Computer Guided Versus Free Hand Immediate Implant Placement
Condition: Dental Implants
Study type: Interventional

Summary: 
      Patients with remaining root or fractured teeth indicated for extraction in the esthetic zone
      will be recruited to the study. After extraction of the tooth implant will be placed
      immediately, implants will be placed either by free hand or computer guided technique.
      patient satisfaction will be evaluated as primary outcome and early implant failure was
      evaluated as secondary outcome.
    

Detailed description: 
      General operative procedures:

      Eligible patients will be randomized, at the surgical phase in two groups, study group (in
      which computer guided implant placement was done using computer aided surgical guide) and
      comparative group (in which free hand implant placement was done).

      Patients of both groups will be subjected to:

      Careful clinical examination and medical and dental history taking. CBCT scan will be
      performed while patients biting on cotton roll to separate the teeth of interest from
      opposing dentition, moreover cotton rolls will be placed in vestibule for separation of lip
      and check from teeth of interest.After examination of the CBCT scan, maxillary and mandibular
      alginate impression will be made for eligible patients.For temporary crown fabrication after
      the surgery, the tooth or root to be extracted will be modified on the study cast and an
      artificial tooth will be placed. After that a 2mm hard vacuum sheet will be pressed on the
      study cast. For the test group (computer guided group), three dimensional (3d) virtual
      planning of the surgical guide and implant position will be made with the aid of Blue Sky ®
      implant planning software . After proper selection of implant size, diameter and position,
      the virtual surgical guide will be exported as a STL file for 3D printing. Before the
      surgery, adaptation of the surgical guide will be checked on the study cast and a metallic
      sleeve will be attached at proposed implant position using adhesive.

      Intraoperative procedure:

      3 days before the surgery, a prophylactic antibiotic will be given to the patient. On the day
      of surgery, local anaesthesia will be injected and a traumatic extraction of the remaining
      root or tooth will be performed. For a traumatic extraction, gentle application of a
      periotome mesio-distally along with slight rotational movement. After extraction, intact
      labial and palatal socket walls will be checked using periodontal probe for immediate implant
      placement. For the test group, the computer aided surgical guide will be checked for
      adaptability and any interference will be removed. After that implant drilling and placement
      will be performed using the surgical guide. For the control group, free hand implant drilling
      and placement will be performed guided by the extraction socket walls. For both groups
      implant primary stability will be checked by application of 35 Ncm2 force using torque wrench
      After that, the final abutment will be screwed in its position and the temporary crown will
      be made using the vacuum stent, where a chair side tooth coloured autopolymerizing resin will
      be injected into the vacuum stent at the proposed implant site. Finally, occlusion will be
      checked for any functional contact in maximum intercuspation and lateral movement. Any
      contact with the opposing should be removed and the patient will be instructed to avoid
      eating or incising on the temporary crown for at least two weeks. Seven days later patients
      will be recalled for inspection and taking postoperative photos, six months thereafter, the
      patient will receive a definitive crown.
    

Intervention name(s): Computer guided implant placement
Intervention type(s): Procedure
Intervention description(s): Implant will be placed immediately using computer aided surgical guide
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: computer guided; immediate implant; patient satisfaction