title: Implant-buccal plate distance as diagnostic parameter: a prospective cohort study on implant placement in fresh extraction sockets.
abstract: BACKGROUND
  The aim of this study is to investigate contour changes around immediate implants in fresh extraction sockets when different grafting procedures are performed, based on the distance between the external implant collar and the bony surface on the buccal plate (I-BP). A secondary aim is to assess the esthetic outcome via the implant esthetic score (IAS).
  
  
  METHODS
  This prospective cohort study was performed in three centers. Suitable patients to undergo implant placement in fresh extraction sockets were selected. Periodontal biotype, horizontal and vertical peri-implant bone defects, and dehiscences were assessed. Depending on I-BP, two types of grafting procedures were performed. In group A (I-BP <4 mm), only the peri-implant gap was grafted during the surgical phase (internal grafting [IG]), whereas group B (I-BP ≥ 4 mm) received both internal and external grafting (IEG). Master casts of the sites, made before implant placement and after 1 year of loading, were optically scanned. A computerized analysis of the contour changes at the involved sites was performed by superimposing the scanned models.
  
  
  RESULTS
  A total of 20 patients (eight males and 12 females) were recruited, and 20 non-submerged implants were placed in fresh extraction sockets. No implant failed during the observation period. The mean follow-up was 25 months (range: 12 to 37 months). After 1 year of loading, group A showed a slight decrease in mean buccal volume, whereas group B had an increase in volume (P = 0.02). IAS was higher for group B than group A.
  
  
  CONCLUSIONS
  When implants are placed immediately after tooth extraction, I-BP may represent a useful diagnostic parameter in choosing the most appropriate grafting procedure (IG versus IEG). In clinical cases in which the distance between implant surface and the buccal plate is <4 mm, the combination of internal and external grafting (IEG) is recommended to maintain the volume and the contour of the ridge and achieve a successful esthetic outcome.
authors.affiliation: Section of Implantology and Oral Rehabilitation, Dental Clinic, Department of Biomedical, Surgical and Dental Sciences, Institute for Scientific Clinical Research and Treatment (IRCCS), Galeazzi Institute, University of Milan, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Capelli
authors.forename: Tiziano
authors.initials: T
authors.lastname: Testori
authors.forename: Fabio
authors.initials: F
authors.lastname: Galli
authors.forename: Francesco
authors.initials: F
authors.lastname: Zuffetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Motroni
authors.forename: Roberto
authors.initials: R
authors.lastname: Weinstein
authors.forename: Massimo
authors.initials: M
authors.lastname: Del Fabbro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016301:Alveolar Bone Loss / Q000601:surgery; D000539:Alveolar Process / Q000601:surgery; D000540:Alveolar Ridge Augmentation / Q000379:methods; D016025:Bone Transplantation / Q000379:methods; D015331:Cohort Studies; D015921:Dental Implants; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D010519:Periodontium / Q000473:pathology; D011446:Prospective Studies; D013524:Surgical Flaps / Q000601:surgery; D020390:Tooth Socket / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015921:Dental Implants