Does the pre-operative buccal soft tissue level at teeth or gingival phenotype dictate the aesthetic outcome after flapless immediate implant placement and provisionalization? Analysis of a prospective clinical case series

Abstract

Background Immediate implant placement (IIP) often is related to mid-buccal recession in literature. To draw conclusions about the behavior of the soft tissues following IIP, pre-operative aesthetic measurements have to be taken into account. The aim of analysis of these prospective clinical case series data was to elucidate whether the pre-operative buccal soft tissue level (STL) or gingival phenotype influence the 1-year pink aesthetic outcome after performing flapless immediate implant placement and provisionalization (FIIPP) maxillary incisor cases. Materials and methods In 97 patients, a maxillary incisor was replaced performing FIIPP. STL and phenotype were analyzed on light-photographs made pre-operatively (T0), direct post-operatively (T1), after placement of the permanent crown (T2), and 1 year post-operatively (T3). To investigate if a pre-operative buccal soft tissue deficiency or excess influenced the total pink esthetic score (total-PES) per patient at T3, PES-3 was modified by adding a minus (“−”) or plus (“+”) in case of a STL-deficiency or excess, respectively. Results Pre-operatively, 40% of the cases showed a mid-buccal recession (STL-deficiency), 19% STL-excess, while in 41% an equal level in comparison with the contra-lateral tooth was observed (STL-neutral). One year post-operatively, 79% (31/39) of the recession cases showed soft tissue gain, while STL-excess cases showed the highest rate of soft tissue reduction (94%; 17/18). This resulted in a decrease of soft tissue recessions and excesses (to 26% and 4%, respectively), and an increase of ideal STL (PES-3-score 2) to 70%. The 1-year aesthetic outcome was not statistically different (p = 0.577) between patients with a pre-operative soft tissue recession (mean T3 total-PES = 12.18) or STL excess (mean T3 total-PES = 11.94). Of the total population, 71 patients with a thin, and 26 with a thick phenotype were evaluated. No statistical difference (p = 0.08) was present in aesthetic outcome between the two phenotypes (thin mean T3 total-PES = 12.30, thick mean T3 total-PES = 11.65). Conclusion Regardless of phenotype, preoperative soft tissue recession, or excess, comparable high aesthetic outcomes were achieved 1 year post-operatively. Trial registration Ethical approval was obtained and registered on 20 October 2015 (NTR5583/NL4170).

Selection criteria for immediate implant placement and immediate loading for single tooth replacement in the maxillary esthetic zone: A systematic review and meta‐analysis

“…Seven studies allowed for small facial dehiscence or fenestration defects of up to 3 mm (Bonnet et al, 2018; Bruno et al, 2014; Bushahri et al, 2021; Hartlev et al, 2013; Ma et al, 2019; McAllister et al, 2012; Migliorati et al, 2015). Larger defects or complete lack of facial bone was reported in 11 studies (Calvo‐Guirado et al, 2009; Cooper et al, 2014; Groenendijk et al, 2021; Kolerman, Nissan, Rahmanov, et al, 2016; Noelken et al, 2011; Noelken, Moergel, Pausch, et al, 2018; Norton, 2011; Rosa et al, 2014; Slagter et al, 2021; Valentini et al, 2010; Zuiderveld et al, 2018). The thickness of facial bone was only considered in eight studies (Bittner et al, 2020; Bushahri et al, 2021; Cardaropoli et al, 2019; Groenendijk et al, 2017; Kolerman, Nissan, Rahmanov, et al, 2016; Noelken, Moergel, Pausch, et al, 2018; Seyssens et al, 2020; Yang et al, 2019), with thicknesses ranging from 0 to 1.6 mm, and no studies reported a minimum of 1 mm facial bone thickness as an inclusion criterion.…”

“…Flapless immediate implant placement was performed in 49 of the included studies (Arora & Ivanovski, 2018a, 2018b; Berberi, Sabbagh, et al, 2014; Bittner et al, 2020; Block et al, 2009; Bonnet et al, 2018; Bruno et al, 2014; Bushahri et al, 2021; Cabello et al, 2013; Canullo et al, 2010; Canullo, Goglia, et al, 2009; Canullo & Rasperini, 2007; Cardaropoli et al, 2015, 2019; Cosyn et al, 2016; Crespi et al, 2008; Degidi et al, 2013; Ferrara et al, 2006; Grandi et al, 2013; Grandi, Garuti, Samarani, et al, 2012; Groenendijk et al, 2017, 2021; Groisman et al, 2003; Hartlev et al, 2013; Kan et al, 2011; Khzam et al, 2014; Ma et al, 2019; Malchiodi et al, 2013; Menchini‐Fabris et al, 2019; Migliorati et al, 2015; Mijiritsky et al, 2021; Noelken et al, 2011; Noelken, Moergel, Pausch, et al, 2018; Paul & Held, 2013; Pieri et al, 2011; Ribeiro et al, 2008; Rosa et al, 2014; Saedi Germi et al, 2020; Sato et al, 2017; Seyssens et al, 2020; Shanelec, 2005; Slagter et al, 2021; Spinato et al, 2012; Tarnow et al, 2014; Tortamano et al, 2010; Van Nimwegen et al, 2016; Vidigal Jr. et al, 2017; Yang et al, 2019; Zuiderveld et al, 2018). The use of a minimal mucoperiosteal flap was reported in three studies (Berberi, Noujeim, et al, 2014; Cosyn et al, 2011; Cristalli et al, 2015), with a further 11 studies reporting raising a full‐thickness mucoperiosteal flap for the purpose of extraction and immediate implant placement ...…”

“…Eighteen studies reported the presence of endodontic infection as an exclusion criteria (Berberi, Noujeim, et al, 2014; Berberi, Sabbagh, et al, 2014; Block et al, 2009; Canullo & Rasperini, 2007; Cosyn et al, 2016; Degidi et al, 2013; Ferrara et al, 2006; Groisman et al, 2003; Hartlev et al, 2013; Khzam et al, 2014; Kolerman, Nissan, Rahmanov, et al, 2016; Pieri et al, 2011; Ribeiro et al, 2008; Spinato et al, 2012; Tarnow et al, 2014; Tortamano et al, 2010; Valentini et al, 2010; Zuiderveld et al, 2018), with eight studies excluding acute infection (Canullo et al, 2010; Canullo, Goglia, et al, 2009; Cardaropoli et al, 2015, 2019; Cosyn et al, 2011; Degidi et al, 2014; McAllister et al, 2012; Yang et al, 2019) and sixteen studies included sites with chronic infection and only excluded acute endodontic infection (Arora & Ivanovski, 2018a, 2018b; Bittner et al, 2020; Calvo‐Guirado et al, 2009; Crespi et al, 2008; Cristalli et al, 2015; Di Alberti et al, 2012; Grandi et al, 2013; Grandi, Garuti, Samarani, et al, 2012; Groenendijk et al, 2017, 2021; Kan et al, 2011; Malchiodi et al, 2013; Mangano et al, 2012; Migliorati et al, 2015; Mijiritsky et al, 2021; Noelken, Moergel, Pausch, et al, 2018). Studies including chronic endodontic infection often reported that some sites with apical fenestration of the labial cortical bone were included.…”

“…Flapless immediate implant placement was performed in 49 of the included studies (Arora & Ivanovski, 2018a, 2018bBerberi, Sabbagh, et al, 2014;Bittner et al, 2020;Block et al, 2009;Bonnet et al, 2018;Bruno et al, 2014;Bushahri et al, 2021;Cabello et al, 2013;Canullo et al, 2010;Canullo, Goglia, et al, 2009;Canullo & Rasperini, 2007;Cardaropoli et al, 2015Cardaropoli et al, , 2019Cosyn et al, 2016;Crespi et al, 2008;Degidi et al, 2013;Ferrara et al, 2006;Grandi et al, 2013;Grandi, Garuti, Samarani, et al, 2012;Groenendijk et al, 2017Groenendijk et al, , 2021Groisman et al, 2003;…”

Single‐rooted extraction socket classification: A systematic review and proposal of a new classification system based on morphologic and patient‐related factors

“… 25 The amount of gingival recession at the extraction site. A gingival recession of more than 3 mm is considered to be associated with risk of soft tissue deficiency following IIP 6,29 (Figure 4B). Determination of soft tissue phenotype: this parameter can be either thin or thick and plays a key role in determination of future peri‐implant soft tissue 25,27 …”