Comparative Clinical Outcomes Of Immediate Versus Delayed Implant Placement Following Minimally Invasive Tooth Extraction In The Anterior Maxillary Region

Objective: To compare the clinical effect of immediate(type Ⅰ)implant and delayed(type IV)implant after minimally invasive tooth extraction in the maxillary anterior esthetic area on the premise of preserving alveolar bone as much as possible,and to provide a reference for implant planning in the maxillary anterior esthetic area.Methods: Between March,2021 and September,2022,39 patients with moderate to thick gingival biotype(41 implants)who required minimally invasive extraction in the maxillary anterior region were randomly divided into two groups: immediate(typeⅠ)implant group(experimental group,n = 20,22 implants)and immediate(type ⅰ)implant group(control group,n = 20,22 implants).There were 19 cases in the delayed(type IV)implant group(control group),with 19 implants in the late bonding restoration.Mesial-distal marginal bone loss(MBL)was recorded at 1 month,3 months,6 months and 12 months after operation.Esthetic red index(PES)and probing depth(PD)were evaluated at the day of restoration completion,3 months,6months,and 12 months after restoration completion.After that,the data were sorted out,processed and compared between groups to draw conclusions.Results:(1)During the follow-up period,the rate of patient loss to follow-up was 2.5%(a total of 40 patients,and 1 patient was lost to follow-up during the follow-up period).In addition,one patient developed peri-implantitis after stage Ⅱ surgery.Although the inflammation was resolved after treatment,the soft tissue of the labial side was significantly atrophie at the end of the restoration.Another patient had partial resorption of labial alveolar bone and soft tissue depression.(2)Mesial and distal marginal bone loss(MBL): there was no significant difference in distal marginal bone loss between the two groups at 6 months after implantation(P>0.05),and the rest were statistically significant(P<0.05).There was no significant difference between the mesial and distal marginal bone resorption in the same group(P>0.05).(3)PES: there was no significant difference in PES between the two groups on the day of restoration(P> 0.05).PES was statistically significant at 3 months,6 months and 12 months after restoration(P<0.05).From the day of treatment completion to 12 months after restoration,the red esthetic index(PES)of the immediate implant group was better than that of the delayed implant group.(4)Probing depth(PD): there were significant differences in PD between the two groups at 1 month and 12 months after completion of the restoration(P<0.05).There was no significant difference in probing depth between the two groups at 3 and 6 months after the completion of the restoration(P>0.05),but the probing depth of the immediate implant group was lower than that of the delayed implant group.Conclusions:(1)Under the premise of minimally invasive tooth extraction with alveolar bone preservation as much as possible,strict indications and strict standardization of surgical procedures,immediate implant placement can reduce the bone resorption in the mesial and distal regions compared with delayed implant placement.In addition,the clinical aesthetic effect of immediate implant group is better than that of delayed implant group.(2)There was no significant difference in probing depth between the two groups.However,by strengthening oral health education and improving patients’ awareness of oral care,the incidence of periimplantitis can be effectively reduced,thus reducing the formation of periodontal pockets,and thus reducing the probability of probing depth increase.