Peri-implant soft and hard tissue condition after alveolar ridge preservation with beta-tricalcium phosphate/type I collagen in the maxillary esthetic zone: A 1-year follow-up study

Abstract

Background/Aim. Alveolar ridge dimensional alterations following tooth extraction in the anterior maxilla often result in an inadequate bone volume for a correct implant placement. In order to obtain optimal bone volume various bone graft substitutes have become commercially available and widely used for socket grafting. The aim of this study was to examine and compare long-term clinical outcomes of dental implant therapy in the maxillary esthetic zone, after socket grafting with beta-tricalcium phosphate (TCP) combined with collagen type I, either with or without barrier membrane and flap surgery, after a 12-month follow-up. Methods. Twenty healthy patients were allocated to either C group (beta-TCP and type I collagen without mucoperiosteal flap coverage) or C+M group (beta-TCP and type I collagen barrier membrane with mucoperiosteal flap coverage). Following clinical parameters were assessed: implant stability (evaluated by a resonance frequency analysis - RFA), periimplant soft tissue stability (sulcus bleeding index - SBI, Mombelli sulcus bleeding index - MBI, periimplant sulcus depth, keratinized gingiva width, gingival level) and marginal bone level at the retroalveolar radiograms. Results. Within C+M group, RFA values significantly increased 12 weeks after implant installation compared to primary RFA values. Comparison between investigated groups showed a significantly reduced keratinized gingiva width in the C+M group compared to the C group after 3, 6, 9 and 12 months. Comparison between groups revealed significantly lower gingival level values in the C+M group at 9th and 12th month when compared to the C group. Conclusion. Implant treatment in the anterior maxilla could be effective when using a 9 months alveolar ridge preservation healing with combined treatment with beta-tricalcium phosphate and type I collagen, with regard to the peri-implant soft and hard tissue stability.

Uvod/Cilj. Posle ekstrakcije zuba, dimenzionalne promene alveolarnog grebena u estetskoj regiji gornje vilice za posledicu često imaju nedovoljnu količinu kosti za ugradnju zubnih implanata. U vezi sa tim, primenjuju se različiti koštani zamenici sa ciljem očuvanja dimenzija alveolarnog grebena posle ekstrakcije zuba. Cilj rada bio je da se, posle prezervacije alveolarnog grebena beta-trikalcijum fosfatom (TCP) sa kolagenom tip 1, sa barijernom membranom i mukoperiostalnim režnjem i bez nje, ispitaju i uporede klinički ishodi zarastanja posle ugradnje zubnih implanata u estetskoj regiji gornje vilice, tokom jednogodišnjeg perioda praćenja. Metode. Dvadeset zdravih bolesnika podeljeno je u dve grupe: C (beta TCP/kolagen tip 1 bez barijerne membrane i mukoperiostalnog režnja) i C+M (beta TCP/kolagen tip 1 sa barijernom membranom i mukoperiostalnim režnjem). Praćeni su uobičajeni klinički parametri ishoda terapije: implantna stabilnost (analiza rezonantne frekvence), stanje mekih tkiva (indeks krvarenja, plak indeks, širina pripojne mukoze, recesija gingive) i nivo periimplantnog koštanog tkiva na retroalveolarnom radiogramu. Rezultati. U C+M grupi, implantna stabilnost posle 12 nedelja bila je značajno veća u odnosu na primarnu stabilnost. U C+M grupi, širina keratinizovane gingive bila je značajno manja posle 3, 6, 9 i 12 meseci u odnosu na C grupu. Recesija gingive bila je značajno veća u C+M grupi u odnosu na C grupu posle 9 i 12 meseci. Zaključak. Razmatrajući stabilnost mekog i tvrdog periimplantnog tkiva, terapija zubnim implantima može biti uspešna prilikom ugradnje u estetskoj regiji gornje vilice.