| Objective:The objective of this study is to evaluate and compare the clinical efficacy of the Socketshield technique(SST)immediate implantation in the maxillary anterior region and conventional flapless immediate implantation through at least 4 years of follow-up.The assessment included implant survival rate,peri-implant bone changes,clinical indices,esthetic score,gingival index,and complications.The study evaluates the medium-term clinical effects,with the aim of providing clinical references for the application of the SST.Materials and methods:According to the inclusion and exclusion criteria,the study selected patients with the SST immediate implantation(SST group)and conventional flapless immediate implantation(control group),who underwent operation in the maxillary anterior at the Stomatology Hospital of Shandong University from March 2017 to April 2019.Clinical and radiographic data at 6 months postoperatively(T2)and 4 years postoperatively(T3)were collected.In this study,the following items was collected:(1)Select the contralateral homonymous tooth as the control natural teeth,and measure the changes in hard tissue at postoperative 6 months(T2)and 4 years(T3).(2)Measure the facial bone width(FBW),bone width(BW),and facial bone height(FBH)of the two groups of implants at different sites(IS-0 shoulder platform level 0 mm,IS-3 shoulder platform level 3 mm,implant middle,and implant apical level)at 6 months and 4 years after operation.And compare the intra-group and inter-group hard tissue absorption during the(T2-T3)period for the two groups.(3)Compare the differences between the two groups in terms of implant survival rate,clinical indicators(modified gingival bleeding index mSBI,modified plaque index mPLI,probing depth PD),pink esthetic score(PES),gingival papilla index,satisfaction,and record postoperative complications at 4 years after operation.(5)Assess the pink esthetic score(PES)of both groups using image information obtained from intraoral color photographs and intraoral scans,and evaluate the effect of the two image acquisition methods on PES results.The CBCT(cone beam computed tomography,New Tom,Italy)imaging data was measured using Mimics Research 21.0(Materialise,Belgium)with DICOM data,and statistical analysis was conducted using SPSS 25.0 software package(IBM,USA).Results:1.The SST group included 9 patients with 10 implants The control group included 13 patients with a total of 16 implants,and the follow-up period was 48-76 months,with an average of 55.65±7.30 months.The general data of the two group showed no significant difference(P>0.05).The implant survival rate of both groups was 100%at four years after operation(P>0.05).The discrepancy in bone resorption at all sites between the two groups of the control natural teeth from(T2-T3)displayed no statistical significance(P>0.05).2.The bone thickness at each site in both the SST group and the control group decreased significantly at four years after surgery compared to six months after surgery,and the difference was statistically significant(P<0.05).3.The comparison of bone absorption showed that in the SST group,the ΔFBW(T2-T3)at the IS-0 site was(0.17±0.09 mm),smaller than that in the control group(0.40±0.22 mm).TheΔFBW(T2-T3)at the implant middle site was(0.12±0.10 mm),smaller than that in the control group(0.26±0.18 mm),and the differences were statistically significant(P<0.05).The ΔBW(T2-T3)at the IS-0 and implant middle site in the SST group was smaller than that in the control group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in ΔFBW(T2-T3)or ΔBW(T2-T3)at the other sites(P>0.05).4.One-way ANOVA showed that the difference of ΔFBW(T2-T3)within the four sites in the SST group had no statistical significance(P>0.05).However,the difference of ΔFBW(T2T3)between the four sites in the control group had statistical significance(P<0.05).The posthoc multiple comparison(LSD)results showed that the ΔFBW(T2-T3)at the IS-0 site(0.40±0.22 mm)was greater than that at the middle site(0.26±0.18 mm)and the apical site(0.17±0.14 mm).At the IS-3 site,the ΔFBW(T2-T3)(0.34±0.20 mm)was greater than the implant apical site(0.17±0.14 mm),and both differences were statistically significant(P<0.05).There was no statistically significant difference in ΔFBW(T2-T3)among the other sites(P>0.05).5.There was no statistically significant difference in FBH between T2(2.74±1.17 mm)and T3(2.64±1.11 mm)in the SST group(P>0.05).The FBH in the control group at T3(1.41±0.91 mm)was significantly reduced compared to T2(2.09±0.93 mm),with a statistically significant difference(P<0.05);The ΔFBH(T2-T3)of the SST group was(0.10±0.18 mm),significantly lower than the control group(0.68±0.51 mm),and the difference was statistically significant(P<0.05).6.After four years of operation,there was no statistically significant difference between the two groups in terms of mSBI,mPLI,PD,gingival papilla filling rate,and satisfaction rate(P>0.05).7.On PES result,there was no statistically significant difference between the SST group(11.90±1.68)and the control group(11.52±1.45)(P>0.05).However,in the evaluation of the alveolar ridge convexity variable,the SST group(2.00±0.00)was significantly higher than the control group(1.49±0.30)with statistical significance(P<0.05).Compared the two image evaluation methods(intraoral color photograph and intraoral scan)on the PES,there was no statistical difference between the two methods in the PES total scores and the 7 evaluation criteria(P>0.05).8.Complications:In the SST group,1 case of peri-implant mucositis and 1 case of crown fracture occurred 36 months after operation.In the control group,1 case of palatal gingival recession with exposure of the abutment and 3 cases of peri-implant mucositis occurred,all of implant were able to function normally.The rest of the implants were used well without any biological or mechanical complications.Conclusion:1.The SST may still result in inevitable resorption of the facial hard tissue after four years of operation.However,the resorption of the shoulder and middle of the implant,as well as the height of the facial bone,is less than that of conventional flapless immediate implantation.The SST could better maintain the facial bone contour of the implant.2.The SST could achieve a satisfactory pink esthetic effect after 4 years follow-up.And the labial arch contour of the implant in harmony with the adjacent teeth.The mid-to-long-term clinical outcomes of the SST is worthy of affirmation. |
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