Effects of Currently Available Surgical and Restorative Interventions on Reducing Midfacial Mucosal Recession of Immediately Placed Single-Tooth Implants: A Systematic Review

• Localización: Journal of periodontology, ISSN 0022-3492, Nº. 1, 2014, págs. 92-102
• Idioma: inglés
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• Resumen

  • Background: Procedures to improve peri-implant soft-tissue outcomes of single, immediately placed implants are a topic of interest. This systematic review investigates the effect of various surgical and restorative interventions on implant mid-buccal mucosal level.

    Methods: An electronic search of five databases (January 1990 to December 2012) and a manual search of peer-reviewed journals for relevant articles were performed. Randomized controlled clinical trials (RCTs), prospective cohort studies, and case series with at least nine participants were included, with data on midfacial mucosal recession (MR) of immediately placed implants following various surgical and restorative interventions with a follow-up period of at least 6 months.

    Results: Thirty-six studies, eight RCTs, one cohort study, and 27 case series were eligible. Six interventions were identified and reviewed: 1) palatal/lingual implant position; 2) platform-switched abutments; 3) flapless approach; 4) bone grafts to fill the gap between buccal plate and fixture; 5) connective tissue grafts; and 6) immediate provisionalization. Three studies consistently showed that palatally/lingually positioned implants had significantly less MR when using tissue-level implants. Mixed results were reported for interventions 2, 3, 5, and 6. One study was available for intervention 4 and did not show a benefit.

    Conclusions: Some interventions might be adopted to reduce the amount of MR on implants with the immediate placement approach, as suggested by the included studies, with various levels of evidence. The conflicting results among studies might be a result of differences in patient and site characteristics, e.g., tissue biotype and buccal plate thickness. Therefore, the use of these interventions might be reserved for patients with moderate to high risk of esthetic complications.

    Immediate implant placement (IIP) is defined as a procedure in which �an implant is placed following tooth extraction in the same surgical procedure.�1 The compelling reason for the popularity of IIP is the patient�s desire for faster dental rehabilitation. Numerous clinical trials2-8 have proved the predictability of this approach, with the survival rate similar to that of the conventional approach, assuming prudent case selection and treatment planning. Some important anatomic factors related to the success of IIP should be assessed, including implant location,9,10 gingival marginal position,2,3,11,12 interdental papilla height,4-6,12 width and thickness of keratinized mucosa,3,7,13 gingival biotypes,2,3,11,14,15 crestal bone level,16,17 position of implant platform,18 thickness of buccal bone wall,9,10 dimension of the horizontal buccal gap,9,10 and sagittal root position.19 Careful evaluation of these factors can avoid most complications associated with IIP.

    Nonetheless, untoward outcomes do happen following IIP procedures. The most commonly reported complications include dehiscence of the wound and exposure of membranes related to the guided bone regeneration procedure,20 inevitable ridge resorption,21,22 midfacial mucosal recession (MR),2,3,8 loss of interdental papilla,6,11,23,24 and a color change of peri-implant soft tissue from improper abutment material selection.25 Of these complications, MR has received attention recently20,26 because it occurs relatively frequently and results in an unpleasing esthetic outcome.

    To avoid advanced MR, various surgical and restorative protocols for IIP have been proposed and tested.5,27-30 For example, a flapless approach might be better for preserving soft-tissue architecture than a flap approach.31 Limited evidence has shown that immediately restoring an immediately placed implant could maintain the level of mucosal margin.5,32 However, there is a lack of reviews that critically investigate the benefit of applying currently available surgical and restorative interventions on facial mucosal level. Therefore, the aim of this systematic review is to evaluate the amount of MR for each of the available procedure modifications, in comparison to controls.