Compare The Esthetic Between The Socket Shield Technique And The Flap-less Immediate Implant Placement In The Maxillary Anterior Area

Aim:To evaluate the esthetic and clinical outcomes of conventional flap-less immediate implant placement(IIP)and the socket-shield technique(SST)in different gingival biotypes of single tooth implantation and adjacent teeth implantations in the maxillary anterior area.Materials and Methods: 30 patients with single tooth and 20 patients with adjacent teeth in maxillary anterior area that needed immediate implant and provisionalization were enrolled.Selected patients were randomly allocated to two equal groups for modified immediate implant with SST and conventional flap-less immediate implant.Then according to the visibility of the periodontal probe,the patients were divided into thin gingival and thick gingival biotype.The patients received provisional crown immediately after surgery and definitive restoration 4 months later.12 months after surgery,the patients were recalled for clinical and esthetic examination.Model analysis including the position of gingival margin and labial contour alternation were analyzed by preoperative and postoperative plaster model data.The esthetic outcomes were evaluated by the pink esthetic scores(PES)assessment and middle gingival papilla height at 4 and 12 months after surgery.Clinical parameters,including the modified sulcus bleeding index(m SBI),postoperative complications and patient satisfaction were also analyzed.Result: 12 months after surgery,all the implant survived.Single tooth implantation:Labial contour alteration was(-0.49±0.18)mm in IIP group and(-0.21±0.18)mm in SST group(P<0.05),for patients with thin gingival biotype,it was(-0.58±0.17)mm in IIP group,and(-0.20±0.19)mm in SST group(P<0.05);The recession of gingival margin reached(-0.76±0.22)mm in IIP group,and(-0.41±0.12)mm in SST group,for patients with thin gingiva,it was(-0.82±0.23)mm in IIP group,and(-0.20±0.19)mm in SST group(P<0.05).The PES score showed a downward trend at 4 and 12 months after surgery.Among the thin gingival biotypes,the PES score of the SST group was higher than that of the IIP group at 4 and 12 months,which was statistically significant.However for patient with thick gingival biotype had no statistical significance in these indexes.Adjacent teeth implantations: Labial contour alteration was(-2.55±0.30)mm in IIP group and(-0.28±0.15)mm in group(P<0.05);The recession of gingival margin reached(-1.85±0.28)mm in IIP group,and(-0.88±0.29)mm in SST group,The height of the middle papilla was consistent with the baseline.It decreased significantly in IIP group at 4 and 12 months after surgery,while the height of the middle gingival papilla in SST group decreased slightly,and the difference was statistically significant.The results of peri-implant exploration showed decreased m SBI values in SST group.The patients in all groups were satisfied with the final esthetic effects.Conclusion: The socket-shield technique can effectively maintain the labial contour protrusion and the position of gingival margin of the implant site,and the height of middle gingival papilla of the adjacent teeth implantations.It is of great significance to impove the quality of gingiva,and to improve the esthetics of anterior dental implant for patients with thin gingival biotype and adjacent teeth implantations.