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.
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.
Full-textDOI: · Available from: Daniel Buser, May 30, 2015
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ABSTRACT: To investigate objective and patient-centred aesthetic outcomes for single-tooth implants in the anterior maxilla. Ninety-eight patients (21 men and 77 women) with a mean age of 51.2 ± 13.8 years were included in this retrospective study. A total of 98 maxillary anterior single-tooth implant crowns with a mean functional time of 68.1 months (range 12-245) were evaluated. Aesthetic outcomes were measured by PES and WES. Statistical analysis was performed using the Mood's median and stepwise logistic regression with backward elimination to assess the effect of patient demographics, clinical parameters and surgical methods on aesthetic outcome (P < 0.05). The median PES was 11 and 94% of implants were deemed aesthetically acceptable. The median WES was 9 and 98% of implants were deemed aesthetically acceptable. The PES was positively influenced by the use of a connective tissue graft (CTG), adding 1 to the score (P = 0.002) and negatively influenced by membrane use (P = 0.026). Flapless techniques employed as part of an immediate implant placement protocol yielded better outcomes compared to flapped sites (P = 0.017). Immediate implant placement demonstrated greater variability in outcomes compared to early implant placement. Satisfactory objective and patient-reported aesthetic outcomes were achieved with dental implants replacing missing single teeth in the anterior maxilla. The use of CTG improved the aesthetic outcome mainly by increasing the alveolar process contour. Less variation in outcomes was observed with early (type 2) placement compared to immediate (type 1 placement). © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.Clinical Oral Implants Research 03/2015; DOI:10.1111/clr.12593 · 3.12 Impact Factor
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ABSTRACT: The reliability of spectrophotometric measurements of gingival color has not been tested. The purpose of this study was to evaluate the repeatability and reproducibility of gingival color measurements with a digital spectrophotometer. Measurement error was estimated by determining the interrater agreement and by repeating measurements in different illumination environments with and without contact of the device with the gingiva. Two trained examiners measured the gingival shade around 30 central incisors with a spectrophotometer with and without external illumination and with and without contact of the device with the gingiva. Color data obtained (CIELab color coordinates; L*, c*, h*, a*, b*) were analyzed with the intraclass correlation coefficient (ICC) and the Student t test for paired samples. Mean L*, c*, a*, and b* values differed significantly between measurements made with and without contact of the device with the tissue, but no difference was found in h* values. An ICC of >0.9 was obtained for interrater and intrarater agreements in all cases. Shade measurements did not differ between the presence and absence of stable ambient light. The repeatability and reproducibility of soft tissue shade measurements were almost perfect (ICC >0.9) under the examination conditions tested. The measurements were affected by pressure but not by ambient light. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.The Journal of prosthetic dentistry 03/2015; DOI:10.1016/j.prosdent.2014.11.003 · 1.42 Impact Factor
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ABSTRACT: Background Diverging opinions exist regarding rough surface abutment usage, and abutment exclusion effects are unstudied.PurposeThe study aims to: (1) assess tissue response to oxidized or machined abutments or no abutment; and (2) evaluate immediate implant-loading effects.Materials and Methods In a 2005–2008 parallel-group randomized, clinical trial, 50 partially edentulous subjects received three Brånemark TiUnite™ (Nobel Biocare®, Gothenburg, Sweden) implants. Superstructures were attached via abutments (one with a TiUnite surface – AOX, and one with a machine-milled surface – AM) or directly at implant level (IL). Implants were immediately loaded (test) or unloaded for 3 months (control). Postoperative examinations were done up to 3 years.ResultsForty-seven subjects were reexamined after 3 years. Four and two implants were lost in test and control groups, respectively, during the first year. Thereafter, no implant loss occurred (95.7% survival). After 1 year, mean (SEM) peri-implant marginal bone loss (MBL) was 1.33 (0.08) mm (test) and 1.25 (0.08) mm (control). Between 1 and 3 years, a nonsignificant MBL occurred: 0.36 (0.08) mm (test) and 0.33 (0.06) mm (control). Similar MBL was found at IL (1.81 [0.93] mm) and AOX (1.77 [0.14] mm) after 3 years and was significantly lower at AM (1.42 [0.17] mm) than at IL (groups merged); 42% of the implants displayed mucosal bleeding at 3 years and probing pocket depths varied between 2.13 (0.12) mm and 3.62 (0.15) mm, significantly lower buccally. Bleeding on probing (BoP) in minute amounts was found in 30–45% of the sites and abundant BoP at about 20% of the sites. Soft tissue retracted mostly during year 1 and was more pronounced buccally. Regression analyses revealed significant effects from smoking, periodontal disease, abundant BoP, and a low initial implant stability quotient on MBL.Conclusions No further significant MBL was found between 1 and 3 years, irrespective of loading protocol. Use of machined abutments may benefit marginal bone stability over time.Clinical Implant Dentistry and Related Research 04/2015; DOI:10.1111/cid.12315 · 2.80 Impact Factor