Description of a ‘soft tissue friendly’ protocol for immediate loading in the esthetic zone: 1 year result of 13 consecutive patients

Objectives: Repeted abutment connection and disconnections compromize the connective and epithelial sealing around implant components, leading to peri-implant bone remodeling (Abrahamsson, 1997). Placing the definitive abutment at the time of implant placement might be a treatment option to minimize this biological rupture. The aim of this study was to evaluate the effectiveness of pre-shaped zirconium abutments for immediate implant loading in the anterior maxilla.
Materials and methods: A total of 13 patients needing the placement of one or several implant in the esthetic zone were treated with Regular Crossfit Bone Level (Straumann) implants. Implants were placed and immediately restored with a pre-shaped zirconium abutments and provisional resin crowns if the primary stability reached at least 20 N/cm2. Implant survival rate, biological and prosthodontic complications as well as peri-implant tissue status (papilla index) were recorded during a follow-up period of 1 year.
Results: A total of 14 implants (8 incisors, 1 canines, 5 premolars) placed in 11 patients (4 men / 7 women) aged from 22 to 60 years old (48,5 +/- 11,5) could be assessed for the entire follow-up period. 2 patients dropped out. All implants reached an adequate primary stability (> 20N/cm2) to perform an immediate implant restoration. Straight pre-shaped Zirconium abutment was used in each case. Six implants were placed in socket preservation sites and five implants were placed simultaneously with a GBR. After a follow-up period of 1 year, all implants fulfilled survival criteria for dental implants with regard to osteointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. One abutment screw loosening was observed during the provisional period and no abutment fracture occurred. Definitive full ceramic-cemented restorations were successfully performed on each implant after a mean period of 6 months and no further complications occurred. In 11 out of 14 implants, an improvement of the papilla index was observed from baseline to 1 year follow-up whereas 3 implants showed a decrease of this index.
Conclusion: The results from this prospective case series suggest that immediately restored implants using a final pre-shaped zirconium abutment in esthetic zone display favorable implant and prosthodontic outcomes and seems to allow an adequate papilla index improvement in most of the cases.