title: Papilla dimension and soft tissue level after early vs. delayed placement of single-tooth implants: 10-year results from a randomized controlled clinical trial.
abstract: OBJECTIVE
  To present the10-year esthetic outcome data for single-tooth implants placed early or delayed after tooth extraction.
  
  
  METHODS
  Forty-four patients randomly allocated to two equal size groups were treated with a single-tooth implant approximately 10 days (Ea; N = 22), or 3 months (De; N = 22) after tooth extraction. Healing abutments were mounted after 3 months of submerged healing, and metal-ceramic crowns cemented after one additional month. Presence of buccal bone defects was registered at the second-stage surgery. Patients attended control visits 1 week and 1-1.5 years after mounting of the crown and 5 and 10 years after implant placement. Marginal bone level at the implant and the adjacent teeth as well as the distance between the implant and the teeth were measured in standardized periapical radiographs. The papilla dimension and clinical crown height (CCH) were assessed on clinical photographs by an experienced prosthodontist.
  
  
  RESULTS
  Two Ea and one De implants failed to osseointegrate. Twenty-eight patients (13 Ea and 15 De) who attended all four control visits were included in the data analysis. Complete papilla fill interproximally was achieved in one-third of the cases and an appropriate clinical crown height in <60% after 10 years. Although not statistically significant, early-placed implants tended to be superior to delayed-placed implants regarding soft tissue appearance just after crown delivery and after 10 years. An improvement in papilla dimensions was seen during the follow-up period for both groups while the CCH was unchanged. The implant region (anterior vs. posterior) did not significantly influence the papilla or CCH scores while younger patients (<50 years of age) received significantly better papilla scores than older patients (≥ 50 years). An apically located bone level at the tooth neighboring the implant influenced negatively the papilla dimension. In contrast, the presence of a bone defect buccally to the implant at second-stage surgery did not have a negative impact on the CCH 10 years after implant placement.
  
  
  CONCLUSIONS
  Early placement of single-tooth implants after tooth extraction performed equally to delayed placement in regard to the esthetic outcome of the soft tissues after 10 years in function.
authors.affiliation: Prosthetic Dentistry, Department of Dentistry, Aarhus University, Aarhus C, Denmark; Oral Radiology, Department of Dentistry, Aarhus University, Aarhus C, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Schropp
authors.forename: Flemming
authors.initials: F
authors.lastname: Isidor
mesh_terms: D000328:Adult; D000368:Aged; D003442:Crowns; D003758:Dental Implantation, Endosseous / Q000379:methods*; D019250:Dental Implants, Single-Tooth; D005260:Female; D005881:Gingiva / Q000033:anatomy & histology*; D006801:Humans; D008297:Male; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D023861:Photography, Dental; D016896:Treatment Outcome
keywords: delayed implantation; dental implant; early implantation; esthetics; randomized controlled trial; single-tooth