Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study.

This retrospective study aimed to analyse the fate of the buccal crest after immediate implant placement (IIP) through the use of cone beam computed tomography (CBCT). In 16 consecutive patients, an implant was placed in a more palatal position after extraction, thereby creating a gap of at least 2mm between the implant and the buccal crest. Subsequently, this gap was filled with a bone substitute. Preoperatively, immediate postoperatively, and late postoperatively, a CBCT was made to measure the thickness of the buccal crest. After application of the bone substitute, the buccal crest increased in thickness from 0.9mm to 2.4mm (mean). At a mean of 103 weeks after IIP, late postoperative CBCT scans showed that the thickness of the buccal crest was compacted to 1.8mm. In the same period, the height of the buccal crest increased by 1.6mm (mean) to, on average, 1.2mm above the implant shoulder. The aesthetic outcome was analysed using the White and Pink Esthetic Score (WES and PES). Both scored high: 8.4 and 11.8, respectively. Within the limitations of this study, the results of this IIP protocol are promising. Long-term prospective research on this topic on a large number of patients is necessary.

[Immediately placed front tooth implants 1. Analysis with cone beam computed tomography after remodelling of the buccal plate]. / Immediaat geplaatste fronttandimplantaten 1. Analyse met conebeamcomputertomografie naar remodellering van de buccale botlamel.

In the period 1 January 2008 to 1 January 2012, an implant was installed in 186 patients immediately after the removal of a maxillary incisor. Subsequent to the placement of the implant, the 2 mm gap between implant and buccal plate was filled with a bone substitute. In the case of 16 patients, in addition to a preoperative and immediately postoperative cone beam computer tomogram, a late-postoperative cone beam computer tomogram was also produced.Immediately post-operative, the buccal plate thickness increased by 1.5 mmfrom 0.9 mm to 2.4 mm. During the evaluation period of 1 to 4 years a reduction took place resulting in a final buccal plate thickness of 1.8 mm on average. Surprisingly, the buccal plate bone height increased by 1.6 mm, to an average of 1.2 mm above the implant shoulder. It was crucial in this case that the implant was placed in such a way that a gap of a minimum of 2.0 mm was created between the original buccal plate and the implant, and that this gap was filled with a bone substitute.

[Immediate front implant placements 2. Objective and subjective aesthetic treatment results]. / Immediaat geplaatste fronttandimplantaten 2. Objectief en subjectief esthetisch behandelresultaat.

In this study, the aesthetic outcome of treatment was analysed after immediate implant placement in 16 patients. During implant installation the gap between the implant and the buccal plate was filled with a bone substitute. Only single tooth replacements were included; the final crowns were placed 3-6 months after implant installation, all with individual manufactured abutments with an emerging profile and platform switching. Postoperative aesthetics were analysed based on clinical photographs and satisfactionquestionnaires. The objectively attained White Esthetic Score and Pink Esthetic Score with an average value of 8.4 and 11.8 respectively, scored high, as was also observed for patient's satisfaction on both treatment and outcome (an average of 8.7). It may be concluded that flapless immediate implant placement together with the application of a bone substitute into the buccal gap in combination with a final crown with emerging profile results in objective and subjective good aesthetics and high patient satisfaction.