Immediate implant in the esthetic zone- Autogenous versus Alloplast. A 1-year prospective study

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Background: Immediate implant placement and provisionalization (IIPP) has been described as a treatment option with acceptable esthetic results for anterior single tooth loss. However, evidence shows midfacial mucosa recession as a common complication. Some studies considered that the association of low resorption bone grafts could maintain the facial bone wall width and minimize the risk for midfacial mucosa recession. However, there is lack of knowledge about the graft`s behavior in the periimplant gap. Aim: To evaluate the influence of the graft material in the response of periimplant hard and soft tissues after IIPP in the esthetic zone. Material and methods: Twenty patients with a central or lateral maxillary incisor indicated for extraction and IIPP were selected. Implants (BL SLA®ctive, Straumann) were placed by the same surgeon in sockets with intact facial walls. Autogenous bone harvested from the tuberosity was grafted in group A and an alloplast (Boneceramic,Straumann) was used in group B. Screwed acrylic resin prosthesis were built immediately after surgery. Sixteen weeks after implant placement the final screw-retained prosthesis were built. The tissues were evaluated two weeks before surgery (T0), at implant placement (T1), 4 months after implant placement (T2) and 1 year after final prosthesis (T3). The following data were evaluated: the variation of the facial gingival level (FGL); papilla index score (PIS); mesial and distal marginal bone levels (MBL); the buccal crest level (BCL) and the buccal alveolar bone thickness (BABT). Statistical analysis: Friedmann and Mann-Whitney U tests at the significance level of 0.05. Results: Ten implants were placed in each group. After 1 year, all implants were osseointegrated and MBL were no statistical difference (p = 0,097 mesial e p = 0,223 distal)mm in group B and a significant reduction over time in group A with (p = 0,022 mesial e p = 0,029 distal)mm. There was no statistical difference for FGL between the groups over time, however, group A presented a significant reduction between T0 and T3 (p = 0.024). The vertical distance from buccal crestal level (BCL) and implant platform revealed a significant reduction over time (p = 0.027) only for the group A; significance was also found between the two groups after 1 year (p = 0.028). There was also no statistical difference between groups over time regarding BABT, however, group A showed a significant reduction between T1 and T3 (p = 0.01). At T3, 100% of the group B and 90% of the group A presented the interproximal space more than 50% filled with papilla (PIS 2 or 3).Conclusions: The use of alloplastic bone substitute allowed a better behavior of the hard and soft tissues after the IIPP in the aesthetic zone in 1 year of observation.