title: Immediate implant placement postextraction without flap elevation.
abstract: BACKGROUND
  The aim of this retrospective study was to assess soft tissue and esthetic outcomes at single-tooth immediate implants placed without flap elevation in maxillary central and lateral incisor sites.
  
  
  METHODS
  Photographic records of 85 consecutive patients with immediate single-tooth implants in maxillary central and lateral incisors that were placed without elevation of surgical flaps were selected. The change in mucosal level was expressed as a percentage of the length of the reference central incisor.
  
  
  RESULTS
  Significant recession of the mesial papilla (-6.2% +/- 6.8%), distal papilla (-7.4% +/- 7.5%), and facial mucosa (-4.6% +/- 6.6%) between surgical placement and 1 year was observed (P <0.001). Recession was greater for implants placed facially within the extraction socket compared to those placed lingually (P = 0.009). Sites with gingival margins initially coronal achieved mucosal levels close to the line of symmetry with the contralateral tooth. Sites initially level or apical failed to reach the line of symmetry and remained receded. For sites with initially level gingival margins, recession >10% occurred at six of 25 thin biotype sites compared to two of 19 thick biotype sites. Acceptable outcomes were achieved in the majority of sites; between 10% and 20% of sites had suboptimal esthetic results.
  
  
  CONCLUSIONS
  Immediate implant placement without elevation of surgical flaps is associated with recession of the marginal mucosa that may fall within the threshold of visually detectable change. The orofacial position of the implant shoulder and the tissue biotype are important contributory factors.
authors.affiliation: Center for Oral Health Science, School of Dental Science, The University of Melbourne, Melbourne, Victoria, Australia.
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
authors.forename: John G
authors.initials: JG
authors.lastname: Clement
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000145:classification; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth; D017267:Dental Prosthesis Design; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D005889:Gingival Recession / Q000145:classification; D005891:Gingivitis / Q000145:classification; D006801:Humans; D007180:Incisor; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D010514:Periodontal Pocket / Q000145:classification; D023861:Photography, Dental; D012189:Retrospective Studies; D013524:Surgical Flaps; D013997:Time Factors; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult