title: Immediate single-tooth implants in the anterior maxilla: 3-year results of a case series on hard and soft tissue response and aesthetics.
abstract: OBJECTIVE
  The objective of this prospective study was to assess the overall outcome of immediate single implant treatment in the anterior maxilla after a 3-year observation period.
  
  
  METHODS
  Thirty consecutively treated patients with a thick gingival biotype, ideal gingival level/contour and intact socket walls at the time of tooth extraction were treated for single-tooth replacement in the aesthetic zone by two experienced clinicians. Treatment included minimal mucoperiosteal flap elevation, immediate implant placement (NobelReplace TiUnite(®)), insertion of a grafting material between the implant and the socket wall and connection of a screw-retained provisional restoration. The latter was replaced by a cemented crown 6 months thereafter. Patients were clinically and radiographically re-examined after 3 years to assess implant survival, complications and hard and soft tissue conditions. The aesthetic outcome was objectively rated using the Pink Esthetic Score (PES) and White Esthetic Score (WES) by a blinded clinician who had not been involved in the treatment.
  
  
  RESULTS
  Twenty-five patients could be re-evaluated after 3 years. One early implant failure had occurred resulting in an implant survival rate of 96%. Radiographic examination yielded on average 1.13 mm mesial, respectively 0.86 mm distal bone loss. The clinical conditions showed fairly low peri-implant plaque (18%) and bleeding (24%) and mean probing depth was 3.17 mm. Mean mesial/distal papilla shrinkage and midfacial soft tissue recession in reference to the pre-operative status accounted for 0.05, 0.08 and 0.34 mm, respectively. Between the 1- and 3-year reassessment mesial papillae showed significant re-growth (0.36 mm; p=0.015). Advanced midfacial recession (>1 mm) was found in 2/25 (8%) cases. Five (21%) cases were aesthetic failures (PES<8 and/or WES<6) and 5/24 (21%) showed an (almost) perfect outcome (PES≥12 and WES≥9). The remainder (14/24 or 58%) demonstrated acceptable aesthetics.
  
  
  CONCLUSIONS
  The proposed strategy seems a valuable and predictable treatment option for well-selected patients in the mid-long term as shown by almost full papillary re-growth and a low risk for advanced midfacial recession.
authors.affiliation: Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, University of Ghent, Dental School, Ghent, Belgium. jan.cosyn@ugent.be
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
authors.forename: Aryan
authors.initials: A
authors.lastname: Eghbali
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
authors.forename: Kristiaan
authors.initials: K
authors.lastname: Collys
authors.forename: Roberto
authors.initials: R
authors.lastname: Cleymaet
authors.forename: Tim
authors.initials: T
authors.lastname: De Rouck
mesh_terms: D000328:Adult; D000368:Aged; D018786:Bone Substitutes / Q000627:therapeutic use; D003442:Crowns; D000044:Dental Abutments; D019250:Dental Implants, Single-Tooth; D003773:Dental Plaque / Q000145:classification; D017268:Dental Prosthesis Retention; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D003794:Dental Restoration, Temporary; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D005884:Gingival Hemorrhage / Q000145:classification; D005889:Gingival Recession / Q000145:classification; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D008903:Minerals / Q000627:therapeutic use; D010514:Periodontal Pocket / Q000145:classification; D011446:Prospective Studies; D013524:Surgical Flaps; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C077540:Bio-Oss; D018786:Bone Substitutes; D008903:Minerals