The placement of implants immediately after tooth extraction has proven to be a predictable treatment with a high success rate. This procedure offers several advantages for the patient as well as for the clinician, including shorter treatment time and fewer surgical procedures. A correct three-dimesional implant position and a management of peri-implant gap are key factors in order to achieve successful functional and esthetic outcomes. The aim of the present 1-year prospective single cohort study was to evaluate the success rate, marginal bone level (MBL) changes and soft tissue stability of tissue-level implants placed in fresh extraction sockets. This prospective cohort study included a total of 10 patients (7 women and 3 men) ranging in age from 23- to 63-years-old (mean 40.1±13.3) with at least one tooth in need of tooth extraction and of immediate implant placement. Tooth extractions and implant placements were carried out with a flapless procedure. The tissue level implants (Prama, Sweden & Martina, Due Carrare, Italy) were placed with the machined-collar at the buccal bone wall level and the implants healed transgingivally. The peri-implant bone defects between the implant surface and bone walls were grafted with corticocancellous porcine bone particles and stabilized with a resorbable membrane. Five months after placement the implants were restored. Outcome evaluations were: implant success, MBL changes, width of keratinized gingiva (WKG), facial soft tissue (FST) levels, modified Plaque Index and modified Bleeding Index. The level of statistical significance was set at 0.05 for all analyses. 10 Implants were placed in 10 patients, no complication occurred during the healing, no immediate post-operative infections were observed. No patient had implant failure within the first year of treatment. Therefore, a total of 10 patients with 10 implants were followed for the study period. The cumulative survival rate was 100% at 1 year-evaluation. The mean MBL was -0.6±0.49 mm at baseline and 0.3±0.36 mm at 1 year follow up. The FST Level was 0.4±0.69 mm at baseline and 0.02±0.70 mm at 1-year follow-up. The Width of Keratinized Gingiva was 3.8± 0.47 mm at baseline and 4.1±0.42 mm at 1-year follow-up. Modified bleeding and plaque indexes had low values during the course of the study. The use of an implant with a machined-transgingival concave neck has shown satisfying results in terms of hard and soft tissue levels at 1-year evaluation. Particularly the increase of Width of Keratinized Gingiva can lead to a stable and esthetically successful results. Immediate implant placement can be successfully performed with a tissue-level implant according to a correct three-dimensional position and to a correct management of peri-implant soft tissue healing.
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