The fate of the labial plate of bone in immediate implant placement (with and without bone graft), versus early implant placement protocols

Abstract

Esthetics poses the major challenge for most operating dentists these days. In the past, the primary objectives were confined to achieving implant osseointegration and rigid fixation. Currently, and with the improvement of instruments and biomaterials, esthetics complications remain the main obstacle that faces many operators. It is believed that IIP show survival rate comparable to delayed ones, operators and researchers should now focus more on the time factor as well as optimizing esthetics since the main disadvantage reported in a literature review was the high esthetic risk. Many authors stress on the importance of having adequate osseous volume of the alveolar ridge (in the three-dimensions (3D)) as a prerequisite for achieving optimum esthetic outcomes. This includes an intact LPB of sufficient thickness and height (Buser & Martin 2004); (Grunder& Gracis S 2005) Other than labial bone qualities, it was also noted that TNB and bone plates are highly susceptible to postextraction bone loss. The gingival biotype (GB) was considered a prime factor in predicting soft tissue stability over time. If it is narrow, with a thin-scalloped biotype, peri-implant mucosa is expected to retract six months after the abutment connection and restoration, due to the reformation of the biologic space. (Small, 2000) Considering the regenerative and reconstructive hard tissue healing potential of GBR techniques and bone grafts respectively as well as the improved soft tissue volume in Early implants, the current study utilized bone grafts for addition to immediate implants or in association with GBR in early placement implants. This study was conducted on 22 patients in a double blind prospective design. First group had immediate implants placed at the day of extraction; the second group had particulate Xenograft within the gap distance around immediate implants; and the third group had Early implants placed at 4-8 weeks from the day of extraction and was associated with contour augmentation through GBR. For all three groups, changes in height and thickness of the Labial plate of bone were performed using CBCT at baseline, 3 and 6 months. The clinical parameters used to assess soft tissue changes were: PES as the objective measure, and Visual Analogue Scale which was subjective. The results of this study suggest that immediate implant placement do not compromise esthetics as some authors claim. Reductions in heights and thickness of the LBW were significantly lower in patients having immediate implants compared to immediate implants with bone or Early implants with contour augmentations. Most subjects having immediate implants had TKB in contrast to the other two groups where most cases had TNB. A significant correlation was found between TNB and increased reductions in LBW height and thickness. Despite the significant difference in LBW changes, all three groups did not reveal significant differences when it comes to the soft tissue esthetic outcomes as shown by the PES and VAS. It is recommended that further studies should be carried out excluding one of the two gingival biotypes and for longer follow up period.