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The term "buccal implant position" is commonly used but lacks a precise definition and missing a reference point. Considering its major impact on peri-implantitis and esthetic failures the purpose of this study was to find a correlation between bucco-palatal implant positioning and the midfacial soft tissue level of implant crowns using newly defined Emergence-points.Patients with unilateral single-tooth implant crowns in the region of the central or lateral maxillary incisor were included in this study. Digital intraoral scans were superimposed over a scan of the master cast or the original digital data set and analyzed in a computer planning program. In relation to the corresponding natural tooth, an ideal Emergence-point (ESeventy-three patients met the inclusion criteria. AD ranged from 0 to 3.5 mm (AD = 0.87 ± 1.01), SIP from 0.2 to 5.1 mm (AD = 2.66 ± 1.64). Statistical analysis showed a significant inverse correlation between AD and SIP (ρ = -.55, p .001). VIP, the implant inclination, time span since implant insertion, and phenotype revealed no significant correlation to AD.The more palatal the implant was positioned, the less AD was observed. The position of the implant shoulder should preferably be planned more than 2 mm behind the ideal E-point. This E-point can be used for implant planning as it defines the ideal crown length for prospective planning.

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.

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

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.

Aim: In this study, the reproducibility of a newly developed pink esthetic score (PES) for evaluating soft tissue around single-tooth implant crowns was assessed. The effect of observer specialization was another point of interest. Material and methods: Twenty observers (five prosthodontists, five oral surgeons, five orthodontists and five dental students) were given photographs of 30 single-tooth implant crowns. Seven variables were evaluated vs. a natural reference tooth: mesial papilla, distal papilla, soft-tissue level, soft-tissue contour, alveolar process deficiency, soft-tissue color and texture. Using a 0-1-2 scoring system, 0 being the lowest, 2 being the highest value, the maximum achievable PES was 14. Each observer was requested to make two assessments at an interval of 4 weeks. At the second assessment, the photographs were scored in the reverse order. Results: The mean PES of evaluations at the first assessment (n=600) was 9.46 (±3.81 SD), and 9.24 (±3.8 SD) at the second one. The difference between these two means was not significant statistically (P=0.6379). Implant-related mean PES for single-tooth implants varied from 2.28 to 13.8, with standard deviations between 0.46 and 3.51. Very poor and very esthetic restorations showed the smallest standard deviations. The mean total PES was 10.6 for the prosthodontists, 9.2 for the oral surgeons, 9.9 for the dental students and 7.6 for the orthodontists. Conclusions: The PES reproducibly evaluates peri-implant soft tissue around single-tooth implants. Thus, an objective outcome of different surgical or prosthodontic protocols can be assessed. Orthodontists were clearly more critical than the other observers.

In a previous study (Haas et al. 1995), we reported on preliminary results of 76 Branemark implants placed in 71 patients with single-tooth gaps. The present study examines the results of the same group over a longer period of time: 55 implants were followed for more than 5 years, 12 for a period between 4 and 5 years and 1 implant for 46 months. One patient died 3 years after implant placement. Five patients lost their implant within 24 months after insertion. The drop-out rate was 2 implants in 2 patients. The recall rate was thus 97%. Of the 5 implant failures, 2 were located in the maxilla and 3 in the mandible. The Kaplan-Meier survival probability was 93% after 120 months. 74% of the sites showed healthy peri-implant soft tissue conditions. At 15 implants (22%) a bone resorption of more than 2 mm was observed on intraoral radiographs. The mean bone resorption was 1.8 mm in the maxilla and 1.3 mm in the mandible and did not increase with time (Pearson correlation coefficient: r = -0.06, P = 0.59). Abutment loosening occurred in 7 implants (10%), however all abutments that were fixed with a defined torque subsequently remained stable. Thus the favourable preliminary results could be maintained over an average 66 months, indicating that if implant loss happens it seems to occur during the first 2 years after insertion.