Soft Tissue Preservation and Pink Aesthetics around Single Immediate Implant Restorations: A 1-Year Prospective Study

Authors

  • Jan Cosyn DDS, MSc, PhD,

    Corresponding author
    1. Periodontist, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, De Pintelaan 185, B-9000 Ghent, Belgium;
    2. periodontist, visiting professor, Free University of Brussels (VUB), Faculty of Medicine and Pharmacy, Dental Medicine, Laarbeeklaan 103, B-1090 Brussels, Belgium;
    • Dr. Jan Cosyn, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, De Pintelaan 185, B-9000 Ghent, Belgium; e-mail: jan.cosyn@ugent.be

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  • Hugo De Bruyn DDS, MSc, PhD,

    1. 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;
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  • Roberto Cleymaet DDS, PhD

    1. prosthodontist, professor, Free University of Brussels (VUB), Faculty of Medicine and Pharmacy, Dental Medicine, Laarbeeklaan 103, B-1090 Brussels, Belgium
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  • Conflicts of interest and source of funding: The authors declare that they have no conflicts of interest and wish to thank Nobel Biocare, Belgium, for their support by delivering part of the implants.

ABSTRACT

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.

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