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Case Selection and Treatment Protocol for Immediate Dental Implants in the Esthetic Zone

Case Selection and Treatment Protocol for Immediate Dental Implants in the Esthetic Zone: A Controlled Clinical Trial

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT02154581
Enrollment
41
Registered
2014-06-03
Start date
2013-01-31
Completion date
2018-04-28
Last updated
2019-07-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Acquired Absence of Single Tooth, Jaw, Edentulous, Partially

Keywords

Dental implants, Esthetic score, Immediate implants, Gingival biotype

Brief summary

In this study a tooth that needs to be extracted will be replaced by an implant (artificial root) placed at the same appointment as the extraction. The investigators want to observe how the gums change shape with healing in two different scenarios: 1. If the soft tissue around your tooth is thin, following extraction and implant placement an extra soft tissue graft (taken from your palate) in the area in order to increase the thickness of your gums after healing. 2. If the soft tissue around your tooth is thick, the implant will be placed without a soft tissue graft. Previous studies have shown that both methods work and can give good results. In fact the two methods are used routinely but they have never been compared objectively to one another in the same research study. The main purpose of this study is to evaluate if there is any difference in terms of esthetic outcomes between these two treatment modalities after a crown has been placed on the implant.

Interventions

DEVICESLActive implant

Sponsors

ITI International Team for Implantology, Switzerland
CollaboratorOTHER
The University of Texas Health Science Center at San Antonio
Lead SponsorOTHER

Study design

Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes

Inclusion criteria

1. The patient is 18 years or older. 2. Ability to understand and provide informed consent before starting the study. 3. Ability and willingness to comply with all study requirements. 4. The patient, if of child-bearing potential, has a negative urine pregnancy test. 5. Adequate oral hygiene to allow for implant therapy consistent with standards of care. 6. Adequate bone volume to accommodate the planned endosseous dental implant placement according to immediate placement protocols utilizing Straumann Bone Level implants RC (Regular Crossfit) 4.1mm or Bone Level Implant NC (Narrow Crossfit) 3.3 mm at 8, 10,12 or 14mm in length. 7. One tooth in the anterior maxilla (first pre-molar to first pre-molar) requiring extraction resulting in a single- tooth gap planned to be restored with a dental implant as determined by the patient's dental provider. 8. The site to be treated is surrounded by two natural teeth. 9. Except the site to be treated, none of the maxillary incisors, canines and first pre-molars display marginal soft tissue recession. 10. Following extraction, intact extraction socket bony walls are present. 11. Primary stability of implant consistent with standards of care is achieved at the time of implant placement. 12. Patient must be able to pay for fees related to the surgical implant placement related to extraction, grafting of the implant site, and half of the cost of the crown at the time of implant placement.

Exclusion criteria

1. Patient reports tobacco use within the last five years. Tobacco use for this study is defined as a current smoking habit with moderate or heavy smoking (more than 10 cigarettes per day) or tobacco chewing use. 2. History of alcoholism or drug abuse within the past 5 years. 3. Severe wear with an etiology of bruxism or clenching habits. 4. Patient has significant untreated periodontal disease (grade III or IV), caries, or clinical or radiographic signs of infection within two adjacent tooth positions of implant area. 5. History of HIV infection, Hepatitis B or C. 6. Patients with a history of systemic disease that precludes standard dental implant therapy or alters daily activities to a level consistent with ASA (American Society of Anesthesiologists) III classification (including cardiovascular, hepatic, renal, gastrointestinal, metabolic, neurologic, pulmonary, endocrine, autoimmune, or psychiatric disorders). 7. Presence of local inflammation or mucosal diseases such as lichen planus. 8. Patient history consistent with high risk for subacute bacterial endocarditis. 9. Current hematological disorder or warfarin (or similar) therapy. 10. Patient has a disease that affects bone metabolism, such as, but not limited to, osteoporosis, hyperthyroidism, hyperparathyroidism, congenital connective tissue disorders (e.g., osteogenesis imperfecta), or Paget's disease. 11. Patient is taking medications or having treatments known to have an effect on bone turnover, including: thiazide diuretics, calcitonin, systemic steroids, bisphosphonates, vitamin D (\>800 IU/day), estrogen or progesterone therapy. 12. Current steroid treatment: defined as any person who within the last two years has received for two weeks a dose equivalent to 20 mg hydrocortisone. 13. Patient currently undergoing chemotherapy. 14. Patient history of radiation treatment to the head or neck. 15. Physical or mental handicaps that would interfere with patient's ability to exercise good oral hygiene on a regular basis. 16. Use of any investigational drug or device within the 30 day period immediately prior to implant surgery. 17. Patient is pregnant. 18. Extraction sites having anatomic conditions that preclude immediate implant placement.

Design outcomes

Primary

MeasureTime frameDescription
Mid Facial Mucosal Level at Implant SiteChange from Baseline to 3 monthsBaseline will be at the time of crown delivery. Thereafter, the mid facial mucosal level at implant site will be recorded at 3, 6, 12 months after crown delivery.

Secondary

MeasureTime frameDescription
Modified Bleeding IndexUp to 1 year after baselineBaseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Bleeding from the gums is measured on probing the gum and measured on scale of 0 to 5, with 0 being the best outcome, with no bleeding, and 5 being the worst outcome, with spontaneous bleeding. The scores are totaled and a mean score reported.
PES/WES (Pink Esthetic Score, White Esthetic Score).Approximately 1 year after baselineBaseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 12 months after crown delivery. The PES (Pink Esthetic Score) and WES (White Esthetic Score) scales are 10 point scales, made up of 5 categories, each with a 2 point value. Each category is scored out of 2, and the scores totaled to give an optimal score out of 10, and then the two scores (PES and WES) added to give a total score out of 20, with 20 being the highest possible score (best outcome) and 0 being the worst outcome.
Probing DepthUp to 1 year after baselineBaseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline, 3 and 12 months after crown delivery. The measurement of the pocket around the implanted tooth, measured with a graduated probe. A healthy pocket depth is around 3 mm with no bleeding during the measurement process. The values are totaled and a mean score of all the readings is reported.
Modified Plaque IndexUp to 1 year after baselineBaseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Measurement of amount of plaque build-up on teeth, using a scale of 0 (no plaque detection), to 3 (an abundance of soft matter). The scores are totaled and a mean score reported.
Radiographic Bone LevelUp to 1 year after baselineBaseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline 3, and 12 months after crown delivery. Radiographic bone measurements recorded following final restoration placement (baseline), after 3 and 12 months of loading, and change between these time points. A positive value indicates bone loss and a negative value indicates bone gain. BIC (Bone implant contact)= Distance from implant shoulder to first bone to implant contact.

Countries

United States

Participant flow

Recruitment details

The recruitment started in January 2013 and ended in November 2016. All patient were recruited at the University of Texas Health San Antonio, Department of Periodontics.

Pre-assignment details

No patient was excluded prior to group assignment.

Participants by arm

ArmCount
Type 1 Implant and Thick Biotype
In this group, immediate implant placement (SLActive implant) is performed including bone grafting of the void between the implant and the fresh extraction socket. SLActive implant
14
Type 1 Implant and Thin Biotype
In this group, immediate implant placement (SLActive implant) is performed in patients with thin tissue biotype. In addition to implant placement bone grafting of the void between the implant and the fresh extraction socket, bone grafting the buccal aspect of the buccal plate (overcontouring) and soft tissue grafting (connective tissue) are performed. SLActive implant
12
Total26

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyLost to Follow-up78

Baseline characteristics

CharacteristicType 1 Implant and Thin BiotypeTotalType 1 Implant and Thick Biotype
Age, Customized
Participants over 18 years of age
12 Participants26 Participants14 Participants
Race and Ethnicity Not Collected0 Participants
Region of Enrollment
United States
12 participants26 participants14 participants
Sex: Female, Male
Female
10 Participants18 Participants8 Participants
Sex: Female, Male
Male
2 Participants8 Participants6 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
0 / 140 / 12
other
Total, other adverse events
0 / 140 / 12
serious
Total, serious adverse events
0 / 140 / 12

Outcome results

Primary

Mid Facial Mucosal Level at Implant Site

Baseline will be at the time of crown delivery. Thereafter, the mid facial mucosal level at implant site will be recorded at 3, 6, 12 months after crown delivery.

Time frame: Change from Baseline to 3 months

ArmMeasureValue (MEAN)Dispersion
Type 1 Implant and Thick BiotypeMid Facial Mucosal Level at Implant Site0.36 mmStandard Deviation 1.29
Type 1 Implant and Thin BiotypeMid Facial Mucosal Level at Implant Site0.49 mmStandard Deviation 1.27
Secondary

Modified Bleeding Index

Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Bleeding from the gums is measured on probing the gum and measured on scale of 0 to 5, with 0 being the best outcome, with no bleeding, and 5 being the worst outcome, with spontaneous bleeding. The scores are totaled and a mean score reported.

Time frame: Up to 1 year after baseline

ArmMeasureGroupValue (MEAN)Dispersion
Type 1 Implant and Thick BiotypeModified Bleeding Index3 months (Mesial)0.29 units on a scaleStandard Deviation 0.47
Type 1 Implant and Thick BiotypeModified Bleeding IndexBaseline at Crown Delivery (Buccal Measurement)0.21 units on a scaleStandard Deviation 0.58
Type 1 Implant and Thick BiotypeModified Bleeding IndexBaseline at Crown Delivery (Distal Measurement)0.43 units on a scaleStandard Deviation 0.51
Type 1 Implant and Thick BiotypeModified Bleeding Index3 months (Buccal)0.36 units on a scaleStandard Deviation 0.5
Type 1 Implant and Thick BiotypeModified Bleeding IndexBaseline crown delivery (Mesial measurement)0.43 units on a scaleStandard Deviation 0.65
Type 1 Implant and Thick BiotypeModified Bleeding Index12 months (Buccal)0.64 units on a scaleStandard Deviation 0.9
Type 1 Implant and Thick BiotypeModified Bleeding Index3 months (distal)0.14 units on a scaleStandard Deviation 0.36
Type 1 Implant and Thick BiotypeModified Bleeding Index12 months (Mesial)0.29 units on a scaleStandard Deviation 0.47
Type 1 Implant and Thick BiotypeModified Bleeding Index3 months (proximal)0.36 units on a scaleStandard Deviation 0.5
Type 1 Implant and Thick BiotypeModified Bleeding Index12 months (distal)0.29 units on a scaleStandard Deviation 0.47
Type 1 Implant and Thick BiotypeModified Bleeding Index12 months (proximal)0.29 units on a scaleStandard Deviation 0.47
Type 1 Implant and Thick BiotypeModified Bleeding IndexBaseline at Crown Delivery (Proximal measurement)0.14 units on a scaleStandard Deviation 0.36
Type 1 Implant and Thin BiotypeModified Bleeding Index12 months (proximal)0.00 units on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Bleeding IndexBaseline crown delivery (Mesial measurement)0.00 units on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Bleeding Index3 months (Mesial)0.08 units on a scaleStandard Deviation 0.29
Type 1 Implant and Thin BiotypeModified Bleeding Index12 months (Mesial)0.08 units on a scaleStandard Deviation 0.29
Type 1 Implant and Thin BiotypeModified Bleeding IndexBaseline at Crown Delivery (Distal Measurement)0.17 units on a scaleStandard Deviation 0.39
Type 1 Implant and Thin BiotypeModified Bleeding Index3 months (distal)0.08 units on a scaleStandard Deviation 0.29
Type 1 Implant and Thin BiotypeModified Bleeding Index12 months (distal)0.17 units on a scaleStandard Deviation 0.39
Type 1 Implant and Thin BiotypeModified Bleeding IndexBaseline at Crown Delivery (Buccal Measurement)0.17 units on a scaleStandard Deviation 0.39
Type 1 Implant and Thin BiotypeModified Bleeding Index3 months (Buccal)0.25 units on a scaleStandard Deviation 0.62
Type 1 Implant and Thin BiotypeModified Bleeding Index12 months (Buccal)0.00 units on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Bleeding IndexBaseline at Crown Delivery (Proximal measurement)0.00 units on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Bleeding Index3 months (proximal)0.00 units on a scaleStandard Deviation 0
Secondary

Modified Plaque Index

Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 3, 6, 12 months after crown delivery. Measurement of amount of plaque build-up on teeth, using a scale of 0 (no plaque detection), to 3 (an abundance of soft matter). The scores are totaled and a mean score reported.

Time frame: Up to 1 year after baseline

ArmMeasureGroupValue (MEAN)Dispersion
Type 1 Implant and Thick BiotypeModified Plaque Index12 months (Buccal)0.29 score on a scaleStandard Deviation 0.47
Type 1 Implant and Thick BiotypeModified Plaque Index12 months (proximal)0.21 score on a scaleStandard Deviation 0.58
Type 1 Implant and Thick BiotypeModified Plaque IndexBaseline crown delivery (Mesial measurement)0.29 score on a scaleStandard Deviation 0.61
Type 1 Implant and Thick BiotypeModified Plaque Index3 months (Mesial)0.36 score on a scaleStandard Deviation 0.63
Type 1 Implant and Thick BiotypeModified Plaque Index12 months (Mesial)0.50 score on a scaleStandard Deviation 0.76
Type 1 Implant and Thick BiotypeModified Plaque IndexBaseline at Crown Delivery (Distal Measurement)0.36 score on a scaleStandard Deviation 0.5
Type 1 Implant and Thick BiotypeModified Plaque Index3 months (distal)0.29 score on a scaleStandard Deviation 0.61
Type 1 Implant and Thick BiotypeModified Plaque Index12 months (distal)0.29 score on a scaleStandard Deviation 0.61
Type 1 Implant and Thick BiotypeModified Plaque IndexBaseline at Crown Delivery (Buccal Measurement)0.14 score on a scaleStandard Deviation 0.36
Type 1 Implant and Thick BiotypeModified Plaque Index3 months (Buccal)0.14 score on a scaleStandard Deviation 0.53
Type 1 Implant and Thick BiotypeModified Plaque IndexBaseline at Crown Delivery (Proximal measurement)0.36 score on a scaleStandard Deviation 0.5
Type 1 Implant and Thick BiotypeModified Plaque Index3 months (proximal)0.07 score on a scaleStandard Deviation 0.27
Type 1 Implant and Thin BiotypeModified Plaque IndexBaseline at Crown Delivery (Distal Measurement)0.17 score on a scaleStandard Deviation 0.58
Type 1 Implant and Thin BiotypeModified Plaque Index12 months (Buccal)0.00 score on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Plaque Index3 months (proximal)0.00 score on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Plaque IndexBaseline at Crown Delivery (Buccal Measurement)0.08 score on a scaleStandard Deviation 0.29
Type 1 Implant and Thin BiotypeModified Plaque Index12 months (proximal)0.00 score on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Plaque Index3 months (distal)0.17 score on a scaleStandard Deviation 0.39
Type 1 Implant and Thin BiotypeModified Plaque IndexBaseline crown delivery (Mesial measurement)0.42 score on a scaleStandard Deviation 1
Type 1 Implant and Thin BiotypeModified Plaque IndexBaseline at Crown Delivery (Proximal measurement)0.00 score on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Plaque Index3 months (Mesial)0.08 score on a scaleStandard Deviation 0.29
Type 1 Implant and Thin BiotypeModified Plaque Index12 months (distal)0.08 score on a scaleStandard Deviation 0.29
Type 1 Implant and Thin BiotypeModified Plaque Index12 months (Mesial)0.00 score on a scaleStandard Deviation 0
Type 1 Implant and Thin BiotypeModified Plaque Index3 months (Buccal)0.00 score on a scaleStandard Deviation 0
Secondary

PES/WES (Pink Esthetic Score, White Esthetic Score).

Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at 12 months after crown delivery. The PES (Pink Esthetic Score) and WES (White Esthetic Score) scales are 10 point scales, made up of 5 categories, each with a 2 point value. Each category is scored out of 2, and the scores totaled to give an optimal score out of 10, and then the two scores (PES and WES) added to give a total score out of 20, with 20 being the highest possible score (best outcome) and 0 being the worst outcome.

Time frame: Approximately 1 year after baseline

ArmMeasureValue (MEAN)Dispersion
Type 1 Implant and Thick BiotypePES/WES (Pink Esthetic Score, White Esthetic Score).12.07 score on a scaleStandard Deviation 2.87
Type 1 Implant and Thin BiotypePES/WES (Pink Esthetic Score, White Esthetic Score).11.64 score on a scaleStandard Deviation 3.22
Secondary

Probing Depth

Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline, 3 and 12 months after crown delivery. The measurement of the pocket around the implanted tooth, measured with a graduated probe. A healthy pocket depth is around 3 mm with no bleeding during the measurement process. The values are totaled and a mean score of all the readings is reported.

Time frame: Up to 1 year after baseline

ArmMeasureGroupValue (MEAN)Dispersion
Type 1 Implant and Thick BiotypeProbing Depth3 months (distal)3.43 mmStandard Deviation 1.02
Type 1 Implant and Thick BiotypeProbing Depth12 months (distal)3.36 mmStandard Deviation 1.01
Type 1 Implant and Thick BiotypeProbing DepthBaseline at Crown Delivery (Buccal Measurement)2.93 mmStandard Deviation 1.14
Type 1 Implant and Thick BiotypeProbing DepthBaseline at Crown delivery (Mesial measurement)3.14 mmStandard Deviation 0.77
Type 1 Implant and Thick BiotypeProbing Depth12 months (Buccal)3.21 mmStandard Deviation 1.58
Type 1 Implant and Thick BiotypeProbing Depth3 months (Mesial)3.21 mmStandard Deviation 0.7
Type 1 Implant and Thick BiotypeProbing DepthBaseline at Crown Delivery (Proximal measurement)2.64 mmStandard Deviation 0.5
Type 1 Implant and Thick BiotypeProbing Depth3 months (Buccal)3.07 mmStandard Deviation 1.27
Type 1 Implant and Thick BiotypeProbing Depth3 months (proximal)2.79 mmStandard Deviation 0.8
Type 1 Implant and Thick BiotypeProbing Depth12 months (Mesial)3.29 mmStandard Deviation 0.83
Type 1 Implant and Thick BiotypeProbing Depth12 months (proximal)2.21 mmStandard Deviation 0.7
Type 1 Implant and Thick BiotypeProbing DepthBaseline at Crown Delivery (Distal Measurement)3.43 mmStandard Deviation 0.85
Type 1 Implant and Thin BiotypeProbing Depth12 months (proximal)1.75 mmStandard Deviation 0.97
Type 1 Implant and Thin BiotypeProbing Depth3 months (distal)2.08 mmStandard Deviation 0.51
Type 1 Implant and Thin BiotypeProbing DepthBaseline at Crown delivery (Mesial measurement)2.50 mmStandard Deviation 1.24
Type 1 Implant and Thin BiotypeProbing Depth3 months (Buccal)1.75 mmStandard Deviation 0.75
Type 1 Implant and Thin BiotypeProbing Depth3 months (Mesial)2.92 mmStandard Deviation 1.16
Type 1 Implant and Thin BiotypeProbing DepthBaseline at Crown Delivery (Distal Measurement)2.33 mmStandard Deviation 0.49
Type 1 Implant and Thin BiotypeProbing Depth12 months (distal)2.42 mmStandard Deviation 0.51
Type 1 Implant and Thin BiotypeProbing DepthBaseline at Crown Delivery (Buccal Measurement)1.75 mmStandard Deviation 0.75
Type 1 Implant and Thin BiotypeProbing Depth12 months (Buccal)1.92 mmStandard Deviation 0.79
Type 1 Implant and Thin BiotypeProbing DepthBaseline at Crown Delivery (Proximal measurement)2.00 mmStandard Deviation 0.85
Type 1 Implant and Thin BiotypeProbing Depth3 months (proximal)1.67 mmStandard Deviation 0.78
Type 1 Implant and Thin BiotypeProbing Depth12 months (Mesial)2.42 mmStandard Deviation 1.31
Secondary

Radiographic Bone Level

Baseline will be at the time of crown delivery. Secondary outcome measures will be recorded at baseline 3, and 12 months after crown delivery. Radiographic bone measurements recorded following final restoration placement (baseline), after 3 and 12 months of loading, and change between these time points. A positive value indicates bone loss and a negative value indicates bone gain. BIC (Bone implant contact)= Distance from implant shoulder to first bone to implant contact.

Time frame: Up to 1 year after baseline

ArmMeasureGroupValue (MEAN)Dispersion
Type 1 Implant and Thick BiotypeRadiographic Bone LevelBaseline to 3 months BIC (Distal Measurement)-0.02 mmStandard Deviation 0.13
Type 1 Implant and Thick BiotypeRadiographic Bone Level3 to 12 months BIC (Mesial)0.05 mmStandard Deviation 0.1
Type 1 Implant and Thick BiotypeRadiographic Bone Level3 to 12 months BIC (distal)-0.07 mmStandard Deviation 0.12
Type 1 Implant and Thick BiotypeRadiographic Bone LevelBaseline to 3 months BIC (Mesial measurement)-0.04 mmStandard Deviation 0.08
Type 1 Implant and Thick BiotypeRadiographic Bone LevelBaseline to 12 months BIC (distal)-0.08 mmStandard Deviation 0.15
Type 1 Implant and Thick BiotypeRadiographic Bone LevelBaseline to 12 months BIC (Mesial)0.00 mmStandard Deviation 0.13
Type 1 Implant and Thin BiotypeRadiographic Bone LevelBaseline to 12 months BIC (distal)0.01 mmStandard Deviation 0.12
Type 1 Implant and Thin BiotypeRadiographic Bone LevelBaseline to 3 months BIC (Mesial measurement)0.02 mmStandard Deviation 0.05
Type 1 Implant and Thin BiotypeRadiographic Bone Level3 to 12 months BIC (Mesial)0.04 mmStandard Deviation 0.1
Type 1 Implant and Thin BiotypeRadiographic Bone LevelBaseline to 3 months BIC (Distal Measurement)-0.04 mmStandard Deviation 0.12
Type 1 Implant and Thin BiotypeRadiographic Bone Level3 to 12 months BIC (distal)0.05 mmStandard Deviation 0.08
Type 1 Implant and Thin BiotypeRadiographic Bone LevelBaseline to 12 months BIC (Mesial)0.06 mmStandard Deviation 0.12

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026