A 5‐year prospective study on single immediate implants in the aesthetic zone. (13th June 2016) - Cosyn, Jan
Abstract: Aim: There is a paucity of long‐term data on soft tissue aesthetics of single immediate implants. The objective of this study was to evaluate the 5‐year clinical and aesthetic outcome of this treatment concept. Materials and methods: Twenty‐two periodontally healthy patients (12 men, 10 women; mean age 50) with low risk for aesthetic complications (thick gingival biotype, intact buccal bone wall, both neighbouring teeth present) were consecutively treated with a single immediate implant in the aesthetic zone (15–25). Flapless surgery was performed and the gap between the implant and buccal bone wall was systematically filled with bovine bone particles. Implants were immediately non‐functionally loaded with a screw‐retained provisional crown. Cases demonstrating major alveolar process changes and/or advanced mid‐facial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). Permanent crowns were installed at 6 months. The clinical and aesthetic results at 5 years were compared to those obtained at 1 year. Results: Seventeen patients attended the 5‐year re‐assessment, of whom five had been treated with a CTG for early aesthetic complications. There was one early implant failure and one complication after 1 year (porcelain chipping). Mean marginal bone loss was 0.12 mm at 1 year and 0.19 mm at 5 years ( p = 0.595) with the moment of implant installation as baseline. Papilla height increased between 1 and 5 years ( p ≤ 0.007), whereas mid‐facial contour ( p = 0.005) and alveolar process deficiency ( p = 0.008) deteriorated. Mean mid‐facial recession was on average 0.28 mm (SD 0.48) at 1 year and 0.53 mm (SD 0.53) at 5 years ( p = 0.072) with the preoperative status as baseline. Three implants demonstrated advanced mid‐facial recession (>1 mm) at 5 years. All three were in a central incisor position and none had been treated with a CTG. Thus, 8/17 implants showed aesthetic complications (five early and three late aesthetic complications). Implants in a lateral incisor position showed stable soft tissue levels. The pink aesthetic score was on average 12.15 at 1 year and 11.18 at 5 years ( p = 0.030). Conclusion: Single immediate implants showed high implant survival and limited marginal bone loss in the long term. However, mid‐facial recession, mid‐facial contour and alveolar process deficiency deteriorated after 1 year. With an aesthetic complication rate of 8/17 in well‐selected patients who had been treated by experienced clinicians, type I placement may not be recommended for daily practice.