Socket Morphology-Based Treatment for Implant Esthetics: A Pilot Study

Purpose: This pilot study aimed to determine the tissue (both soft and hard) clinical criteria of extraction sockets that are needed to develop ideal implant esthetics following immediate or delayed implant placement. Materials and Methods: Twenty-five maxillary anterior teeth from 25 patients (15 men and 10 women; age 18 to 51 years, mean age 32.4 ± 9.1 years) were extracted. Soft and hard tissue assessments of the sockets were performed immediately after extraction. Therapeutic approaches were made according to a proposed classification. The esthetic outcomes of the implants were evaluated at the time of prosthesis placement and 1 year after function. Results: A treatment decision tree for immediate and delayed implant placement was proposed based on the soft and hard tissue morphology of the extraction sockets. Five extraction sockets were categorized as adequate, 12 as compromised, and 8 as deficient. Type I sockets achieved "adequate" esthetic results regardless of the treatment modalities used. All type II sockets treated with immediate implantation achieved an "adequate" esthetic result at prosthesis placement, but after 1 year, 50% of these sockets were downgraded to the "compromised" category. Type II sockets treated with immediate-delayed implantation (ie, implant placed at 6 weeks after tooth extraction) showed better results: 87.5% of the cases were rated "adequate" at prosthesis placement and 62.5% were rated "adequate" after 1 year of function. Seventy-five percent of type III sockets treated with delayed implantation after soft and hard tissue surgery scored "adequate" at both evaluation periods. Conclusions: Treatment of extraction sockets based on soft and hard tissue morphology promotes the ability to achieve predictable implant esthetics. Keywords: esthetic outcomes, esthetics, guided bone regeneration, immediate implants, single-tooth replacement