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Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study
Jan Cosyn1, Hugo De Bruyn, Roberto Cleymaet
1Periodontist, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, De Pintelaan 185, B-9000 Ghent, Belgium; periodontist, visiting professor, Free University of Brussels (VUB), Faculty of Medicine and Pharmacy, Dental Medicine, Laarbeeklaan 103, B-1090 Brussels, Belgium; periodontist, professor, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, De Pintelaan 185, B-9000 Ghent, Belgium; prosthodontist, professor, Free University of Brussels (VUB), Faculty of Medicine and Pharmacy, Dental Medicine, Laarbeeklaan 103, B-1090 Brussels, Belgium.
Purpose:
(1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single-tooth removal; (2) to evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed.
Materials And Methods:
Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15-25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate nonocclusal loading with a screw-retained provisional crown, and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6, and 12 months. Cases demonstrating major alveolar process remodeling and/or advanced midfacial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns.
Results:
Twenty-two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for nonperiodontal reasons using a novel bone condensing implant with variable-thread design, conical connection, and platform switch (NobelActive®, Nobel Biocare, Göteborg, Sweden). One implant failed and mean marginal bone loss was 0.1 mm (p = .059). Temporary mesial papilla reduction occurred, whereas distal papilla reduction was permanent (mean 0.5 mm; p = .001). At 3 months, five cases demonstrated major alveolar process remodeling and two advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p = .053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p ≤ .037). At 12 months, pink aesthetics (mean PES 12.15) was comparable to the preoperative status (mean PES 11.86; p = .293). Distal papillae had significantly deteriorated (p = .020) in this time span, whereas midfacial contour had significantly improved (p = .005).
Conclusions:
Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one-third of the patients. Major alveolar process remodeling is the main reason for additional treatment.
