Single-Tooth Replacement in the Anterior Maxilla by Means of Immediate Implantation and Early Loading: Clinical and Aesthetic Results at 5 Years

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Abstract
Background: The hypothesis of the present study was that the early loading of single implants-supported restorations, replacing single extracting teeth in the anterior region of the maxilla in case of fresh extraction sockets with residual hard and soft tissue preservation, could be a successful procedure. Methods: Twenty-one implants were placed into maxillary anterior fresh extraction sockets using a flapless technique. Temporary restorations, which were fabricated from the impression taken immediately after implant placement, were connected within 2 weeks. These temporary restorations were adjusted in order to avoid any direct occlusive contacts. Six months after implantation, the implants were restored with single-teeth all-ceramic prostheses. Patients were followed for 5 years. Radiographic and clinical examinations were made at baseline, at time of definitive crowns delivery, and each subsequent year. Survival rate, cortical bone responses, and peri-implant mucosal responses were evaluated. Results: One implant was lost at 6 months. Clinical osseointegration of 20 implants was achieved (95.2% implant survival rate after 5 years) with minimal gingival recession and papillae preservation. The mean change in marginal cortical bone level was 0.40 mm at 6 months and 0.83 mm at 5 years. Conclusions: Within the limit of the present study, the data indicate that, under a strictly controlled oral hygienic regimen, single-tooth implants, with immediate placement and early loading protocol, may be used in anterior maxillary fresh extraction sockets with residual hard and soft tissues preservation, if patients are selected carefully and if high primary stability is strictly followed.

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