The thickness of labial bone affects the esthetics of immediate implant placement and provisionalization in the esthetic zone: A prospective cohort study

Abstract

Background A 1‐2 mm thick labial plate is generally advocated in immediate implant placement and provisionalization (IIPP). However, most of the human labial plates fail to meet this requirement. Purpose This study aimed to investigate the effect of labial plate thickness on hard tissue, soft tissue, and esthetic outcomes in IIPP. Materials and Methods In this prospective cohort study, 40 patients received IIPP of 50 single‐crown implants in the anterior maxilla. Patients were categorized into three groups according to their presurgical thickness of labial bone: 0‐0.5, 0.5‐1, and ≥ 1 mm. CBCT, mucosa recession and the papilla index were used to analyze labial hard and soft tissue alterations with a 1‐year follow‐up. Results At 1 year, OCI bone losses were 1.17 ± 0.73, 0.37 ± 0.39, 0.46 ± 0.35 mm; ICH bone losses were 2.23 ± 1.83, 0.74 ± 0.71, 0.72 ± 1.27 mm; TM recessions were 1.00 ± 0.51, −0.06 ± 0.37, −0.30 ± 0.88 mm; TL recessions were 0.61 ± 1.02, −0.18 ± 0.40, −0.26 ± 1.15 mm; TD recessions were 0.61 ± 1.02, −0.18 ± 0.40, −0.26 ± 1.15 mm; PIS scores were 1.63 ± 0.64, 2.20 ± 0.71, 2.71 ± 0.57 in group 0‐0.5, 0.5‐1 and ≥ 1 mm, respectively. No statistical significance was found between group 0.5‐1 and ≥ 1 mm in bone resorption, gingival recession, and papilla index. The bone resorption and gingival recession were significantly the highest in group 0‐0.5 mm at 6 months and 1 year. Conclusions Group 0.5‐1 mm had similar tissue dimensional alteration as group ≥1 mm, while group <0.5 mm suffered more massive bone resorption and gingival recession. Concerning the thickness of the labial plate, this study may suggest an expansion in the indication of IIPP.

Immediate implant placement with or without connective tissue graft: A systematic review and meta‐analysis

“…All this suggests that by adding a CTG to thin gingival biotype sites, one may achieve similar outcomes as IIP at thick gingival biotype sites. In a recent study, it has also been shown that very thin buccal bone walls (<0.5 mm) suffer more resorption and mid‐facial recession (Yang et al, 2019). Finally, mid‐facial recession is more critical in the incisor/cuspid area due to aesthetic reasons.…”

Correlation between alveolar bone morphology and volumetric dimensional changes in immediate maxillary implant placement: A 1‐year prospective cohort study

“…Because of this, we can speculate that some of the volumetric outcomes of the alveolar ridge might be because of compensatory variations of the mucosa, has suggested by Chappuis et al 46 Despite of this, our study results are in accordance with several authors that emphatize the importance of the thin labial bone plate as a predictor factor for higher rates of mucosal recession and bone resorption around immediate implants inserted at the esthetic maxillary area. 47 Also, we must highlight the importance of a long-term follow-up of this treatment modality. Cosyn et al, concluded that after the 1-year evaluation, and despite the favourable early results obtained by immediate maxillary implants in terms of survival rate and MBL, mid-facial recession and mid-facial contour deterioration could be noticed.…”

Analysis of Alveolar Bone Morphology of the Maxillary Central and Lateral Incisors with Normal Occlusion

“…It is noted that peri-implant tissue stability may be determined by the crestal bone thickness [16]. It is suggested that a 1 to 2 mm thick labial plate is necessary in immediate implant placement [17]. In another report, presurgical thickness of the labial bone was categorized as 0–0.5, 0.5–1, and ≥1 mm, and the esthetics of immediate implant placement was evaluated at 1 year follow-up; the results showed that more massive bone resorption and gingival recession were seen in groups with less than 0.5 mm thickness [17].…”