Single immediate implant placement in the maxillary aesthetic zone with and without connective tissue grafting: Results of a 5-year randomized controlled trial

AIM

To assess the 5-year effects of grafting connective tissue while undertaking single immediate implant placement and provisionalization at the mid-buccal mucosa level (MBML). Secondary outcomes were buccal bone wall thickness (BBT), marginal bone level (MBL) and patient satisfaction.

MATERIALS AND METHODS

Sixty patients with a single failing tooth in the maxillary anterior region were provided with an immediately placed and provisionalized implant. At implant placement, the patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). The alveolar socket classification was mainly Type 2A. Data were collected before removing the failing tooth (T0 ), and at 1 (T1 ), 12 (T12 ) and 60 (T60 ) months after final crown placement. The primary outcome was the change in MBML compared with the pre-operative situation. Additionally, the change in BBT, MBL, aesthetics (using the Pink Aesthetic Score-White Aesthetic Score), soft-tissue peri-implant parameters and patient satisfaction were assessed.

RESULTS

At the 5-year follow-up, 27 patients could be analysed from each group. In each group, one implant was lost during the osseointegration period, within 3 months of placement, resulting in an implant survival rate of 96.7% in both groups. MBML change at T60 was -0.6 (-1.1 to -0.1) mm in the control group and 0.1 (-0.4 to 0.5) mm in the test group (p = .008). BBT and MBL, aesthetics, soft-tissue peri-implant parameters and patient satisfaction showed stable results and satisfied patients, without clinically relevant differences between the groups.

CONCLUSIONS

This 5-year follow-up study shows that grafting connective tissue when replacing a single failing tooth with immediately placed and provisionalized implant results in favourable peri-implant tissues and fewer MBML changes.

Effect of connective tissue grafting on buccal bone changes based on cone beam computed tomography scans in the esthetic zone of single immediate implants: A 1-year randomized controlled trial

BACKGROUND

Connective tissue grafting has a beneficial effect on the peri-implant mucosa, but the effect of grafting the buccal mucosa on buccal bone thickness (BBT) has not been investigated, although BBT is proposed to be a key factor for the soft-tissue contour. The aim of this trial was to assess the outcome of a connective tissue graft (CTG) in the esthetic zone of single immediate implants on the change of BBT according to cone beam computed tomography (CBCT) scan analysis.

METHODS

In a 1-year randomized controlled trial, 60 patients received an immediately placed implant and provisionalization, either combined with CTG (test group) or without CTG (control group). CBCTs were taken preoperatively (T_pre ) and 1 year after definitive restoration (T₂ ). Any change in BBT was assessed at different implant levels. Additionally, the change in mid-buccal mucosal level (MBML) and approximal marginal bone level were assessed.

RESULTS

Fifty-five patients were available for statistical analysis (test group, n = 28; control group, n = 27). At T₂ , the average change in BBT was significantly larger in the test group (-0.84 ± 0.61 mm) than in the control group (-0.46 ± 0.54 mm, P = 0.02). A MBML gain of 0.07 ± 0.85 mm in the test and a MBML loss -0.52 ± 1.16 mm in the control group was observed at T₂ . Average loss of marginal bone was 0.05 ± 0.33 mm and 0.01 ± 0.38 mm, respectively.

CONCLUSIONS

The application of CTG in the esthetic zone of immediately placed and provisionalized implants is accompanied with more loss of BBT, but at the same time better maintains the mid-buccal mucosal level.

Outcome of Treatment with Single Implants in Preserved Versus Nonpreserved Alveolar Ridges: A 1-year Cohort Study

PURPOSE

To evaluate the effect of placement of single implants in the esthetic zone of the maxilla in preserved alveolar ridges, compared with nonpreserved alveolar ridges, on the change in midlabial mucosal level, esthetics, marginal bone level, and patient satisfaction.

MATERIALS AND METHODS

Patients with a failing single tooth, and demonstrating a large vertical defect (≥ 5 mm) of the labial wall of the extraction socket, were pre-augmented with a mixture of autologous bone and anorganic bovine bone. A mucosal graft sealed the pocket. After 4 months, a single implant was placed in the preserved alveolar ridge (test group; n = 20). The results were compared with those from patients who had one missing tooth and were treated with placement of an implant in a nonpreserved alveolar ridge, whereby the connective tissue graft was combined with the placement of the implant (control group; n = 20). Changes in midlabial mucosal level were scored on intraoral images. Intraoral radiographs were made to assess marginal bone level changes after definitive crown placement (1 month [T₁], 12 [T₁₂] months). The pink esthetic score/white esthetic score at T₁₂ was used to determine esthetics. Patient satisfaction was assessed before treatment (T_pre), and at T₁ and T₁₂.

RESULTS

The mean midlabial mucosal level changes were 0.07 ± 0.29 mm and -0.15 ± 0.23 mm at T₁ and T₁₂ for the control and test groups, respectively (P = .01). No significant changes were observed for the other outcome variables.

CONCLUSION

Single implant treatment in a preserved alveolar ridge and nonpreserved alveolar ridge is accompanied by clinically nonrelevant changes in the midlabial mucosal level. Changes in marginal bone level, esthetics, and patient satisfaction were comparable between the groups.

Immediate placement and provisionalization of implants in the aesthetic zone with or without a connective tissue graft: A 1-year randomized controlled trial and volumetric study

Objective

To volumetrically compare peri‐implant mid‐facial soft tissue changes in immediately placed and provisionalized implants in the aesthetic zone, with or without a connective tissue graft.

Material and methods

Sixty patients were included. All implants were placed immediately after extraction. After randomization, in one group, a connective tissue graft (test group, n = 30) was inserted at the buccal aspect of the implant. The other group (control group, n = 30) received no connective tissue graft. Clinical parameters, digital photographs and conventional impressions were obtained before extraction (T_pre) and at 12 months following definitive crown placement (T₁₂). The casts were digitized by a laboratory scanner, and a volumetric analysis was performed between T_pre and T₁₂.

Results

Twenty‐five patients in each group were available for analysis at T₁₂. Volumetric change, transformed to a mean (±SD) change in thickness, was −0.68 ± 0.59 mm (test) and −0.49 ± 0.54 mm (control) with a non‐significant difference between groups (p = .189). The mid‐facial mucosa level was significantly different between both groups (p = .014), with a mean (±SD) change of +0.20 ± 0.70 mm (test) and −0.48 ± 1.13 mm (control). The Pink Esthetic Score was similar between both groups.

Conclusions

The use of a CTG in immediately placed and provisionalized implants in the aesthetic zone did not result in less mucosal volume loss after 12 months, leading to the assumption that a CTG cannot fully compensate for the underlying facial bone loss, although a significantly more coronally located mid‐facial mucosa level was found when a CTG was performed.

Effect of connective tissue grafting on peri-implant tissue in single immediate implant sites: A RCT

AIM

To assess the effect of connective tissue grafting on the mid-buccal mucosal level (MBML) of immediately placed and provisionalized single implants in the maxillofacial aesthetic zone.

MATERIALS AND METHODS

Sixty patients with a failing tooth were provided with an immediately placed and provisionalized implant. During implant placement, patients randomly received either a connective tissue graft from the maxillary tuberosity (n = 30, test group) or no graft (n = 30, control group). Follow-up visits were at one (T₁ ) and twelve months (T₁₂ ) after final crown placement. The primary outcome measure was any change in MBML compared to the pre-operative situation. In addition, gingival biotype, aesthetics (using the Pink Esthetic Score-White Esthetic Score), marginal bone level, soft tissue peri-implant parameters and patient satisfaction were assessed.

RESULTS

The mean MBML change at T₁₂ was -0.5 ± 1.1 mm in the control group and 0.1 ± 0.8 mm in the test group (p = .03). No significant differences regarding other outcome variables were observed, neither was gingival biotype associated with a gain or loss in MBML.

CONCLUSIONS

This one-year study shows that connective tissue grafting in single, immediately placed and provisionalized implants leads to less recession of the peri-implant soft tissue at the mid-buccal aspect, irrespective of the gingival biotype (www.trialregister.nl: TC3815).

Immediate placement and provisionalization of an implant after removal of an impacted maxillary canine: two case reports

Single immediate implant replacement is accompanied by excellent survival rates and a favorable esthetic outcome. The objective of this report was to describe a surgical approach for removal of a buccal or palatally located impacted secondary canine, combined with extraction of the failing primary canine, and immediate placement and provisionalization of an implant. A window technique was applied for surgical removal of the impacted canine. The alveolar crest was preserved. After extraction of the primary canine, the implant was inserted with primary stability. Finally, the exposed surfaces of the implant were covered with a 1:1 mixture of autologous bone and Bio-Oss®. At the 1-year evaluation, both implants were successfully osseointegrated and in function. Esthetics were excellent. It is concluded that under premise of preservation of sufficient bone to achieve primary stability of the implant, removal of the canines can be combined with immediate placement and provisionalization of the implant.