Immediate placement and restoration of implants in the aesthetic zone with a trimodal approach: soft tissue alterations and its relation to gingival biotype
- 9 July 2012
- journal article
- Published by Wiley in Clinical Oral Implants Research
- Vol. 24 (10), 1094-1100
- https://doi.org/10.1111/j.1600-0501.2012.02516.x
Abstract
The aim of this prospective study was to evaluate the soft tissue changes around implants in the aesthetic zone, placed under a trimodal approach (immediate post-extraction placement, flapless, and immediate provisional restoration) and its relationship to gingival/periodontal biotype of the patient. The sample consisted of 14 patients from two private practices that were in need of a tooth extraction in the anterior maxillary region (cuspid to cuspid) and were candidates to a replacement with a dental implant. An initial measurement (baseline) of the position or the mesial and distal papillae and gingival zenith was made at this time, with a rigid dental-supported stent and an electronic precision caliper, able to the second tenth of a millimeter; after careful tooth extraction, the periodontal thickness, at a point 5 mm apical to de gingival buccal margin, with an analogical thickness gauge, able to one tenth of a millimeter. Once the implant was inserted an immediate provisional restoration was delivered. To evaluate the soft tissue changes measurements were repeated at 3, 6, and 12 months. A statistical analysis was performed to evaluate the changes in the gingival margin around the implant restorations and to identify a possible correlation to patient's periodontal thickness. All 14 patients received Straumann (®) implants (9 Tissue Level [TL] Regular Neck [RN], 2 TL Narrow Neck [NN], 2 Bone Level [BL] Narrow Crossfit [NC], and 1 BL Regular Crossfit [RC]). All implants integrated and none had any biological complications. Three provisional restorations presented screw loosening and retightened once and one loss retention and was recemented once. In one patient, with a severe bruxing habit, the final restoration suffered screw loosening and was retightened. Of the final restorations, 12 were screw-retained and 2 cemented on custom-made Zirconia abutments. A mean recession of the buccal margin of 0.45 mm was recorded at 12 months ( ± 0.25 mm). An acceptable papilla level was present in all cases at 1 year, with mean changes of 0.38 mm ( ± 0.60) for the mesial and 0.80 mm ( ± 0.90) of the distal papilla, respectively. No correlation could be established between the soft tissue changes and the periodontal biotype of the patient. Within the limitations of this study, the good aesthetic outcome and minimal complications seem to validate the trimodal approach protocol as a reliable and simple protocol to place and restore immediate implants in the aesthetic zone. No correlation between the patient's gingival biotype and the soft tissue alterations could be established. Additional studies are needed to verify long-term aesthetic results with this approach and to better define and quantify biotypes.Keywords
This publication has 26 references indexed in Scilit:
- Tissue Biotype and Its Relation to the Underlying Bone MorphologyThe Journal of Periodontology, 2010
- Immediate restoration/loading of immediately placed single implants: is it an effective bimodal approach?Clinical Oral Implants Research, 2009
- Effect of a xenograft on early bone formation in extraction sockets: an experimental study in dogClinical Oral Implants Research, 2008
- Two‐year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zoneClinical Oral Implants Research, 2008
- Ridge alterations following immediate implant placement in the dog: flap versus flapless surgeryJournal of Clinical Periodontology, 2008
- Esthetic outcomes of immediate implant placementsClinical Oral Implants Research, 2007
- A prospective clinical study of non‐submerged immediate implants: clinical outcomes and esthetic resultsClinical Oral Implants Research, 2007
- Immediate implant placement with transmucosal healing in areas of aesthetic priority: A multicentre randomized‐controlled clinical trial I. Surgical outcomesClinical Oral Implants Research, 2007
- Soft and hard tissue assessment of immediate implant placement: a case seriesClinical Oral Implants Research, 2007
- Tissue modeling following implant placement in fresh extraction socketsClinical Oral Implants Research, 2006