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Esthetic Outcome of Immediately Placed and Non-Functionally Loaded Implants in the Anterior Maxilla- Peri-Implant Gap Management
EAO Online Library. Altarawneh S. Oct 9, 2018; 232653; P-PA - 1
Sandra Altarawneh
Sandra Altarawneh
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Immediate implant placement and provisionalization in the esthetic area of the maxilla has several advantages. However, strict selection criteria should be followed to achieve a stable and esthetic longterm result. It has been advocated that grafting the peri-implant gap can result in superior esthetic results and would reduce the alveolar process deficiency that occurs following extraction and implant placement. Yet, the effect of provisionalization has not been thoroughly investigated. To evaluate the aesthetic outcome of immediate dental implantation and immediate non-functional loading utilizing definitive abutments in the aesthetic zone, with and without bony substitutes filling the peri-implant gap.In this prospective clinical trial, 11 implants were placed in 10 subjects utilizing a flapless immediate post extraction approach in the esthetic area of the maxilla (15 to 25). Atraumatic extraction was performed keeping an intact facial bone plate. Implants were placed with a gap of at least 2 mm from the inner surface of the facial plate. The gap between the implant and the inner surface of the facial plate was either left without grafting or filled with natural bovine bone mineral granules. Upon achieving a torque of 30 Ncm or more, immediate non-functional loading was performed utilizing a definitive abutment. Definitive crowns were fabricated 12 weeks post implant placement. Pink Esthetic Score (PES) (Furhauser et al. 2005) was assessed preoperatively (PES0), 1 year (PES1) and 2 years (PES2) after delivery of definitive crowns. Dental casts were made at those points of time as well. Those casts were scanned, registered and All image analysis steps were done using Slicer CMF.The range of the gap left between the implant and the inner surface of the facial plate varied from 2mm to 4mm. All implants remained integrated and restorations were functional at the end of a two year follow up period. The means of PES score were as following- PES0= 9.4, PES1=9.5, PES2=10.2, PES(graft group)=10.3, PES (non-grafting group)=10.2. There were no statistically significant differences in PES scores at different points of time both collectively (P=0.19 for PES0 vs PES1, P=0.24 for PES0 vs PES2, and P=0.52 for PES1 vs PES2), and when compared for the grafting group versus non-grafting group (P=0.24 for PES2 graft vs. PES2 non-grafting). As for casts scans, the surface distances between the 2 time points for all cases were less than 1 mm in all reference planes and there were no statistically significant differences.Immediate placement and immediate non-functional loading utilizing a definitive abutment in a one-abutment-at one-time protocol in the esthetic area of the maxilla appears to result in a favorable and stable result as far as esthetic outcome, and alveolar process sufficiency are concerned. It seems grafting the horizontal gap has no additional benefit in promoting better clinical outcomes given that the provisional restoration is meticulously fabricated and strict selection criteria are applied.
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