[Clinical evaluation of the socket-shield technique for immediate implantation in the maxillary anterior region]

Analysis of Soft Tissue Changes and Influencing Factors of Implant Absorption after Immediate Restoration of Anterior Teeth

Objective

Using a digital model, evaluate the changes in the soft tissue following rapid restoration of anterior teeth and analyze the factors impacting implant absorption.

Methods

A retrospective analysis was performed on 84 patients who received immediate implant restoration for a single anterior tooth in the department of Stomatology of our hospital from April 2020 to August 2021. According to different surgical methods, they were divided into the study group (n = 42) and control group (n = 42). Immediate implant repair was given to the research group, while delayed implant restoration was given to the control group. The influence of the two surgical techniques on the alterations of soft tissues around implants was studied using a 3Shape oral scan and a digital model before and 1, 3, and 5 months after the operation, respectively. Patients in the study group were divided into the excellent group (n = 26) and poor group (n = 16) according to the test results of implant bone absorption, and the risk factors of poor implant absorption after immediate restoration of anterior teeth were analyzed by univariate and multivariate analyses.

Results

The levels of 1 mm and 3 mm below the gum mucosa margin in the two groups increased gradually with the time, and the gingival level and soft tissue thickness at the lip of the baseline implant also increased gradually. However, the changes of soft tissue in the study group were better than those in the control group at 3 and 6 months after surgery (P < 0.05). The PES score was significantly improved in both groups after treatment, and the aesthetic score was higher in the study group than in the control group (P < 0.05). Univariate and binary logistic multifactor regression showed that smoking and poor implant health were the related factors affecting implant absorption (P < 0.05).

Conclusion

Immediate anterior tooth implantation and pharyngeal implant restoration can better restore the soft tissue and aesthetic degree of patients, but immediate implant restoration can more effectively restore the soft tissue, and controlling smoking and keeping clean around the implant after surgery is conducive to implant absorption.

Dimensional Changes in the Alveolus after a Combination of Immediate Postextraction Implant and Connective Grafting and/or Socket Shield Technique

Immediate implant placement protocols after dental extraction have enabled a reduction in surgical phases. This procedure has increased patient satisfaction and similar survival rates to late implant placement procedures. However, placing an implant immediately after dental extraction does not counteract the physiological remodeling of alveolar bone. For this reason, additional surgical techniques have been developed, such as the placement of a connective tissue graft (CTG) or the socket shield technique (SST). Dimensional changes in the peri-implant tissues were observed after placement of immediate implants following the extraction and CTG and/or SST. A total of 26 surgical interventions were carried out in which dimensional change variables of peri-implant tissues were analyzed. The preoperative state and immediate postoperative situation were compared with the situation after one year. Measurements were taken at 3, 5, and 7 mm from the gingival margin and analyzed in this CBCT radiological study (Planmeca Promax 3D). The implant platform was used as a reference point for the measurement of changes in alveolar crest height. One year after performing either of the two techniques (CTG and/or SST), a significant increase in the gingiva thickness and vestibular cortex occurred at 5 mm (0.65 ± 1.16 mm) and 7 mm (0.95 ± 1.45 mm) from the gingival margin. Additionally, an increase in thickness of palatal bone was registered at 3 mm (0.48 ± 0.90 mm). The graft placement group showed an increase in thickness of peri-implant tissue in the vestibular area after one year, although CTG and SST groups were clinically similar. The implementation of SST revealed promising results regarding the buccal thickness of hard and soft tissues after one year. A significant increase in vestibular cortical bone thickness, as well as the overall mucosa thickness and buccal bone at 3 mm from the gingival margin, was observed. A significant reduction in the distance from the bone crest to the platform was detected in both techniques. Both techniques (CTG and SST) are appropriate to provide sufficient volume to peri-implant tissues in the vestibular area of anterior maxillary implants. Some limitations were detected, such as the lack of an aesthetic analysis or small sample size, so results should be interpreted with caution. Future studies are necessary to further evaluate the long-term predictability of these techniques.