Accuracy of Tooth Guided Immediate Implant Placement at Molar Region

Study Overview
=================
Brief Summary
-----------------
Introduction: The concept of immediate implant placement has become popular due to reduced trauma and reduced overall treatment time. Removal of molar teeth provides a challenging and intriguing dilemma due to multiple root morphology. In cases of extraction and immediate placement of implants in the molar region, removal of the inter-radicular septum should be avoided to attain initial implant stability at the time of placement, and prevent slipping of the implant into the extraction socket. Following this technique prevents the slippage of the implant and allows the implant to be guided into the inter-radicular septum. Objectives: To assess the accuracy of implant placement using the remaining roots of multi-radicular mandibular molars, evaluate bone density around implants and implant stability in fresh extracted site. Materials and Methods: A prospective study was done on 10 patients with badly destructed mandibular molars. The technique of implant insertion consisted of a progressive preparation of the implant site using the anatomy of the root of the multi-radicular mandibular molars to be extracted as a reference and as an aid to engage the inter-radicular septum.

Official Title
-----------------
Accuracy of Tooth Guided Immediate Implant Placement at Molar Region

Conditions
-----------------
Immediate Implant Placement Guided by the Roots of Multiradicular Teeth

Intervention / Treatment
-----------------
* Procedure: Tooth guided immediate implant placement


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Badly destructed mandibular molar teeth. Integrity of the roots. Bone coverage of 2/3 of the root. Sufficient bone volume. Adequate interocclusal distance >7mm. Adequate amount of keratinized mucosa. Age ranging from 20-45 years. Medically fit patients. Exclusion Criteria: Unfavorable position of the tooth or remaining roots. Molars with Fused roots. Root ankylosis. Patients with systemic conditions known to affect the periodontal status and healing such as uncontrolled diabetes and osteoporosis. Patients receiving chemotherapy or radiotherapy. Heavy smokers.

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 45 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: tooth guided immediate implant placement group<br> | Procedure: Tooth guided immediate implant placement<br>* The technique of implant insertion consisted of a progressive preparation of the implant site using the anatomy of the root of the multi-radicular mandibular molars to be extracted as a reference and as an aid to engage the inter-radicular septum<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| implant stability quotient | implant stability quotient will be assessed using Osstell device. | 3 months | 
| Implant position accuracy using cone beam computed tomography | Immediate postoperative and a preoperative conebeam CT will be done. The preoperative and postoperative scans will then be over¬lapped using a dedicated algorithm, which will allow the comparison of the virtually planned and the actual implant positions. Three deviation parameters between each planned and placed implant will be measured. All measurements will be performed using Mimics Innovation Suite 19 ™ software (Materialise Mimics software 3D Medical Imaging, Belgium). For analyzing the accuracy, the planned position of the implant will be compared with the actual position of the implant after insertion. Several measuring points will be measured: Horizontal deviation at coronal side of the implant. Horizontal deviation at apex of the implant. Angular deviation. | immediately | 
| Bone density around implant |  | 6 months |