title: A prospective clinical study of non-submerged immediate implants: clinical outcomes and esthetic results.
abstract: OBJECTIVE
  To evaluate healing of marginal defects in immediate transmucosal implants grafted with anorganic bovine bone, and to assess mucosal and radiographic outcomes 3-4 years following restoration.
  
  
  METHODS
  Thirty immediate transmucosal implants in maxillary anterior extraction sites of 30 patients randomly received BioOss (N=10; BG), BioOss and resorbable collagen membrane (N=10; BG+M) or no graft (N=10; control).
  
  
  RESULTS
  Vertical defect height (VDH) reductions of 81.2+/-5%, 70.5+/-17.4% and 68.2+/-16.6%, and horizontal defect depth (HDD) reductions of 71.7+/-34.3%, 81.7+/-33.7% and 55+/-28.4% were observed for BG, BG+M and control groups, respectively, with no significant inter-group differences. Horizontal resorption was significantly greater in control group (48.3+/-9.5%) when compared with BG (15.8+/-16.9%) and BG+M (20+/-21.9%) groups (P=0.000). Ten sites (33.3%) exhibited recession of the mucosa after 6 months; eight (26.7%) had an unsatisfactory esthetic result post-restoration due to recession. Mucosal recession was significantly associated (P=0.032) with buccally positioned implants (HDD 1.1+/-0.3 mm) when compared with lingually positioned implants (HDD 2.3+/-0.6 mm). In 19 patients followed for a mean of 4.0+/-0.7 years, marginal mucosa and bone levels remained stable following restoration.
  
  
  CONCLUSIONS
  BioOss significantly reduced horizontal resorption of buccal bone. There is a risk of mucosal recession and adverse soft tissue esthetics with immediate implant placement. However, this risk may be reduced by avoiding a buccal position of the implant in the extraction socket.
authors.affiliation: Centre for Oral Health Science, School of Dental Science, The University of Melbourne, Melbourne, Vic., Australia. schen@mira.net
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chen
authors.forename: Ivan B
authors.initials: IB
authors.lastname: Darby
authors.forename: Eric C
authors.initials: EC
authors.lastname: Reynolds
mesh_terms: D020341:Absorbable Implants; D016301:Alveolar Bone Loss / Q000209:etiology; D000540:Alveolar Ridge Augmentation; D001857:Bone Matrix / Q000637:transplantation; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods; D003094:Collagen; D003758:Dental Implantation, Endosseous / Q000379:methods*; D015921:Dental Implants; D004955:Esthetics, Dental; D005500:Follow-Up Studies; D005889:Gingival Recession / Q000209:etiology; D006801:Humans; D008567:Membranes, Artificial; D008903:Minerals / Q000627:therapeutic use; D010512:Periodontal Index; D011183:Postoperative Complications; D011446:Prospective Studies; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: C077540:Bio-Oss; D018786:Bone Substitutes; D015921:Dental Implants; D008567:Membranes, Artificial; D008903:Minerals; D003094:Collagen