The relationship between labial soft tissue changes and jumping spaces after immediate implant placement and restoration in the anterior maxilla: A prospective study

Abstract

We investigated the changes of labial soft tissue contours with different jumping spaces after immediate implant placement and restoration (IIPR) in the maxillary esthetic area and also provided a long-term stability measurement for the changing trend of soft tissue contour. First, an intraoral pre-operation scanning was used to obtain a digital impression (baseline) of 32 patients with single tooth loss in the maxillary esthetic area. After minimally invasive extraction, the implant had been embedded at the alveolar socket’s palatal side with flapless surgery. A low replacement bone substitute material (Bio-oss bone powder) was then implanted in the jumping space and covered with platelet-rich fibrin (PRF) and screw retention temporary crown was worn. All patients had been separated into three groups based on the jumping space: group A (horizontal defect dimension [HDD] ≤ 2 mm), group B (2 mm < HDD ≤ 3 mm), and group C (HDD > 3 mm) and the digital impressions were obtained in the first, third and sixth month after the operation. The linear changes in peri-implant soft tissue volume, labial gingival margin level, and soft tissue profile were quantitatively analyzed by Geomagic Studio 2013, and the esthetic effect was assessed using the pink esthetic score (PES). The volume of labial soft tissue decreased continuously within six months after IIPR, particularly in the first three months. The changes of gingival mucosa levels, the average thickness of soft tissue contour volume and the linear change of submarginal level decreased gradually across the three groups, with the largest change of submarginal level being at 5 mm. The size of jumping space was moderately negatively correlated with the level and average thickness of gingival mucosa and the linear changes of 3 mm and 5 mm under gingival margin, while there was no significant correlation with PES and the linear change of the 1 mm under the gingival margin. Therefore, enough jumping spaces should be set aside during the immediate implantation to reduce the contour alterations of the soft tissue. Generally, IIPR of upper anterior teeth can achieve esthetic satisfaction, and the level of soft tissue around the implant can be well preserved.