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Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study

Jan Cosyn (UGent) , Hugo De Bruyn (UGent) and Roberto Cleymaet
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Abstract
Purpose: (1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single-tooth removal; (2) To evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed. Material and methods: Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15 – 25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate non-occlusal loading with a screw-retained provisional crown and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6 and 12 months. Cases demonstrating major alveolar process remodelling and/or advanced midfacial recession (> 1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns. Results: Twenty-two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for non-periodontal reasons using a novel bone condensing implant with variable-thread design, conical connection and platform switch (NobelActive®, Nobel Biocare, Göteborg, Sweden). One implant failed and mean marginal bone loss was 0.1 mm (p = 0.059). Temporary mesial papilla reduction occurred whereas distal papilla reduction was permanent (mean 0.5 mm; p = 0.001). At 3 months 5 cases demonstrated major alveolar process remodelling and 2 advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p = 0.053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p ≤ 0.037). At 12 months pink aesthetics (mean PES 12.15) was comparable to the pre-operative status (mean PES 11.86; p = 0.293). Distal papillae had significantly deteriorated (p = 0.020) in this time span, whereas midfacial contour had significantly improved (p = 0.005). Conclusions: Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one third of the patients. Major alveolar process remodelling is the main reason for additional treatment.
Keywords
white esthetic score, pink esthetic score, maxilla, Dental implant, immediate, single tooth, RANDOMIZED-CONTROLLED-TRIAL, TOOTH REPLACEMENT, ANTERIOR MAXILLA, CONNECTIVE-TISSUE, CASE SERIES, FOLLOW-UP, FLAP ELEVATION, CLINICAL-TRIAL, BONE LOSS, PLACEMENT

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MLA
Cosyn, Jan, Hugo De Bruyn, and Roberto Cleymaet. “Soft Tissue Preservation and Pink Aesthetics Around Single Immediate Implant Restorations: a 1-year Prospective Study.” CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH 15.6 (2013): 847–857. Print.
APA
Cosyn, J., De Bruyn, H., & Cleymaet, R. (2013). Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 15(6), 847–857.
Chicago author-date
Cosyn, Jan, Hugo De Bruyn, and Roberto Cleymaet. 2013. “Soft Tissue Preservation and Pink Aesthetics Around Single Immediate Implant Restorations: a 1-year Prospective Study.” Clinical Implant Dentistry and Related Research 15 (6): 847–857.
Chicago author-date (all authors)
Cosyn, Jan, Hugo De Bruyn, and Roberto Cleymaet. 2013. “Soft Tissue Preservation and Pink Aesthetics Around Single Immediate Implant Restorations: a 1-year Prospective Study.” Clinical Implant Dentistry and Related Research 15 (6): 847–857.
Vancouver
1.
Cosyn J, De Bruyn H, Cleymaet R. Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH. 2013;15(6):847–57.
IEEE
[1]
J. Cosyn, H. De Bruyn, and R. Cleymaet, “Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study,” CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, vol. 15, no. 6, pp. 847–857, 2013.
@article{1999773,
  abstract     = {Purpose: (1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single-tooth removal; (2) To evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed.
Material and methods: Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15 – 25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate non-occlusal loading with a screw-retained provisional crown and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6 and 12 months. Cases demonstrating major alveolar process remodelling and/or advanced midfacial recession (> 1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns.
Results: Twenty-two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for non-periodontal reasons using a novel bone condensing implant with variable-thread design, conical connection and platform switch (NobelActive®, Nobel Biocare, Göteborg, Sweden). One implant failed and mean marginal bone loss was 0.1 mm (p = 0.059). Temporary mesial papilla reduction occurred whereas distal papilla reduction was permanent  (mean 0.5 mm; p = 0.001). At 3 months 5 cases demonstrated major alveolar process remodelling and 2 advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p = 0.053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p ≤ 0.037). At 12 months pink aesthetics (mean PES 12.15) was comparable to the pre-operative status (mean PES 11.86; p = 0.293). Distal papillae had significantly deteriorated (p = 0.020) in this time span, whereas midfacial contour had significantly improved (p = 0.005).
Conclusions: Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one third of the patients. Major alveolar process remodelling is the main reason for additional treatment.},
  author       = {Cosyn, Jan and De Bruyn, Hugo and Cleymaet, Roberto},
  issn         = {1523-0899},
  journal      = {CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH},
  keywords     = {white esthetic score,pink esthetic score,maxilla,Dental implant,immediate,single tooth,RANDOMIZED-CONTROLLED-TRIAL,TOOTH REPLACEMENT,ANTERIOR MAXILLA,CONNECTIVE-TISSUE,CASE SERIES,FOLLOW-UP,FLAP ELEVATION,CLINICAL-TRIAL,BONE LOSS,PLACEMENT},
  language     = {eng},
  number       = {6},
  pages        = {847--857},
  title        = {Soft tissue preservation and pink aesthetics around single immediate implant restorations: a 1-year prospective study},
  url          = {http://dx.doi.org/10.1111/j.1708-8208.2012.00448.x},
  volume       = {15},
  year         = {2013},
}

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