Immediate implant placement and loading using a prefabricated final reconstruction. A proof-of-concept study

To evaluate patient-reported outcome measures (PROMs) and prosthetic outcomes in patients receiving a definitive restoration after extraction and immediate implant placement in the esthetic zone.

Twelve patients in need of tooth extraction and immediate implant placement and provisionalization in the esthetic zone were consecutively recruited. Restoration-based treatment planning was performed applying a fully digital workflow including the fabrication of a prefabricated definitive monolithic zirconia crown prior to the surgery. Tooth extraction and guided surgery was performed in all patients and immediate placement and loading was carried out with the prefabricated definitive restoration on the day of surgery. The restoration was evaluated by the patients and by two experienced and calibrated clinicians using modified USPHS (United States Public Health Service) criteria to evaluate the treatment outcome.

In 9 out of 12 patients, the crowns were inserted at the same visit without any adjustments. Two crowns required minor adjustment-one at the incisal edge position and another at the distal contact area. These were delivered at the same clinical visit after the necessary adjustments had been made. One crown showed a misfit and was in need of a new scan and an adjustment in the laboratory prior to insertion at the next visit on the following day. Patient satisfaction was 9.41 ± 0.49 at baseline and 9.6 ± 0.47 at the 6-month follow-up. Clinical outcomes in terms of periimplant soft tissue health, interdental papillae levels, and midfacial mucosal levels were assessed at the time of implant placement (baseline) and 6 months postoperatively. All patients reported highly satisfactory results for all the parameters assessed.

Digitally driven immediate implant placement and loading with prefabricated definitive restorations in the esthetic zone may serve as a valid clinical protocol. However, further randomized controlled clinical trials are needed to prove the efficacy of this protocol.

Immediate definitive restorations were inserted on the day of immediate implant placement following digital protocols. However, clinicians should be cautious when applying the immediate implant protocol in the esthetic zone as the prosthesis may need minor adjustments.