title: Aesthetics in oral implantology: biological, clinical, surgical, and prosthetic aspects.
abstract: OBJECTIVE
  The aim of this study was to identify a correct clinical, surgical, and prosthetic management of endosseous implants replacing missing teeth in the anterior maxilla, achieving predictable aesthetic outcomes. Placement of immediate post-extraction implants without incisions or flap elevation is one of the surgical treatment options able to improve the healing and regenerative potentials of the fresh socket.
  
  
  METHODS
  Fifty-five patients (33 men, 22 women), ranging in age from 19 to 57 years (mean 29), were selected for this study. All the patients were not smokers, no bruxers, presented stable soft tissue conditions, an acceptable occlusion, and the absence of pathologies that would contraindicate bone healing. Patients were treated with implants made by 2 manufacturers: Institute Straumann, Walderburg, Switzerland and Friadent, Mannheim, Germany. A total of 87 implants were placed immediately after each failing tooth had been removed. The temporary restoration was placed 3 months after implant placement, and the final restoration was placed 4 months from the surgical procedure. The patients were evaluated clinically and radiographically at implant placement, and 2, 4, 18, and 24 months post-insertion.
  
  
  RESULTS
  At 24 months, only 3 implants were lost (2 in male patients;1 in female patient). All of these failed implants did not achieve osseointegration. The overall success rate was 96.6%, with an implant failure rate of 3.4%, all prior to restoration.
  
  
  CONCLUSIONS
  The immediate placement in the anterior maxilla fresh extraction sockets without incisions or flaps elevation is a surgical option that can ensure ideal peri-implant tissues healing, preserving the presurgical gingival and bone aspects. For a predictable aesthetic result, the most important aspect seems to be the height and thickness of the buccal bone wall, which remain after immediate placement of the fixture.
authors.affiliation: University of Naples Federico II, Faculty of Medicine, Department of Odontostomatologic and Maxillo-Facial Science, Naples, Italy. gilberto.sammartino@unina.it
authors.forename: Gilberto
authors.initials: G
authors.lastname: Sammartino
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marenzi
authors.forename: Alessandro Espedito
authors.initials: AE
authors.lastname: di Lauro
authors.forename: Guerino
authors.initials: G
authors.lastname: Paolantoni
mesh_terms: D000328:Adult; D003442:Crowns; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003794:Dental Restoration, Temporary; D003831:Denture, Partial, Immediate; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D013997:Time Factors; D020390:Tooth Socket / Q000601:surgery*