Implant rehabilitation of the esthetic area: A five-year retrospective study comparing conventional and fully guided surgery.

Abstract

To compare the clinical outcomes of anterior single maxillary implants placed using conventional or guided implant surgery. In this retrospective clinical study 44 patients rehabilitated with a single anterior implant in the maxillary arch were included. Twenty-four implants were inserted applying a guided surgery approach (GS), and 20 applying a conventional freehand approach (CS). Outcome measures were: implant survival rate and complications; mean bone level (MBL) evaluated at surgery (T0), after 6 weeks (6W), and after 1 year (1Y), 2 years (2Y), 3 years (3Y), 4 years (4Y), and 5 years (5Y); patients' satisfaction evaluated through a questionnaire filled out before surgery (BS) and at 1week, 6W, 2Y and 5Y; Pink esthetic score (PES) and white esthetic score (WES) evaluated at 1Y, 3Y and 5 Y. Significance of differences between groups were tested by Fisher's exact test, Mann-Whitney U test, and Wilcoxon's signed rank test. During the 5-year follow-up there were no drop-outs and no implant failed. No significant differences between groups were found in MBL. A significant difference between groups was found in VAS scores regarding speech at 2 years, aesthetics at 6 weeks, confidence at 1week and 6 weeks, satisfaction at T0 and at 1W, pain/comfort at 1W and at 6W; all VAS scores resulted significantly improved compared to baseline. No significant differences in WES were found, while significant differences in PES scores between CS and GS groups were found at 3 and 5 years (p value=0.023 and 0.004 respectively) with better outcomes for GS. A significant difference over time was found in PES between 5-year and one-year values. Guided surgery and conventional surgery implants did not show any difference in MBL during the 5-year observation period. Guided surgical procedure guarantee optimal esthetic outcome and seems able to guarantee better soft tissue result over time, even though more long-term studies are necessary to confirm this data.