Cabello, G., Rioboo, M., Fábrega. J.G.

Purpose
The aim of this prospective study was to evaluate the soft tissue changes around implants in the aesthetic zone, placed under a trimodal approach (immediate post-extraction placement, flapless, and immediate provisional restoration) and its relationship to gingival/periodontal biotype of the patient.

Materials and methods
The sample consisted of 14 patients from two private practices that were in need of a tooth extraction in the anterior maxillary region (cuspid to cuspid) and were candidates for replacement with a dental implant. An initial measurement (baseline) of the position of the mesial and distal papillae and gingival zenith was made at this time, with a rigid dental-supported stent and an electronic precision caliper, able to the second tenth of a millimeter; and, after careful tooth extraction, the periodontal thickness, at a point 5mm apical to the gingival buccal margin, with an analogical thickness gauge, able to one tenth of a millimeter. Once the implant was inserted, an immediate provisional restoration was delivered. To evaluate the soft tissue changes, measurements were repeated at three, six, and 12 months. A statistical analysis was performed to evaluate the changes in the gingival margin around the implant restorations and to identify a possible correlation to the patient’s periodontal thickness.

Results
All 14 patients received Straumann® implants (nine tissue level [TL] regular neck [RN], two TL narrow neck [NN], two bone level [BL] narrow crossfit [NC], and one BL regular crossfit [RC]). All implants integrated and none had any biological complications. Three provisional restorations presented with screw loosening and were retightened once, and one presented with loss retention and was re-cemented once. In one patient, with a severe bruxing habit, the final restoration suffered screw loosening and was retightened. Of the final restorations, 12 were screw retained and two cemented on custom-made Zirconia abutments.

A mean recession of the buccal margin of 0.45mm was recorded at 12 months (± 0.25mm). An acceptable papilla level was present in all cases at one year, with mean changes of 0.38mm (± 0.60) for the mesial and 0.80mm (± 0.90) for the distal papilla, respectively. No correlation could be established between the soft tissue changes and the periodontal biotype of the patient.

Conclusions
Within the limitations of this study, the good aesthetic outcome and minimal complications seem to validate the trimodal approach protocol as a reliable and simple protocol to place and restore immediate implants in the aesthetic zone. No correlation between the patient’s gingival biotype and the soft tissue alterations could be established. Additional studies are needed to verify long-term aesthetic results with this approach and to better define and quantify biotypes.

Clinical Oral Implants Research 2013; 24 (10): 1094-1100.