Long Term Clinical and Aesthetic Outcomes of Implants Placed With Immediate and Early Protocol in the Anterior Maxilla: A Systematic Review.

OBJECTIVES

The aim of this review was to assess the long-term clinical and aesthetic outcomes of implants placed with immediate and early protocols in the anterior maxilla with a follow-up greater than 5 years.

MATERIALS AND

METHODS

An electronic search in Pubmed, Embase, CINAHL via EBSCO, and the Cochrane database was performed to identify studies on single-tooth implants placed with immediate (Type 1) and early (Type 2) placement protocols in the anterior maxilla that reported outcomes on aesthetics, hard and soft tissue changes with a mean follow up ≥ 5 years.

RESULTS

Fifteen studies on immediate and early protocol single implants placed in the anterior maxilla with a ≥ 5 year follow up were included. A lack of studies comparing the two placement protocols was observed. Soft tissue changes were found to be acceptable for immediately placed implants, with seven studies reporting mean mid-buccal gingival recession of 0.15 ± 0.27 mm and mean papillary height loss of 0.07 mm mesial and 0.20 mm distal after a follow up of ≥ 5 years. Advanced buccal recession (> 1 mm) occurred in 12.17% of cases. Ten of the 15 included studies reported a mean bone loss of 0.68 ± 0.42 mm. Favorable aesthetic outcomes were reported by most studies with a 2.83% incidence of aesthetic failures (aesthetic score < 50% of maximum achievable). The few studies that reported on patient-centered outcomes showed a high level of patient satisfaction post treatment.

CONCLUSIONS

Immediate and early implant placement protocols showed acceptable soft tissue and aesthetic outcomes, with suboptimal aesthetic outcomes reported in 2.83% of cases. More long-term follow-up studies are necessary to identify factors that influence aesthetic outcomes in implants placed with various placement protocols in the anterior maxilla.