Soft Tissue Preservation and Pink Aesthetics around Single Immediate Implant Restorations: A 1-Year Prospective Study

Purpose: (1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single-tooth removal; (2) to evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed. Materials and Methods: Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15-25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate nonocclusal loading with a screw-retained provisional crown, and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6, and 12 months. Cases demonstrating major alveolar process remodeling and/or advanced midfacial recession (>1mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns. Results: Twenty-two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for nonperiodontal reasons using a novel bone condensing implant with variable-thread design, conical connection, and platform switch (NobelActive (R), Nobel Biocare, Goteborg, Sweden). One implant failed and mean marginal bone loss was 0.1mm (p=.059). Temporary mesial papilla reduction occurred, whereas distal papilla reduction was permanent (mean 0.5mm; p=.001). At 3 months, five cases demonstrated major alveolar process remodeling and two advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p=.053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p.037). At 12 months, pink aesthetics (mean PES 12.15) was comparable to the preoperative status (mean PES 11.86; p=.293). Distal papillae had significantly deteriorated (p=.020) in this time span, whereas midfacial contour had significantly improved (p=.005). Conclusions: Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one-third of the patients. Major alveolar process remodeling is the main reason for additional treatment.