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Contains fulltext : 288300.pdf (Publisher’s version ) (Open Access) BACKGROUND: Flapless immediate implant placement and provisionalization (FIIPP) in the aesthetic zone is still controversial. Especially, an initial buccal crest thickness (BCT) of ≤1 mm is thought to be disruptive for the final buccal crest stability jeopardizing the aesthetic outcome. PURPOSE: To radiographically assess the BCT and buccal crest height (BCH) after 1 year and to calculate the correlation between initial and final achieved BCT. MATERIALS AND METHODS: The study was designed as a prospective study on FIIPP. Only patients were included in whom one maxillary incisor was considered as lost. In six centers, 100 consecutive patients received FIIPP. Implants were placed in a maximal palatal position of the socket, thereby creating a buccal space of at least 2 mm, which was subsequently filled with a bovine bone substitute. Files of preoperative (T0), peroperative (T1) and 1-year postoperative (T3) cone beam computed tomogram (CBCT) scans were imported into the Maxillim™ software to analyze the changes in BCT-BCH over time. RESULTS: Preoperatively, 85% of the cases showed a BCT ≤1 mm, in 25% of the patients also a small buccal defect (≤5 mm) was present. Mean BCT at the level of the implant-shoulder increased from 0.6 mm at baseline to 3.3 mm immediate postoperatively and compacted to 2.4 mm after 1 year. Mean BCH improved from 0.7 to 3.1 mm peroperatively, and resorbed to 1.7 mm after 1 year. The Pearson correlation of 0.38 between initial and final BCT was significant (p = 0.01) and therefore is valued as moderate. If only patients (75%) with an intact alveolus were included in the analysis, still a "moderate correlation" of 0.32 (p = 0.01) was calculated. CONCLUSIONS: A "moderate correlation" was shown for the hypothesis that "thinner preoperative BCT's deliver thinner BCT's" 1 year after performing FIIPP.

Background: Immediate implant placement and provisionalization (IIPP) is considered as a high-risk treatment for aesthetic failure and generally only recommended in case of post-extraction intact sockets and a thick phenotype gingiva. During a prospective clinical cohort study on one-hundred consecutive patients, using this strict flapless immediate implant placement and provisionalization (FIIPP) protocol, we found high and stable aesthetic outcomes (WES/PES = 8.2/12.1) in both intact – and defect sockets, and both thin- as thick gingival phenotype. By means of one case report (Case 1), the total FIIPP treatment is illustrated. Results of two other cases, show that comparable high aesthetic outcomes can be reached in cases with a thin phenotype gingiva or buccal bone defect using the same protocol. Case Presentation: In a 24-year-old male with good general and oral health, root fracture of tooth 21 was diagnosed and FIIPP was indicated. Direct post-extraction, an implant was placed in a palatal position of an intact socket by a flapless approach. A minimum space of 2 mm in front of the implant was created and filled with a bone-substitute prior to implant placement. Subsequently, the implant was restored by use of a titanium abutment and a composite temporary crown. Three months later, the temporary crown was replaced by a customized zirconium abutment and ceramic crown resulting in a high aesthetic outcome. A comparable aesthetic outcome using this protocol can be reached in cases with a thin phenotype gingiva and/or a buccal bone defect (Case 2). Conclusion: Using described surgical FIIPP protocol, high aesthetic outcomes are reached in only 4 visits and within a treatment period of 4 months. A thin phenotype gingiva, or a pre-operative buccal bone defect, does not seem to affect the aesthetic outcome using this treatment method.

Contains fulltext : 220439.pdf (Publisher’s version ) (Closed access) BACKGROUND: Prospective aesthetic outcomes on a high number of patients after immediate implant placement and provisionalization (IIPP) are lacking. PURPOSE: To analyze the aesthetic outcome after IIPP. MATERIALS AND METHODS: One hundred consecutive patients with a failing maxillary incisor were provided with an immediately placed and provisionalized nonloaded implant using a flapless procedure and palatal implant positioning. The remaining gap buccally was filled with a bone substitute. Preoperatively (T0), 2 weeks postoperatively (T1), direct after placement of the permanent crown (T2), and 1 year after IIPP (T3), standardized light photographs were made. Change in aesthetic score was the primary outcome measure. Both the white aesthetic score (WES) and pink aesthetic score (PES) were used. RESULTS: In the first year postsurgery, the mean total-WES and total-PES scores raised from 4.5 to 8.2, and from 9.9 to 12.1, respectively. The mean PES scores for mesial and distal papilla, soft tissue marginal level, contour, color, and texture, raised significantly (P < .05), while the alveolar process contour, on average, remained stable from T0 to T3. CONCLUSIONS: Within the limitations of this 1-year research, it may be concluded that, following this minimal invasive IIPP procedure, a high aesthetic outcome was achieved.

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.

Tandvervanging in de esthetische zone is een procedure waarbij de kleinste fout in de behandeling van de harde en zachte weefsels leidt tot een onbevredigend esthetisch resultaat en een ontevreden patient. De standaard tot nu toe is om eerst de resterende wortel te verwijderen, waarna een genezingsperiode van 6-12 weken in acht wordt genomen. Helaas blijkt dat juist in de eerste 12 weken na extractie de tandkas substantieel resorbeert. Hierdoor wordt het eindresultaat van de implantaatbehandeling, vooral in esthetisch opzicht, onvoorspelbaar. Op basis van de wetenschappelijke literatuur hebben we een protocol opgesteld voor immediate replacement waarbij dit probleem wordt ondervangen. Dit protocol ligt ten grondslag aan ons promotie-onderzoek dat momenteel loopt.

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.

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.

This double-blind study used a split-mouth design to investigate the microbiological and clinical effects of 0.2% chlorhexidine enclosed in fixtures. Twelve patients had 46 fixtures implanted. At second-stage surgery, a microbiological sample (baseline sample) of the inner parts of the fixtures was taken. Then, a 0.2% chlorhexidine solution was applied into the inner space of 23 fixtures (test group), and in 23 fixtures saline was applied (control group). Abutments were installed and gingival index, plaque index and crevicular fluid flow were monitored weekly. After 6 weeks, a second microbiological sample of the inner part of the fixtures was taken. At baseline, viable bacteria were detected within 46% of the fixtures. After weeks, bacteria were found in 87% of the fixtures. The numbers of bacteria in the control group were significantly higher than those in the test group. The results indicate that, after first-stage surgery, contamination of the inner spaces of the fixtures is commonplace. Application of a 0.2% chlorhexidine solution at second-stage surgery inhibits growth or acquisition of bacteria in the fixtures. In both test and control groups, the crevicular fluid flow as well as the gingival index decreased during the experimental period. At 4, 5, and 6 weeks after chlorhexidine application, these values in the test group appeared lower, but did not attain statistical significance.