Aesthetic implant placement in immediate or delayed protocol
Purpose: The purpose of the present study was to identify the most reliable clinical and radiological criteria of potential extraction site in order to optimize prognose for immediate omplant procedures in the maxillary anterior region of the mouth. Materials and methods: Fourteen titanium screw-shaped implants (Nobel Biocare, Replace Select®) were immediately placed after extraction in 12 patients, 4 women and 8 men (age 17 to 49 years, average=8). Implants were placed after extraction socket soft and hard tissues parameters evaluation. Periimplant bone defects were filled using guided bone regeneration (GBR). GBR was done using deorganified bovine bone and resorbable collagen membranes. Soft tissues deficiency was corrected using rotated split palatal flap and/or transposition of buccal mucoperiosteal flap. Success rate and aesthetic evaluation was done after prosthetic rehabilitation. Results: Immediate implantation with good regenerative potential and aesthetic prognosis was possible at 6 extraction sites (42.9%) for 6 patients (3 male and 3 female). Six patients (5 male and 1 female) had 8 extraction sites (57.1%) with compromised soft tissue and bone volume. After 6 months of healing, at re-entry, the mean vertical extension of all sites was 0.45 mm (SD 0.3 mm, range 0-1.1 mm). The considerable decrease in bone defect of 89.6% (SD 7.9%) was statistically significant (p<0.05). Mean DIP for all patients were 2.9 mm (SD 0.27 mm, range 2.5-3.3 mm). Mean value of KMW was recorded in 13 (92.9%) implant cases. Only in one case KMW was 1 mm. Conclusion: It was concluded that compomised soft tissue and bone volume is not a contra indication and that careful evaluation following strict clinical and radiological criteria provides successful aesthetic and functional results.