Objective: To volumetrically compare peri‐implant mid‐facial soft tissue changes in immediately placed and provisionalized implants in the aesthetic zone, with or without a connective tissue graft.Material and methods: Sixty patients were included. All implants were placed immediately after extraction. After randomization, in one group, a connective tissue graft (test group, n = 30) was inserted at the buccal aspect of the implant. The other group (control group, n = 30) received no connective tissue graft. Clinical parameters, digital photographs and conventional impressions were obtained before extraction (T_pre) and at 12 months following definitive crown placement (T₁₂). The casts were digitized by a laboratory scanner, and a volumetric analysis was performed between T_pre and T₁₂.Results: Twenty‐five patients in each group were available for analysis at T₁₂. Volumetric change, transformed to a mean (±SD) change in thickness, was −0.68 ± 0.59 mm (test) and −0.49 ± 0.54 mm (control) with a non‐significant difference between groups (p = .189). The mid‐facial mucosa level was significantly different between both groups (p = .014), with a mean (±SD) change of +0.20 ± 0.70 mm (test) and −0.48 ± 1.13 mm (control). The Pink Esthetic Score was similar between both groups.Conclusions: The use of a CTG in immediately placed and provisionalized implants in the aesthetic zone did not result in less mucosal volume loss after 12 months, leading to the assumption that a CTG cannot fully compensate for the underlying facial bone loss, although a significantly more coronally located mid‐facial mucosa level was found when a CTG was performed.

Objectives: High crown‐to‐implant ratios may lead to complications due to unfavorable occlusal forces, including nonaxial forces, on the bone surrounding the neck of the implant and within the connection of the crown and implant itself. The aim of this study was to perform a systematic review on the influence of crown‐to‐implant ratio of single‐tooth, nonsplinted, implants on biological and technical complications.Materials and Methods: MEDLINE (1950–January 2018), EMBASE (1966–January 2018), and Cochrane Central Register of Controlled Trials database (1800–January 2018) were searched to identify eligible studies. Inclusion criteria were as follows: crown‐to‐implant ratio of single‐tooth, nonsplinted, implant‐supported restorations in the posterior maxilla or mandible and follow‐up of at least 1 year. Main outcome measures were as follows: implant survival rate, marginal bone level changes, biological complications, and technical complications. Two reviewers independently assessed the articles. A meta‐analysis was carried out for implant survival rate and peri‐implant bone changes.Results: Of 154 primarily selected articles, eight studies fulfilled the inclusion criteria. Study groups presented a mean crown‐to‐implant ratio varying from 0.86 (with 10‐mm implants) to 2.14 (with 6‐mm implants). The meta‐analysis showed an implant survival of more than 99% per year and mean peri‐implant bone changes of <0.1 mm per year. Limited biological and technical complications were reported.Conclusion: Data reviewed in the current manuscript on crown‐to‐implant ratio, ranging from 0.86 to 2.14, of single‐tooth, nonsplinted, implants did not demonstrate a high occurrence of biological or technical complications.

Background: It is unclear if an intact buccal bony plate is a prerequisite for immediate implant placement in post‐extraction sockets. The aim of this 5‐year randomized controlled trial was therefore comparison of peri‐implant soft and hard tissue parameters, esthetic ratings, and patient‐reported satisfaction of immediate implant placement in post‐extraction sockets with buccal bony defects of ≥ 5 mm in the esthetic zone, with delayed implant placement after ridge preservation.Methods: Patients presenting a failing tooth in the esthetic region and a buccal bony defect of ≥ 5 mm after extraction were randomly assigned to immediate (Immediate group, n = 20) or delayed (Delayed group, n = 20) implant placement. Second‐stage surgery and placement of a provisional restoration occurred 3 months after implant placement in both groups, followed by definitive restorations 3 months thereafter. The follow‐up was 5 years. Marginal bone level (primary outcome), buccal bone thickness, soft tissue parameters, esthetics, and patient‐reported satisfaction were recorded.Results: Mean marginal bone level change was −0.71 ± 0.35 mm and −0.54 ± 0.41 mm in respectively the Immediate group and the Delayed group after 5 years (P = 0.202). This difference, and in other variables, was not significant.Conclusions: Marginal bone level changes, buccal bone thickness, clinical outcomes, esthetics, and patients’ satisfaction following immediate implant placement, in combination with bone augmentation in post‐extraction sockets with buccal bony defects of ≥ 5 mm, were comparable to those following delayed implant placement after ridge preservation in the esthetic zone.

Aim: To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in the aesthetic region after five years of function.Materials and Methods: Forty patients with a failing tooth in the maxillary anterior region were randomly assigned immediate implant placement with immediate (Group A: n = 20) or delayed (Group B: n = 20) provisionalization. Definitive crown placement occurred three months after provisionalization. The primary outcomes were changes in marginal bone level. In addition, survival rates, buccal bone thickness, soft peri‐implant tissues, aesthetics and patient‐reported outcomes were assessed.Results: After 5 years, the mean mesial and distal marginal bone level changes were 0.71 ± 0.68 mm and 0.71 ± 0.71 mm, respectively, in group A and 0.49 ± 0.52 mm and 0.54 ± 0.64 mm, respectively, in group B; the difference between the groups was not significant (p = .305 and p = .477, respectively). Implant and restoration survivals were 100%. No clinically relevant differences in buccal bone thickness or in mid‐facial peri‐implant mucosal level, aesthetic and patient outcomes were observed.Conclusions: The mean marginal bone level changes following immediate implant placement and provisionalization were comparable with immediate implant placement and delayed provisionalization. (www.isrctn.com: ISRCTN57251089 and www.trialregister.nl: NL8255).