A custom Root Replica Abutment solution to improve emergence profile and maintain peri-implant tissue in immediate implant placement and restoration

Abstract

To compare the effect of immediate implant restoration using a prefabricated customized Root Replica Abutment (RRA) v/s a Stock Abutment (SA), for crestal and marginal bone level changes and peri-implant soft tissue changes over a 1-year follow-up. Patients requiring single tooth extraction and immediate implant were planned for guided surgery and immediate loading with a SA or a custom RRA and a restoration. Post extraction, guided, flap-less implant placement was done and the jumping gap was filled with a biomaterial. These were immediately loaded using a SA or a custom RRA, replicating 3mm of the root anatomy from the cementoenamel junction (CEJ) of the tooth. Data from the day of surgery to 12 months was assessed for crestal bone level with CBCT scans and transferred into a medical image processing program (ITK-SNAP 2.4.0). Soft tissue analysis using intra-oral scan (IOS), were obtained and merged using prosthetic software (exoplan®, exocad). Inter-group mean crestal bone volume changes are significantly higher in SA compared to the RRA group. Mean bone Volume-Vpre-op and Vpost-op did not differ significantly. Intra-group mean crestal bone changes at 12-months follow-up did not differ significantly. V post-op is significantly lower compared to V pre-op for both study groups. Labial soft tissue contour at 12 months did not differ significantly between groups. However higher values were observed for the SA group. Marginal gingiva changes at 12 months were higher in the SA group. Custom RRA helps maintain socket volume and provides better support for the peri-implant tissue resulting in the optimal and stable aesthetic final restoration.