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Purpose: To evaluate the role of different healing abutment designs in compensating for the buccolingual volumetric tissue change that occurs following flapless single-tooth immediate extraction placement in the molar area., Materials and Methods: Patients in need of extraction and replacement of a first or second molar in the mandible or maxilla were consecutively recruited. Immediately after extraction and implant placement, an abutment was connected. Five different types of abutments were randomly selected to be used for each case. The study population was divided into five categories according to abutment design: 5-mm diameter healing abutment (group 1); 6-mm diameter healing abutment (group 2); 7.5-mm diameter healing abutment (group 3); provisional restoration (group 4); and customized healing abutment (group 5). The buccopalatal dimension (BPD) was measured on the study casts at 1, 3, and 5 mm apical to the free gingival margin, and horizontal volumetric changes were compared between baseline and 2, 4, and 6 months., Results: A total of 267 implants were inserted in 246 patients. The breakdown of placed implants for each group was as follows: 67 implants in group 1; 64 in group 2; 71 in group 3; 33 in group 4; and 32 in group 5. Changes in the mean horizontal ridge dimension were as follows. After 6 months in group 1, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 4.21 ± 0.158, 3.38 ± 0. 178 and 2.35 ± 0.178 mm. In group 2, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 3.16 ± 0.198, 2.56 ± 0.198, and 1.62 ± 0.198 mm. In group 3, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 2.53 ± 0.138, 2.16 ± 0.144, and 1.56 ± 0.144 mm. In group 4, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 1.11 ± 0.179, 1.23 ± 0.179, and 1.12 ± 0.179 mm. In group 5, BPD diminished at 1-, 3-, and 5-mm distance from the free gingival margin, respectively, by 0.25 ± 0.225, 0.30 ± 0.225, and 0.19 ± 0.225 mm. Mixed-effect regression and post hoc means comparisons were used to model the impact of the restoration technique, height of measurement, and time on BPD using a significance reference level of .05. Statistical analysis showed that the type of abutment, the height of measurement, and the time significantly influenced the BPD and that there were complex interaction effects between these variables., Conclusion: The observed volumetric soft tissue changes in the 6-month short-term follow-up appeared to vary based on the use of different healing abutment sizes that were connected to implants placed immediately after tooth extraction in the molar area. In particular, the use of a customized healing abutment resulted in preservation of the original horizontal dimension of the molar soft tissue.

This article aims to evaluate the effect of anatomically designed, single-unit provisional restorations on soft tissue preservation following immediate implant placement. Patients in need of a single-tooth replacement in the esthetic area were recruited for this study. An immediate provisional restoration with a transmucosal area anatomically designed to support the soft tissue was used for every patient. The horizontal volumetric tissue changes and the presence and amount of vertical recession were measured at baseline (T0) and after 1 month (T1), 3 months (T2), and 6 months (T3). Sixty-three patients received 66 implants that were placed into fresh extraction sites. The average follow-up time was 48 months (range: 24 to 60 months). All implant restorations were successful, and the cumulative implant survival rate and success of restorations was 100%. After 6 months, the mean horizontal ridge measured midbuccally had increased by 0.10 ± 0.10 mm at 1 mm from the free gingival margin, had decreased by 0.09 ± 0.10 mm at 3 mm, and had decreased by 0.20 ± 0.10 mm at 5 mm. In addition, the mean recession at the midbuccal surfaces was 0.04 ± 0.37 mm. Measurements were made clinically and compared to measurements made on the casts. According to the results of this study, the use of customized anatomically designed immediate provisional restorations following single-tooth extraction and immediate implant placement appeared to minimize the loss of tissue volume that results from postextraction bone remodeling, thus optimizing the final esthetic result.