Influence of Immediate Implant Loading on Peri-implant Soft Tissue Morphology in the Edentulous Maxilla

Purpose: This study investigates the pre- and posttreatment morphology of the mucosa around immediately loaded implants in the edentulous maxilla. Materials and Methods: Implants were placed and immediately loaded in edentulous maxillae; pre- and posttreatment impressions were obtained. The resulting casts were digitalized into 3-dimensional images, and the pre- and posttreatment images were superimposed. The width and height of the maxillary alveolar process were measured at central and interproximal implant sites in a vertical section of the superimposed holograms. For statistical analysis, the Delta value (d) was defined as the difference between the pre- and posttreatment images for all measurements. Results: Sixty-seven Straumann implants placed in 9 patients and immediately restored with provisional fixed restorations were analyzed. An increase in width at all measurement sites was observed after treatment. Width increased for both central implant (1.51 ± 1.16 mm, P .001) and interproximal implant sections (1.02 ± 1.21 mm, P .001). Mean d for height was found to be decreased at central implant sites (-1.21 ± 1.67 mm, P = .012) and at interproximal sections (-0.72 ± 1.68 mm, P = .098). Discussion and Conclusion: Clinically, it has been observed that the placement of an immediate provisional affects the peri-implant tissue morphology according to its emergence profile. The result after treatment was a wider contour of the peri-implant soft tissue, located in a more apical position than the original mucosal level. The most coronal part of the papillalike mucosa at interproximal sites would be nearest to the original mucosal level before treatment. The scalloped mucosal configuration obtained was consistent along the rehabilitated arch. Statistically significant dimensional changes of the peri-implant mucosa were observed with an immediate loading approach. (Clinical Trial) Keywords: dental implants, edentulous maxilla, immediate loading, papilla-like mucosa, peri-implant soft tissue, scalloped mucosa, screw-retained provisional prostheses