Title

Does Immediate Implant Placement Result in More Soft Tissue Recession Than Conventional Implant Placement for Patients Requiring Tooth Extraction in Esthetic Areas?

Clinical Question

Will there be a difference in the position of the soft tissue margins following tooth extraction if an implant is placed immediately versus placing an implant in a delayed fashion, three months later following bone grafting?

Clinical Bottom Line

Immediate implant and delayed implant placement fail to show any significant differences between patients for midbuccal or interproximal soft tissue recession. However, immediate implant placement sites had greater reductions in ridge width 6 months following extraction than the delayed placement group. (See Comments on the CAT below)

Best Evidence

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
20556256	Oates/2010	24 patients	Randomized Controlled Trial
Key results	An initial total of 24 patients with a total of 26 sites were randomly assigned to two treatment groups – immediate implant placement or delayed implant placement. Immediate placement sites received an extraction and implant the same day utilizing a full thickness flap. Sites with a horizontal defect between the implant and cortical wall > 2mm received a freeze-dried bone allograft (FDBA). Sites with defects < 2mm did not. Neither site received a membrane. The delayed group received an extraction and FDBA with a collagen plug following full thickness flap elevation. Following three months of healing a second surgical procedure was performed to allow for implant placement with a full thickness flap. All implants received a transgingival abutment at the time of placement regardless of timing of placement. A series of five measurements were taken at 0, 3 and 6 months to evaluate midbuccal recession, interproximal tissue height and ridge width. No significant differences in the position of the midbuccal soft tissue were noted between the two groups, with recession averaging 0.17 mm. Interproximal soft tissue height decreased on both treatment groups with no significant difference, 1.73 mm on the mesial and 1.48 mm on the distal. There was a significantly greater reduction in ridge width for the nongrafted immediate sites comparted to the delayed sites. However, there was minimal difference in ridge width at 6 months for the grafted delayed sites and the grafted immediate sites.

Evidence Search

“Delayed Implants” [Mesh] AND “Immediate Implants” [Mesh] AND “Soft Tissue Recession” [Mesh]

Comments on
The Evidence

The hypothesis of this study was that a delayed approach would result in fewer soft tissue changes thus leading to a better esthetic outcome. The patient selection excluded smokers, severe bruxers, patients with systemic disease and those with uncontrolled dental diseases. Computer randomization of treatment selection eliminated operator bias. The use of clinical photographs as well as study casts allowed for two sets of data for comparison. Measurements were also made by two independent examiners and compared and contrasted.

Applicability

The preservation of soft tissue on the midbuccal has clearly been shown to be predictable with implant placement either in an immediate or delayed approach. A full thickness flap was used in this study and resulted in significant loss of papilla regardless whether an immediate or delayed implant was placed. The use of a flapless approach was not considered in this study, which could provide different results. Grafting was only employed when the gap between the implant and the cortical place was >2mm. Perhaps grafting all defects would have led to a greater amount of buccal palatal ridge width. No membranes were used at the time of implant placement which also could have led to the loss of some of the bone graft or soft tissue loss. The results of this study show clearly that both techniques are similar with regard to the buccal positon of soft tissue and the position of the mesial and distal papilla utilizing full thickness flaps at the time of placement and extraction. If we are to look at this study only, it would appear to make sense to always do immediate implants for it would decrease the need for a second surgery and save time.

Specialty

(Periodontics)

Keywords

Immediate implants, delayed implants, bone grafting

ID#

2861

Date of submission

03/27/2015

E-mail

sonick@livemail.uthscsa.edu

Author

Rebecca Sonick

Co-author(s)

Co-author(s) e-mail

Faculty mentor

Thomas Oates, DMD, PhD

Faculty mentor e-mail

OATES@uthscsa.edu

Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)

None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

by Olivia Gassmann (San Antonio, TX) on 03/31/2015
Critically Appraised Topic #2880 discusses a similar question. Consistent with this study, immediately placed implants are determined to be a successful treatment option when compared to conventionally placed implants. However, immediately placed implants are associated with greater variability of outcomes regarding midfacial mucosal recession 1-3 years post-placement. This is supported by a Systematic Review of Randomized Control Trials and numerous studies that measured objective esthetic indices in 594 total patients, determining that a median of 26% of sites had greater than 1 mm of midfacial mucosal recession 1-3 years after immediate implant placement.