Clin Implant Dent Relat Res. 2022 Jan 03; doi: 10.1111/cid.13060. Epub 2022 Jan 03.

Does initial buccal crest thickness affect final buccal crest thickness after flapless immediate implant placement and provisionalization: A prospective cone beam computed tomogram cohort study.

Clinical implant dentistry and related research

Tristan Ariaan Staas, Edith Groenendijk, Ewald Bronkhorst, Luc Verhamme, Gerry Max Raghoebar, Gerrit Jacobus Meijer

PMID: 34981616 DOI: 10.1111/cid.13060

Abstract

BACKGROUND: Flapless immediate implant placement and provisionalization (FIIPP) in the aesthetic zone is still controversial. Especially, an initial buccal crest thickness (BCT) of ≤1 mm is thought to be disruptive for the final buccal crest stability jeopardizing the aesthetic outcome.

PURPOSE: To radiographically assess the BCT and buccal crest height (BCH) after 1 year and to calculate the correlation between initial and final achieved BCT.

MATERIALS AND METHODS: The study was designed as a prospective study on FIIPP. Only patients were included in whom one maxillary incisor was considered as lost. In six centers, 100 consecutive patients received FIIPP. Implants were placed in a maximal palatal position of the socket, thereby creating a buccal space of at least 2 mm, which was subsequently filled with a bovine bone substitute. Files of preoperative (T0), peroperative (T1) and 1-year postoperative (T3) cone beam computed tomogram (CBCT) scans were imported into the Maxillim™ software to analyze the changes in BCT-BCH over time.

RESULTS: Preoperatively, 85% of the cases showed a BCT ≤1 mm, in 25% of the patients also a small buccal defect (≤5 mm) was present. Mean BCT at the level of the implant-shoulder increased from 0.6 mm at baseline to 3.3 mm immediate postoperatively and compacted to 2.4 mm after 1 year. Mean BCH improved from 0.7 to 3.1 mm peroperatively, and resorbed to 1.7 mm after 1 year. The Pearson correlation of 0.38 between initial and final BCT was significant (p = 0.01) and therefore is valued as moderate. If only patients (75%) with an intact alveolus were included in the analysis, still a "moderate correlation" of 0.32 (p = 0.01) was calculated.

CONCLUSIONS: A "moderate correlation" was shown for the hypothesis that "thinner preoperative BCT's deliver thinner BCT's" 1 year after performing FIIPP.

© 2022 The Authors. Clinical Implant Dentistry and Related Research published by Wiley Periodicals LLC.

Keywords: CBCT analysis; aesthetic outcome; flapless immediate implant placement; immediate restoration

References

1. Lang NP, Pun L, Lau KY, Li KY, Wong MC. A systematic review on survival and success rates of implants placed immediately into fresh extraction sockets after at least 1 year. Clin Oral Implants Res. 2012;23(Suppl 5):39-66. - PubMed
2. Slagter KW, den Hartog L, Bakker NA, Vissink A, Meijer HJ, Raghoebar GM. Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis. J Periodontol. 2014;85(7):e241-e250. - PubMed
3. Chen ST, Buser D. Esthetic outcomes following immediate and early implant placement in the anterior maxilla-a systematic review. Int J Oral Maxillofac Implants. 2014;29(Suppl):186-215. - PubMed
4. Araújo MG, Lindhe J. Dimensional ridge alterations following tooth extraction. An experimental study in the dog. J Clin Periodontol. 2005;32(2):212-218. - PubMed
5. Van der Weijden F, Dell'Acqua F, Slot DE. Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol. 2009;36(12):1048-1058. - PubMed
6. Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res. 2012;23(Suppl 5):1-21. - PubMed
7. Scala A, Lang NP, Schweikert MT, de Oliveira JA, Rangel-Garcia I Jr, Botticelli D. Sequential healing of open extraction sockets. An experimental study in monkeys. Clin Oral Implants Res. 2014;25(3):288-295. - PubMed
8. Zekry A, Wang R, Chau AC, Lang NP. Facial alveolar bone wall width - a cone-beam computed tomography study in Asians. Clin Oral Implants Res. 2014;25(2):194-206. - PubMed
9. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on esthetics. Int J Periodontics Restorative Dent. 2005;25(2):113-119. - PubMed
10. Chappuis V, Engel O, Shahim K, Reyes M, Katsaros C, Buser D. Soft tissue alterations in esthetic postextraction sites: a 3-dimensional analysis. J Dent Res. 2015;94(9 Suppl):187s-193s. - PubMed
11. Araújo MG, Wennström JL, Lindhe J. Modeling of the buccal and lingual bone walls of fresh extraction sites following implant installation. Clin Oral Implants Res. 2006;17(6):606-614. - PubMed
12. Araújo MG, Silva CO, Souza AB, Sukekava F. Socket healing with and without immediate implant placement. Periodontol 2000. 2019;79(1):168-177. - PubMed
13. Chappuis V, Engel O, Reyes M, Shahim K, Nolte LP, Buser D. Ridge alterations post-extraction in the esthetic zone: a 3D analysis with CBCT. J Dent Res. 2013;92(12 Suppl):195s-201s. - PubMed
14. Iasella JM, Greenwell H, Miller RL, et al. Ridge preservation with freeze-dried bone allograft and a collagen membrane compared to extraction alone for implant site development: a clinical and histologic study in humans. J Periodontol. 2003;74(7):990-999. - PubMed
15. Wang RE, Lang NP. Ridge preservation after tooth extraction. Clin Oral Implants Res. 2012;23(Suppl 6):147-156. - PubMed
16. Barone A, Ricci M, Tonelli P, Santini S, Covani U. Tissue changes of extraction sockets in humans: a comparison of spontaneous healing vs. ridge preservation with secondary soft tissue healing. Clin Oral Implants Res. 2013;24(11):1231-1237. - PubMed
17. Vignoletti F, Matesanz P, Rodrigo D, Figuero E, Martin C, Sanz M. Surgical protocols for ridge preservation after tooth extraction. A systematic review. Clin Oral Implants Res. 2012;23(Suppl 5):22-38. - PubMed
18. Araújo MG, da Silva JCC, de Mendonça AF, Lindhe J. Ridge alterations following grafting of fresh extraction sockets in man. A randomized clinical trial. Clin Oral Implants Res. 2015;26(4):407-412. - PubMed
19. Hämmerle CH, Araújo MG, Simion M. Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res. 2012;23(Suppl 5):80-82. - PubMed
20. Ten Heggeler JM, Slot DE, Van der Weijden GA. Effect of socket preservation therapies following tooth extraction in non-molar regions in humans: a systematic review. Clin Oral Implants Res. 2011;22(8):779-788. - PubMed
21. Sanz M, Lindhe J, Alcaraz J, Sanz-Sanchez I, Cecchinato D. The effect of placing a bone replacement graft in the gap at immediately placed implants: a randomized clinical trial. Clin Oral Implants Res. 2017;28(8):902-910. - PubMed
22. Sicilia A, Botticelli D. Computer-guided implant therapy and soft- and hard-tissue aspects. The Third EAO Consensus Conference 2012. Clin Oral Implants Res. 2012;23(Suppl 6):157-161. - PubMed
23. Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res. 2008;19(1):73-80. - PubMed
24. Kan JYK, Rungcharassaeng K, Deflorian M, Weinstein T, Wang HL, Testori T. Immediate implant placement and provisionalization of maxillary anterior single implants. Periodontol 2000. 2018;77(1):197-212. - PubMed
25. Saijeva A, Juodzbalys G. Immediate implant placement in non-infected sockets versus infected sockets: a systematic review and meta-analysis. J Oral Maxillofac Res. 2020;11(2):e1. - PubMed
26. Chen ST, Wilson TG Jr, Hämmerle CH. Immediate or early placement of implants following tooth extraction: review of biologic basis, clinical procedures, and outcomes. Int J Oral Maxillofac Implants. 2004;19(Suppl):12-25. - PubMed
27. den Hartog L, Slater JJ, Vissink A, Meijer HJ, Raghoebar GM. Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction. J Clin Periodontol. 2008;35(12):1073-1086. - PubMed
28. Sanz M, Cecchinato D, Ferrus J, Pjetursson EB, Lang NP, Lindhe J. A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla. Clin Oral Implants Res. 2010;21(1):13-21. - PubMed
29. Bittner N, Schulze-Späte U, Silva C, et al. Changes of the alveolar ridge dimension and gingival recession associated with implant position and tissue phenotype with immediate implant placement: a randomised controlled clinical trial. Int J Oral Implantol (Berl). 2019;12(4):469-480. - PubMed
30. Noelken R, Moergel M, Pausch T, Kunkel M, Wagner W. Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: a retrospective analysis with follow-up between 1 and 8 years. Clin Implant Dent Relat Res. 2018;20(3):285-293. - PubMed
31. Weigl P, Strangio A. The impact of immediately placed and restored single-tooth implants on hard and soft tissues in the anterior maxilla. Eur J Oral Implantol. 2016;9(Suppl 1):S89-S106. - PubMed
32. Canellas J, Medeiros PJD, Figueredo C, Fischer RG, Ritto FG. Which is the best choice after tooth extraction, immediate implant placement or delayed placement with alveolar ridge preservation? A systematic review and meta-analysis. J Craniomaxillofac Surg. 2019;47(11):1793-1802. - PubMed
33. Al Qabbani A, Al Kawas S, Enezei H, et al. Biomechanical and radiological assessment of immediate implants for alveolar ridge preservation. Dent Res J (Isfahan). 2018;15(6):420-429. - PubMed
34. Cho YB, Moon SJ, Chung CH, Kim HJ. Resorption of labial bone in maxillary anterior implant. J Adv Prosthodont. 2011;3(2):85-89. - PubMed
35. Groenendijk E, Staas TA, Bronkhorst E, Raghoebar GM, Meijer GJ. Immediate implant placement and provisionalization: aesthetic outcome 1 year after implant placement. A prospective clinical multicenter study. Clin Implant Dent Relat Res. 2020;22(2):193-200. - PubMed
36. Groenendijk E, Staas TA, Graauwmans FEJ, et al. Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study. Int J Oral Maxillofac Surg. 2017;46(12):1600-1606. - PubMed
37. Atieh MA, Payne AG, Duncan WJ, Cullinan MP. Immediate restoration/loading of immediately placed single implants: is it an effective bimodal approach? Clin Oral Implants Res. 2009;20(7):645-659. - PubMed
38. Gelb DA. Benchmark for tooth replacement: immediate implant with immediate provisional restoration. Outcome analytics from 29 years of documentation. Compend Contin Educ Dent. 2018;39(7):469-481. - PubMed
39. Qahash M, Susin C, Polimeni G, Hall J, Wikesjö UM. Bone healing dynamics at buccal peri-implant sites. Clin Oral Implants Res. 2008;19(2):166-172. - PubMed
40. Tarnow DP, Chu SJ, Salama MA, et al. Flapless postextraction socket implant placement in the esthetic zone: part 1. The effect of bone grafting and/or provisional restoration on facial-palatal ridge dimensional change-a retrospective cohort study. Int J Periodontics Restorative Dent. 2014;34(3):323-331. - PubMed
41. Cabello G, Rioboo M, Fábrega JG. Immediate placement and restoration of implants in the aesthetic zone with a trimodal approach: soft tissue alterations and its relation to gingival biotype. Clin Oral Implants Res. 2013;24(10):1094-1100. - PubMed
42. Caplanis N, Lozada JL, Kan JY. Extraction defect assessment, classification, and management. J Calif Dent Assoc. 2005;33(11):853-863. - PubMed
43. Katafuchi M, Weinstein BF, Leroux BG, Chen YW, Daubert DM. Restoration contour is a risk indicator for peri-implantitis: a cross-sectional radiographic analysis. J Clin Periodontol. 2018;45(2):225-232. - PubMed
44. Cocchetto R, Canullo L. The “hybrid abutment”: a new design for implant cemented restorations in the esthetic zones. Int J Esthet Dent. 2015;10(2):186-208. - PubMed
45. Denardi RJ, da Silva RD, Thomé G, et al. Bone response after immediate placement of implants in the anterior maxilla: a systematic review. Oral Maxillofac Surg. 2019;23(1):13-25. - PubMed
46. De Rouck T, Collys K, Wyn I, Cosyn J. Instant provisionalization of immediate single-tooth implants is essential to optimize esthetic treatment outcome. Clin Oral Implants Res. 2009;20(6):566-570. - PubMed
47. Naji BM, Abdelsameaa SS, Alqutaibi AY, Said Ahmed WM. Immediate dental implant placement with a horizontal gap more than two millimetres: a randomized clinical trial. Int J Oral Maxillofac Surg. 2021;50(5):683-690. - PubMed
48. Vera C, De Kok IJ, Chen W, Reside G, Tyndall D, Cooper LF. Evaluation of post-implant buccal bone resorption using cone beam computed tomography: a clinical pilot study. Int J Oral Maxillofac Implants. 2012;27(5):1249-1257. - PubMed
49. Brownfield LA, Weltman RL. Ridge preservation with or without an osteoinductive allograft: a clinical, radiographic, micro-computed tomography, and histologic study evaluating dimensional changes and new bone formation of the alveolar ridge. J Periodontol. 2012;83(5):581-589. - PubMed
50. Spray JR, Black CG, Morris HF, Ochi S. The influence of bone thickness on facial marginal bone response: stage 1 placement through stage 2 uncovering. Ann Periodontol. 2000;5(1):119-128. - PubMed
51. Kazor CE, Al-Shammari K, Sarment DP, Misch CE, Wang HL. Implant plastic surgery: a review and rationale. J Oral Implantol. 2004;30(4):240-254. - PubMed
52. Juodzbalys G, Wang HL. Soft and hard tissue assessment of immediate implant placement: a case series. Clin Oral Implants Res. 2007;18(2):237-243. - PubMed
53. Menezes CC, Janson G, da Silveira MC, Cambiaghi L, Garib DG. Precision, reproducibility, and accuracy of bone crest level measurements of CBCT cross sections using different resolutions. Angle Orthod. 2016;86(4):535-542. - PubMed
54. Sennerby L, Andersson P, Pagliani L, et al. Evaluation of a novel cone beam computed tomography scanner for bone density examinations in preoperative 3D reconstructions and correlation with primary implant stability. Clin Implant Dent Relat Res. 2015;17(5):844-853. - PubMed
55. Morimoto T, Tsukiyama Y, Morimoto K, Koyano K. Facial bone alterations on maxillary anterior single implants for immediate placement and provisionalization following tooth extraction: a superimposed cone beam computed tomography study. Clin Oral Implants Res. 2015;26(12):1383-1389. - PubMed
56. Januário AL, Duarte WR, Barriviera M, Mesti JC, Araújo MG, Lindhe J. Dimension of the facial bone wall in the anterior maxilla: a cone-beam computed tomography study. Clin Oral Implants Res. 2011;22(10):1168-1171. - PubMed
57. Degidi M, Daprile G, Nardi D, Piattelli A. Buccal bone plate in immediately placed and restored implant with Bio-Oss(®) collagen graft: a 1-year follow-up study. Clin Oral Implants Res. 2013;24(11):1201-1205. - PubMed
58. Vance GS, Greenwell H, Miller RL, Hill M, Johnston H, Scheetz JP. Comparison of an allograft in an experimental putty carrier and a bovine-derived xenograft used in ridge preservation: a clinical and histologic study in humans. Int J Oral Maxillofac Implants. 2004;19(4):491-497. - PubMed
59. Degidi M, Nardi D, Daprile G, Piattelli A. Buccal bone plate in the immediately placed and restored maxillary single implant: a 7-year retrospective study using computed tomography. Implant Dent. 2012;21(1):62-66. - PubMed

Publication Types

• Journal Article