A 5-year prospective study on single immediate implants in the aesthetic zone.
There is a paucity of long-term data on soft tissue aesthetics of single immediate implants. The objective of this study was to evaluate the 5-year clinical and aesthetic outcome of this treatment concept.



Twenty-two periodontally healthy patients (12 men, 10 women; mean age 50) with low risk for aesthetic complications (thick gingival biotype, intact buccal bone wall, both neighbouring teeth present) were consecutively treated with a single immediate implant in the aesthetic zone (15-25). Flapless surgery was performed and the gap between the implant and buccal bone wall was systematically filled with bovine bone particles. Implants were immediately non-functionally loaded with a screw-retained provisional crown. Cases demonstrating major alveolar process changes and/or advanced mid-facial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6 months. The clinical and aesthetic results at 5 years were compared to those obtained at 1 year.



Seventeen patients attended the 5-year re-assessment, of whom five had been treated with a CTG for early aesthetic complications. There was one early implant failure and one complication after 1 year (porcelain chipping). Mean marginal bone loss was 0.12 mm at 1 year and 0.19 mm at 5 years (p = 0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5 years (p ≤ 0.007), whereas mid-facial contour (p = 0.005) and alveolar process deficiency (p = 0.008) deteriorated. Mean mid-facial recession was on average 0.28 mm (SD 0.48) at 1 year and 0.53 mm (SD 0.53) at 5 years (p = 0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession (>1 mm) at 5 years. All three were in a central incisor position and none had been treated with a CTG. Thus, 8/17 implants showed aesthetic complications (five early and three late aesthetic complications). Implants in a lateral incisor position showed stable soft tissue levels. The pink aesthetic score was on average 12.15 at 1 year and 11.18 at 5 years (p = 0.030).



Single immediate implants showed high implant survival and limited marginal bone loss in the long term. However, mid-facial recession, mid-facial contour and alveolar process deficiency deteriorated after 1 year. With an aesthetic complication rate of 8/17 in well-selected patients who had been treated by experienced clinicians, type I placement may not be recommended for daily practice.
Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium.|Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Jan
J
Cosyn
Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Aryan
A
Eghbali
Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Alexander
A
Hermans
Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium.
Stijn
S
Vervaeke
Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, Ghent University, Ghent, Belgium.|Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden.
Hugo
H
De Bruyn
Oral Health Research Group (ORHE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Roberto
R
Cleymaet
D000818:Animals; D002417:Cattle; D003442:Crowns; D015921:Dental Implants; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
D015921:Dental Implants
dental implant; immediate; long term; single tooth