title: Immediate and conventional single implant treatment in the anterior maxilla: 1-year results of a case series on hard and soft tissue response and aesthetics.
abstract: OBJECTIVE
  The main objective of this clinical study was to document midfacial soft tissue dynamics following single immediate implant treatment (IIT) and conventional implant treatment (CIT) in the anterior maxilla when performed by experienced clinicians in well-selected patients.
  
  
  METHODS
  Appropriate bone volume and ideal soft tissue levels were considered requirements for implant therapy. Additional prerequisites for IIT were intact socket walls and a thick gingival biotype. CIT included standard flap elevation whereas IIT was either performed with a flap or flapless procedure. All implants were provisionally restored using cemented acrylic crowns. Bone levels, papillae and midfacial soft tissue levels were monitored at regular intervals. The aesthetic outcome was assessed after 1 year using the pink aesthetic score (PES) and white aesthetic score (WES).
  
  
  RESULTS
  Sixteen patients (10 men, six women; mean age 45) received an immediate implant and 23 patients (12 men, 11 women; mean age 40) had conventional implant surgery. One immediate implant failed in the early healing phase. The mean bone level from the implant-abutment interface was 0.85mm for IIT and 0.65mm for CIT after 1 year (p=0.144). Mesial papillae remained stable over time. Minute loss of distal papillae occurred following IIT (-0.38mm) and a tendency for re-growth was found following CIT (0.60mm). Midfacial soft tissues remained stable over time following IIT with only 7% showing advanced recession (>1mm). Flapless surgery induced less midfacial recession than flap surgery (p=0.023). Significant midfacial recession occurred following CIT (-1mm). Overall, 24% were aesthetic failures (PES<8 and/or WES<6) and 8% showed an (almost) perfect outcome (PES12 and WES9). The remainder (68%) demonstrated acceptable aesthetics.
  
  
  CONCLUSIONS
  Immediate implants demonstrated fairly stable midfacial soft tissue levels with only a minority of cases showing advanced recession. Irrespective of the timing of implant placement, aesthetic failures seem to be rather common and only a strict minority may show perfection.
authors.affiliation: Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, University of Ghent, Ghent, Belgium.
authors.forename: Filiep
authors.initials: F
authors.lastname: Raes
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Crommelinck
authors.forename: Peter
authors.initials: P
authors.lastname: Coessens
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
mesh_terms: D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000209:etiology; D000539:Alveolar Process / Q000473:pathology; D003442:Crowns; D000044:Dental Abutments; D003758:Dental Implantation, Endosseous; D019250:Dental Implants, Single-Tooth; D018772:Dental Marginal Adaptation; D017267:Dental Prosthesis Design; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D005889:Gingival Recession / Q000209:etiology; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D010519:Periodontium / Q000473:pathology*; D013499:Surface Properties; D013524:Surgical Flaps; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult