This article is another landmark study where much of what we know about how to position anterior esthetic immediate implants. With the information here, you should be able to set yourself up for successful esthetic outcomes.
Bone dimensional variations at implants placed in fresh extraction sockets: a multilevel multivariate analysis
Cristiano Tomasi et. al
What factors affect the tissue alterations occurring at the buccal and palatal aspects of the bony crest during healing after the immediate placement of an implant into an extraction socket?
Briefly, Anterior immediate maxillary implants were placed and a healing abutment applied according to a 1 stage protocol, anatomic measurements were made at this time. 4 months later a flap was reflected to measure the landmarks again for comparison.
What they found:
1. Worse gap-fill in smokers:
Residual horizontal gap was on average .25mm greater in smokers
2. Worse gap-fill in older patients:
Residual horizontal gap was on average .03mm larger for every year older
3. For every 1mm facial the implant was placed in the socket, you lose .25m of vertical
Equates to exposed threads
4. There were dehiscences (thread show) of implants 4 months later that were initially placed at the crest up to 2 mm deep.
At 2mm deep, the implants did not have thread show 4 months later.
Key takeaway points to achieve an esthetic result:
- Results are inherently worse in smokers and older patients
- Place implants as palatally as possible (while obviously still maintaining restorability)
- Place implants 2mm apical to the crest of bone
“In essence, the positions of the implant placed immediately into the extraction socket appears to the the outmost importance for treatment outcomes.”
