Clinical and radiographic peri-implant health status around narrow diameter implant-supported single and splinted crowns

Retrospective study on the clinical and radiographic outcomes of 2.8 mm diameter implants supporting fixed prostheses up to 11 years

OBJECTIVES

This study aimed to report the clinical and radiographic results of 2.8 mm two-piece narrow diameter implant (NDI) supporting fixed restorations.

MATERIALS AND METHODS

Clinical and radiographic data of 54 NDIs in 32 patients were retrospectively assessed after 2 to 11 (mean 8.17) years of follow-up. Clinical and radiographic measurements were taken. Survival rate, implant and prosthesis failure, pink aesthetic scores (PES), white aesthetic scores (WES), bleeding on probing (BOP), probing depth (PD), marginal bone loss (MBL), and mechanical and biological complications were evaluated.

RESULTS

An implant failed during the follow-up period, resulting in a cumulative survival rate of 98.15% at the implant level and 96.88% in the patient. The total mean values of PES and WES for 2.8 mm NDIs were 7.09 ± 1.15 (range: 3.33-9.00) and 7.42 ± 1.03 (range: 3.67-9.33). The prevalence of sites with positive BOP was 38.14 ± 29.77%. The mean PD value was 2.46 ± 0.62 mm. The average MBL was 1.15 ± 0.74 mm (range: 0.25-4.03 mm). No implant or abutment fracture was detected. A veneer chipping was present in one patient, and a loose crown appeared in another patient. Two implants (3.7%) and two patients (6.3%) were diagnosed with peri-implantitis.

CONCLUSION

Within the limitation of the study, the results indicate that the use of two-piece 2.8 mm NDI for the fixed prosthetic rehabilitation of edentulous regions with reduced interdental and/or buccal-lingual width is viable.

Impact of splinting implant-supported crowns on the performance of adjacent posterior implants: A systematic review and meta-analysis

STATEMENT OF PROBLEM

While rehabilitation with implant-supported crowns in the posterior region is widely practiced, guidance on clinical considerations when choosing between splinted or nonsplinted implant-supported crowns is limited.

PURPOSE

The purpose of this systematic review with meta-analysis was to assess whether adjacent implants with internal connections in the posterior region should be treated with splinted or nonsplinted crowns.

MATERIAL AND METHODS

The systematic review was registered on the prospective register of systematic reviews (PROSPERO) under the code, CRD42021248525. Two authors searched 4 electronic databases (PubMed, Cochrane Library, Scopus, and Web of Science) independently for articles published up to December 2023. Additionally, a hand search was conducted in the nonpeer-reviewed literature and the reference lists of included articles. Only clinical studies comparing splinted and nonsplinted hexagonal or conical internal connection adjacent implants in the posterior region were considered. A single-arm meta-analysis was conducted using RevMan. Risk of bias and quality were assessed using the Cochrane Collaboration's Tool for Assessing Risk and the Newcastle-Ottawa scale.

RESULTS

Qualitative synthesis included 17 studies, and quantitative synthesis involved 13 studies. A total of 2085 implants (1244 splinted and 841 nonsplinted) were inserted in 1027 participants, with observation times ranging from 5 months to 16 years. Thirteen studies related the type of crown retention (cemented or screw-retained). Only 2 studies related annual bone loss results considering the type of crown retention, but whether they were splinted or nonsplinted crowns and significant differences were not specified. The meta-analysis revealed no statistical differences between splinted and nonsplinted implants for biological complications (P=.95, I2=0%). However, the nonsplinted implants exhibited significantly more mechanical complications than the splinted implants (P<.001, I2=1%, RR 0.37; 95% IC [0.26-0.54]). The studies included demonstrated a low risk of bias and were of good quality.

CONCLUSIONS

Splinting was not found to affect the incidence of biological complications in posterior adjacent implants. However, more mechanical complications occurred in nonsplinted crowns than splinted ones.

Long-Term Clinical Outcomes and Risk Indicator Analyses of Narrow-Diameter Implants in the Posterior Jaw: A Retrospective Cohort Study of 10 to 27 Years

OBJECTIVES

To assess the long-term clinical outcomes and patient satisfaction with narrow-diameter implants (NDIs) in the posterior jaws and to identify the risk indicators for NDI failure.

MATERIALS AND METHODS

This retrospective study reviewed 479 patients with 666 NDIs (diameter ≤ 3.5 mm) -supported fixed prostheses in posterior jaws, with a minimum 10-year follow-up. Implant survival, success, complications, demographics, and implantation characteristics were collected. Risk indicators for posterior NDI failure were analyzed using multilevel Cox regression analyses with mixed effects. Patient satisfaction and oral health impact profile (OHIP) were surveyed in a random 10% sample.

RESULTS

Over a mean follow-up of 14.0 ± 3.6 years, implant survival was 95.9% at the implant level and 94.6% at the patient level. Success rates were 93.5% at the implant level and 91.6% at the patient level. Multilevel Cox regression analysis identified an implant length of 10 mm or less (p = 0.001) and the use of single crowns (p = 0.005) as significant risk indicators for posterior NDI failure. Patients showed high satisfaction (4.54/5) with posterior NDIs, and the mean OHIP score of 1.15 reflected an acceptable level of oral health.

CONCLUSION

NDIs in the posterior jaws demonstrated robust long-term success and high patient satisfaction. An implant length of 10 mm or less and the use of single crowns are potential risk indicators for posterior NDI failure.

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR2200062337 on 2022/08/02.

An up to thirty-year retrospective study on the success and survival of single unit and splinted implant-supported crowns in a dental school setting

STATEMENT OF PROBLEM

Studies investigating the survival of implant-supported crowns provided in a dental school setting are sparse.

PURPOSE

The purpose of this retrospective study was to evaluate the success and reasons for failure of single unit and splinted implant-supported crowns provided in a dental school.

MATERIAL AND METHODS

Using the axiUm dental management software program and paper charts, all single unit and splinted implant-supported crowns provided between September 1989 and January 2020 were included for evaluation. Success, survival, and failure were recorded as well as reasons for failure. A Kaplan-Meier survival estimate with an associated P value, a life table analysis, and a log-rank test comparing the survival of single unit and splinted implant-supported crowns were performed.

RESULTS

Over 30 years, 678 implant-supported crowns (586 single unit and 92 splinted) had been provided. Of these crowns, 17 (2.90%) single unit crowns and 5 (5.43%) splinted crowns failed, with most being prosthetic failures for both single units (64.7%) and splinted (80%), rather than biologic failures. A total of 371 single unit (63.3%) and 46 splinted (50.0%) implant crowns were a complete success, and 215 single unit (36.7%) and 46 splinted (50.0%) crowns survived but had some type of complication. The overall implant-supported crown survival rate was 96.8%. The survival distribution of the single unit and splinted implant-supported crowns was not statistically significantly different [χ2(2)=1.285, P=.257].

CONCLUSIONS

Both single unit and splinted implant-supported crowns had high success rates and showed similar survival rates. The most common causes of complications were also similar, with debonding and screw loosening of crowns being the most common complication for both single unit and splinted crowns.

Clinical challenges of biomechanical performance of narrow-diameter implants in maxillary posterior teeth in aging patients: A finite element analysis

This study evaluated the biomechanical performance of narrow-diameter implant (NDI) treatment in atrophic maxillary posterior teeth in aging patients by finite element analysis. The upper left posterior bone segment with first and second premolar teeth missing obtained from a patient's cone beam computed tomography data was simulated with cortical bone thicknesses of 0.5 and 1.0 mm. Three model groups were analyzed. The Regimen group had NDIs of 3.3 × 10 mm in length with non-splinted crowns. Experimental-1 group had NDIs of 3.0 × 10 mm in length with non-splinted crowns and Experimental-2 group had NDIs of 3.0 × 10 mm in length with splinted crowns. The applied load was 56.9 N in three directions: axial (along the implant axis), oblique at 30° (30° to the bucco-palatal plane compared to the vertical axis of the tooth), and lateral load at 90° (90° in the bucco-palatal plane compared to the vertical axis of the tooth). The results of the von Mises stress on the implant fixture, the elastic strain, and principal value of stress on the crestal marginal bone were analyzed. The axial load direction was comparable in the von Mises stress values in all groups, which indicated it was not necessary to use splinted crowns. The elastic strain values in the axial and oblique directions were within the limits of Frost's mechanostat theory. The principal value of stress in all groups were under the threshold of the compressive stress and tensile strength of cortical bone. In the oblique and lateral directions, the splinted crown showed better results for both the von Mises stress, elastic strain, and principal value of stress than the non-splinted crown. In conclusion, category 2 NDIs can be used in the upper premolar region of aging patients in the case of insufficient bone for category 3 NDI restorations.

Use of narrow-diameter implants in the posterior segments of the jaws: A retrospective observational study of 2 to 11 years

STATEMENT OF PROBLEM

The placement of narrow-diameter implants (NDIs) in the posterior region is still debated in view of the high biomechanical risks in these areas.

PURPOSE

The purpose of this retrospective observational study was to evaluate the success and survival rates of NDIs restored with fixed prostheses in the posterior region (primary outcome) and analyze whether splinting multiple units (prosthesis design) affects the biological and mechanical complications (secondary outcome).

MATERIAL AND METHODS

Dental records from 2 private clinics were reviewed for NDIs in the posterior region installed between 2009 and 2018. Ninety study participants (58 women and 32 men) aged between 21 and 84 years (mean age 49.9 years) were recalled for the assessment of implant survival and success of 160 NDIs previously provided for partial posterior edentulism associated with moderate horizontal bone loss or reduced interradicular space (105 premolars and 55 molars). The implants were restored with metal-ceramic single crowns or splinted multiple-unit prostheses, either screw-retained or cemented on custom (n=100) or stock titanium abutments (n=60). Peri-implant probing depth (PPD), bleeding on probing (BOP), bone quality, type of edentulism, and patient satisfaction were scored. The chi-squared test for independence and 2-sample Welch t test were performed for statistical analysis (α=.05).

RESULTS

The overall success rate was 89.37%. One implant had been removed 4 years after loading, another after 9 years, yielding a cumulative survival rate of 98.75%. Fourteen implants exhibited PPD > 5 mm. One implant and 1 abutment screw fractured, and 16 restorations demonstrated porcelain chipping. The chi-squared test showed no significant relationship between prosthetic design and complications whether biological (P=.087) or mechanical (P=.805). Eighty-two percent of patients were satisfied with esthetics, 76% with function, 85% with total duration of treatment, and 90% with overall treatment cost.

CONCLUSIONS

Within the limitations of this retrospective study, NDIs may be considered a reliable option to replace posterior teeth. The prosthetic design had no significant impact on biological or mechanical complications.

Implant prosthodontic design as a predisposing or precipitating factor for peri-implant disease: A review

Over the past decade, emerging evidence indicates a strong relationship between prosthetic design and peri-implant tissue health. The objective of this narrative review was to evaluate the evidence for the corresponding implant prosthodontic design factors on the risk to peri-implant tissue health. One of the most important factors to achieve an acceptable implant restorative design is the ideal implant position. Malpositioned implants often result in a restorative emergence profile at the implant-abutment junction that can restrict the access for patients to perform adequate oral hygiene. Inadequate cleansability and poor oral hygiene has been reported as a precipitating factors to induce the peri-implant mucositis and peri-implantitis and are influenced by restorative contours. The implant-abutment connection, restorative material selection and restoration design are also reported in the literature as having the potential to influence peri-implant sort tissue health.

A comparison of marginal bone loss, survival rate, and prosthetic complications in implant-supported splinted and nonsplinted restorations: A systematic review and meta-analysis

Aim

To compare marginal bone loss (MBL), implant survival rate and prosthetic complications of implant-supported splinted and non-splinted restorations (NSR).

Settings and Design

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines (PRISMA). The PROSPERO registry, which keeps track of prospective systematic reviews, also received this paper (CRD42021229477).

Material and Methods

An electronic search was done in PubMed, the Cochrane Central Trials Register, Scopus, Science Direct, and Google Scholar searches were carried out. The search was limited to articles published in English and covered the period from January 2010 to August 2020.

Statistical Analysis Used

To conduct the meta analysis, researchers employed methodologies such as continuous measurement and odds ratios.

Results

For both qualitative and quantitative analysis, 19 scientific studies were chosen. 3682 implants were placed in 2099 patients with a mean age of 59 years (splinted, 2529; non-splinted, 1153); the mean age was not provided in 5 trials. For splinted restorations, there were statistically significant differences in MBL, indicating the former has less MBL than for NSR. Splinted restorations had much greater survival rates than NSR, according to a qualitative study. Rest prosthesis complications with or without splinting were essentially the same.

Conclusions

Splinted implant restorations lost less bone than non-splinted implant restorations, according to this meta analysis. This was particularly true for posterior restorations. Lower implant failure was associated with splinted restorations. Restorations with and without splinting had the same level of prosthetic problems.

Survival Rates of Splinted and Nonsplinted Prostheses Supported by Short Dental Implants (≤8.5 mm): A Systematic Review and Meta-Analysis

PURPOSE

To evaluate and compare the implant survival rates, marginal bone loss, and mechanical complications of prostheses supported by splinted and nonsplinted short implants (≤8.5 mm).

MATERIAL AND METHODS

Electronic database (MEDLINE, CENTRAL, Web of Science, and EMBASE) and manual searches up to May 2021 were conducted to identify studies comparing splinted and nonsplinted short implants (≤8.5 mm). The primary outcome was implant survival rate. Secondary outcomes were marginal bone loss and mechanical complications. The quality of included studies and risk-of-bias were assessed according to the Newcastle-Ottawa Scale. A random-effects model was used to analyze the data.

RESULTS

Twelve studies fulfilled the inclusion criteria and featured 1506 short implants (596 nonsplinted and 910 splinted) with a follow-up time ranging from 1 to 16 years. Quantitative analysis found no statistically significant differences between splinted and nonsplinted short implants (≤8.5 mm) for survival rate (RR = 0.98; 95% CI 0.96, 1.01; p = 0.26)) and marginal bone loss (SMD = -0.08; 95% CI - 0.23, 0.07; p = 0.28). Veneer chipping, abutment screw breakage, screw loosening, and loss of retention were reported in the selected studies as common complications. However, no statistically significant difference was found between splinted and nonsplinted short implants (RR = 0.56; 95% CI 0.20, 1.54; p = 0.26).

CONCLUSIONS

Within the limitations of the present meta-analysis, it might be concluded that splinted short implants (≤8.5 mm) do not present superior performance in survival rate, marginal bone maintenance and prevention of mechanical complications compared with single-unit prostheses.

Association of Self-Rated Pain with Clinical Peri-Implant Parameters and Cytokine Profile in Smokers and Never Smokers with and without Peri-Implantitis

To examine the association between self-perceived pain (SPP), clinical and radiographic peri-implant parameters, and biomarker levels among smokers and never smokers with and without peri-implantitis. Sixty individuals (20 smokers with peri-implantitis [group-1], 20 never smokers with peri-implantitis [group-2] and 20 never smokers without peri-implantitis [control-group]) were included. SPP was evaluated using a numeric pain rating scale (NPRS). Peri-implant plaque index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded. After obtaining the samples, the levels of TNF-α, MMP-1, and IL-8 were measured. The mean SPP score in group-1, group-2, and the control group was 1.3 ± 1, 3.4 ± 1, and zero, respectively. The peri-implant mean PD (p < 0.05), BOP (p < 0.05), PI (p < 0.05), and crestal bone loss (CBL) (p < 0.05) were significantly higher among test groups than the control group. The levels of TNF-α, MMP-1, and IL-8 were significantly raised among group-1 and group-2 than the control group. A significant correlation between increasing SPP and PICF TNF-α, MMP-1, and IL-8 levels was observed based on regression analysis. Proinflammatory biomarkers were higher in smokers with peri-implantitis than never smokers with and without peri-implantitis, with a significant association between the proinflammatory cytokines and SPP.

Narrow Diameter Dental Implants as an Alternative Treatment for Atrophic Alveolar Ridges. Systematic Review and Meta-Analysis

To determine the marginal bone loss and the survival, success and failure rates of narrow dental implants, a systematic literature search was carried out in the MEDLINE (Pubmed), Cochrane, Scopus, and Scielo databases for articles published between 2010 and 2021. The exclusion criteria were: systematic reviews, case reports, expert opinions; animal studies; samples of less than 10 subjects; follow-up periods of less than 36 months; smokers of minimum 10 cigarettes/day; and articles about mini-implants for orthodontic anchorage. Meta-analyses were performed to assess marginal bone loss and implant survival, success, and failure rates. Fifteen studies were included: 7 clinical trials, 3 randomized clinical trials, 3 cohort studies, and 2 case series. The total number of subjects was 773, in whom 1245 implants were placed. The survival rate for the narrow diameter implants was 97%, the success rate 96.8%, and the failure rate 3%. Marginal bone loss was 0.821 mm. All these data were evaluated at 36 months. Based on the literature, it can be considered that there is sufficient evidence to consider small diameter implants a predictable treatment option. These show favorable survival and success rates and marginal bone loss. All of them are comparable to those of standard diameter dental implants.

Influence of implant protrusion length on non-grafting osteotome sinus floor elevation with simultaneous implant: a 3- to 9-year retrospective study

BACKGROUND

This study analyzed the influence of implant protrusion length (IPL) on the possible factors that affect the long-term outcomes utilizing non-grafting osteotome sinus floor elevation (OSFE) with simultaneous implant placement, and to explore the optimal range of IPL.

MATERIALS AND METHODS

A retrospective study design was adopted. The clinical and radiographic data of 105 implants in 65 patients were collected after 3-9 (mean 5.04) years follow-up. IPL was divided into three groups (group1, IPL<2mm; group2, 2mm≤IPL<4mm; group3, IPL≥4mm). Endo-sinus bone gain (ESBG), peri-implant marginal bone loss (MBL), bone to implant contact length (BICL), and percentage of ESBG (%ESBG) were used to evaluate non-grafting OSFE. A Kaplan-Meier analysis was performed to assess the cumulative survival rate. Multiple linear regression model was used to explore the relationship between the possible influence factors and ESBG. Analysis of variance (ANOVA) was applied to explore the correlation of IPL with ESBG, MBL, BICL, and %ESBG.

RESULTS

A total of 102 implants in 62 patients fulfilled the survival criteria, giving the cumulative survival rates of 96.4% and 94.1% for implant-based analysis and patient-based analysis, respectively. The mean ESBG, MBL, and BICL at the latest follow-up were 1.95±0.88 mm, 0.58±0.68 mm, and 5.51±1.47 mm. ESBG was found to be positively correlated to IPL. A significant decreased bone formation efficiency was found when IPL was over 4 mm (P=0.02).

CONCLUSIONS

An optimal range of IPL within 4 mm was recommended for better long-term outcomes when applying non-grafting OSFE with simultaneous implant placement.

Evaluation of the implant diameter on the initial-stability of narrow- and standard-diameter implants placed in simulated Type-I and Type-IV bone-blocks

Objective:

A comparison of the initial stability of narrow- and standard-diameter implants (SDIs) placed in Type-I and Type-IV bone-blocks is not yet reported. The aim was to evaluate in-vitro the influence of implant diameter on the initial stability of narrow- and standard-diameter implants (SDIs) placed in simulated Type-I and Type-IV bone-blocks.

Methods:

The present experimental in-vitro study was performed between July and September 2020 at the Specialist Dental Practice, Riyadh, Saudi Arabia. Narrow- and standard-diameter implants were placed 3-mm apart in simulated soft (Type-IV) and dense (Type-I) bone blocks by a trained and calibrated investigator. In groups A (Type-IV bone blocks) and B (Type-I bone blocks), implants were inserted using an insertion-torque and drilling-speed of 15-30 Ncm and 1000-1500 rpm, respectively with the implant collar at the crest of simulated bone blocks. In all samples, initial-stability was recorded using resonance frequency analysis (RFA). Sample-size estimation was done and group-comparisons were carried out. A P-value of 0.01 or less reflected statistical significance.

Results:

In Groups-A and -B, 44 (22 NDIs and 22 SDIs) and 44 (22 NDIs and 22 SDIs) were placed. In group-A, the mean RFA values for NDIs and SDIs were 68.5 ± 3.5 and 69.1 ± 2.4, respectively. In Group-B, the mean RFA values for NDIs and SDIs were 78.06 ± 9.6 and 75.3 ± 5.2. RFA values among NDIs and SDIs in groups A and B were similar.

Conclusion:

The NDIs and SDIs show comparable initial-stability when positioned in simulated Type-I and Type-IV bone blocks.

Primary stability of narrow-diameter dental implants with a multiple condensing thread design placed in bone with and without osteotomes: An in vitro study

BACKGROUND

The authors hypothesized that there is no difference in the primary stability (PS) of multiple condensing thread design (MCTD) implants placed in simulated type-IV bone with and without using osteotomes.

PURPOSE

This in vitro study assessed the PS of narrow-diameter dental implants with MCTD placed in simulated soft (type-IV) bone with and without using osteotomes.

MATERIALS AND METHODS

Sixty MCT-designed implants (diameter: 3.0 mm; length: 11.5 mm) were placed using 800 rpm drilling speed in cellular rigid polyurethane foam bone-blocks that simulated type-IV bone. Prior to placement, the implants were divided into three groups (20 implants per group) depending upon the protocol used for osteotomy preparation-Group-1: Conventional drilling (CD); Group-2: CD followed by osseous condensation using a chisel-shaped tapered osteotome with maximum diameter of 3 mm; and Group-3: CD followed by osseous condensation using a cylindrical osteotome with maximum diameter of 3 mm. Abutments were connected to all implants and PS was recorded using resonance frequency analysis (RFA) and the periotest (PTV). Group comparisons were performed using analysis and Bonferroni post-hoc adjustment tests. Level of significance was set at P < .05.

RESULTS

There was no statistically significant difference in the RFA values for the MCT-designed implants placed in groups 1, 2, and 3 (59.85 ± 0.72, 59.67 ± 0.76 and 59.42 ± 0.92, respectively). There was no statistically significant difference in the PTV values for MCT-designed implants in groups 1, 2, and 3 (1.655 ± 0.82, 1.405 ± 0.57, and 1.078 ± 0.63, respectively).

CONCLUSION

The MCTD implants with narrow diameters have a high PS in artificial soft bone in vitro. Due to the condensation effect of the thread design, there is no need for additional condensation of the peri-osteotomy bone in order to improve implant stability.

Clinical and radiographic assessment of narrow-diameter and regular-diameter implants in the anterior and posterior jaw: 2 to 6 years of follow-up

Purpose

The present retrospective clinical study aimed to evaluate and compare the clinical and radiographic parameters, complications, and satisfaction in patients who received fixed prostheses supported by narrow-diameter implants (NDIs) in the anterior and posterior jaw.

Methods

Patients aged ≥30 years who had NDI-supported fixed prostheses in the anterior or posterior region of either jaw for at least 2 years were included. Complications such as chipping of the crown; loosening or fracture of the screw, crown abutment, or implant; and loss of retention were recorded. Clinical peri-implant outcomes and crestal bone loss (CBL) were measured. A questionnaire was used to record responses regarding the aesthetics and function of the fixed restorations. Analysis of variance was used to assess the significance of between-group mean comparisons. The log-rank test was performed to analyze the influence of location and prosthesis type on technical complications.

Results

Seventy-one patients (mean age: 39.6 years) provided informed consent with a mean follow-up duration of 53 months. Only bleeding on probing showed a statistically significant difference between NDIs in the anterior and posterior regions. The complication rate for NDIs in the posterior region was significantly higher than that for NDIs in the anterior region (P=0.041). For NDIs, CBL was significantly higher around splinted crowns than single crowns (P=0.022). Overall mean patient satisfaction was 10.34±3.65 on a visual analogue scale.

Conclusions

NDIs in the anterior and posterior jaws functioned equally well in terms of peri-implant soft and hard tissue health and offered acceptable patient satisfaction and reasonable complication rates.

Esthetic aspects in implant-prosthetic rehabilitation

The esthetic component is critical for the successful outcome and patients’ satisfaction regarding the implant-prosthetic therapy. The esthetic outcome success depends mostly on the optimization of the algorithms specific to the pro-implant and implant stage as well as to the designing and technological execution of the future prosthetic restoration. A proper planning of optimal facial esthetics must involve a multidisciplinary approach with inclusion of periodontists, orthodontists, oral surgeons and implantology specialists. The dental practitioner must consider various factors that influence the esthetic outcome (tooth position, root position of the adjacent teeth, biotype of the periodontium, tooth shape, smile line, implant site anatomy, implant positioning). Also, some factors (anatomical limits of the implant site, periodontal status, occlusal parameters), which can alter the final esthetic result, must be assessed prior to planning the esthetic parameters of the future prosthetic restoration. The esthetic outcome can be improved by using new digital technologies based on software applications for assessment of clinical and biological indices of the prosthetic field, virtual planning of implants positioning and design projection of future prosthetic restoration.