Copyright © 2018 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited. Immediate Implant Placement Into Fresh Extraction Sites Using Single-Drilling Bur and Two Loading Procedures: Follow-Up Results Raphae ´l Bettach, DDS, y Silvio Taschieri, MD, DDS, z§jj Carmen Mortellaro, MD, DDS, jjô and Massimo Del Fabbro, MSc, PhD z§ Abstract: Modern clinical protocols in implantology aim at short- ening the treatment time and reducing duration and discomfort of the surgical phase, while maintaining optimal treatment outcomes. The purpose of this study was to evaluate clinical outcomes of implants immediately placed in extraction sites, using a single drilling step for implant site preparation. One-hundred thirty-three patients (mean age 55.3  12.7 [SD] years, range 20–83 years) were treated at 2 clinical centers. Two-hundred sixty-one implants were inserted in fresh post- extraction sockets. One-hundred sixty-five implants were immediately loaded (IL) and 96 underwent delayed loading (DL). Implant survival, peri-implant bone level change and patients’ satisfaction were assessed after at least 3 years of function. No patient dropout occurred. The mean follow-up was 63.61  11.52 months (range 39.71–85.71 months) from prosthesis delivery. Two IL and 1 DL implant failed in 3 patients. Implant survival was 98.8% and 99% for IL and DL group, respec- tively. The mean marginal bone loss after 1 year was 0.48  0.40 mm and 0.52  0.34 mm for IL and DL group. No biological nor mechani- cal complications occurred. All patients demonstrated full satisfaction. The present protocol with single burs for site preparation produced satisfactory clinical outcomes independent of the loading timing. Further long-term comparative studies are needed to confirm the present findings. Key Words: Dental implants, immediate implants, immediate loading, implant site preparation, postextraction socket (J Craniofac Surg 2018;00: 00–00) F or many years, prior to dental implant placement, the compro- mised teeth were removed and the extraction sockets left unrestored until complete healing. Then, the implant was positioned and covered for several months to achieve osseointegration, before prosthesis delivery. 1 However, shortening the time between tooth extraction and implant placement would be favorably accepted by a large majority of the patients. In addition to the reduced number of surgical sessions and the shortened treatment time, further advantages of immediate implant placement have been identified as the ideal positioning of implants in fresh extraction sites, the preservation of bony structures, and soft tissue aesthetics, as well as a simplification of the prosthetic phase. 2–8 This contributes to increasing patient comfort and satis- faction and also patients’ acceptance toward implant therapy. 9–13 On the other hand, limited bone apical to the socket, presence of infection at the extraction site, gaps between the surface of the implant and the socket walls, and alterations of the ridge dimensions during the healing period are all factors that may negatively affect the outcome of immediate implant placement, underlining the importance of a careful patient selection. 14–17 Lang et al 18 in a systematic review published in 2012 observed a high survival rate of implants placed immediately into fresh extrac- tion sockets, after at least 1 year of function. Despite this promising finding, the authors underlined the need for more long-term studies to determine the success of such treatment, especially in regard to the aesthetic outcome that can also be correlated to the resorption of buccal plate. 18 The debate in timing of implant placement into extraction socket is still controversial, therefore a new classification defining the time for the positioning of implants has been proposed. 19 This classifi- cation is based on morphologic, dimensional, and histological changes that follow tooth extraction and on common practice derived from clinical experience. In particular, postextraction implants are divided into type 1 (implants placed during the same surgical procedure as extraction), type 2 (implants placed after soft tissue healing, 4 – 8 weeks after extraction), type 3 (implants placed after radiographic filling of the socket), and type 4 (implants placed in healed sites, at least 3–4 months after extraction). 19 Another critical phase of the surgical procedure is the implant site preparation. To ensure a successful osseointegration of dental implants, it is recommended to minimize surgical trauma to bone tissue. 20 In particular, the overheating of surrounding bone due to the attrition of burs during drilling can cause bone necrosis, 21 thus influencing early peri-implant bone loss and implant survival. 22 The conventional drill protocol for the correct preparation of the implant site consists of a sequence of incremental diameter drills, in the attempt to minimize bone damage during its instrumentation, but this technique may become time-consuming for both clinician and patient and cause prolonged tissue exposure of the surgical site and thermal trauma to bone tissue due to repeated drilling procedures. 23 Therefore, a 4-bladed drill with a special design has been recently introduced in the market, allowing for the implant site preparation with a single drilling step in different types of bone. In a preliminary study, implants associated with the use of a single drilling step showed excellent success rate. 24 From the  New York University, New York, NY; y Private Practice, Gretz- Armainvilliers, France; z Department of Biomedical, Surgical and Dental Sciences, Universita ` degli Studi di Milano; § Dental Clinic, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; jj I. M. Sechenov First Mos- cow State Medical University, Moscow, Russia; and ô Department of Medical Science, University of Eastern Piedmont, Novara, Italy. Received January 26, 2018. Accepted for publication April 16, 2018. Address correspondence and reprint requests to Prof. Massimo Del Fabbro, MSc, PhD, IRCCS Galeazzi Orthopedic Institute, University of Milano, Via Riccardo Galeazzi 4, 20161 Milano, Italy; E-mail: massimo.delfabbro@unimi.it The authors report no conflicts of interest. Copyright # 2018 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000004675 CLINICAL STUDY The Journal of Craniofacial Surgery  Volume 00, Number 00, Month 2018 1