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1 - y e a r s t u d y o f n o n s u b m e r g e d i m p l a n t s A B C D E Figs. 3A–E Preoperative Post-extraction Immediate placement After 6 months After 12 months Figs. 3A–E Periapical radiograph sequence of immediate implant placement restoring a fractured endodontically treated lateral incisor. (A) Preoperative radiograph. (B) Post-extraction radiograph. (C) A 3.8 × 11.5 mm implant was placed nonsubmerged immediately after extraction. A stable MBL was observed at 6 months (D) and it remained stable at the 12-month follow-up (E). biotype (60.19%), may explain these results. Demonstrating a healthy gingiva with no inflam- mation, 95.44% of the implants showed an opti- mal soft-tissue texture. In order to further con- solidate these results, BoP at the 12-month evaluation was negative in approximately 90% of the periimplant sites evaluated. It is known that plaque accumulation around implant restorations may induce soft- tissue chronic inflammation, gingival bleeding and, in the long-term, periimplant bone loss.39 Little plaque accumulation was present around implant sites at 12 months. Sites totally free from plaque ranged from 58.4% to 83.3%. The 3 mm machined surface of the implant neck, the crown design and the hygienic recall program may also have contributed to this result. It has been reported that machined surfaces may reduce plaque and bacteria accumulation around the implant emergence profile.40 Limitations of the study are represented by the small sample size and the short-term follow- up. Thus, results should be interpreted with cau- tion. Further investigations in the long term and with a larger study cohort may confirm our results. The Prama implant, following BOPT principles, allows the clinician to model the soft tissue and have the gingival margin level with the periim- plant tissue in the same way as natural tooth-supported restorations, as no finishing line is present. Moreover, the implant emer- gence profile with the hyperbolic configuration allows creation of the crown finishing line cor- responding to the gingival margin or to the periimplant sulcus without any tissue compres- sion. Within the limitations of this preliminary study, the results demonstrated some advan- tages that may be the result of simpler pros- thetic management: 1. use of a noninvasive flapless technique with no second surgery for neck exposure and no need for a healing screw; 2. possibility of positioning the crown margin at different levels close to the periimplant sulcus and corresponding to the (yellow) implant neck; 3. implant–abutment connection above the gin- gival level; 4. minimal trauma and stress on the soft tissue during prosthetic procedures to preserve the MBL; 5. adequate control to avoid excess cement. Two drawbacks must be reported: 1. Surgical implant positioning is critical, as no modification of the abutment axis may be later performed, so a partial lack of abutment versatility must be included. 2. The implant requires adequate distance from the opposite antagonist tooth, as the implant neck plus abutment requires at least 5 mm plus crown restoration. Conclusion The use of a 2-piece nonsubmerged implant with a hyperbolic neck profile offers a new approach to the management of soft and hard tissue. In this, the prosthetic preparation makes it possible to preserve a good MBL, to reduce healing time, to perform a minimally invasive surgery, to avoid additional re-entry and to have fewer complications. Competing interests The authors declare that they have no compet- ing interests. 40 Volume 3 | Issue 4/2017 Journal of Oral Science & Rehabilitation