This case series evaluated the facial gingival stability following single immediate tooth replacement in conjunction with subepithelial connective tissue graft (SCTG). Implant success rate and peri-implant tissue response were also reported. Ten patients (6 male, 4 female), with a mean age of 52.1 (range  =  22.7 to 67.1) years, underwent immediate implant placement and provisionalization with SCTG and were evaluated clinically and radiographically at presurgery (T0), at the time of immediate tooth replacement and SCTG (T1), and 3 months (T2), 6 months (T3), and 12 months (T4) after surgery. Data were analyzed using the Friedman and Wilcoxon signed-ranks tests at the significance level of α  =  .05. At 1 year, 9 of 10 implants remained osseointegrated with the overall mean marginal bone change of −0.31 mm and a mean facial gingival level change of −0.05 mm. The modified plaque index scores showed that patients were able to maintain a good level of hygiene throughout the study. The papilla index score indicated that at T4, more than 50% of the papilla fill was observed in 89% of all sites. When proper 3-dimensional implant position is achieved and bone graft is placed into the implant-socket gap, favorable success rate and peri-implant tissue response of platform switching implants can be achieved following immediate tooth replacement in conjunction with subepithelial connective tissue graft.

Introduction

The success of single immediate tooth replacement in the esthetic zone begins with proper 3-dimensional implant placement along with a properly contoured provisional restoration.15 The concept of immediate implant placement and provisionalization (IIPP) was introduced by Wöhrle, and has since been proven to be a predictable treatment modality in ideal esthetic situations, with success rates comparable to those of delayed implant placement with delayed prosthetic loading procedures.69 

While IIPP has been shown to be a successful procedure, slight facial gingival recession has been reported following the first year of function.1014 Facial gingival biotype conversion through subepithelial connective tissue graft (SCTG) procedure at the time of implant placement has been advocated and proven to be successful in preserving soft tissue levels by rendering the gingival tissue more resistant to recession.1,10,15,16 

Peri-implant marginal bone level (MBL) change is one of the parameters used in evaluating implant success rate.17 Recently, it has been suggested that the peri-implant MBL may be influenced by the way the implant and the abutment connect, and that the size discrepancy between the implant and the abutment used, also known as “platform switching,” may be beneficial in maintaining the peri-implant MBL.18 

The purpose of this study was to evaluate the success rate and peri-implant tissue response of platform switching implants following immediate tooth replacement in conjunction with subepithelial connective tissue graft.

Materials and Methods

Patient selection

This study was approved by the Institutional Review Board of Loma Linda University and was conducted in the Center for Implant Dentistry, Loma Linda University School of Dentistry, California. To be included in this study, the patient must have: (1) been at least 18 years of age or older with good hygiene, (2) had a single failing maxillary (number 4–13) or mandibular (number 20–29) tooth with the presence of adjacent and opposing natural dentition and without active infection, and (3) had sufficient bone volume to accommodate placement of a single implant with a minimum dimension of 3.25 mm × 15 mm. The following patients were excluded: (1) patients with a history of smoking,19 head and neck radiation treatment,2022 bruxism,23 and parafunction; (2) patients with a lack of stable posterior occlusion; and (3) patients in whom primary implant stability could not be achieved.

Clinical procedures

All patients received standardized diagnosis and treatment planning (Figures 1 and 2). An acrylic resin provisional shell was fabricated prior to the implant surgery using an autopolymerizing acrylic resin (Jet, Lang Dental, Wheeling, Ill). Following the administration of local anesthetic, the failing tooth was removed atraumatically and an implant (Osseotite Prevail, Biomet 3i, Warsaw, Ind) was placed immediately into the extraction socket with the implant-prosthetic platform 3 mm apical to the predetermined gingival margin (Figure 3).7 Primary implant stability was achieved with a minimum insertion torque of 30 Ncm (manufacturer recommended value, Biomet 3i). Xenograft (Bio-Oss, Osteohealth Co, Shirley, NY) was utilized to fill the implant-socket gap. A customized temporary titanium cylinder (Temporary Cylinder, Biomet 3i) was then placed and hand-tightened onto the implant. Flowable composite resin (PermaFlo, Ultradent Products Inc, South Jordan, Utah) was expressed into the site and photopolymerized to recreate the emergence profile of the extracted tooth. The prefabricated provisional shell was relined with acrylic resin (Jet, Lang Dental) and adapted to the custom temporary abutment. The provisional restoration was adjusted to clear all contacts in centric and eccentric movements, polished, and cemented with non-eugenol temporary cement (TempBond, Kerr Corp, Orange, Calif). A periapical radiograph was taken to ascertain the fit of the provisional restoration and complete cement removal (Figure 4).

Figures 1–4.

Figure 1. Preoperative labial view of the failing maxillary left central incisor. Figure 2. Preoperative periapical radiograph of the failing maxillary left central incisor due to root resorption. Figure 3. Implant placement. Figure 4. Periapical radiograph immediately after implant surgery.

Figures 1–4.

Figure 1. Preoperative labial view of the failing maxillary left central incisor. Figure 2. Preoperative periapical radiograph of the failing maxillary left central incisor due to root resorption. Figure 3. Implant placement. Figure 4. Periapical radiograph immediately after implant surgery.

An SCTG was harvested from the palate utilizing a single incision technique.24 A full-thickness envelope was created between the labial bony plate and the gingiva of the extraction site.1 The SCTG was inserted into the prepared envelope space and secured using a resorbable suture material (6-0 chromic gut blue, Ethicon Johnson & Johnson, Somerville, NJ) (Figure 5). Light pressure was applied over the SCTG with moist gauze for 10 minutes to minimize blood clot and dead space formation between the graft and the underlying bone.1 

Figures 5–9.

Figure 5. Labial view of the provisional restoration and connective tissue graft at implant surgery. Figure 6. Labial view of the definitive implant abutment and tooth preparations. Figure 7. Labial view of the definitive restoration after 1 year of function. Figure 8. Periapical radiograph 1 year after the implant surgery. Figure 9. Reference line (RL) used to determine changes in marginal bone level (MBL).

Figures 5–9.

Figure 5. Labial view of the provisional restoration and connective tissue graft at implant surgery. Figure 6. Labial view of the definitive implant abutment and tooth preparations. Figure 7. Labial view of the definitive restoration after 1 year of function. Figure 8. Periapical radiograph 1 year after the implant surgery. Figure 9. Reference line (RL) used to determine changes in marginal bone level (MBL).

Antibiotics and analgesics were prescribed for postoperative use. Patients were instructed to rinse with 0.12% chlorhexidine gluconate solution (Peridex, Zila Pharmaceuticals Inc, Phoenix, Ariz), refrain from functioning at the surgical site, and remain on a liquid diet for 2 weeks following the surgery. Over the next 3 months, a soft diet was recommended.

At 6 months, the final implant impression was made with poly (vinyl siloxane) impression material (Aquasil Monophase, Dentsply, York, Pa). The final restoration was fabricated as a 1-piece screw retained or a 2-piece cement-retained metal ceramic restoration. The screw-retained restoration was cast in a high noble metal (W3 Ceramic Alloy, Ivoclar Vivadent Inc, Amherst, NY) onto the cast gold abutment (UCLA Abutment, Biomet 3i) followed by ceramic application (Vita Omega 900, Vident Inc, Brea, Calif). The prosthetic screw for the final 1-piece metal ceramic restoration was torqued to 20 Ncm (manufacturer's recommendation, Biomet 3i). The cement-retained restoration consisted of a definitive custom abutment cast in Type IV gold (Monogram IV, Leach & Dillion, San Diego, Calif) onto the cast gold abutment (UCLA Abutment, Biomet 3i) and a definitive metal-ceramic restoration (W-3, Vita Omega 900). The custom abutment was torqued to 20 Ncm (manufacturer's recommendation) and the definitive metal-ceramic restoration was cemented using resin-modified glass ionomer cement (Rely-X, 3M ESPE, St Paul, Minn) (Figures 6 through 8).

Data collection

All examinations and corresponding data collection were performed by 1 examiner (S.C.). The data, when indicated, was collected and compared between each follow-up time interval: presurgery (T0), immediately after immediate tooth replacement and SCTG (T1), and 3 months (T2), 6 months (T3), and 12 months (T4) after surgery. The implant success/failure and marginal bone level changes were evaluated at T1, T2, T3, and T4; facial gingival level change at T0, T2, T3, and T4; Periotest values at T1 and T3; modified plaque index at T2, T3, and T4; and papilla index at T1, T2, T3, and T4.

Implant Failure

The implants were evaluated according to the criteria proposed by Smith and Zarb17 where applicable. The implants were considered a failure with the presence of mobility, peri-implant radiolucency, persistent pain, discomfort, and/or infection.

Marginal Bone Level Change

MBLs on the mesial and distal aspects of each implant were measured with the use of sequential periapical radiographs and long cone paralleling technique with a commercial Rinn XCP holder (XCP post bite blocks 54-0862, Dentsply, Elgin, Ill).25 An occlusal jig constructed with poly (vinyl siloxane) interocclusal record material (Exabite II, GC America, Alsip, Ill) was used to standardize the position and angulation of the film to the X-ray beam. The platform of the implant was used as the reference line (RL) (Figure 9). The distance between the reference line and the implant-bone contact was measured. A value of zero was given when the marginal bone level was at or coronal to the reference line. A negative value was given when marginal bone level was apical to the reference line. The overall MBL of each implant was the average value of mesial and distal measurements. The overall MBL values were compared between each follow-up time interval (T1, T2, T3, and T4), and the MBL change was calculated. The intraexaminer reliability of the measurements was determined by using double assessments of MBL measured 3 months apart by 1 examiner and expressed as the intraclass correlation coefficient (ICC).

Facial Gingival Level Change

A master cast was made at different time intervals (T0, T2, T3, and T4) to evaluate the facial gingival level (FGL). A customized stent fabricated from the preoperative master cast was used to standardize probing points and the direction of probe insertion. Baseplate wax (Type II Dentsply) was placed around the failing tooth, and the modified cast was duplicated. A vacuum-formed, 0.060-inch thick polyethylene terephthalate, glycol modified clear template (Ultradent) was adapted and trimmed to remove all undercuts. This allowed for sufficient clearance to accommodate changes in the contours of the restoration from the provisional to the definitive implant restoration. A perpendicular slot was created at the most apical part of the midfacial gingival level, and the apical border of the customized stent was used as a reference line. The FGL was evaluated at each time interval using a periodontal probe (15 UNC Color-Coded Probe, Hu-Friedy, Chicago, Ill), and the FGL change was calculated. All measurements were made to the nearest 0.5 mm. The intraexaminer reliability of the measurements was determined by using a double assessment of FGL measured 3 months apart by 1 examiner and expressed as the ICC.

Implant Mobility

The Periotest (Siemens AG, Bensheim, Germany) instrument was utilized to evaluate implant stability at T1 and at T3.2629 A 6-mm healing abutment (Biomet 3i) was hand tightened onto the implant and utilized as the tapping surface for the Periotest (Siemens) instrument. Measurements were made 2 to 4 times, until 2 duplicate Periotest values (PTV) were registered and recorded.

Modified Plaque Index

The presence of plaque was assessed at the mesiolabial, labial, distolabial, mesiolingual, lingual, and distolingual surfaces of the implant provisional and definitive restoration according to the modified plaque index (mPI).30 Only the highest index score of each implant was used for statistical analysis.

Papilla Index Score

The interproximal soft tissue was evaluated using the papilla index score (PIS).31 Mesial and distal PIS values were individually analyzed.

Surgical Complications

Surgical complications were documented as connective tissue graft necrosis, infection around the implant, and/or any deviation from the manufacturer's placement protocol, which resulted in additional modifications to the surgical site in order to establish adequate primary stability.

Prosthetic Complications

Prosthetic complications were documented as any repairs or modifications of the provisional restoration or definitive prosthesis. These included, but were not limited to, debonding of the provisional restoration, fracture of the provisional restoration, occlusal adjustments, and/or abutment screw loosening.

Data analysis

The Friedman test was used to evaluate MBL, FGL, mPI, and PIS; and Wilcoxon signed-ranks test was used to evaluate PTV. The level of significance was set at α  =  .05.

Results

A total of 6 male and 4 female patients between the ages of 22.7 and 67.1 (mean  =  52.1) years participated in this study. Of the 10 implants, 3 were located in the maxillary central incisor, 3 in the maxillary lateral incisor, 2 in the maxillary canine, 1 in the maxillary second premolar, and 1 in the mandibular second premolar position. The implants used were 3.25 × 15 mm (4), 4.0 × 15 mm (4), 5.0 × 13 mm (1), and 5.0 × 15 mm (1).

Implant Failure

One patient experienced an early implant failure (number 9) at the 3-month follow-up appointment (T2) due to mobility. Since the implant failure occurred at T2, it was excluded from the data analysis. The remaining 9 implants were stable and maintained osseointegration at the 1-year follow-up (T4), resulting in an overall cumulative implant success rate of 90% (9/10).

Marginal Bone Level Change

The ICC for MBL measurements was 0.955, indicating that the measurement method was reliable and reproducible. Statistical values for the MBL are presented in Table 1. The mean MBL change from T1 to T4 was −0.31 mm. No statistically significant differences (P  =  .10) for MBL were noted between all time intervals.

Table 1

Comparison of marginal bone level at different time intervals using Friedman test at α < .05*

Comparison of marginal bone level at different time intervals using Friedman test at α < .05*
Comparison of marginal bone level at different time intervals using Friedman test at α < .05*

Facial Gingival Level Change

The ICC for FGL measurements was 0.998, indicating that the measurement method was reliable and reproducible. Statistical values for the FGL are presented in Table 2. The mean FGL change from T1 to T4 was −0.05 mm. No statistically significant differences (P  =  .75) for FGL were noted between all time intervals.

Table 2

Comparison of facial gingival level at different time intervals using Friedman test at α < .05*

Comparison of facial gingival level at different time intervals using Friedman test at α < .05*
Comparison of facial gingival level at different time intervals using Friedman test at α < .05*

Implant Mobility

The mean PTV at T3 (−2.0 ± 0.9) was statistically significantly lower than that at T1 (−0.1 ± 2.2) (P  =  .008).

Modified Plaque Index

The mPI scores of 0 and 1 were consistently recorded throughout the study (Table 3). There was no statistically significant difference in the mPI (P  =  .56) scores among the 3 time intervals (T2, T3, and T4).

Table 3

Comparison of distribution of modified plaque index scores at different time intervals using the Friedman test at α  =  .05*

Comparison of distribution of modified plaque index scores at different time intervals using the Friedman test at α  =  .05*
Comparison of distribution of modified plaque index scores at different time intervals using the Friedman test at α  =  .05*

Papilla Index Score

The PIS ranged from 0 to 3 at all time intervals in this study (Table 4). No statistically significant difference was noted on both mesial and distal papilla levels with respect to time (P  =  .91 and .85, respectively) (Table 4). At T4, more than 50% of the papilla fill was observed in 89% of all sites.

Table 4

Comparison of distribution of papilla index score at different time intervals using the Friedman test at α  =  .05

Comparison of distribution of papilla index score at different time intervals using the Friedman test at α  =  .05
Comparison of distribution of papilla index score at different time intervals using the Friedman test at α  =  .05

Surgical Complications

Despite the tearing of the facial gingival margin in 1 patient while preparing the recipient site for the SCTG, the result was inconsequential. Partial necrosis of the SCTG was observed in 2 patients. At T4, while one patient did not experience significant facial gingival tissue change, 1.0 mm of facial gingival recession was noted in the other patient.

Prosthetic Complications

During the provisional phase, 3 episodes of provisional restoration debonding, 4 fractured provisional restorations, and 1 abutment screw loosening were observed and resolved uneventfully.

Discussion

The cumulative implant success rate following single immediate tooth replacement and SCTG in this study was 90% (9/10) after a follow-up period of 1 year. Although comparable implant success rates have been reported with single immediate tooth replacement without SCTG with a similar implant system (91% to 100%),3245 it is slightly less than similar procedures performed without SCTG with other implant systems (98% to 100%).6,7,1113,41,4652 This is a consequence of the small sample size since each implant corresponds to 10% in the present case series.

Studies involving single implants have reported peri-implant marginal bone level changes from −0.2 mm to −1.0 mm for immediate tooth replacement procedures,7,11,13,41,47,51 and from −0.4 mm to −1.6 mm for delayed loaded procedures after the first year of function.9,53,54 It has been suggested that the “platform switching” feature could be beneficial in maintaining peri-implant MBL both mechanically (by reducing the force transmitted to the implant-bone interface) and biologically (by creating a better seal at the implant-abutment interface and relocating the inflammatory zone [inward] away from the bone).18 With regard to implant studies with the platform switching feature, MBL changes have ranged from 0 mm to −0.78 mm with a follow-up period of 6 to 57 months.3245 In this study, the mean peri-implant MBL change of −0.31 mm at T4 was within the range of the aforementioned studies and other studies similar in nature.

Minimal mean facial gingival tissue recession (−0.5 to −0.8 mm) has been observed in short-term studies (1 to 2 years of follow-up) with immediate tooth replacement procedures.7,11,13 In this study, the viability of SCTG was examined in conjunction with immediate tooth replacement. Despite partial necrosis encountered in 2 patients, the overall mean FGL change was minimal at T4 (−0.05 mm) (Table 2). In fact, the mean FGL change of the remaining 7 implants without necrotic SCTG was +0.07 mm. This is similar to the data reported by Kan et al55 and Cornelini et al56 respectively, where a mean facial gingival tissue gain of 0.2 mm was observed 1 year following immediate implant placement with SCTG. This implies that SCTG in conjunction with immediate tooth replacement in the esthetic zone may be beneficial in minimizing facial gingival tissue recession when proper 3-dimensional implant position is achieved and bone graft is placed into the implant socket gap.55 Nevertheless, a high necrosis rate (2/10  =  20%) observed in this study also implied that bilaminar SCTG in conjunction with immediate tooth replacement procedures is a technique sensitive procedure with inherent risks that must not be overlooked.

The validity of the Periotest instrument has been the subject of debate; however, the PTV of an implant seems to provide an acceptable level of objectivity for diagnosing initial implant stability.26,57 It has been suggested that a PTV of −5 to +5 is required for proper osseointegration.26 Based on this, the mean PTV at T1 of −0.1 (range −2 to +5) reported in this study suggested that primary stability of some implants was not optimal. The high PTV may be related to the density/quality of the maxillary bone as well as to the immediate implant placement in an extraction site where implant stability relies mainly on the engagement of the apical and the palatal aspects of the anterior extraction socket.5 In addition, a statistically significant lower mean PTV was noted at T3 (−2; range −3 to −1), suggesting that osseointegration is a dynamic process and that the implant stability in this study improved over time.

While it is generally agreed that plaque accumulation can potentially induce a negative mucosal response,7 the relationship between compromised oral hygiene and implant failure has been contentious.5863 The mPI scores observed throughout the duration of this study were either 0 or 1, implying that the patients were able to maintain a good level of oral hygiene (Table 3). To minimize the peri-implant gingival tissue disturbance following immediate tooth replacement and SCTG, the patients were advised to refrain from brushing the surgical site for 1 month. Meanwhile, the oral hygiene was adequately maintained through light swabbing of the surgical area with a cotton-tipped applicator soaked in 0.12% chlorhexidine gluconate (Peridex).

The PIS in the present study ranged from 0 to 3, at T1, T2, T3, and T4. There were no statistically significant differences in the PIS among different time intervals (Table 4; P > .05) when immediate tooth replacement with SCTG was performed, even when necrosis of the SCTG in 2 patients was observed. This validates the idea that the implant papilla level is dictated by the proximal bone level of the adjacent teeth,64,65 and the best way to maintain the papilla is to provide support immediately after tooth removal.4,5,7,66 

Although useful information was found in this study, due to the small sample size, its limitations should be acknowledged. Future studies involving a larger sample size with a control group and long-term follow-up will undoubtedly provide more useful information on the viability of this particular procedure.

Conclusions

When proper 3-dimensional implant position is achieved and bone graft is placed into the implant-socket gap, favorable success rate and peri-implant tissue response of platform switching implants can be achieved following immediate tooth replacement in conjunction with subepithelial connective tissue graft.

Abbreviations

     
  • FGL

    facial gingival level

  •  
  • IIPP

    immediate implant placement and provisionalization

  •  
  • MBL

    marginal bone level

  •  
  • mPI

    modified plaque index

  •  
  • PIS

    papilla index score

  •  
  • PTV

    Periotest values

  •  
  • RL

    reference line

  •  
  • SCTG

    subepithelial connective tissue graft

Note

This research was in partial fulfillment of an MS degree for the primary author.

The authors thank Biomet 3i, Warsaw, Ind, for providing the implants and related prosthetic components related to this research.

References

References
1.
Kan
JYK
,
Rungcharassaeng
K
,
Lozada
JL
.
Bilaminar subepithelial connective tissue grafts for immediate implant placement and provisionalization in the esthetic zone
.
J Calif Dent Assoc
.
2005
;
33
:
865
871
.
2.
Kan
JYK
,
Rungcharassaeng
K
.
Site development for anterior single implant esthetics: the dentulous site
.
Compend Contin Educ Dent
.
2001
;
22
:
221
226, 228, 230–231
.
3.
Roe
P
,
Kan
JYK
,
Rungcharassaeng
K
.
Fabrication of a provisional restoration using a translucent matrix and composite resin for immediate tooth replacement
.
Pract Proced Aesthet Dent
.
2009
;
21
:
245
247
.
4.
Kois
JC
,
Kan
JYK
.
Predictable peri-implant gingival aesthetics: surgical and prosthodontic rationales
.
Pract Proced Aesthet Dent
.
2001
;
13
:
691
698
.
5.
Kan
JYK
,
Rungcharassaeng
K
.
Immediate placement and provisionalization of maxillary anterior single implants: a surgical and prosthodontic rationale
.
Pract Periodontics Aesthet Dent
.
2000
;
12
:
817
824
.
6.
Wöhrle
PS
.
Single-tooth replacement in the aesthetic zone with immediate provisionalization: fourteen consecutive case reports
.
Pract Periodontics Aesthet Dent
.
1998
;
10
:
1107
1114
.
7.
Kan
JYK
,
Rungcharassaeng
K
,
Lozada
J
.
Immediate placement and provisionalization of maxillary anterior single implants: 1-year prospective study
.
Int J Oral Maxillofac Implants
.
2003
;
18
:
31
39
.
8.
Groisman
M
,
Frossard
WM
,
Ferreira
HM
,
de Menezes Filho
LM
,
Touati
B
.
Single-tooth implants in the maxillary incisor region with immediate provisionalization: 2-year prospective study
.
Pract Proced Aesthet Dent
.
2003
;
15
:
115
122
.
9.
Goodacre
CJ
,
Kan
JYK
,
Rungcharassaeng
K
.
Clinical complications of osseointegrated implants
.
J Prosthet Dent
.
1999
;
81
:
537
552
.
10.
Grunder
U
.
Stability of the mucosal topography around single-tooth implants and adjacent teeth: 1-year results
.
Int J Periodontics Restorative Dent
.
2000
;
20
:
11
17
.
11.
De Rouck
T
,
Collys
K
,
Cosyn
J
.
Immediate single-tooth implants in the anterior maxilla: a 1-year case cohort study on hard and soft tissue response
.
J Clin Periodontol
.
2008
;
35
:
649
657
.
12.
Palattella
P
,
Torsello
F
,
Cordaro
L
.
Two-year prospective clinical comparison of immediate replacement vs. immediate restoration of single tooth in the esthetic zone
.
Clin Oral Implants Res
.
2008
;
19
:
1148
1153
.
13.
Kan
JYK
,
Rungcharassaeng
K
,
Liddelow
G
,
Henry
P
,
Goodacre
CJ
.
Periimplant tissue response following immediate provisional restoration of scalloped implants in the esthetic zone: a one-year pilot prospective multicenter study
.
J Prosthet Dent
.
2007
;
97
:
S109
S118
.
14.
Kan
JYK
,
Rungcharassaeng
K
,
Lozada
JL
.
Facial gingival tissue stability following immediate placement and provisionalization of maxillary anterior single implants: a 2- to 8-year follow-up
.
Int J Oral Maxillofac Implants
.
2011
;
26
:
179
187
.
15.
Bianchi
AE
,
Sanfilippo
F
.
Single-tooth replacement by immediate implant and connective tissue graft: a 1-9-year clinical evaluation
.
Clin Oral Implants Res
.
2004
;
15
:
269
277
.
16.
Leziy
SS
,
Miller
BA
.
Replacement of adjacent missing anterior teeth with scalloped implants: a case report
.
Pract Proced Aesthet Dent
.
2005
;
17
:
331
338
.
17.
Smith
DE
,
Zarb
GA
.
Criteria for success of osseointegrated endosseous implants
.
J Prosthet Dent
.
1989
;
62
:
567
572
.
18.
Lazzara
RJ
,
Porter
SS
.
Platform switching: a new concept in implant dentistry for controlling postrestorative crestal bone levels
.
Int J Periodontics Restorative Dent
.
2006
;
26
:
9
17
.
19.
Bain
CA
.
Smoking and implant failure—benefits of a smoking cessation protocol
.
Int J Oral Maxillofac Implants
.
1996
;
11
:
756
759
.
20.
Esposito
M
,
Grusovin
MG
,
Patel
S
,
Worthington
HV
,
Coulthard
P
.
Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants
.
Cochrane Database Syst Rev
.
2008
:
CD003603
.
21.
Granstrom
G
.
Osseointegration in irradiated cancer patients: an analysis with respect to implant failures
.
J Oral Maxillofac Surg
.
2005
;
63
:
579
585
.
22.
Granstrom
G
.
Placement of dental implants in irradiated bone: the case for using hyperbaric oxygen
.
J Oral Maxillofac Surg
.
2006
;
64
:
812
818
.
23.
Lobbezoo
F
,
Brouwers
JE
,
Cune
MS
,
Naeije
M
.
Dental implants in patients with bruxing habits
.
J Oral Rehabil
.
2006
;
33
:
152
159
.
24.
Lorenzana
ER
,
Allen
EP
.
The single-incision palatal harvest technique: a strategy for esthetics and patient comfort
.
Int J Periodontics Restorative Dent
.
2000
;
20
:
297
305
.
25.
Strid
KG
.
Radiographic results
.
In:
Branemark
PI
,
Zarb
GA
,
Albrektsson
T
,
eds
.
Tissue Integrated Prosthesis. Osseointegration in Clinical Dentistry
.
Chicago, Ill
:
Quintessence
;
1985
:
187
193
.
26.
Olive
J
,
Aparicio
C
.
Periotest method as a measure of osseointegrated oral implant stability
.
Int J Oral Maxillofac Implants
.
1990
;
5
:
390
400
.
27.
Truhlar
RS
,
Morris
HF
,
Ochi
S
,
Winkler
S
.
Assessment of implant mobility at second-stage surgery with the Periotest: DICRG Interim Report No. 3. Dental Implant Clinical Research Group
.
Implant Dent
.
1994
;
3
:
153
156
.
28.
Walker
L
,
Morris
HF
,
Ochi
S
.
Periotest values of dental implants in the first 2 years after second-stage surgery: DICRG interim report no. 8. Dental Implant Clinical Research Group
.
Implant Dent
.
1997
;
6
:
207
212
.
29.
Faulkner
MG
,
Giannitsios
D
,
Lipsett
AW
,
Wolfaardt
JF
.
The use and abuse of the Periotest for 2-piece implant/abutment systems
.
Int J Oral Maxillofac Implants
.
2001
;
16
:
486
494
.
30.
Mombelli
A
,
van Oosten
MA
,
Schurch
E
Jr,
Land
NP
.
The microbiota associated with successful or failing osseointegrated titanium implants
.
Oral Microbiol Immunol
.
1987
;
2
:
145
151
.
31.
Jemt
T
.
Regeneration of gingival papillae after single-implant treatment
.
Int J Periodontics Restorative Dent
.
1997
;
17
:
326
333
.
32.
Calvo Guirado
JL
,
Saez Yuguero
MR
,
Pardo Zamora
G
,
Munoz Barrio
E
.
Immediate provisionalization on a new implant design for esthetic restoration and preserving crestal bone
.
Implant Dent
.
2007
;
16
:
155
164
.
33.
Hurzeler
M
,
Fickl
S
,
Zuhr
O
,
Wachtel
HC
.
Peri-implant bone level around implants with platform-switched abutments: preliminary data from a prospective study
.
J Oral Maxillofac Surg
.
2007
;
65
:
33
39
.
34.
Calvo-Guirado
JL
,
Ortiz-Ruiz
AJ
,
Lopez-Mari
L
,
et al.
Immediate maxillary restoration of single-tooth implants using platform switching for crestal bone preservation: a 12-month study
.
Int J Oral Maxillofac Implants
.
2009
;
24
:
275
281
.
35.
Kemppainen
P
,
Eskola
S
,
Ylipaavalniemi
P
.
A comparative prospective clinical study of two single-tooth implants: a preliminary report of 102 implants
.
J Prosthet Dent
.
1997
;
77
:
382
387
.
36.
Norton
MR
.
The Astra Tech Single-Tooth Implant System: a report on 27 consecutively placed and restored implants
.
Int J Periodontics Restorative Dent
.
1997
;
17
:
574
583
.
37.
Palmer
RM
,
Smith
BJ
,
Palmer
PJ
,
Floyd
PD
.
A prospective study of Astra single tooth implants
.
Clin Oral Implants Res
.
1997
;
8
:
173
179
.
38.
Puchades-Roman
L
,
Palmer
RM
,
Palmer
PJ
,
et al.
A clinical, radiographic, and microbiologic comparison of Astra Tech and Branemark single tooth implants
.
Clin Implant Dent Relat Res
.
2000
;
2
:
78
84
.
39.
Cooper
L
,
Felton
DA
,
Kugelberg
CF
,
et al.
A multicenter 12-month evaluation of single-tooth implants restored 3 weeks after 1-stage surgery
.
Int J Oral Maxillofac Implants
.
2001
;
16
:
182
192
.
40.
Gotfredsen
K
.
A 5-year prospective study of single-tooth replacements supported by the Astra Tech implant: a pilot study
.
Clin Implant Dent Relat Res
.
2004
;
6
:
1
8
.
41.
Norton
MR
.
A short-term clinical evaluation of immediately restored maxillary TiOblast single-tooth implants
.
Int J Oral Maxillofac Implants
.
2004
;
19
:
274
281
.
42.
Wennstrom
JL
,
Ekestubbe
A
,
Grondahl
K
,
Karlsson
S
,
Lindhe
J
.
Implant-supported single-tooth restorations: a 5-year prospective study
.
J Clin Periodontol
.
2005
;
32
:
567
574
.
43.
De Kok
IJ
,
Chang
SS
,
Moriarty
JD
,
Cooper
LF
.
A retrospective analysis of peri-implant tissue responses at immediate load/provisionalized microthreaded implants
.
Int J Oral Maxillofac Implants
.
2006
;
21
:
405
412
.
44.
Cooper
LF
,
Ellner
S
,
Moriarty
J
,
et al.
Three-year evaluation of single-tooth implants restored 3 weeks after 1-stage surgery
.
Int J Oral Maxillofac Implants
.
2007
;
22
:
791
800
.
45.
Palmer
RM
,
Farkondeh
N
,
Palmer
PJ
,
Wilson
RF
.
Astra Tech single-tooth implants: an audit of patient satisfaction and soft tissue form
.
J Clin Periodontol
.
2007
;
34
:
633
638
.
46.
Hui
E
,
Chow
J
,
Li
D
,
et al.
Immediate provisional for single-tooth implant replacement with Branemark system: preliminary report
.
Clin Implant Dent Relat Res
.
2001
;
3
:
79
86
.
47.
Kan
JYK
,
Rungcharassaeng
K
,
Sclar
A
,
Lozada
JL
.
Effects of the facial osseous defect morphology on gingival dynamics after immediate tooth replacement and guided bone regeneration: 1-year results
.
J Oral Maxillofac Surg
.
2007
;
65
:
13
19
.
48.
Evans
CD
,
Chen
ST
.
Esthetic outcomes of immediate implant placements
.
Clin Oral Implants Res
.
2008
;
19
:
73
80
.
49.
Barone
A
,
Rispoli
L
,
Vozza
I
,
Quaranta
A
,
Covani
U
.
Immediate restoration of single implants placed immediately after tooth extraction
.
J Periodontol
.
2006
;
77
:
1914
1920
.
50.
Canullo
L
,
Rasperini
G
.
Preservation of peri-implant soft and hard tissues using platform switching of implants placed in immediate extraction sockets: a proof-of-concept study with 12- to 36-month follow-up
.
Int J Oral Maxillofac Implants
.
2007
;
22
:
995
1000
.
51.
Crespi
R
,
Cappare
P
,
Gherlone
E
,
Romanos
GE
.
Immediate versus delayed loading of dental implants placed in fresh extraction sockets in the maxillary esthetic zone: a clinical comparative study
.
Int J Oral Maxillofac Implants
.
2008
;
23
:
753
758
.
52.
Tsirlis
AT
.
Clinical evaluation of immediate loaded upper anterior single implants
.
Implant Dent
.
2005
;
14
:
94
103
.
53.
Romeo
E
,
Chiapasco
M
,
Ghisolfi
M
,
Vogel
G
.
Long-term clinical effectiveness of oral implants in the treatment of partial edentulism. Seven-year life table analysis of a prospective study with ITI dental implants system used for single-tooth restorations
.
Clin Oral Implants Res
.
2002
;
13
:
133
143
.
54.
Levin
L
,
Sadet
P
,
Grossmann
Y
.
A retrospective evaluation of 1,387 single-tooth implants: a 6-year follow-up
.
J Periodontol
.
2006
;
77
:
2080
2083
.
55.
Kan
JYK
,
Rungcharassaeng
K
,
Morimoto
T
,
Lozada
J
.
Facial gingival tissue stability after connective tissue graft with single immediate tooth replacement in the esthetic zone: consecutive case report
.
J Oral Maxillofac Surg
.
2009
;
67
:
40
48
.
56.
Cornelini
R
,
Barone
A
,
Covani
U
.
Connective tissue grafts in postextraction implants with immediate restoration: a prospective controlled clinical study
.
Pract Proced Aesthet Dent
.
2008
;
20
:
337
343
.
57.
Atsumi
M
,
Park
SH
,
Wang
HL
.
Methods used to assess implant stability: current status
.
Int J Oral Maxillofac Implants
.
2007
;
22
:
743
754
.
58.
Adell
R
,
Lekholm
U
,
Rockler
B
,
et al.
Marginal tissue reactions at osseointegrated titanium fixtures (I). A 3-year longitudinal prospective study
.
Int J Oral Maxillofac Surg
.
1986
;
15
:
39
52
.
59.
van Steenberghe
D
,
Klinge
B
,
Linden
U
,
et al.
Periodontal indices around natural and titanium abutments: a longitudinal multicenter study
.
J Periodontol
.
1993
;
64
:
538
541
.
60.
Berglundh
T
,
Lindhe
J
,
Marinello
C
,
Ericsson
I
,
Liljenberg
B
.
Soft tissue reaction to de novo plaque formation on implants and teeth. An experimental study in the dog
.
Clin Oral Implants Res
.
1992
;
3
:
1
8
.
61.
Apse
P
,
Zarb
GA
,
Schmitt
A
,
Lewis
DW
.
The longitudinal effectiveness of osseointegrated dental implants. The Toronto Study: peri-implant mucosal response
.
Int J Periodontics Restorative Dent
.
1991
;
11
:
94
111
.
62.
Teixeira
ER
,
Sato
Y
,
Akagawa
Y
,
Kimoto
T
.
Correlation between mucosal inflammation and marginal bone loss around hydroxyapatite-coated implants: a 3-year cross-sectional study
.
Int J Oral Maxillofac Implants
.
1997
;
12
:
74
81
.
63.
Block
MS
,
Kent
JN
.
Long-term follow-up on hydroxylapatite-coated cylindrical dental implants: a comparison between developmental and recent periods
.
J Oral Maxillofac Surg
.
1994
;
52
:
937
943
.
64.
Kan
JYK
,
Rungcharassaeng
K
,
Umezu
K
,
Kois
JC
.
Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans
.
J Periodontol
.
2003
;
74
:
557
562
.
65.
Choquet
V
,
Hermans
M
,
Adriaenssens
P
,
et al.
Clinical and radiographic evaluation of the papilla level adjacent to single-tooth dental implants. A retrospective study in the maxillary anterior region
.
J Periodontol
.
2001
;
72
:
1364
1371
.
66.
Spear
FM
.
Maintenance of the interdental papilla following anterior tooth removal
.
Pract Periodontics Aesthet Dent
.
1999
;
11
:
21
28
.