A new index for rating aesthetics of implant-supported single crowns and adjacent soft tissues - the Implant Crown Aesthetic Index

Single-piece zirconia versus single-piece titanium, narrow-diameter dental implants in the anterior maxilla: 5-year post-loading results of a randomized clinical trial

OBJECTIVES

The aim of this study was to evaluate esthetic parameters in the anterior maxillary region by comparing single-piece zirconia versus titanium narrow-diameter implants. Additionally, clinical, radiological and patient-reported outcome measures (PROMs) were analyzed.

MATERIALS AND METHODS

Thirty implants (tissue level implant) were placed in 30 patients in the maxillary esthetic sector. Depending on randomization, a zirconia (test) or titanium implant (control) was placed. Esthetic, clinical, and radiological parameters, including the implant crown esthetic index (ICAI), pink esthetic score (PES), probing pocket depth, bleeding on probing, plaque index, and marginal bone levels, were evaluated at 12, 36 and 60 months after loading.

RESULTS

Sixty months after crown placement, no significant differences were found between groups. The ICAI values were 5.25 ± 4.21 and 4.50 ± 2.98 for the test and control groups, respectively. The corresponding PES values were 7.44 ± 1.93 and 7.43 ± 1.74 for the test and control groups, respectively. There were no significant intergroup differences for the rest of the parameters evaluated.

CONCLUSION

It can be suggested that monotype zirconia implants may serve as a potential alternative to titanium implants in selected clinical scenarios. While the results demonstrated comparable esthetic, clinical, and radiological aspects for zirconia implants as compared to titanium implants after a 5-year follow-up period, further research with larger sample sizes and longer-term follow-up is recommended.

High-Power Laser Application for Immediate Implant Placement in Infected Sites: A Systematic Review

Objective: The purpose of this study was to review the literatures regarding the treatment outcomes of applying laser to the infected sites in immediate implant placement. The review tended to primarily target a question: does applying high-power laser have any positive effect on infected sites in immediate implant placement? Background: Although immediate placement of dental implants has been referred to as a predictable and successful procedure, it is prone to the presence of infection that interferes with the healing process, and triggers the failure of implants. Materials and methods: A thorough electronic database search was conducted on PubMed/Medline, Embase, Web of Science, Google Scholar, and the Cochrane library in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two writers worked separately on screening the eligible studies, assessing whether there was a risk of bias, and extracting the required data. Results: Five out of the 60 studies nominated by the database search matched the inclusion criteria. The studies were carried out on a total of 192 patients with 296 implants in all. Ultimately, the study focused on 245 implants whose infected bed had been already decontaminated and prepared with the help of the high-intensity laser, used either alone or in combination with other approaches before implantation. With only nine failures, the implants inserted in infected and irradiated areas had a 96.3% overall survival rate. Conclusions: Taking the limitations of the review into account, the authors arrived at the conclusion that high-power laser irradiation can be beneficial for immediate implant placement in infected sites.

Heterogeneity of outcomes in randomized controlled trials on implant prosthodontic therapy is hindering comparative effectiveness research: meta-research study

BACKGROUND

Consistency in outcomes across clinical trials allows for comparing and combining results from different studies. A core outcome set (COS), representing a minimally agreed standardized group of outcomes that should be monitored and measured through research in a specific field of medicine, is not yet available for trials in implant prosthodontic (dental implant) therapy. This meta-research study aimed to analyze outcomes used in clinical trials on implant prosthodontic therapy.

METHODS

We searched the Cochrane Oral Health Group (COHG) register to identify systematic reviews of interventions in implant prosthodontic therapy published by October 2023. From the randomized controlled trials (RCTs) included in the relevant reviews, we extracted data on the characteristics of the included trials and the outcomes used. We categorized outcomes into domains.

RESULTS

From 182 systematic reviews in the COHG register, we included 11 systematic reviews on dental implant therapy. The reviews included 117 unique RCTs with 4725 participants, published from 1995 to 2020, which analyzed 74 different outcomes. Using different definitions, implant failure was analyzed in 73 RCTs. Seventeen RCTs did not define implant failure. Failure was most often (30 RCTs) followed up for one year. Only one RCT assessed implant failure after five years. Trials used 17 definitions of implant failure, while 17 trials did not report on the criteria of implant failure. Complications were analyzed in 48 RCTs, although they were not clearly defined in 12 RCTs. Failure of prosthodontic supra-structure was analyzed in 74 RCTs, with definitions of failure and criteria not clearly defined in 44 RCTs. Trials considered adverse events, peri-implant tissue health, patient attitudes, and other outcomes, including cost, aesthetics, or procedure duration. These outcomes were often different between trials. Twenty-six outcomes were used only once per study.

CONCLUSIONS

Clinical trials in implant prosthodontics used different outcomes, different definitions of outcomes and used different times to monitor them. Standardization of outcomes is necessary to allow comparability and evidence synthesis about the effectiveness of implant prosthodontic therapy.

Three-Dimensional Peri-Implant Tissue Changes in Immediately vs. Early Placed Tapered Implants Restored with Two Different Ceramic Materials-1 Year Results

BACKGROUND

A prospective multi-center randomized controlled clinical trial was performed to digitally analyze tissue volume changes in immediately and early placed implants with simultaneous bone augmentation restored with two different all-ceramic materials.

METHODS

A total of 60 patients received 60 bone-level tapered implants (BLT, Straumann AG) immediately (n = 30) or early placed, 8-10 weeks after tooth extraction, (n = 30). Implants were restored with all-ceramic single crowns fabricated out of zirconia (Lava Plus, 3M), or lithium disilicate (E.max CAD, Ivoclar Vivadent AG) bonded to titanium base abutments (Variobase for Cerec, Straumann AG). Impressions were taken at baseline (BL), 6 and 12 months, and STL data were used to define an area of interest (AOI) to analyze peri-implant volume changes and midfacial recessions.

RESULTS

For immediate placement, a mean volume loss of -5.56 mm3 (±5.83 mm3) was found at 6 months, and of -6.62 mm3 (±6.56 mm3) at 12 months. For early placement, a mean volume loss of -1.99 mm3 (±5.82 mm3) at 6 months, and of -3.7 mm3 (±5.62 mm3) at 12 months was found. The differences in volume loss at 12 months between the two implant placement protocols were significant (p = 0.005). In both groups, mean midfacial recessions of 0.48 mm (±0.52) occurred.

CONCLUSIONS

A more pronounced peri-implant volume loss can be expected 12 months after immediate implant placement compared with early placement.

The Influence of the Clinicians' Experience on the Outcome of Dental Implants: A Clinical Audit

The purpose of this outcome audit is to evaluate the influence of the clinicians' experience on the outcome of dental implants. In addition, it is to identify the associated risk factors that might influence the success and survival of these implants.

METHODOLOGY

The records of patients treated with SLA/SLActive Straumann implants were screened. This enabled us to have a minimum of 12 months of follow-up. Eligible patients, according to the inclusion criteria, were contacted and invited to undergo a follow-up assessment. Success was accounted for and defined in a comprehensive manner by considering four different categories: implant perspective, peri-implant soft tissue perspective, prosthetic perspective, and patient satisfaction. The patient investigations included a clinical examination of the implant mobility, suppuration, width of keratinized mucosa, probing depth, plaque accumulation, prosthetic complications, and patient satisfaction. In addition, a periapical radiograph was taken to evaluate bone loss and peri-implant radiolucency. The data were analysed using SPSS version 26.

RESULTS

Thirty-eight patients with 84 SLA/SLActive Straumann implants were available for the assessment. The mean age of the patients at implant surgery was 49.05 ± 13.19 years. Over the mean follow-up period of 26 months, no implant fractures were noted. Overall, eight implants were considered failures (9.5%). Two out of six patients with a history of periodontitis (HoP) and two out of five smokers exhibited failed implants. The patients' satisfaction responses showed that all the responses were statistically higher than the test median value of three. The median value of general satisfaction using a visual analogue scale was 9 out of 10.

CONCLUSIONS

The implants placed on partially and fully edentulous patients revealed high survival and success rates (100% and 90.5%, respectively) at a mean follow-up time of 26 months. It can be concluded that the implant practise among trainees in the programme is satisfactory. A history of periodontitis and a lack of patient compliance with supportive periodontal therapy in some cases have been shown to be risk factors associated with increased implant failure, mainly peri-implantitis.

Do different incision techniques for implant surgery affect gingival papilla height around dental implants? A retrospective study of 115 cases

BACKGROUND

Surgical incision designs are considered closely correlated to gingival papilla of dental implants. This study aims to explore whether different incision techniques for implant placement and second stage surgery affect gingival papilla height.

METHODS

Cases using different incision techniques (intrasulcular incisions or papilla sparing incisions) between November 2017 and December 2020 were selected and analyzed. A digital camera was used to capture images of gingival papilla at different time points. Ratio of papilla height to crown length using different incision techniques were measured and statistically compared.

RESULTS

A total of 115 papillae (68 patients) were eligible according to the inclusion/exclusion criteria. The average age was 39.6 years. Decreased postoperative papilla height were observed after implant placement surgery in all groups without statistical difference. However, for second stage surgery, intrasulcular incisions lead to more atrophy in gingival papilla compared to papilla sparing incisions.

CONCLUSIONS

Selection of incision techniques in implant placement surgery does not significantly affect papilla height. For second stage surgery, intrasulcular incisions significantly leads to more papilla atrophy compared with papilla sparing incisions. Trial registration KQCL2017003.

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

Randomized controlled pilot study assessing efficacy, efficiency, and patient-reported outcomes measures of chairside and labside single-tooth restorations

OBJECTIVES

To test whether or not a chairside workflow (CHAIR) is similar to a labside workflow (LAB) in terms of efficacy (primary outcome) and efficiency (secondary outcome).

MATERIAL AND METHODS

Eighteen subjects in need of a single-tooth restoration in the posterior region of the maxilla or mandible were consecutively recruited and randomly assigned to the CHAIR or LAB workflow. Patient-reported outcome measures (PROMs; efficacy) were assessed using a questionnaire with visual analog scale. The white AEsthetic score (WES) was applied to evaluate the AEsthetic outcome objectively. The clinical and laboratory time (efficiency) were recorded. Nonparametric methods were applied for the group comparisons.

RESULTS

The overall median AEsthetic evaluation after treatment was 10 (interquartile range = IQR: 9.5-10) in group CHAIR and 10 (IQR: 9.5-10) in-group LAB (Mann-Whitney [MW] test p = 1.000). The WES amounted to 4 (IQR: 3-5) (CHAIR) and to 8 (IQR: 7-9) (LAB) (MW test p < 0.0001). The median total working time for the clinician in-group CHAIR was 49.9 min. (IQR: 40.9-63.7) and 41.4 min. (IQR: 37.2-58.2) in-group LAB (MW test p = 0.387).

CONCLUSIONS

Subjective PROMs of single-tooth supported restorations fabricated in a CHAIR or LAB workflow led to similar scores of patients' satisfaction and a moderate negative correlation for the objective evaluation of the clinician in the LAB workflow.

CLINICAL SIGNIFICANCE

PROMs can be considered a key element in the decision-making process for restoring single-tooth restorations. The patients' perception of AEsthetics was similar for the CHAIR or LAB workflows. The additional efforts undertaken with the LAB workflow did not result in a patient benefit when compared to a CHAIR workflow.

Comparison of Classifications and Indexes for Extraction Socket and Implant Supported Restoration in the Aesthetic Zone: a Systematic Review

OBJECTIVES

The primary objective of the present systematic review is to test the hypothesis - the revision of the complexity of the extraction sockets morphology classifications will reveal the most important parameters for implant aesthetic and functional success in case of immediate dental implant placement in aesthetic zone. The secondary objective is to revise the most important parameters of aesthetic indexes created for implant-supported restoration in aesthetic zone.

MATERIAL AND METHODS

MEDLINE (PubMed) and Cochrane Library search in combination with hand-search of relevant journals was conducted including human studies published in English between 1 January 2005 and 1 February 2022. After evaluation of the titles and abstracts in accordance with the PRISMA guidelines, risk-of-bias assessment was evaluated and data was extracted from the full papers.

RESULTS

Electronic and hand searching resulted in 477 entries. Five systematic reviews, research syntheses and 7 prospective studies met the inclusion criteria and were included in the final data synthesis. Selected articles reported the different classifications complexity of the extraction sockets morphology and aesthetic indexes for implant supported restoration in aesthetic zone.

CONCLUSIONS

The most important parameters for implant aesthetics and functional success, incorporated in classifications of extraction sockets are facial soft tissue level and quality, gingival biotype, keratinized gingival, mesial and distal papillae appearance, buccal bone level and thickness, labial and buccal bone plates damage and bone lesions. The most important aesthetic indexes parameters are soft tissue contour position, including colour and texture, interdental papilla, mesial and distal interproximal bone height, gingival biotype.

Impact of a new combined preoperative cleft assessment on dental implant success in patients with cleft and palate: a retrospective study

Background

Bone height assessment alone is frequently used to guide rehabilitation choice, without consideration for soft tissues or adjacent teeth. This study aimed to evaluate the impact of different preoperative cleft assessments on implant success and patient satisfaction.

Methods

The study involved a retrospective assessment of records from 40 patients with cleft lip and palate (CLP). The alveolar cleft score (ACS; clinical criteria), interdental alveolar bone height (IABH) score (radiological criteria), patient compliance score (dental hygiene, medical visit observance, and smoking), and a novel combined score (IABH-ACS-Compliance) were assessed from patient records. Patients who required prosthetic tooth rehabilitation in the cleft dental arch space were included. Twenty-six patients (Group 1) were treated with dental implants, and 14 patients (Group 2) selected another prosthetic option (fixed prosthodontics, removal prosthesis), orthodontic space closure, or no rehabilitation. The main outcomes measured were relative implant success (no implant loss involving marginal bone loss ≤ 1.9 mm) for patients treated with dental implant therapy (Group 1) and patient satisfaction for all patients (Groups 1 and 2).

Results

Forty dental implants were placed in the patients in Group 1. Four implants in four patients (Group 1 relative failure, RF) were lost (implant survival rate of 90%) after 36 (± 12.4) months of follow-up. Twenty-two patients who received implants belonged to the relative implant success group (Group 1 RS). The average “IABH-ACS-Compliance” scores were significantly different (p < 0.05): 16.90 ± 2.35 and 12.75 ± 0.43 for the Group 1 RS and RF groups, respectively.

Conclusions

Preoperative cleft parameters have an impact on relative implant success and patient satisfaction. The new cleft assessment combined-score (“IABH-ACS-Compliance”) allows an accurate selection of cleft cases eligible for dental implants, thereby improving postoperative outcomes.

Success Rates and Complications Associated with Single Immediate Implants: A Systematic Review

This study examined the success rates of single immediate implants and their associated biological, hardware and aesthetic complications. Using a developed search strategy, randomized controlled trials (RCTs) on single-unit immediate implants with at least six human participants, a minimum follow-up time of 12 months and published between January 1999 and January 2021 were identified. Data was extracted independently using pre-designed data extraction forms. Information on success rates and associated biological, hardware and aesthetic complications were obtained and assessed. Out of 191 potentially eligible studies, 26 RCTs assessing 1270 patients with a total of 1326 single implants were included and further evaluated. In this review, success rate was reported to be 96.7–100% over a total of 9 studies. However, there was a lack of consensus on a universal success criterion between authors emphasizing the need for agreement. The average follow up was 29 months and most reported complications were aesthetic (63 cases, 4.7%), whilst there were relatively fewer biological, (20 cases, 1.5%), and hardware complications (24 cases, 1.8%). Success rate is an uncommon clinical outcome with 9 out of 26 of the selected RCTs reporting it. In these studies, single immediate implants showed a high success rate with low numbers of biological and hardware complications, and high patient satisfaction with aesthetics were reported in the short-term follow-up of one year.

Esthetic complications in implant dentistry

Esthetic complications in implant dentistry have become a significant consideration for patients and practitioners. This review presents an appraisal on the current knowledge of the physiological peri-implant soft-tissue dimensions and factors that may compromise peri-implant tissue esthetics. Factors such as papilla fill adjacent to the implant and midfacial mucosal height are critical parameters that determine the esthetic success of implant-supported restorations. Papilla fill adjacent to a single dental implant appears to depend upon the clinical attachment level of the neighboring tooth. A horizontal inter-implant distance of at least 3 mm is necessary to ensure optimal interproximal mucosal embrasure between two adjacent implants in the anterior maxilla. In cases where implants cannot be placed at least 3 mm apart, a single implant with a cantilever bridge should be considered. Buccolingual implant positioning plays a major role in midfacial mucosal height. Soft-tissue volume grafting following immediate implant placement in the presence of a thin soft-tissue phenotype or simultaneous to surgical peri-implantitis therapy might help to overcome facial mucosa recession.

Oral health-related quality of life of patients rehabilitated with fixed and removable implant-supported dental prostheses

Dental implants have become a mainstream treatment approach in daily practice, and because of their high survival rates over time, they have become the preferred treatment option for prosthetic rehabilitation in many situations. Despite the relatively high predictability of implant therapy and high costs to patients, patient perceptions of success and patient-reported outcome measures have become increasingly significant in implant dentistry. Increasing numbers of publications deal with oral health-related quality of life and/or patient-reported outcome measures. The aim of this paper was to provide an overview of the available evidence on oral health-related quality of life of fully and partially dentate patients rehabilitated with fixed and removable implant-supported dental prostheses. A comprehensive electronic search was performed on publications in English up to 2021. A selection of standardized questionnaires and scales used for the evaluation of oral health-related quality of life were analyzed and explained. The analysis encompassed three aspects: a functional evaluation of oral health-related quality of life, an esthetic assessment of oral health-related quality of life, and a cost-related evaluation of oral health-related quality of life for rehabilitation with dental implants. The data demonstrated that the preoperative expectations of patients markedly affected the outcomes perceived by the patients. As expected, reconstructions supported by implants substantially improved the stability of conventional dentures and allowed improved function and patient satisfaction. However, from a patient's perspective, oral health-related quality of life was not significantly greater for dental implants compared with conventional tooth-supported prostheses. The connection of the implants to the prostheses with locators or balls indicated high oral health-related quality of life. The data also suggest that patient expectation is not a good predictor of treatment outcome. In terms of esthetic outcomes, the data clearly indicate that patients' perceptions and clinicians' assessments differed, with those of clinicians yielding higher standards. There were no significant differences found between the esthetic oral health-related quality of life ratings for soft tissue-level implants compared with those for bone-level implants. Comparison of all-ceramic and metal-ceramic restorations showed no significant differences in patients' perceptions in terms of esthetic outcomes. Depending on the choice of outcome measure and financial marginal value, supporting a conventional removable partial denture with implants is cost-effective when the patient is willing to invest more to achieve a higher oral health-related quality of life. In conclusion, the oral health-related quality of life of patients rehabilitated with implant-supported dental prostheses did not show overall superiority over conventional prosthetics. Clinicians' and patients' evaluations, especially of esthetic outcomes, are, in the majority of cases, incongruent. Nevertheless, patient-reported outcomes are important in the evaluation of function, esthetics, and the cost-effectiveness of treatment with implant-supported dental prostheses, and should be taken into consideration in daily practice.

Reducing errors in guided implant surgery to optimize treatment outcomes

Clinical considerations and treatment criteria in implant placement are constantly evolving. Prosthetically driven implant surgery has become the standard of care to improve short and long-term functional and esthetic outcomes. Therefore, implant position and angulation are planned according to the available bone, anatomical structures, and the requirements of the future prosthetic superstructure. In parallel with these developments, significant progress has been made in data imaging and different software technologies to allow the integration of data within a digital file format. Digitalization in implant surgery enables optimal planning of implant position, as well as the ability to transfer this planning to the surgical field-a process defined as "computer-supported implant planning and guided surgery." The aims of the present review are as follows: (a) to critically appraise the indications and potential "added value" of guided implant surgery, elaborating the main differences between dynamic and static guidance; and (b) to discuss the most important clinical considerations relevant for the different steps of the workflow that might influence the surgical outcome and to offer recommendations on how to avoid or reduce process errors in order to optimize treatment outcomes.

Outcome measures and methods of assessment of soft tissue augmentation interventions in the context of dental implant therapy: A systematic review of clinical studies published in the last 10 years

AIM

To identify and report outcome measures and methods of assessment on soft tissue augmentation interventions in the context of dental implant therapy reported in clinical studies published in the last 10 years.

MATERIAL AND METHODS

The protocol of this PRISMA 2020-compliant systematic review was registered in PROSPERO (CRD42021252214). A literature search was conducted to identify articles that met the pre-established eligibility criteria. Data of interest, with an emphasis on outcome measures, were extracted. For each outcome, specific methods and timing of assessment were described in detail. Following a critical qualitative analysis of the data, outcome measures were categorized. Primary outcomes were identified and frequency of reporting in the selected articles was calculated. Additionally, risk of bias assessments were performed for individual articles and primary outcomes.

RESULTS

Ninety-two articles, of which 39 reported randomized controlled trials (RCTs), 20 reported non-RCTs, and 33 reported case series studies, were selected. Outcome measures were categorized into either investigator-evaluated outcome measures (i.e., clinical, digital imaging, esthetic, histologic, biomarker, and safety) or patient-reported outcome measures (PROMs). Clinical outcomes were the most frequently reported type of outcome. Considering all categories, the most frequently reported primary outcomes were facial mucosa thickness assessed with clinical methods (22.83%), facial keratinized mucosa width assessed with clinical methods (19.57%), facial mucosal margin position / recession assessed with clinical methods (18.48%), facial mucosa thickness assessed with digital imaging methods (11.96%), facial soft tissue volume assessed with digital imaging methods (9.78%), and supracrestal tissue height assessed with clinical methods (9.78%). No distinguishable patterns of association between specific types or quality (level of bias) of clinical studies and the choice of primary outcomes were observed.

CONCLUSION

Clinical research on peri-implant soft tissue augmentation has progressively increased in the last 10 years. Although clinical outcome measures were the most frequently reported outcomes in the selected literature, trends in the field are indicative of a shift from traditional clinical assessment methods to the use of digital technologies. PROMs were generally underreported but should be considered an integral methodological component in future clinical studies. This article is protected by copyright. All rights reserved.

Immediately provisionalized tapered conical connection implants for single-tooth restorations in the maxillary esthetic zone: a 5-year prospective single-cohort multicenter analysis

Objectives

This open, single-cohort, multicenter, prospective study investigated the efficacy of immediately provisionalized tapered conical connection implant for single-tooth restorations in the anterior and premolar regions of the maxilla after 5 years of function.

Materials and methods

All implants were placed in healed sites and immediately provisionalized. MBLs, soft-tissue parameters, and oral-health impact profile (OHIP) were evaluated at implant insertion, 6, 12, 24, 36, and 60 months. Paired Wilcoxon signed-rank tests and Kaplan–Meier survival analysis was used for statistical and implant survival/success analyses, respectively.

Results

Seventy-seven patients (81 implants) completed the 5-year follow-up. The 5-year cumulative survival and success rates were 97.8%, and the mean MBL change from implant insertion to 5 years was − 0.80 ± 1.13 mm. Optimal papilla index scores were observed at 90.1% of sites at 5 years compared with 32.8% of sites at insertion. Pink esthetic score, modified bleeding and plaque indices, and OHIP showed statistically significant improvement at the 5-year follow-up.

Conclusions

Immediately provisionalized tapered conical connection implants promote marginal bone stability and excellent esthetic outcomes after 5 years of function.

Clinical relevance

This treatment is a viable option for patients requiring immediately provisionalized single-tooth restorations in the esthetic zone and shows favorable long-term clinical outcomes, including marginal bone stability and excellent esthetics.

A 3-year prospective clinical study to evaluate the outcome of single-piece implant-prosthetic complex after immediate nonfunctional loading in the maxillary anterior and mandibular posterior areas in varied bone densities

Context:

There is limited evidence on the outcome of single-piece implant-prosthetic complex after immediate nonfunctional loading in varied bone densities.

Aim:

The aim of this study was to report the outcome of single-piece implant-prosthetic complex with a novel cervical platform design in the anterior and posterior jaws 3 years after loading.

Setting and Design:

Prospective clinical study.

Materials and Methods:

The present study included placement of 90 single-piece implants in the anterior and the posterior jaws in varied bone densities. After immediate loading, survival and marginal bone loss was recorded at regular intervals.

Statistical Analysis:

Independent sample t-test and paired t-test were done (P = 0.05).

Results:

Group I, annual marginal bone loss at the end of one, 2 and 3 years was 0.21, respectively, in both bone densities. Group II, annual marginal bone loss in D2 regions was 0.75,0.38 and 0.18; 0.64, 0.28 and 0.18 in D3 regions at the end of 1, 2, and 3 years, respectively. Group I showed no statistically significant difference in marginal bone loss between D2 and D3 bone annually in contrast to Group II. Intragroup comparisons of mean between baseline and various time intervals showed statistically significant bone loss in both bone densities.

Conclusion:

Three years after loading, single-piece implants with the novel cervical platform design provided survival rates of 93% in the maxillary anteriors and 91% in the mandibular posteriors. D3 bone showed more marginal bone loss than D2 bone.

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.

Is the timing of implant placement and loading influencing esthetic outcomes in single-tooth implants?-A systematic review

OBJECTIVES

To address the following question: "Is the timing of implant placement and/or loading influencing the esthetic outcomes of implant-supported single crowns?"

MATERIAL AND METHODS

A literature screening was performed in four electronic databases until June 2020. Randomized controlled clinical trials with a minimum of 10 patients and 1 year of follow-up and reporting on dimensional changes of the peri-implant mucosa (midfacial recession, papilla level) and esthetic indexes were included. Cochrane Risk of Bias Tool was used, and comparable trials were subjected to meta-analyses.

RESULTS

Out of 8549 articles, 72 full-text articles were assessed for eligibility and 18 were included. Nine trials evaluated the timing of implant placement, and nine trials evaluated the timing of loading. The included trials comparing immediate implant placement to delayed implant placement evaluating the midfacial recession reported heterogeneous findings. No differences were found at 1 and 2-years, when comparing midfacial recession and papilla level between immediate and early implant placement. In immediate and delayed implant placement, when comparing conventional and immediate loading, the midfacial mucosal margin change was not statistically significant at the 1-year follow-up. When evaluating the timing of implant placement and/or loading the included trials found no differences in the Pink Esthetic score, White Esthetic score, and Papilla Index between groups.

CONCLUSIONS

Both immediate and early implant placement protocols presented stable treatment results in terms of esthetic outcomes at the 1-, 2-, and 10-years follow-up. Loading protocols did not seem to influence esthetic outcomes in short- and medium-term follow-ups.

Mechanical Performance of Chairside Ceramic CAD/CAM Restorations and Zirconia Abutments with Different Internal Implant Connections: In Vitro Study and Finite Element Analysis

(computer-aided design-computer-aided manufacturing) CAD/CAM monolithic restorations connected to zirconia abutments manufactured with a chairside workflow are becoming a more common restorative option. However, their mechanical performance is still uncertain. The aim of this study was to evaluate the mechanical behavior of a combination of a zirconia abutment and monolithic all-ceramic zirconia and lithium disilicate crown manufactured with a chairside workflow, connected to titanium implants with two types of internal connection—tube in tube connection and conical connection with platform switching. They were thermally cycled from 5 °C to 55 °C and were subjected to a static and fatigue test following ISO 14801. The fractured specimens from the fatigue test were examined by SEM (scanning electron microscopy). Simulations of the stress distribution over the different parts of the restorative complex during the mechanical tests were evaluated by means of (finite element analysis) FEA. The mechanical performance of the zirconia abutment with an internal conical connection was higher than that of the tube in tube connection. Additionally, the use of disilicate or zirconia all-ceramic chairside CAD/CAM monolithic restorations has similar results in terms of mechanical fracture and fatigue resistance. Stress distribution affects the implant/restoration complex depending on the connection design. Zirconia abutments and monolithic restorations seem to be highly reliable in terms of mechanical resistance.

Effect of customized healing abutments on the peri-implant linear and volumetric tissue changes at maxillary immediate implant sites: A 1-year prospective randomized clinical trial

BACKGROUND

Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices (CM) seems to reduce the amount of resorption at peri-implant areas. Recently, customized healing abutments (CA) appeared as another solution in order to seal the socket and preserve the original soft tissue contour.

PURPOSE

To evaluate peri-implant tissues dimensional changes after using customized healing abutments compared with the use of xenogeneic collagen matrices as socket sealing options in flapless maxillary immediate implant placement.

MATERIAL AND METHODS

The present study was designed as a prospective, randomized, controlled clinical trial. Patients were allocated into two groups depending on the socket sealing option: in the CM group a collagen matrix was used and in the CA group a customized abutment. Digital impressions were taken prior to extraction, 1, 4, and 12 months after implant insertion and the digital files allowed to evaluate linear buccal changes (MBC) and the buccal volumetric variation (BVv) between the different time points at peri-implant tissue areas. Additionally, mucosa variation was computed assessing the papilla presence and the midfacial mucosa height. Statistical significance was set at 0.05.

RESULTS

Twenty-eight patients were observed during a 12-month period. Significant differences between mean values of BVv at the first month were observed at the CM and CA group (-9.75 ± 6.65% and -4.76 ± 5.29%, respectively) (p = 0.043). At the 1-year follow-up, no significant differences were found in terms of BVv between the two groups, although the thin bone phenotype (≤1 mm) significantly influenced the volumetric variations that occurred in each group. No significant differences were noticed in midfacial mucosa and papillae alteration between groups, after 1 year of treatment.

CONCLUSION

Both treatment options are predictable solutions for socket sealing in IIP, although a higher volumetric variation can be expected in the presence of thin bone phenotypes.

Three-dimensional (3D) facially driven workflow for anterior ridge defect evaluation: a treatment concept

The esthetic rehabilitation of anterior ridge defects and the achievement of patient satisfaction has become major clinical challenges for dentists and technicians. Poor diagnosis and treatment planning are frequently associated with multiple surgical procedures which fail to meet patient expectations. The loss of hard and soft tissues in esthetic compromised zone is commonly associated with anterior ridges and affects the rehabilitation prognosis. The presence of interdental papilla and papillary configuration play a decisive role in patient satisfaction. A treatment planning considering esthetic parameters, prosthetic needs, and morphological defects must be conducted to improve treatment outcomes. Therefore, this study aims to propose a treatment concept for anterior ridge defects focusing on digital evaluation systems and guided by an ideal facially driven smile design project. In addition, the relevance of the papilla for the esthetic outcomes and the treatment alternatives for anterior ridge defects are also addressed.

Titanium vs ceramic single dental implants in the anterior maxilla: A 12-month randomized clinical trial

OBJECTIVE

The aim of this randomized clinical trial was to compare ceramic and titanium implants with respect to the esthetic and clinical parameters, and patient-reported outcome measures (PROMs).

MATERIAL AND METHODS

Thirty patients received thirty implants (8-12 mm in length, 3.3 mm diameter, and a tissue level design) to replace single teeth in the anterior maxilla. Patients were randomly allocated to receive a ceramic or a titanium implant. Esthetic, clinical parameters, and PROMs were evaluated 18 months after surgery.

RESULTS

At 12 months post-final loading, there were no significant differences between groups with respect to esthetics. Mean Index Crown Aesthetic score was 6.31 (95% C.I. 4.59-8.04) and 6.07 (95% C.I. 4.21-7.93) for ceramic and titanium implants, respectively. The pink esthetic score (PES) was 7.81 (95% C.I. 6.90-8.73) for ceramic implants and 7.86 (95% C.I. 7.11-8.60) for titanium implants, with no significant differences between groups. No statistically significant differences were found for any of the other clinical parameters and PROMs.

CONCLUSIONS

Monotype ceramic implants have proven to be a good treatment option in the upper anterior sector, showing favorable esthetic results, being comparable to titanium implants. This clinical trial has been registered in clinical trials with the identifier CI_RCT_US16 and registration number NCT04707677. A retrospective registration of the clinical trial was carried out since registration was not mandatory on the date the study began.

Aesthetic outcomes of non-functional immediately restored single post-extraction implants with and without connective tissue graft: A multicentre randomized controlled trial

OBJECTIVES

To compare the 1-year aesthetic results of flapless single implants, placed in fresh extraction sockets with bone replacement and immediate provisional restoration with or without a connective tissue graft (CTG).

MATERIAL AND METHODS

The present study proposes a partially blinded multicentre parallel randomized controlled trial, where computer-generated tables were used for central randomization to allocate treatments. A total of 59 of the 60 patients screened by eight private practices in Northern Italy fulfilled the inclusion criteria. Immediate implants were placed in a fresh extraction socket with a non-functional immediate provisional restoration with (Test group) or without (Control group) a CTG. The primary outcome variable was the implant Crown Aesthetic Index (ICAI) at the 1-year follow-up.

RESULTS

ICAI for the 59 randomized patients (Test group = 31, Control group = 28) at the 1-year follow-up was 4.69 (95% CI = 3.16-6.22) for the Test group and 3.45 (95% CI = 1.83-5.08) for the Control group, without statistically significant difference between the two groups (p = .086). One implant failure was recorded in each group, resulting in an implant survival rate of 96.8% [95% CI = 83.3-99.9] for the Test group and 96.4% [95% CI = 81.7-99.9] for the Control group. Other secondary outcome variables and complication rates were comparable across the two groups.

CONCLUSIONS

Within the limitations of the present clinical trial, the results suggested that the adjunct use of CTG is not mandatory to achieve successful aesthetic outcomes for a well-planned immediate implant placement with immediate non-functional provisional restoration in a fresh extraction socket.

Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants

Background

This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry.

Materials and Methods

A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.”

Results

The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development.

Conclusions

Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores

OBJECTIVES

To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability.

MATERIALS AND METHODS

Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables.

RESULTS

Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters.

CONCLUSION

The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.

The peri-implant phenotype and implant esthetic complications. Contemporary overview

OBJECTIVE

To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications.

OVERVIEW

The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications.

CONCLUSIONS

While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications.

CLINICAL SIGNIFICANCE

Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

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.

A randomized controlled study comparing guided bone regeneration with connective tissue graft to re-establish buccal convexity: One-year aesthetic and patient-reported outcomes

OBJECTIVES

To compare guided bone regeneration (GBR) with connective tissue graft (CTG) in terms of aesthetic and patient-reported outcomes (PROMs).

MATERIALS AND METHODS

Patients with a single tooth gap in the anterior maxilla and horizontal alveolar defect were enrolled in a single-blind RCT. All sites had a buccopalatal bone dimension of at least 6 mm, received a single implant and were randomly allocated to the control (GBR) or test group (CTG) to re-establish buccal soft tissue convexity. Primary outcomes were Pink Esthetic Score (PES) and Mucosal Scarring Index (MSI) assessed after 1 year. Secondary outcomes included PROMs registered during the early stages of healing and after 1 year.

RESULTS

Twenty-one patients were included per group (control: 11 females, mean age 51; test: nine females, mean age 48). Although there was no significant difference in the PES between the groups (control: 10.11; test: 10.48; p = .577), the MSI was significantly lower in the test (1.10) than in the control group (2.53) (p = .017). Based on descriptive statistics, the latter demonstrated wider scars, more colour mismatch and slightly more suture marks. However, these were not considered disturbing by the patients given similar VAS on soft tissue aesthetics (control: 84; test: 87). Oedema and haematoma were rated twice as high in the control group on at least two postoperative time points, and patients took more painkillers (7.10 vs. 4.86). OHIP-14 decreased in both groups between baseline and 1-year follow-up, indicative of less discomfort in daily life. Differences in MSI and PROMs between the groups may be explained by the need of a vertical releasing incision in order to achieve sufficient access for GBR, periosteal incisions and the use of biomaterials that may induce inflammation.

CONCLUSION

GBR and CTG resulted in favourable aesthetic outcomes as assessed by professionals and patients. However, given additional vertical and periosteal incisions, GBR resulted in more scarring, postoperative discomfort and a higher need for painkillers.

Evaluation of esthetic parameters related to a single implant restoration by laypeople and dentists

STATEMENT OF PROBLEM

Currently available assessment tools for evaluating the esthetic outcome of implant restorations consist of objective indices created for dentists. The investigation of esthetic parameters according to the patient's perspective is lacking.

PURPOSE

The purpose of this observational study was to evaluate and compare the importance of different soft-tissue and restoration-related esthetic parameters for patients and clinicians.

MATERIAL AND METHODS

A photoediting software program (Photoshop CC; Adobe Corp) was used to produce 10 photographs with modified smiles from the original photograph by altering 1 parameter of the pink esthetic score and white esthetic score (PES/WES) at a time. A total of 120 participants were recruited in the study, including 40 laypeople, 40 prosthodontists, and 40 periodontists. A total of 440 visual analog scale (VAS) values were obtained for each group to record participants' subjective esthetic assessments of all photographs (10 modified and 1 original photograph). Repeated-measures ANOVA and post hoc mean comparison (t grouping) were used to identify whether the individual alteration on the PES and WES indices was significant for each group.

RESULTS

For the laypeople, color (hue and value) appeared to be the most important parameter. After color, the order of importance was as follows: root convexity along with soft-tissue color and texture, level of facial mucosa, distal papilla, mesial papilla, translucency or characterization, surface texture, and tooth form. For the periodontists, color (hue and value) was also the most important parameter, but it was not separable from a cluster of other parameters: level of facial mucosa, root convexity along with soft-tissue color and texture, mesial papilla, and distal papilla. For the prosthodontists, color (hue and value) and level of facial mucosa were the most important parameters affecting esthetic assessment, followed by root convexity along with soft-tissue color and texture, mesial papilla, and distal papilla.

CONCLUSIONS

All groups graded color (hue and value) as the most important parameter affecting the esthetic outcome and the original unaltered photograph as the most esthetically pleasing image. All participants (laypeople and dental specialists) appeared to be able to perceive the same 5 parameters including color (hue and value), level of facial mucosa, mesial papilla, distal papilla, and root convexity along with soft-tissue color and texture that are negatively affecting esthetic outcomes. Except for color (hue and value), restoration-related esthetic parameters had a lesser effect on the overall esthetic assessments for all groups.

The dental esthetic screening index: A new tool for assessment of dento-facial esthetics in restorative dentistry

OBJECTIVES

There is a lack of comprehensive indexes, which can measure conditions or changes in dento-facial esthetics before and after treatment. Therefore, the 12-item Dental Esthetic Screening Index (DESI) was developed and validated.

MATERIALS AND METHODS

Reliability was tested by five dental professionals, who evaluated 30 standardized patient photographs baseline and after 14 days. Clinical validation was done on 52 patients before and after restorative treatment. For subjective assessment, patients completed a validated questionnaire before and after treatment. Statistical analysis included inter and intrarater reliability, Wilcoxon test and linear regression analysis.

RESULTS

The single item analysis identified two weak extraoral items (κ = 0.15; κ = -0.05), that were removed from the DESI. After this modification, both inter- (κ = 0.83-0.86) and intrarater reliability (ICC_1-5 = 0.75-0.86) were in excellent to good agreement. In the clinical validation, the DESI was significantly lower after restorative treatment (P < .0001). The patients' perception questionnaires showed significant improvement after restorative therapy (P < .0001). A correlation of the DESI and the results of patients' perception questionnaires could be assumed (P < .0001; R² = 0.32).

CONCLUSIONS

The DESI was found to be a reliable and valid instrument for the quantitative assessment of dento-facial esthetics. It correlated well with the subjective assessment of the patients.

CLINICAL SIGNIFICANCE

This comprehensive index would allow for objective quantification of clinical situations, for reliable baseline and outcome assessment in esthetic dentistry. As patients' esthetic feelings and sensations are subjective, this objective index is also proven to be congruent to patients' individual subjective assessment of dento-facial esthetics.

Soft tissue replication in single unit implant impressions-A three dimensional clinical study

OBJECTIVE

Comparison of soft tissue replication between conventional and digital impressions for definitive single unit implant rehabilitation in the esthetic zone.

MATERIALS AND METHODS

Six patients were recruited according to inclusion criteria for this cross-over pilot study and submitted to a conventional silicone implant impression with customized coping and a digital impression with an intraoral scanner. Stereolithography files obtained from the same patient were superimposed with appropriate software and trueness evaluated between methods at predetermined locations (56 in hard and soft tissues and 18 in the emergence profile, per patient). Results were presented as mean root mean square (RMS) ± 95% confidence interval and effect size calculated with Hedges' g ± 95%. Mann-Whitney and Kruskal-Wallis were performed when appropriate and α was set at .05.

RESULTS

Trueness between methods equated to 51.08[45.68;56.47] μm and 60.46[52.29;68.62] μm in hard and soft tissues, respectively. Soft tissue replication by intraoral scanner acquisition corresponded to a statistically significant RMS of 243.89[209.15;278.63] μm equating to a Hedges' g of 1.52[1.22;1.82] which corresponded to a large effect size.

CONCLUSIONS

The proposed method could be considered for soft tissues assessment and the results suggest that intraoral impression techniques produce statistically significant changes in peri-implant soft tissue replication, although below the clinically detectable threshold.

CLINICAL SIGNIFICANCE

The proposed technique allows for the 3D determination of peri-implant tissues changes in digital models with higher sensitivity than visual techniques, thus presenting itself as a promising alternative in clinical studies and that the use of an intraoral scanner obtained significant differences in the soft tissue emergence profile replication when compared with the gold standard.

Patient-reported outcome measures focusing on aesthetics of implant- and tooth-supported fixed dental prostheses: A systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review and meta-analysis was to summarize the existing evidence on patient-reported aesthetic outcome measures (PROMs) of implant-supported, relative to tooth-supported fixed dental prostheses.

MATERIAL AND METHODS

In April 2017, two reviewers independently searched the Medline (PubMed), EMBASE, and Cochrane electronic databases, focusing on studies including patient-reported aesthetic outcomes of implant- and tooth-supported fixed dental prostheses (FDPs). Human studies with a mean follow-up period of at least 1 year, a minimum of ten patients, and English, German, or French publication were included. For the comparison of subgroups, random-effects meta-regression for aggregate-level data was used.

RESULTS

The systematic search for implant-supported prostheses focusing on patient-reported outcomes identified 2,675 titles, which were screened by two independent authors. Fifty full-text articles were analyzed, and finally, 16 publications (including 19 relevant study cohorts) were included. For tooth-supported prostheses, no studies could be included. A total of 816 implant-supported reconstructions were analyzed by patients. Overall aesthetic evaluation by the patients' visual analogue scale (VAS) rating was high in implant-supported FDPs (median: 90.3; min-max: 80.0-94.0) and the surrounding mucosa (median: 84.7; min-max: 73.0-92.0). Individual restorative materials, implant neck design (i.e., tissue or bone level type implants), and the use of a fixed provisional had no effect on patients' ratings of the definitive implant-supported FDPs.

CONCLUSIONS

Aesthetics is an important patient-reported measure, which lacks in standardized methods; however, patients' satisfaction was high for implant- supported FDPs and the surrounding mucosa.

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.

Evaluation of implant esthetics using eight objective indices-Comparative analysis of reliability and validity

OBJECTIVES

The aim of the present study was to give a detailed analysis on eight proposed implant esthetic indices including a total of 48 parameters with respect to validity and reproducibility as well as its correlation to patients' perception of esthetics.

MATERIAL AND METHODS

Standardized intraoral photographs of 189 patients with 189 implant-supported crowns and adjacent peri-implant soft tissue in the esthetic zone (central and lateral incisors, canine, first premolar) served as basis for this evaluation. Eight indices (Papilla Index [PI], Pink Esthetic Score [PES], Implant Crown Aesthetic Index [ICAI], Pink and White Esthetic Score [PES/WES], Complex Esthetic Index [CEI], Implant Aesthetic Score [IAS], Subjective Esthetic Score [SES], and Rompen Index) with a total of 48 parameters were selected. Esthetic evaluation was performed twice by five examiners with an interval of 4 weeks between the evaluations.

RESULTS

A total of 1,890 evaluations including eight esthetic indices served as basis for the statistical analysis. Among the overall main scores tested for inter-rater reliability, the highest ρ^inter values were computed for CEI, PES, PI, and IAS scores. By contrast, SES and Rompen showed the worst inter-rater reliability, respectively. The highest level of intra-rater reproducibility was noted for PI, PES, and CEI. The lowest level of intra-rater reproducibility showed Rompen, SES, and ICA. The Papilla Index demonstrated the highest level of inter-rater reliability. The remainder of the single variables (n = 46) did not reach the ρ^inter level of 0.6. The single variables PI mesial, PI distal as well as CEI P4 showed the highest ρ^intra with statistical significance higher than 0.8. The lowest agreement was observed among the variables ICA3, WES5, and IASm2. In general, VAS did not show any good correlation to the esthetic indices proposed so far. The influence of esthetic parameters on subjective patient satisfaction was generally low.

CONCLUSION

In conclusion, significant differences regarding reliability and validity could be observed in the present comparison of eight esthetic indices. Objective evaluation of the esthetic outcome of implant therapy inherently fails to reflect subjective patient opinion, however, requires consistency of results to enable between-study comparison and meta-analysis.

Evaluation of the influence of implant placement timing on the esthetic outcomes of single tooth implant treatment in the anterior maxilla: A retrospective study

OBJECTIVES

The purpose of this retrospective study was to investigate the influence of implant placement timing on the esthetic outcomes for single implants in the anterior maxilla.

MATERIALS AND METHODS

One hundred and ten patients (48 males; 62 females) who received a single-tooth implant after extraction either immediately (Type 1); after 4-8 weeks (Type 2); after 8-16 weeks (Type 3); or more than 16 weeks (Type 4) were evaluated in terms of esthetic outcomes after a mean post-placement interval of 26.3 months (range 12-116). Esthetic outcomes were measured using the Pink and White Esthetic Score (PES; WES). Stepwise regression analysis was performed to analyze the effect of timing of placement, as well as patient demographics and other clinical parameters on the esthetic outcomes.

RESULTS

No statistically significantly differences in PES were found between the various treatment modalities with Type 1 implants (n = 33) scoring 10.58 ± 1.65 (median: 11), followed by 10.36 ± 2.09 (median: 10.5), 9.68 ± 2.43 (median: 10), and 9.63 ± 2.21 (median: 10) for Type 2 (n = 14), Type 3 (n = 19), and Type 4 (n = 44), respectively. For immediate implants, a trend towards better esthetic outcomes was observed when implant placement was done flaplessly in cases with intact buccal bone (Type 1A, median PES 11) as compared to cases with partial/complete missing buccal plates where a flap was raised (Type 1B, median PES 10). Overall, the only parameter that influenced esthetic outcomes (as measured by PES) was gender, with females having significantly superior results. The median WES was 8 and 96% of the crowns were deemed esthetically acceptable, with crowns placed by specialist prosthodontists yielding higher scores than those placed by general practitioners.

CONCLUSIONS

Single tooth implants in the anterior maxilla showed satisfactory outcomes when measured with objective esthetic criteria. Timing of implant placement did not significantly influence the esthetic outcomes, although a trend towards better outcomes was seen with immediate implant placement as observed by higher median PES values.

CLINICAL SIGNIFICANCE

Single tooth implant placement in the anterior maxilla is a predictable treatment modality for achieving acceptable esthetic outcomes regardless of the timing of placement.

Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients

In recent years the scientific community has shown a clear interest in the esthetic outcome of implant treatment. The present paper provides an overview of the esthetic ratings that have been used in implant dentistry. A distinction can be made between objective evaluations by clinicians and subjective evaluations by patients. The former mainly include: midfacial and interproximal soft-tissue levels; two-dimensional/three-dimensional soft-tissue alterations; assessment of the color match between the natural dentition, on the one hand, and the peri-implant tissues and the reconstruction, on the other hand; and ordinal indices, such as the pink and white esthetic score. Patient's needs and judgment may differ from objective indicators of implant success and esthetics. As a result, assessing treatment on the basis of patient-reported outcomes measures should be considered important. Validated questionnaires have been used that mainly assess the impact of oral health on the overall well-being of individuals. The esthetic judgment of patients is usually based on nonstandardized questions with varying scoring methods, including visual analog scales, Likert and other category scales and open questions. The heterogeneity in scoring systems between studies may compromise proper comparison of objective and subjective esthetic outcomes between studies and therapeutic concepts.

Surgery without papilla incision: tunneling flap procedures in plastic periodontal and implant surgery

Diverse clinical advancements, together with some relevant technical innovations, have led to an increase in popularity of tunneling flap procedures in plastic periodontal and implant surgery in the recent past. This trend is further promoted by the fact that these techniques have lately been introduced to a considerably expanded range of indications. While originally described for the treatment of gingival recession-type defects, tunneling flap procedures may now be applied successfully in a variety of clinical situations in which augmentation of the soft tissues is indicated in the esthetic zone. Potential clinical scenarios include surgical thickening of thin buccal gingiva or peri-implant mucosa, alveolar ridge/socket preservation and implant second-stage surgery, as well as soft-tissue ridge augmentation or pontic site development. In this way, tunneling flap procedures developed from a technique, originally merely intended for surgical root coverage, into a capacious surgical conception in plastic periodontal and implant surgery. The purpose of this article is to provide a comprehensive overview on tunneling flap procedures, to introduce the successive development of the approach along with underlying ideas on surgical wound healing and to present contemporary clinical scenarios in step-by-step photograph-illustrated sequences, which aim to provide clinicians with guidance to help them integrate tunneling flap procedures into their daily clinical routine.

Esthetic Evaluation of Implant-Supported Single Crowns: The Implant Restoration Esthetic Index and Patient Perception

PURPOSE

To test the validity and reliability of a newly developed Implant Restoration Esthetic Index (IREI) and to compare esthetic outcomes reported by patients and professionals.

MATERIALS AND METHODS

Ten graduate students and 10 prosthodontists assessed esthetic outcomes of 27 single-tooth implants with the IREI. Six peri-implant soft tissue parameters were measured using visual analog scales: mesial papilla presence, distal papilla presence, gingival trigone, soft tissue curvature, alveolar process deficiency, and soft tissue color and texture, as well as the six crown parameters: crown contour, crown position, crown labial convexity, crown characterization, crown color and translucency, and abutment visibility. The validity was tested based on Pearson's correlation. The internal consistency reliability was analyzed by Cronbach's alpha. Interclass correlation coefficients (ICC) were calculated to express the test-retest reliability and the inter-rater reliability. The correlations between patient and professional evaluations were analyzed by Pearson's correlation.

RESULTS

The IREI demonstrated significant correlation (p < 0.05) to the pink esthetic score and white esthetic score (PES/WES). The internal consistency reliability showed a Cronbach's Alpha of 0.830. The test-retest reliability was excellent in both the graduate student group and the prosthodontist group, with ICCs of 0.961 and 0.952, respectively (p < 0.05). The inter-rater reliability was acceptable, with ICCs of 0.649 and 0.667, respectively (p < 0.05). Low correlation coefficients were found between patient and professional evaluations.

CONCLUSIONS

The results of this study indicated that the IREI was considered a valid and reliable index involving sufficient parameters for professional esthetic evaluation of single-tooth implant restorations. The patient-reported esthetic outcomes had poor or no significant correlation to professional-reported outcomes.