A long‐term prospective cohort study on immediately restored single tooth implants inserted in extraction sockets and healed ridges: CBCT analyses, soft tissue alterations, aesthetic ratings, and patient‐reported outcomes

Background Soft tissue dynamics in the esthetic zone are gaining increasing attention in recent years. Emerging intraoral scanning technology allows easier capture of soft tissue contours. Purpose To quantitatively assess the time‐dependent contour alterations of labial soft tissue following single immediate implants and immediate provisionalization (IIPP) in maxillary incisors via intraoral scanning. Materials and Methods This was a prospective cohort study. Thirty eligible consecutive patients were included and received immediate replacement of a failure maxillary single incisor. A screw‐retained immediate restoration was delivered for each patient. Subsequently, the anterior maxillary region was scanned by an intraoral scanning system at four time points: preoperation (baseline, BL), 3 months (3 m), 6 months (6 m), and 12 months (12 m). The Standard Tessellation Language files were exported to a dedicated software and superimposed for visual analysis. At 3, 6, and 12 months, the mid‐facial mucosa level (ML) was assessed, and the precise three‐dimensional (3D) configuration of the altered volume was calculated and reconstructed for visual analysis. Furthermore, quantitative analysis of the reconstructed morphology was performed using the following parameters: mean change in thickness (△d), mesio‐distal width (w), coronal‐apical height (h), and horizontal and vertical position of the thickest point represented by coordinates (x, z). Result Twenty‐seven of thirty enrolled patients were finally available for analysis at the 1‐year follow‐up. In general, the frontal view of the reconstructed volume exhibited a crescent shape. The mid‐facial ML change at 3, 6, and 12 months was −0.05 ± 0.36 mm, −0.03 ± 0.32 mm, and −0.24 ± 0.37 mm, respectively (P = .012). The mean change in thickness at 3 months (△d3m), 6 months (△d6m), and 12 months (△d12m) was 0.50 ± 0.19 mm, 0.59 ± 0.21 mm, and 0.62 ± 0.22 mm, respectively (P <.001). At 12 months, nine patients had a △d less than 0.5 mm. The mean △d3 m/△d12 m and △d6 m/△d12 m was 0.81 ± 0.17 and 0.96 ± 0.13. The w, h, x, and z results showed no significant differences during the 1‐year observation (P = .126, P = .324, P = .635, P = .263). At 12 months, w, h, x, and z were 11.57 ± 1.77 mm, 6.46 ± 2.01 mm, 0.03 ± 1.43 mm, and 2.16 ± 0.65 mm, respectively. Conclusion During the 1‐year observation following single IIPP treatment in maxillary incisors, the labial soft tissue contour showed a continuous alteration resulting in a mean change in thickness of 0.62 mm that occurred mainly in the first 3 months and tended to be relatively stable after 6 months, while the crescent‐like shape, width, height, and thickest point position of the alteration volume remained stable after 3 months. No advanced mid‐facial recession was observed.

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Labial soft tissue contour dynamics following immediate implants and immediate provisionalization of single maxillary incisors: A 1‐year prospective study

Tian

Wei

Zhao

et al. 2019

“…Groenendijk and colleagues reported in a 2‐year retrospective study on 16 patients a buccal bone thickness of 1.8 mm (varying from 0.9 to 2.4 mm). Raes and colleagues reported on a 8‐year prospective study with 16 patients with immediate placement. Median buccal bone thickness varied from 0.80 to 1.24 mm along the implant axis and never exceeded 2 mm.…”

Section: Discussionmentioning

confidence: 99%

Buccal bone thickness at dental implants in the maxillary anterior region with large bony defects at time of immediate implant placement: A 1‐year cohort study

Meijer

Slagter

Vissink

et al. 2018

Background There is lack of studies regarding preservation and possible changes in BBT at dental implants. Purpose To assess, on cone beam computer tomograms, the presence of bone at the time of tooth extraction in the maxillary esthetic region and the mean buccal bone thickness 1 month and 1 year after final restoration placement in patients with large bony defects. Material and Methods In a cohort study, patients were selected presenting a failing tooth with a large bony defect (test group [ n = 20]: large bony defect , immediate placed implant and delayed provisionalization). Results were compared with a group in which patients presented a failing tooth without or with a small bony defect: (control group [ n = 20]: without or small bony defect , immediate placed implant and delayed provisionalization). Cone beam computer tomograms were made preoperatively, and 1 month and 1 year after placement of the restoration, and buccal bone thickness was analyzed. Results In both groups approximately 1 mm of buccal bone thickness was present after 1 month and 1 year, without a significant difference between the groups. Conclusion In patients with large bony defects at a failing tooth it was possible to create a bone layer buccally of the implant and this bone layer remained stable during a 1‐year follow‐up; there were no significant differences between thickness of buccal bone at 1 month and 1 year in patients with large buccal bony defects and patients without or with small bony defects.

“…In total, 24% of the cases were aesthetically inadequate (PES <8 and/or WES <6). Recently the 8-year aesthetic outcome of the same patient population was published with a mean PES-score of 10.4,45 indicating that the PES value, as scored after 1 year, remained stable after 8 to 10 years. Comparable studies, with long-term results on such a high number of patients treated with IIPP, are lacking.…”

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confidence: 96%

Immediate implant placement and provisionalization: Aesthetic outcome 1 year after implant placement. A prospective clinical multicenter study

Groenendijk¹,

Staas

Bronkhorst

et al. 2020

Background Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking. Purpose To analyze the aesthetic outcome after IIPP. Materials and Methods One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used. Results In the first year postsurgery, the mean total‐WES and total‐PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3. Conclusions Within the limitations of this 1‐year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved.