الفهرس 
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Abstract
Tooth extraction socket mainly in the esthetic area is a major indication for immediate implant placement greatly improving patient satisfaction and preserving the alveolar ridge. However, non-axial forces effect of on bone with subsequent early implant failure remains unclear.
Aims: Evaluate the prognosis of implants immediately placed and restored with angled in comparison to straight abutments in the esthetic area using computer aided surgical guides.
Settings and Design:
This study was designed as a randomized controlled clinical trial where a total of 90 patients were recruited from the outpatient clinics fulfilling the inclusion criteria.
Methods and Material:
Badly decayed irrestorable teeth in the esthetic zone (anterior or premolars) were extracted atraumatically. Immediately after guided implant insertion, the abutments were adjusted and placed according to the allocation group then a temporary crown was performed out of occlusion in centric and eccentric relation. Early implant failure was assessed at three and six months.
Statistical analysis used:
Data were explored for normality using Kolmogorov-Smirnov and Shapiro-Wilk tests and showed non-parametric distribution. Mann Whitney test was used to compare between two groups in non-related samples. The significance level was set at P ≤ 0.05.
Results:
There was no statistically significant difference between the two groups (P=0.305). Straight and angled abutment groups showed 6 (14.3%) and 8 (20%) failed cases respectively. Post hoc sub group analysis showed no statistically significant difference between Angle 15 and Angle 25 degree groups where (P=0.686) or between (Anterior) and (Posterior) groups (P=0.853).
Conclusions:
Combining several risk factors together may outweigh the benefit gained from this treatment, therefore, cases should be carefully selected.
Key-words:
Inclined implants; axial implants; offset loads; early implant failures; immediate implants.
Key Messages:
More failure is anticipated and subsequently should be accounted for cautiously when multiple risk factors are combined including the risk of immediate implant placement and temporization, placing implant in poor bone quality (maxilla), non-splinted prosthesis, increased crown height space, and use of angled abutments creating horizontal cantilever. Combining all these factors together may outweigh the benefit gained from this treatment.