title: Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study.
abstract: OBJECTIVE
  (1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single-tooth removal; (2) to evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed.
  
  
  METHODS
  Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15-25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate nonocclusal loading with a screw-retained provisional crown, and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6, and 12 months. Cases demonstrating major alveolar process remodeling and/or advanced midfacial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns.
  
  
  RESULTS
  Twenty-two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for nonperiodontal reasons using a novel bone condensing implant with variable-thread design, conical connection, and platform switch (NobelActive®, Nobel Biocare, Göteborg, Sweden). One implant failed and mean marginal bone loss was 0.1 mm (p = .059). Temporary mesial papilla reduction occurred, whereas distal papilla reduction was permanent (mean 0.5 mm; p = .001). At 3 months, five cases demonstrated major alveolar process remodeling and two advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p = .053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p ≤ .037). At 12 months, pink aesthetics (mean PES 12.15) was comparable to the preoperative status (mean PES 11.86; p = .293). Distal papillae had significantly deteriorated (p = .020) in this time span, whereas midfacial contour had significantly improved (p = .005).
  
  
  CONCLUSIONS
  Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one-third of the patients. Major alveolar process remodeling is the main reason for additional treatment.
authors.affiliation: Periodontist, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, De Pintelaan 185, B-9000 Ghent, Belgium; periodontist, visiting professor, Free University of Brussels (VUB), Faculty of Medicine and Pharmacy, Dental Medicine, Laarbeeklaan 103, B-1090 Brussels, Belgium; periodontist, professor, University of Ghent, Faculty of Medicine and Health Sciences, Dental School, Department of Periodontology and Oral Implantology, De Pintelaan 185, B-9000 Ghent, Belgium; prosthodontist, professor, Free University of Brussels (VUB), Faculty of Medicine and Pharmacy, Dental Medicine, Laarbeeklaan 103, B-1090 Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
authors.forename: Hugo
authors.initials: H
authors.lastname: De Bruyn
authors.forename: Roberto
authors.initials: R
authors.lastname: Cleymaet
mesh_terms: D019250:Dental Implants, Single-Tooth; D004955:Esthetics, Dental; D006801:Humans; D057893:Immediate Dental Implant Loading; D011446:Prospective Studies