Laurens den Hartog

Treatment outcome of immediate, early and conventional single-tooth implants in the aesthetic zone: a systematic review to survival, bone level, soft-tissue, aesthetics and patient satisfaction

AIM This study evaluated, through a systematic review of the literature, the outcome of single-implant restorations in the aesthetic zone with natural adjacent teeth, thereby addressing immediate, early and conventional implant approaches. MATERIAL AND METHODS MEDLINE (1950-2008), EMBASE (1966-2008), and CENTRAL (1800-2008) were searched to identify eligible studies. Two reviewers independently assessed the methodological quality using specific study-design-related assessment forms. RESULTS Out of 86 primarily selected articles, 19 studies fulfilled the inclusion criteria. A meta-analysis showed an overall survival rate of 95.5% [95% confidence interval: (93.0-97.1)] after 1 year. A stratified meta-analysis revealed no differences in survival between immediate, early and conventional implant strategies. Little marginal peri-implant bone resorption was found together with low incidence of biological and technical complications. No significant differences in outcome measures were reported in clinical trials comparing immediate, early or conventional implant strategies. CONCLUSION The included literature suggested that promising short-term results could be achieved for immediate, early and conventional single-implants in the aesthetic zone. However, important parameters as aesthetic outcome, soft-tissue aspects, and patient satisfaction were clearly underexposed. The question whether immediate and early single-implant therapies would result in better treatment outcomes remained inconclusive due to lack of well-designed controlled clinical studies.

A systematic review of the prognosis of short (<10 mm) dental implants placed in the partially edentulous patient

AIM This study evaluated, through a systematic review of the literature, the estimated implant survival rate of short (<10 mm) dental implants installed in partially edentulous patients. MATERIALS AND METHODS A systematic search was conducted in the electronic databases of MEDLINE (1980-October 2009) and EMBASE (1980-October 2009) to identify eligible studies. Two reviewers independently assessed the methodological quality of the articles using specific study design-related quality assessment forms. RESULTS Twenty-nine methodologically acceptable studies were selected. A total of 2611 short implants (lengths 5-9.5 mm) were analysed. An increase in implant length was associated with an increase in implant survival (from 93.1% to 98.6%). Heterogeneity between studies was explored by subgroup analyses. The cumulative estimated failure rate of studies performed in the maxilla was 0.010 implants/year, compared with 0.003 found in the studies in the mandible. For studies that also included smokers, the failure rate was 0.008 compared with 0.004 found in studies that excluded smokers. Surface topography and augmentation procedure were not sources of heterogeneity. CONCLUSION There is fair evidence that short (<10 mm) implants can be placed successfully in the partially edentulous patient, although with a tendency towards an increasing survival rate per implant length, and the prognosis may be better in the mandible of non smoking patients.

Immediate placement of dental implants in the esthetic zone: a systematic review and pooled analysis

BACKGROUND Research interest on immediate placement of dental implants has shifted from implant survival toward optimal preservation of soft and hard tissues. The aim of this study is to systematically assess the condition of implant survival, peri-implant hard and soft tissue changes, esthetic outcome, and patient satisfaction of immediately placed single-tooth implants in the esthetic zone. METHODS MEDLINE, EMBASE, and CENTRAL databases were searched for publications up to June 2013. Studies reporting on implant survival, changes in hard and soft peri-implant tissues, esthetic outcome, and patient satisfaction were considered. A pooled analysis was performed to identify factors associated with survival and peri-implant tissue changes after immediate implant placement. RESULTS Thirty-four studies were considered eligible. Immediate placement of single-tooth implants in the esthetic zone was accompanied by excellent 1-year implant survival (97.1%, 95% confidence interval [CI]: 0.958 to 0.980). Mean marginal peri-implant bone loss was 0.81 ± 0.48 mm, mean loss of interproximal peri-implant mucosa level was 0.38 ± 0.23 mm, and mean loss of peri-implant midfacial mucosa level was 0.54 ± 0.39 mm. Regression analysis revealed that delayed provisionalization (odds ratio [OR] 58.03, 95% CI: 8.05 to 418.41, P <0.000), use of a flap (OR 19.87, 95% CI: 10.21 to 38.66, P <0.000), and use of a connective tissue graft (OR 4.56, 95% CI: 1.72 to 12.08, P <0.002) were associated with marginal peri-implant bone-level change >0.50 mm. Because of underreporting, esthetic results and patient outcome did not allow for reliable analysis. CONCLUSION Immediate placement with immediate provisionalization of dental implants in the esthetic zone results in excellent short-term treatment outcome in terms of implant survival and minimal change of peri-implant soft and hard tissue dimensions.

Single-tooth implants with different neck designs: a randomized clinical trial evaluating the aesthetic outcome

AIM To evaluate the aesthetic outcome of single-tooth implants in the aesthetic zone with different neck designs from a professionals and patients perception. MATERIALS AND METHODS Ninety-three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post-implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patients perception. standardized radiographs were taken to measure marginal bone level changes. RESULTS One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19±0.82mm, rough neck 0.90±0.57mm, scalloped neck 2.01±0.77mm), there were no differences in aesthetic outcome. According to the professionals assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0±1.0 out of a maximum of 10). According to the professionals assessment, a pre-implant augmentation procedure was associated with less favorable aesthetics of the mucosa. CONCLUSION This study shows that the aesthetics of single-tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre-implant surgery.

Immediate loading and customized restoration of a single implant in the maxillary esthetic zone: a clinical report.

The replacement of a single missing anterior tooth with an implant-supported crown is a demanding therapy. This report describes a treatment in which an anterior maxillary implant was immediately restored with a provisional restoration. During the provisional phase, an optimal emergence profile was created by adjusting the provisional restoration. An impression was made with an individually fabricated impression post for an accurate reproduction of the established emergence profile and, finally, a screw-retained all-ceramic crown was placed. By implementing this protocol, an optimal definitive result could be achieved, together with immediate patient satisfaction. However, cooperation among several disciplines and careful patient selection were required.

Significance of buccopalatal implant position, biotype, platform switching, and pre-implant bone augmentation on the level of the midbuccal mucosa

This study assessed whether buccopalatal implant position, biotype, platform switching, and pre-implant bone augmentation affects the level of the midbuccal mucosa (MBM). Ninety patients with a single-tooth implant in the esthetic zone were included. The level of the MBM was measured on photographs taken 1 year after crown placement. The factors analyzed only explained 22% of the level of the MBM. The more an implant was placed to the buccal, the more the MBM was positioned apically. A comparable phenomenon was observed in cases with a thick biotype and cases that underwent pre-implant bone augmentation. Platform switching did not affect the level of the MBM.

Patient satisfaction with single-tooth implant therapy in the esthetic zone.

This prospective study assessed patient satisfaction before and after single-tooth implant therapy in the esthetic zone. Before implant therapy, patients wore an acrylic resin tissue-supported removable partial denture (RPD). A total of 153 patients were included. Self-administered questionnaires regarding function, comfort, and esthetics were used to measure patient satisfaction with the RPD and with the implant at 6 and 18 months post-implant placement. Overall satisfaction was explored with a visual analog scale. It was suggested that patient satisfaction with a single-tooth implant in the esthetic zone is high and it improved when compared with an RPD that patients wore before implant treatment.

Comparison of two different abutment designs on marginal bone loss and soft tissue development.

PURPOSE To assess the response of soft tissues around two different abutment designs in healed sites in the esthetic zone. MATERIALS AND METHODS Twenty-six subjects received two endosseous implants in healed, bilateral implant sites in the esthetic zone in the maxilla or the mandible. After 17 to 19 weeks and left/right randomization, the implants were restored with either a conventional (control) or curved (experimental) titanium abutment and a provisional crown. Eight weeks after abutment placement, definitive crowns were cemented (T0). Soft tissue development was assessed based on peri-implant bone loss, Pink Esthetic Score (PES), and probing depths immediately after placement of the definitive crown and after 1 year (T12) and compared between sites. Possible confounding variables (abutment angle, plaque presence, gingival bleeding, width of attached mucosa) were also documented at T0 and T12. RESULTS The mean peri-implant marginal bone loss from T0 to T12 was 0.00 ± 0.37 mm in the experimental group and 0.12 ± 0.27 mm in the control group. Differences were not statistically significant (P = .25). At T12, the curved abutment scored a mean PES of 10 ± 2.3 and the straight abutment scored 9.7 ± 2.3. The difference was not significant (P = .46)). Probing depths were also not significantly different between the two groups (P = .85). Correlation and regression analysis showed no hints of predictive behavior for the possible confounding variables. CONCLUSION A titanium abutment with a circumferential curved design is of no additional benefit to soft tissue development and preservation of marginal bone compared to a conventional straight abutment design for the restoration of single-tooth implants in the esthetic zone.

Immediate Loading of Anterior Single Tooth Implants Placed in Healed Sites: Five-Year Results of a Randomized Clinical Trial

PURPOSE The aim of this study was to compare the 5-year outcome of immediate loading with that of conventional loading for anterior single-tooth implants placed in healed sites. It was hypothesized that immediate loading is not inferior to conventional loading. MATERIALS AND METHODS A total of 62 patients with a missing maxillary anterior tooth were included. At random, patients were treated with an implant that was restored either with a nonoccluding temporary crown within 24 hours after implant placement (immediate group) or according to a two-stage procedure after 3 months (conventional group). All implants were placed in healed sites. Follow-up visits were performed after definitive crown delivery and 1 and 5 years thereafter. Outcome measures were radiographic marginal bone level changes, implant survival, complications, soft tissue aspects (probing depth, plaque, bleeding, soft tissue level changes), esthetic outcome, and patient satisfaction. RESULTS Three patients in each study group were lost to follow-up. No significant differences were found in terms of marginal bone loss (1.16 ± 0.93 mm in the immediate group and 1.20 ± 1.10 mm in the conventional group), survival (one implant lost in the immediate group), complications, soft tissue aspects, esthetic outcome, and patient satisfaction. CONCLUSION For anterior single-tooth implants placed in healed sites, the outcome of immediate loading is not inferior to conventional loading.

Anterior single implants with different neck designs: 5 Year results of a randomized clinical trial

Background The design of the implant neck might be significant for preservation of marginal bone. Purpose To compare the 5-year radiographic and clinical outcome of single anterior implants provided with a smooth neck, a rough neck or a scalloped rough neck. Materials and Methods 93 Patients with a missing anterior tooth in the maxilla were included. At random, patients received an implant with a 1.5 mm smooth neck (“smooth group”), a rough neck with grooves (“rough group”) or a scalloped rough neck with grooves (“scalloped group”). Implants were installed in healed sites. Follow-up visits were conducted after final crown delivery and 1 year and 5 years later. Results Scalloped implants showed significantly more initial marginal bone resorption. The total amount of bone loss was 1.26 ± 0.90 mm in the smooth group, 1.20 ± 1.1 mm in the rough group and 2.28 ± 0.97 mm in the scalloped group (P < .05). Survival rates were 96.2% for the smooth and scalloped group and 100% for the rough group. Scalloped implants showed deeper pocket depths, more bleeding and more technical complications. There were no differences in esthetic outcome nor in patient satisfaction. Conclusions For anterior single tooth replacements, scalloped implants show less favorable radiographic and clinical outcome compared to regular implants with a smooth neck or rough neck.