Rajiv Gandhi University of Health Science, Bangalore,

Karnataka



MDS ORAL & MAXILLOFACIAL SURGERY



Synopsis for Registration of Dissertation.




M. R. Ambedkar Dental College and Hospital
#1/36, Cline Road, Cooke Town
Bangalore, Karnataka- 560005






RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE.
ANNEXURE II
SYNOPSIS FOR REGISTRATION OF DISSERTATION

1

NAME OF THE CANDIDATE
AND ADDRESS

DR. SAURABH GUPTA
Dept. Of Oral & maxillofacial surgery
M. R. Ambedkar Dental College & Hospital
#1/36, Cline Road ,Cooke Town
Bangalore-560005.


2

NAME OF INSTITUTION

M. R. AMBEDKAR DENTAL COLLEGE & HOSPITAL
#1/36, Cline Road ,Cooke Town
Bangalore-560005.


3

COURSE OF STUDY AND
SUBJECT

M.D.S ORAL & MAXILLOFACIAL SURGERY

4

DATE OF ADMISSION

01-06-2011

5

TITLE OF THE TOPIC:
Immediate Implant Placement into Extraction Sockets with Periapical Pathology: A Clinical and
Radiographical Evaluation




6
6.1





















BRIEF RESUME OF WORK :
NEED FOR STUDY :
Immediate implant placement of dental implants into fresh extraction sockets was shown to be a
predictable and successful procedure when proper protocols were followed.
Placement into sites associated with chronic periapical pathology has been considered a relative
contraindication. However, data from animal research, human case reports and case series, and
prospective studies showed similar success rates for implants placed into sites associated with chronic
periapical pathology compared with implants placed in non pathologic or pristine sites.
The need of this study is to evaluate the success of dental implants placed immediately into extraction
sites in the presence of chronic periapical pathology.












6.2






















REVIEW OF LITERATURE :
In this study it has been shown that implants can be placed successfully into fresh extraction sites.
However, can implants be safely placed chronically infected extraction sockets? Several authors have
stated that extraction sites should be infection free to place immediate implants. In a study of 30
partially edentulous patients, 61 transmucosal implants were placed immediately into sites with chronic
periapical lesions. Of those implants, only one failed, for a success rate of 98.4% [1]
In this study it was concluded that immediate implant placement in the presence of chronic periapical
infection could be considered a safe, effective, and predictable treatment option [2]
In this study it was concluded that for those implants where primary stability was achieved, the
immediate implant placement performed at extraction sockets exhibiting periapical pathology did not
lead to an increased rate of complications and rendered an equally favorable type of tissue integration of
the implants in both groups. Implants placement into such sites can, therefore, be successfully
performed[3]
A study was conducted on 15 patient with periapical lesions who underwent immediate implant
placement. Fifteen implants with single tooth extractions and no periapical pathology served as the
control. Clinical parameters such as probing depth, modified plaque index, modified bleeding index,
marginal gingival level, keratinized mucosa, and marginal bone levels were evaluated at baseline and at
12 and 24 months after implant placement. Both study groups had a survival rate of 100% [4]
Several other studies have been performed with similar results. The sample size of these investigations
has been relatively small. The purpose of these retrospective chart review is to explore the viability of
immediately placed implants into extraction sites with radiolucencies in a large cohort of patients[5-9]
In this study it is concluded that when utilizing the protocol outlined, implants can be placed into
extraction sockets previously associated with subacute or chronic infections of periodontal and
endodontic origin[9]
Whenever the decision has been made to replace a failed tooth with an implant, careful consideration
should be given to placing the implant at the time of extraction, rather than delaying placement until
after healing of the site has occurred[10]

























Immediate implants are increasingly predictable and as illustrated in this study, with all parameters
being favorable to success, can provide esthetically superior results at least in the short term follow-up
period[11]
According to this study immediate implant placement following tooth extraction has been found to be a
viable and predictable solution to tooth loss. Minimally invasive surgical technique, ease of procedure
and shorter time involved together with minimum postextraction complications are the important
advantages of this method. However, proper case selection and meticulous postoperative care preceded
by good surgical and prosthetic protocol are the essentials for success[12]














6.3






















AIMS AND OBJECTIVES OF THE STUDY:
The aim of the study is to evaluate the clinical and radiographic analysis of immediate placement of
implant in the presence of chronic periapical radiolucencies of mean size less than 3mm.
Following are the criteria to be assessed:
1. To evaluate the stability of the implant clinically.
2. To evaluate the amount of bone formation around the peri-implant surface radiographically.
3. Radiographic assessment of any sign of peri-implant pathology.



















7.

7.1





















MATERIALS AND METHODS:
SOURCE OF DATA:
Patients who would be visiting the department of Oral & maxillofacial surgery of M. R. Ambedkar
Dental College and Hospital, Bangalore will be selected. Ten implants will be placed immediately
following tooth extraction with periapical pathology. Placement of graft (Alloplast) is done if required.
Implant will be loaded after 4-6 months. Patients will be evaluated for clinical and radiographic
parameters at 1 week, 1 month, 2 months, 3months, 6 months and 9 months.
INCLUSION CRITERIAS
1. Patients with age group 18-60.
2. Patients who are medically fit and are willing for extraction and undergo immediate implant
placement procedure and can come for regular post operative follow up
3. Presence of chronic periapical radiolucencies of mean size less than 3 mm
4. Patient who will strictly follow the maintenance and oral hygiene instructions to prevent peri-
implantitis
EXCLUSION CRITERIAS
1. Medically compromised patients like uncontrolled diabetes, hypertension
2. Patients who are undergoing corticosteroid therapy
3. Chronic smokers
4. Pregnancy



7.2
















7.3





METHOD OF COLLECTION OF DATA:
On clinical and radiographical evaluation of patient, following parameters will be recorded:
PARAMETERS
RADIOLOGICALLY:
1) Crestal bone level changes around implant surface on intra oral periapical radiograph at 3
months, 6 months and 9 months.
2) Presence or absence of periapical radiolucencies on intra oral periapical radiographs.
CLINICALLY :
1) Initial stability of the Implant at the time of placement and during abutment placement and
at 9 months.
2) Presence of any source of infection in and around implant at 3 weeks, 3 months and 6
months and 9 months.




ANALYSIS OF DATA:
The results will be then statistically analyzed by Student T-test.



7.4





7.5



















DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON
PATIENTS ON OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE
BRIEFLY.
The Study requires IOPA radiographic views at standardized angles and blood investigations which are
routinely done on patients for diagnosis in M R Ambedkar Dental College and Hospital, Bangalore. CT
radiographs will be taken if required.
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF
7.4 ?
To be obtained.











8






REFERENCES :
1. Christopher Lincoln Bell, David Diehl, Bryan Michael Bell and Robert E. Bell, 2011
Immediate placement of dental implants into extraction sites with periapical lesions: A
retrospective chart review. International Journal of oral and maxillofacial surgeons
2. Siegenthaler DW et al, 2007 Replacement of teeth exhibiting periapical pathology by
immediate implant placement: a prospective, controlled clinical trial Clinical and Oral
Implants Research. 2007 Dec;18(6):727-37.
Epub 2007 Sep 20.
3. Del Fabbro M et al, 2009. Immediate implant placement into fresh extraction sites with
chronic periapical pathologic features combined with plasma rich in growth factors:
preliminary results of single-cohort study. Journal of Oral and Maxillofacial Surgery. 2009
Nov;67(11):2476-84.
4. Crespi R et al, 2010. Fresh-socket implants in periapical infected sites in humans
Journal of Periodontology. 2010 Mar;81(3):378-83.
5. Chang SW et al. Immediate implant placement into infected and noninfected extraction
sockets: a pilot study.
6. Waasdorp JA et al, 2010. Immediate placement of implants into infected sites: a systematic
review of the literature Journal of Periodontology.2010 Jun;81(6):801-8.
7. Novaes AB et al, Immediate implants placed into infected sites: a clinical report
International Journal of Oral Maxillofacial Implants. 1995 Sep-Oct;10(5):609-13.
8. Naves Mde M et al, 2009 Immediate implants placed into infected sockets: a case report
with 3-year follow-up Braz Dent J. 2009;20(3):254-8.



9. N., Zelster C et al, 2007. Immediate Placement of Dental Implants Into Debrided Infected
Dentoalveolar Sockets. Journal of Oral and Maxillofacial Surgery. Vol 65 No.3 pp 384-
392.
10. Jack Haln et al, 2010. The Emergency Implant: Immediate Extraction Replacement in the
Esthetic Zone. International Journal of Oral Implantology and Clinical Research, January-
April 2010;1(1):1-10.
11. T.V Narayan et al, 2010.Immediate Implantation in the Anterior Maxilla: A case Report
and Discussion of Advantages and Pitfalls. International Journal of Oral Implantology and
Clinical Research, January- april 2010;1(1):33-36
12. Sahitya Sanivarupa et al, 2010. Immediate Implant Placement Following Tooth Extraction:
A clinical and Radiological Evaluation, International Journal of Oral Implantology and
Clinical Research, May-August 2010;1(2):67-76.



9

SIGNATURE OF THE
CANDIDATE


10

REMARKS OF GUIDE


11

NAME AND DESIGNATION OF
GUIDE


DR.SHASHIKALA R.
PROFESSOR & HEAD OF DEPARTMENT
DEPARTMENT OF ORAL & MAXILLOFACIAL
SURGERY


11.1

SIGNATURE



11.2

CO-GUIDE


,

11.3

SIGNATURE


11.4

HEAD OF THE DEPARTMENT


DR. SHASHIKALA R.
PROFESSOR & HEAD OF DEPARTMENT,
DEPARTMENT OF ORAL & MAXILLOFACIAL
SURGERY.

11.5

SIGNATURE


11.6

REMARKS OF PRINCIPAL


11.7

SIGNATURE