Relationship between soft tissue dimensions and tomographic radial root position classification system for immediate implant installation

The aim of this study was to evaluate the relationship between soft tissue dimensions and radial root position (RRP) classification for immediate implant placement on maxillary anterior teeth. Maxillary anterior teeth (n = 420) were analyzed in the radial plane of cone beam computed tomography (CBCT) scans. Each tooth was classified according to its RRP: class I, (IA, IB); class II (IIA, IIB) class III; class IV, and class V. Soft tissue thickness at different landmarks, supracrestal soft tissue height, and crestal bone thickness were measured in CBCT. Keratinized tissue width was clinically measured. Gingival phenotype (thick or thin) was evaluated by transparency of the periodontal probe and at the landmark 2 mm from the gingival margin in CBCT. Class I tooth position accounted for 31.7%, class II for 45%, class III for 13.3%, class IV for 0.5%, and class V for 9.5%. The gingival phenotype was associated with RRP (χ² test, p < 0.05). Soft tissue dimensions were significantly different over RRP classes (ANOVA and Tukey tests, p < 0.05). Types IA and IIA presented both thick soft and hard tissues. When planning immediate implants in the anterior maxilla, soft tissue dimensions evaluation should be incorporated into RRP classification to increase the accuracy and predictability of treatment outcomes.