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

Edith Groenendijk,Gert Jacobus Meijer,Ewald Maria Bronkhorst

doi:10.1186/s40729-021-00366-3

Edith Groenendijk, Gert Jacobus Meijer + Show 1 more

Open Access

https://doi.org/10.1186/s40729-021-00366-3

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Abstract

BackgroundImmediate 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 methodsIn 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.ResultsPre-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).ConclusionRegardless of phenotype, preoperative soft tissue recession, or excess, comparable high aesthetic outcomes were achieved 1 year post-operatively.Trial registrationEthical approval was obtained and registered on 20 October 2015 (NTR5583/NL4170).

Highlights

Immediate implant placement (IIP) often is related to mid-buccal recession in literature
The risk of a poor pink aesthetic outcome of immediately placed implants often is related to mid-buccal recession in literature [1,2,3]
In our prospective cases series, we reported a high over-all aesthetic outcome 1 year after flapless immediate implant placement and provisionalization (FIIPP) [15]

Summary

Introduction

Immediate implant placement (IIP) often is related to mid-buccal recession in literature. The total pink aesthetic score (total-PES) ranges from 0 to 14 (total-PES1–14) This method is applied in many researches [5,6,7,8,9,10,11,12,13,14,15] and generally preferred over the simplified-PES, introduced by Belser et al [16]. This latter was launched in favor of ‘ease of use and understanding’ by varying the total-PES score between 1 and 10 (total-PES1–10). Important information is sacrificed by merging the original criteria “alveolar deficiency,” “soft tissue color,” and “soft tissue texture.”

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