| Objective:This study was performed to compare and evaluate the clinical effects of the socket-shield technique for immediate implantation and flapless immediate implantation in the maxillary anterior region.The future application of the socket-shield technique for immediate implantation was also discussed.Materials and methods:According to the inclusion/exclusion criteria,patients with maxillary anterior teeth that can not be reserved in the implant center of Shandong University Stomatological Hospital from Oct,2016 to Mar,2018 were enrolled in this study.The selected patients were randomly divided into an experimental group and a control group.After tooth extraction,the experimental group received the socket-shield technique for immediate implantation while the control group received flapless immediate implantation.In both groups,the permanent crown was applied 6 months after the surgery.All patients were recalled one year after the surgery to evaluate the clinical effects of the different implantation techniques.In this study,the following information was collected:(1)the general information of the patients and the records of the clinical examination as well as the therapeutic processes.(2)the calculation of the one-year success rate of the implants according to the success standards proposed by Cochran.(3)The CBCT examination was performed both immediately after the surgery and at one year after the surgery.The thickness of the labial,palatal and total bone around the implants at the cervical,middle and apical levels was measured.The same natural tooth on the opposite side of the implant or the natural tooth adjacent to the implant was selected as a control,and the thickness of the labial and palatal bone around the control natural tooth was measured.(4)One year after the surgery,the contour of the mesial and distal gingival papilla of the implants was evaluated and classified according to the Jemt’s index.(5)One year after the surgery,the soft and hard tissues around the implants and the implant crowns were evaluated according to the Pink Esthetic Scores/White Esthetic Scores(PES/WES)proposed by Belser.(6)One year after the surgery,patient satisfaction surveys were performed.The data were analyzed using the SPSS 20.0 software package(SPSS,Chicago,IL,USA).The basic patient information of the experiment group and the control group was firstly evaluated.The success rates of the implants were then compared between the experimental group and the control group.The changes in the thickness of the bone around the implants immediately after the surgery and one year after the surgery,as well as those in the thickness of the bone around the control natural teeth,were also evaluated in both the experimental group and the control group.Changes in the thickness of the bone were then compared between the experimental group and the control group.The difference in the contour of the gingival papilla,the esthetic outcomes of the implant crowns and the patient satisfaction was also compared between the experimental group and the control group.P<0.05 was considered as statistically significant.Results:1.Totally 28 implants in 26 patients were enrolled in this study,with 13 plants in 12 patients in the experimental group and 15 implants in 14 patients in the control group.No statistically significant difference was detected in the gender or age of the patients between the two groups(P>0.05).Immediately after the surgery,no difference was revealed in the thickness of the bone around the implants between the experimental group and the control group(P>0.05).2.One year after the surgery,no patients reported pain or other discomforts,and no prosthetic complications were detected.CBCT examination illustrated that all of the 28 implants showed complete osteointegration with no signs of peri-implantitis.The success rate of the implants were both 100%in the experiment group and the control group,and no statistical difference was detected between the two groups(P>0.05).3.The labial and palatal thickness of the bone around the control natural teeth was measured immediately after the surgery and at one year after the surgery.In both the experimental group and the control group,no statistically significant difference was detected in the bone thickness between the two time points(P>0.05).4.In the experimental group,the thickness of the labial bone around the implants at the cervical,middle and apical levels determined one year after the surgery was significantly lower than those determined immediately after the surgery(P<0.05).No differences were detected between the two time points in the thickness of the palatal bone around the implants or in the thickness of the total bone around the implants at the cervical,the middle and the apical levels(P>0.05).One-way ANOVA showed that no difference was detected among the changes in the thickness of the labial bone around the implants at the cervical,middle and apical levels(F=0.89,P>0.05).5.In the control group,the thickness of the labial bone and the total bone around the implants at the cervical,middle and apical levels determined one year after the surgery was all significantly lower than those determined immediately after the surgery(P<0.05).In contrast,no differences were detected between the two time points in the thickness of the palatal bone around the implants at all of the three levels(P>0.05).One-way ANOVA showed significant difference among the changes in the thickness of the labial bone around the implants at the cervical,middle and apical levels(F=5.71,P<0.05).Fisher’s Least Significant Difference(LSD)method was used to show that in the control group,the reduction in the thickness of the labial bone around the implants at the cervical and middle levels was significantly more prominent when compared with that detected at the apical level(P<0.05).In the control group,no difference was detected between the reduction in the thickness of the labial bone around the implants at the cervical level and at the middle level(P>0.05).6.One year after the surgery,the reduction in the thickness of the labial bone around the implants at the cervical and middle levels was significantly lower in the experimental group than in the control group(P<0.05).No difference was detected in the reduction in the thickness of the labial bone around the implants at the apical level between the experimental group and the control group(P>0.05).7.One year after the surgery,the contour of the mesial and distal gingival papilla was evaluated and analyzed using the Chi-square test.We found that the rate of interdental papilla recession was 30.8%in the experimental group and 60.0%in the control group,respectively,and the difference was statistically significant(P<0.05).8.One year after the surgery,the implant crowns were evaluated using the PES and WES scoring system.The PES score in the experimental group(8.95±1.07)was significantly higher than that in the control group(7.93±1.10)(P<0.05).No significant difference was detected in the WES score between the experimental group(9.31±0.63)and the control group(8.80±0.77)(P>0.05).9.One year after surgery,the patient satisfaction surveys were performed.We found that 83.3%of the experimental group was very satisfied,and 16.7%was satisfied.In contrast,78.6%of the control group was very satisfied while 21.4%satisfied.No difference was detected in patient satisfaction between the experimental group and the control group(P>0.05).Conclusions:1.The application of the socket-shield technique for immediate implantation in the maxillary anterior region cannot completely reverse the resorption of the labial bone around the implants.However,this technique results in a lower reduction in the thickness of the labial bone around the implants,decreases the incidence of the interdental papilla recession,and shows a higher PES score,when compared with the flapless immediate implantation technique.2.The short-term clinical effects of the socket-shield technique for immediate implantation in the maxillary anterior region are satisfactory.However,the long-term clinical effects still need further investigation. |
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