Esthetic risk assessment of immediate implant: Position paper and proposal of a novel diagnostic parameter

Objectives: The aim of this paper is to assess the risk factors that could influence the esthetic and long term results of implant placement in fresh extraction sockets. Materials and methods: The immediate implant risk factors that could influence the final outcome are analyzed and could be summarized in: the peri-implant soft tissue biotype, the vestibular bone thickness, the alveolar host infected site, the residual peri-implant gap and the final implant position. Furthermore a diagnostic parameter that could influence the therapeutic approach is proposed. Discussion: Several factors have been proposed as being important in determining the stability of the peri-implant mucosa, including implant shoulder position in the bucco-lingual and apico-coronal direction and tissue biotype. The initial thickness of the buccal crestal bone may be a factor in determining the extent of the vestibular bone resorption. Thick soft and hard peri-implant tissues could contribute to marginal stability. Infected alveolar site is not a contradiction to implant placement and the peri-implant gap should be grafted in order to minimize the horizontal resorption. The implant position and diameter should be carefully analyzed in order to preserve peri-implant soft tissue stability. Conclusions: Marginal tissue recession, occurred at both thin and thick biotype sites. When implants are placed immediately after tooth extraction, the implant-vestibular plate distance is a critical parameter to evaluate, and can be a useful diagnostic parameter that guides the clinician in the choice of the most appropriate grafting procedure. Grafting the marginal defects may limit the horizontal resorption, however "overbuilding" the buccal aspect may be a suitable technique to compensate for the physiological alveolar bone changes.