Implant supported single-tooth replacements compared to contralateral natural teeth. Crown and soft tissue dimensions

Prevalence, incidence, risk, and protective factors for soft tissue dehiscences at implant sites in the absence of disease: An AO/AAP systematic review and meta-regression analysis

BACKGROUND

The aim of the present review was to evaluate the prevalence and incidence of soft tissue dehiscences at implant sites in absence of disease, together with the related risk and protective factors.

METHODS

A systematic search was conducted to identify cross-sectional and prospective studies reporting information on soft tissue dehiscences. Mixed-effects uni- and multi-level regression analyses were performed to identify predictive factors associated with these conditions.

RESULTS

A total of 221 eligible studies were included. Soft tissue dehiscences ("recessions") were identified as peri-implant soft tissue dehiscences (PSTDs), Mucosal level (ML) apical shifts, and mucosal recessions (MRECs). The mean prevalence of PSTD and MREC was 46.2% and 23.1%, respectively. The incidence of PSTD, MREC, and apical shift of ML within 5 years following loading was up to 38.3%, 47.8%, and 23.6%, respectively. Limited mucosal thickness (MT), immediate implant therapy, and lack of peri-implant soft tissue augmentation were risk factors for PSTD, while limited MT, lack of/limited keratinized mucosa (KM) width, and immediate implant therapy were risk factors for ML apical shift. Guided implant surgery, bone grafting at implant placement, soft tissue augmentation, and adequate KM and MT were protective factors for the stability of ML. Lack of/limited KM width and interproximal marginal bone loss were risk factors for MREC.

CONCLUSIONS

Soft tissue dehiscences are commonly observed at implant sites. Risk and protective factors associated with PSTD, ML apical shift, and MREC were identified. A new diagnostic system and format for assessing and reporting soft tissue dehiscence at implant sites was proposed.

PLAIN LANGUAGE SUMMARY

The aim of the present review was to evaluate the prevalence and incidence of soft tissue recession ("gum loss") at healthy implant sites. A systematic search was conducted to identify studies reporting information on soft tissue recession at implant sites. The statistical analysis also explored correlations of different factors with soft tissue recession. A total of 221 studies were included. Soft tissue dehiscences ("recession") were identified as peri-implant soft tissue dehiscences (PSTDs), Mucosal Level (ML) apical shift, and mucosal recessions (MRECs). The prevalence of soft tissue recession was, on average, 46.2%. The factors associated with this condition were thin soft tissue, lack of a band of keratinized tissue, and lack of a soft tissue graft surgery at the time of implant placement. On the other hand, placing dental implants using a surgical guide, performing bone grafting and soft tissue grafting at the time of implant placement, and having adequate thickness and keratinization of the soft tissue were protective factors reducing the risk of recession.

Protein profile at newly restored implants compared to contralateral teeth over 12-months: a pilot study

OBJECTIVES

To determine crevicular fluid alterations in protein expression of newly restored implants during their first year of function and associate them with those of contralateral teeth.

MATERIALS AND METHODS

In ten non-smokers, successfully treated for periodontitis, one newly restored implant (baseline-T0) and one corresponding tooth were followed for 12-months (T1). Oral hygiene was monitored during the study. Periodontal clinical indices and crevicular fluid were collected from an implant-site (PICF) and a tooth-site (GCF). Total proteomic profiles of PICF and GCF were investigated using label-free quantitative proteomics.

RESULTS

Clinical recordings remained stable at 12-months on the tooth-/implant-site basis. The comparative analysis of protein enrichment between teeth and implants at T0 revealed 664 human proteins, with 93 found only in teeth and 217 exclusively in implants. Among the 354 overlapping proteins, 46 were upregulated (log2FC > 1) in teeth, while 61 in implants. At T1, 569 human proteins were exclusively identified, with 67 found only in teeth and 193 exclusively in implants. Of the 309 overlapping proteins, 22 were upregulated in teeth, while 48 were in implants. The over-representation enrichment analysis identified "interferon-alpha response" and "allograft rejection" pathways, as significantly regulated categories at T0, with the latter being over-represented at T1.

CONCLUSIONS

Peri-implant tissue maturation was evident during the study. Proteins expressed in crevicular fluid reflected unique patterns between implants and teeth that are worth studying.

CLINICAL RELEVANCE

Different proteomic patterns were observed at the implant-site compared to the contralateral tooth-site towards inflammatory processes that prevail within otherwise clinically healthy peri-implant tissues.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov ID: NCT06379022.

Soft and hard tissue evaluation for vestibular socket therapy of immediately placed implants in infected and non-infected sockets: a 1-year prospective cohort study

BACKGROUND

Immediate implant placement using vestibular socket therapy (VST) proved to offer a successful treatment option in compromised sockets. However, the presence of active signs infection complicates immediate implants in sockets with defective labial plates, due to the possible contamination of the implant or the bone graft with existing infected tissues or oral environment via the fistula. This study, therefore, aims to explore the success of immediate implant placement using VST in managing infected compromised sockets.

METHODS

We included 26 age- and sex-matched patients with 41 implants sites. Thirteen patients had 19 infected (group I) and 13 had 21 non-infected type 2 sockets (group N). Both groups were treated using vestibular socket therapy (VST) and a 6-day protocol. Implant survival, changes in facial bone thickness, and mid, mesial, and distal mucosal levels were evaluated 1 year after implant placement. The Mann-Whitney U test was used to compare both groups. Furthermore, the Wilcoxon signed-rank test was used to study changes with time within each group. The statistical significance level was set at P < 0.05.

RESULTS

All implants survived; no significant difference was found between groups N and I regarding apical, mid, and crestal bone thickness and soft tissue level, except at the mesial papilla, where the recession was significantly more in group N than in group I. Changes over time were statistically significant in the apical, mid, and crestal bone thickness in both groups. The mean bone thickness gain ranged from 0.85 to 2.4 mm and 0.26-1.63 mm in groups I and N, respectively. Additionally, the mean mucosal recession ranged from 0.29 to 0.51 mm and 0.39-1.47 mm in groups I and N, respectively.

CONCLUSION

Within the limitations of this study immediate implant placement in type II infected sockets using the 6-day protocol and VST achieved 100% implant survival, while maintaining the regenerated facial bone thickness with minimal mucosal recession.

TRIAL REGISTRATION

The protocol for this study was registered on clinicaltrials.gov at 3/10/2021 (registration number NCT04787224).

Treatment of absent maxillary lateral incisors: orthodontic space closure and associated procedures

Missing maxillary lateral incisors can be treated either with orthodontic space closure or preservation of the edentulous space for tooth replacement. Orthodontic space closure coupled with non-invasive post-orthodontic cosmetic dentistry is a compelling option compatible with optimal function, favourable aesthetics, and periodontal health in the long-term. We present the rationale for space closure and detail contemporary clinical strategies underpinning interdisciplinary treatment planning and excellence in finishing.

Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial

OBJECTIVES

The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla.

MATERIALS AND METHODS

Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12).

RESULTS

No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups.

CONCLUSION

Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters.

CLINICAL RELEVANCE

There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.

Clinical study on the association between keratinized mucosa and peri-implant health when external hexagon implants are installed in the posterior region of the maxilla and mandible: a cohort study

This study evaluated the association between keratinized mucosa (KM) and peri-implant health of external hexagon implants in the posterior region in 84 patients with 242 implants. Modified plaque index (MPI), modified sulcular bleeding index (MSBI), probing depth (PD), keratinized mucosa (KM) width, and peri-implant bone loss were evaluated. The implants were divided according to the KM: (1) absence of KM, (2) KM width >0 and <2 mm, and (3) KM width ≥2 mm. Of the 242 implants evaluated, 63 (26.0%) had no KM band, 56 (23.1%) had KM width <2 mm, and 123 (50.8%) had KM width ≥2 mm. One hundred and sixty-seven (69.0%) were used in multiple unit restorations and 75 (31.0%) in single tooth restorations; 66.9% were placed in the mandible and 33.1% in the maxilla. For single tooth and multiple unit implant restorations, MPI (P=0.069 and P=0.387, respectively), MSBI (P=0.695 and P=0.947, respectively), PD (P=0.270 and P=0.258, respectively), and mesial bone loss (P=0.121 and P=0.239, respectively) were not affected by the KM width. On the distal surface, bone loss was influenced by the absence of KM when single tooth implant restorations were used (P=0.032). No association was found between KM width and the peri-implant tissue health.

The connective tissue graft as a membrane to improve esthetics according the defect

Dental implants are now one of the most useful therapies worldwide with higher rates of success from simple to complex cases, but also, with different results regarding the esthetics, cost and long-term success maintenance. In the beginning, dental implants therapy function and survival was the main goal. Nevertheless, through the years, the success criteria have increased, evolved, and improved beyond function to include esthetic and patient-related outcomes. Parallel to implant therapy, guide bone regeneration and periodontal plastic surgery have also evolved to achieve predictable, functional, and esthetic results in shallow and complex defects. However, they are mostly performed during different surgical procedures at different stages, raising the treatment time and cost for patients, directly related to the bio materials used and surgical times. The purpose of this case series is to present a simplified clinical scenario using a connective tissue graft as a membrane to improve esthetics and patient satisfaction while reducing treatment time and cost.

Longitudinal study on the effect of keratinized mucosal augmentation surrounding dental implants in preventing peri-implant bone loss

Background

Dental implant therapy is a well-established method of prosthetic rehabilitation of missing teeth. To maintain the health of the surrounding tissue, management of risk factors/indicators and daily maintenance are important. It still remains controversial whether a certain amount of keratinized mucosal width is essential for maintaining the health of peri-implant tissue. The purpose of this multicenter retrospective study was to assess the correlation between bone loss around dental implant and the amount of keratinized tissue width.

Methods

A total of 1,644 implants were evaluated. Data was collected about participants' general and dental history, as well as implant details. Bone resorption around implant was calculated from intra-oral radiographs taken after 1 year and more than 3 years of function. Implants were classified into three groups; received free gingival graft or apically repositioned flap surgery for increasing the keratinized mucosa ≥2 mm width (group A), keratinized mucosa width ≥2 mm (group B), and keratinized mucosa width <2 mm (group C). These data were analyzed by propensity score analysis and a generalized linear regression analysis was performed to compare the bone resorption among groups.

Results

Mean functional time was 55.8 months (SD = 20.5) in group A, 67.6 months (SD = 28.1) in group B, and 74.5 months (SD = 32.9) in group C. Mean bone resorption of groups A, B, and C were 0.08 mm (SD = 0.40), 0.18 mm (SD = 0.66), and 0.44 mm (SD = 0.40). Groups A and B had significantly lower bone resorption than group C.

Conclusion

The results in this study show the importance of keratinized mucosa in maintaining the peri-implant bone. Our findings also suggest that mucosal transplantation is useful, as opposed to narrowing of the keratinized mucosa.

Estimation of Soft and Hard Tissue Revolutionization Surrounding Dental Implant: A 2-Year Retrospective Study

A dental implant is an idyllic mode of operandi for oral rehabilitation for complete and partially edentulous patients. The success of an implant is based on the health of its surrounding tissues. Therefore, the biological and clinical aspects of implant prosthesis and their surrounding tissues must persist to be investigated. A two-year retrospective clinical-radiological study was conducted to estimate peri-implant soft and hard tissue revolutionization after the placement of implants. A clinical-radiological investigation was carried out to determine the amount of soft and hard tissue revolutionization that occurred following the implantation of 200 implants. From October 2020 to March 2021, the research was carried out in the College of Dentistry at King Khalid University in Saudi Arabia. It was decided to conduct this study using a retrospective clinical record, which involved gathering information about patients who had previously received dental implants within the previous two years. Plaque index (PI), gingival index (GI), bleeding index (BI), peri-implant probing depth (PD), and peri-implant crestal bone level were measured at baseline and three months after implant placement in adult patients ranging in age from 20 to 50 years. The results were compared to the full-mouth index (FMI). Ethical clearance and written informed consent were obtained from all the study participants. The statistical analysis was done by using Statistical Package for Social Sciences (SPSS-23.0 version) (IBM; Chicago). The present study concluded that plaque accumulation, gingival bleeding, and probing depth were increased around implants during the follow-up, but it would not affect crestal bone loss. Still, it is essential to conduct a similar study with a larger sample size and a long follow-up period to give more precise results.

Lithium disilicate and peek implant-retained single crowns - a randomized, prospective clinical study

Introduction/Objective. Comparing two materials under the same conditions is the best way to define differences between them. PEEK is a polymer that has many possible uses in dentistry as already well-known lithium disilicate ceramics. The aim of this study was to compare peri-implant soft tissue healing and evaluate patient satisfaction with esthetics in different observation periods, as well as the success and survival rate of both types of crowns. Methods. The study was conducted as a clinical, prospective, randomized split-mouth study on 17 patients with bilaterally missing upper teeth of the same type, replaced with dental implants. Study outcomes have been analyzed with subjective (VAS scale) and objective parameters (MBI, MPI and PPD) baseline, six and twelve months after fixing crowns onto the implants. Results. Comparison of the results between PEEK and lithium disilicate crowns showed no statistical differences in terms of MPI, MBI and PPD in the observed periods. Analyzing MPI during observation periods in the PEEK group of crowns, statistical significance was registered between baseline values and after 6 months. Also, statistical significance was noticed in terms of PPD during the observation time both in the study and control group of crowns. Results for VAS for the esthetics showed no statistically significant difference between the groups, while VAS for restoration satisfaction showed a statistically significant difference. Conclusion. This study showed that scores of the applied subjective and objective parameters can be a reliable tool to rate the clinical outcome of implant-retained single crowns over time.

Radiographic evaluation of a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis

Background

To evaluate a cross-shaped incision technique for thick-gingiva and thin-gingiva patients treated with implant-supported fixed prosthesis.

Methods

Total 55 patients receiving cross-shaped incision were assigned into thick-gingiva group (29 cases) and thin-gingiva group (26 cases). Follow-up was performed at 3 and 12-month after final restoration.

Results

Mesial and distal papilla height was significantly greater in thick-gingiva group than thin-gingiva group at 3 and 12 months, while periodontal depth and crestal marginal bone level around implant had no significant difference between the two groups during follow-up. No case of recession of buccal marginal gingiva was observed in thick-gingiva group. However, the recession of marginal gingiva of buccal aspect of the crown was found in 5 patients (19.2%) with thin-gingiva.

Conclusions

The cross-shaped incision may be applied to reconstruct gingival papillae and avoid the gingival recession in patients with thick-gingiva phenotype.

Trial registration This study was registered at ClinicalTrials.gov (registration number NCT04706078, date 12 January 2021, Retrospectively registered).

Soft tissue metric parameters, methods and aesthetic indices in implant dentistry: A critical review

OBJECTIVES

The primary objective was to provide an overview of soft tissue metric parameters, methods, and aesthetic indices in implant dentistry. The secondary objective was to describe reliability and validity of aesthetic indices.

MATERIALS AND METHODS

Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase, and Cochrane databases up to October 2020 to identify studies on soft tissue metric parameters, methods, and aesthetic indices. Aesthetic indices were evaluated in terms of reliability and validity. Data extraction was performed by the same reviewers.

RESULTS

Five metric parameters (papilla height, linear changes in soft tissue level, color assessment, soft tissue thickness, and profilometric soft tissue changes) registered by means of several methods (intra-oral registrations, radiographic assessments, digital analyses, and ultrasonic assessments), and 15 aesthetic indices (Papilla Index (PI), ad hoc questions scored with Visual Analogue Scales, Pink Esthetic Score (PES), Implant Crown Aesthetic Index (ICAI), Implant Aesthetic Score (IAS), Rompen Index, Subjective Esthetic Score, White Esthetic Score, Copenhagen Index, Complex Esthetic Index, Californian Dental Association Index (CDAI), Peri-Implant, and Crown Index, Functional Implant Prosthodontic Score, Implant Restoration Esthetic Index (IREI), and Mucosal Scarring Index (MSI)) could be identified. With respect to metric parameters and methods, intra-oral registrations were least accurate whereas profilometric soft tissue changes on the basis of digital surface models were most accurate. Six aesthetic indices showed good inter-rater reliability (PI, PES, ICAI, CDAI, IREI, and MSI). Good validity could only be shown for two indices (PES and CEI). Given this and on the basis of ease of use and ease of interpretation, PES qualified best for clinical research on single implants. None of the indices fulfilled the quality criteria for clinical research on multiple implants.

CONCLUSION

Many soft tissue assessment methods with varying reliability and validity have been described and used, which hampers uniform reporting in implant dentistry. Clinical investigators are advised to measure linear and profilometric soft tissue changes using digital surface models, and to use a reliable and validated aesthetic index. Currently, PES qualifies best for aesthetic evaluation of single implants. An index is to be developed to assess the aesthetic outcome of rehabilitations on multiple implants.

Evaluation of Bone Regeneration around Implants with and Without Flap Elevation

Background:

The aim of this study is to clinically evaluate and compare the clinical success and the relative bone healing of the implants which are placed using a flapless procedure and compare it to those placed by the conventional flap technique.

Materials and Methods:

This study was conducted with ten patients that were randomly divided into two groups. Group A included patients with immediately placed implants after extraction with flap elevation. Group B included patients with immediately placed implants after extraction without any flap elevation. The clinical parameters recorded were Plaque index, Modified Gingival Index, Early Wound Healing Index, Buser's criteria, Distance between implant shoulder and the crestal bone (DIB), and Radiographic Examination in a standardized manner to evaluate changes for the DIB values.

Results:

There was an improvement in Plaque Score from baseline to 1 month and baseline to abutment placement (6 months), which was statistically significant, but the plaque score from 3 months to abutment placement (6 months) was statistically nonsignificant in both the group. There was an increase in modified gingival score from baseline to 3 months, baseline to abutment placement (6 months), and 3 months to abutment placement (6 months), which was statistically significant in both the groups. The DIB scores in Group A recorded at baseline to 6 months were 2.80 ± 0.57 and 1.90 ± 0.42, respectively, showing a mean difference of −0.90 and P = 0.001 in comparison. Whereas, the DIB scores in Group B at baseline to 6 months were 3.20 ± 0.57 and 2.50 ± 0.50, respectively, showing a mean difference of −0.70 and P = 0.001 in comparison. The DIC scores in Group A at baseline to 6 months were 1.60 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.60 and P = 0.003 in comparison, Whereas the DIC scores in Group B at baseline to 6 months were 1.40 ± 0.54 and 0.00 ± 0.00, respectively, showing a mean difference of −1.40 and P = 0.005 in comparison.

Conclusion:

Implants placed in fresh extraction sockets with and without mucoperiosteal flap elevation can be successfully done with augmentation procedures. Short-term survival rates and clinical outcomes of both groups were similar and appeared to be predictable treatment modalities.

Randomized clinical trial of zirconia and polyetheretherketone implant abutments for single-tooth implant restorations: A 5-year evaluation

STATEMENT OF PROBLEM

Titanium-supported polyetheretherketone (PEEK) abutments provide an economic alternative to zirconia abutments in esthetically important areas. Research comparing the performance regarding esthetics, longevity, and biologic parameters of PEEK abutments is lacking.

PURPOSE

The purpose of this clinical study was to determine whether PEEK implant abutments provide similar esthetic and biologic parameters and survival rates as zirconia implant abutments.

MATERIAL AND METHODS

Forty participants (age 20 to 50 years) receiving maxillary anterior and premolar implants were enrolled in the study and randomly assigned into 1 of 2 groups: Group PEEK (20 titanium-supported PEEK abutments) and group ZIR (20 zirconia abutments). Both groups were restored with pressed lithium disilicate ceramic crowns. Technical, biologic, and esthetic evaluation was performed at baseline and at 1, 3, and 5 years. The probing pocket depth, plaque control record, and bleeding on probing were recorded at the abutments (test) and compared with those at the corresponding contralateral teeth (control) and also between the 2 test groups. Standardized digital radiographs of the implants were made, and the bone level was recorded with the implant shoulder as the reference on the mesial and distal sides. The color difference between the peri-implant mucosa and control teeth gingiva and the discoloration of the implant crowns were determined with a spectrophotometer. The Student unpaired t test and repeated-measure ANOVA were used to statistically analyze the data (α=.05).

RESULTS

From the 5-year evaluation, both PEEK and zirconia abutments with ceramic crowns showed 100% survival rate without any fracture or restoration loss. Differences in the biologic parameters of zirconia and PEEK abutments were statistically similar: mean probing pocket depth (group ZIR: 2.32 ±0.50 mm, group PEEK: 2.13 ±0.60 mm); mean plaque control record (group ZIR: 0.19 ±0.19, group PEEK: 0.15 ±0.17); and mean bleeding on probing (group ZIR: 0.12 ±0.11, group PEEK: 0.08 ±0.12). The mean marginal bone loss at 5 years was similar for implants supporting zirconia and PEEK abutments: mean mesial bone level (group ZIR: 1.8 ±0.5 mm; group PEEK: 1.9 ±0.6 mm), and mean distal bone level (group ZIR: 1.7 ±0.6 mm, group PEEK: 1.8 ±0.3 mm). The initial color difference (ΔE) between the peri-implant mucosa and gingiva of the analogous contralateral teeth diminished over time. No discoloration of the definitive restoration supported by PEEK or zirconia was detected over 5 years.

CONCLUSIONS

At the 5-year evaluation, zirconia and PEEK abutments exhibited the same survival rate with similar biologic and esthetic outcomes.

Reproducibility and validity of anterior implant esthetic indices: A review

Background:

The purpose of this review was to narrate about the reproducibility and validity of different indices evaluating esthetic aspects in anterior single implant-supported restorations.

Materials and Methods:

An electronic search of Medline, Scopus, Embase, Cochrane Central, and Web of Science databases was performed using the keywords “dental implants,” “anterior esthetics,” “esthetic score,” and “esthetic index.” Besides, a manual search of dental implant journals was carried out.

Results:

The electronic search revealed 932 titles. After further review, 14 articles fulfilled the eligibility criteria and were included in this review. Because of the heterogeneity of the study designs, interventions, and parameters used for assessment of esthetics, no meta-analysis could be performed.

Conclusion:

Many indices have been proposed for the evaluation of the esthetic aspects of single implant-supported reconstructions in the anterior maxilla. All of them have some advantages and drawbacks that this review pointed out. The evidence level of studies used for the validation of these indices is poor. It is necessary to achieve a consensus on the tools for assessment of the esthetic aspect and perform evidence-based studies to validate an appropriate index.

Facial Gingival Changes With and Without Socket Gap Grafting Following Single Maxillary Anterior Immediate Tooth Replacement: One-Year Results

This 1-year prospective study evaluated horizontal and vertical facial gingival tissue changes after immediate implant placement and provisionalization (IIPP) with and without bone graft in the implant-socket gap (ISG). During IIPP, 10 patients received bone graft material in the ISG (G group), while the other 10 patients did not (NG group). The implants were evaluated for implant stability quotient (ISQ), modified plaque index (mPI), modified bleeding index (mBI), marginal bone level (MBL), facial gingival level (FGL), and facial gingival profile (FGP) changes. The mean ISQ value at 9-month follow-up was statistically significantly greater than on the day of implant surgery (P &lt; .05). The mPI and mBI scores demonstrated that patients were able to maintain a good level of hygiene. There were no statistically significant differences in the mean MBL changes between the G and NG groups (P &gt; .05). There were statistically significant differences in FGL changes between the G (-0.77 mm) and NG (-1.35 mm) groups (P = .035). There were no statistically significant differences in FGP changes between the G and NG groups (P &gt; .05). However, statistically significant differences were noted in FGP change between the 3–12 and 0–12 month intervals in both groups (P &lt; .05). Within the limitations of this study, although no significant differences were noted in FGP changes between groups, G group experienced significantly less FGL changes than NG group. Bone graft material placement into ISG seems to be advantageous for tissue preservation during IIPP. However, future long-term studies, with larger sample size, are needed to validate the efficacy of such procedure

Orthodontic management of patients with congenitally missing permanent teeth

Dental agenesis is one of the most common developmental anomalies in humans. It occurs as part of a genetic syndrome or as an isolated sporadic or familial finding. Third molars, second mandibular premolars and maxillary lateral incisors are the most frequently targeted teeth of the permanent dentition. Clinically, patients with congenitally missing permanent teeth seeking treatment present with unesthetic diastemas, midline deviation and tilting of adjacent teeth in the edentulous areas. The impact of tooth agenesis reflects on esthetics, function, psychological and social well-being of the individuals affected. Orthodontics can contribute to the treatment plan selected by rearranging the present teeth so as to open spaces for prosthetic restorations or close spaces by reshaping teeth if needed. Following orthodontic space opening/maintaining, the usual alternatives involve single implants, two-(cantilever) or full coverage(cantilever) prostheses. Less frequently, the treatment modality of autotransplantation is proposed with a good esthetic result but feasible only in young patients where the roots of the premolars are still developing. In orthodontic space closure, treatment is accomplished sooner without waiting for the completion of growth of the patient. Depending on various factors such as the malocclusion, the dento-skeletal profile, the smile line, the space requirements, the teeth missing, the periodontal issues, the age of the patient and any financial issues, the clinician will determine the most appropriate treatment approach. The final esthetic and functional result should resemble an intact natural dentition.

Factors Influencing the Presence of Papilla between Adjacent Implants and between a Tooth and an Implant

Aim

The aim this study was to evaluate the factors that influence the presence or absence of the interproximal papilla between implants adjacent to the teeth or other implants, through clinical and radiographic evaluation.

Material and Methods

The non-probabilistic sample comprised 44 patients of both genders aged between 21 and 68 years, rehabilitated with 114 osseointegrated implants. Through a retrospective clinical study, the patients were divided according to the presence or absence of the interproximal papilla: Group 1 - Absence of Papilla, Group 2 - Partial Presence of Papilla and Group 3 - Total Presence of Papilla. The success of the implants, the periodontal biotype, and the vertical and horizontal distances of the interproximal regions included in the study were evaluated.

Results

Of the 114 implants, 46.5% were considered unsuccessful, and bleeding was present in 29.8%. The periodontal biotype presented as thin and scalloped was found in 85.1% of the regions. The evaluation of the groups according to the confirmation of the interproximal space showed a statistically significant difference (p = 0.007), with 61.9% of the wide and long interproximal spaces classified as Group 1, while 31% of the narrow and short interproximal spaces were classified as Group 3.

Conclusion

It was concluded that the morphology of the interproximal space was the factor that was most strongly associated with the presence or absence of the interproximal papilla.

Peri-implant health

OBJECTIVE

The aim is to define clinical and histologic characteristics of peri-implant tissues in health and describe the mucosa-implant interface.

IMPORTANCE

An understanding of the characteristics of healthy peri-implant tissues facilitates the recognition of disease (i.e., departure from health).

FINDINGS

The healthy peri-implant mucosa is, at the microscopic level, comprised of a core of connective tissue covered by either a keratinized (masticatory mucosa) or non-keratinized epithelium (lining mucosa). The peri-implant mucosa averages about 3 to 4 mm high, and presents with an epithelium (about 2 mm long) facing the implant surface. Small clusters of inflammatory cells are usually present in the connective tissue lateral to the barrier epithelium. Most of the intrabony part of the implant appears to be in contact with mineralized bone (about 60%), while the remaining portion faces bone marrow, vascular structures, or fibrous tissue. During healing following implant installation, bone modeling occurs that may result in some reduction of the marginal bone level.

CONCLUSIONS

The characteristics of the peri-implant tissues in health are properly identified in the literature, including tissue dimensions and composition. Deviation from the features of health may be used by the clinician (and researcher) to identify disease, including peri-implant mucositis and peri-implantitis.

Maxillary Sinus Floor Augmentation With Autogenous Bone Graft From the Ascending Mandibular Ramus

PURPOSE

The objective of the present study was to assess patient satisfaction and esthetic implant outcome 10 years after maxillary sinus floor augmentation with autogenous bone graft from the mandibular ramus.

MATERIALS AND METHODS

Maxillary sinus floor augmentation with autogenous bone graft from the mandibular ramus was conducted in 48 consecutive patients from 2002 to 2006. Records and radiographs were retrospectively analyzed. Twenty-four patients including 34 sinus augmentation procedures and 37 implants were evaluated after 10 years. Subjective and professional evaluations of the final periimplant soft tissue, implant crown, and total implant treatment were conducted.

RESULTS

The 10-year survival of suprastructures and implants was 84% and 100%, respectively. The patients were highly satisfied with the esthetic and implant treatment outcome expressed by scores >90 on the visual analog scale. Most implants were characterized by scores of 1 or 2, resulting in a mean pink esthetic score of 9 (maximum 14) and a white esthetic score of 8 (maximum 10).

CONCLUSION

Maxillary sinus floor augmentation with autogenous bone graft is characterized by high long-term implant survival rate and patient satisfaction.

Does Peri-Implant Mucosa Have a Prognostic Value?

The need for keratinized tissue around implants remains a controversial topic. However, reconstruction of keratinized mucosa may be needed to facilitate restorative procedures, improve aesthetics, and control plaque during oral hygiene. Free gingival grafts, connective tissue grafts, allogenic/xenograft materials, and apically positioned flaps have been used to augment soft tissue around implants. Four different timing protocols have been explored with regard to soft-tissue augmentation: before and during implant placement, during the second-stage surgery, or after restoration. The timing and technique of soft-tissue augmentation remain controversial and lack support from literature. Long-term clinical studies to establish clear guidelines are warranted.

Periodontal complications with age

The present literature review on periodontal complications in aging focuses on the diagnosis, etiology and development of periodontal complications as a complete entity. In addition, the review also focuses on some of the common systemic diseases that either may further add to periodontal complications or, as result of anti-inflammatory treatment, limit the expression of periodontal disease. There is no evidence to suggest that clinical methods to provide periodontal therapies have been developed especially for older individuals. There is evidence that aging can be associated with periodontally healthy conditions through life and with a high level of tooth retention and function. Periodontal complications that are difficult to manage are usually associated with concurrent medical diseases and complications, or with socio-economic factors that limit the ability to provide dental care for the aging population. Currently, some systemic medical conditions are managed with anti-inflammatory medications with positive effects, while slowing the progression and expression of chronic periodontitis. The lack of data from clinical studies on how to manage periodontal complications in aging is obvious.

Prosthetic Rehabilitation of Edentulous Patients With Implants Based on Facial Profile Assessment: A Case Report

PURPOSE

To introduce a user-friendly protocol for implant-retained prosthetic rehabilitation of fully edentulous patients based on facial profile and the cephalometric intermaxillary relationship.

MATERIALS AND METHODS

The prosthetic rehabilitation of edentulous patients with implants based on facial profile assessment protocol commences with a clinical and cephalometric analysis, followed by a preliminary projection to obtain a harmonious interarch relationship, eventually stabilized by the preplanned prosthesis. The protocol is divided into the following 5 phases: esthetic evaluation; cephalometric-occlusal assessment; surgery; provisionalization; and definitive prosthesis. Evaluation of patient's satisfaction from the treatment provided was performed through a preoperative and postoperative visual analogue scale scores.

RESULTS

The patient was granted immediate function and superior esthetics at day 1 of the treatment. These results were re-evaluated on an interval of 18 months and continued to be stable. The overall treatment time was significantly reduced.

CONCLUSION

Our recommended protocol gives the clinician a chance to grasp results beyond the offered by traditional protocols by using a wider perspective of rehabilitation, involving the patient's facial profile, thus fulfilling the integration of both occlusal and cephalometric parameters in a unified surgical-prosthetic approach.

Effectiveness and compliance of an oscillating-rotating toothbrush in patients with dental implants: a randomized clinical trial

Background

The aim of this randomized clinical trial was to assess the efficacy of an oscillating-rotating toothbrush in reducing plaque and inflammation around dental implants.

Methods

Eighty patients presenting dental implants were enrolled in this study and assigned randomly to two different groups: 40 patients in the test group and 40 in the control one. Each patient in the test group received an oscillating-rotating toothbrush while in the control group patients kept using the manual toothbrush. Furthermore, the test group received a special toothbrush head designed for dental implants and another one for natural teeth. Domiciliary oral hygiene instructions were given to both groups. Periodontal parameters like plaque index (PI), bleeding on probing (BoP), and probing pocket depth (PPD) were recorded at the baseline and after 1 and 3 months.

Results

At the end of the study, the difference of plaque and bleeding indices with the baseline was statistically significant for both test and control groups (P < 0.0001). Implant sites showed higher values of both BoP and PI when compared to the natural teeth. In the second part of the study, comparing the 1–3-month period, the oscillating-rotating toothbrush was effective in reducing new plaque formation (P < 0.0001) and bleeding (P < 0.0001) both at the implant sites and the dental sites comparing to manual ones (P > 0.05). No significant differences were appreciated concerning the PPD.

Conclusions

The oscillating-rotating toothbrush can be successfully used for the plaque and bleeding control of the peri-implant tissues.

Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla

BACKGROUND

Resorption of hard and soft tissues following immediate implant insertion is frequently reported. Data regarding the influencing factors on facial tissue thickness are rare.

PURPOSE

This retrospective study investigated the impact of connective tissue grafting, the orofacial angulation and position of immediately inserted and provisionalized implants on the facial hard and soft tissue thickness in the anterior maxilla within a 1- to 5-year follow-up.

MATERIAL AND METHODS

Implants with the prerequisite of having preoperative and postoperative cone beam computed tomography (CBCT) and a follow-up of 1 to 5 years were included. Facial bone deficiencies were grafted flaplessly with autogenous bone in all sites. In a subgroup of implants additional connective tissue grafting was performed, whereas the remaining implants were not grafted with soft tissue. The orofacial tooth and implant angulation, the change of horizontal position and the facial bone thickness were measured by CBCT, the facial mucosa thickness by an ultrasonic device.

RESULTS

In total, 76 implants were placed in 55 patients. Sixty-nine sites showed a facial bone defect. Thirty-eight received a connective tissue graft additionally. All implants were still in function after a mean follow-up of 36 months. The mean thickness of the facial mucosa was 1.72 mm at 1 mm, 1.63 mm at 4 mm, 1.52 mm at 6 mm, and 1.66 mm at 9 mm apically to mucosal margin. The bone thickness was 0.02, 0.25, and 0.36 mm initially and 1.32, 1.26, and 1.11 mm finally at 1, 3, and 6 mm apically to implant shoulder level. Mixed model analysis revealed an impact of the preoperative bone status on the facial bone increase. The facial soft tissue thickness was significantly influenced by the gingival biotype.

CONCLUSIONS

The results indicate that an initial severe hard tissue defect allows for significant bone regeneration. The facial soft tissue thickness is primarily influenced by the gingival biotype.

Esthetic evaluation of natural teeth in anterior maxilla using the pink and white esthetic scores

BACKGROUND

Natural teeth in the anterior maxilla are critical in determination the esthetic outcome of single implant prosthesis.

PURPOSE

The present study aimed to explore aesthetics of natural teeth in the anterior maxilla using the Pink Esthetic Score/White Esthetic Score (PES/WES) index. Additionally, inherent weak spots of natural teeth and high-risk parameters of prostheses were also considered.

MATERIAL AND METHODS

This cross-sectional study was performed by photographic analysis.

RESULTS

A total of 102 subjects and 306 teeth (the right incisor, lateral incisor and canine) were included. The grand means of the PES and WES were 12.92 and 8.75, respectively. The score of soft tissue margin, soft tissue contour and outline/volume of the crown were significantly lower than other variables. The PES and WES showed a downward trend with age. Most of the PES/WES values of the females exceeded those of the males.

CONCLUSION

The average level of natural teeth in PES and WES assessment were around 13 and 9, respectively. The soft tissue margin, soft tissue contour and outline/volume of the crown were high-risk parameters for the esthetic outcomes of implant reconstructions. Underlying factors, such as age and gender, contributed to the esthetics of natural teeth change.

Soft-tissue esthetic outcome of single implants: Immediate placement in fresh extraction sockets versus conventional placement in healed sockets

Background:

Immediate implant placement has advantages such as requiring fewer surgical procedures and decreased treatment time; however, unpredictable soft- and hard-tissue outcome is a problem. This study aimed to compare the soft-tissue esthetic outcome of single implants placed in fresh extraction sockets versus those placed in healed sockets.

Materials and Methods:

This cross-sectional, retrospective study was performed on 42 patients who received single implants. Twenty-two patients with a mean age of 40.14 years received immediate implants while 18 patients with a mean age of 43.40 years were subjected to conventional (delayed) implant placement. The mean follow-up time was 14.42 ± 8.37 months and 18.25 ± 7.10 months in the immediate and conventional groups, respectively. Outcome assessments included clinical and radiographic examinations. The esthetic outcome was objectively rated using the pink esthetic score (PES).

Results:

All implants fulfilled the success criteria. The mean PES was 8.54 ± 1.26 and 8.10 ± 1.65 in the immediate and conventional groups, respectively. This difference was not statistically significant (P = 0.329). The two PES parameters, namely, the facial mucosa curvature and facial mucosa level had the highest percentage of complete score.

Conclusions:

Immediate and conventional single implant treatments yielded comparable esthetic outcomes.

Assessment of CAD-CAM zirconia crowns designed with 2 different methods: A self-controlled clinical trial

STATEMENT OF PROBLEM

In computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the correlation method is an efficient way to design complete crowns. However, the occlusal relationship and patient satisfaction with prostheses fabricated using this method remain unclear.

PURPOSE

The purpose of this clinical trial was to compare the occlusion of monolithic zirconia crowns designed using the correlation and library methods.

MATERIAL AND METHODS

Twenty-three teeth of 21 participants received 2 monolithic zirconia crowns designed by using the correlation or the library method. Defective teeth were scanned using an intraoral scanner to obtain references and working casts from before and after the preparation. Before cementation, the occlusal relationship of both crowns and patient satisfaction were evaluated, and the occlusal adjustment time was recorded.

RESULTS

The correlation method resulted in less lateral occlusal interference of the crowns than the library method (P<.01). The occlusal adjustment times of the correlation and library conditions were 455.8 ±357.1 seconds and 575.3 ±488.0 seconds, respectively (P>.05). Relative occlusal force was significantly higher in the correlation than in the library condition and was related to before preparation relative occlusal force (r=0.706, P<.01). The visual analog score before occlusal adjustment was higher in the correlation than in the library condition (P<.05). The occlusal contacts, occlusal contact distributions, and number of occlusal contacts did not differ between conditions (P>.05).

CONCLUSIONS

Better eccentric occlusion and reduced lateral occlusal interference were obtained when the correlation method was used to design crowns. The correlation method yielded higher relative occlusal force, which helped to restore the original occlusal force.

Comparison of interdental papilla around single implants in the anterior maxilla between two implant systems: A cohort study

Background. In successful replacement of a tooth with a dental implant, soft tissue esthetic is as important as stability and function of the implant. Quality and quantity of the peri-implant mucosa can influence esthetic outcomes. This study assessed implant esthetic success of two different implant systems. In this regard the interdental papilla was evaluated and the relation-ship between implant type and crestal bone loss adjacent to implant was assessed.

Methods. Eighteen patients (11 males, 7 females) with a total of 18 implants participated in this historical cohort study. Patients were divided into two groups based on the type of implants: Implantium group and SPI group; 36 interproximal papillae were evaluated photographically, using Jemt’s papillary presence index (PPI). Radiographic analysis was carried out to find out the relation between bone loss and type of implant. Analysis of data was performed with SPSS 18, using Fisher's exact test, independent t-test, Spearman's correlation coefficient and ANOVA.

Results. Comparison of photographs did not show a statistically significant difference in PPI between the two groups (P=0.94). Radiographic evaluation of crestal bone loss adjacent to implant shoulder did not reveal significant differences between the two groups (P=0.30).

Conclusion. Implant therapy in the anterior maxilla, using Implantium or SPI system, did not result in significant differences in esthetics. In this study, there was an inverse relationship between the distance of contact point to bone crest and papilla index (P=0.002 in the SPI group) (P=0.02 in the Implantium group).

Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports

OBJECTIVE

Many techniques have been developed to enhance the gingival thickness, gingival level and emergence profile around the implant in the esthetic zone.

INTRODUCTION

In this study, a buccal rotational flap was used to improve the implant site in the esthetic zone and increase gingival tissue thickness.

METHODS

Two cases involved the use of a rotational flap during second-stage implant surgery, one case involved the use of a temporary crown with a healing abutment, and another case involved the use of a healing abutment.

RESULT

The cases were followed up until the final crown was placed. The implant site was improved in 2 cases; the gingival thickness increased, the gingival level was enhanced and the emergence profile was developed.

CONCLUSION

Many factors affect the results of a rotational flap; some factors are surgical, while others are prosthetic, biological and anatomical.

Anterior single implants with different neck designs: 5 Year results of a randomized clinical trial

BACKGROUND

The design of the implant neck might be significant for preservation of marginal bone.

PURPOSE

To compare the 5-year radiographic and clinical outcome of single anterior implants provided with a smooth neck, a rough neck or a scalloped rough neck.

MATERIALS AND METHODS

93 Patients with a missing anterior tooth in the maxilla were included. At random, patients received an implant with a 1.5 mm smooth neck ("smooth group"), a rough neck with grooves ("rough group") or a scalloped rough neck with grooves ("scalloped group"). Implants were installed in healed sites. Follow-up visits were conducted after final crown delivery and 1 year and 5 years later.

RESULTS

Scalloped implants showed significantly more initial marginal bone resorption. The total amount of bone loss was 1.26 ± 0.90 mm in the smooth group, 1.20 ± 1.1 mm in the rough group and 2.28 ± 0.97 mm in the scalloped group (P < .05). Survival rates were 96.2% for the smooth and scalloped group and 100% for the rough group. Scalloped implants showed deeper pocket depths, more bleeding and more technical complications. There were no differences in esthetic outcome nor in patient satisfaction.

CONCLUSIONS

For anterior single tooth replacements, scalloped implants show less favorable radiographic and clinical outcome compared to regular implants with a smooth neck or rough neck.

Gingival profiles in a select Asian cohort: A pilot study

AIM

The aim of the present study was to determine the facial gingival profiles of teeth with a healthy periodontium in an Asian population.

METHODS

A total of 51 patients with a healthy periodontium were examined. Gingival thickness (GT) and gingival width (GW) were assessed at the maxillary and mandibular incisors to the first molars. GT was measured by transgingival probing (GT-TGP), and probe visibility through the marginal gingiva (GT-TRAN) was assessed. Results between groups (anterior and posterior, tooth types) were analyzed using one-way analysis of variance and t-test.

RESULTS

The mean age was 30.3±11.4 years, with 27 females and 24 males. The mean GT-TGP was 1.39±52 mm, while the mean GW was 4.59±1.34 mm. Considerable intra-individual and interindividual variation in GT (TGP and TRAN) was noted. GT increased from the anterior to posterior, and was thinnest at the mandibular centrals to the first premolars and maxillary canines. GT-TGP and GW were influenced by tooth type, plaque, recession, and TRAN, but not age, sex, or ethnicity. GW were recorded lowest at the mandibular canines and all premolars. Thin gingiva was recorded at 63.8%-92% (GT-TGP<1.5 mm) and 75%-90% (GT-TRAN) of the anterior teeth.

CONCLUSION

A high percentage of anterior teeth had thin marginal gingiva. There was poor agreement between GT-TGP and GT-TRAN.

Effect of Microthread Design on Marginal Bone Level Around Dental Implants Placed in Fresh Extraction Sockets

PURPOSE

This study was designed to compare radiographically the effect of microthread on the coronal portion of the fixture on marginal bone level (MBL) around immediately placed dental implants in human subjects.

MATERIAL AND METHODS

Forty-one roughened surface screw type Dentium oral implants (Dentium) were inserted in fresh extraction sockets of the anterior segment of maxilla of 30 patients. The implants were selected randomly using either microthread design on coronal portion of the fixture (Implantium) (test group) or without microthread thread design (Superline) (control group). MBL was measured using digital subtraction radiography technique after 3, 6, and 12 months.

RESULTS

At month 3, the microthread groups have been associated with more marginal bone loss than the control group (P = 0.04). At months 6 and 12, both groups had comparable bone levels (P = 0.21).

CONCLUSION

The microthread design of the implant collar could not have a positive effect in maintaining the MBL around implants placed in fresh extraction socket in anterior maxilla.

Long-term Stability of Soft Tissue Esthetic Outcomes Following Conventional Single Implant Treatment in the Anterior Maxilla: 10-12 Year Results

Purpose:

The present study aimed to evaluate the long-term stability of esthetic outcomes of soft tissue around maxillary anterior single-tooth implants after 10-to-12 years of loading.

Methods:

Patients who had been treated for single-tooth implants in the anterior maxilla between February 2000 and July 2002 were invited to participate in the study. All implants had been placed according to delayed implant placement and conventional loading protocols without any connective tissue graft or papilla preservation flaps. Pink Esthetic Score (PES) was rated using standardized clinical photographs to assess the esthetic outcomes of the implant treatment at the time of crown placement and at time of follow-up examination which was at least 10 years after the crown placement.

Results:

A total of 19 patients were included. The mean score of PES was 11.63 (SD 1.61; range 7-14) at baseline. After 10-to-12 years of function, a mean PES score of 11.05 (SD 2.09; range 6–14) was recorded. No significant differences were found in the esthetic outcomes, categorized based on clinically relevant levels, between the baseline and follow-up session (p>0.05).

Conclusion:

Within limitation of the present study, it can be concluded that the esthetic outcomes of soft tissue around the maxillary anterior single-tooth implants placed using conventional implant placement technique remained stable in the long-term.

Factors Influencing the Soft Tissue Changes Around Single Laser Microtextured Implants-Abutments in the Anterior Maxilla: A 5-Year Retrospective Study

PURPOSE

The aim of this study was to evaluate the possible factors that influenced the periimplant soft tissue changes around single implants-abutments with laser-microtextured surface (LMS) in the esthetic zone.

MATERIALS AND METHODS

Thirty-nine units, formed by implant-abutment with LMS were studied. Variables possibly associated with the periimplant soft tissue changes were obtained from clinical measurements (plaque [present/absent], periimplant biotype [thin/thick], and probing depth); intrasurgical measurements (vertical height in millimeters of the keratinized gingiva in the vestibular part of the implant site vestibular keratinized gingiva [VKG], implant vestibular crestal exposition, vestibular crestal level, and vestibular bone width); cast models (implant position [buccal/palatal], implant abutments angle); periapical radiographs (distance from the contact point to the interproximal bone crest of the adjacent tooth [CP-BC], distance from the contact point to the implant platform [CP-P], distance from the contact point to the first bone to implant contact [CP-IB]); and digital clinical photographs. Fisher exact test was used to determine the influence of each factor on the papilla level and on the facial marginal mucosal level.

RESULTS

The papillae level at the implant sites was significantly associated with the distance from the contact point to the alveolar bone crest, whereas no association was found with other variables. Periimplant biotype, differences in the VKG, CP-BC, and CP-IB were found associated with the different facial marginal mucosal level groups.

CONCLUSIONS

This study showed that the papilla level at single-tooth implants-abutments with LMS in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth, whereas the marginal mucosal level was affected by periimplant biotype, facial bone crest level, and crestal implant exposition.

Esthetic outcome for maxillary anterior single implants assessed by different dental specialists

PURPOSE

The aim of this study was to assess the esthetic outcome of maxillary anterior single implants by comparing the esthetic perception of dental professionals and patients.

MATERIALS AND METHODS

Twenty-three patients with single implants in the esthetic zone were enrolled in this study. Dentists of four different dental specialties (Three orthodontists, three oral surgeons, three prosthodontists, and three periodontists) evaluated the pink esthetic score (PES)/white esthetic score (WES) for 23 implant-supported single restorations. The satisfactions of the patients on the esthetic outcome of the treatment have been evaluated according to the visual analog scale (VAS).

RESULTS

The mean total PES/WES was 12.26 ± 4.76. The mean PES was 6.45 ± 2.78 and mean WES was 5.80 ± 2.82. There was a statistically significant difference among the different specialties for WES (P<.01) and Total PES/WES (P<.01). Prosthodontists were found to have assigned poorer ratings among the other specialties, while oral surgeons gave the higher ratings than periodontists, orthodontists, and prosthodontists.

CONCLUSION

Prosthodontists seemed to be stricter when assessing aesthetic outcome among other specialties. Moreover, a clear correlation existed between dentists' and patients' esthetic perception, thereby providing rationales for involving patients in the treatment plan to achieve higher levels of patient satisfaction.