Midfacial Recession Research Articles

The Association Between Buccal Mucosa Thickness and Periimplant Bone Loss and Attachment Loss: A Cross-Sectional Study.

The aim of this study was to assess if there is an association between buccal mucosa thickness and periimplant attachment loss after 1 year of function. A total of 28 patients (14 periimplantitis implants and 14 healthy implants) were included. The buccal mucosal thickness was assessed using K-files at 3 mm apical to the soft tissue margin of the implant. Probing depth, recession (REC), clinical attachment level (CAL), bleeding on probing, and radiographic bone loss on mesial and distal sites of the implant were recorded. The data showed that there was a statistically significant difference in midfacial REC between thin and thick buccal mucosa groups. However, the CAL was not statistically significant different between both groups. In addition, there was no statistically significant difference in mesial and distal bone loss between implants with thin and thick mucosa. When the midfacial soft tissue thickness was thin, the midfacial REC was greater and the CAL also tended to be higher. There was no association between buccal mucosa thickness and periimplant bone loss on mesial and distal sites of the implant after 1 year of function.

Peri-implant Tissues and Patient Satisfaction After Treatment of Vertically Augmented Atrophic Posterior Mandibles with Intraoral Onlay Block Bone Grafts: A Retrospective 3-Year Case Series Follow-up Study.

To evaluate the peri-implant soft and hard tissues of dental implants placed in vertically regenerated posterior mandibles with intraoral onlay block bone grafts and patient satisfaction at 3-year follow-up. A retrospective study of patients with dental implants placed in posterior mandibular sites vertically augmented with intraoral onlay block bone grafts was carried out between 2005 and 2009 at the University of Valencia. The outcomes assessed at the 3-year follow-up visit were the peri-implant soft tissues (Plaque Index and Bleeding Index, probing depth, keratinized mucosa width, and recession), implant survival and success rates, marginal bone loss, and patient satisfaction. Sixteen patients with 36 implants were included. The mean Plaque Index and Bleeding Index scores were ≤ 0.4. The mean band of facial keratinized mucosa was ≥ 3 mm in 52.7% of implants; 38.8% of the implants showed facial recession. The mean midfacial recession was -0.31 ± 0.75 mm. Implant survival reached 100%, while the success rate was 85%, and the mean marginal bone loss was 1 ± 1.03 mm (range: 0.1 to 5.3). Good quality of life (9.19 ± 0.40) was reported for all patients, and the overall general satisfaction score was 8.07 ± 1.04 (mucosa esthetics: 7.71 ± 1.45; prosthesis esthetics: 8.42 ± 0.6; chewing: 8.68 ± 0.94; ease of cleaning: 8.01 ± 1.03). Considering the limitations of the study, implants in vertically augmented posterior mandibular areas with intraoral onlay block bone grafts showed good soft tissue levels and high patient satisfaction. No implants were lost at 3 years postloading, though one-fifth of the patients showed a statistically significant marginal bone loss.

Soft Tissue Changes Around Immediately Placed Implants: A Systematic Review and Meta-Analyses With at Least 12 Months of Follow-Up After Functional Loading.

Immediate implant placement (IIP) is predictable but can lead to esthetic challenges, including midfacial recession (MFR) and papillary height (PH) loss. The aim of this systematic review is to examine the effect of IIP on MFR and PH after at least 12 months of functional loading. Literature review of the Cochrane and MEDLINE electronic databases and hand search up to January 2016 identified eligible studies. Four reviewers independently assessed data quality and methodology. A total of 106 articles satisfied the inclusion criteria. Twelve studies qualified for three meta-analyses. MFR was slightly less in conventional implant placement (CIP) than in IIP, but the result was not statistically significant (mean difference [MD] -0.064 mm; P = 0.687). Similarly, there was better PH maintenance in CIPs, with statistical significance for distal PH (DPH) only (cumulative PH: MD -0.396, P = 0.010; DPH: MD -0.765, P <0.001; mesial PH [MPH]: MD -0.285, P = 0.256). MFR was slightly less in IIP with thick versus thin biotypes, but not statistically significantly different (MD -0.373, P = 0.243). Pooled data showed statistically significantly less MFR and better PH maintenance in IIP with thick biotype (MFR: MD -0.478, P <0.001; cumulative PH: MD -0.287, P <0.001; MPH: MD -0.288, P <0.001; DPH: MD -0.310, P <0.001). Non-significantly less MFR (MD 0.253, P = 0.384) and significantly better PH maintenance were found in IIP with immediate provisionalization versus conventional restoration (MD -0.519, P = 0.028). IIP in thick biotype and with immediate provisionalization had less MFR and better PH than IIP in thin biotype or with delayed restoration. However, these findings should be interpreted with caution due to high heterogeneity, which was calculated using comprehensive meta-analysis statistical software that took into account sample size and different treatment groups, and limited qualified studies.

Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile: one-year results.

To evaluate the 1-year outcome of Minimally Invasive Single Implant Treatment (M.I.S.I.T.) based on ridge preservation and contour augmentation in patients with a high aesthetic risk profile. Periodontally healthy non-smoking patients with a failing tooth in the anterior maxilla (15-25) were selected. All were in need of a single implant and demonstrated high risk for aesthetic complications given mid-facial recession at the failing tooth and/or a buccal bone dehiscence and/or a thin-scalloped gingival biotype. Patients without mid-facial recession (NRG) received flapless tooth extraction and ridge preservation using a collagen-enriched bovine-derived xenograft, flapless installation of a bone condensing implant with variable-thread design (4-6 months later), a provisional screw-retained crown and connective tissue graft (CTG) inserted in the buccal mucosa (3 months later) and a permanent crown (3 months later). Patients with mid-facial recession (RG) were treated similarly, yet they received a CTG at the time of ridge preservation. All patients were treated by an experienced periodontist using a microsurgical approach. Primary outcome variables included papillary and mid-facial recession. Clinical parameters, pink (PES) and white aesthetic score (WES) were considered secondary outcome variables. Fifty patients (25 females, 25 males; mean age 39, range 19-81; 42 in NRG and 8 in RG) met the selection criteria and consented to the treatment. Forty-seven could be examined at 12 months and all implants survived. Mean bone loss amounted to 0.48 mm (range 0.00-1.80) at 12 months. Papillary recession was minimal in both groups at 12 months (mean ≤ 0.3 mm), as was mid-facial recession in the NRG (mean 0.1 mm). Twelve patients in the NRG even demonstrated coronal migration of the mucosal margin following CTG and needed adaptation of the provisional crown to induce soft tissue retraction. Due to CTG at the time of ridge preservation in the RG, mid-facial soft tissue gain amounted to 0.9 mm at 12 months, hereby eliminating 2/3rd of the initial recession. PES and WES were favourable pointing to 10.9/14 and 8.2/10 respectively. This short-term prospective study offers a proof of principle of M.I.S.I.T. in patients with a high aesthetic risk profile.

Biomimetic Zirconia Abutment for Single Implant Supported Restoration: A Case Report

Treatment outcome of prosthetic restorations in the aesthetic zone is potentially subjected to change following the dynamic status of the oral environment. Long-term evaluation of these restorations can reveal a less aesthetic appearance due to alteration of the surrounded soft tissue. The aim of this clinical report is to present a prosthetically oriented technique that may contribute to the enhancement of soft tissue appearance of implant-supported restorations in the aesthetic zone if mid facial recession occurs. Particularly, this approach utilizes a biomimetically fabricated implant abutment consisting of the pink subgingival portion and the white supragingival portion to mimic the soft tissue and tooth structure shades, respectively.

A prospective cohort study on the impact of smoking on soft tissue alterations around single implants.

To compare smokers to non-smokers in terms of soft tissue alterations following single implant treatment in healed bone. Non-smoking and smoking patients with sufficient bone volume in need of a single implant in the anterior maxilla (15-25) were consecutively recruited in three centres. Conventional single implant surgery was performed and an immediate provisional crown was installed. Eight to 12weeks later, the latter was replaced by a permanent one (baseline). Papilla regrowth and midfacial recession was registered after 2years of function. The sample consisted of 39 non-smokers (21 females; mean age 42) and 46 smokers (22 females; mean age 45). Smokers had three early failures, whereas all implants integrated successfully in non-smokers. Statistically significant papilla regrowth was observed in non-smokers (distal 0.63mm, mesial 0.76mm), whereas smokers showed stable papillae (between cohorts: P≤0.025). Midfacial soft tissue level demonstrated statistically significant regrowth in non-smokers (0.53mm), whereas it remained stable in smokers (between cohorts: P=0.004). Smokers failed to demonstrate papilla regeneration and showed more midfacial recession following single implant treatment when compared to non-smokers.

Efficacy of Acellular Dermal Matrix and Coronally Advanced Flaps for the Treatment of Induced Gingival Recession Defects: A Histomorphometric Study in Dogs

Gingival recession (GR) defects can be treated by various methods, including acellular dermal matrix (ADM) or coronally advanced flaps (CAFs). The aim of this histomorphometric experiment is to compare the efficacy of ADM and CAF for treating GR defects in dogs. In eight beagle dogs, a critical-size labial GR defect was surgically induced on bilateral maxillary cuspids under general anesthesia. Test sites received ADM and CAF, and control sites underwent CAF treatment alone. Plaque index (PI), bleeding index (BI), and gingival index (GI) were measured at 4 weeks (baseline), 8 weeks, and 16 weeks. Width of keratinized gingiva (KG) was determined at baseline and at 16 weeks. Depth of recession and width of GR below the cemento-enamel junction (CEJ) was also determined. After 4 months, animals were sacrificed, and jaw blocks were histomorphometrically assessed for tissue thickness and distance from the stent to the gingival margin (GM) and to the CEJ. At 4-, 8-, and 16-week intervals, there was no significant difference in the BI, GI, and PI at the test and control sites. At 16 weeks, thickness of KG was significantly higher at the control sites than test sites (P <0.01). There was no difference in the midfacial recession depth and recession width at the test and control sites at baseline and before euthanasia (16 weeks). Histomorphometrically, there was no significant difference in tissue thicknesses and distances from the stent to the GM and CEJ in the test and control sites. ADM might yield similar results to a CAF alone and could decrease the amount of KG.

Alterations in soft tissue levels and aesthetics over a 16–22year period following single implant treatment in periodontally‐healthy patients: a retrospective case series

Long term studies on single implants are scarce and merely focus on clinical response parameters, complications and bone remodelling. The objective of this retrospective case series was to assess alterations in soft tissue levels and aesthetics over a 16-22year period in periodontally-healthy patients. Patients who had received a single turned implant in the anterior maxilla/mandible at the Dental Specialist Clinic in Malmö between 1987 and 1993 were invited for a re-examination on the basis of a number of inclusion criteria. Both neighbouring teeth had to be present at re-examination and baseline clinical photographs (within the first year of function) had to be available for soft tissue evaluation. These photographs were superimposed onto final clinical photographs to assess longitudinal soft tissue alterations. Twenty-one patients (nine females; mean age 23, range 16-41) treated with 24 single implants met the criteria for soft tissue evaluation. Peri-implant soft tissue levels (papillae, midfacial level) remained stable over a 16-22year observation period (p≥0.372). However, neighbouring teeth demonstrated midfacial recession and eruption pointing to a major distortion with the implant crown (>1mm) in 5/24 (21%) and 10/24 (42%) of the cases, respectively. Baseline aesthetics was considered poor (mean Pink Esthetic Score 7.42, mean White Esthetic Score 5.43), yet a significant time effect could not be demonstrated (p≥0.552). Implant and tooth bone loss was low (mean 0.6mm and 0.4mm, respectively) over a 16-22year period. This limited case series demonstrated stable peri-implant soft tissue levels and aesthetics in the long term following single implant treatment in periodontally-healthy patients. However, midfacial recession and eruption may be expected at neighbouring teeth.

Regenerative periodontal therapy of infrabony defects using minimally invasive surgery and a collagen‐enriched bovine‐derived xenograft: a 1‐year prospective study on clinical and aesthetic outcome

To evaluate the clinical and aesthetic outcome of regenerative periodontal therapy (RPT) using minimally invasive surgery and a collagen-enriched bovine-derived xenograft (1); to identify risk factors for failure (clinical attachment level (CAL) gain ≤ 1 mm) and advanced gingival recession (REC) increase (>1 mm) (2). Ninety-five non-smoking patients, with ≤ 25% full-mouth plaque and bleeding presenting ≥ 6 months after initial periodontal therapy with ≥ 1 isolated inter-dental infrabony defect were recruited. Patients were consecutively treated by the same clinician using minimally invasive surgery and a collagen-enriched bovine-derived xenograft. Clinical, radiographic and aesthetic data were collected before surgery and up to 1 year. Multivariate analyses were used to identify risk factors for failure and advanced REC increase. Eighty-four patients (39 men, 45 women; mean age 53) complied and demonstrated mean probing depth (PD) of 7.8 mm, CAL of 10.0 mm and defect depth of 5.2 mm before surgery. At 1 year, postsurgery mean PD reduction was 3.5 mm (range 0.0-8.0), CAL gain was 3.1 mm (range 0.0-7.0) and radiographic defect fill was 53% (range 0-100). Forty-nine percentage showed ≥ 4 mm CAL gain, whereas 15% were considered failures. Mean inter-dental and midfacial REC increase was 0.3 mm (range-2.0-2.0) and 0.5 mm (range-1.5-2.0) respectively. Midfacial REC increase and contour deterioration contributed most to a small, yet significant reduction in the Pink Esthetic Score from 10.06 to 9.42 (p = 0.002). Risk factors for failure included defects with a non-supportive anatomy (OR: ≥ 10.4), plaque (OR: 14.7) and complication(s) (OR: 12.0). Risk factors for advanced midfacial REC increase included defects with a non-supportive anatomy (OR: 58.8) and a thin-scalloped gingival biotype (OR: 76.9). RPT using minimally invasive surgery and a collagen-enriched bovine-derived xenograft demonstrated favourable clinical outcome after 1 year, even though soft tissue aesthetics could not be fully preserved. Defects with a non-supporting anatomy may be at risk for failure and advanced midfacial recession.

Predictors of inter‐proximal and midfacial recession following single implant treatment in the anterior maxilla: a multivariate analysis

A number of factors have been associated with soft tissue recession following single implant treatment. However, given the cross-sectional design of most of these studies and crude associations based on univariate analyses, such factors may only be considered risk indicators. The objective of the present retrospective cohort study using multivariate analyses was to identify predictors of recession. Patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 for a single implant in the anterior maxilla were re-examined in 2009 and their records were scrutinized. Subjects treated via flap surgery with and without ridge re-contouring were considered. Outcome variables were inter-proximal and midfacial recession. Explanatory variables included demographic data, the surgical approach and a number of local factors that were evaluated on radiographs taken pre-operatively or at permanent crown installation (baseline). Data pertaining to 97/115 (60 females, 37 males; mean age 51, SD 13, range 23-80) patients were available for evaluation. Significant bone loss was observed between baseline and re-examination at the implant surface (0.2-0.3mm, p<0.001) and tooth surface (0.3-0.5mm, p<0.001). Surgery with ridge re-contouring demonstrated 0.2mm additional bone loss at the distal tooth surface when compared to surgery without ridge re-contouring (p=0.034). This could be explained by a disparity in possible papilla-opening procedures (three versus one or two). As a result, regression analyses identified surgery with ridge re-contouring as a predictor of inter-proximal recession (OR≥3.4). Pre-operative bone level at the tooth surface was another predictor of inter-proximal recession (OR≥2.1). Recession of the distal papilla was also affected by a missing contact point (OR=221.9), the implant-to-tooth distance (OR=0.3) and the distance of the bone peak to the contact point (OR=2.9). Midfacial recession was only associated with a buccal shoulder position (OR=17.2). To optimize soft tissue levels around single implants, clinicians should limit papilla-opening procedures and pay utmost attention to a correct implant and contact point positioning.

A systematic review on the frequency of advanced recession following single immediate implant treatment

It has been stated that midfacial recession is common following immediate implant treatment (IIT). The objective of this systematic review was to assess the frequency of advanced recession (>1 mm) following single IIT. An electronic search in Pubmed, Web of Science and the Cochrane Oral Health Group Specialized Trials Register database was performed using a search algorithm. Reference lists of relevant articles were also scrutinized to identify prospective studies on ≥10 implants installed in patients with an intact buccal bone wall and followed for ≥12 months. Study eligibility and quality were independently assessed by two investigators. Primary outcome variables were advanced inter-proximal and midfacial recession defined as soft tissue loss surpassing 1 mm between the pre- or postoperative status and the final re-assessment. Thirteen of 171 papers were selected. Inter-examiner agreement on eligibility (κ = 0.879; p < 0.001) and quality (κ = 0.788; p < 0.001) was high. Advanced inter-proximal recession was described in 0-27% of the cases. However, these data were only based on two studies. Mean inter-proximal recession was frequently reported (11/13) and was <1 mm in all studies suggesting limited risk for advanced inter-proximal recession. Advanced midfacial recession was described in 0-64% of the cases. Again, few papers provided such information (4/13). Only one of these studies demonstrated high risk for advanced midfacial recession (>10%). This could be attributed to the fact that implants had not been restored with an immediate implant crown, which seems of pivotal importance given the results of a randomized controlled trial reporting on the preserving effect of immediate provisionalization on midfacial mucosa level. There is limited evidence to support an increased risk for midfacial recession following flap surgery and in patients with a thin-scalloped gingival biotype. The impact of implant-specific parameters on inter-proximal and midfacial soft tissue level seems conflicting. Soft tissue recession may be expected following IIT and multiple factors seem to contribute to the phenomenon. Taking into account the paucity of papers, patients with an intact buccal bone wall and thick gingival biotype, treated by means of flapless surgery and an immediate implant crown may demonstrate limited risk for advanced midfacial recession (<10%). Proper risk assessment addressing diagnostic, surgical and restorative aspects is mandatory to avoid compromised outcome of IIT.

Soft Tissue Preservation and Pink Aesthetics around Single Immediate Implant Restorations: A 1‐Year Prospective Study

(1) To document soft tissue aspects using a specific protocol for immediate implant treatment (IIT) following single-tooth removal; (2) to evaluate whether this protocol allows preservation of pink aesthetics as objectively assessed. Patients with a thick gingival biotype and intact buccal bone wall upon extraction of a single tooth in the aesthetic zone (15-25) were consecutively treated. The protocol included flapless extraction and implant surgery, socket grafting, immediate nonocclusal loading with a screw-retained provisional crown, and replacement by a permanent crown 6 months thereafter. The outcome was assessed after 3, 6, and 12 months. Cases demonstrating major alveolar process remodeling and/or advanced midfacial recession (>1 mm) at 3 months were additionally treated with a connective tissue graft (CTG). The emergence profile of the provisional crown was replicated for all permanent crowns. Twenty-two patients (12 men, 10 women; mean age 50) were treated after tooth extraction for nonperiodontal reasons using a novel bone condensing implant with variable-thread design, conical connection, and platform switch (NobelActive®, Nobel Biocare, Göteborg, Sweden). One implant failed and mean marginal bone loss was 0.1 mm (p = .059). Temporary mesial papilla reduction occurred, whereas distal papilla reduction was permanent (mean 0.5 mm; p = .001). At 3 months, five cases demonstrated major alveolar process remodeling and two advanced midfacial recession. Hence, slight initial decline in the pink esthetic score (PES) (p = .053) was observed. CTG resulted in a steady improvement of the PES after 3 months (p ≤ .037). At 12 months, pink aesthetics (mean PES 12.15) was comparable to the preoperative status (mean PES 11.86; p = .293). Distal papillae had significantly deteriorated (p = .020) in this time span, whereas midfacial contour had significantly improved (p = .005). Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one-third of the patients. Major alveolar process remodeling is the main reason for additional treatment.

Clinical, Aesthetic, and Patient‐Related Outcome of Immediately Loaded Single Implants in the Anterior Maxilla: A Prospective Study in Extraction Sockets, Healed Ridges, and Grafted Sites

The objective of this prospective clinical study was to document the overall treatment outcome of immediately loaded single Astra Tech Osseospeed™ (Astra Tech AB, Mölndal, Sweden) implants placed in extraction sockets, healed ridges, and grafted sites. Forty-eight patients in need of a single implant in the anterior maxilla (15-25) were recruited. Patients were allocated to a conventional implant treatment (CIT) or immediate implant treatment (IIT) group on the basis of specific criteria. If the buccal bone plate was damaged or missing upon tooth removal, patients were allocated to a grafted implant treatment (GIT) group. Irrespective of the treatment concept, implants were immediately provisionalized. Hard and soft tissue alterations, aesthetic parameters (pink and white esthetic scores, [PES and WES]) and patient's opinion (Oral Health Impact Profile [OHIP-14] questionnaires) were registered at different time points. After 1 year of function, the overall implant survival rate was 98% with one failure following IIT. The mean bone level to the implant-abutment interface was 0.65 (SD 0.79), 0.85 (SD 0.64), and 0.56 mm (SD 0.44) for CIT, IIT, and GIT. Complete papilla loss was rare following either strategy. Mean midfacial recession amounted to 1.00 (SD 1.15), 0.12 (SD 0.78), and 0.49 mm (SD 0.82) for CIT, IIT, and GIT, respectively. The aesthetic outcome showed a mean PES of 10.30 (SD 1.89) and mean WES of 7.11 (SD 2.14), all patients considered. Patient's satisfaction showed a significant improvement after 1 year of function on all seven domains (p < .001). This prospective study showed that single implants clinically and aesthetically perform well under immediate non-occlusal loading conditions in the premaxilla. In this context, it is of pivotal importance to stress that patients were carefully selected for IIT and GIT.

A 1‐Year Prospective Study on Co‐Axis® Implants Immediately Loaded with a Full Ceramic Crown

The Co-Axis implant (Southern Implants, Irene, South Africa) has a 12-degree angle in the implant neck to overcome angulation problems. To examine bone loss, peri-implant health, and aesthetical outcome after 1-year follow-up. Fifteen single implants were placed in 14 patients in the premaxilla and immediately loaded with a screw-retained full ceramic crown. Periapical radiographs and standardized photographs were taken to determine bone loss and soft tissue changes. Plaque and bleeding levels were assessed. Patients' satisfaction was measured using the Oral Health Impact Profile-14 questionnaire. After 1 year, all implants survived and mean bone loss was 1.20 mm, with no significant changes after 6 months. Plaque levels were low and no significant changes were observed. Bleeding levels decreased during the initial 3 months, but were constant thereafter. Before final torqueing was performed after 6 months, four cases of screw loosening occurred. Also, one crown had a piece of porcelain chipped off. Patients reported an overall increase in well-being. A mean midfacial recession of 0.37 mm was observed. The mesial papilla showed a slight increase of 0.14 mm, while the distal papilla decreased 0.35 mm. With 100% survival and stable bone levels after 6 months, the Co-Axis implant showed a good clinical outcome when immediately loaded. The use of a full ceramic crown as a first and final restoration resulted in a good aesthetic outcome with few changes in papilla fill, although midfacial soft tissue was stable only after 1 year.

Immediate single-tooth implants in the anterior maxilla: 3-year results of a case series on hard and soft tissue response and aesthetics

The objective of this prospective study was to assess the overall outcome of immediate single implant treatment in the anterior maxilla after a 3-year observation period. Thirty consecutively treated patients with a thick gingival biotype, ideal gingival level/contour and intact socket walls at the time of tooth extraction were treated for single-tooth replacement in the aesthetic zone by two experienced clinicians. Treatment included minimal mucoperiosteal flap elevation, immediate implant placement (NobelReplace TiUnite(®)), insertion of a grafting material between the implant and the socket wall and connection of a screw-retained provisional restoration. The latter was replaced by a cemented crown 6 months thereafter. Patients were clinically and radiographically re-examined after 3 years to assess implant survival, complications and hard and soft tissue conditions. The aesthetic outcome was objectively rated using the Pink Esthetic Score (PES) and White Esthetic Score (WES) by a blinded clinician who had not been involved in the treatment. Twenty-five patients could be re-evaluated after 3 years. One early implant failure had occurred resulting in an implant survival rate of 96%. Radiographic examination yielded on average 1.13 mm mesial, respectively 0.86 mm distal bone loss. The clinical conditions showed fairly low peri-implant plaque (18%) and bleeding (24%) and mean probing depth was 3.17 mm. Mean mesial/distal papilla shrinkage and midfacial soft tissue recession in reference to the pre-operative status accounted for 0.05, 0.08 and 0.34 mm, respectively. Between the 1- and 3-year reassessment mesial papillae showed significant re-growth (0.36 mm; p=0.015). Advanced midfacial recession (>1 mm) was found in 2/25 (8%) cases. Five (21%) cases were aesthetic failures (PES<8 and/or WES<6) and 5/24 (21%) showed an (almost) perfect outcome (PES≥12 and WES≥9). The remainder (14/24 or 58%) demonstrated acceptable aesthetics. The proposed strategy seems a valuable and predictable treatment option for well-selected patients in the mid-long term as shown by almost full papillary re-growth and a low risk for advanced midfacial recession.

Immediate and conventional single implant treatment in the anterior maxilla: 1-year results of a case series on hard and soft tissue response and aesthetics

The main objective of this clinical study was to document midfacial soft tissue dynamics following single immediate implant treatment (IIT) and conventional implant treatment (CIT) in the anterior maxilla when performed by experienced clinicians in well-selected patients. Appropriate bone volume and ideal soft tissue levels were considered requirements for implant therapy. Additional prerequisites for IIT were intact socket walls and a thick gingival biotype. CIT included standard flap elevation whereas IIT was either performed with a flap or flapless procedure. All implants were provisionally restored using cemented acrylic crowns. Bone levels, papillae and midfacial soft tissue levels were monitored at regular intervals. The aesthetic outcome was assessed after 1 year using the pink aesthetic score (PES) and white aesthetic score (WES). Sixteen patients (10 men, six women; mean age 45) received an immediate implant and 23 patients (12 men, 11 women; mean age 40) had conventional implant surgery. One immediate implant failed in the early healing phase. The mean bone level from the implant-abutment interface was 0.85mm for IIT and 0.65mm for CIT after 1 year (p=0.144). Mesial papillae remained stable over time. Minute loss of distal papillae occurred following IIT (-0.38mm) and a tendency for re-growth was found following CIT (0.60mm). Midfacial soft tissues remained stable over time following IIT with only 7% showing advanced recession (>1mm). Flapless surgery induced less midfacial recession than flap surgery (p=0.023). Significant midfacial recession occurred following CIT (-1mm). Overall, 24% were aesthetic failures (PES<8 and/or WES<6) and 8% showed an (almost) perfect outcome (PES12 and WES9). The remainder (68%) demonstrated acceptable aesthetics. Immediate implants demonstrated fairly stable midfacial soft tissue levels with only a minority of cases showing advanced recession. Irrespective of the timing of implant placement, aesthetic failures seem to be rather common and only a strict minority may show perfection.

Instant provisionalization of immediate single‐tooth implants is essential to optimize esthetic treatment outcome

The immediate single-tooth implant has become a viable treatment option. However, the impact of the restorative procedure on esthetics is currently unclear. The goal of this study was to compare the soft tissue outline at immediate implants following two restorative protocols: immediate connection of a temporary crown or submerged healing during which a removable partial denture is used. A 1-year single-blind randomized clinical study was performed in 49 patients. Twenty-four patients were assigned to the immediate restoration group and 25 to the delayed restoration group. Clinical and radiographic evaluations of soft and hard tissues were carried out after 3, 6 and 12 months. Implant survival, bone remodeling, probing depth and bleeding tendency were not influenced by the restorative protocol. Delayed restoration resulted in initial papilla loss taking up to 1 year to attain comparable height as for immediate restoration. Midfacial recession was systematically 2.5-3 times higher following delayed restoration pointing to a 0.75 mm additional loss in comparison with immediate restoration after 1 year. If the primary implant stability permits it, immediate single-tooth implants should be instantly provisionalized in the interest of optimal midfacial esthetics.