Bone Volume Assessment Around Immediate Dental Implant in the Esthetic Area with Immediate Tooth-Like Single Crown Provisionalization: A Laser and Computed Tomography 1-Year Retrospective Study

Purpose: To examine the remodeling process of both the soft and hard tissue components of the postextraction socket around immediately loaded dental implants after tooth extraction in maxillary esthetic areas. Materials and Methods: Subjects underwent immediate placement of single implants in postextraction sockets without bone grafting, and their immediate provisionalization with custom tooth-like interim crowns were fabricated using digital diagnostic impressions and a dental milling machine. Intraoperative and 1-year follow-up layered scans of the postextraction sockets after implantation were acquired using a 3D optical system. In the short term, subjects underwent computed tomographic scans. Digital impressions for gingival contours, originally stored as STL (standard tessellation language) files, were converted to DICOM (Digital Imaging and Communications in Medicine) files with the implant shoulder working as a referral point, which were then superimposed to 3D radiologic images. The observed volumetric and linear outcomes were measured using a program known as DentaScan. The width of the alveolar crest at the level of the implant shoulder and marginal bone levels were acquired. Nonparametric tests were applied with a level of significance set at P <.01. Results: No failure was reported after a follow-up of 1 year. Little or no inflammation of the treated areas was registered, and there were practically no signs of suppuration. The areas showed a significant reduction in the overall volumes for both soft and bone tissue, with a P value <.0001 from the baseline (0.983 +/- 0.172 cm(3)) to the 1-year survey (0.865 +/- 0.156 cm(3)). If the soft and bone tissue changes were separately evaluated, a significant loss (with a P value <.0001) was registered for only the bone tissues (from 0.434 +/- 0.075 to 0.355 +/- 0.061 cm(3)). Moreover, changes in gingival tissue from baseline to the 1-year survey (-0.040 +/- 0.067) appeared to be significantly different from the overall volume loss (-0.118 +/- 0.083 cm(3)). A shrinkage in width (-0.5 +/- 0.7 mm) was found from baseline (12.6 +/- 0.6 mm) to the 1-year follow-up (12.1 +/- 0.9 mm). Marginal bone levels were 0.97 +/- 0.70 mm and 0.39 +/- 0.78 mm, respectively, at the mesial and distal aspects of the implants. Conclusions: The present analysis suggested that immediately customized provisionalization was effective enough to prevent both volume loss and linear shrinkage at the layers of the treated areas. Moreover, the buccal aspects seemed to be the areas most affected by the loss of volume. The mean loss in width, which amounted to roughly 0.5 mm, appeared to be negligible when compared to the overall width measured before surgery.