Analysis Of The Clinical Efficacy Following Immediate And Early Implant Placement In The Anterior Esthetic Area Of Maxillary

Objective: In this experimental study,by setting four groups of different implant timings and different types of implants in the anterior esthetics of the maxillary teeth.Different observation and measurement methods were used to evaluate the advantages and disadvantages of the four groups of implants.The choice of implant timing and technique provides a reliable theoretical basis.Materials and Methods: Collected patients who underwent concurrent implant and restoration of dentition defects in the esthetic area of the maxillary teeth from January 2015 to March 2019 in the Department of Implantology of Dalian Stomatological Hospital,including: 1)20 patients with immediate implant without flaps;2)immediately 24 flap patients;3)24 early patients at 4-8 weeks;4)28 early patients at 12-16 weeks.CBCT and intraoral images were collected before,on the same day and 6 months after implant.The analysis of the following indicators to evaluate the advantages and disadvantages of the four groups of different implant methods: 1)implant operation time;2)during the observation period accepted by the patients,the incidence of complications after implant(mechanical complications + biological complications);3)Calculate the bone resorption rate of the lip side of the implant 6 months after implantation using Mimics software measurement;4)Use the Mimics soft nail to implant the remaining bone thickness of the lip side 6 months after implant;5)Use Guide Mia Master,Geomagic Control X,and Plasty CAD1.7 softwares to model and match the CBCT of patients at different periods,and finally measured the bone graft volume,bone resorption volume,and bone at the labial bone graft area at 6 months after surgery by subtraction.Absorption rate;6)The red esthetic index(PES)and white esthetic index(WES)were evaluated at 6 months after implant and 14.5 months after implant;7)Self-made patient satisfaction questionnaire: after the patient has undergone permanent restoration,the patient is asked to score the entire treatment process to evaluate the patient’s satisfaction.Through the above seven groups of data,the advantages and disadvantages of each group were compared and evaluated.Results:(1)Because the immediate flapless Implant technique trauma is small,flap is not required,the entire operation time is the shortest.The immediate flapless group and the early implantation time of 4-8 weeks and 12-16 weeks have a P value of <0.05,the difference is has statistical significance.(2)The complication rate of the immediate flapless group was 19.23%;the complication rate of the immediate flap group was 13.33%;the complication rate of the early implant group in the 4-8 weeks was 6.06%.The incidence of disease was 3.03%.There was no statistical difference in the incidence of complications between the four groups(P> 0.05).(3)The thickness of bone increase(preoperative and postoperative day),bone absorption(postoperative day and 6 months)and the absorption rate of labial bone were measured.The difference between the two groups was statistically significant(P < 0.05).The thickness of the remaining bone in the six months after implantation was measured.The thickness of the remaining bone in the six months after implantation in the immediate flap group was less than that in the 4-8 weeks and 12-16 weeks early implantation groups(P < 0.05).The thickness of the remaining bone in the immediate flap group was less than that in the 4-8 weeks and 12-16 weeks early implantation groups(P < 0.05)The difference was statistically significant(P < 0.05).(4)Through the three-dimensional reconstruction of CBCT taken by patients in different periods(before operation,on the day of bone grafting,and six months after bone grafting),the volume measurement showed that the incremental volume of labial bone and the absorption volume of labial bone in the group without flap flap immediately were less than those in the early implantation group at 4-8 weeks and 12-16 weeks(P < 0.05),the difference was statistically significant.(5)The patient returned to the clinic 6 months after the completion of implantation.The stability of the implant was obtained by measuring the ISQ value of the implant.There was no significant statistical significance in the ISQ value between the four groups.(6)The highest red esthetic index was 8.90 ± 0.12 in the immediate flapless group at 6 months after implant,which was significantly different from the other three groups.At 14.5 months after implant,there was no significant difference in the red and white aesthetic index among the groups,but the red and white esthetic index increased in the early implant groups.(7)The satisfaction rate of the immediate flapless group was the highest,8 ± 0.73,and the satisfaction rate of the early group was the lowest,which was 6.95 ± 0.71 at 12-16 weeks.The satisfaction rate of the immediate flap group and 4-8 weeks was between the first two groups.There was a statistically significant difference between the immediate flapless group and early implantation at 12-16 weeks(P <0.05).Conclusion:(1)The immediate flapless group has the least time to implant and minimal trauma,but the bone graft is limited.(2)Five postoperative complications were statistically significant between the four groups,but the incidence of complications in the immediate implantation group was higher than that in the early implantation group.(3)Bone augmentation in the immediate implantation group <the early implantation group,the bone resorption rate is lower than the early group,but the remaining bone thickness of the labial bone plate 6 months after the operation: early implant of 4 to 8 weeks> early implant of 12 to 16 weeks >flap of immediate implant> flapless of immediate implant.(4)Bone resorption volume at 6 months after implantation: flap of immediate implant > flapless of immediate implant > early implant of 4 to 8 weeks > early implant of 12 to 16 weeks.(5)The ISQ values between the four groups were not statistically significant.(6)The red esthetic index of immediate flapless group was the highest at 6 months after implant,which was significantly different from the other three groups.At 14.5 months after implant,there was no significant difference in the red and white esthetic index between the groups.(7)The satisfaction rate of the immediate flapless group was the highest,8±0.73,and the satisfaction rate of the early group was the lowest,which was 6.95 ± 0.71 at 12-16 weeks.There was a statistically significant difference in P value between the immediate non-flap group and the early 12-16 weeks.