title: Correlation between pre-operative buccal bone thickness and soft tissue changes around immediately placed and restored implants in the maxillary anterior region: A 2-year prospective study.
abstract: OBJECTIVE
  This study evaluated the correlation between pre-operative buccal cortical bone thickness and peri-implant tissue response following immediate placement and restoration of implants in the maxillary aesthetic zone.
  
  
  METHODS
  Eighteen patients (3 males, 15 females) with an age range of 19-57 years requiring the replacement of a single maxillary anterior tooth were included in this prospective study. Patients were selected on the basis of defined criteria: intact socket walls, absence of any acute infection in the sockets, absence of any gingival marginal pathology and attainment of a high primary stability (≥30 Ncm) at implant placement. Regardless of buccal bone thickness, all participating patients underwent the same treatment strategy that involved removal of the failed tooth, flapless surgery, immediate implant placement, grafting of the implant-socket gap and connection of a screw-retained provisional restoration. Buccal bone thickness was evaluated using pre-operative CBCT scans. Intra-oral photographs were taken before implant placement (baseline) and at 1- and 2-year follow-up to assess soft tissue changes around the implants. Aesthetic evaluation was carried out using the pink esthetic score (PES).
  
  
  RESULTS
  All implants remained osseointegrated during the follow-up period of 2 years with mesial papilla, distal papilla, and mid-facial gingiva showing a mean recession of 0.06 ± 0.71 mm, 0.25 ± 0.78 mm, and 0.22 ± 0.83 mm, respectively. Pink esthetic score values improved from a median value of 9 (IQR 8.75-10.25) pre-operatively to 11 (IQR 9.75-12) at the end of 2 years. No significant correlation was found between buccal bone thickness (range 0.45-1.24 mm) and soft tissue or aesthetic changes.
  
  
  CONCLUSIONS
  Within the limits of this study, no significant correlation could be found between pre-operative buccal bone width and the soft tissue and aesthetic outcome following immediate implant placement and restoration in the anterior maxilla. Therefore, favourable clinical and aesthetic outcomes could be achieved by applying a strict selection criteria and treatment protocol regardless of the initial thickness of the buccal bone.
authors.affiliation: School of Dentistry and Oral Health, MHIQ, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Himanshu
authors.initials: H
authors.lastname: Arora
authors.affiliation: School of Dentistry and Oral Health, MHIQ, Griffith University, Gold Coast, QLD, Australia.
authors.forename: Saso
authors.initials: S
authors.lastname: Ivanovski
mesh_terms: D000328:Adult; D000069343:Bone-Implant Interface / Q000033:anatomy & histology*; D003793:Dental Restoration, Permanent; D005260:Female; D005881:Gingiva / Q000033:anatomy & histology*; D006801:Humans; D057893:Immediate Dental Implant Loading; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D057234:Preoperative Period; D011446:Prospective Studies; D055815:Young Adult
keywords: aesthetics; dental implant; immediate placement and restoration; osseointegration; soft tissue