Soft tissue evaluation of an immediate esthetic zone single implant with a stereolithographic guide using 3D reconstruction and a CAD/CAM customized titanium anatomic abutment
By: Tae-Heung Kim, You-Kyoung Oh, Chang-Mo Jeong, Edward Chengchuan Ko, George K. Sandor and Yong-Deok Kim
Purpose
The purpose of this study was to evaluate the changes in the soft tissue following an immediate implant procedure using guided surgery in combination with a computer-aided design and computer-aided manufacturing (CAD/CAM) customized titanium anatomic abutment in the esthetic zone.
Materials & Methods
Study design : Retrospective clinical study
Subjects and Outcomes of the study
Period : between April 2017 and May 2018(The mean follow-up period was 14.7 months, and the minimum follow-up period was one year)
Patients : 13 patients who consisted of five males and eight females with a mean age of 49.6 years
Implants : TS III 13 implants
Outcome measures : The changes in the soft tissue dimension, interdental papilla, and esthetic score
Results
1) Soft Tissue Dimension
There was no statistically significant change in the midfacial mucosa (p-value: 0.028).The loss of the mesial papillary height was 0.32 0.83 mm (p-value 0.203), and of the distal papillary height, 0.10 0.060 mm (p-value: 0.594). The mean horizontal change in the midfacial soft tissue volume was 0.32 0.83 mm.
Table 1. The Change in the Soft Tissue Dimension
| Parameters | Amounts of Change | p-Value |
| Midfacial mucosa level | 0.27 ± 0.42 | 0.028 |
| Mesial papilla level | 0.32 ± 0.83 | 0.203 |
| Distal papilla level | 0.01 ± 0.06 | 0.594 |
| Horizontal change in the labial soft tissue Mean standard deviation |
0.32 ± 0.83 | 0.060 |
2) Jemt’s Index
There was no significant dierence in the mesial and distal papilla index between the measurements made prior to the extraction and at one year of follow-up, according to the Wilcoxon signed-rank test (p-value: 0.180, 0.157) (Table 2).
Table 2. The Jemt’s Index
| Parameters | Amounts of Change | p-Value |
| Mesial papilla | 1.342* | 0.180 |
| Distal papilla | 1.414* | 0.157 |
| * : Z value |
3) PES
The mean and standard deviation of the PES and of each variable are depicted in Table 3. The overall score was
11.16 2.17 before treatment, and 10.25 1.42 after the follow-up period. There were two cases with a total score
of 8 or less in both the pre-operative and follow-up periods, which can be regarded as esthetic failures.
Table 3. The Pink Esthetic Score
| PES Parameter | Pre-Operative | Follow-Up | p-Value |
| Mesial papilla | 1.33 ± 0.49 | 1.25 ± 0.45 | 0.586 |
| Distal papilla | 1.42 ± 0.51 | 1.58 ± 0.51 | 0.438 |
| Midfacial mucosa level | 1.67 ± 0.65 | 1.42 ± 0.51 | 0.117 |
| Midfacial contour | 1.58 ± 0.51 | 1.33 ± 0.49 | 0.191 |
| Alveolar process deficiency | 1.33 ± 0.78 | 1.16 ± 0.72 | 0.504 |
| Soft tissue color | 1.58 ± 0.51 | 1.42 ± 0.51 | 0.339 |
| Soft tissue texture | 1.50 ± 0.52 | 1.42 ± 0.51 | 0.586 |
| Total score | 10.58 ± 1.97 | 9.83 ± 1.34 | 0.137 |
Conclusion
The immediate post-extraction placement of an implant in the esthetic zone should satisfy the esthetic and functional demands. The clinical case series in the present study provides clinicians with a scientific basis for an immediate placement procedure using a 3D reconstruction stereolithographic guide and restoration protocols with a CAD/CAM titanium anatomic abutment. This advanced technique provides an option with predictable outcomes for the replacement of teeth in the esthetic zone.
