| Objective:It's difficult for implant placement in maxillary aesthetic region,we aim to not only get the osseointegration,but also get the aesthetic effect.To assess the differences of clinical effect that immediate and delayed implant placement,we use retrospect study to compare the preoperative tissue situation,postoperative reaction,implant survival rate,pink esthetic score,the change of bone and gingiva,patients satisfaction in immediate and delayed implant placement,so that we can conclude how to choose the best surgery protocol for our patients who need the implant placement in aesthetic zone.Methods: Twenty-one patients(8 males and 13 females,mean age 43.57)treated with single implant placement in aesthetic zone were selected in the Affiliated Stomatological Hospital of Dalian Medical University from 2013 to 2016.we separate them into two groups according to timing of implant placement,immediate group including 9 patients(9 implants),delayed group including 12 patients(12 implants),and the average obeservation period is 23.27 months.The procedure of immediate implant placement consists of periodontal treatment,atraumatic extraction,immediate implant insertion,GBR(guided bone regeneration),temporary restoration,osseointegration,permanent restoration,follow-up observation.The delayed implant placement is composed of tooth extraction,bone healing,periodontal treatment,bone grafting,implant insertion,GBR,temporary restoration,osseointegration,permanent restoration,follow-up observation.The indicators were evaluated such as the preoperative ERA(esthetic risk assessment),postoperative reaction,implant survival rate,the change of bone and gingiva,complications,patient satisfaction.The differences of these indexes were compared and assessed statistically for the influences for esthetic effect.Results:(1)All the cases displayed normal healing after surgery without nerve and adjacent tooth damage,no other complications were found.(2)The survival rate was100% in immediate implant group and delayed implant group at 2 years after implant placement.(3)In all the cases after loading 2 years,the average mesial gingival papilla height in the implant area of immediate group and delayed group increased by 0.42 mm and 0.95 mm,respectively;the distal gingival papilla height increased by 0.24 mm and0.57 mm,respectively;while the labial gingival margin level reduction were 0.71 mm and 0.94 mm,respectively.(4)The mean PES score after permanent restoration was10.44 and 9.56 in immediate group and in delayed group,and at the time of follow-up it was 7.5 and 9.16 in immediate group and in delayed group.(5)The peri-implant bone loss in the mesial side and distal side in immediate group were 1.62±0.14 mm and1.58±0.33 mm,respectively,while in the delayed group were 1.63±0.31 mm and1.74±0.28 mm,respectively.(6)Satisfaction level: For surgery operation,the percent of“satisfied” evaluation in immediate group was higher than delayed group,while for restoration effect,patients in the delayed group got the higher scores.(7)Complications:GBR infection with exposure of PRF occurred in 1 case in immediate group,and it recovered after incision,drainage and wound irrigation.Gingivitis appeared in another case and it became better after wound irrigation.While in delayed group,the exposure of bone grafting materials was found in 1 case without inflammation.Conclusions:In the maxillary anterior single tooth replacement with immediate or delayed implant,an acceptable functional and aesthetic effects can be achieved by careful preoperative risk assessment,reasonable treatment planning and standardized treatment process.Under the premise of strict grasp of indications,there is no significant difference in the short-term effect between immediate placement and delayed placement of single dental implantation in the anterior area.But compared with delayed implant placement,immediate implantation can shorten the period of treatment and reduce the postoperative reaction,but the choice of indications and the requirements of clinical skills are stricter. |
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