Immediate Single Tooth Replacement With Subepithelial Connective Tissue Graft Using Platform Switching Implants: A Case Series
This case series evaluated the facial gingival stability following single immediate tooth replacement in conjunction with subepithelial connective tissue graft (SCTG). Implant success rate and peri-implant tissue response were also reported. Ten patients (6 male, 4 female), with a mean age of 52.1 (range = 22.7 to 67.1) years, underwent immediate implant placement and provisionalization with SCTG and were evaluated clinically and radiographically at presurgery (T0), at the time of immediate tooth replacement and SCTG (T1), and 3 months (T2), 6 months (T3), and 12 months (T4) after surgery. Data were analyzed using the Friedman and Wilcoxon signed-ranks tests at the significance level of α = .05. At 1 year, 9 of 10 implants remained osseointegrated with the overall mean marginal bone change of −0.31 mm and a mean facial gingival level change of −0.05 mm. The modified plaque index scores showed that patients were able to maintain a good level of hygiene throughout the study. The papilla index score indicated that at T4, more than 50% of the papilla fill was observed in 89% of all sites. When proper 3-dimensional implant position is achieved and bone graft is placed into the implant-socket gap, favorable success rate and peri-implant tissue response of platform switching implants can be achieved following immediate tooth replacement in conjunction with subepithelial connective tissue graft.

Figure 1. Preoperative labial view of the failing maxillary left central incisor. Figure 2. Preoperative periapical radiograph of the failing maxillary left central incisor due to root resorption. Figure 3. Implant placement. Figure 4. Periapical radiograph immediately after implant surgery.

Figure 5. Labial view of the provisional restoration and connective tissue graft at implant surgery. Figure 6. Labial view of the definitive implant abutment and tooth preparations. Figure 7. Labial view of the definitive restoration after 1 year of function. Figure 8. Periapical radiograph 1 year after the implant surgery. Figure 9. Reference line (RL) used to determine changes in marginal bone level (MBL).
Contributor Notes