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A 5-year prospective study on single immediate implants in the aesthetic zone.

Jan Cosyn (UGent) , Aryan Eghbali (UGent) , ALEXANDER HERMANS (UGent) , Stijn Vervaeke (UGent) , Hugo De Bruyn (UGent) and Roberto Cleymaet
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Abstract
Aim: 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. Materials and methods: 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 (>1mm) at 3months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6months. The clinical and aesthetic results at 5years were compared to those obtained at 1 year. Results: 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 0.12mm at 1 year and 0.19mm at 5years (p=0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5years (p0.007), whereas mid-facial contour (p=0.005) and alveolar process deficiency (p=0.008) deteriorated. Mean mid-facial recession was on average 0.28mm (SD 0.48) at 1 year and 0.53mm (SD 0.53) at 5years (p=0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession (>1mm) at 5years. 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 5years (p=0.030). Conclusion: 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 1year. 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.
Keywords
immediate, dental implant, long-term, aesthetic outcome, survival, single tooth, OUTCOMES FOLLOWING IMMEDIATE, RANDOMIZED CONTROLLED-TRIAL, CONNECTIVE-TISSUE GRAFT, ANTERIOR MAXILLA, SOFT-TISSUE, EXTRACTION SOCKETS, TOOTH IMPLANTS, NOBELACTIVE IMPLANTS, DENTAL IMPLANTS, VARIABLE-THREAD

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Chicago
Cosyn, Jan, Aryan Eghbali, ALEXANDER HERMANS, Stijn Vervaeke, Hugo De Bruyn, and Roberto Cleymaet. 2016. “A 5-year Prospective Study on Single Immediate Implants in the Aesthetic Zone.” Journal of Clinical Periodontology 43 (8): 702–709.
APA
Cosyn, J., Eghbali, A., HERMANS, A., Vervaeke, S., De Bruyn, H., & Cleymaet, R. (2016). A 5-year prospective study on single immediate implants in the aesthetic zone. JOURNAL OF CLINICAL PERIODONTOLOGY, 43(8), 702–709.
Vancouver
1.
Cosyn J, Eghbali A, HERMANS A, Vervaeke S, De Bruyn H, Cleymaet R. A 5-year prospective study on single immediate implants in the aesthetic zone. JOURNAL OF CLINICAL PERIODONTOLOGY. 2016;43(8):702–9.
MLA
Cosyn, Jan, Aryan Eghbali, ALEXANDER HERMANS, et al. “A 5-year Prospective Study on Single Immediate Implants in the Aesthetic Zone.” JOURNAL OF CLINICAL PERIODONTOLOGY 43.8 (2016): 702–709. Print.
@article{8052153,
  abstract     = {Aim: 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. 
Materials and methods: 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 ({\textrangle}1mm) at 3months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6months. The clinical and aesthetic results at 5years were compared to those obtained at 1 year. 
Results: 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 0.12mm at 1 year and 0.19mm at 5years (p=0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5years (p0.007), whereas mid-facial contour (p=0.005) and alveolar process deficiency (p=0.008) deteriorated. Mean mid-facial recession was on average 0.28mm (SD 0.48) at 1 year and 0.53mm (SD 0.53) at 5years (p=0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid-facial recession ({\textrangle}1mm) at 5years. 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 5years (p=0.030). 
Conclusion: 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 1year. 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.},
  author       = {Cosyn, Jan and Eghbali, Aryan and HERMANS, ALEXANDER and Vervaeke, Stijn and De Bruyn, Hugo and Cleymaet, Roberto},
  issn         = {0303-6979},
  journal      = {JOURNAL OF CLINICAL PERIODONTOLOGY},
  keyword      = {immediate,dental implant,long-term,aesthetic outcome,survival,single tooth,OUTCOMES FOLLOWING IMMEDIATE,RANDOMIZED CONTROLLED-TRIAL,CONNECTIVE-TISSUE GRAFT,ANTERIOR MAXILLA,SOFT-TISSUE,EXTRACTION SOCKETS,TOOTH IMPLANTS,NOBELACTIVE IMPLANTS,DENTAL IMPLANTS,VARIABLE-THREAD},
  language     = {eng},
  number       = {8},
  pages        = {702--709},
  title        = {A 5-year prospective study on single immediate implants in the aesthetic zone.},
  url          = {http://dx.doi.org/10.1111/jcpe.12571},
  volume       = {43},
  year         = {2016},
}

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