Esthetic outcomes of immediate implant placements

Background: Single-rooted teeth deemed not restorable via conventional means may be candidates for implant placement at the time of tooth extraction. Immediate implant placements are believed to preserve soft and hard tissue form and contours, reduce the need for augmentation procedures, minimize surgical exposure of the patient, reduce treatment time and improve esthetic outcomes. Method: This retrospective review analyzed the esthetic outcomes of 42 non-adjacent single-unit implant restorations completed using an immediate implant surgical placement protocol. Results: The mean time in function was 18.9 months (range 6-50 months) and the majority of implants placed had a restorative platform diameter of 4.1 and 4.8 mm. A highly significant change in crown height due to marginal tissue recession of 0.9 +/- 0.78 mm (P=0.000) was recorded for all sites, with no difference seen between implant systems (P=0.837). Thin tissue biotype showed slightly greater recession than thick tissue biotype (1 +/- 0.9 vs. 0.7 +/- 0.57 mm, respectively); however, this difference was not statistically significant (P=0.187). Implants with a buccal shoulder position showed three times more recession than implants with a lingual shoulder position (1.8 +/- 0.83 vs. 0.6 +/- 0.55 mm, respectively) with the difference being highly statistically significant (P=0.000). Conclusions: Immediate implant placement requires very careful case selection and high surgical skill levels if esthetic outcomes are to be achieved. Long-term prospective studies on tissue stability and esthetic outcomes are needed.