title: Preserving soft tissue after placing implants in fresh extraction sockets in the maxillary esthetic zone and a prosthetic template for interim crown fabrication: a prospective study.
abstract: BACKGROUND
  The technique of immediate implant placement is said to have success rates similar to those of implantation into a healed socket. An implant-supported restoration in an esthetic area must achieve a harmonious balance of functional, esthetic, and biologic imperatives to be considered effective.
  
  
  OBJECTIVE
  The purpose of this clinical study was to assess the height of the interproximal gingival papillae adjacent to immediate implants with immediate loading. The hypothesis was that specific positioning of the proximal contact areas of the interim crowns would facilitate the maintenance or regeneration of the interproximal papilla.
  
  
  METHODS
  Twenty-eight participants were provided implants (n=36) in the anterior maxillary area that were loaded with a specifically contoured interim crown immediately after tooth extraction. The proximal contact areas of the interim crowns were positioned 5 to 6 mm incisal to the interproximal bony crest by using a prosthetic template. Papilla height was classified according to a previously described papilla index. A comparison was made between the papilla height before the extraction, at interim crown placement after the implant placement, and at 6 and 12 months postoperatively. Parametric and nonparametric tests were used when appropriate (Kolmogorov-Smirnov). Significance was expressed at the α=.05 level. Cross tables were used to describe the changes in the papilla index score.
  
  
  RESULTS
  During the 1-year follow-up, the score of the distal and mesial papilla indices increased significantly (repeated-measures Friedman exact test; P=.035 and P=.002).
  
  
  CONCLUSIONS
  This prospective study indicated that the use of a prosthetic template for positioning an interim crown on immediately placed implants and for ensuring that the proximal contact areas of the crown with adjacent teeth are 5 to 6 mm incisal to the interproximal bony crest does not seem to hinder the maintenance or regeneration of the height of the interproximal papillae.
authors: Lecturer, Department of Prosthodontics, Dental School, University of Ferrara, Ferrara, Italy. Electronic address: vincenzobruno@me.com.
authors: Vincenzo
authors: V
authors: Bruno
authors: Professor, School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors: Dominic
authors: D
authors: O'Sullivan
authors: Private practice, Pinerolo, Turin, Italy.
authors: Mauro
authors: M
authors: Badino
authors: Chief and Associate Professor, Department of Prosthodontics, Dental School, University of Ferrara, Ferrara, Italy.
authors: Santo
authors: S
authors: Catapano
mesh_terms: D000328:Adult; D000368:Aged; D000539:Alveolar Process / Q000000981:diagnostic imaging; D003442:Crowns; D003758:Dental Implantation, Endosseous / Q000295:instrumentation; D019250:Dental Implants, Single-Tooth; D017267:Dental Prosthesis Design / Q000295:instrumentation; D003794:Dental Restoration, Temporary; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000033:anatomy & histology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D057893:Immediate Dental Implant Loading / Q000379:methods; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D019252:Radiography, Dental, Digital / Q000379:methods; D014081:Tooth Extraction / Q000379:methods; D020390:Tooth Socket / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult