Dear Mohammad,

1-The following publication (attached file) describes a comparison of Delayed Implant Placement vs Immediate Implant Placement Using Resonance Frequency Analysis: A Pilot Study on Rabbits. The conclusion of the study is:

Findings of this study show faster rates of osseointegration for implants placed by the

delayed placement method, as compared with immediately placed implants.

2-Another study entitled " Immediate and Delayed Restoration of Dental Implants in Patients with a History of Periodontitis: A Prospective Evaluation up to 5 Years" (see attached file).

Purpose: To evaluate the radiographic crestal bone level changes around immediately restored dental implants up to 5 years after insertion in patients with a history of periodontitis. Materials and Methods: Patients previously treated for chronic periodontitis who required a fixed full-arch restoration for the maxilla or

mandible or a fixed partial restoration in the esthetic zone were treated. Implant surgery included extraction of hopeless teeth, debridement around remaining adjacent teeth, and implant insertion guided by a surgical stent. A prefabricated screw-retained provisional restoration was immediately placed on selected implants. Periapical radiographs were taken at implant placement, 6 and 12 months postsurgery, and annually thereafter. The distance between the alveolar crest and the implant shoulder was measured at the mesial and distal aspects of each implant. Bone changes (BC) and annual rate of bone change (Rate) were calculated for the first year and the following 4 years. Results: Total BC (mean ± standard deviation) from baseline to 5 years (BCt0–t5) was –1.41 ± 0.67 mm. First-year BC (BCt0–t1) was –1.14 ± 0.86 mm, and BC in years 2 to 5 (BCt1–t5) was –0.27 ± 0.69 mm. Ratet0–t1 was –0.98 ± 0.79 mm/year and ratet1–t5 was –0.06 ± 0.17 mm/year. Fifty-seven of 61 available implants met the criterion of cumulative bone loss of no more than 1.5 mm for the first year and 0.2 mm/year for the following years. Four implants (7%; 95% confidence interval: 0.4% to 13.6%) failed the criterion. Conclusions: Dental implants in patients with a history of periodontitis showed radiographic bone changes similar to previous reports in the literature. After the first year, immediately restored implants exhibited crestal bone loss rates similar to those seen for conventionally restored implants. Int J Oral Maxillofac Implants 2012;27:1137–1143

Key words: bone loss, dental implants, immediate loading, periodontal disease

Conclusions

In the present study, dental implants in periodontally susceptible patients showed radiographic bone changes similar to previous reports in the literature regarding

patients with and without a history of periodontitis. After the first year, immediately restored implants exhibited bone loss rates similar to those seen around conventionally restored implants.

3-Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)

M Esposito, MG Grusovin, IP Polyzos, P Felice, HV Worthington

ABSTRACT

Background: ‘Immediate’ implants are placed in dental sockets just after tooth extraction. ‘Immediate-delayed’ implants are those implants inserted after weeks up to about a couple of months to allow for soft tissue healing. ‘Delayed’ implants are those placed thereafter in partially or completely healed bone. The potential

advantages of immediate implants are that treatment time can be shortened and that bone volumes might be partially maintained thus possibly providing good

aesthetic results. The potential disadvantages are an increased risk of infection and failures. After implant placement in postextractive sites, gaps can be present

between the implant and the bony walls. It is possible to fill these gaps and to augment bone simultaneously to implant placement. There are many techniques to

achieve this but it is unclear when augmentation is needed and which could be the best augmentation technique.

Objectives: To evaluate success, complications, aesthetics and patient satisfaction between ‘immediate’, ‘immediate-delayed’ and ‘delayed’ implants. To evaluate

whether and when augmentation procedures are necessary and which is the most effective technique.Search strategy: The Cochrane Oral Health Group’s

Trials Register (to 2 June 2010), CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE via OVID (1950 – 2 June 2010) and EMBASE via OVID (1980 – 2

June 2010) were searched. Several dental journals were handsearched.

Selection criteria: Randomized controlled trials (RCTs) comparing immediate, immediate-delayed and delayed implants, or comparing various bone augmentation procedures around the inserted implants, reporting the outcome of the interventions to at least 1 year after functional loading.

Data collection and analysis: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted independently and in duplicate. Trial authors were contacted for any missing information. Results were expressed as random-effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous

outcomes with 95% confidence intervals (CIs). The statistical unit of the analysis was the patient. Main results: Fourteen eligible RCTs were identified but

only 7 trials could be included. Four RCTs evaluated implant placement timing. Two RCTs compared immediate versus delayed implants in 126 patients and found

no statistically significant differences. One RCT The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions

about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews on the effects of healthcare interventions. The Cochrane Oral Health Group aims to produce systematic reviews which primarily include all randomized control trials (RCTs) of oral health, including prevention, treatment and rehabilitation of oral, dental and craniofacial diseases and disorders. Full copies of the review papers can be accessed electronically at http:// www.cochrane.org/reviews/index.htm, clicking on ‘Login to the Cochrane Library’, followed by clicking on ‘Cochrane Reviews’, and selecting the appropriate review. This is a free service provided by the Australian Government.

The Australian Dental Journal publishes selected abstracts in each issue for our readers’ interest. A detailed description of the activities of the Cochrane Oral Health Group, written by the Review Group Co-ordinator, Dr Emma Tavender, was published in the June 2004 issue of the Journal (Aust Dent J 2004;49:58–59). Also, for explanations of abbreviations and terminology please see Appendix 1 on page 59 of the aforementioned article.

Australian Dental Journal 2011; 56: 100–102

doi: 10.1111/j.1834-7819.2010.01308.x

http://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2010.01308.x/pdf

4-

Eur J Oral Implantol. 2010 Autumn;3(3):189-205.

Timing of implant placement after tooth extraction: immediate, immediate-delayed or delayed implants? A Cochrane systematic review.

Esposito M1, Grusovin MG, Polyzos IP, Felice P, Worthington HV.

Author information

Abstract

This review is based on a Cochrane systematic review entitled ‘Interventions for replacing missing teeth: dental implants in fresh extraction sockets (immediate, immediate-delayed and delayed implants)' published in The Cochrane Library (see http://www.cochrane.org/ for information). Cochrane systematic reviews are regularly updated to include new research, and in response to comments and criticisms from readers. If you wish to comment on this review, please send your comments to the Cochrane website or to Marco Esposito. The Cochrane Library should be consulted for the most recent version of the review. The results of a Cochrane review can be interpreted differently, depending on people's perspectives and circumstances. Please consider the conclusions presented carefully. They are the opinions of the review authors, and are not necessarily shared by the Cochrane Collaboration.

PURPOSE:

To evaluate success, complications, aesthetics and patient satisfaction among immediate, immediate-delayed and delayed implants in post-extractive sockets and whether and when augmentation procedures are necessary and which is the most effective augmentation technique.

MATERIALS AND METHODS:

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched up to the 2nd of June 2010 for randomised controlled clinical trials (RCTs) with a follow-up of at least 1 year in function comparing immediate, immediate-delayed and delayed implants, or comparing various bone augmentation procedures around the inserted implants. Outcome measures were prosthesis and implant failures, complications, patient satisfaction and preference including aesthetics, aesthetics evaluated by a dentist, peri-implant marginal bone level changes, etc. Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. The statistical unit of the analysis was the patient. Results were expressed as fixed effects models using mean differences for continuous outcomes and risk ratios (RR) for dichotomous outcomes with 95% confidence intervals (CIs).

RESULTS:

Fourteen eligible RCTs were identified but only seven trials could be included. Four RCTs evaluated implant placement timing. Two RCTs compared immediate versus delayed implants in 126 patients and found no statistically significant differences. One RCT compared immediate-delayed versus delayed implants in 46 patients. After 2 years, patients in the immediate-delayed group perceived the time to functional loading significantly shorter, were more satisfied and an independent blinded assessor judged the level of the peri-implant marginal mucosa in relation to that of the adjacent teeth as more appropriate (RR = 1.68; 95% CI 1.04 to 2.72). These differences disappeared 5 years after loading, and significantly more complications occurred in the immediate-delayed group (RR = 4.20; 95% CI 1.01 to 17.43). One RCT compared immediate with immediately delayed implants in 16 patients for 2 years and found no differences. Three RCTs evaluated different techniques of bone grafting for implants immediately placed in extraction sockets. No statistically significant differences were observed when evaluating whether autogenous bone is needed in post-extractive sites (one trial with 26 patients) or which was the most effective augmentation technique (two trials with 56 patients).

CONCLUSIONS:

There is insufficient evidence to determine the possible advantages or disadvantages of immediate, immediate-delayed or delayed implants, therefore these preliminary conclusions are based on few underpowered trials often judged to be at high risk of bias. There is a suggestion that immediate and immediate-delayed implants may be at a higher risk of implant failure and complications than delayed implants, on the other hand the aesthetic outcome might be better when placing implants just after tooth extraction. There is not enough reliable evidence supporting or refuting the need for augmentation procedures at immediate implants placed in fresh extraction sockets or whether any of the augmentation techniques is superior to the others.

http://www.ncbi.nlm.nih.gov/pubmed/20847990

Hoping this will be helpful,

Rafik

Immediate, Delayed-Immediate, and Delayed implant placement: Which one is superior over the others? 

Is there any significant difference between them regarding primary stability, alveolar bone loss, and/or the success rate?

 ITI describes the immediate, early and traditional or conventional loading protocols. Are you talking about loading protocols or implant placement protocols relative to tooth removal?

Tooth extraction followed by implant placement (immediately or after a few months of healing) does not seem to result in any implant survival differences.  Most authors report a slightly improved been response if the implant is placed on the day of tooth extraction but this is often dependent upon the location in the dental arch.

Considering loading protocols there certainly is a difference in implant performance relative to loading protocol.  Of course there are factors that favor each protocol in different instances.  I suggest looking at the article by Gallucci et al that documents the consensus conference of ITI recommendations.  There is no straightforward simple answer.

Consensus statements and clinical recommendations for implant loading protocols. Gallucci GO, Benic GI, Eckert SE, Papaspyridakos P, Schimmel M, Schrott A, Weber HP. Int J Oral Maxillofac Implants. 2014;29 Suppl:287-90. doi: 10.11607/jomi.2013.g4. 

I think the safest is the delayed placement. You actually know what if there and plan treatment accordingly.

There is no right answer. The immediate approach which we have been doing full arches since 1994 has been highly successful and the literature bears out that the bone-implant-contacts are actually improved with immediate function. It is really about the patient, their risk factors (periodontal/occlusal/smoking/bruxing, etc) and their specific site (CBCT eval) as to how I look at each case. The ITI Consensus Papers & Consensus statements on Loading protocols published in 2008 & 2014 in IJOMI are excellent guides as to how to handle cases. The opinions also vary based on countries as North America has always been more immediate placement where as parts of Europe/Australia with their excellent research (Buser, Chen et al) have excellent results with the delayed approach. It is really in my mind a site specific decision making process based on the individual site & patient.

Thank you very much dear Drs for your valuable answers.

if you look at reviews especially Cochrane revew, then, as of now the data is insufficient to suggest which one is better. most of the studies with RCTs FAIL to prove one better than the other.

Osseointegration of Dental implant is very similar to healing of an extraction  socket. Whatever the protocol we follow in the surgical  placement of the implant ...for the implant fixture to be effective  functionally to bear the prosthetic load ...it is preferrable to wait atleast 12weeks...that is DELAYED LOADING