.

      Before implant insertion, the prepared osteotomy will be lavaged thoroughly to remove any
      drill debris from the socket.

      The implant will be placed and the insertion torque will be checked using manual torque
      wrench. Implants with insertion torque less than 35Ncm will not be loaded and will be
      excluded from the study.

      Periapical radiographs will be taken to ensure proper seating of the implant. The abutment,
      whether straight or angled according to the allocation group, will be attached to the implant
      fixture.

      The vacuum stent will be used to perform the temporary crown using autopolymerizing resin.
      The crown will be checked to be out of occlusion in centric and eccentric occlusion to avoid
      any premature contact and subsequent overloading. Then the crown will be cemented and excess
      cement will be removed using dental floss.

      The patient will be called for follow up after 1 week for the first 3 weeks then at 1 month
      and 3 months.
    

Intervention name(s): Angled Abutment; straight abutment
Intervention type(s): Other; Other
Intervention description(s): virtual implants will be placed on a planning software allowing abutments to be placed at an angle to the implant. Teeth will be extracted at the surgery using periotome and implants will be placed using computer aided surgical guide. The angled abutment will be placed and a temporary crown material will be fabricated.; virtual implants will be placed on a planning software allowing abutments to be placed at straight to the implant. Teeth will be extracted at the surgery using periotome and implants will be placed using computer aided surgical guide. The straight abutment will be placed and a temporary crown material will be fabricated.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: immediate implants, implant failure, angled abutments