Evaluation of soft and hard tissue remodelling in post-extraction immediate dental implants placed with a flap and flapless approach in the aesthetic regionclinical and radiographic prospective evaluation at one year

Abstract

Aim: The aim of this PhD investigation is to compare the survival/success rate, aesthetic outcomes and buccal plate resorption of immediate dental implants (Biomimetic OCEAN, Avinent¿) using a flap vs. flapless approach. This was assessed with clinical/ radiographic information, aesthetic indexes and patient¿s reported outcomes at one-year post-loading. Materials and methods: Subjects requiring single tooth extraction in the anterior and premolar areas were recruited for this study. Implant position and choice of platform were restoratively driven and aiming to optimise aesthetics. In the control group, implant placement was performed with the elevation of a mucoperiosteal flap whereas in the test group this was performed flapless. Measurements and analyses were performed by masked examiners. Results: 40 cases were selected and randomised, of which 28 were included for the elaboration of this PhD. No implants were lost during the duration of this study. Success rate varied from 62.9%-84.6% in the test group and 84.6% to 92.3% in the control group. No statistically significant differences were noted in buccal plate resorption/remodelling between control (0.72 +/-0.22) and test group (0.92+/-0.31), PES (10.54 control vs. 10.80 test), WES (6.97 control vs. 6.95 test) or patient¿s reported outcomes at one-year post-loading. Mixed effect model for Total PES and WES score were created using treatment group (flap/flapless), dentist groups, and buccal plate thickness at 12 months as fixed effects covariates while measurement occasion nested examiner as random effects covariate. The only statistically significant association was found between ¿PES¿ and ¿Periodontist/orthodontist group¿. Conclusions: Immediate dental implant treatment with a flap/flapless approach seemed to provide a similar survival rate, mean buccal plate resorption/remodelling, mean PES/WES scores and patients¿ satisfaction. However, a flapless approach resulted in lower success rates vs. a flap approach although this was not statistically significant. Optimal aesthetics seemed difficult to achieve and failures were quite prevalent in both groups despite of careful selection and patients been treated by an experienced clinician. More prospective, randomised and better powered studies are needed to monitor soft/hard tissue dynamics over longer time periods of time as it is currently unclear to what extent a flap vs. flapless approach may influence the aesthetic outcomes in the long term. For this, the wider use of accepted aesthetic indexes, validated PROMs tools and CBCT examination in futures studies would be needed to objectively monitor these outcomes over the time.