and 3 other(s)
Objective: To evaluate the aesthetic outcome of immediate dental implantation and immediate non-functional loading utilizing definitive abutments in the aesthetic zone, with and without bony substitutes filling the peri-implant gap. Methods: in this prospective clinical trial, 12 implants were placed in 11 subjects (6 males, 5 females) utilizing a flapless immediate post extraction approach in the esthetic area of the maxilla (15 to 25). All participants were above 21 years old and medically fit. Atraumatic extraction was performed for teeth that were indicated for extraction keeping an intact facial bone plate. Implants were placed free hand with a gap of at least 2 mm from the inner surface of the facial plate bucco-lingually, and in the range of 3–4 mm from the future gingival margin in a corono-apical direction (Buser et al. 2004). The gap between the implant and the inner surface of the facial plate was either left without grafting or filled with natural bovine bone mineral granules based on a coin toss method regardless of the size of the gap. Upon achieving a torque of 30 Ncm, immediate non-functional loading was performed utilizing a definitive abutment as in a one-abutment-at-one-time protocol (Canullo et.al 2010). Definitive crowns fabrication was performed 12 weeks post implant placement. Pink Esthetic Score (PES) (Furhauser et al. 2005) was assessed preoperatively (PES0), 1 year after delivery of definitive crowns (PES1), and at 2 years follow up (PES2). Dental casts were made at those points of time as well. Those casts were scanned using an imes-icore table-top scanner, and the scans were registered using surface to surface registration and then signed closest point distances were measured. Surface models were cropped to include one tooth mesial and distal to the region of interest (implant site) in an attempt to remove the outliers that may result from differences else were on that cast. All image analysis steps were done using Slicer CMF. Appropriate statistical analyses were performed. Results: The range of the gap left between the implant and the inner surface of the facial plate varied from 2mm to 4mm. All implants remained integrated and restorations were functional at the end of a two year follow up period. The means of PES score were as following: PES0= 9.51.68, PES1=9.51.98, PES2=9.832.89. There were no statistically significant differences in PES scores at different points of time both collectively (P=0.08 for PES0 vs PES1, P=0.14 for PES0 vs PES2, and P=0.61 for PES1 vs PES2), and when compared for the grafting group versus non-grafting group (P=0.24 for PES2 graft vs. PES2 non-grafting). As for casts scans, the surface distances between the 2 time points for all cases were less than 1 mm in all reference planes and there were no statistically significant differences. This reflects a stable surgical outcome of this approach. Conclusions: Immediate placement and immediate non-functional loading utilizing a definitive abutment in a one-abutment-at one-time protocol in the esthetic area of the maxilla appears to result in a favorable and stable result as far as esthetic outcome, and alveolar process sufficiency are concerned. It seems grafting the horizontal gap has no additional benefit in promoting better clinical outcomes given that the provisional restoration is meticulously fabricated and strict selection criteria are applied for such cases. Of notice is the limitation present in this study as the sample number is small as this is a pilot clinical trial.
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