Elamrousy Novel Approach for Immediate Implant Placement Using Socket Sheild Technique
Condition: Implant Site Reaction; Tooth Extraction Status Nos; Dental Implant Failed
Study type: Interventional

Summary: 
      The current trial aim was to evaluate clinically and radiographically the changes around
      dental implants inserted immediately in maxillary anterior esthetic zone using a novel
      combination of autogenous demineralized dentin graft (ADDG) with socket shield technique
      (SST) and compared this approach to socket shield technique (SST) alone.

      The present study included 50 participants, aged 20 to 45, with teeth that needed to be
      extracted. After Kafrelsheikh University research ethics committee approval, participants
      were randomized into 2 groups: the control group patients underwent immediate implantation
      using SS protocol, while the study group patients underwent the same procedure, but ADDG was
      created using the extracted palatal portion of the tooth; and then placed in the peri-implant
      gap defect.
    

Detailed description: 
      However, Immediate placement protocol of dental implants reported favorable improvement of
      esthetic indices such as the Pink Esthetic Score (PES), mid-facial mucosal recession (MFMR)
      was the most common esthetic drawback. MFMR occurrences increase in case of thin gingival
      biotype, facial implant malposition, and thin or destroyed facial bone plate after tooth
      removal.

      To avoid MFMR, dental implants should be placed immediately only when the clinical conditions
      are ideal including completely intact facial plate of bone, more than 1mm thick facial plate
      of bone, absence of periapical pathosis or infection at the extracted socket, thick gingival
      biotype, presence of sufficient bone palatal and apical to the extraction socket for proper
      positioning of the implant fixture and obtaining acceptable primary stability. These ideal
      conditions are rarely observed in the maxillary anterior region. Although proper patients'
      selection and treatment by specialists with high experience and skills, the esthetic outcomes
      of immediately placed dental implant showed unsatisfactory deteriorated facial tissues on the
      mid- to long-term.

      Following root extraction, the thin delicate avascular cortical bone plate showed massive
      loss and deterioration due to loss of its vascular blood supply obtained from the root
      periodontal ligament. To overcome this negative esthetic outcome during immediate placement
      of dental implants, different materials and techniques were used around implants such as bone
      graft substitutes, growth factors and barrier membranes.

      In 2010, Hurzeler and colleagues introduced a novel approach for immediate implantation
      called Socket Shield Technique (SST). This minimal invasive technique resulted in
      preservation of facial bone plate which in turn improved the esthetic outcomes. Partial
      extraction therapy, the root membrane technique and the modified SST are different
      terminologies and modifications of the original approch. In SST protocol, tooth decoronation
      followed by root splitting mesio-distally. The palatally splitted portion of the root is
      atraumatically extracted while the intact buccal root portion is kept in place with thickness
      of 1.5mm. The implant fixture is then placed palatally with 2mm gap distance in between.
      finally, that gap might be grafted or left without grafts.

      SST showed enhancement of hard and soft tissue conditions around implants, implant stability
      and esthetic results compared with traditional immediate placement protocol of dental
      implants. Till now, few studies evaluated the effect of grafting the gap between the buccal
      tooth shield and the implant fixture.

      Globally, extracted teeth are regarded as infectious waste. Teeth are made up of organic
      matrix and inorganic hydroxyapatite reinforcing phase, that's why teeth are gaining
      popularity as a potential resource for alveolar bone repair. Non-demineralized tooth grafts
      produced positive outcomes, but bone and tooth demineralization enhances the bioavailability
      of non-collagenous proteins associated with the matrix, such as osteocalcin, osteonectin,
      bone sialoprotein, phosphophoryn, and bone morphogenetic protein, which could promote the
      creation of new bone. A valuable three-dimensional biological scaffold with osteopromotive
      and osteoconductive properties is provided by ADDG. Additionally, it saves the patient money
      on the cost of other graft materials and lowers the worldwide amount of infectious dental
      waste.

      The specific question of the current research was: Does using ADDG for grafting the gap
      between the tooth shield and the implant fixture in immediate dental implantation with SST
      improve the clinical and radiographic outcomes in comparison to immediate implant placement
      with SST alone without using bone graft?
    

Intervention name(s): Elamrousy Novel Approach for Immediate Implant Placement Using Socket Shield Technique; Immediate Implant Placement Using Socket Shield Technique alone
Intervention type(s): Procedure; Procedure
Intervention description(s): The flapless strategy was used. To prepare the SS, tooth decoronation followed by root splitting mesio-distally. The palatally splitted portion of the root is atraumatically extracted while the intact buccal root portion is kept in place with thickness of 1.5mm.(12) The implant fixture is then placed palatally with 2mm gap distance in between. finally, that gap was grafted with ADDG; The flapless strategy was used. To prepare the SS, tooth decoronation followed by root splitting mesio-distally. The palatally splitted portion of the root is atraumatically extracted while the intact buccal root portion is kept in place with thickness of 1.5mm.(12) The implant fixture is then placed palatally with 2mm gap distance in between. finally, that gap was left without grafts.
Other intervention name(s): Immediate Implant Placement Using Socket Shield Technique grafted by autogenous demineralized dentin graft
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The present study included 50 participants, aged 20 to 45, with teeth that needed to be extracted. After Kafrelsheikh University research ethics committee approval, participants were randomized into 2 groups: the control group patients underwent immediate implantation using SS protocol, while the study group patients underwent the same procedure, but ADDG was created using the extracted palatal portion of the tooth; and then placed in the peri-implant gap defect. Clinically, pink aesthetic score (PES), midfacial mucosal alterations (MFMA), implant stability quotient (ISQ) were observed at baseline, six and twelve months after implantation. Moreover, baseline, 6- and 12-months alterations of radiographic horizontal bone dimension (HBD), buccal marginal bone level (BMBL), peri-implant Bone Density (PIBD) and peri-implant vertical bone defect (PIVBD) changes were assessed using cone beam computed tomography (CBCT).
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment