Aesthetics in Oral Implantology: Biological,

Clinical, Surgical, and Prosthetic Aspects

Gilberto Sammartino, MD, DDS,* Gaetano Marenzi, DMD, PhD,† Alessandro Espedito di Lauro, DMD, PhD,‡
and Guerino Paolantoni, DMD§

hen Brånemark introduced Objectives: The aim of this study place-ment, and the final restoration

W the osseointegration concept,

he established some requi-
sites for correct dental implantology1
was to identify a correct clinical, sur-
gical, and prosthetic management of
endosseous implants replacing miss-
was placed 4 months from the surgical
procedure. The patients were evalu-
ated clinically and radiographically at
without considering the aesthetic as- ing teeth in the anterior maxilla, implant placement, and 2, 4, 18, and
pects. Today, in clinical practice,
achieving predictable aesthetic out- 24 months post-insertion.
many patients consider the aesthetic
final result to be the most important comes. Placement of immediate post- Results: At 24 months, only 3 im-
aspect of an oral rehabilitation. To en- extraction implants without incisions plants were lost (2 in male patients;1 in
sure aesthetics in implant treatment or flap elevation is one of the surgical female patient). All of these failed im-
means the rigorous respect of many bi- treatment options able to improve the plants did not achieve osseointegration.
ological and biomechanical concepts. healing and regenerative potentials of The overall success rate was 96.6%,
Many factors were identified by several the fresh socket. with an implant failure rate of 3.4%, all
authors to influence a satisfactory aes- Materials: Fifty-five patients (33 prior to restoration.
thetic final result in oral implantology.2–5 men, 22 women), ranging in age from Conclusions: The immediate
Some of these are individual: gingival 19 to 57 years (mean 29), were se- placement in the anterior maxilla
morphology and plane orientation, lected for this study. All the patients fresh extraction sockets without inci-
periodontal biotype, upper and lower were not smokers, no bruxers, pre- sions or flaps elevation is a surgical
lip position in relaxed smile, occlu-
sion, and adequate interdental and in-
sented stable soft tissue conditions, an option that can ensure ideal peri-
terocclusal space. Others are surgical: acceptable occlusion, and the absence implant tissues healing, preserving the
soft tissue and/or bone regeneration, of pathologies that would contraindi- presurgical gingival and bone aspects.
no incision or flaps elevation tech- cate bone healing. Patients were For a predicable aesthetic result, the
nique, and correct implant position treated with implants made by 2 man- most important aspect seems to be the
and placement. Others are strictly ufacturers: Institute Straumann, height and thickness of the buccal
prosthetic: morphology and propor- Walderburg, Switzerland and Fria- bone wall, which remain after imme-
tion of the crown, the use of dent, Mannheim, Germany. A total of diate placement of the fixture. (Im-
prosthetic-guided soft tissue, and pros- 87 implants were placed immediately plant Dent 2007;16:54 – 65)
thetic components. An accurate clini- after each failing tooth had been re- Key Words: gingival aesthetics, tooth
cal evaluation of the patient can lead moved. The temporary restoration extraction, immediate implant place-
the surgeon to identify the surgical
was placed 3 months after implant ment, temporary restoration
options able to ensure a better preser-
vation or recreation of natural alveolar
ridge anatomy. After tooth extraction,
the alveolar bone resorption may not only leave an aesthetic problem for the result in poor aesthetics.10 The exam-
fabrication of conventional or implant- ination of the clinical parameters
*Associate Professor, University of Naples “Federico II,”
supported prostheses but can also should influence the presurgical im-
Faculty of Medicine, Department of Odontostomatologic and
Maxillo-Facial Science, Naples, Italy.
make a correct placement of an endos- plant plan, including a predictable
†Oral Surgeon, University of Naples “Federico II,” Faculty of
Medicine, Department of Odontostomatologic and Maxillo-
seous implant difficult or even impos- bone and soft tissues healing. Place-
Facial Science, Naples, Italy.
‡Assistant Professor, University of Naples “Federico II,” Faculty
sible.6 Resorption of the buccal wall of ment of an implant immediately after
of Medicine, Department of Odontostomatologic and Maxillo- the extraction socket may lead to sig- tooth extraction may help to maintain
Facial Science, Naples, Italy.
§Private practice, Naples, Italy. nificant disadvantages, especially in the bone crest and lead to an ideal
the anterior part of the maxilla.7–9 A implant position from a prosthetic
ISSN 1056-6163/07/01601-054
Implant Dentistry buccal concavity in the alveolar pro- point of view.11,12 This technique has
Volume 16 • Number 1
Copyright © 2007 by Lippincott Williams & Wilkins cess or an implant placed more lin- proven to be a successfully predictable
DOI: 10.1097/ID.0b013e3180327821 gually than the neighboring teeth can treatment modality11–23 according to

54 AESTHETICS IN ORAL IMPLANTOLOGY

the criteria proposed by Roos et al.24 Table 1. Dimensions of the Friadent Immediate Post-extraction Implants Placed
The advantages include reduction in
Dimensions of Implant Placed
morbidity and treatment time, preser-
Length (mm)
vation of residual ridge width and Dimensions of Frialit Implants
height, and an optimal aesthetic result. Placed Diameter 10 13 15
Immediate 1-stage post-extraction im-
3.4 mm 0 2 0
plants have better opportunities for os-
3.8 mm 0 7 2
seointegration because of the healing
4.5 mm 1 14 3
potential of the fresh extraction site.25 5.5 mm 0 3 2
Recent preliminary studies have re-
ported high success rates following the
provisional restoration of a single en-
following immediate implant immediate implantation, to preserve
dosseous implant placed immediately
placement (at least 4 mm beyond the papillae of the adjacent teeth and
following tooth extraction in the max-
the root apex). prevent recession of gingival margins,
illary anterior area. The temporary
7. No smokers. no flaps or incisions were designed to
restoration was identified as a valid
8. A correct and stable occlusion. achieve primary closure. The primary
technique for preserving the gingival
9. No parafunctional habits (e.g., stability of the fixtures was confirmed
architecture and existing osseous.15
bruxism). prior to completion of the surgery. The
The aim of the present study was to
temporary restoration was placed 2
evaluate the clinical and aesthetic re- Exclusion criteria were as follows: months later. The definitive restora-
sults given by a surgical approach
1. No consent for inclusion into the tion was placed 4 months after the
characterized by no incision or flap
study. surgical time.
elevation. The cases were evaluated
2. Poor oral hygiene with no possi- Amoxicillin (1 g) was adminis-
24 months after the definitive pros-
bility of improvement. trated 1 hour prior to surgery. For the
thetic treatment.
3. Poor interest and cooperation. penicillin-allergic patients (8.7%), 0.5 g
4. Chronic or acute systemic pathol- Erythrocin (Abbott Laboratories, Abbott
MATERIALS AND METHODS Park, IL) was the drug of choice. Chlo-
Patients
ogies that might affect the surgical
procedure (uncontrolled diabetes, rhexidine rinses were used prior the sur-
The study population consisted of hemorrhagic diatheses, immunode- gery, and the patients were instructed to
55 patients (33 men, 22 women), rang- ficiency, cardiac ischemia, hy- rinse twice daily for 2 minutes with a
ing in age from 19 to 57 years. All pertension) or the subsequent 0.1% chlorhexidine solution during the
patients were given oral and written prosthodontic treatment and re- first 4 weeks following surgery. An an-
information regarding the study, and quired follow-ups. tibiotic prophylaxis (amoxicillin 1 g, 2
their written informed consents were 5. Presence of active infection tablets/day) and antiinflammatory agent
obtained. All patients required tooth around the failing tooth. (naprossene 550 mg, 2 tablets/day) was
extraction and replacement with an 6. Existence of nontreated general- prescribed for 10 days postsurgery. Oral
immediately placed implant. The pa- ized progressive periodontitis. hygiene instruction was given and rein-
tients were selected according to spe- 7. Pathologic changes at the receptor forced at each visit; at the same time,
cific inclusion and exclusion criteria. site (cysts, tumors, osteomyelitis). professional hygiene measures were
Inclusion criteria were as follows: 8. Medical history of alcohol or drug done around each experimental fixture
dependency. using teflon curettes, rubber points, and
1. Age 18 years or older.
9. Psychological problems. prophylaxis paste.
2. Indication for tooth (maxillary inci-
sor, canine, or premolar) extraction 10. Irradiation in the implant area.
due to prosthetic reasons (root frac- 11. Patient still growing. Clinical and Radiographic Evaluations
tures, nonrestorable carious lesions, 12. Pregnant or nursing woman. Tomograms and periapical radio-
residual roots, trauma), periodontal 13. Peri-implant horizontal bone de- graphs were evaluated for mesiodistal
compromise, or endodontic failures. fects exceeding 4 mm. width (interradicular distance), resid-
3. The absence of pathologies that ual bone beyond the apex, socket
would contraindicate bone healing. Treatment Techniques width, and root angulation. An indi-
4. The presence of stable soft tissue A total of 87 implants (53 Institute vidual bite registration film holder was
conditions. Straumann implants and 34 Friadent fabricated for each patient, ensuring in
5. No presence of dehiscences or fen- implants) (Tables 1 and 2) were placed this way that all radiographs had the
estrations in the extraction sites, or immediately after tooth extraction in same position. Periapical radiographs
the loss of labial bony plate follow- 55 patients according to the standard were taken at the preoperative phase,
ing tooth removal and/or implant surgical procedure by the same expert immediately postoperatively, and at 3, 6,
osteotomy as ascertained by bone surgeons between the time of the first 18, and 24 months after implant place-
sounding technique.15 immediate implant placement on Feb- ment. Marginal bone loss from the im-
6. Adequate apical bone volume to ruary 2001 and the last definitive pros- plant placement to the radiological
achieve primary implant stability thetic treatment on June 2004. In the examination time was calculated by

IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 55

 Table 2. Dimensions of the Institute Straumann Immediate Post-extraction of the patients, 18.3% had 2 implants,
Implants Placed and 12.6% had 3 or more fixtures.
Apart from 3 lost implants, none
Dimensions of Implant Placed
of the patients suffered postoperative
Length (mm)
Dimensions of Straumann Implants complications, and the implant suc-
Placed Diameter 10 12 14 cess rate was 96.6%. Forty days after
the time of surgery, 1 fixture (13 mm
3.3 mm NN 0 2 0
in length and 4.5 mm of diameter),
3.3 mm RN 0 8 3
4.1 mm RN 3 21 4
placed in the first premolar region,
4.8 mm RN 2 4 0 was lost. No infection or negative mu-
4.1/4.8 mm TE 0 3 0 cosal response was present. The pa-
3.3/4.8 mm TE 0 3 0 tient presented to the department
showing a mobility of the healing
abutment. A periapical radiograph
subtracting from 2 subsequent periapi- rials and/or barrier membranes were showed bone loss around the fixture. It
cal radiographs the distance between used to treat the peri-implant defects was decided to remove the fixture. At
the implant shoulder (implant-healing not exceeding 2 mm. This was in the reopening, the loss of all the buc-
screw junction) and the most coronal accordance with the observation re- cal bone wall was evident. We have
part of the alveolar crest. During the ported by other authors,16,27 who ob- justified this failure because of the
prescription follow-up, both the tained spontaneous bone healing of postoperative thinness of the buccal
plaque and gingival indices were these defects with primary flap clo- wall. In another 2 patients, the im-
examined. sure. Cases that showed gaps larger plants were mobile at the abutment
than 2 mm were excluded from this connection stage (4 months from the
Surgical and Prosthetic Protocols study. The longest (15 mm) and wid- surgical procedure).
After administering local anes- est (5.5 mm) were placed where pos- Just after implant placement, 54
thetic, the teeth were luxated with an sible to achieve an optimal primary of a total 87 sites (62.0%) around im-
elevator, and carefully removed avoid- stability, a normal emergence profile, plants were found to have horizontal
ing fracture of the buccal and palatal and the maximal vertical bone preser- defects. Table 4 presents the location
bone walls. The socket was debrided. vation in the maxillary incisors, ca- of postoperative infrabony defects. All
Implant receptor sites were prepared nine, and premolar regions. No sutures implants had uneventful healing times
by sequential standard drills, inter- were made to achieve primary closure. and the aesthetic outcomes of the tem-
nally and externally irrigated, reduced After 2 months from the surgical pro- porary rehabilitation 2 months after
low speed, without incision or flaps cedure, the patients had a temporary surgery. No screw loosening of the
elevation. The osteotomies were real- nonfunctional restoration. After 4 temporary abutment was observed,
ized using the bony walls as guides months, they were restored with func- and no complications were noted after
and taking advantage by the maximum tional ceramometal crowns. the definitive restoration placements.
use of bone apical to extraction sock- The peri-implant soft tissues anat-
ets (at least 4 mm). The distance be- omy was considered clinically accept-
Assessment of Success
tween the gingival margin and bone able in all patients, with no need for
was measured with a millimetric stan- The implants were deemed suc- additional mucogingival surgery.
dard periodontal probe. Implant place- cessful if they fulfilled Roos et al’s24 The same examiner always re-
ment in the prepared site was made criteria under function. All implants corded clinical parameters. Plaque In-
1-mm apical to the height of the most restored were tested for mobility, pres- dex scores of 0 and 1 were observed
coronal wall of the bony housing. The ence of gingival inflammation, and throughout the study. No significant
implant dimensions were chosen ac- patient discomfort. Radiographic ex- differences in the Plaque Index score
cording to the extraction socket. Prior amination was utilized to ascertain the among the 4 time intervals (2, 4,1 8,
to placement, the mean depth and buc- presence of peri-implant translucen- and 24 months), implanting that good
colingual and mesiodistal widths of cies or absence of progressive bone oral hygiene had been maintained by
the alveolus amounted to 8.0 (range loss ⬎0.2 mm annually. the patient.
4.5–12.5), 7.8 (range 4.0 –12.5), and
6.4 mm (range 3.5–10.0), respectively.
Primary implant stability was RESULTS DISCUSSION
achieved, and after placement, the All treated patients had returned In this study, in 41.4% of the im-
healing screw was immediately ap- for the scheduled appointments up to plantations, the reason for tooth ex-
plied. The presence of a gap from the the 24-month follow-up. A total of 87 traction was unsuccessful endodontic
implant surface to the surrounding implants were evaluated that included treatment; the implants replacing re-
marginal bone walls was noted and 18 central incisors, 16 lateral incisor, sidual roots represented 23.0%. In
measured with a graded periodontal 13 canines, 22 first premolars, and 18 17.3% of the implantations, the reason
probe placed perpendicular to the long second maxillary premolars (Table 3). for tooth loss was advanced periodon-
axis of the implant. No grafting mate- Single implants were placed in 69.1% titis. Of implants, 9.3% replaced a

56 AESTHETICS IN ORAL IMPLANTOLOGY

 Table 3. Location and Reason for Failure of the Tooth Replaced With Immediate Anterior Single Implant
Endodontic Residual Number of
Tooth Unsuccessful Root Periodontitis Trauma Carious Lesion Teeth
Central incisor 10 5 2 1 18
Lateral incisor 9 5 2 16
Canine 6 4 1 1 1 13
First maxillary premolar 7 8 5 2 22
Second maxillary premolar 4 3 4 3 4 18

Table 4. Location, Type, and Dimension of Bone Defect Around Immediate Post-extraction Implant
Number of Teeth With
Defect Type at Implant Dimension of Largest Horizontal
Placement Implantation Site Perpendicular-Width Defect Defect
All Lateral incisor 0.4 ⫾ 0.8 mm 7
Canine 0.5 ⫾ 0.3 mm 4
First maxillary premolar 1.7 ⫾ 0.3 mm 11
Second maxillary premolar 0.7 ⫾ 0.9 mm 9
3-wall infrabony Lateral incisor 0.9 ⫾ 0.7 mm 6
Canine 1.2 ⫾ 0.5 mm 3
First maxillary premolar 1.5 ⫾ 0.5 mm 8
Second maxillary premolar 1.3 ⫾ 0.7 mm 6
Dehiscences — — —

tooth failed by a trauma, and nonre- gingivae ensures not only the preser- A possible complication of this
storable carious lesions procured only vation of its morphology but gives the method is the presence of bone defects
9.2% of the cases (Table 4). Because possibility to improve adaptation of between the coronal aspect of the im-
the number of subjects observed in the the soft tissues to the crown favoring a plant body and surrounding socket
present study was small and the length satisfactory aesthetic final result. wall.27–29 Our treated cases presented 4
of the follow-up period was short,
conclusions should be drawn with cau-
tion. Results of this seem to demon-
strate a positive effect of a surgical
procedure without flap elevation on
soft tissues healing around implants
placed in post-extraction sockets. A
success rate of 96.6% as found in this
study is comparable to results reported
in other studies of immediate post-
extraction implant placement.25 Imme-
diate post-extraction implantology has
the advantage to offer the possibility Fig. 1. Clinical view of the failing
for placing the implant in a optimal maxillary left central incisor.
position (i.e., in the same position and Fig. 2. Preoperative periapical ra-
inclination as the natural tooth) diograph.
from a prosthetic point of view, Fig. 3. Intraoral view of prepara-
avoiding post-extraction bone re- tion of the implant receptor site
sorption.26 This technique helps the with sequential standard drills
without incision or flap elevation
clinician to maintain the presurgical after atraumatic extraction of the
gingival architecture and is able to tooth.
ensure better opportunities for os- Fig. 4. Clinical view of the implant
seointegration because of the healing placed in the fresh socket. The
potential of the fresh extraction site.17 application of the healing abut-
It is our opinion that the healing po- ment. No suture was made to
achieve primary closure.
tential of the fresh socket is able to Fig. 5. Immediate postoperative
promote both hard and soft peri- periapical radiograph of the
implant tissue. A correct relation of implant.
the immediately placed fixture with

IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 57

or 3 wall defects in relation to the size trauma to the buccal wall and its vas- sults. We believe a very thin and fes-
and morphology of the socket. This cularization. The implants were nor- tooned biotype of gingival tissue is not
was present especially in premolar im- mally placed along the palatal wall of a good prognostic element for imme-
plantation sites rather than the incisor/ the extraction socket in the incisor and diate implant placement in the anterior
canine areas. This study is evidence canine areas, and centrally in the maxilla. Conversely, the available
that the presence, after inserting the socket in the premolar areas (Figs. temporary components made by the in-
implant, of horizontal gaps of 2 mm or 1–5). Our opinion is that the surgical dustries ensure the respect of the soft
less is a clinical situation that does not respect of the buccal socket wall is the tissues and its correct modulation. The
need any guided bone regeneration most important factor for obtaining a temporary rehabilitation reduces the
technique.12 Our experience suggests satisfactory aesthetic result. The idea dead space between the soft tissue cov-
to avoid this surgical technique in aes- of inserting the fixtures without flap erage and bone, reduces the chances of
thetic areas when the fixture dimen- elevation is an attempt to have a major infection, and enhances the maturation
sions are not able to reduce the bone respect of the buccal wall and its peri- and modeling process.33 The temporary
defect within 2 mm. The role of the osteal membrane minimizing soft tis- dentures cannot cause pressure on the
implant surface in bone defect healing sue trauma. Another aspect that the soft tissues (Fig. 8).
appears to be very important, but it clinician must take into account, imag- In this study, the occlusal height
was not within the scope of this study. ining the final aesthetic result, is the of the acrylic resin temporary crowns
Some authors30 question the need for gingival morphology and thickness was shortened about 2 mm to prevent
primary closure in immediate implan- (Figs. 6 and 7). Several authors31,32 the load transmission directly to the
tation. In this study, as protocol, we reported facial gingival recession after implant. The use of a fixed provisional
did not use sutures; and in all cases, definitive prosthesis placement. Preop- restoration can help to control the oc-
we had good aesthetic results. We erative clinical examination must note clusal forces that are applied to the
believe optimal aesthetic result is con- gingival anatomy and architecture, healing bone-to-implant interface
nected to the bone quality and dimen- and the presence of inflammation/ within a physiologic range.33 This is a
sions of the buccal wall. Resorption of edema or recessions in the implanta- very satisfactory solution for the pa-
this may produce a buccal concavity in tion sites. These factors can reduce the tient and prevents excessive stress to
the alveolar process that usually pro- possibility of predicable aesthetic re- the fixture (Figs. 9 –11).
duces a compromised aesthetic situa-
tion.7–9 The thickness of the buccal
aspect of the alveolar process after
implant placement, immediate or not,
is the real important prognostic factor.
In this study, during the implant site
preparation, the burs were positioned
in contact with the palatal socket walls
with the end to reduce the surgical

Fig. 6. Buccal view of soft tissues healing Fig. 8. Clinical view of the temporary restoration.
after 2 months from surgical time. Fig. 9. Clinical view of the final casting.
Fig. 7. Occlusal view of soft tissues healing Fig. 10. Clinical view of the final restoration.
after 2 months from surgical time. Fig. 11. Periapical radiograph after 24 months from surgical time.

58 AESTHETICS IN ORAL IMPLANTOLOGY

CONCLUSIONS gration in Clinical Dentistry. Chicago, IL: extraction applications. Int J Oral Maxillo-
Quintessence; 1985:199-204. fac Implants. 1997;12:299-309.
Within the limits of this study, the 11. Schulte W, Kleineikenscheidt H, 24. Roos J, Sennerby L, Lekholm U, et
preliminary results have confirmed Linder K, et al. The Tubingen immediate al. A qualitative and quantitative method for
that immediate implantation in fresh implant in clinical studies [in German]. evaluating implant success: A 5 year retro-
extraction sites of the anterior maxilla, Dtsch Zahnarztl Z. 1978;5:348-359. spective analysis of the Brånemark im-
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et al. Immediate one-stage postextraction 12:504-514.
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appears to foster a well-preserved gin- case report. Int J Oral Maxillofac Implants. ries analysis of the factors determining im-
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Disclosure dited patient care: A case report. Int J Oral placement into extraction sites: Surgical and
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cial interest in any company or any of et al. Immediate mandibular rehabilitation 27. Schropp L, Kostopoulos L, Wenzel
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IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 59

 Abstract Translations

untersucht. Ergebnisse: Nach 24 Monaten musste nur bei

GERMAN / DEUTSCH drei Implantaten ein Fehlschlagen festgestellt werden, wobei
AUTOR(EN): Gilberto Sammartino, MD, DDS*, Gaetano zwei dieser Implantate männlichen Patienten eingesetzt wor-
Marenzi, DMD, PhD**, Alessandro Espedito di Lauro DMD den waren und eines bei einer Patientin. Keines der ver-
PhD***, Guerino Paolantoni DMD****. *A.O. Professor, sagenden Implantate konnte eine Knochengewebsintegration
Universität von Neapel “Federico II”. Medizinische Fakultät. erzielen. Die vor der abschließenden Wiederherstellung er-
Abteilung für Odontostomatologie und Gesichts- und Kief- mittelte Gesamterfolgsquote lag bei 96,6% mit einer Versa-
erheilkunde. Neapel, Italien. **Oralchirurg, Universität von gensrate der Implantate von 3,4%. Schlussfolgerungen: Die
Neapel “Federico II”. Medizinische Fakultät. Abteilung für sofortige Platzierung von Implantaten in die frischen Extrak-
Odontostomatologie und Gesichts- und Kieferheilkunde. tionshöhlen des vorderen Oberkiefers ohne zusätzliche Ein-
Neapel, Italien. ***Assistenzprofessor, Universität von schnitte oder Lappenanhebungen stellen eine chirurgische
Neapel “Federico II”. Medizinische Fakultät. Abteilung für Option dar, die unter Erhalt der vor der Operation
Odontostomatologie und Gesichts- und Kieferheilkunde. bestehenden Zahnfleisch- und Knochenbedingungen eine op-
Neapel, Italien. ****Privat praktizierender Arzt, Neapel, Ital- timale Gewebsheilung im das Implantat umlagernden
ien. Schriftverkehr: Gilberto Sammartino, MD, DDS, Dip. di Gewebe garantieren kann. Für ein vorhersagbar gutes ästhe-
Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di tisches Ergebnis scheinen die Höhe und Dicke der wangense-
Medicina e Chirurgia dell’Università degli studi di Napoli itigen Knochenwand, die nach der sofortigen Anbringung der
“Federico II”, Via Pansini 5, 80125 Neapel, Italien. Telefon: Deckprothese verbleiben, die wichtigste Rolle zu spielen.
⫹39-081/7462654, e-Mail: [email protected]
Ásthetik in der Oralimplantologie: biologische, klinische, SCHLÜSSELWÖRTER: Ásthetik im Zahnfleischbereich,
chirurgische und prothetische Aspekte Zahnextraktion, sofortige Implantatsetzung, vorübergehende
Wiederherstellungslösung
ZUSAMMENFASSUNG: Zielsetzungen: Diese Studie zielte
darauf ab, eine korrekte klinische, chirurgische und prothe-
tische und auf ein vorhersagbar gutes ästhetisches Ergeb- SPANISH / ESPAÑOL
nis abzielende Vorgehensweise bei der Einsetzung
AUTOR(ES): Gilberto Sammartino, MD, DDS*, Gaetano
Knochengewebsintegrierender Implantate zu erfassen, die
Marenzi, DMD, PhD**, Alessandro Espedito di Lauro, DMD,
zum Zweck des Ersatzes fehlender Zähne im vorderen Oberk-
PhD***, Guerino Paolantoni, DMD****. *Profesor Aso-
iefer eingesetzt werden. Die sofort in die Extraktionshöhlen
ciado, Universidad de Nápoles “Federico II”, Facultad de
vorgenommene Einpflanzung von Implantaten ohne zusätzli-
Medicina, Departamento de Ciencias Odontoestomatológi-
che Einschnitte und Lappenanhebungen stellt eine der chiru-
cas y Maxilofaciales, Nápoles, Italia. **Cirujano Oral, Uni-
rgischen Behandlungsoptionen dar, um die Heilungschancen
versidad de Nápoles “Federico II”, Facultad de Medicina,
und regenerativen Möglichkeiten der frischen Pfanne zu ver-
Departamento de Ciencias Odontoestomatológicas y Maxilo-
bessern. Materialien und Methoden: 55 Patienten, davon 33 faciales, Nápoles, Italia. ***Profesor Asistente, Universidad
Männer und 22 Frauen im Alter von 19 bis 57 Jahren (mit 29 de Nápoles “Federico II”, Facultad de Medicina, Departa-
als durchschnittlichem Alter) wurden zur Teilnahme an dieser mento de Ciencias Odontoestomatológicas y Maxilofaciales,
Studie ausgewählt. Keiner der Patienten rauchte oder knir- Nápoles, Italia. ****Práctica Privada, Nápoles, Italia. Cor-
schte mit den Zähnen. Bei allen lagen stabile Weich- respondencia a: Gilberto Sammartino, MD, DDS, Dip. di
gewebsbedingungen vor, der Zahnreihenschluss war bei allen Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di
weitestgehend zufrieden stellend und keiner wies krankhafte Medicina e Chirurgia dell’Università degli studi di Napoli
Veränderungen auf, die eine Knochenheilung beeinträchtigen “Federico II”, Via Pansini 5, 80125 Napoli, Italy. Teléfono:
könnten. Die Patienten wurden mit Implantaten zweier ver- ⫹39-081/7462654, Correo electrónico: gilberto.sammartino@
schiedener Hersteller behandelt, zum ersten vom Institut unina.it
Straumann, Walderburg, Schweiz, und zum zweiten von Fria- La estética en la implantologı́a oral: aspectos biológicos,
dent, Mannheim, Deutschland). 87 Implantate wurden sofort clı́nicos, quirúrgicos y prostéticos
nach Entfernen des jeweiligen versagenden Zahns implantiert. 3
Monate nach Implantatsetzung wurde die vorübergehende ABSTRACTO: Objetivos: El objetivo de este estudio fue
Prothetik angebracht und 4 Monate nach dem chirurgischen identificar una atención clı́nica, quirúrgica y prostética cor-
Eingriff folgte die abschließende Wiederherstellung. Die Pa- recta de los implantes endoóseos para reemplazar dientes que
tienten wurden klinisch und röntgentechnisch bei Implantat- faltan en la maxila anterior para lograr resultados estéticos
setzung sowie 2, 4, 18 und 24 Monate nach Implantierung pronosticables. La colocación de los implantes inmediatos a

60 AESTHETICS IN ORAL IMPLANTOLOGY

la post-extracción sin incisiones o elevación de las aletas es ⫹39-081/7462654, e-Mail: [email protected]
una de las opciones de tratamiento quirúrgico capaces de Estética em implantologia oral: Aspectos biológicos, clı́ni-
mejorar el potencial regenerativo y de curación de la cavidad cos, cirúrgicos e protéticos
fresca. Materiales y métodos: Se seleccionaron para el estu-
dio cincuenta y cinco pacientes (33 hombres, 22 mujeres), RESUMO: Objetivos: O objetivo deste estudo era identificar
con edades desde los 19 a los 57 (edad media de 29) años. um tratamento clı́nico, cirúrgico e protético correta de im-
Todos los pacientes no eran fumadores, sin bruxismo, pre- plantes endósseos substituindo dentes ausentes na maxila
sentaban tejidos suaves estables, una oclusión aceptable y la anterior alcançando resultados estéticos previsı́veis. A colo-
ausencia de patologı́as que pudieran contraindicar la curación cação de implantes de pós-extração imediata sem incisões ou
del hueso. Los pacientes fueron tratados con implantes he- elevação do retalho é uma das opções de tratamento cirúrgico
chos por 2 fabricantes (Institute Straumann, Walderburg, capazes de melhorar a cura e os potenciais regenerativos do
Suiza y Friadent, Mannheim, Alemania). Ochenta y siete alvéolo fresco. Materiais e Métodos: Cinqüenta e cinco pa-
implantes fueron colocados inmediatamente después de la cientes (33 homens, 22 mulheres), compreendendo em idade
extracción de cada diente fallado. La restauración temporal se de 19 a 57 (idade média 29) anos, foram selecionados para
colocó tres meses después de la colocación del implante y la este estudo. Todos os pacientes eram não-fumantes, não-
restauración final se colocó 4 meses después del procedi- bruxistas, apresentavam condições de tecido mole estáveis,
miento quirúrgico. Los pacientes fueron evaluados clı́nica- uma oclusão aceitável e a ausência de patologias que contra-
mente y radiográficamente en el momento de la colocación indicassem a curta do osso. Os pacientes foram tratados com
del implante y a los 2, 4, 18 y 24 meses posteriores a la implantes feitos por 2 fabricantes (Institute Straumann,
colocación. Resultados: A los 24 meses solamente se habı́an Walderburg, Suı́ça e Friadent, Mannheim, Alemanha). 87
perdido tres implantes (2 en pacientes masculinos y 1 en una implantes foram colocados imediatamente depois que cada
paciente femenina). Todos los implantes fallados no lograron dente deficiente for removido. A restauração temporária foi
la oseointegración. La tasa general de éxito fue del 96.6% con colocada três meses após a colocação do implante e a restau-
una tasa de falla del implante del 3.4%, todos antes de la ração final foi colocada 4 meses a partir do procedimento
restauración. Conclusiones: La colocación inmediata en las cirúrgico. Os pacientes foram avaliados clı́nica e radiografi-
cavidades de extracción frescas de la maxila anterior sin camente na colocação do implante e em 2, 4, 18 e 24 meses
incisiones o elevación de la aleta es una opción quirúrgica pós inserção. Resultados: Em 24 meses apenas três implantes
que puede asegurar una curación ideal de los tejidos periim- foram perdidos (2 em pacientes masculinos;1 em paciente
plante para proteger los aspectos gingivales y del hueso feminino). Todos esses implantes fracassados deixaram de
previo a la cirugı́a. Para lograr un resultado estético pronos- alcançar a osseointegração. A taxa de sucesso geral foi de
ticable, el aspecto más importante parece ser la altura y el 96.6% com taxa de fracasso do implante de 3.4%, tudo antes
espesor de la pared del hueso bucal que queda luego de la da restauração. Conclusões: A colocação imediata nos alvéo-
colocación inmediata del aparato. los de extração frescos da maxila anterior sem incisões ou
elevação do retalho é uma opção cirúrgica que pode assegurar
PALABRAS CLAVES: estética gingival, extracción de a cura ideal de tecidos de periimplante, preservando os as-
dientes, colocación inmediata del implante, restauración pectos gengivais e ósseos pré-cirúrgicos. Para um resultado
temporal estético previsı́vel o aspecto mais importante parece ser a
altura e espessura da parede do osso bucal que permanecem
após a imediata colocação do aparelho.
PORTUGUESE / PORTUGUÊS PALAVRAS-CHAVE: estética gengival, extração de dentes,
AUTOR(ES): Gilberto Sammartino Médico, Cirurgião- colocação imediata de implantes, restauração temporária
Dentista*, Gaetano Marenzi Doutor em Medicina, PhD**,
Alessandro Espedito di Lauro Doutor em Medicina, PhD***,
Guerino Paolantoni Doutor em Medicina****. *Professor
Associado, Universidade de Nápoles “Federico II”. Facul-
RUSSIAN /
dade de Medicina. Departamento de Ciência Odontostoma-
О: Глбо С  о (Gilberto
tológica e Maxilo-Facial. Náoles, Itália. **Cirurgião Oral, Sammartino) доко д , доко со олог*,
Universidade de Nápoles “Federico II”. Faculdade de Me- Г  о    (Gaetano Marenzi) доко со оло-
dicina. Departamento de Ciência Odontostomatológica e г, доко флософ**, лсс до сдо д
Maxilo-Facial. Nápoles, Itália. ***Professor Assistente, Uni- Л уо (Alessandro Espedito di Lauro) доко со оло-
versidade de Nápoles “Federico II”. Faculdade de Medicina. г, доко флософ***, Гу о  ол о 
Departamento de Ciência Odontostomatológica e Maxilo- (Guerino Paolantoni) доко со олог****.
Facial. Náoles, Itália. ****Clı́nica particular, Nápoles, Itá- *
дк- оф сссо у с   ол “Fed-
lia. Correspondência: Gilberto Sammartino, MD, DDS, Dip. erico II”.  дск фкул . Кф д  одоосо-
di Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà олог  у   лс  л.  ол,
di Medicina e Chirurgia dell’Università degli studi di Napoli л. ** у г-соолог, у с   ол
“Federico II”, Via Pansini 5, 80125 Napoli, Italy. Telefone: “Federico II”.  дск фкул . Кф д  одо-

IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 61

осоолог  у   лс  л.  ол, л  , ол   2 гоол  ( су-
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Facciali, Facoltà di Medicina e Chirurgia dell’Università degli  4 с осл угского  ' лс .
studi di Napoli “Federico II”, Via Pansini 5, 80125 Napoli, Italy. Бл од кл ск    дологск 
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62 AESTHETICS IN ORAL IMPLANTOLOGY

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