Soft Tissue Level Research Articles

Bone Ring Augmentation Around Immediate Implants: A Clinical and Radiographic Study.

Purpose:The purpose of this study was to evaluate the efficacy of bone ring augmentation technique for three-dimensional augmentation of severely defective sockets along with placement of immediate dental implants.Materials and Methods:A clinical study was conducted on 14 patients with 15 defective sockets requiring extractions and immediate implant placement. Following extraction, bone ring with an implant osteotomy, harvested from chin, was sculptured and fitted into the extraction socket. The bone apical to the socket was prepared for implant through the central osteotomy of the ring. Implant was then placed through the ring into the apical bone. After 6 months, prosthesis was placed. Clinical and radiographic examination was done to evaluate the soft tissue and crestal bone level around implants immediate postoperatively and at 1st, 3rd, 6th, and 9th month postoperatively.Results:Out of 15 grafted sockets, 14 showed an evidence of bone healing with no significant crestal bone resorption. One ring showed soft tissue dehiscence which underwent severe resorption at 6th month postoperative visit.Conclusion:The bone ring augmentation technique is an effective method for three-dimensional augmentation of severely defective sockets. This technique helps in reducing the overall treatment time by allowing grafting and placement of implant simultaneously in a single visit. However, longer observation periods are needed to draw more definite conclusions on the success of bone ring augmentation technique.

Esthetic assessments in implant dentistry: objective and subjective criteria for clinicians and patients.

In recent years the scientific community has shown a clear interest in the esthetic outcome of implant treatment. The present paper provides an overview of the esthetic ratings that have been used in implant dentistry. A distinction can be made between objective evaluations by clinicians and subjective evaluations by patients. The former mainly include: midfacial and interproximal soft-tissue levels; two-dimensional/three-dimensional soft-tissue alterations; assessment of the color match between the natural dentition, on the one hand, and the peri-implant tissues and the reconstruction, on the other hand; and ordinal indices, such as the pink and white esthetic score. Patient's needs and judgment may differ from objective indicators of implant success and esthetics. As a result, assessing treatment on the basis of patient-reported outcomes measures should be considered important. Validated questionnaires have been used that mainly assess the impact of oral health on the overall well-being of individuals. The esthetic judgment of patients is usually based on nonstandardized questions with varying scoring methods, including visual analog scales, Likert and other category scales and open questions. The heterogeneity in scoring systems between studies may compromise proper comparison of objective and subjective esthetic outcomes between studies and therapeutic concepts.

Reconstruction of Extensive Bucco‐Palatal Defects Using Twin Block Grafts: A Clinical Report of the Sandwich Technique in Two Cases

Three-dimensional alveolar ridge defects in the anterior maxilla necessitate bone augmentation before implant placement. Bone volume, contour, and the overlying soft tissue form have to be optimized for an ideal outcome. A large three-dimensional defect needs osteogenic bone to predictably reconstruct the defect. Autogenous bone in the form of block and particulate is the graft of choice in such situations. Two cases are presented here with severe three-dimensional alveolar ridge deficiency in the maxillary right lateral incisor and maxillary canine areas, respectively. Both cases had a three-dimensional bone and contour deficiency. Restorative-driven positioning of the implant necessitated augmentation of the buccal and palatal aspects of the defects. The defects were grafted with autogenous corticocancellous bone blocks harvested from the mandibular symphysis. In both sites, one block was placed on the buccal side and the other on the palatal side, "sandwiching" the host bone and the remainder of the gap filled with particulate autogenous bone. Implants were placed in both cases 5 months after the grafting, and the final restorations were placed 5 months subsequently. The implants and the grafts successfully integrated at the sites with stable bone and soft tissue levels. At the 3-year follow-up, both implants showed stable bone and soft tissue levels. Autogenous corticocancellous block grafts used in a sandwich technique reconstructed the lost bone volume, but also facilitated implant placement and optimal restorative outcomes.

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

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. 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. 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. For anterior single-tooth implants placed in healed sites, the outcome of immediate loading is not inferior to conventional loading.

Transmucosal Implant Placement with Submarginal Connective Tissue Graft in Area of Shallow Buccal Bone Dehiscence: A Three-Year Follow-Up Case Series.

The aim of the present case series study was to evaluate the short- and long-term (3 years) soft tissue stability of a surgical technique combining transmucosal implant placement with submarginal connective tissue graft (CTG) in an area of shallow buccal bone dehiscence. A sample of 20 patients were treated by positioning a transmucosal implant in an intercalated edentulous area. A CTG sutured to the inner aspect of the buccal flap was used to cover the shallow buccal bone dehiscence. Clinical evaluations were made at 6 months (T₁) and 1 (T₂) and 3 (T₃) years after the surgery. Statistically significant increases in buccal soft tissue thickness and improvement of vertical soft tissue level were achieved at the T₁, T₂, and T₃ follow-ups. A significant increase in keratinized tissue height was also found at T₃. No significant marginal bone loss was recorded. The submarginal CTG technique was able to provide simultaneous vertical and horizontal soft tissue increases around single implants with shallow buccal bone dehiscence and no buccal mucosal recession or clinical signs of mucositis or peri-implantitis at 1 and 3 years.

The level of detail required in a deformable phantom to accurately perform quality assurance of deformable image registration

The primary purpose of the study was to determine how detailed deformable image registration (DIR) phantoms need to adequately simulate human anatomy and accurately assess the quality of DIR algorithms. In particular, how many distinct tissues are required in a phantom to simulate complex human anatomy?Pelvis and head-and-neck patient CT images were used for this study as virtual phantoms. Two data sets from each site were analyzed. The virtual phantoms were warped to create two pairs consisting of undeformed and deformed images. Otsu’s method was employed to create additional segmented image pairs of n distinct soft tissue CT number ranges (fat, muscle, etc). A realistic noise image was added to each image. Deformations were applied in MIM Software (MIM) and Velocity deformable multi-pass (DMP) and compared with the known warping. Images with more simulated tissue levels exhibit more contrast, enabling more accurate results. Deformation error (magnitude of the vector difference between known and predicted deformation) was used as a metric to evaluate how many CT number gray levels are needed for a phantom to serve as a realistic patient proxy.Stabilization of the mean deformation error was reached by three soft tissue levels for Velocity DMP and MIM, though MIM exhibited a persisting difference in accuracy between the discrete images and the unprocessed image pair.A minimum detail of three levels allows a realistic patient proxy for use with Velocity and MIM deformation algorithms.

Successful Surgical Protocols in the Treatment of Peri-Implantitis: A Narrative Review of the Literature.

The aim was to identify and evaluate those surgical protocols reporting on positive clinical outcomes for treating peri-implantitis with 12 or more months of follow-up. Method of surface decontamination (SDC) was evaluated for any correlation with outcomes. A literature search was performed of all articles published in English between January 1, 2001 and April 30, 2015. Of the 639 identified, 26 satisfied the inclusion criteria. Outcomes reported on included reductions in bleeding on probing (BoP) and probing depth (PD), mean radiographic bone fill (RBF), and mean change in marginal soft tissue levels (MR±). Methods of SDC included mechanical debridement (MD) with and without saline use, MD plus laser or photodynamic therapy, MD with air powder abrasion, MD with chemotherapeutic implant surface decontamination, and combination approaches. The results suggested that various methods of SDC were effective. Heterogeneity of the studies made it impossible to determine correlations between clinical outcome and SDC method. Most studies over 12 months reporting better treatment outcomes employed a bone replacement. Additionally, studies where patients with periodontitis were treated before their peri-implantitis care also had better outcomes. The current review failed to reveal any correlation between any particular method for SDC or defect treatment protocol and positive clinical outcomes. Further comparative studies are warranted to determine the most appropriate approach for both of these topics.

Histological assessment of hard and soft tissues surrounding a novel ceramic implant: a pilot study in the minipig.

The aim of this study was to investigate clinical and soft/hard tissues histomorphological outcomes of a ceramic implant comparatively to a titanium implant in a minipig model. Eighteen soft tissue level implants (9 Ceramic with ZLA(®) surface as test, and 9 titanium SLActive(®) as control, Institut Straumann, Basel, Switzerland) were randomly placed into the mandible of 6 minipigs (n=6). Two months later, animals were sacrificed and block biopsies were obtained to assess histomorphological outcomes. Unadjusted paired comparisons, of both groups were performed using the Wilcoxon signed rank test. The Dunnett-Hsu test was used to adjust for multiple comparisons. All implants showed excellent integration into bone and soft tissue. The fBIC (distance implant shoulder to most coronal implant contact) and BIC% (percentage bone-to-implant contact) were for both groups; test: 3.95mm and 85.4%; control 3.97mm and 84.3% respectively. No difference in peri-implant mucosa height was found, however, the sulcular epithelium was significantly shorter for the ZrO2 (mean: 0.76, 95%CI: 0.46-1.06) than for the Ti (mean: 1.40, 95%CI: 1.10-1.70) (p=0.0090). Within the limits of this pilot study, no difference was found between the ceramic implant with ZLA(®) surface and a titanium implant in terms of bone tissue integration. Furthermore, the epithelial attachment favoured this ceramic implant over titanium.

COMPARATIVE STUDY BETWEEN TWO TYPES OF ATTACHMENTS USED FOR ROOT-SUPPORTED OVERDENTURE

INTRODUCTION: The incorporation of attachments in overdentures into everyday dental practice will open up another dimension in dental treatment planning and patient satisfaction. Teeth that might be considered for extraction may be considered as long or short term alternatives to implant or total edentulousness. Some teeth are maintained to support and/or retain the prosthesis and therefore, maximizing prosthesis stability, besides preserving proprioception of the periodontal ligament and reducing bone loss. Tooth-supported overdentures can be retained with attachments and can improve both retention and stability while simultaneously reducing alveolar bone resorption. They may also be more cost-effective and maintain more dental proprioception than implant-supported overdentures. OBJECTIVES: To compare clinically and radiographically between flex pivot (precision attachment with flexible male sphere) and castable pivot (semiprecision attachment) used for root-supported overdenture.MATERIALS AND METHOD: This randomized parallel controlled clinical study was conducted on twelve patients having bilateral mandibular single rooted teeth; canines or first premolars. Those were divided into two groups of six subjects. Group A (study group) each of six patients received flex pivots (precision attachment with flexible male sphere) bilaterally as test group. Group B (control group) six patients received castable pivots (semiprecision attachment) bilaterally as control group.RESULTS: When the data of changes in the clinical and radiographic parameters of periodontal status over a 6 months period were compared at immediate post-treatment, 1, 3, and 6 months intervals relative to type of attachment, the findings revealed there were no significant differences among precision attachment group in most of the mean values, while the opposite was shown in semiprecision attachment.CONCLUSIONS: Precision attachment with flex pivot was associated with more superior clinical periodontal parameters than precision attachment, and it is more biocompatible, hygienic, and maintaining healthy, stable periodontal soft tissue and crestal alveolar bone level.

Three Years of a Nonsurgical Periodontal Treatment Protocol to Observe Clinical Outcomes in ≥ 6-mm Pockets: A Retrospective Case Series

A total of 25 patients were treated with a nonsurgical periodontal treatment protocol (NSPTP) consisting of four appointments (three within 1 week and one approximately 30 days later). Nonsurgical periodontal instrumentation was implemented, with the adjunctive use of thermal diode lasers (wavelength of 808 or 980 nm). The patients were scheduled for recall visits every 3 months and reevaluated 1 year post-NSPTP. They were subsequently monitored at 4-month intervals for the remaining 2-year follow-up maintenance period. In total, 698 teeth (210 multirooted and 488 single-rooted) were included in the study. The mean bleeding on probing was 43% at baseline and decreased to 12% at 12 months and to 8% at 3 years. The initial ≥ 6-mm probing pocket depth (PPD) in single-rooted teeth decreased from 6.2 mm at baseline to a mean of 1.8 mm at 12 months and remained at 1.8 mm at 3 years, with a mean clinical attachment level (CAL) gain of 4.4 mm. In multirooted teeth, the PPD decreased from 6.7 mm to a mean of 3.9 mm at 12 months and 3.6 mm at 3 years, with a mean CAL gain of 2.9 mm. The mean overall recession was 0.3 mm at baseline, 0.1 mm at 1 year, and 0.3 mm at the 3-year follow-up. In the short-term followup period, uniform and consistent implementation of the NSPTP used here with adjunctive use of thermal diode lasers seemed to convey therapeutic benefits, stable periodontal soft tissue levels, and satisfactory esthetics in patients with moderate to severe chronic periodontitis. The present protocol is relevant as a treatment option for medically compromised patients, those who refuse or delay surgical treatment, or those who present with other limitations.

Clinical Outcomes of Implants Placed in Extraction Sockets and Immediately Restored: A 7-Year Single-Cohort Prospective Study.

The placement of implants immediately after tooth extraction has proven to be a predictable treatment strategy with a very high success rate. The aim of the present 7-year prospective single cohort study was to evaluate the success rate, marginal bone level (MBL), soft tissue stability of implants placed in fresh extraction sockets and immediately restored. This prospective cohort study included 37 implants in 32 patients (19 females and 13 males) with an average age of 40.1 ± 13.3 (range: 21-63 years) who received immediate implants and immediate single unit restorations. Outcome evaluations were: implant failures, complications, MBL, width of keratinized gingiva, facial soft tissue (FST) levels, modified Plaque Index and modified Bleeding Index. The cumulative survival rate was of 94.6% at 7-year visit. The mean MBL was -0.6 ± 0.49 mm at baseline and 1 ± 0.2 mm after 7 years. The FST Level was 0.4 ± 0.69 mm at baseline and 0.02 ± 0.70 mm at the 7-year follow-up. The Width of Keratinazed Gingiva was 3.8 ± 0.47 mm at baseline and 3.1 ± 0.42 mm at 7-year follow-up. Implants placed immediately after tooth extraction and immediately restored showed predictable clinical outcomes in this prospective study.

Evaluation of peri-implant soft tissue and bone levels around early loaded implant in restoring single missing tooth: A clinico-radiographic study.

Background:One-stage nonsubmerged protocol which can achieve success rates comparable to implants placed in a two-staged submerged procedure also the preconditions for periimplant bone regeneration has lead to more refined concepts of implant loading.Materials and Methods:Twenty sites with single missing tooth were included in this study. Clinical parameters included sulcus bleeding index (sBI), probing pocket depth (PD), and papilla index (PI) and radiographic parameters included crestal bone level were assessed for a period of 9 months.Results:The crestal bone loss showed mean value ranging from baseline 0.25 ± 0.11 to 0.31 ± 0.08 at 3 weeks, to 0.67 ± 0.13 at 3 months, to 0.85 ± 0.09 at 6 months, and to 0.88 ± 0.12 at 9 months. Probing PD, the mean value for probing PD at 3 weeks 1.20 ± 0.83, 3 months 1.60 ± 1.1, at 6 months 1.40 ± 1.14, and at 9 months 1.20 ± 1.0. sBI, mean value for sBI at 3 weeks 0.00 ± 0.00, 3 months 0.3 ± 0.11, at 6 months 0.09 ± 0.25, and at 9 months 0.08 ± 0.24. PI, showed a significant difference among at different points of time with P = 0.000.Conclusion:The dental implants showed <1 mm of crestal bone loss at 9 months follow-up, clinically significant marginal bone loss occurred between the time of implant placement and 3 months. Subsequent to that, bone loss observed around the implant up to 9 months was minimal. The periimplant soft tissue maturity was maintained throughout the study.

The effect of collar designs and developments over the years on soft tissue and bone level

The effect of collar designs and developments over the years on soft tissue and bone level

Long-term outcomes of soft tissue augmentation around dental implants on soft and hard tissue stability: a systematic review.

To investigate whether the height and volume of the soft tissues and peri-implant bone levels around dental implants are stable, when soft tissue augmentation has been performed. Three operators conducted a search on electronic databases (MEDLINE, COCHRANE, EMBASE) and a hand searching on the main journals dealing with periodontology and implantology until 30 October 2014. Only articles that considered peri-implant soft tissue augmentation performed in a group of at least 10 patients and with a follow-up of at least 1 year were selected. The outcome variables were peri-implant attached/keratinized tissue width (KTW) changes, peri-implant marginal soft tissue level (PSL) changes, and peri-implant marginal bone level (PBL) changes. The review was performed according to the PRISMA statements. Ten articles were selected for the qualitative synthesis, but only one meta-analysis was accomplished, indicating that 1 year after implant recession coverage procedures, a mean gain of 1.65 ± 0.01 mm (90% CrI [1.44; 1.85]) was observed. There is no long-term evidence whether augmented soft tissues can be maintained over time and able to influence the peri-implant bone levels.

Clinical and Radiological Long-Term Outcome of a Tapered Implant System with Special Emphasis on the Influence of Augmentation Procedures.

Tapered implant designs aim to improve primary stability and implant survival in soft bone. However, respective clinical long-term data are scarce. Therefore, a clinical and radiological evaluation of the long-term success of a transgingival-supracrestal inserted tapered implant system with special emphasis on the influence of augmentation procedures was conducted. In a retrospective study design, all in the Department of Oral and Maxillofacial Surgery of the University Medical Centre, Mainz, Germany, between May 2002 and March 2012, placed tapered implants (Straumann TE®, Basel, Switzerland) were analyzed. In this time period, a total of one hundred ninety-seven tapered implants were inserted in 90 patients. For patients available for clinical recall, success criteria according to Albrektsson and Buser were evaluated. The in situ rate was 96.3% after an average time in situ of 62 ± 31 months. In one hundred twenty-seven sites, bone augmentation procedures were performed. Hereof, 96 sites were sinus augmentation procedures and 31 sites were alveolar ridge augmentations. For patients with sinus augmentation procedures, implant survival was 97.9% and for patients with alveolar ridge augmentations, implant survival was 93.5% after 5 years, indicating a higher implant survival for sinus augmentation, however not statistically different (p = .194). Implant diameter and timing of implant placement had no significant impact on implant survival (p > .05). Mean marginal bone loss was -0.50 ± 1.54 mm for patients receiving maxillary sinus augmentation and -1.16 ± 1.13 mm for patients with alveolar ridge augmentations, indicating a lower marginal bone loss in patients receiving maxillary sinus augmentation (p = .046). Implant success rates ranged between 88% and 92% after a mean follow-up of 6 years. Within the limits of the retrospective character of this study, the tapered soft tissue level implant showed especially in maxillary sinus augmentation promising long-term survival and success rates and a low peri-implant bone resorption compared with the literature.

The use of a xenogeneic collagen matrix at the time of implant placement to increase the volume of buccal soft tissue.

The purpose of this study was to evaluate the efficacy of Mucograft (MG; a porcine-derived purified collagen membrane) to increase the thickness and height of the buccal soft tissue when placed at the time of implant placement in patients with thin or deficient keratinized tissue (KT). The primary endpoint of the study was the change in thickness and height of the buccal KT. Secondary endpoints included stability of the midbuccal soft tissue level; clinician rating of color, texture, and contour of treatment site; probing pocket depths (PPDs); assessment of satisfaction outcome; and patient assessment of pain/discomfort. Thirty-two patients were enrolled and 31 patients completed the study. There were no statistically significant (SS) differences between the MG and control groups for height measures. There was no SS difference for KT thickness (P = .117) between the groups at the final measurement (3 months postsurgery). However, there was an SS difference (P = .009) in favor of the MG group when comparing the difference in presurgical KT thickness to that 3 months postsurgery. Thus, MG was successful (compared to the control) in increasing the buccal KT. There were no SS differences between the groups for any of the other endpoints, including color, texture, contour, and pain assessment at any visit or successful outcome between the treatment group and the control. More cases and longer follow-up of implants placed with MG are needed to verify the results of this randomized prospective study.

10-year survival rate and the incidence of peri-implant disease of 374 titanium dental implants with a SLA surface: a prospective cohort study in 177 fully and partially edentulous patients.

This prospective cohort study evaluates the 10-year survival and incidence of peri-implant disease at implant and patient level of sandblasted, large grid, and acid-etched titanium dental implants (Straumann, soft tissue level, SLA surface) in fully and partially edentulous patients. Patients who had dental implant surgery in the period between November 1997 and June 2001, with a follow-up of at least 10years, were investigated for clinical and radiological examination. Among the 506 inserted dental implants in 250 patients, 10-year data regarding the outcome of implants were available for 374 dental implants in 177 patients. In the current study, peri-implantitis was defined as advanced bone loss (≧1.5mm. postloading) in combination with bleeding on probing. At 10-year follow-up, only one implant was lost (0.3%) 2months after implant surgery due to insufficient osseointegration. The average bone loss at 10year postloading was 0.52mm. Advanced bone loss at 10-year follow-up was present in 35 dental implants (9.8%). Seven percent of the observed dental implants showed bleeding on probing in combination with advanced bone loss and 4.2% when setting the threshold for advanced bone loss at 2.0mm. Advanced bone loss without bleeding on probing was present in 2.8% of all implants. In this prospective study, the 10-year survival rate at implant and patient level was 99.7% and 99.4%, respectively. Peri-implantitis was present in 7% of the observed dental implants according to the above-mentioned definition of peri-implantitis. This study shows that SLA implants offer predictable long-term results as support in the treatment of fully and partially edentulous patients.

Clinical, Esthetic, and Radiographic Evaluation of Small-Diameter (3.0-mm) Implants Supporting Single Crowns in the Anterior Region: A 3-Year Prospective Study

Fifty patients underwent single-tooth replacement in the maxillary and mandibular incisor area using two-piece 3.0-mm-diameter implants. Clinical and radiographic measurements of soft and hard tissue levels and esthetic parameters (pink esthetic score/white esthetic score [PES/WES]) were assessed at 3 years. No implant failed (success rate: 100%), and facial soft tissues and marginal bone levels remained stable throughout the study period. The mean total PES/WES was high (14.1 ± 1.75), and only one implant demonstrated an unfavorable esthetic outcome (PES/WES = 10). The use of 3.0-mm-diameter implants appears to be a viable treatment procedure in the medium term for single-tooth anterior restorations with limited dimensions.

Prosthodontic management of maxillectomy patients with dental implants in residual zygomatic bone: a preliminary report.

This report describes the 3-year follow-up of clinical and radiographic evaluation of soft and hard tissue outcomes for dental implants placed in residual zygoma in patients with surgical resections. Obturator retention and support, together with a questionnaire evaluation of the patients' satisfaction before and after insertion of implants, also were carried out. A novel approach to the palatomaxillary reconstruction of eight maxillectomy patients (mean age: 40 years) using dental implants inserted into the remaining zygomatic bone on the affected side and left unloaded for 3 months is described. Ball (O-ring) abutments were used with acrylic resin soft tissue conformers after surgical soft tissue thinning above the implants. All patients were radiographically evaluated and clinically documented at regular follow-up appointments. The 3-year follow-up period showed no implant failures, stable peri-implant soft tissue level, and an increase in all of the patients' satisfaction with their implant-supported obturators. Osseointegrated implants in residual zygomas are an integral part of oral rehabilitation strategies, with minimal cost and complications, for maxillectomy patients. This short-term record underscores both the potential of such management interventions and the importance of even longer-term clinical outcome documentation.

Papilla dimension and soft tissue level after early vs. delayed placement of single-tooth implants: 10-year results from a randomized controlled clinical trial.

To present the10-year esthetic outcome data for single-tooth implants placed early or delayed after tooth extraction. 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. Two 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. 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.