الفهرس 
Aim of the StudyOnly 14 pages are availabe for public view
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Abstract
The concept of immediate single-tooth replacement has been widely accepted as the treatment of choice in ideal esthetic situations. After tooth extraction, the remaining bundle bone becomes non-functional due to loss of its blood supply from the periodontal ligament and ultimately undergoes complete resorption. Although early studies demonstrated that implants placed in fresh extraction sockets may help to preserve the alveolar bone dimension, other studies demonstrated that such a technique was not capable of maintaining the alveolar bone crest in its original shape after 3 or 4 months of healing. The clinical concern that arises from these studies is that alteration in hard tissue after tooth extraction may cause deficiencies in bone contours that can compromise the esthetic outcome of immediate implants. While immediate tooth replacement with immediate implant placement (IIP) has been proven to be a successful procedure and advantageous in preserving the vertical height of the interdental papilla, slight facial gingival recession has been reported following the first year of function. Many authors have recommended the routine use of connective tissue graft to thicken the labial soft tissue to ˃2 mm. However, to date, studies regarding the efficacy of connective tissue grafts in conjunction with immediate tooth replacement have been rare. The aim of this study was to assess the clinical treatment outcomes of immediate implant placement; with or without connective tissue graft, in single-tooth gaps located in the esthetic zone by clinical parameters.
The present study was conducted on 20 patients (6 males and 14
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females); randomized into two equal groups (group1 and group 2). Each patient received one implant. The study protocol was approved by the ethical committee for clinical studies of Faculty of Dentistry, Ain Shams University. Patients were selected according to the inclusion and exclusion criteria from the outpatient clinic of the Faculty of Dentistry, Ain Shams University. All patients received standardized diagnosis and treatment-planning procedures. Patients were given detailed explanations of the study purpose, benefits, risks and complications and each patient signed an informed consent of the procedure. Each patient was randomly assigned (by choosing a letter from an envelope) to be either in (Group 1) or in (Group 2). Each patient of group 1 (gp1) received one implant that was placed immediately following atraumatic tooth extraction without flap elevation and without using connective tissue graft. While each patient of group 2 (gp2) received one implant that was placed immediately following atraumatic tooth extraction, with simultaneous soft tissue augmentation using subepithelial connective tissue graft (SCTG) that was transferred from the palate into a split-thickness envelope prepared on the facial aspect of the implant. Four months after implant placement, the abutment was screwed and conventional loading was applied using permanent porcelain fused to metal crown. However, 4 patients could not be enrolled in the study and a total of 16 patients completed the one year study; 8 patients in each group.
Clinical examination was conducted at 4, 8 and 12 months; the following clinical parameters were assessed: Plaque score (mPI),
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Bleeding score (mBI), Probing depth, Width of the keratinized mucosa (KM), Pink esthetic score (PES) and White esthetic score (WES). Impressions were taken at 4, 8, and 12 months to perform cast analysis. Cone beam computed tomography (CBCT) was used at baseline and 4 and 12 months of implant placement to measure changes in facial bone height (FBH), peri-implant bone density (BD) and facial crestal gingival thickness (FCGT) aided by software. No technical complications such as screw loosening, crown fracture, or pain during chewing were observed during the follow up period. All patients were satisfied with the esthetic outcome of implant therapy, and none of the patients observed any change in the gingival level around the implants. This study shows that implants placed in fresh extraction sockets with or without SCTG have a high success rate (100%) through one year follow-up and that there were no differences in survival and success rates of implants whether SCTG procedure was performed or not. Mean mPI, mBI, and probing depth values at the 12- month examination indicated healthy peri-implant soft tissues and were all in line with previous prospective studies using the same parameters. There was statistically significant decrease in the mean KM within gp1 from 4 months to 8 months interval and from baseline to 12 months interval while the mean change in KM within gp2 was not statistically significant through the whole follow up period. The mean PES of gp2 in the present study was greater than that of gp1 indicating an overall successful esthetic outcome when SCTG was used in gp2.
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The values of cast analysis did not reach the level of significance when tested within gp1 or gp2 over time or between both groups The measurements of FBH at different time points from the implant placement seemed to suggest that in both groups a certain bone resorption occurs; however, bone resorption was significant in both groups at 4 months follow up interval with no significant difference between the two groups. The mean FCGT at 4 months follow up interval for the gp2 (SCTG group) was significantly greater than that at baseline as well as at 4 months follow up interval in the gp1. The clinical results from our study could support the hypothesis that flapless immediate implant placement in conjunction with connective tissue grafting does not offer better preservation of facial bone height than that without. However, connective tissue grafting can predictably and sufficiently improve gingival tissue thickness, preserve width of keratinized mucosa and produce esthetically pleasing soft tissue contour when performed in conjunction with immediate implant placement.