Aesthetics in Oral Implantology: Biological,
Clinical, Surgical, and Prosthetic Aspects
Gilberto Sammartino, MD, DDS,* Gaetano Marenzi, DMD, PhD,† Alessandro Espedito di Lauro, DMD, PhD,‡
and Guerino Paolantoni, DMD§
hen Brånemark introduced
W the osseointegration concept,
he established some requi-
sites for correct dental implantology1
without considering the aesthetic as-
pects. Today, in clinical practice,
many patients consider the aesthetic
final result to be the most important
aspect of an oral rehabilitation. To en-
sure aesthetics in implant treatment
means the rigorous respect of many bi-
ological and biomechanical concepts.
Many factors were identified by several
authors to influence a satisfactory aes-
thetic final result in oral implantology.2–5
Some of these are individual: gingival
morphology and plane orientation,
periodontal biotype, upper and lower
lip position in relaxed smile, occlu-
sion, and adequate interdental and in-
terocclusal space. Others are surgical:
soft tissue and/or bone regeneration,
no incision or flaps elevation tech-
nique, and correct implant position
and placement. Others are strictly
prosthetic: morphology and propor-
tion of the crown, the use of
prosthetic-guided soft tissue, and pros-
thetic components. An accurate clini-
cal evaluation of the patient can lead
the surgeon to identify the surgical
options able to ensure a better preser-
vation or recreation of natural alveolar
ridge anatomy. After tooth extraction,
the alveolar bone resorption may not
*Associate Professor, University of Naples “Federico II,”
Faculty of Medicine, Department of Odontostomatologic and
Maxillo-Facial Science, Naples, Italy.
†Oral Surgeon, University of Naples “Federico II,” Faculty of
Medicine, Department of Odontostomatologic and Maxillo-
Facial Science, Naples, Italy.
‡Assistant Professor, University of Naples “Federico II,” Faculty
of Medicine, Department of Odontostomatologic and Maxillo-
Facial Science, Naples, Italy.
§Private practice, Naples, Italy.
ISSN 1056-6163/07/01601-054
Implant Dentistry
Volume 16 • Number 1
Copyright © 2007 by Lippincott Williams & Wilkins
DOI: 10.1097/ID.0b013e3180327821
54 AESTHETICS IN ORAL IMPLANTOLOGY
Objectives: The aim of this study
was to identify a correct clinical, sur-
gical, and prosthetic management of
endosseous implants replacing miss-
ing teeth in the anterior maxilla,
achieving predictable aesthetic out-
comes. Placement of immediate post-
extraction implants without incisions
or flap elevation is one of the surgical
treatment options able to improve the
healing and regenerative potentials of
the fresh socket.
Materials: Fifty-five patients (33
men, 22 women), ranging in age from
19 to 57 years (mean 29), were se-
lected for this study. All the patients
were not smokers, no bruxers, pre-
sented stable soft tissue conditions, an
acceptable occlusion, and the absence
of pathologies that would contraindi-
cate bone healing. Patients were
treated with implants made by 2 man-
ufacturers: Institute Straumann,
Walderburg, Switzerland and Fria-
dent, Mannheim, Germany. A total of
87 implants were placed immediately
after each failing tooth had been re-
moved. The temporary restoration
was placed 3 months after implant
only leave an aesthetic problem for the
fabrication of conventional or implant-
supported prostheses but can also
make a correct placement of an endos-
seous implant difficult or even impos-
sible.6 Resorption of the buccal wall of
the extraction socket may lead to sig-
nificant disadvantages, especially in
the anterior part of the maxilla.7–9 A
buccal concavity in the alveolar pro-
cess or an implant placed more lin-
gually than the neighboring teeth can
place-ment, and the final restoration
was placed 4 months from the surgical
procedure. The patients were evalu-
ated clinically and radiographically at
implant placement, and 2, 4, 18, and
24 months post-insertion.
Results: At 24 months, only 3 im-
plants were lost (2 in male patients;1 in
female patient). All of these failed im-
plants did not achieve osseointegration.
The overall success rate was 96.6%,
with an implant failure rate of 3.4%, all
prior to restoration.
Conclusions: The immediate
placement in the anterior maxilla
fresh extraction sockets without inci-
sions or flaps elevation is a surgical
option that can ensure ideal peri-
implant tissues healing, preserving the
presurgical gingival and bone aspects.
For a predicable aesthetic result, the
most important aspect seems to be the
height and thickness of the buccal
bone wall, which remain after imme-
diate placement of the fixture. (Im-
plant Dent 2007;16:54 – 65)
Key Words: gingival aesthetics, tooth
extraction, immediate implant place-
ment, temporary restoration
result in poor aesthetics.10 The exam-
ination of the clinical parameters
should influence the presurgical im-
plant plan, including a predictable
bone and soft tissues healing. Place-
ment of an implant immediately after
tooth extraction may help to maintain
the bone crest and lead to an ideal
implant position from a prosthetic
point of view.11,12 This technique has
proven to be a successfully predictable
treatment modality11–23 according to
the criteria proposed by Roos et al.24
The advantages include reduction in
morbidity and treatment time, preser-
vation of residual ridge width and
height, and an optimal aesthetic result.
Immediate 1-stage post-extraction im-
plants have better opportunities for os-
seointegration because of the healing
potential of the fresh extraction site.25
Recent preliminary studies have re-
ported high success rates following the
provisional restoration of a single en-
dosseous implant placed immediately
following tooth extraction in the max-
illary anterior area. The temporary
restoration was identified as a valid
technique for preserving the gingival
architecture and existing osseous.15
The aim of the present study was to
evaluate the clinical and aesthetic re-
sults given by a surgical approach
characterized by no incision or flap
elevation. The cases were evaluated
24 months after the definitive pros-
thetic treatment.
MATERIALS AND METHODS
Patients
The study population consisted of
55 patients (33 men, 22 women), rang-
ing in age from 19 to 57 years. All
patients were given oral and written
information regarding the study, and
their written informed consents were
obtained. All patients required tooth
extraction and replacement with an
immediately placed implant. The pa-
tients were selected according to spe-
cific inclusion and exclusion criteria.
Inclusion criteria were as follows:
1. Age 18 years or older.
2. Indication for tooth (maxillary inci-
sor, canine, or premolar) extraction
due to prosthetic reasons (root frac-
tures, nonrestorable carious lesions,
residual roots, trauma), periodontal
compromise, or endodontic failures.
3. The absence of pathologies that
would contraindicate bone healing.
4. The presence of stable soft tissue
conditions.
5. No presence of dehiscences or fen-
estrations in the extraction sites, or
the loss of labial bony plate follow-
ing tooth removal and/or implant
osteotomy as ascertained by bone
sounding technique.15
6. Adequate apical bone volume to
achieve primary implant stability
Table 1. Dimensions of the Friadent Immediate Post-extraction Implants Placed
Dimensions of Frialit Implants
Placed Diameter
3.4 mm
3.8 mm
4.5 mm
5.5 mm
following immediate implant
placement (at least 4 mm beyond
the root apex).
7. No smokers.
8. A correct and stable occlusion.
9. No parafunctional habits (e.g.,
bruxism).
Exclusion criteria were as follows:
1. No consent for inclusion into the
study.
2. Poor oral hygiene with no possi-
bility of improvement.
3. Poor interest and cooperation.
4. Chronic or acute systemic pathol-
ogies that might affect the surgical
procedure (uncontrolled diabetes,
hemorrhagic diatheses, immunode-
ficiency, cardiac ischemia, hy-
pertension) or the subsequent
prosthodontic treatment and re-
quired follow-ups.
5. Presence of active infection
around the failing tooth.
6. Existence of nontreated general-
ized progressive periodontitis.
7. Pathologic changes at the receptor
site (cysts, tumors, osteomyelitis).
8. Medical history of alcohol or drug
dependency.
9. Psychological problems.
10. Irradiation in the implant area.
11. Patient still growing.
12. Pregnant or nursing woman.
13. Peri-implant horizontal bone de-
fects exceeding 4 mm.
Treatment Techniques
A total of 87 implants (53 Institute
Straumann implants and 34 Friadent
implants) (Tables 1 and 2) were placed
immediately after tooth extraction in
55 patients according to the standard
surgical procedure by the same expert
surgeons between the time of the first
immediate implant placement on Feb-
ruary 2001 and the last definitive pros-
thetic treatment on June 2004. In the
IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007
Dimensions of Implant Placed
Length (mm)
10 13 15
0 2 0
0 7 2
1 14 3
0 3 2
immediate implantation, to preserve
the papillae of the adjacent teeth and
prevent recession of gingival margins,
no flaps or incisions were designed to
achieve primary closure. The primary
stability of the fixtures was confirmed
prior to completion of the surgery. The
temporary restoration was placed 2
months later. The definitive restora-
tion was placed 4 months after the
surgical time.
Amoxicillin (1 g) was adminis-
trated 1 hour prior to surgery. For the
penicillin-allergic patients (8.7%), 0.5 g
Erythrocin (Abbott Laboratories, Abbott
Park, IL) was the drug of choice. Chlo-
rhexidine rinses were used prior the sur-
gery, and the patients were instructed to
rinse twice daily for 2 minutes with a
0.1% chlorhexidine solution during the
first 4 weeks following surgery. An an-
tibiotic prophylaxis (amoxicillin 1 g, 2
tablets/day) and antiinflammatory agent
(naprossene 550 mg, 2 tablets/day) was
prescribed for 10 days postsurgery. Oral
hygiene instruction was given and rein-
forced at each visit; at the same time,
professional hygiene measures were
done around each experimental fixture
using teflon curettes, rubber points, and
prophylaxis paste.
Clinical and Radiographic Evaluations
Tomograms and periapical radio-
graphs were evaluated for mesiodistal
width (interradicular distance), resid-
ual bone beyond the apex, socket
width, and root angulation. An indi-
vidual bite registration film holder was
fabricated for each patient, ensuring in
this way that all radiographs had the
same position. Periapical radiographs
were taken at the preoperative phase,
immediately postoperatively, and at 3, 6,
18, and 24 months after implant place-
ment. Marginal bone loss from the im-
plant placement to the radiological
examination time was calculated by
55
 Table 2. Dimensions of the Institute Straumann Immediate Post-extraction
Implants Placed
Dimensions of Straumann Implants
Placed Diameter
3.3 mm NN
3.3 mm RN
4.1 mm RN
4.8 mm RN
4.1/4.8 mm TE
3.3/4.8 mm TE
subtracting from 2 subsequent periapi-
cal radiographs the distance between
the implant shoulder (implant-healing
screw junction) and the most coronal
part of the alveolar crest. During the
prescription follow-up, both the
plaque and gingival indices were
examined.
Surgical and Prosthetic Protocols
After administering local anes-
thetic, the teeth were luxated with an
elevator, and carefully removed avoid-
ing fracture of the buccal and palatal
bone walls. The socket was debrided.
Implant receptor sites were prepared
by sequential standard drills, inter-
nally and externally irrigated, reduced
low speed, without incision or flaps
elevation. The osteotomies were real-
ized using the bony walls as guides
and taking advantage by the maximum
use of bone apical to extraction sock-
ets (at least 4 mm). The distance be-
tween the gingival margin and bone
was measured with a millimetric stan-
dard periodontal probe. Implant place-
ment in the prepared site was made
1-mm apical to the height of the most
coronal wall of the bony housing. The
implant dimensions were chosen ac-
cording to the extraction socket. Prior
to placement, the mean depth and buc-
colingual and mesiodistal widths of
the alveolus amounted to 8.0 (range
4.5–12.5), 7.8 (range 4.0 –12.5), and
6.4 mm (range 3.5–10.0), respectively.
Primary implant stability was
achieved, and after placement, the
healing screw was immediately ap-
plied. The presence of a gap from the
implant surface to the surrounding
marginal bone walls was noted and
measured with a graded periodontal
probe placed perpendicular to the long
axis of the implant. No grafting mate-
56 AESTHETICS IN ORAL IMPLANTOLOGY
Dimensions of Implant Placed
Length (mm)
10 12 14
0 2 0
0 8 3
3 21 4
2 4 0 was lost. No infection or negative mu-
0 3 0 cosal response was present. The pa-
0 3 0 tient presented to the department
rials and/or barrier membranes were
used to treat the peri-implant defects
not exceeding 2 mm. This was in
accordance with the observation re-
ported by other authors,16,27 who ob-
tained spontaneous bone healing of
these defects with primary flap clo-
sure. Cases that showed gaps larger
than 2 mm were excluded from this
study. The longest (15 mm) and wid-
est (5.5 mm) were placed where pos-
sible to achieve an optimal primary
stability, a normal emergence profile,
and the maximal vertical bone preser-
vation in the maxillary incisors, ca-
nine, and premolar regions. No sutures
were made to achieve primary closure.
After 2 months from the surgical pro-
cedure, the patients had a temporary
nonfunctional restoration. After 4
months, they were restored with func-
tional ceramometal crowns.
Assessment of Success
The implants were deemed suc-
cessful if they fulfilled Roos et al’s24
criteria under function. All implants
restored were tested for mobility, pres-
ence of gingival inflammation, and
patient discomfort. Radiographic ex-
amination was utilized to ascertain the
presence of peri-implant translucen-
cies or absence of progressive bone
loss ⬎0.2 mm annually.
RESULTS
All treated patients had returned
for the scheduled appointments up to
the 24-month follow-up. A total of 87
implants were evaluated that included
18 central incisors, 16 lateral incisor,
13 canines, 22 first premolars, and 18
second maxillary premolars (Table 3).
Single implants were placed in 69.1%
of the patients, 18.3% had 2 implants,
and 12.6% had 3 or more fixtures.
Apart from 3 lost implants, none
of the patients suffered postoperative
complications, and the implant suc-
cess rate was 96.6%. Forty days after
the time of surgery, 1 fixture (13 mm
in length and 4.5 mm of diameter),
placed in the first premolar region,
showing a mobility of the healing
abutment. A periapical radiograph
showed bone loss around the fixture. It
was decided to remove the fixture. At
the reopening, the loss of all the buc-
cal bone wall was evident. We have
justified this failure because of the
postoperative thinness of the buccal
wall. In another 2 patients, the im-
plants were mobile at the abutment
connection stage (4 months from the
surgical procedure).
Just after implant placement, 54
of a total 87 sites (62.0%) around im-
plants were found to have horizontal
defects. Table 4 presents the location
of postoperative infrabony defects. All
implants had uneventful healing times
and the aesthetic outcomes of the tem-
porary rehabilitation 2 months after
surgery. No screw loosening of the
temporary abutment was observed,
and no complications were noted after
the definitive restoration placements.
The peri-implant soft tissues anat-
omy was considered clinically accept-
able in all patients, with no need for
additional mucogingival surgery.
The same examiner always re-
corded clinical parameters. Plaque In-
dex scores of 0 and 1 were observed
throughout the study. No significant
differences in the Plaque Index score
among the 4 time intervals (2, 4,1 8,
and 24 months), implanting that good
oral hygiene had been maintained by
the patient.
DISCUSSION
In this study, in 41.4% of the im-
plantations, the reason for tooth ex-
traction was unsuccessful endodontic
treatment; the implants replacing re-
sidual roots represented 23.0%. In
17.3% of the implantations, the reason
for tooth loss was advanced periodon-
titis. Of implants, 9.3% replaced a
 Table 3. Location and Reason for Failure of the Tooth Replaced With Immediate Anterior Single Implant
Endodontic Residual Number of
Tooth Unsuccessful Root Periodontitis Trauma Carious Lesion Teeth
Central incisor 10 5 2 1 18
Lateral incisor 9 5 2 16
Canine 6 4 1 1 1 13
First maxillary premolar 7 8 5 2 22
Second maxillary premolar 4 3 4 3 4 18

Table 4. Location, Type, and Dimension of Bone Defect Around Immediate Post-extraction Implant
Number of Teeth With
Defect Type at Implant Dimension of Largest Horizontal
Placement Implantation Site Perpendicular-Width Defect Defect
All Lateral incisor 0.4 ⫾ 0.8 mm 7
Canine 0.5 ⫾ 0.3 mm 4
First maxillary premolar 1.7 ⫾ 0.3 mm 11
Second maxillary premolar 0.7 ⫾ 0.9 mm 9
3-wall infrabony Lateral incisor 0.9 ⫾ 0.7 mm 6
Canine 1.2 ⫾ 0.5 mm 3
First maxillary premolar 1.5 ⫾ 0.5 mm 8
Second maxillary premolar 1.3 ⫾ 0.7 mm 6
Dehiscences — — —

tooth failed by a trauma, and nonre-
storable carious lesions procured only
9.2% of the cases (Table 4). Because
the number of subjects observed in the
present study was small and the length
of the follow-up period was short,
conclusions should be drawn with cau-
tion. Results of this seem to demon-
strate a positive effect of a surgical
procedure without flap elevation on
soft tissues healing around implants
placed in post-extraction sockets. A
success rate of 96.6% as found in this
study is comparable to results reported
in other studies of immediate post-
extraction implant placement.25 Imme-
diate post-extraction implantology has
the advantage to offer the possibility
for placing the implant in a optimal
position (i.e., in the same position and
inclination as the natural tooth)
from a prosthetic point of view,
avoiding post-extraction bone re-
sorption.26 This technique helps the
clinician to maintain the presurgical
gingival architecture and is able to
ensure better opportunities for os-
seointegration because of the healing
potential of the fresh extraction site.17
It is our opinion that the healing po-
tential of the fresh socket is able to
promote both hard and soft peri-
implant tissue. A correct relation of
the immediately placed fixture with
gingivae ensures not only the preser-
vation of its morphology but gives the
possibility to improve adaptation of
the soft tissues to the crown favoring a
satisfactory aesthetic final result.
A possible complication of this
method is the presence of bone defects
between the coronal aspect of the im-
plant body and surrounding socket
wall.27–29 Our treated cases presented 4
Fig. 1. Clinical view of the failing
maxillary left central incisor.
Fig. 2. Preoperative periapical ra-
diograph.
Fig. 3. Intraoral view of prepara-
tion of the implant receptor site
with sequential standard drills
without incision or flap elevation
after atraumatic extraction of the
tooth.
Fig. 4. Clinical view of the implant
placed in the fresh socket. The
application of the healing abut-
ment. No suture was made to
achieve primary closure.
Fig. 5. Immediate postoperative
periapical radiograph of the
implant.

IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 57

or 3 wall defects in relation to the size
and morphology of the socket. This
was present especially in premolar im-
plantation sites rather than the incisor/
canine areas. This study is evidence
that the presence, after inserting the
implant, of horizontal gaps of 2 mm or
less is a clinical situation that does not
need any guided bone regeneration
technique.12 Our experience suggests
to avoid this surgical technique in aes-
thetic areas when the fixture dimen-
sions are not able to reduce the bone
defect within 2 mm. The role of the
implant surface in bone defect healing
appears to be very important, but it
was not within the scope of this study.
Some authors30 question the need for
primary closure in immediate implan-
tation. In this study, as protocol, we
did not use sutures; and in all cases,
we had good aesthetic results. We
believe optimal aesthetic result is con-
nected to the bone quality and dimen-
sions of the buccal wall. Resorption of
this may produce a buccal concavity in
the alveolar process that usually pro-
duces a compromised aesthetic situa-
tion.7–9 The thickness of the buccal
aspect of the alveolar process after
implant placement, immediate or not,
is the real important prognostic factor.
In this study, during the implant site
preparation, the burs were positioned
in contact with the palatal socket walls
with the end to reduce the surgical
Fig. 6. Buccal view of soft tissues healing
after 2 months from surgical time.
Fig. 7. Occlusal view of soft tissues healing
after 2 months from surgical time.
58 AESTHETICS IN ORAL IMPLANTOLOGY
trauma to the buccal wall and its vas-
cularization. The implants were nor-
mally placed along the palatal wall of
the extraction socket in the incisor and
canine areas, and centrally in the
socket in the premolar areas (Figs.
1–5). Our opinion is that the surgical
respect of the buccal socket wall is the
most important factor for obtaining a
satisfactory aesthetic result. The idea
of inserting the fixtures without flap
elevation is an attempt to have a major
respect of the buccal wall and its peri-
osteal membrane minimizing soft tis-
sue trauma. Another aspect that the
clinician must take into account, imag-
ining the final aesthetic result, is the
gingival morphology and thickness
(Figs. 6 and 7). Several authors31,32
reported facial gingival recession after
definitive prosthesis placement. Preop-
erative clinical examination must note
gingival anatomy and architecture,
and the presence of inflammation/
edema or recessions in the implanta-
tion sites. These factors can reduce the
possibility of predicable aesthetic re-
Fig. 8. Clinical view of the temporary restoration.
Fig. 9. Clinical view of the final casting.
Fig. 10. Clinical view of the final restoration.
Fig. 11. Periapical radiograph after 24 months from surgical time.
sults. We believe a very thin and fes-
tooned biotype of gingival tissue is not
a good prognostic element for imme-
diate implant placement in the anterior
maxilla. Conversely, the available
temporary components made by the in-
dustries ensure the respect of the soft
tissues and its correct modulation. The
temporary rehabilitation reduces the
dead space between the soft tissue cov-
erage and bone, reduces the chances of
infection, and enhances the maturation
and modeling process.33 The temporary
dentures cannot cause pressure on the
soft tissues (Fig. 8).
In this study, the occlusal height
of the acrylic resin temporary crowns
was shortened about 2 mm to prevent
the load transmission directly to the
implant. The use of a fixed provisional
restoration can help to control the oc-
clusal forces that are applied to the
healing bone-to-implant interface
within a physiologic range.33 This is a
very satisfactory solution for the pa-
tient and prevents excessive stress to
the fixture (Figs. 9 –11).
CONCLUSIONS
Within the limits of this study, the
preliminary results have confirmed
that immediate implantation in fresh
extraction sites of the anterior maxilla,
even without the incision or flap re-
flection, is a surgical procedure that
appears to foster a well-preserved gin-
gival architecture contributing to a sat-
isfactory aesthetic final result.
Disclosure
The authors claim to have no finan-
cial interest in any company or any of
the products mentioned in this article.
REFERENCES
1. Brånemark PI, Hansson BO, Adell R.
Osseointegrated implants in the treatment
of the edentulous jaw. Experience from a
10-year period. Scand J Plast Reconstr
Surg Suppl. 1977;16:1-132.
2. Belzer UC, Bernard JP, Buser D.
Implant-supported restorations in anterior
region: Prosthetic consideration. Pract Pe-
riodontics Aesthet Dent. 1996;8:875-883.
3. Belzer UC, Bernard JP, Hess D, et
al. Aesthetic implant restoration in partially
edentulous patients: A critical appraisal.
Periodontol 2000. 1998;17:132-150.
4. Belzer UC, Bernard JP, Buser D.
Implant-placement in aesthetic zone. In Lindhe
J, Karring T, Lang NP, eds. Clinical Periodon-
tology and Implant Dentistry. 4th ed. London:
Blackwell Munksgaard; 2003:915-944.
5. Kois JC. Predictable single tooth
peri-implant aesthetics: Five diagnostic
keys. Compend Contin Educ Dent. 2001;
22:199-206.
6. Zitzmann NU, et al. Immediate or
delayed immediate implantation versus
late implantation when using the principles
of guided bone regeneration. Acta Med
Dent Helv. 1996;1:221-227.
7. Carlsson GE, Persson G. Morphologic
changes of the mandible after extraction and
wearing of dentures. A longitudinal, clinical, and
x-ray cephalometric study covering 5 years.
Odontol Revy. 1967;18:27-54.
8. Atwood D. Post-extraction changes
in adult mandible as illustrated by microra-
diograph of midsagittal section and serial
cephalometric roentgenograms. J Pros-
thet Dent. 1963;13:810-816.
9. Ulm C, Solar T, Blahout R. et al. Re-
duction of the compact and cancellous
bone substance of the edentulous mandi-
ble caused by resorption. Oral Surg Oral
Med Oral Pathol. 1992;74:131-136.
10. Brånemark P, Zarb GA, Albrektsson
T. Tissue-Integrated Prostheses: Osseointe-
gration in Clinical Dentistry. Chicago, IL:
Quintessence; 1985:199-204.
11. Schulte W, Kleineikenscheidt H,
Linder K, et al. The Tubingen immediate
implant in clinical studies [in German].
Dtsch Zahnarztl Z. 1978;5:348-359.
12. Cornelini R, Scarano A, Covani U,
et al. Immediate one-stage postextraction
implant: A human clinical and histologic
case report. Int J Oral Maxillofac Implants.
2000;15:432-437.
13. Balshi TJ, Wolfinger GJ. Immediate
placement and implant loading for expe-
dited patient care: A case report. Int J Oral
Maxillofac Implants. 2002;17:587-592.
14. Cooper LF, Rahman A, Moriarty J,
et al. Immediate mandibular rehabilitation
with endosseous implant: Simultaneous
extraction, implant placement, and load-
ing. Int J Oral Maxillofac Implants. 2002;
17:517-525.
15. Kan JYK, Rungcharassaeng K,
Lozada J. Immediate placement and provi-
sionalization of maxillary anterior single
implants: 1 year prospective study. Int J Oral
Maxillofac Implants. 2003;18:31-39.
16. Rosenquist B, Grenthe B. Immedi-
ate placement of implants into extraction
sockets: Implant survival. Int J Oral Maxil-
lofac Implants. 1996;11:205-209.
17. Barzilay I, Graser GN, Iranpour B,
et al. Immediate implantation of pure tita-
nium implants into extraction sockets of
Macaca fascicularis. Part II: Histologic ob-
servations. Int J Oral Maxillofac Implants.
1996;11:489-497.
18. Fugazzotto PA. Implant placement
in maxillary first premolar fresh extraction
sockets: Description of technique and re-
port of preliminary results. J Periodontol.
2002;73:669-674.
19. Block MS, Kent JN. Placement of
endosseous implant into tooth extraction
sites. J Oral Maxillofac Surg. 1991;49:
1269-1276.
20. Tolman D, Keller E. Endosseous
implant placement immediately follow-
ing dental extraction and alveoloplasty:
Preliminary report with 6 year follow up.
Int J Oral Maxillofac Implants. 1991;6:
24-28.
21. Gomez-Roman G, Schulte W. Im-
mediate post-extraction implant place-
ment with root analog stepped implants:
Surgical procedure and statistical out-
come after 6 years. Int J Oral Maxillofacial
Implants. 2001;16:503-513.
22. Garber DA, Salama MA, Salama H.
Immediate total tooth replacement. Com-
pend Contin Educ Dent. 2001;22:210-
216.
23. Gomez-Roman G, Schulte W,
d’Hoedt B, et al. The Frialit-2 implant
system: Five-year clinical experience in
single-tooth and immediately post-
IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007
extraction applications. Int J Oral Maxillo-
fac Implants. 1997;12:299-309.
24. Roos J, Sennerby L, Lekholm U, et
al. A qualitative and quantitative method for
evaluating implant success: A 5 year retro-
spective analysis of the Brånemark im-
plant. Int J Oral Maxillofac Implants. 1997;
12:504-514.
25. Grunder U. Retrospective case se-
ries analysis of the factors determining im-
mediate implant placement. Compend
Contin Educ Dent. 2000;21:805-811.
26. Lazzara RJ. Immediate implant
placement into extraction sites: Surgical and
restorative advantages. Int J Periodontics
Restorative Dent. 1989;9:332-343.
27. Schropp L, Kostopoulos L, Wenzel
A. Bone healing following immediate versus
delayed placement of titanium implants into
extraction sockets: a prospective clinical
study. Int J Oral Maxillofac Implants. 2003;
18:189-199.
28. Wilson TG, Schenk R, Buser D, et
al. Implant placed in immediate extrac-
tion sites: A report of histologic and his-
tometric analysis of human biopsies. Int
J Oral Maxillofac Implants. 1998;13:333-
341.
29. Paolantonio M, Dolci M, Scarano
A, et al. Immediate implantation in fresh
extraction sockets. A controlled clinical
and histological study in man. J Periodon-
tol. 2001;72:1560-1571.
30. Schwartz-Arad D, Chaushu G.
Placement of implant into fresh extraction
sites: 4 to 7 years retrospective evaluation
of 95 immediate implants. J Periodontol.
1997;68:1110-1116.
31. Bengazi F, Wennstrom JL, Lek-
holm U. Recession of the soft tissue mar-
gin at oral implants. A 2-year longitudinal
prospective study. Clin Oral Implants Res.
1996;7:303-310.
32. Oates TW, West J, Jones J, et al.
Long-term changes in soft tissue height on
the facial surface of dental implants. Im-
plant Dent. 2002;11:272-279.
33. Lorenzoni M, Pertl C, Zhang K, et
al. Immediate loading of single tooth im-
plants in the anterior maxilla. Preliminary
result after one year. Clin Oral Implants
Res. 2003;14:180-187.
Reprint requests to and correspondence to:
Gilberto Sammartino, MD, DDS
Dip. di Scienze Odontostomatologiche e
Maxillo-Facciali
Facoltà di Medicina e Chirurgia dell’Università
degli studi di Napoli “Federico II”
Via Pansini 5
80125 Napoli, Italy
Phone: (39) 081-7462654
E-mail: gilberto.sammartino@unina.it
59
 Abstract Translations
GERMAN / DEUTSCH
AUTOR(EN): Gilberto Sammartino, MD, DDS*, Gaetano
Marenzi, DMD, PhD**, Alessandro Espedito di Lauro DMD
PhD***, Guerino Paolantoni DMD****. *A.O. Professor,
Universität von Neapel “Federico II”. Medizinische Fakultät.
Abteilung für Odontostomatologie und Gesichts- und Kief-
erheilkunde. Neapel, Italien. **Oralchirurg, Universität von
Neapel “Federico II”. Medizinische Fakultät. Abteilung für
Odontostomatologie und Gesichts- und Kieferheilkunde.
Neapel, Italien. ***Assistenzprofessor, Universität von
Neapel “Federico II”. Medizinische Fakultät. Abteilung für
Odontostomatologie und Gesichts- und Kieferheilkunde.
Neapel, Italien. ****Privat praktizierender Arzt, Neapel, Ital-
ien. Schriftverkehr: Gilberto Sammartino, MD, DDS, Dip. di
Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di
Medicina e Chirurgia dell’Università degli studi di Napoli
“Federico II”, Via Pansini 5, 80125 Neapel, Italien. Telefon:
⫹39-081/7462654, e-Mail: gilberto.sammartino@unina.it
Ásthetik in der Oralimplantologie: biologische, klinische,
chirurgische und prothetische Aspekte
ZUSAMMENFASSUNG: Zielsetzungen: Diese Studie zielte
darauf ab, eine korrekte klinische, chirurgische und prothe-
tische und auf ein vorhersagbar gutes ästhetisches Ergeb-
nis abzielende Vorgehensweise bei der Einsetzung
Knochengewebsintegrierender Implantate zu erfassen, die
zum Zweck des Ersatzes fehlender Zähne im vorderen Oberk-
iefer eingesetzt werden. Die sofort in die Extraktionshöhlen
vorgenommene Einpflanzung von Implantaten ohne zusätzli-
che Einschnitte und Lappenanhebungen stellt eine der chiru-
rgischen Behandlungsoptionen dar, um die Heilungschancen
und regenerativen Möglichkeiten der frischen Pfanne zu ver-
bessern. Materialien und Methoden: 55 Patienten, davon 33
Männer und 22 Frauen im Alter von 19 bis 57 Jahren (mit 29
als durchschnittlichem Alter) wurden zur Teilnahme an dieser
Studie ausgewählt. Keiner der Patienten rauchte oder knir-
schte mit den Zähnen. Bei allen lagen stabile Weich-
gewebsbedingungen vor, der Zahnreihenschluss war bei allen
weitestgehend zufrieden stellend und keiner wies krankhafte
Veränderungen auf, die eine Knochenheilung beeinträchtigen
könnten. Die Patienten wurden mit Implantaten zweier ver-
schiedener Hersteller behandelt, zum ersten vom Institut
Straumann, Walderburg, Schweiz, und zum zweiten von Fria-
dent, Mannheim, Deutschland). 87 Implantate wurden sofort
nach Entfernen des jeweiligen versagenden Zahns implantiert. 3
Monate nach Implantatsetzung wurde die vorübergehende
Prothetik angebracht und 4 Monate nach dem chirurgischen
Eingriff folgte die abschließende Wiederherstellung. Die Pa-
tienten wurden klinisch und röntgentechnisch bei Implantat-
setzung sowie 2, 4, 18 und 24 Monate nach Implantierung
60 AESTHETICS IN ORAL IMPLANTOLOGY
untersucht. Ergebnisse: Nach 24 Monaten musste nur bei
drei Implantaten ein Fehlschlagen festgestellt werden, wobei
zwei dieser Implantate männlichen Patienten eingesetzt wor-
den waren und eines bei einer Patientin. Keines der ver-
sagenden Implantate konnte eine Knochengewebsintegration
erzielen. Die vor der abschließenden Wiederherstellung er-
mittelte Gesamterfolgsquote lag bei 96,6% mit einer Versa-
gensrate der Implantate von 3,4%. Schlussfolgerungen: Die
sofortige Platzierung von Implantaten in die frischen Extrak-
tionshöhlen des vorderen Oberkiefers ohne zusätzliche Ein-
schnitte oder Lappenanhebungen stellen eine chirurgische
Option dar, die unter Erhalt der vor der Operation
bestehenden Zahnfleisch- und Knochenbedingungen eine op-
timale Gewebsheilung im das Implantat umlagernden
Gewebe garantieren kann. Für ein vorhersagbar gutes ästhe-
tisches Ergebnis scheinen die Höhe und Dicke der wangense-
itigen Knochenwand, die nach der sofortigen Anbringung der
Deckprothese verbleiben, die wichtigste Rolle zu spielen.
SCHLÜSSELWÖRTER: Ásthetik im Zahnfleischbereich,
Zahnextraktion, sofortige Implantatsetzung, vorübergehende
Wiederherstellungslösung
SPANISH / ESPAÑOL
AUTOR(ES): Gilberto Sammartino, MD, DDS*, Gaetano
Marenzi, DMD, PhD**, Alessandro Espedito di Lauro, DMD,
PhD***, Guerino Paolantoni, DMD****. *Profesor Aso-
ciado, Universidad de Nápoles “Federico II”, Facultad de
Medicina, Departamento de Ciencias Odontoestomatológi-
cas y Maxilofaciales, Nápoles, Italia. **Cirujano Oral, Uni-
versidad de Nápoles “Federico II”, Facultad de Medicina,
Departamento de Ciencias Odontoestomatológicas y Maxilo-
faciales, Nápoles, Italia. ***Profesor Asistente, Universidad
de Nápoles “Federico II”, Facultad de Medicina, Departa-
mento de Ciencias Odontoestomatológicas y Maxilofaciales,
Nápoles, Italia. ****Práctica Privada, Nápoles, Italia. Cor-
respondencia a: Gilberto Sammartino, MD, DDS, Dip. di
Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà di
Medicina e Chirurgia dell’Università degli studi di Napoli
“Federico II”, Via Pansini 5, 80125 Napoli, Italy. Teléfono:
⫹39-081/7462654, Correo electrónico: gilberto.sammartino@
unina.it
La estética en la implantologı́a oral: aspectos biológicos,
clı́nicos, quirúrgicos y prostéticos
ABSTRACTO: Objetivos: El objetivo de este estudio fue
identificar una atención clı́nica, quirúrgica y prostética cor-
recta de los implantes endoóseos para reemplazar dientes que
faltan en la maxila anterior para lograr resultados estéticos
pronosticables. La colocación de los implantes inmediatos a
la post-extracción sin incisiones o elevación de las aletas es
una de las opciones de tratamiento quirúrgico capaces de
mejorar el potencial regenerativo y de curación de la cavidad
fresca. Materiales y métodos: Se seleccionaron para el estu-
dio cincuenta y cinco pacientes (33 hombres, 22 mujeres),
con edades desde los 19 a los 57 (edad media de 29) años.
Todos los pacientes no eran fumadores, sin bruxismo, pre-
sentaban tejidos suaves estables, una oclusión aceptable y la
ausencia de patologı́as que pudieran contraindicar la curación
del hueso. Los pacientes fueron tratados con implantes he-
chos por 2 fabricantes (Institute Straumann, Walderburg,
Suiza y Friadent, Mannheim, Alemania). Ochenta y siete
implantes fueron colocados inmediatamente después de la
extracción de cada diente fallado. La restauración temporal se
colocó tres meses después de la colocación del implante y la
restauración final se colocó 4 meses después del procedi-
miento quirúrgico. Los pacientes fueron evaluados clı́nica-
mente y radiográficamente en el momento de la colocación
del implante y a los 2, 4, 18 y 24 meses posteriores a la
colocación. Resultados: A los 24 meses solamente se habı́an
perdido tres implantes (2 en pacientes masculinos y 1 en una
paciente femenina). Todos los implantes fallados no lograron
la oseointegración. La tasa general de éxito fue del 96.6% con
una tasa de falla del implante del 3.4%, todos antes de la
restauración. Conclusiones: La colocación inmediata en las
cavidades de extracción frescas de la maxila anterior sin
incisiones o elevación de la aleta es una opción quirúrgica
que puede asegurar una curación ideal de los tejidos periim-
plante para proteger los aspectos gingivales y del hueso
previo a la cirugı́a. Para lograr un resultado estético pronos-
ticable, el aspecto más importante parece ser la altura y el
espesor de la pared del hueso bucal que queda luego de la
colocación inmediata del aparato.
PALABRAS CLAVES: estética gingival, extracción de
dientes, colocación inmediata del implante, restauración
temporal
PORTUGUESE / PORTUGUÊS
AUTOR(ES): Gilberto Sammartino Médico, Cirurgião-
Dentista*, Gaetano Marenzi Doutor em Medicina, PhD**,
Alessandro Espedito di Lauro Doutor em Medicina, PhD***,
Guerino Paolantoni Doutor em Medicina****. *Professor
Associado, Universidade de Nápoles “Federico II”. Facul-
dade de Medicina. Departamento de Ciência Odontostoma-
tológica e Maxilo-Facial. Náoles, Itália. **Cirurgião Oral,
Universidade de Nápoles “Federico II”. Faculdade de Me-
dicina. Departamento de Ciência Odontostomatológica e
Maxilo-Facial. Nápoles, Itália. ***Professor Assistente, Uni-
versidade de Nápoles “Federico II”. Faculdade de Medicina.
Departamento de Ciência Odontostomatológica e Maxilo-
Facial. Náoles, Itália. ****Clı́nica particular, Nápoles, Itá-
lia. Correspondência: Gilberto Sammartino, MD, DDS, Dip.
di Scienze Odontostomatologiche e Maxillo-Facciali, Facoltà
di Medicina e Chirurgia dell’Università degli studi di Napoli
“Federico II”, Via Pansini 5, 80125 Napoli, Italy. Telefone:
IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007
⫹39-081/7462654, e-Mail: gilberto.sammartino@unina.it
Estética em implantologia oral: Aspectos biológicos, clı́ni-
cos, cirúrgicos e protéticos
RESUMO: Objetivos: O objetivo deste estudo era identificar
um tratamento clı́nico, cirúrgico e protético correta de im-
plantes endósseos substituindo dentes ausentes na maxila
anterior alcançando resultados estéticos previsı́veis. A colo-
cação de implantes de pós-extração imediata sem incisões ou
elevação do retalho é uma das opções de tratamento cirúrgico
capazes de melhorar a cura e os potenciais regenerativos do
alvéolo fresco. Materiais e Métodos: Cinqüenta e cinco pa-
cientes (33 homens, 22 mulheres), compreendendo em idade
de 19 a 57 (idade média 29) anos, foram selecionados para
este estudo. Todos os pacientes eram não-fumantes, não-
bruxistas, apresentavam condições de tecido mole estáveis,
uma oclusão aceitável e a ausência de patologias que contra-
indicassem a curta do osso. Os pacientes foram tratados com
implantes feitos por 2 fabricantes (Institute Straumann,
Walderburg, Suı́ça e Friadent, Mannheim, Alemanha). 87
implantes foram colocados imediatamente depois que cada
dente deficiente for removido. A restauração temporária foi
colocada três meses após a colocação do implante e a restau-
ração final foi colocada 4 meses a partir do procedimento
cirúrgico. Os pacientes foram avaliados clı́nica e radiografi-
camente na colocação do implante e em 2, 4, 18 e 24 meses
pós inserção. Resultados: Em 24 meses apenas três implantes
foram perdidos (2 em pacientes masculinos;1 em paciente
feminino). Todos esses implantes fracassados deixaram de
alcançar a osseointegração. A taxa de sucesso geral foi de
96.6% com taxa de fracasso do implante de 3.4%, tudo antes
da restauração. Conclusões: A colocação imediata nos alvéo-
los de extração frescos da maxila anterior sem incisões ou
elevação do retalho é uma opção cirúrgica que pode assegurar
a cura ideal de tecidos de periimplante, preservando os as-
pectos gengivais e ósseos pré-cirúrgicos. Para um resultado
estético previsı́vel o aspecto mais importante parece ser a
altura e espessura da parede do osso bucal que permanecem
após a imediata colocação do aparelho.
PALAVRAS-CHAVE: estética gengival, extração de dentes,
colocação imediata de implantes, restauração temporária
RUSSIAN /

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Sammartino) доко д , доко со олог*,
Г  о    (Gaetano Marenzi) доко со оло-
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Л уо (Alessandro Espedito di Lauro) доко со оло-
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61
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Facciali, Facoltà di Medicina e Chirurgia dell’Università degli  4 с осл угского  ' лс .
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62 AESTHETICS IN ORAL IMPLANTOLOGY

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IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 63

 CHINESE /

64 AESTHETICS IN ORAL IMPLANTOLOGY

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IMPLANT DENTISTRY / VOLUME 16, NUMBER 1 2007 65