Outcome evaluation of early placed maxillary anterior single-tooth implants using objective esthetic criteria: A cross-sectional, retrospective study in 45 patients with a 2- to 4-year follow-up using pink and white esthetic scores

Department of Fixed Prosthodontics and Occlusion, School of Dental Medicine, University of Geneva, Geneva, Switzerland.
Journal of Periodontology (Impact Factor: 2.57). 02/2009; 80(1):140-51. DOI: 10.1902/jop.2009.080435
Source: PubMed

ABSTRACT To validate the concept of early implant placement for use in the esthetically sensitive anterior maxilla, clinical trials should ideally include objective esthetic criteria when assessing outcome parameters.
In this cross-sectional, retrospective 2- to 4-year study involving 45 patients treated with maxillary anterior single-tooth implants according to the concept of early implant placement, a novel comprehensive index, comprising pink esthetic score and white esthetic score (PES/WES; the highest possible combined score is 20), was applied for the objective esthetic outcome assessment of anterior single-tooth implants.
All 45 anterior maxillary single-tooth implants fulfilled strict success criteria for dental implants with regard to osseointegration, including the absence of peri-implant radiolucency, implant mobility, suppuration, and pain. The mean total PES/WES was 14.7 +/- 1.18 (range: 11 to 18). The mean total PES of 7.8 +/- 0.88 (range: 6 to 9) documents favorable overall peri-implant soft tissue conditions. The two PES variables facial mucosa curvature (1.9 +/- 0.29) and facial mucosa level (1.8 +/- 0.42) had the highest mean values, whereas the combination variable root convexity/soft tissue color and texture (1.2 +/- 0.53) proved to be the most difficult to fully satisfy. Mean scores were 1.6 +/- 0.5 for the mesial papilla and 1.3 +/- 0.5 for the distal papilla. A mean value of 6.9 +/- 1.47 (range: 4 to 10) was calculated for WES.
This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.

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Available from: Daniel Buser, Aug 16, 2015
    • "A difficulty that surgeons and restorative dentists have to face when dealing with the task of replacing a tooth in the aesthetic zone is to provide optimal blend and harmony within the existing dentition (Belser et al. 1998; Buser et al. 2004). Among the factors that are considered to represent the aesthetic outcome of a tooth replacement, there are the facial soft tissue level, contour, colour and texture (F€ urhauser et al. 2005; Belser et al. 2009). Prospective studies on soft tissue level at delayed implants in the aesthetic zone reported that a recession on average not greater than 0.7 mm (Grunder 2000; Gotfredsen 2004; Cardaropoli et al. 2006; Schropp & Isidor 2008), but ranging in some cases up to 1.5 mm (Gotfredsen 2004), may develop. "
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    ABSTRACT: This case series investigated by means of CBCT, buccal bone three-dimensional anatomy at delayed, two-stage implants in the maxillary incisal tooth region. Moreover, the relation between buccal bone anatomy and soft tissue aesthetics was assessed. Twelve implants were analysed after on average 8.9 years in function. Baseline and re-evaluation photographs were assessed using the pink aesthetic score (PES). Marginal bone changes were measured from intraoral X-rays. The buccal bone volume associated with the implant and the implant surface not covered by visible buccal bone was computed on CBCT data sets. Buccal bone thickness and level were assessed, as well as the thickness of the crest distally and mesially of the implant. Changes in soft tissue forms and correlation between aesthetics and bone anatomy were calculated by nonparametric statistics. Buccal bone level was located 3.8 mm apical of the implant shoulder, and none of the implants had complete bone coverage. Buccal bone volume was 144.3 mm(3) , and 4.29 mm(3) in the more coronal 2 mm portion. PES did not differ at re-evaluation (9.7) and baseline (9.2). PES was directly correlated with crestal thickness mesially and distally of the implant shoulder. No other significant correlations were observed between bone anatomy and PES or buccal peri-implant health. Marginal bone gain over time was associated with greater coronal bone volume buccally and with greater buccal and marginal bone thickness, while loss was related to less or no bone. Within present limitations, acceptable and stable aesthetics are not jeopardized by a thin or missing buccal bone. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
    Clinical Oral Implants Research 07/2015; DOI:10.1111/clr.12664 · 3.12 Impact Factor
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    • "Due to various reasons, no attempt was made to condition the soft tissues by means of a provisional crown in any of the patients at that time of the present study. The lack of the provisional crowns in the present study could also explain the relatively low PESs at the baseline when compared to the studies, in which cement or screw-retained provisional crowns were used (Belser et al. 2009; Buser et al. 2011, 2013; Raes et al. 2013). However, the PESs at the baseline are still comparable with the studies when the provisional crowns were not being used (Cosyn et al. 2013; Dierens et al. 2013). "
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    ABSTRACT: Abstract Purpose: To evaluate the long-term aesthetic outcome of the single crowns supported by softtissue level implants placed in healed sites in the anterior maxilla region via the pink aesthetic score (PES) and the white aesthetic score (WES). Material and methods: According to the inclusion criteria, patients who had received a single Straumann� Standard Plus implant in the anterior maxilla at the Shanghai 9th People’s Hospital between 2005 and 2008 were invited for a re-examination based on a number of inclusion criteria and exclusion criteria. Clinical, radiographic and aesthetic outcomes (PES/WES) were assessed during their revisit at 5–8 years after crown placement. Results: Forty-five patients were enrolled in the study. All 45 implants were successfully integrated and most of the implants did not show signs of peri-implant disease at the time of the assessment. The marginal bone resorption was 1.10 � 0.92 mm. The mean total PES was 8.48 � 2.62 at the baseline, 9.57 � 2.37 at the 6–10 months revisit and 9.01 � 2.45 at the 5–8 years follow-up. The scores of the mesial and distal papillae increased significantly between the baseline and 6– 10 months follow-up, this improvement remained stable at the 5–8 years follow-up. The scores of soft tissue level, colour of the soft tissue, soft tissue texture and the alveolar process decreased significantly between the 6–10 months and 5-8 years revisits. The mean WES was 7.83 � 1.60 at the baseline and 7.72 � 1.43 at the 5–8 years revisit. There was no significant difference of the WES between the baseline and 5–8 years revisit. Conclusion: The possibility of spontaneous papillae regeneration after implant treatment and the long-term stability of the regenerated papillae were confirmed. However, recession of the facial soft tissue has been found. The incidence of the recession at thin biotype sites tended to be higher.
    Clinical Oral Implants Research 12/2014; DOI:10.1111/clr.12540 · 3.12 Impact Factor
    • "To rate the esthetics of implant-supported restorations in an objective and reproducible manner, various criteria and indices have been proposed (Jemt 1997; F€ urhauser et al. 2005; Meijer et al. 2005; Cooper 2008; Gehrke et al. 2008, 2009; Belser et al. 2009). "
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    ABSTRACT: AimTo present the10-year esthetic outcome data for single-tooth implants placed early or delayed after tooth extraction.Material and Methods Forty-four patients randomly allocated to two equal size groups were treated with a single-tooth implant approximately 10 days (Ea; N = 22), or 3 months (De; N = 22) after tooth extraction. Healing abutments were mounted after 3 months of submerged healing, and metal–ceramic crowns cemented after one additional month. Presence of buccal bone defects was registered at the second-stage surgery. Patients attended control visits 1 week and 1–1.5 years after mounting of the crown and 5 and 10 years after implant placement. Marginal bone level at the implant and the adjacent teeth as well as the distance between the implant and the teeth were measured in standardized periapical radiographs. The papilla dimension and clinical crown height (CCH) were assessed on clinical photographs by an experienced prosthodontist.ResultsTwo Ea and one De implants failed to osseointegrate. Twenty-eight patients (13 Ea and 15 De) who attended all four control visits were included in the data analysis. Complete papilla fill interproximally was achieved in one-third of the cases and an appropriate clinical crown height in <60% after 10 years. Although not statistically significant, early-placed implants tended to be superior to delayed-placed implants regarding soft tissue appearance just after crown delivery and after 10 years. An improvement in papilla dimensions was seen during the follow-up period for both groups while the CCH was unchanged. The implant region (anterior vs. posterior) did not significantly influence the papilla or CCH scores while younger patients (<50 years of age) received significantly better papilla scores than older patients (≥50 years). An apically located bone level at the tooth neighboring the implant influenced negatively the papilla dimension. In contrast, the presence of a bone defect buccally to the implant at second-stage surgery did not have a negative impact on the CCH 10 years after implant placement.Conclusion Early placement of single-tooth implants after tooth extraction performed equally to delayed placement in regard to the esthetic outcome of the soft tissues after 10 years in function.
    Clinical Oral Implants Research 09/2014; 26(3). DOI:10.1111/clr.12489 · 3.12 Impact Factor
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