Computer Guided Immediate Implant Placement in Mandibular Molars Using Patient Specific 3D Printed Polylactic Acid Graft Versus Conventional Immediate Implant Placement With Xenograft

This is a prospective randomized controlled clinical trial designed to evaluatecomputer‐guided immediate implant placement in mandibular molar extraction sockets usinga patient‐specific 3D‐printed polylactic acid (PLA) socket guide and customized root‐formPLA graft, compared with conventional freehand immediate implant placement usingxenograft.Immediate implant placement in mandibular molar extraction sockets can be challengingbecause of the wide socket morphology and the limited amount of bone available forachieving primary implant stability. The interradicular septum and apical bone areimportant for implant anchorage, while the irregular shape of the extraction socket maymake conventional freehand osteotomy preparation and implant positioning difficult.In the experimental group, preoperative cone‐beam computed tomography (CBCT) data will beused for three‐dimensional digital planning of the implant position. The implantposition, angulation, diameter, and length will be planned using Blue Sky Plan 4software. A patient‐specific socket‐supported PLA surgical guide will then be designedaccording to the planned implant position. A customized root‐form PLA graft will also bedesigned to fit the peri‐implant gap within the extraction socket.The PLA socket guide and customized PLA graft will be fabricated using additivemanufacturing. The patient‐specific guide will be used during osteotomy preparation tocontrol the drilling trajectory and facilitate placement of the implant according to thedigitally planned position. The customized PLA graft will be positioned within theresidual gap between the implant and extraction socket walls.Participants allocated to the control group will undergo conventional immediate implantplacement using a freehand surgical technique. Xenograft will be used for grafting of theperi‐implant gap according to the conventional treatment protocol.All participants will undergo preoperative clinical and radiographic assessment. Clinicalassessment includes medical and dental history, periodontal assessment, occlusalassessment, and plaque‐control assessment. CBCT will be used to evaluate the extractionsocket, root morphology, interradicular bone, and available bone dimensions beforeimplant placement.The primary outcomes of the study are implant primary stability and implant positionalaccuracy. Implant stability will be assessed using resonance frequency analysis/implantstability measurement at the time of implant placement and during follow‐up. Implantpositional accuracy will be assessed by comparing the virtually planned implant positionwith the actual postoperative implant position using CBCT‐based evaluation. Positionalaccuracy will be assessed as a single positional accuracy outcome incorporating themeasured deviations between the planned and actual implant position.Participants will be followed clinically during the healing period, with assessment ofimplant stability at the planned follow‐up period. A postoperative CBCT examination willbe used to evaluate the actual implant position and compare it with the preoperativevirtual plan.The study is intended to determine whether the patient‐specific 3D‐printed PLA socketguide and customized PLA graft can improve primary implant stability and the accuracy ofimmediate implant placement compared with the conventional freehand technique usingxenograft.