title: A 4-year evaluation of the peri-implant parameters of immediately loaded implants placed in fresh extraction sockets.
abstract: BACKGROUND
  The present study considers the correlation between the meaning of keratinized mucosa (KM) and the long-term maintenance of endosseous root-form dental implants placed in fresh sockets and immediately loaded.
  
  
  METHODS
  Twenty-nine patients requiring extractions of ≥2 teeth in the maxilla and mandible were selected. One-hundred thirty-two maxillary and 32 mandibular teeth, in the incisor, canine, and premolar regions, were extracted. Implants were positioned in fresh sockets and immediately loaded. Based on the amounts of KM, implants were categorized as follows: KM ≥2 mm (group A) and KM <2 mm (group B). Clinical parameters (probing depth, modified plaque index, modified bleeding index, and gingival index) and marginal bone levels were followed at 4 years after implant placement. Comparisons between group A and B values were performed by the Student two-tailed t test.
  
  
  RESULTS
  At 4-year follow-up, a survival rate of 100% was reported for all implants. The mean values of group B were significantly higher (P <0.05) than group A for the following parameters: gingival index (group A, 0.67 ± 0.09; group B, 1.01 ± 0.11); modified plaque index (group A, 1.18 ± 0.09; group B, 1.71 ± 0.12); and modified bleeding index (group A, 0.35 ± 0.05; group B, 0.78 ± 0.05). Gingival recession was significantly elevated in group B. In both group A and group B, up to 60% of gingival recession occurred within the first 6 months. For mean bone loss values, statistically non-significant differences were reported between groups.
  
  
  CONCLUSIONS
  At 4-year follow-up, the results suggested that the presence of mid-buccal KM is not a critical factor in the maintenance of interproximal bone level around fresh socket implants immediately loaded. Conversely, less width of KM is significantly associated with more gingival inflammation, more plaque accumulation, and more gingival recession.
authors.affiliation: Department of Dentistry, Vita Salute University, San Raffaele Hospital, Milan, Italy. robcresp@libero.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Crespi
authors.forename: Paolo
authors.initials: P
authors.lastname: Capparè
authors.forename: Enrico
authors.initials: E
authors.lastname: Gherlone
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000145:classification; D001641:Bicuspid / Q000601:surgery; D003481:Cuspid / Q000601:surgery; D000044:Dental Abutments; D015921:Dental Implants; D003774:Dental Plaque Index; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology*; D005884:Gingival Hemorrhage / Q000145:classification; D005889:Gingival Recession / Q000145:classification; D005891:Gingivitis / Q000145:classification; D006801:Humans; D057893:Immediate Dental Implant Loading; D007180:Incisor / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D010518:Periodontitis / Q000145:classification; D010519:Periodontium / Q000473:pathology*; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D015921:Dental Implants