Refinement of the immediate dental implantation method in the maxillary aesthetic zone in cases of alveolar bone atrophy: A stratified clinical study

Background. Advanced dental implantology requires not only a high level of surgical skill, but also comprehension on the patterns of tissue regeneration following immediate implantation. Particular emphasis should be placed on preserving the vestibular wall of the alveolus, as it affects the morphometric parameters of the mucous membrane, the width of the alveolar ridge, and the depth of the oral vestibule. This study aims to evaluate the clinical dynamics of these parameters in patients with different initial conditions.

Objective. To conduct a comparative analysis of changes in the parameters of the mucous membrane, alveolar ridge, and vestibular wall after immediate implantation in patients with different vestibular wall conditions.

Methods. A stratified clinical study included 80 patients who applied between January 2020 and January 2024 to the National Medical Research Center “Central Research Institute of Dentistry and Maxillofacial Surgery” with various clinical diagnoses for dental implantation in the maxillary anterior region. The patients were divided into three groups of 20 people each based on the degree of damage to the vestibular wall and the tactics used for dental implantation: Group I — sockets with an intact vestibular wall, conventional immediate dental implantation without bone grafting, using a connective tissue autograft; Group II — sockets with damage to the vestibular wall up to 1/3 of the length, dental implantation with bone grafting and the use of connective tissue autograft; Group III — sockets with damage to more than 1/3 of the length, dental implantation with bone grafting and regenerative materials was also performed. The control group (Group IV) included 20 patients who had teeth extracted 5–6 months prior to dental implantation. Assessments were made of the thickness of the mucous membrane, the width of the alveolar ridge, the distances from the neck and body of the implant to the vestibular wall, and the depth of the oral cavity vestibule before surgery, immediately after surgery, and at 1, 4, 6, and 12 months. Statistical data processing included calculating average values and assessing the reliability of differences. Differences were considered statistically significant at p ≤ 0.05.

Results. Patients in Group I had the optimal initial clinical conditions, with a mucosal thickness of 1.53 ± 0.11 mm and an alveolar ridge width of 9.80 ± 0.13 mm. However, after 12 months, a decrease in alveolar ridge width by 11.0% (p < 0.001) was observed. Group II (defect < 1/3) showed the highest increase in mucosal thickness (+65.2%) (p < 0.001) and improvement in the alveolar ridge width parameter (+8.9%) after 12 months (p < 0.001). Similarly, Group III (defect > 1/3) showed positive dynamics in mucosal thickness, with an increase of +58.9%, and alveolar ridge width, with an increase of +12.2% (for each indicator, p < 0.001). Meanwhile, the control Group IV exhibited a decrease in all indicators: mucosal thickness decreased from 1.41 to 1.10 mm, alveolar ridge width decreased from 6.16 to 4.34 mm, and oral cavity depth decreased from 6.4 to 4.8 mm. All differences were statistically significant (p < 0.001).

Conclusion. While the most favorable initial clinical parameters were observed in Group I, the most pronounced positive changes were achieved in Group II patients using bone regeneration techniques. These data confirm the high effectiveness of immediate implantation combined with plastic surgery for defects of the vestibular wall less than 1/3. Furthermore, the considerable impact of the initial clinical condition of patients on postoperative outcomes has been demonstrated, which emphasizes the relevance of a comprehensive assessment of tissue condition on the stage of treatment planning.

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