Dental implant treatment for two adjacent missing teeth in the maxillary aesthetic zone: a comparative pilot study and test of principle

Effects of socket-shield therapy on inter-implant papilla preservation between upper central and lateral incisors: A case series with 3-5 year follow-up

OBJECTIVE

Despite significant progress within implant prosthetic therapy, preserving the papilla between two adjacent implants in the esthetic zone, particularly between central and lateral incisors, remains challenging. This case series aims to report a papilla preservation approach between adjacent upper central-lateral incisor implants using the socket-shield technique.

CLINICAL CONSIDERATIONS

Six patients with natural dentition received unilateral adjacent central-lateral incisor implants with different socket shield configurations. The esthetic outcomes were clinically assessed after 3-5 years of follow-up. Post-operative papilla fill was evaluated on intraoral images compared to baseline characteristics and the contralateral papilla. Papilla height was preserved in all cases, with minimal alterations observed.

CONCLUSIONS

Within the limitations of the present case series, the socket-shield technique demonstrated favorable outcomes in preserving the papilla between adjacent upper central-lateral incisor implants in the midterm follow-up. Clinical studies are warranted to validate these results.

CLINICAL SIGNIFICANCE

The socket-shield technique seems promising in preserving the inter-implant papilla between adjacent central-lateral incisor implants.

Dental implant treatment for two adjacent missing teeth in the esthetic region: A systematic review and 10-year results of a prospective comparative pilot study

OBJECTIVES

The aim of the systematic review was to compare studies on implant-supported two-unit cantilever crowns with two adjacent implant-supported crowns in the anterior region. The second aim was to assess in a 10-year prospective comparative pilot study, hard and soft peri-implant tissue changes in patients with a missing central and adjacent lateral upper incisor, treated with either an implant-supported two-unit cantilever crown or two single implant-supported crowns.

MATERIALS AND METHODS

Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched (last search March 1, 2023). Inclusion criteria were studies reporting outcomes of two missing adjacent teeth in the esthetic region and treated with a single implant-supported two-unit cantilever fixed dental prosthesis, or with two solitary implant-supported crowns. Outcome measures assessed included implant survival (primary), changes in marginal bone and gingiva level, restoration survival, subjective and objective esthetic scores, papilla volume, mid-facial marginal mucosa level, probing depth, bleeding on probing, and biological and technical complications with ≥1-year follow-up. In addition, in a 10-year pilot study, the same outcome measures were assessed of five patients with a single implant-supported two-unit cantilever crown and compared with five patients with two adjacent single implant-supported crowns in the esthetic zone.

RESULTS

Nine articles with 11 study groups were found eligible for data extraction. Meta-analyses of implant survival rates were 96.9% (mean follow-up 3.4 ± 1.4 years) for the implant-cantilever treatment and 97.6% (mean follow-up 3.0 ± 1.8 years) for the adjacent implants treatment (p = .79). In the 10-year comparative pilot study, no clinically relevant changes in hard and soft peri-implant tissue levels occurred in both groups. Patient satisfaction was also high in both groups.

CONCLUSION

Single implant-supported two-unit crowns can be a viable alternative to the placement of two adjacent single implant crowns in the esthetic zone.

Interdisciplinary treatment with implant-supported two-unit cantilever prosthesis for a patient with hypodontia: A clinical report

A 21-year-old woman with multiple congenitally missing maxillary anterior teeth received interdisciplinary treatment to restore function and esthetics. The treatment was initiated with orthodontic treatment, followed by implant placement, bone and soft-tissue augmentation, and prosthetic treatment including a screw-retained implant-supported 2-unit cantilever fixed dental prosthesis.

Whole-Process Digitalization-Assisted Immediate Implant Placement and Immediate Restoration in the Aesthetic Zone: A Prospective Study

Background

This study explored the clinical effects of whole-process digitalization (WD)-assisted immediate implant placement (IIP) and immediate restoration (IR) in the aesthetic zone and clarified the clinical procedures.

Material/Methods

Patients who received maxillary aesthetic region IIP and IR treatment were randomly distributed into WD-assisted and conventional groups. Postoperative assessment included implant accuracy, marginal bone loss, aesthetic evaluation, and patient satisfaction evaluation. The aesthetic evaluation included visual analog score (VAS), pink aesthetic score (PES), and white aesthetic score (WES). Numerical data, measurement data, and grade data were analyzed by χ² test, t test, and Mann-Whitney U test.

Results

The WD-assisted group exhibited decreased implant accuracy, including coronal deviation, apical deviation, angular deviation, and depth deviation, compared with the conventional group (P<0.05). The marginal bone loss in both the mesiodistal direction and the buccolingual direction were significantly lower in the WD-assisted group than in the conventional group (P<0.05). The VAS, PES, and WES were all significantly higher in the WD-assisted group than in the conventional group at 3, 6, and 12 months after surgery (P<0.05). Patients in the WD-assisted group also reported a higher satisfaction level than those in the conventional group (P<0.05).

Conclusions

WD-assisted IIP and IR treatment in the aesthetic zone increased implant accuracy, decreased marginal bone loss, improved aesthetic effect, and increased patient satisfaction compared with conventional treatment. Therefore, WD-assisted IIP and IR treatment constitutes a promising approach in clinical oral implantology.

A retrospective study of an alternative technique for implant repositioning in the maxillary esthetic region

BACKGROUND

Implant-bone block segment repositioning may be an option of treatment for patients with vertical alveolar bone atrophy.

PURPOSE

To assess implant-bone block movement, gingival outcome and the subjective appreciation of patients after an alternative treatment of an implant-bone block segment repositioning in the maxillary esthetic region.

MATERIALS AND METHODS

Patients who underwent implant-bone block segment relocation in areas of vertical alveolar bone atrophy in the anterior esthetic region were assessed. The outcome measures were implant failure, complications after initial loading, vertical bone augmentation, papilla index, width of the keratinized mucosa, and patient satisfaction.

RESULTS

Twenty-five implants in nine consecutive patients were included in this study. During the follow-up period, only one implant failed. Vertical bone augmentation ranged from 3.0 to 8.4 mm (mean 4.9 mm). A significant improvement (P < .001) in the papilla index was observed, improving the esthetic outcome. Six patients (66.6%) had more than 2 mm of keratinized mucosa and all of the patients were satisfied with the treatment.

CONCLUSIONS

The esthetics and functional gingival outcome of oral rehabilitation in areas with vertical alveolar bone atrophy can be successfully improved with the presented technique, which had a high overall implant survival rate within a short period.

Disparity in embrasure fill and papilla height between tooth- and implant-borne fixed restorations in the anterior maxilla: a cross-sectional study

PURPOSE

The objective of the present study was to compare inter-proximal fill and papilla height between different embrasures.

MATERIAL & METHODS

One hundred and fifty non-smoking consecutive patients (mean age 54, range 32-73; 63 males and 87 females) without periodontal disease were selected in a multidisciplinary practice during regular supportive care. All had been treated for multiple tooth loss in the anterior maxilla at least 1 year earlier by means of a fixed restoration on teeth (n = 50) or implants (n = 100) using straightforward procedures (without hard and/or soft tissue augmentation). Embrasure fill was assessed by means of Jemt's papilla index and papilla height was registered following local anaesthesia by means of bone sounding by one clinician.

RESULTS

Tooth-pontic and tooth-implant embrasures demonstrated comparable inter-proximal fill and papilla height (≥58% Jemt's score 3; mean papilla height ≥4.1 mm). Between missing teeth, embrasure fill and papilla height were lower regardless of the embrasure type. The implant-implant and implant-pontic embrasure demonstrated comparable outcome (≤42% Jemt's score 3; mean papilla height ≤ 3.3 mm; p ≥ 0.416), which was significantly poorer when compared to the pontic-pontic embrasure (82% Jemt's score 3; mean papilla height 3.7 mm; p ≤ 0.019). Overall, papilla index and papilla height demonstrated a weak correlation (Spearman's correlation coefficient: 0.198; p = 0.002).

CONCLUSIONS

The re-establishment of a papilla is difficult when there is no tooth involved. In that scenario a short papilla should be expected and implant-borne restorations demonstrate the poorest outcome. Moreover, an implant with a pontic may not perform better than adjacent implants.