
The present case series reports clinical and radiological results from 50 dental implants (C-Tech Implants Esthetic Line, C-Tech Implants, Bologna, Italy) that were placed immediately after the extraction of non-salvageable teeth in 21 patients (11 women, 10 men) in the HL Dentclinic in Baden Baden, Germany. Patients presented prior to implant placement with teeth that were not worth preserving in the mandible and maxilla. Implants were placed immediately after tooth extraction in case of an intact alveolar socket in the upper (31 implants) and lower (19 implants) jaw. A total of 10 implants, all of which were inserted in the upper molar region, were loaded immediately, while 40 implants were restored after a mean Osseointegration period of six months after the implants were placed. In total, 44 implants were restored with fixed, and 6 implants with removable prosthetics. After a mean loading period of two years, the placed implants were examined regarding implant survival, implant success and marginal bone loss. In some of the participating patients, further implants were placed delayed after tooth loss, and these implants were, therefore, not included in the present follow-up investigation.
In the present case series, dental implants of the Esthetic Line (EL, C-Tech Implants, Bologna, Italy) were placed. The implant system combines several design features that have proven to guarantee long-term stability, peri-implant health and favorable handling. The Bone Level Implants allow equi- or subcrestal setting and prevent exposure of the implant through bone resorption. They are therefore ideal for the esthetic zone. Implants are manufactured with three different threading profiles, adapted to different bone structures along the depth of the implant, and guarantee high grades of primary stability. Further, they have a beveled shoulder, which facilitates bone growth above the shoulder and a grit-blasted and acid-etched surface topography. Regarding the implant abutment connection, the implant provides a Morse locking conical connection with platform switching and an indexing hex. Therefore, peri-implant bone loss is prevented and the biological width can be preserved.
Immediate implant placement was considered in case of teeth not worth preserving that were free of acute infections, with stable extraction sockets and sufficient bone quality and quantity to achieve a sufficient rate of primary stability. In all patients, implant placement and previous tooth extraction was performed under local anesthesia. After tooth extraction, a minimal-invasive mucoperiosteal flap without releasing incisions was mobilized for a better overview of the extraction site. Thereby, particular attention was paid to the buccal bone. In the upper incisor region, the implant position was set slightly palatinally in relation to the extracted teeth. Subsequently, implant bed preparation was performed according to the surgical protocol of the C-Tech dental implant system. The number, localization, length and diameter of the implants were planned by clinical patient investigation, analysis of jaw models and two- or three-dimensional radiographics (Dental volume tomography or panoramic radiographics). Implants were placed subcrestally with an insertion torque of at least 25 Ncm. A sealing screw was incorporated, and wound margins were adapted with absorbable tension-free single sutures.
Two years after implant insertion, a clinical and radiological follow up investigation was conducted at the HL Dentclinic Baden, Germany, according to previously published methods [36,37].
Patient | Gender (m/f) |
Age (years) |
Implant lokalisation (Regio) |
Implant diameter (mm) |
Implant length (mm) |
Loading protocol |
Prosthetic rehabilitation |
1 | f | 51 | 14 | 3,5 | 13 | d.l. | f.p. |
11 | 3,5 | 13 | d.l. | f.p. | |||
21 | 4,3 | 11 | d.l. | f.p. | |||
24 | 3,5 | 13 | d.l. | f.p. | |||
31 | 3 | 11 | d.l. | f.p. | |||
41 | 3 | 11 | d.l. | f.p. | |||
2 | m | 74 | 21 | 3 | 11 | d.l. | f.p. |
23 | 4,3 | 13 | d.l. | f.p. | |||
3 | m | 51 | 16 | 3,5 | 13 | d.l. | f.p. |
d.l. | f.p. | ||||||
4 | f | 54 | 25 | 3,5 | 13 | d.l. | f.p. |
5 | m | 69 | 14 | 3,5 | 11 | d.l. | f.p. |
d.l. | f.p. | ||||||
6 | m | 59 | 12 | 4,3 | 13 | d.l. | f.p. |
7 | f | 62 | 46 | 4,3 | 11 | d.l. | f.p. |
8 | m | 58 | 46 | 4,3 | 11 | d.l. | f.p. |
d.l. | f.p. | ||||||
9 | f | 65 | 12 | 3,5 | 13 | d.l. | f.p. |
10 | f | 66 | 15 | 3,5 | 11 | i.l. | f.p. |
14 | 3,5 | 13 | i.l. | f.p. | |||
13 | 3,5 | 13 | i.l. | f.p. | |||
23 | 3,5 | 13 | i.l. | f.p. | |||
24 | 3,5 | 13 | i.l. | f.p. | |||
25 | 3,5 | 11 | i.l. | f.p. | |||
11 | m | 69 | 42 | 3,5 | 13 | d.l. | f.p. |
12 | m | 51 | 34 | 3,5 | 11 | d.l. | f.p. |
46 | 4,3 | d.l. | f.p. | ||||
13 | f | 64 | 15 | 3,5 | 13 | d.l. | f.p. |
14 | f | 71 | 44 | 3,5 | 11 | d.l. | f.p. |
15 | f | 69 | 36 | 3,5 | 11 | d.l. | f.p. |
16 | m | 54 | 22 | 3,5 | 13 | d.l. | f.p. |
37 | 4,3 | 13 | d.l. | f.p. | |||
47 | 4,3 | 9 | d.l. | f.p. | |||
17 | f | 47 | 13 | 3,5 | 11 | d.l. | f.p. |
15 | 3,5 | 11 | d.l. | f.p. | |||
18 | f | 69 | 41 | 3 | 11 | d.l. | f.p. |
19 | f | 58 | 17 | 3,5 | 11 | d.l. | f.p. |
21 | 3,5 | 13 | i.l. | f.p. | |||
22 | 3,5 | 13 | i.l. | f.p. | |||
23 | 3,5 | 13 | i.l. | f.p. | |||
24 | 3,5 | 11 | i.l. | f.p. | |||
20 | m | 56 | 17 | 4,3 | 11 | d.l. | f.p. |
27 | 3,5 | 11 | d.l. | f.p. | |||
37 | 4,3 | 11 | d.l. | f.p. | |||
46 | 3,5 | 11 | d.l. | f.p. | |||
47 | 3,5 | 11 | d.l. | f.p. | |||
21 | m | 64 | 41 | 3,5 | 13 | d.l. | r.p. |
43 | 3,5 | 13 | d.l. | r.p. | |||
31 | 3,5 | 13 | d.l. | r.p. | |||
33 | 3,5 | 13 | d.l. | r.p. | |||
Total:21 | 11*f; 10* m |
Mean: 61 | total:50; 31*u.j, 19*l.j. | 4*3mm, 34*3,5mm, 12*4,3mm |
1*9mm, 25*11mm, 24*13mm |
10*i.l., 40*d.l. |
44*f.p., 6*r.p |
f: female; m: male; d.l.: delayed loading; i.l.: immediate loading; f.p.: fixed prosthetics; r.p.: removable prosthetics; u.j.: upper jaw; l.j.: lower jaw
• Implant being in situ
• Width and thickness of peri-implant keratinized gingiva
• Pink esthetic score (PES)
• Probing depth
• Bleeding on probing (BOP)
• Peri-implant bone loss
• Presence of peri-implant osteolysis
Altogether, 50 implants were placed after the extraction of non-salvageable teeth: 31 implants were placed in the upper jaw and 19 implants in the lower jaw. The implant diameter varied between 3 mm (4 implants), 3.5 mm (34 implants) and 4.3 mm (12 implants). The implant length varied between 9 mm (1 implant), 11 mm (25 implants) and 13 mm (24 implants). A total of 10 implants, all in the upper jaw, were restored and loaded immediately, and 40 implants were delay loaded after a mean healing period of 6 months (4-7 months). Prosthetic restoration consisted of fixed prosthetics (44 implants) and removable prosthetics (r.p.) (6 implants) (see Table 2).
Patient rehabilitation |
Implant lokalisation (Regio) |
Implant loss (+/-) |
buccal width of keratinized peri-implant gingiva (mm) |
buccal thickness of keratinized peri-implant gingiva (mm) |
Pink Esthetic Score (PES) |
Probing depth (mm) at six sites (mb, b, db, mo, o, do) |
Bleeding on Probing (BOP) (+/-) |
Peri-implant bone loss (mm) mesial and distal |
Presence of peri-implant osteolysis (+/-) |
1 | 14 | - | 2 | 3 | 11 | 4,3,2,3,3,3 | + | 0.7; 0.5 | - |
11 | - | 3 | 2 | 12 | 3,3,2,2,2,3 | - | 0.5; 0.9 | - | |
21 | - | 3 | 2 | 12 | 3,3,2,2,2,3 | - | 0.6; 0.8 | - | |
24 | - | 2 | 3 | 10 | 2,2,3,3,3,2 | - | 0.8; 0.9 | - | |
31 | - | 2 | 1 | r.p. | 2,2,1,1,1,2 | - | 1.1; 0.7 | - | |
41 | - | 2 | 1 | r.p. | 2,2,1,1,1,2 | - | 0.4; 0.6 | - | |
2 | 21 | - | 2 | 2 | 12 | 4,2,3,2,2,3 | + | 1.1; 0.6 | - |
23 | - | 3 | 3 | 11 | 3,2,3,3,3,2 | - | 0.5; 0.7 | - | |
3 | 16 | - | 1 | 1 | 9 | 3,1,3,3,1,3 | - | 0.7; 0.6 | - |
24 | - | 2 | 1 | 11 | 2,1,2,2,1,2 | - | 0.8; 0.5 | - | |
4 | 25 | - | 2 | 1 | 11 | 3,1,2,2,1,2 | - | 0.7; 1.2 | - |
5 | 14 | - | 2 | 2 | 11 | 4,2,2,2,2,3 | + | 0.6; 0.8 | - |
15 | - | 1 | 2 | 10 | 3,2,2,3,1,4 | + | 1.4; 0.7 | - | |
6 | 12 | - | 3 | 2 | 12 | 4,2,3,2,2,3 | + | 1.1; 0.8 | - |
7 | 46 | - | 1 | 1 | 9 | 2,1,3,2,1,3 | - | 0.8; 0.7 | - |
8 | 46 | - | 2 | 2 | 10 | 4,2,3,2,2,3 | - | 0.6; 0.6 | - |
26 | - | 3 | 2 | 11 | 3,3,2,2,2,3 | - | 0.8; 1.0 | - | |
9 | 12 | - | 2 | 1 | 12 | 3,1,2,3,1,3 | + | 1.2; 1.4 | - |
10 | 15 | - | 2 | 1 | 11 | 3,1,2,3,1,4 | + | 0.8; 0.6 | - |
14 | - | 2 | 1 | 12 | 3,2,1,1,2,2 | - | 1.2; 0.8 | - | |
13 | - | 3 | 2 | 12 | 3,2,1,1,2,2 | - | 1.4; 1.2 | - | |
23 | - | 3 | 2 | 12 | 3,3,2,2,2,3 | - | 1.1; 1.3 | - | |
24 | - | 2 | 2 | 12 | 2,1,2,1,1,2 | - | 0.6; 0.8 | - | |
25 | - | 1 | 1 | 11 | 3,2,2,3,1,2 | - | 0.5; 0.5 | - | |
11 | 42 | - | 2 | 1 | 10 | 3,1,3,4,1,3 | + | 1.2; 0.9 | - |
12 | 34 | - | 2 | 2 | 11 | 2,2,3,2,1,3 | - | 1.2; 0.9 | - |
46 | - | 1 | 1 | 10 | 3,2,2,2,1,3 | - | 0.8; 0.5 | - | |
13 | 15 | - | 2 | 2 | 11 | 3,2,2,2,1,3 | - | 0; 0.4 | - |
14 | 44 | - | 1 | 2 | 13 | 4,2,1,2,2,3 | + | 0.4; 0.8 | - |
15 | 35 | - | 2 | 1 | 11 | 3,1,2,1,1,3 | - | 1.2; 0.6 | - |
16 | 22 | - | 2 | 2 | 13 | 2,2,3,2,1,3 | + | 1.4; 1.2 | - |
37 | - | 1 | 2 | 11 | 2,1,2,2,2,1 | - | 0; 0.5 | - | |
47 | - | 1 | 3 | 12 | 2,1,3,3,2,2 | - | 0.7; 0.9 | - | |
17 | 13 | - | 3 | 2 | 11 | 4,2,3,2,2,3 | + | 1.0; 1.2 | - |
15 | - | 2 | 2 | 11 | 2,1,2,3,2,2 | - | 0.8; 0.6 | - | |
18 | 41 | - | 3 | 2 | 10 | 4,2,3,2,2,3 | + | 0; 0.4 | - |
19 | 17 | - | 1 | 2 | 9 | 3,2,3,2,2,3 | - | 0.8; 1.4 | - |
21 | - | 2 | 2 | 10 | 2,1,3,2,2,2 | - | 1.2; 0.7 | - | |
22 | - | 2 | 2 | 11 | 2,1,3,4,2,2 | + | 0.6; 0.6 | - | |
23 | - | 3 | 2 | 11 | 3,3,2,2,2,3 | + | 0.4; 0 | - | |
24 | - | 2 | 1 | 11 | 2,1,2,3,1,2 | - | 0.6; 0.9 | - | |
20 | 17 | - | 2 | 1 | 10 | 4,1,2,3,1,3 | - | 1.0; 1.2 | - |
27 | - | 3 | 1 | 9 | 3,2,3,2,1,3 | - | 1.6; 1.4 | - | |
37 | - | 1 | 1 | 10 | 2,1,3,2,1,2 | - | 0.9; 1.3 | - | |
46 | - | 1 | 1 | 11 | 3,2,3,2,1,3 | - | 1.7; 1.5 | - | |
47 | - | 1 | 1 | 10 | 4,2,2,3,3,3 | + | 1.2; 0.9 | - | |
21 | 41 | - | 3 | 1 | r.p. | 3,1,2,1,1,3 | - | 0.6; 0 | - |
43 | - | 2 | 2 | r.p. | 3,2,2,4,2,2 | + | 0.8; 1.3 | - | |
31 | - | 3 | 1 | r.p. | 3,2,2,3,1,3 | - | 1.3; 1.0 | - | |
33 | - | 3 | 2 | r.p. | 3,1,3,2,2,3 | + | 0.8; 0.6 | - | |
Total: 21 |
Total:50; 31*u.j; 19*l.j. |
Total: 0 | Mean total: 2.04mm; Mean u.j.: 2.19mm; Mean l.j.: 1.79mm |
Mean total: 1.66mm; Mean u.j.: 1.77mm; Mean l.j.: 1.47mm |
Mean total: 10.91; Mean u.j.: 11.03; Mean l.j.: 10.62 |
Mean total: 2.25mm; Mean u.j.: 2.31mm; Mean l.j.: 2.14mm |
Mean total: 34.0%; Mean u.j.: 35.5%; Mean l.j.: 31.6% |
Mean total: 0.83mm; Mean u.j.: 0.85mm; Mean l.j.: 0.8mm |
0 |
mb: mesio-buccal; b: Buccal; db: disto-buccal; mo: mesio-oral; o: oral; do: disto-oral; +: present; -: absent; f.p.: fixed prosthetics; r.p.: removable prosthetics; u.j.: upper jaw; l.j.: lower jaw
Radiological images (Yoshida, Japan), recorded after implant placement to control the implant position and for the regular follow-up investigation after two years of loading, were investigated to determine the peri-implant bone level and uncover potential peri-implant osteolysis. Analysis showed that in all 50 implants there was a stable peri-implant bone level reaching the implant shoulder. Further, no osseous peri-implant defect was obvious in the groups. The mean bone loss calculated digitally was 0.83 mm (upper jaw: 0.85 mm; lower jaw: 0.8 mm), ranging from 0 to 1.7 mm.

Figure 2: Clinical image of patient 15 at the 2-year follow-up. Dental implant was inserted in regio 36 restored with fixed prosthetics.

Figure 3: Radiographic images of patient 15. (A) X-ray image of the implant placed immediately after extraction of tooth 36. (B) X-ray image of dental implant regio 36 one year after prosthetic rehabilitation. The bone level reaches the implant shoulder. (C) X-ray image of dental implant regio 36 at the 2-year follow up investigation. The peri-implant bone level is stable and no peri-implant osteolysis or bone resorption could be detected.
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Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis
PMID: 28066845 [PubMed]
PMCID: PMC5214344
EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology
PMID: 28936490 [PubMed]
PMCID: PMC5604476
EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia
PMID: 28713879 [PubMed]
PMCID: PMC5510658
EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature
PMID: 28133641 [PubMed]
PMCID: PMC5267489
EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling
PMID: 29333536 [PubMed]
PMCID: PMC5766278
EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.
PMID: 31032493 [PubMed]
PMCID: PMC6483108
EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.
PMID: 30957099 [PubMed]
PMCID: PMC6448571
EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.
PMID: 30101228 [PubMed]
PMCID: PMC6086333
EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.
PMID: 31080964 [PubMed]
PMCID: PMC6508883
EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.
PMID: 31093608 [PubMed]
PMCID: PMC6513001
EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.
PMID: 31552397 [PubMed]
PMCID: PMC6758937
EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.
PMID: 31681909 [PubMed]
PMCID: PMC6824723
EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.
PMID: 31681910 [PubMed]
PMCID: PMC6824726
EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.
PMID: 31528859 [PubMed]
PMCID: PMC6746603
EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?
PMID: 31276119 [PubMed]
PMCID: PMC6604646
EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.
PMID: 31406965 [PubMed]
PMCID: PMC6690616
EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.
PMID: 31517314 [PubMed]
PMCID: PMC6741290
EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.
PMID: 31633124 [PubMed]
PMCID: PMC6800226
EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.
PMID: 29662969 [PubMed]
PMCID: PMC5898812
EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.
PMID: 30215058 [PubMed]
PMCID: PMC6133268
News and Events
January Issue Release
We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the January issue of respective journals and can be viewed in the current issue pages.
Submission Deadline for January Issue
Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before January 30, 2021.
Certificate of Publication
Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.
Best Article of the Issue
Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.
Certifying for Review
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