The Anatomical Conditions of the Alveolar Process of the Anterior Maxilla in Terms of Immediate Implantation-Radiological Retrospective Case Series Study

Piotr Wychowański; Anna Starzyńska; Martyna Osiak; Jan Kowalski; Barbara Alicja Jereczek-Fossa; Blanka Seklecka; Tadeusz Morawiec; Paulina Adamska; Jarosław Woliński

doi:10.3390/jcm10081688

The Anatomical Conditions of the Alveolar Process of the Anterior Maxilla in Terms of Immediate Implantation-Radiological Retrospective Case Series Study

J Clin Med. 2021 Apr 14;10(8):1688. doi: 10.3390/jcm10081688.

Authors

Affiliations

¹ Department of Oral Surgery, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland.
² Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland.
³ Department of Periodontology and Oral Diseases, Medical University of Warsaw, 6 Binieckiego Street, 02-097 Warsaw, Poland.
⁴ Department of Oncology and Hemato-Oncology, University of Milan, 7 Festa del Perdono Street, 20-112 Milan, Italy.
⁵ Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, 435 Ripamonti Street, 20-141 Milan, Italy.
⁶ Early Clinical Trials Unit, University Clinical Centre, 17 Smoluchowskiego Street, 80-214 Gdańsk, Poland.
⁷ Department of Oncology and Radiotherapy, Medical University of Gdansk, 3a M. Skłodowskiej-Curie Street, 80-210 Gdańsk, Poland.
⁸ Department of Oral Surgery Silesian Medical University, 17 Plac Akademicki Street, 41-902 Bytom, Poland.
⁹ Department of Animal Physiology, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 3 Instytucka Street, 05-110 Jabłonna, Poland.

Abstract

The feasibility and the level of difficulty of immediate flapless implantation depend largely on the residual alveolar bone. The purpose of the study was to determine how often immediate flapless implantation in the anterior maxilla is feasible and assess the difficulty level using cone-beam computed tomography (CBCT) scans. A radiological retrospective case series study was conducted. In total, 1200 CBCT scans from 300 consecutive patients were analyzed with dedicated planning software. Immediate flapless implants were possible in 78.33% of cases. Drilling direction was either through the apex or the palatal slope. Bimodal was conducted in 9% of the cases; only through the apex in 13.08% of the cases and in 56.25% only in the slope. In 21.67%, immediate flapless implants were excluded. The feasibility and degree of difficulty differed statistically to the disadvantage of the lateral incisors compared to the central incisors. Drilling direction caused that BASE classification reflects the difficulty level of immediate implantation. CBCT is a helpful diagnostic tool for assessing the feasibility of immediate flapless implants due to the residual bone shape and volume. BASE classification helps to determine a challenge level that may also facilitate communication and result in comparison. The alveolar bone condition allows for immediate flapless implants in most cases in the aesthetic region of the maxilla, but they should be performed by an experienced specialist with regard to the bone and soft tissue quality.

Keywords: aesthetic region of maxilla; alveolar bone shape; bone anatomy; classification; cone-beam computer tomography (CBCT); dental implants; flapless implants; immediate implantation; predictable implantation.