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Background: Due to chronic inflammation or trauma facial bone is frequently missing after tooth loss in the esthetic zone. As a consequence, procedures to augment or at least to preserve bone are frequently necessary prior to implant placement., Purpose: The aim of this retrospective case series is to demonstrate the applicability of a staged all-flapless concept to establish satisfactory implant restorations following situations of partial missing facial bone in the esthetic zone., Materials and Methods: Radiological/clinical data of 25 patients were analyzed and an esthetic evaluation of 24 patients was performed. The staged concept included ridge preservation at time of tooth extraction and delayed guided implant placement. Marginal bone loss was measured radiologically and esthetic evaluation was performed based on standardized photographs using the Pink Esthetic Score as well as the Papilla Index., Results: Implant success rate revealed 100%. The mean radiological peri-implant marginal bone loss measured 1.16 mm (SD: 0.16). Regarding the esthetic outcome 71% of patients were evaluated with a Pink Esthetic Score higher or equal to 10 constituting satisfactory esthetics (median pink esthetic score: 10). The mean follow-up time for clinical and radiographic analysis was 1.3 years (SD: 0.6 years) and 1.2 years (SD: 0.6) for esthetic evaluation., Conclusion: Although marginal bone loss cannot be avoided, the staged concept of flapless ridge preservation and subsequent delayed flapless guided implant placement carries the potential to improve esthetics of single-tooth implants in the anterior maxilla., (© 2018 Wiley Periodicals, Inc.)

Background: The amount of marginal bone resorption around dental implants is considered to have a significant impact on implant stability as well as implant survival rates., Purpose: The aim of this prospective study was to investigate the influence of prosthetic as well as patient specific factors on marginal bone loss around short dental implants., Materials and Methods: Seventy-six implants, which supported splinted crowns were included for investigation. All implants were from the same type and had an intraosseous length of 6.5 mm and a diameter of 4.0 mm. Twenty implants were additionally splinted onto longer ones. Measurements of marginal bone loss were performed at a mean of 12.38 months after prosthetic loading and the mean follow-up for clinical evaluation was 20.52 months., Results: Overall two implant failures were recorded, revealing a survival rate of 97.3%. Marginal bone resorption around 72 short implants measured 0.71 mm (SD: 0.74 mm) and was found to have a strong correlation with calculated Crown-to-Implant ratio (r = .71; P < .001). Age, gender, insertion torque, implant surface area, location, position, bone quality, and insertion torque did not influence peri-implant bone loss after one year of loading., Conclusion: Within the limitations of the study, it is suggested that Crown-to-Implant ratios should not exceed 1.7 to avoid increased early marginal bone loss., (© 2017 Wiley Periodicals, Inc.)

Background: Implant esthetics may benefit from individualized zirconia abutments copying the emergence profile of the natural tooth and delivered within days after immediate implant insertion., Purpose: To investigate the esthetic outcome of the Copy-Abutment technique using the Pink Esthetic Score (PES)., Materials and Methods: A total of 77 patients with single-tooth implants in the anterior maxilla restored at the day of immediate implant placement using Copy-Abutments and provisional crowns were followed-up after 1 week, 1 month, 4 months, 6 months, 1, 2, 3, 4, and 5 years to assess implant esthetics., Results: PES ranged between 7 and 14 (median: 13) and improved significantly between the 6 month and 1 year follow-up (p < .001), then remained stable up to the fifth year. Significant improvement was seen for the variables PES-6 soft tissue color (p = .002) and PES-7 soft tissue texture (p < .001) up to the 1 year follow-up, while PES-5 alveolar process deficiency deteriorated (p = .016). Mean mucosal recession was 0.26 ± 0.86 mm (range: 0-1.6) after 5 years and not related to gingival biotype., Conclusion: Copy-Abutments for immediate restoration of implants in the esthetic zone show satisfactory long-term esthetic outcomes., (© 2016 Wiley Periodicals, Inc.)

Background: Discrimination between ongoing and solved research questions may help to distinguish established dogmas from evidence-based implant dentistry., Purpose: The purpose of this study was to investigate topics of interest in the field of oral implant science and evolving thematic trends in clinical studies during the last decade., Materials and Methods: Electronic and manual searches of English literature were performed to identify clinical studies on oral implants. Out of 15,695 publications screened, 2,875 clinical investigations were included., Results: Among the most prevalent topics were immediate loading (14.3%), bone substitutes (11.6%), lateral sinus grafting (10.7%), implant overdentures (10.5%), single-tooth implant crowns (8.8%), cross-arch implant bridges (8.0%), immediate implant placement (7.5%), implant surfaces (7.0%), simultaneous implant placement and augmentation (6.4%) as well as guided bone regeneration (5.3%). Significant increase of scientific interest was seen in immediate loading (+6.3%, p < .001), platform switching (+2.9%, p < 0.001), lateral sinus grafting (+2.3%, p = .024), flapless implant surgery (+2.2%, p < 0.001), and guided implant surgery (+1.9%, p = .011), while research on implant overdentures (-6.6%, p = .033) and tooth-to-implant connection (-2.5%, p = .010) was on the decline., Conclusions: Literature coverage, since the beginning of the 21st century, has seen greater focus on surgical topics compared to prosthodontic issues (p = .005) while only few topics experienced decrease of interest indicating scientific consensus., (© 2015 Wiley Periodicals, Inc.)

Purpose: To compare five different implant treatment protocols in the anterior maxilla, including immediate, early, and delayed implant placement, as well as implant placement in conjunction with simultaneous guided bone regeneration and implant placement 3 months following horizontal autologous bone block grafting., Material and Methods: Aesthetic indices used included the Pink Esthetic Score (PES), Papilla Index (PI), Subjective Esthetic Score (SES), and White Esthetic Score (WES). Subjective evaluation of implant aesthetics was performed using a visual analogue scale (VAS). The VAS consisted of a 10 cm-long line representing the degree of discontent (0%) or satisfaction (100%)., Results: A total of 153 implants in 153 patients (80 women, 73 men) were evaluated after a mean follow-up of 4.5 ± 2.9 years. Mean peri-implant bone loss was 1.6 ± 0.9 mm and not affected by treatment protocol, time after implant placement, or crown length. Papilla presence, by contrast, differed significantly between the protocols: Papilla formation was more pronounced following delayed and immediate implant placement. No statistical significance was found among treatment modalities with regard to PES, SES, or WES. Longer crowns were associated with lower PES and PI ratings and correlated with greater midfacial recession. SES was also influenced by time after implant placement and keratinized mucosa. Patient satisfaction differed significantly among treatment protocols, favoring immediate implant placement. Agreement between objective and subjective aesthetic ratings was low., Conclusion: The present study suggests that comparable clinical, radiological, and aesthetic results can be achieved with all treatment protocols. Gingival recession, however, seems to occur in the long term irrespective of the technique used., (© 2014 Wiley Periodicals, Inc.)

Background: Flapless implant placement using surgical templates may guarantee predictable and esthetic results provided that preplanned implant positions are transfered precisely into surgical reality., Purpose: The study aims to investigate the effect of three-dimensional accuracy in guided implant surgery on the esthetic outcome of single-tooth implants in the anterior maxilla., Materials and Methods: Single-tooth implants for delayed replacement of upper incisors were inserted in 27 patients using stereolithographic templates. Superimposition of postoperative cone beam computed tomography (CBCT) scans allowed assessment of positional inaccuracy at the implant shoulder and apex, as well as angular deviation. Objective evaluation of implant esthetics was performed after a mean follow-up of 2.3 years using the Pink Esthetic Score (PES)., Results: Mean deviation between planned and actual implant position was 0.84 mm at the implant shoulder and significantly correlated to average PES of 12 (p = .031). Inaccuracy toward the buccal side was most frequent (70%). Deviations  ≥  0.8  mm resulted in significantly worse implant esthetics (median PES: 9.5, interquartile range [IQR]: 8-11) compared with more accurate implant positions (median PES: 13, IQR: 12-13, p = .039)., Conclusion: Positional inaccuracy is low in guided implant surgery, but may however significantly compromise implant esthetics in the anterior maxilla., (© 2014 Wiley Periodicals, Inc.)

Background: The first year of prosthetic loading is crucial to peri-implant bone levels; however, contributing factors are yet barely understood., Purpose: The purpose of the study is to investigate the influence of patient-, implant-, and prosthetic-related parameters on marginal bone resorption in partially edentulous patients within the first year of prosthetic loading., Materials and Methods: This retrospective multifactorial analysis involved the following influencing factors: patient gender and age, implant diameter, implant location and neck design, insertion torque, insertion depth, splinted versus single-tooth restorations, crown height space, and crown-to-implant ratio., Results: Mean peri-implant bone resorption around 200 dental implants was 0.98 ± 0.76 mm and significantly correlated to higher implant insertion depth (p < .001), whereas no association to prosthetic parameters could be observed., Conclusions: Within the limits of the present analysis, it can be concluded that apical implant positioning may constitute a relevant determinant of early peri-implant bone resorption., (© 2013 Wiley Periodicals, Inc.)

Purpose: The aim of this study is to assess the impact of insertion torque and implant neck design on peri-implant bone levels and gain insights into dynamic crestal tissue alterations by radiological, clinical, and biochemical examinations., Material and Methods: In this prospective trial, a total of 84 implants (four implants in each patient) in the interforaminal region of 21 edentulous mandibles were randomly alternated according to a split-mouth design. Implant placement was performed using different insertion torques (≤20 Ncm vs >50 Ncm). In each group, one machined and one anodized implant neck design (1.5 mm length) was used in the same jaw side. Evaluation of peri-implant tissues involved radiological, clinical examination and immunoassays for interleukin-1β., Results: No significant influence of insertion torque or implant neck design on peri-implant bone level was found. Protein levels of interleukin-1β in the peri-implant crevicular fluid revealed no difference between both insertion torque groups and different neck designs., Conclusion: Interactive effects of insertion torque and neck surface modification may exist; however, no clinically significant differences in marginal bone resorption after 1 year could be observed in the edentulous anterior mandible., (© 2013 Wiley Periodicals, Inc.)