Rehabilitation of the Maxillary Aesthetic Zone with Immediate Bicortical Implants and One Abutment at One Time Protocol: A Prospective Cohort with Fully Digital Workflow
To evaluate the clinical and radiographic outcomes of guided immediate bicortical implant placement combined with a one-abutment-one-time (OAOT) protocol using prefabricated microgrooved abutments with zirconia crowns (Zircopings) and a fully digital prosthetic workflow in the maxillary aesthetic zone. In this non-randomized, single-arm prospective cohort study, 40 patients underwent flapless tooth extraction and guided placement of long implants engaging the nasal/palatal cortex (insertion torque ≥50 Ncm). Prefabricated custom Zircopings and composite provisional restorations were delivered immediately, followed by definitive lithium-disilicate crowns after 3 months, which served as the baseline for hard- and soft-tissue evaluation. Patients were assessed at 3, 6, and 12 months for implant and prosthesis survival, marginal bone level (MBL) changes, mid-facial mucosal recession, and interproximal papilla fill. Longitudinal changes were analyzed using the Friedman and Bonferroni-adjusted Wilcoxon signed-rank tests. All 40 participants completed the 12-month follow-up. Implant and prosthesis survival were 100% (95% CI: 91.2%–100%). From the 3-month baseline to 12 months, mean MBL changes were 0.14 mm (95% CI: 0.01–0.27 mm; p = .0009) mesially and 0.09 mm (95% CI: −0.02 to 0.21 mm; p = .0009) distally. Mid-facial mucosal recession measured 0.06 ± 0.09 mm (95% CI: 0.03–0.09 mm; p = .0008). The mean Jemt papilla score improved from 2.88 ± 0.29 to 3.00 ± 0.00 ( p = .0012). Guided immediate bicortical implant placement with a digital OAOT protocol achieved excellent short-term clinical and radiographic outcomes in the maxillary aesthetic zone. Further controlled studies with longer follow-up are warranted.