Variations in Soft and Hard Tissues following Immediate Implant Placement versus Delayed Implant Placement following Socket Preservation in the Maxillary Esthetic Region: A Randomized Controlled Clinical Trial.

Vedavalli Subramanian,Vincenzo Grassia,Muthukumar Santhanakrishnan,R Kamaleeshwari,Nithyakalyani Ramesh

doi:10.1155/2021/5641185

Vedavalli Subramanian, Vincenzo Grassia + Show 3 more

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https://doi.org/10.1155/2021/5641185

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Abstract

Introduction Although retrospective analysis has shown immediate placement of implants (IIP) in the maxillary esthetic zone showing promising outcomes compared to delayed placement of implants following socket preservation (DIP), a direct comparison in a prospective, well-designed randomized fashion with adequate power analysis between the two implant placement protocols is still lacking. This study is aimed at radiographically evaluating the effect of IIP after extraction as compared to implant placed in preserved sockets 4 months following extraction (DIP) in terms of changes in buccal plate thickness(CBT) after 6 months of healing and evaluation of pink esthetic score (PES) for assessment of soft tissue changes and patient-related outcome measures (PROMs) using visual analogue scale (VAS). Materials and Methods 25 implants were placed immediately following extraction in the IIP group, and 25 implants were placed four months following socket preservation with demineralized bovine bone mineral (DBBM) and advanced platelet-rich fibrin (A-PRF) in the DIP group, control group, in the maxillary esthetic region. CBCT was taken preoperatively and 6 months postoperatively to assess the dimensional changes in the buccal bone plates(CBT). PES and PROMs for pain threshold and patient satisfaction using VAS were evaluated at the time of implant placement and 6 months postoperatively. Results Significant differences in mean reduction in buccal plate thickness (CBT) were found in the test group (IIP) 0.2 ± 0.02 compared to the control group (DIP) which showed a mean reduction in CBT of 0.4 ± 0.1 (p < 0.001) at the end of 6 months. Although there was no statistically significant difference in PES between the groups, there was a significant difference between the groups when individual values of PES were compared at p < 0.001. Conclusion The IIP group showed lesser reduction in CBT and a better PES which is an important clinical information which could be translated clinically in situations where implant placement is planned in the maxillary esthetic region. This trial is registered with CTRI/2019/06/019723.

Highlights

Retrospective analysis has shown immediate placement of implants (IIP) in the maxillary esthetic zone showing promising outcomes compared to delayed placement of implants following socket preservation (DIP), a direct comparison in a prospective, well-designed randomized fashion with adequate power analysis between the two implant placement protocols is still lacking
Extraction of tooth causes resorption of bundle bone leading to significant changes in soft and hard tissues surrounding the socket eventually leading to reduction in both horizontal and vertical directions, which cannot be prevented with the help of the techniques which are currently available
Case selection was carefully done limiting to include teeth which are non-restorable, and patients with type 1 extraction sockets alone were included to ensure intact bony wall at the time of implant placement to prevent any variations in assessment of crestal bone thickness (CBT) that could occur if patients with varying degrees of resorption of the buccal bony wall were included

Summary

Introduction

Retrospective analysis has shown immediate placement of implants (IIP) in the maxillary esthetic zone showing promising outcomes compared to delayed placement of implants following socket preservation (DIP), a direct comparison in a prospective, well-designed randomized fashion with adequate power analysis between the two implant placement protocols is still lacking. This study is aimed at radiographically evaluating the effect of IIP after extraction as compared to implant placed in preserved sockets 4 months following extraction (DIP) in terms of changes in buccal plate thickness(CBT) after 6 months of healing and evaluation of pink esthetic score (PES) for assessment of soft tissue changes and patient-related outcome measures (PROMs) using visual analogue scale (VAS). The IIP group showed lesser reduction in CBT and a better PES which is an important clinical information which could be translated clinically in situations where implant placement is planned in the maxillary esthetic region. The limitation in using bovine bone includes its delayed rate of resorption and healing with fibrous encapsulation with limited or no remodelling of the augmented socket towards its central aspect [1, 2]

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