Open Journal of Stomatology, 2013, 3, 392-396 OJST http://dx.doi.org/10.4236/ojst.2013.37066 Published Online October 2013 (http://www.scirp.org/journal/ojst/ ) Effect of immediate implant placement and loading on soft tissue management Erdem Özdemir 1* , Yener Oguz 2 1 Metin Kasapoğlu Caddesi, Yeşilbahce Mah. No: 59/9 PK. 07160 Muratpaşa, Ankara, Turkey 2 Department of Oral Maxillofacial Surgery, Dentistry Faculty, Baskent University, Ankara, Turkey Email: dnterdem@gmail.com Received 11 August 2013; revised 21 October 2013; accepted 28 October 2013 Copyright © 2013 Erdem Özdemir, Yener Oğuz. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT The recent article describes immediate implant place- ment and loading in the anterior segment. The main aim of this treatment option was to deliver provi- sional prosthesis to the patient in the same day of surgery, form papilla contours, and eliminate waiting of osseointegration time and the second surgery. Keywords: Immediate Implant Placement; Provisional Denture; Papilla Forming 1. INTRODUCTION Traditionally, when incisors are lost in the anterior max- illa, canines/premolars-supported fixed partial denture is the mandatory treatment option. The number of lost teeth, the length of the arch, and the mobility of the abutment teeth should be carefully considered before deciding the number of abutments [1]. Furthermore, fixed partial den- tures in the anterior maxilla cause increased bending forces than the anterior mandibula because of the larger curve. In case all maxillary incisors are lost, the pontics will lie outside of the inter-abutment axis line and the forces will act as a lever arm that operates the torquing forces on the canines/premolars [1]. In such cases, im- plant treatment options, which also eliminate the prepa- ration of teeth, become a viable treatment option for pa- tients [2]. Teeth loss will decrease the bone level of the extrac- tion site and the surrounding soft tissue volume [3], with significant tissue loss in the first month; this will keep decreasing for at least six months [4]. In the healed sites, because of decreased bone height, shorter implants can be placed and longer crowns should be designed because of the lost soft and hard tissues. This short-implant/ long-crown combinations can face some mechanical problems and result in bone resorption, which can cause implant failure. The loss of soft tissue will result in lost interdental papillae. Interdental papillae loss will also affect the esthetic configuration [5]—“black triangle” areas that affect the esthetic dental harmony which can be observed between the crowns [6]. The lack of inter- dental papillae will also result in phonetic problems and food impaction [6]. Immediate implant placement terminology describes implant placement following tooth extraction immedi- ately into extraction cavity. Immediate implant place- ment has favorable outcomes [7]—decreasing the treat- ment time, decreasing the number of surgeries, and de- creasing the risk of hard and soft tissue resorption [8,9]. In other words, it was shown that immediate implant placement at the extraction sites preserves the bone and soft tissue volume [10-12]. In the cases, primary stability can be observed, and immediate loading protocol can be executed in the anterior sites. At least a 32 - 35 Ncm torque is required for the single implants’ immediate loading [13,14]. Mozatti et al. [15] showed in their ret- rospective study that immediate implant placement and loading have successful long-term results as compared to delayed implant loading. Juodzbalys and Wang [16] placed implants into extraction sockets and followed for one year. They found that the implant success rate was 100% and the keratinize soft tissue volume was suffi- cient with 92.9%. Immediate implant placement and delivery of provi- sional crowns in the same day of surgery provide imme- diate comfort to the patients, keep the teeth in place and support the lip [17]. Following extraction, immediate implant placement and loading support the hard and soft dental tissues at the extraction sites [18,19]. Provisional crowns maintain and reshape the soft tissue contours during healing [20]. Di Alberti et al. [21] showed in their study that immediate implant loading in the anterior maxilla preserves the interdental papillae and supports the soft tissue contours. In another study, it was shown that immediate implant placement and loading main- OPEN ACCESS