Immediate single-tooth implants in the anterior maxilla: 3-year results of a case series on hard and soft tissue response and aesthetics

J Clin Periodontol. 2011 Aug;38(8):746-53. doi: 10.1111/j.1600-051X.2011.01748.x.


Purpose: The objective of this prospective study was to assess the overall outcome of immediate single implant treatment in the anterior maxilla after a 3-year observation period.

Material and methods: Thirty consecutively treated patients with a thick gingival biotype, ideal gingival level/contour and intact socket walls at the time of tooth extraction were treated for single-tooth replacement in the aesthetic zone by two experienced clinicians. Treatment included minimal mucoperiosteal flap elevation, immediate implant placement (NobelReplace TiUnite(®)), insertion of a grafting material between the implant and the socket wall and connection of a screw-retained provisional restoration. The latter was replaced by a cemented crown 6 months thereafter. Patients were clinically and radiographically re-examined after 3 years to assess implant survival, complications and hard and soft tissue conditions. The aesthetic outcome was objectively rated using the Pink Esthetic Score (PES) and White Esthetic Score (WES) by a blinded clinician who had not been involved in the treatment.

Results: Twenty-five patients could be re-evaluated after 3 years. One early implant failure had occurred resulting in an implant survival rate of 96%. Radiographic examination yielded on average 1.13 mm mesial, respectively 0.86 mm distal bone loss. The clinical conditions showed fairly low peri-implant plaque (18%) and bleeding (24%) and mean probing depth was 3.17 mm. Mean mesial/distal papilla shrinkage and midfacial soft tissue recession in reference to the pre-operative status accounted for 0.05, 0.08 and 0.34 mm, respectively. Between the 1- and 3-year reassessment mesial papillae showed significant re-growth (0.36 mm; p=0.015). Advanced midfacial recession (>1 mm) was found in 2/25 (8%) cases. Five (21%) cases were aesthetic failures (PES<8 and/or WES<6) and 5/24 (21%) showed an (almost) perfect outcome (PES≥12 and WES≥9). The remainder (14/24 or 58%) demonstrated acceptable aesthetics.

Conclusions: The proposed strategy seems a valuable and predictable treatment option for well-selected patients in the mid-long term as shown by almost full papillary re-growth and a low risk for advanced midfacial recession.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Bone Substitutes / therapeutic use
  • Crowns
  • Dental Abutments
  • Dental Implants, Single-Tooth*
  • Dental Plaque / classification
  • Dental Prosthesis Retention
  • Dental Prosthesis, Implant-Supported
  • Dental Restoration Failure
  • Dental Restoration, Temporary
  • Esthetics, Dental*
  • Female
  • Follow-Up Studies
  • Gingiva / pathology
  • Gingival Hemorrhage / classification
  • Gingival Recession / classification
  • Humans
  • Immediate Dental Implant Loading*
  • Male
  • Maxilla / pathology
  • Maxilla / surgery*
  • Middle Aged
  • Minerals / therapeutic use
  • Periodontal Pocket / classification
  • Prospective Studies
  • Surgical Flaps
  • Tooth Socket / surgery
  • Treatment Outcome
  • Young Adult


  • Bio-Oss
  • Bone Substitutes
  • Minerals