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Objectives: The aim of this study was to review available evidence for Type 1A (immediate implant placement and immediate loading) of single tooth replacement in the maxillary esthetic zone. Materials and Methods: An electronic search was conducted utilizing the databases of MEDLINE, Embase, and Cochrane to identify publications reporting on the outcomes of Type 1A for single tooth replacement in the maxillary esthetic zone. The success and survival rates of the included articles were reported, which were further categorized according to the clinical criteria reported in Type 1A. Mean survival rates were univariately compared between risk groups and additionally between studies published before and since 2012 using bias‐corrected and study size‐weighed bootstrap tests. A study time‐correcting meta‐analysis was then performed to obtain an overall effect for the study pool. Results: A total of 3118 publications were identified in the search, with a total of 68 articles included. A mean number of implants per study were 37.2 and mean follow‐up was 2.8 years. All the included studies utilizing Type 1A report highly selective inclusion and exclusion criteria. Univariate risk group comparison determined that studies before 2012 report a significantly lower mean survival rate (difference of −1.9 percentage points [PP], 95% CI: [−0.3, −4.0], p =.02), facial gap dimension had an impact on survival rates (+3.1 PP [0.2, 5.3] for width >2 mm, p =.04), as well as presence of endodontic infection (+2.6 PP [0.9, 5.1], p =.004). Conclusions: Type 1A has a high survival rate in studies reporting strict patient and site selection criteria. Further research is required to assess esthetic and functional success with Type 1A treatments. [ABSTRACT FROM AUTHOR]

Objective: A scarf‐shaped connective tissue graft can be placed at the facial and proximal aspect of the peri‐implant soft tissue zone during immediate implant placement and provisionalization (IIPP) procedures in the esthetic zone to optimize implant esthetics without the need of flap reflection. This retrospective study evaluated soft tissue stability after scarf‐connective tissue graft (S‐CTG) in conjunction with IIPP procedures in the esthetic zone. Materials and Methods: Patients who received IIPP with S‐CTG with a minimum 1‐year follow‐up were evaluated. Mid‐facial gingival level (MFGL) change and mid‐facial gingival thickness (MFGT) change were measured and compared at the pre‐op (T0), IIPP + S‐CTG surgery (T1), follow up appointment with MFGT measurement (T2), and latest follow‐up appointment (T3). Implant success rate and graft necrosis were also recorded. Results: A total of 22 IIPP and S‐CTG procedures in 20 patients were evaluated in the study. After a mean follow‐up of 8.2 years (3.9–13.4) (T3), all implants remained osseointegrated (22/22 [100%]), with statistically insignificant mean midfacial gingival level change of −0.19 mm (−1.5 to 0.8). Statistically significant difference in midfacial gingival thickness (MFGT) was noted (2.5 mm [1.8–3.5 mm]) after a mean follow‐up time (T2) of 2.3 years (1–8.6) when compared with MFGT at baseline (1.1 mm [0.6–1.3 mm]) (T1). Necrosis of S‐CTG during initial healing phase was noted in 9% (2/22) of the sites. Conclusions: Within the confines of this study, scarf‐connective tissue graft at time of immediate implant placement and provisionalization can thicken the gingiva and maintain the gingival level at the critical soft tissue zone. Clinical Significance: Managing the soft tissue zone is as important as that of the hard tissue zone for peri‐implant esthetics. Connective tissue graft is one of the methods that can enhance the final esthetic outcomes. This retrospective study has demonstrated that Scarf‐CTG technique is an effective treatment modality to maintain soft tissue stability. [ABSTRACT FROM AUTHOR]

Objective: This article describes an updated step‐by‐step protocol for transmucosal abutment selection and treatment sequencing after immediate implant placement in the esthetic zone. Clinical Considerations: Current surgical and prosthetic concepts strive to preserve hard and soft‐tissues to provide optimal esthetics at the implant‐abutment interface. Consequently, restoring implants in the esthetic zone with transmucosal abutments presents a great challenge and must take into consideration implant depth, angulation, and bucco‐lingual position as well as transmucosal height and space for an optimized emergence profile of the restoration and the dimensions of the anterior tooth to be restored. The proper selection of the type, shape, and dimensions of implant components and connections, determined by the product portfolio offered by the implant manufacturer, play a critical role in the ability to adequately address these challenges. This article provides an update on surgical and prosthetic workflows for single implant restorations in the esthetic zone. Conclusions: Following esthetic, mechanical, and biologic principles, the long‐term success of implant‐supported restorations in the esthetic zone is directly correlated to proper execution and sequencing of surgical and prosthetic treatment steps, especially after immediate implant placement. These steps must be critically assessed based on the current scientific evidence to achieve the desired clinical outcomes on a predictable and consistent basis. Clinical Significance: Selection of surgical and prosthetic treatment protocols to achieve ideal esthetic outcomes and emergence profiles in implant dentistry is often a great challenge, not only determined by technical and clinical skills of the provider but also by the type and dimensions of implant components and connections offered by the manufacturer. Following certain decision‐making principles and workflows are key for clinical success with implant‐supported restorations after immediate implant placement the esthetic zone. [ABSTRACT FROM AUTHOR]

Aim: To test whether the emergence profile (CONVEX or CONCAVE) of implant‐supported crowns influences the mucosal margin stability up to 12 months after insertion of the final restoration. Materials and Methods: Forty‐seven patients with a single implant in the anterior region were randomly allocated to one of three groups: (1) CONVEX (n = 15), implant provisional and an implant‐supported crown both with a convex profile; (2) CONCAVE (n = 16), implant provisional and an implant‐supported crown both with a concave profile; (3) CONTROL (n = 16), no provisional (healing abutment only) and an implant‐supported crown. All patients were recalled at baseline, 6, and 12 months. The stability of mucosal margin along with clinical, aesthetic, and profilometric outcomes as well as time and costs were evaluated. To predict the presence of recession, multivariable logistic regressions were performed and linear models using generalized estimation equations were conducted for the different outcomes. Results: Forty‐four patients were available at 12 months post‐loading. The frequency of mucosal recession amounted to 64.3% in group CONVEX, 14.3% in group CONCAVE, and 31.4% in group CONTROL. Regression models revealed that a CONVEX profile was significantly associated with the presence of recessions (odds ratio: 12.6, 95% confidence interval: 1.82–88.48, p =.01) compared with the CONCAVE profile. Pink aesthetic scores amounted to 5.9 in group CONVEX, 6.2 in group CONCAVE, and 5.4 in group CONTROL, with no significant differences between the groups (p =.735). Groups CONVEX and CONCAVE increased the appointments and costs compared with the CONTROL group. Conclusions: The use of implant‐supported provisionals with a CONCAVE emergence profile results in a greater stability of the mucosal margin compared with a CONVEX profile up to 12 months of loading. This is accompanied, however, by increased time and costs compared with the absence of a provisional and may not necessarily enhance the aesthetic outcomes. Trial registration: German Clinical Trials Register; DRKS00009420. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to quantitatively evaluate the effect of implant‐supported provisional restorations (ISPRs) on the accuracy of the intraoral scanned peri‐implant soft‐tissue profile in the esthetic area. Materials and Methods: Sixteen patients with a single ISPR in the maxillary central incisor's region were recruited for this study. Three impression methods were sequentially used in each patient: (1) an intraoral scanning (IOS) with the ISPR, (2) a conventional impression using the ISPR as impression coping, and (3) a routine IOS without the ISPR. The stereolithography files of the three impression methods obtained from the same patient were superimposed, and the conventional impression method was used as the reference model. Two‐dimensional (2D) and three‐dimensional (3D) analyses were performed to measure the peri‐implant soft‐tissue deviation between the reference models and IOS from the groups with or without the ISPR, respectively. Data were presented as the means ± standard deviations. Two‐way analyses of variance with post hoc Sidak's multiple comparisons and paired t‐tests were performed for 2D and 3D analyses, respectively. The significance level was set at p <.05. Results: The peri‐implant mucosa without the ISPR immediately collapsed (<20 s), particularly on the palatine side of the labial mucosa and labial side of the palatine mucosa. Consequently, the IOS without the ISPR led to 414.7 ± 116.0 μm of overall dimensional deformation in the cuff‐like submucosal region, which was significantly larger (p <.0001) than that in the IOS with the ISPR (230.6 ± 85.5 μm). Conclusion: Implant‐supported provisional restorations are important for accurate replication of the intraorally scanned peri‐implant soft‐tissue profile. [ABSTRACT FROM AUTHOR]

Objectives: The primary objective was to provide an overview of soft tissue metric parameters, methods, and aesthetic indices in implant dentistry. The secondary objective was to describe reliability and validity of aesthetic indices. Materials and methods: Two independent reviewers conducted an electronic literature search in Pubmed, Web of Science, Embase, and Cochrane databases up to October 2020 to identify studies on soft tissue metric parameters, methods, and aesthetic indices. Aesthetic indices were evaluated in terms of reliability and validity. Data extraction was performed by the same reviewers. Results: Five metric parameters (papilla height, linear changes in soft tissue level, color assessment, soft tissue thickness, and profilometric soft tissue changes) registered by means of several methods (intra‐oral registrations, radiographic assessments, digital analyses, and ultrasonic assessments), and 15 aesthetic indices (Papilla Index (PI), ad hoc questions scored with Visual Analogue Scales, Pink Esthetic Score (PES), Implant Crown Aesthetic Index (ICAI), Implant Aesthetic Score (IAS), Rompen Index, Subjective Esthetic Score, White Esthetic Score, Copenhagen Index, Complex Esthetic Index, Californian Dental Association Index (CDAI), Peri‐Implant, and Crown Index, Functional Implant Prosthodontic Score, Implant Restoration Esthetic Index (IREI), and Mucosal Scarring Index (MSI)) could be identified. With respect to metric parameters and methods, intra‐oral registrations were least accurate whereas profilometric soft tissue changes on the basis of digital surface models were most accurate. Six aesthetic indices showed good inter‐rater reliability (PI, PES, ICAI, CDAI, IREI, and MSI). Good validity could only be shown for two indices (PES and CEI). Given this and on the basis of ease of use and ease of interpretation, PES qualified best for clinical research on single implants. None of the indices fulfilled the quality criteria for clinical research on multiple implants. Conclusion: Many soft tissue assessment methods with varying reliability and validity have been described and used, which hampers uniform reporting in implant dentistry. Clinical investigators are advised to measure linear and profilometric soft tissue changes using digital surface models, and to use a reliable and validated aesthetic index. Currently, PES qualifies best for aesthetic evaluation of single implants. An index is to be developed to assess the aesthetic outcome of rehabilitations on multiple implants. [ABSTRACT FROM AUTHOR]

Background: Immediately placed single implants with either immediate provisionalization (test) or delayed restoration (control) were followed for up to 1 year in our previous randomized clinical trial. Peri-implant tissues continue to remodel after implants are in function. Therefore, the primary aim of this study was to evaluate the facial mucosal level changes in the intermediate term between the two groups and to study potential factors influencing the mucosal level change.Methods: Patients who had already completed the previous clinical trial by receiving a single immediately placed implant were re-invited to this study. The facial mucosal level as well as the other peri-implant hard and soft tissue dimensions and conditions were measured clinically, radiographically and with ultrasound. These data were compared between the test and control implants. The mucosal level change as the function of the final crown contour, measured as the abutment-crown angle (ACA), was estimated with a linear regression model.Results: Twenty-eight patients (n of test/control = 16/12) with a mean 30-month follow-up were recruited. The mean mucosal level change was -0.38 mm (control) and 0.06 mm (test), without statistical difference between the two groups. The other clinical, radiographic, and ultrasound parameters were not statistically different. ACA was statistically significant associated with the recession (P = 0.02). The estimate effect was 0.25 mm per 10° increase (adjusted R2  = 0.18; 95% CI, 0.02 to 0.49 mm). After adjusting for vertical implant position, implant abutment angle and the group, the effect became borderline significant (P = 0.09).Conclusions: Peri-implant tissues, including the mucosal level change of immediately placed implants with either immediate provisionalization or delayed restoration remained stable and did not differ between the groups in the intermediate term. The final crown angle, influenced by implant position and abutment angle, might be associated with mucosal margin level change. [ABSTRACT FROM AUTHOR]

Objectives: To assess the effect of connective tissue graft (CTG) in terms of vertical mid‐facial soft tissue change when applied at the buccal aspect following single immediate implant placement (IIP). Materials and methods: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, EMBASE and Cochrane databases as well as a manual search to identify eligible clinical studies up to January 2020. Randomized controlled trials (RCTs) and non‐randomized controlled studies (NRSs) comparing IIP with CTG and without CTG over a mean follow‐up of at least 12 months were included for a qualitative analysis. Meta‐analyses were performed on data provided by RCTs. Results: Out of 1814 records, 5 RCTs and 3 NRSs reported on 409 (IIP + CTG: 246, IIP: 163) immediately installed implants with a mean follow‐up ranging from 12 to 108 months. Only 1 RCT showed low risk of bias. Meta‐analysis revealed a significant difference in terms of vertical mid‐facial soft tissue change between IIP + CTG and IIP pointing to 0.41 mm (95% CI [0.21; 0.61], p <.001) in favour of soft tissue grafting. This outcome was clinically relevant since the risk for ≥1 mm asymmetry in mid‐facial vertical soft tissue level was 12 times (RR 12.10, 95% CI [2.57; 56.91], p =.002) lower following IIP + CTG. Soft tissue grafting also resulted in a trend towards less bleeding on probing (MD 17%, 95% CI [−35%; 1%], p =.06). Meta‐analyses did not reveal significant differences in terms of pink aesthetic score, marginal bone level change and probing depth. Results were inconclusive for horizontal mid‐facial soft tissue change and papilla height change. Based on GRADE guidelines, a moderate recommendation for the use of a CTG following IIP can be made. Conclusion: CTG contributes to mid‐facial soft tissue stability following IIP. Therefore, CTG should be considered when elevated risk for mid‐facial recession is expected in the aesthetic zone (thin gingival biotype, <0.5 mm buccal bone thickness). [ABSTRACT FROM AUTHOR]

The present systematic review and meta‐analysis was carried out to determine the extent to which supracrestal tissue attachment (STA) thickness affects marginal bone loss (MBL) around dental implants. An electronic search was conducted in PubMed (MEDLINE), EMBASE, and complementary sources covering the period up to June 2018. The studies were meta‐analyzed based on implant position with respect to the alveolar bone crest (crestal/supracrestal). The MBL values were categorized according to STA width (thick/thin). Of the 1062 eligible titles, nine articles were included in the review. The implants were positioned crestal or supracrestal with respect to the alveolar ridge. The difference between (thin/thick) STA was statistically significant among analytical subsets in terms of lesser MBL (crestal‐positioned: weighted mean difference [WMD] = 0.52, 95% CI [0.03‐1.01]; P = 0.036; supracrestal‐positioned: WMD = 1.26; 95% CI [1.12‐1.39]; P = 0.00; pooled analysis: WMD = 0.73; 95% CI [0.033‐1.13]; P < 0.01). Implant positioning and patient age showed statistical significance in the meta‐regression analysis. The heterogeneity explained by age was R2 = 39.8%. Despite its limitations, the present study demonstrates that implants with thin STA result in greater MBL. There is moderate certainty of the evidence for a large effect of MBL prevention "in favor" of a thick STA environment in crestal‐positioned implants and the pooled analysis, but lesser certainty when only supracrestal‐positioned implants are considered. No trials studying this topic in subcrestal‐positioned implants were found. [ABSTRACT FROM AUTHOR]

Objective: This second of a two‐part series reviews the single dental implant as the most current treatment alternative for replacement of a missing or lost maxillary lateral incisor. Assessments of dental maturity for implant placement, implant space requirements, surgical and restorative influence on soft tissue profiles, and implant success are reviewed. Overview: Recent data indicates that implant success rates are high, and esthetics and soft tissue profiles appear to be stable for maxillary lateral incisor implants. Implant placement should be assessed by dental maturity of the specific patient as opposed to chronological age, and implant spacing should be developed and assessed by all team members. Conclusions: Implant replacement of a missing lateral incisor is a predictable treatment mode if implant placement is deferred until dental maturity and then accurately placed in a well‐developed site. Treatment involves more complicated planning and execution from team members than other alternatives, but innovations in techniques and materials render it a favorable alternative for lateral incisor replacement. Clinical significance: Implant restoration of a missing or lost maxillary lateral incisor is surgically and restoratively more complex than space closure or a resin‐bonded fixed dental prosthesis but demonstrates high success rates and high esthetic potential when team members follow strict treatment protocols. [ABSTRACT FROM AUTHOR]

Objective: Comparison of soft tissue replication between conventional and digital impressions for definitive single unit implant rehabilitation in the esthetic zone. Materials and Methods: Six patients were recruited according to inclusion criteria for this cross‐over pilot study and submitted to a conventional silicone implant impression with customized coping and a digital impression with an intraoral scanner. Stereolithography files obtained from the same patient were superimposed with appropriate software and trueness evaluated between methods at predetermined locations (56 in hard and soft tissues and 18 in the emergence profile, per patient). Results were presented as mean root mean square (RMS) ± 95% confidence interval and effect size calculated with Hedges' g ± 95%. Mann‐Whitney and Kruskal‐Wallis were performed when appropriate and α was set at.05. Results: Trueness between methods equated to 51.08[45.68;56.47] μm and 60.46[52.29;68.62] μm in hard and soft tissues, respectively. Soft tissue replication by intraoral scanner acquisition corresponded to a statistically significant RMS of 243.89[209.15;278.63] μm equating to a Hedges' g of 1.52[1.22;1.82] which corresponded to a large effect size. Conclusions: The proposed method could be considered for soft tissues assessment and the results suggest that intraoral impression techniques produce statistically significant changes in peri‐implant soft tissue replication, although below the clinically detectable threshold. Clinical Significance: The proposed technique allows for the 3D determination of peri‐implant tissues changes in digital models with higher sensitivity than visual techniques, thus presenting itself as a promising alternative in clinical studies and that the use of an intraoral scanner obtained significant differences in the soft tissue emergence profile replication when compared with the gold standard. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review aimed at answering the following PICO question: In patients receiving immediate (Type 1) implant placement, how does immediate compare to early or conventional loading in terms of Patient‐Reported Outcome Measures (PROMs)? Material and Methods: Following search strategy development, the OVID, PubMed, EMBASE, and Cochrane Database of Systematic Reviews databases were search for the relevant literature. All levels of evidence including randomized controlled trials, prospective and retrospective cohort studies, and case series of at least five patients were considered for possible inclusion. An additional manual search was performed by screening the reference lists of relevant studies and systematic reviews published up to May 2017. The intervention considered was the placement of immediate implant. Study selection and data extraction were performed independently by two reviewers. Results: The search yielded a list of 1,102 references, of which nine were included in this systematic review. The limited number of studies included and the heterogeneity of the data identified prevented the performance of a meta‐analysis. Three studies, one of which was a randomized controlled trial, allowed the extraction of comparative data specific to the aim of the present systematic review. The remaining studies allowed only data extraction for one single treatment modality and were viewed as single cohort studies. Overall, irrespective of the PROMs chosen, patients' satisfaction was overall high with little difference between the two loading protocols. Moreover, studies indicated a positive impact on oral health‐related quality of life following immediate implant placement and loading. Conclusions: Within the limitations of the present systematic review, immediate implant placement and loading in single tooth edentulous space seems to be a well‐accepted treatment modality from the patients' perspective and is worthy of consideration in clinical practice. However, the paucity of comparative data limits any definitive conclusions as to which loading protocol; immediate or early/conventional, should be given preference based on PROMs. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to give a detailed analysis on eight proposed implant esthetic indices including a total of 48 parameters with respect to validity and reproducibility as well as its correlation to patients’ perception of esthetics. Material and methods: Standardized intraoral photographs of 189 patients with 189 implant‐supported crowns and adjacent peri‐implant soft tissue in the esthetic zone (central and lateral incisors, canine, first premolar) served as basis for this evaluation. Eight indices (Papilla Index [PI], Pink Esthetic Score [PES], Implant Crown Aesthetic Index [ICAI], Pink and White Esthetic Score [PES/WES], Complex Esthetic Index [CEI], Implant Aesthetic Score [IAS], Subjective Esthetic Score [SES], and Rompen Index) with a total of 48 parameters were selected. Esthetic evaluation was performed twice by five examiners with an interval of 4 weeks between the evaluations. Results: A total of 1,890 evaluations including eight esthetic indices served as basis for the statistical analysis. Among the overall main scores tested for inter‐rater reliability, the highest ρ ^ inter values were computed for CEI, PES, PI, and IAS scores. By contrast, SES and Rompen showed the worst inter‐rater reliability, respectively. The highest level of intra‐rater reproducibility was noted for PI, PES, and CEI. The lowest level of intra‐rater reproducibility showed Rompen, SES, and ICA. The Papilla Index demonstrated the highest level of inter‐rater reliability. The remainder of the single variables (n = 46) did not reach the ρ ^ inter level of 0.6. The single variables PI mesial, PI distal as well as CEI P4 showed the highest ρ ^ intra with statistical significance higher than 0.8. The lowest agreement was observed among the variables ICA3, WES5, and IASm2. In general, VAS did not show any good correlation to the esthetic indices proposed so far. The influence of esthetic parameters on subjective patient satisfaction was generally low. Conclusion: In conclusion, significant differences regarding reliability and validity could be observed in the present comparison of eight esthetic indices. Objective evaluation of the esthetic outcome of implant therapy inherently fails to reflect subjective patient opinion, however, requires consistency of results to enable between‐study comparison and meta‐analysis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate peri‐implant crestal bone loss during the osseointegration period, comparing submerged and non‐submerged implants with healing abutments of different design. Materials and methods: A total of 90 Avinent® dental implants (Avinent Implant System, Barcelona, Spain) were placed in 90 patients. All were sited in the posterior mandibular zone to replace teeth 3.6 or 4.6. Patients were divided randomly into three groups: submerged (n = 30), non‐submerged with anatomical healing abutment (n = 30), and non‐submerged with esthetic healing abutment (n = 30). Peri‐implant crestal bone loss was evaluated in intraoral radiographs taken at baseline, 1, and 3 months after implant placement. Results: Peri‐implant crestal bone loss at the end of the (3‐month) osseointegration period was lowest in the submerged group (0.11 ± 0.14 mm), followed by the esthetic non‐submerged group (0.15 ± 0.06 mm), but without statistically significant difference between these groups (P = 0.234). The greatest bone loss was produced in the non‐submerged group with anatomical healing abutments (0.37 ± 0.12 mm), with significant differences between this group and the other two (P < 0.001). Conclusions: On the basis of these findings, bone resorption during the osseointegration period using the non‐submerged technique varied significantly depending on the morphology of the healing abutment used. The non‐submerged technique with an esthetic healing post‐produced an equally predictable outcome compared with the submerged technique. [ABSTRACT FROM AUTHOR]

Criteria for successful implants, in the rehabilitation of a single missing tooth in the esthetic area, should be determined by composite outcomes, including functional and esthetic aspects of soft tissues and the reconstruction, as well as patient-reported outcomes. This paper focuses on current methods in esthetic assessment and patient-centered/reported outcomes in single-tooth implant rehabilitation in the esthetic area. The relationship between subjective, patient-based esthetic evaluations and objective, professional-based esthetic evaluations is reviewed. In spite of increasing interest in the assessment of 'success' in implant dentistry, it is not yet possible to provide evidence-based conclusions because of the lack of consensus on a universal implant-supported crown esthetic index. There is also a need to standardize reporting of patient-centered outcomes in partially edentulous patients treated with implants. [ABSTRACT FROM AUTHOR]

An inevitable loss of soft and hard tissue after tooth extraction often results in a compromised site for anterior implant esthetics in both vertical and horizontal dimensions. Immediate implant placement and provisionalization has been a viable option for replacing failing maxillary anterior teeth as it preserves the vertical existing osseous and gingival architecture. With the simultaneous addition of soft- and hard-tissue grafts, the peri-implant horizontal tissue topography can also be maintained. The esthetic success of immediate implant placement and provisionalization procedures is influenced by a number of factors that can be identified as patient-dependent or clinician-dependent. This article describes in detail the process of patient selection, indications, contraindications, diagnosis, treatment planning and treatment execution required to achieve functional and esthetic success with immediate implant placement and provisionalization. [ABSTRACT FROM AUTHOR]

Patient expectations from implant treatment have changed over the years and esthetics plays an important role in defining what is now called success of rehabilitation. Of the many factors that influence the outcome of the rehabilitation, the two main ones are the bone and soft-tissue deficiencies at the intended implant site. Many surgical approaches are described in terms of timing of implant placement and management of regenerative procedures. The aim of this article is to discuss the different implant placement alternatives in the esthetic area, in particular: (i) the timing of implant placement/regenerative procedures/skeletal growth/altered passive eruption; (ii) the correct three-dimensional position of the fixture between the cuspids and in the premolar area; (iii) multiple missing teeth in the esthetic area with single tooth/pontic or cantilevered options/prosthetic compensation; (iv) placement of implants into infected sites; and (v) the influence of abutment and crown morphology on implant position. Combining our long-standing clinical experience and the pertinent literature, the following conclusions can be drawn: Immediate implant placement can be a successful procedure in terms of esthetics but it is technique sensitive and requires an experienced team. Immediate placement is less traumatic to the patient as fewer surgical procedures are involved and patients tend to prefer this clinical approach with regards to quality of life. The diagnostic phase is of utmost importance, with not only bone and soft tissue deficiencies being addressed but also: skeletal growth, dental/implant soft tissue parameters such as altered passive eruption and the morphology of the roots adjacent to the edentulous area. Post-extraction immediate loading is feasible in infected sites. The correct position of the fixture should follow widely accepted guidelines but the abutment morphologies play a role in the vestibular/palatal position of the implant. The long axis of the implant, aiming at the incisal edge of the future restorations, is the most appropriate implant position when a shoulder-less abutment is used and allows a restorative crown morphology with a cervical contour resembling a natural tooth. The use of a shoulder-less abutment gives more space for the tissue to grow compared with the traditional abutment with shoulder finish line. [ABSTRACT FROM AUTHOR]

Objectives To compare the radiographic bone changes, clinical parameters and aesthetic outcomes of immediately provisionalised and conventionally restored implants at 12- and 24-months post-implant placement. Material and methods In 24 patients, 24 bone level implants with a hydrophilic ( SLActive) surface were placed in healed sites and they were either immediately provisionalised with a non-occluding temporary crown (test group) or left without a crown (control group). In both groups, the definitive restoration was placed 16 weeks after implant placement. Clinical and radiographic parameters were calculated at 12- and 24-months post-implant placement, together with implant success/survival rates according to three different sets of criteria. The aesthetic outcome was evaluated through the Papilla Fill Index and the Pink Aesthetic Score. Results The mean marginal bone loss at 1 year was −0.73 mm ( SD 0.83 mm) in the test group and −0.22 mm ( SD 0.46 mm) in the control group ( p > .05). Whilst 100% survival rate and positive aesthetic outcomes were recorded in both groups, three patients of the test group did not fulfil all success criteria. Conclusions Immediate provisionalisation may represent a viable option for the replacement of single missing teeth, with radiographic, clinical and aesthetic results comparable to those of conventionally loaded implants at 2 years of follow-up. [ABSTRACT FROM AUTHOR]

Background: Contradictory results exist regarding influence of apico-coronal implant placement on crestal bone levels.Methods: Complete charts of patients ≥18 years old with one or more dental implants were included. Demographic, medical, surgical, and prosthetic information was recorded. Implant bone levels were evaluated at initial placement, implant uncovery, prosthetic delivery, and 3 to 6, 7 to 11, and 12 to 18 months post-implant placement.Results: Charts of 55 patients and 134 implants were included. At baseline, 19.5%, 67.3%, and 13.3% of implants were recorded as equicrestal, subcrestal, and supracrestal, respectively, on their mesial aspect, and 32.1%, 50.0%, and 17.9% on their distal aspect, respectively. At time of prosthetic delivery, mesial aspect implant position was equicrestal in 35.4%, subcrestal in 17.7%, and supracrestal in 46.9% of cases, whereas on their distal aspects, the same categorical positions were found in 28.4%, 21.1%, and 50.5% of implants. For the mesial aspect of the implant, 3- to 6-, 7- to 11-, and 12- to 18-month intervals, and for the distal aspect of the implant, 7- to 11- and 12- to 18-month intervals, along with diabetes (for both mesial and distal), were associated with a statistically more apical position of the bone compared with baseline. Although the odds ratio of a subcrestal implant position at follow-up times was statistically greater for implants located subcrestally at surgery, linear measures of differential crestal bone loss (CBL) as a function of the categorical initial placement of the implant (supracrestal, equicrestal, subcrestal) at 3- to 6-, 7- to 11-, and 12- to 18-month time points generally showed no significant differences among groups.Conclusion: A subcrestal position of the implant at time of surgery leads to reduced odds of having implant threads exposed; however, it is associated with similar linear CBL compared with an equicrestal or supracrestal surgical position. [ABSTRACT FROM AUTHOR]

Background Single-tooth replacement often requires a prefabricated dental implant and a customized crown. The benefits of individualization of the abutment remain unclear. Purpose This randomized controlled clinical trial aims to study potential benefits of individualization of zirconia implant abutments with respect to preservation of marginal bone level and several clinical and patient-based outcome measures. Material and Methods Fifty participants with a missing premolar were included and randomly assigned to standard (ZirDesign, DentsplySirona Implants, Mölndal, Sweden) or computer aided design/computer aided manufacturing (CAD/CAM) customized (Atlantis, DentsplySirona Implants, Mölndal, Sweden) zirconia abutment therapy. Peri-implant bone level (primary outcome), Plaque-index, calculus formation, bleeding on probing, gingiva index, probing pocket depth, recession, appearance of soft tissues and patients' contentment were assessed shortly after placement and one year later. Results No implants were lost and no complications related to the abutments were observed. Statistically significant differences between stock and CAD/CAM customized zirconia abutments could not be demonstrated for any of the operationalized variables. Conclusion The use of a CAD/CAM customized zirconia abutment in single tooth replacement of a premolar is not associated with an improvement in clinical performance or patients' contentment when compared to the use of a stock zirconia abutment. [ABSTRACT FROM AUTHOR]

Objectives To systematically review changes in mucosal soft tissue thickness and keratinised mucosa width after soft tissue grafting around dental implants. Materials and Methods An electronic literature search was conducted of the MEDLINE database published between 2009 and 2014. Sequential screenings at the title, abstract, and full-text levels were performed. Clinical human studies in the English language that had reported changes in soft tissue thickness or keratinised mucosa width after soft tissue grafting at implant placement or around a present implant at 6-month follow-up or longer were included. Results The search resulted in fourteen articles meeting the inclusion criteria: Six of them reported connective tissue grafting around present dental implants, compared to eight at the time of implant placement. Better long-term soft tissue thickness outcomes were reported for soft tissue augmentation around dental implants (0.8-1.4 mm), compared with augmentation at implant placement (−0.25-1.43 mm). Both techniques were effective in increasing keratinised tissue width: at implant placement (2.5 mm) or around present dental implants (2.33-2.57 mm). Conclusions The present systematic review discovered that connective tissue grafts enhanced keratinised mucosa width and soft tissue thickness for an observation period of up to 48 months. However, some shrinkage may occur, resulting in decreases in soft tissue, mostly for the first three months. Further investigations using accurate evaluation methods need to be done to evaluate the appropriate time for grafting. [ABSTRACT FROM AUTHOR]

Objective To evaluate the influence of abutment geometry on papillary fill in the esthetic zone in a delayed crown protocol. Materials and methods Twenty-six subjects received two non-adjacent endosseous implants in the esthetic zone. Functional temporary crowns were installed 17-19 weeks later, using conventional (control) and curved (experimental) abutments. The abutments were randomized in each patient independently. Final crowns were cemented after 2 months ( T0). Standard intraoral photographs and radiographs were made to evaluate papillary fill after 12 months ( T12). The interproximal papilla fill was measured by means of the papilla index score ( PIS) and related to the maximum bone level between the implant and the adjacent root as well as the peri-implant marginal bone level at T12, both measured radiographically. Results No statistically significant difference between the experimental and the control group could be demonstrated ( P = 0.25). Ordinal regression analysis showed a positive correlation between the maximum bone level and papilla fill ( P < 0.01) and a negative correlation between the peri-implant marginal bone level and papilla fill ( P < 0.05). Conclusion A concave abutment does not exhibit a better fill of the papilla compared with a straight abutment in single-tooth implant placement using a delayed protocol in the esthetic zone after 12 months of function. [ABSTRACT FROM AUTHOR]

Background Straumann® Bone Ceramic™ is a synthetic biphasic calcium phosphate ( BCP) aimed for sinus floor augmentation. Long-term follow-up of implants placed in BCP after sinus augmentation is still missing. Purpose The primary aim of the study was to compare survival rates and marginal bone loss of Straumann SLActive implants placed in either BCP (test) or Bio- Oss® ( DBB) (control) after sinus floor augmentation. The secondary aim was to calculate graft sinus height at different time points. Materials and Methods Bilateral sinus floor augmentation was performed in a split mouth model. Eleven patients (mean age 67 years) received 100% BCP on one side and 100% DBB on the contralateral side. After 8 months of graft healing, 62 Straumann SLActive implants were placed. After 5 years of functional loading (6 years after augmentation) of implants, marginal bone levels and grafted sinus height were measured, and implant survival and success rates were calculated. Results After 5 years of loading, all prosthetic constructions were in function although two implants were lost in each grafting material. The overall implant survival rate was 93.5% (91.7% for BCP, 91.3% for DBB, and 100% for residual bone). The success rates were 83.3% and 91.3% for BCP and DBB, respectively. There was no statistically significant difference in mean marginal bone level after 5 years between BCP (1.4 ± 1.2 mm) and DBB (1.0 ± 0.7 mm). Graft height reduction ( GHR) after 6 years was limited to 6.6% for BCP and 5.8% for DBB. Conclusion In this limited RCT study, the choice of biomaterial used for sinus floor augmentation did not seem to have any impact on survival rates and marginal bone level of the placed implants after 5 years of functional loading and GHR was minimal. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effect of treated periodontitis on implant outcomes in partially edentulous individuals compared with periodontally healthy patients. Material and methods Longitudinal studies reporting on implant survival, success, incidence of peri-implantitis, bone loss and periodontal status, and on partially dentate patients with a history of treated periodontitis were included. Results The search yielded 14,917 citations. Twenty-seven publications met the inclusion criteria for qualitative data synthesis. Implant success and survival were higher in periodontally healthy patients, whilst bone loss and incidence of peri-implantitis was increased in patients with history of treated periodontitis. There was a higher tendency for implant loss and biological complications in patients previously presenting with severe forms of periodontitis. The strength of the evidence was limited by the heterogeneity of the included studies in terms of study design, population, therapy, unit of analysis, inconsistent definition of baselines and outcomes, as well as by the inadequate reporting of statistical analysis and accounting for confounding factors; thus, meta-analysis could not be performed. Conclusions Implants placed in patients treated for periodontal disease are associated with higher incidence of biological complications and lower success and survival rates than those placed in periodontally healthy patients. Severe forms of periodontal disease are associated with higher rates of implant loss. However, it is critical to develop well-designed, long-term prospective studies to provide further substantive evidence on the association of these outcomes. [ABSTRACT FROM AUTHOR]

Objectives To objectively assess the influence that three different implant-abutment interface designs had on peri-implant mucosal esthetics at 1 year post-implant placement via the pink esthetic score ( PES). Additionally, to demonstrate the novel employment of a tablet-based digital imaging format to reliably assess and score clinical images as part of a multicenter clinical trial according to PES criteria. Materials and Methods Adult subjects ( n = 141) with healed tooth-bound edentulous sites in the anterior maxilla as well as first premolar region were randomized to receive one of three different implant-abutment interface designs (conical interface = CI; flat-to-flat interface = FI; or platform switch interface = PS). Immediate provisionalization was performed with prefabricated titanium abutments, with definitive custom CAD/ CAM zirconia abutments and all-ceramic cement-based crowns being delivered 12-week post-implant placement. Bilateral (anterior sites) or unilateral (premolar sites) digital clinical photographs were made at 1, 3, 6, and 12 months post-implant placement. Five calibrated faculty evaluators of different clinical backgrounds scored images during a 4-week timeframe on a standardized, tablet-based, digital imaging format. Results Six hundred and forty-nine clinical photographs were evaluated resulting in a total of 3245 sum PES values and 22,715 individual PES values. Faculty evaluator intra- and inter-rater reliability was found to be 'strong' ( ICC = 0.84) and 'substantial' ( ICC = 0.64), respectively, demonstrating repeatability of both the PES, evaluator calibration, and standardization of tablet-based scoring. All implant-abutment interface groups demonstrated significant improvements in mean sum PESs up to 1 year, with the largest improvement between restoration delivery and 6 months. No significant differences were found between groups in mean sum PESs both for individual study visits as well as for changes between study visits. Conclusions No significant differences in mean sum PESs were found between subjects randomized to three different implant-abutment interfaces. However, significant differences were found as a function of time for all three groups, with the largest improvement in mean sum PESs occurring between definitive abutment and restoration delivery and 6 months. Use of electronic, tablet-based digital imaging scoring formats represents a novel and repeatable methodology for scoring PES images in large, multicenter clinical trials. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this animal study was to compare the effects of narrow, concave–straight and wide anatomic healing abutments on changes to soft tissues and crestal bone levels around implants immediately placed into extraction sockets in foxhound dogs. Materials and Methods: Forty-eight titanium implants (Bredent Medical GMBH, Germany) of the same dimensions were placed in six foxhound dogs. They were divided into two groups (n = 24): test (implants with anatomic abutment) and control (implants with concave–straight abutment). The implants were inserted randomly in the post extraction sockets of P2, P3, P4, and M1 bilaterally in six dogs. After eight and twelve weeks, the animals were sacrificed and samples extracted containing the implants and the surrounding soft and hard tissues. Soft tissue and crestal bone loss (CBL) were evaluated by histology and histomorphometry. Results: All implants were clinically and histologically osseointegrated. Healing patterns were examined microscopically at eight and twelve weeks. After eight and twelve weeks, for hard tissues, the distance from the implant shoulder to the first bone-to-implant contact (IS-C) was higher for control group in the lingual aspect with statistical significance (P < 0.05). For soft tissues (STL), the distance from the top of the peri-implant mucosa to the apical portion of the junction epithelium (PM-Je) was significantly less on the lingual aspect in the test group (with wider abutment) at eight and twelve weeks (P < 0.05). The distance from the top of the apical portion of the junction epithelium to the first bone-to-implant contact (Je-C) was significantly higher in the test group (wider abutment) in the lingual aspect at eight and twelve weeks (P < 0.05). There was no connective tissue contact with any abutment surface. Conclusions: Within the limitations of this animal study, anatomic healing abutments protect soft and hard tissues and reduce crestal bone resorption compared with concave–straight healing abutments. [ABSTRACT FROM AUTHOR]

Background Crestal remodeling/bone loss appears to be a common sequel to dental implant placement. Several hypotheses/clinical strategies have been proposed to explain/avert crestal remodeling; however, causative mechanisms remain unclear and the efficacy of these clinical approaches uncertain. Objective The objective of the present study was to provide a histological account of crestal bone levels and mucosal profile at platform shift/switch and concave abutments following flapless and conventional flap surgery and subcrestal implant placement using a dog model. Methods Four dental implants each were placed in the left/right mandibular posterior jaw quadrants in five adult male Hound/ Labrador mongrel dogs using flap surgery with a 1 × 5 mm gap defect or using a flapless approach, both involving placement 2 mm subcrestally and platform shift/switch versus concave abutments. Block biopsies for histological/histometric analysis were collected at 8 weeks. Results No significant differences were observed regarding crestal bone levels, with all groups showing mean bone levels above the implant platform. Similarly, crestal bone-implant contact was not significantly different among groups. Moreover, peri-implant mucosal profiles were not statistically different among groups for buccal sites; average mucosal height reached 4.1 to 4.9 mm above the implant platform. Comparison between buccal and lingual sites showed a nonsignificant tendency toward greater crestal resorption at buccal sites, adjusting for other factors. Mean crestal bone-implant contact level approximated the implant platform for lingual sites while consistently remaining below the platform at the buccal sites. Peri-implant mucosal height was significantly higher at buccal than at lingual sites, with the epithelial attachment located a significant distance away from the implant platform at buccal sites. Conclusions The surgical approaches (subcrestal implant placement by flap surgery or a flapless approach) and abutment designs (platform shift/switch or concave) used in this study seem to have a limited impact on crestal remodeling, associated bone loss, and mucosal profile. Bioclinical strategies should be developed to circumvent the limitations of current clinical protocol. [ABSTRACT FROM AUTHOR]

Background The advantages of platform switching using narrower abutments remain controversial. Many researchers suggest that platform switching can yield enhanced clinical results, while others remain skeptical. We hypothesize that the effectiveness of platform switching might be associated with the degree of reduction in size of the abutment. Purpose To radiographically and clinically examine a new abutment design created to move the implant-abutment interface farther medially. Materials and Methods This was a prospective, randomized controlled clinical trial that included 27 patients (41 MIS Lance Plus® implants; MIS Implant Technologies, Karmiel, Israel). The patients' age ranged from 39 to 75 years. At the second stage of the surgery, the implants were randomly assigned to either the new platform switch Tulip abutment ( TA) design or to the standard platform abutment ( SA). Implant probing depth ( IPD) and bleeding on probing ( BOP) were recorded at baseline and after 12 months. Standardized periapical radiographs were taken (at baseline and at 12 months) and the marginal bone height measured. Results All implants were successfully integrated. The mean IPD at 1 year post-op was 2.91 mm for the SA group and 2.69 mm for the TA group ( p > .05). Similarly, the BOP at 1 year was almost identical in both groups. The mean values of bone resorption at baseline were 0.98 ± 0.37 mm and 0.69 ± 0.20 for the TA and SA groups, respectively ( p > .05). Bone loss (baseline to 12 months) was significantly greater in the SA group compared with the TA group. Conclusions Use of the new TA, with its significantly downsized diameter, resulted in reduced bone loss at 1 year. Further research will be required to assess the long-term effect of this abutment on peri-implant health. [ABSTRACT FROM AUTHOR]

Purpose To describe contact, thickness, density, and orientation of connective tissue fibers around healing abutments of different geometries by means of a new method using coordinates. Materials and Methods Following the bilateral extraction of mandibular premolars ( P2, P3, and P4) from six fox hound dogs and a 2-month healing period, 36 titanium implants were inserted, onto which two groups of healing abutments of different geometry were screwed: Group A (concave abutments) and Group B (wider healing abutment). After 3 months the animals were sacrificed and samples extracted containing each implant and surrounding soft and hard tissues. Histological analysis was performed without decalcifying the samples by means of circularly polarized light under optical microscope and a system of vertical and horizontal coordinates across all the connective tissue in an area delimited by the implant/abutment, epithelium, and bone tissue. Results In no case had the connective tissue formed a connection to the healing abutment/implant in the internal zone; a space of 35 ± 10 μm separated the connective tissue fibers from the healing abutment surface. The total thickness of connective tissue in the horizontal direction was significantly greater in the medial zone in Group B than in Group A ( p < .05). The orientation of the fibers varied according to the coordinate area so that internal coordinates showed a higher percentage of parallel fibers in Group A ( p < .05) and a higher percentage of oblique fibers in Group B ( p < .05); medial coordinates showed more oblique fibers ( p < .05); and the area of external coordinates showed the highest percentage of perpendicular fibers ( p < .05). The fiber density was higher in the basal and medial areas ( p < .05). Conclusions Abutment geometry influences the orientation of collagen fibers; therefore, an abutment with a profile wider than the implant platform favors oblique and perpendicular orientation of collagen fibers and greater connective tissue thickness. [ABSTRACT FROM AUTHOR]

Objective The aim of the current review was to systematically appraise the esthetic outcome of soft tissue around single implant crowns following type 1 and type 3 implants placement in published dental literature. Materials and methods A PubMed, Embase, and the Cochrane Central Register of Controlled Trials search up to March 2013 was conducted for articles published in the dental literature and limited to human trials with no language restricted. Furthermore, the reference lists of related articles were systematically screened, and additional manual searches were also performed. The primary outcome was pink esthetics score ( PES). Results The electronic search in the database of PubMed, Embase, and the Cohrane Central Register of Controlled Trials resulted in the identification of 463 titles. These titles were initially screened by the two independent reviewers for possible inclusion. Screening the abstracts and titles led to 28 articles for future full-text consideration. From these articles, 18 studies were excluded. Manual search identified one article. After quality assessment, eight studies were included in this review. This review showed that no significant difference of PES index could be found between type 1 and type 3 implant placement. Conclusion According to the current evidence, short-term esthetic outcomes of peri-implant soft tissue did not show significant difference following type 1 and type 3 implants placement with well-selected patients. However, caution should be taken for clinicians to extrapolate this result to all types of patients, as more randomized clinical trials are needed for long-term soft-tissue esthetic outcome in patients with high esthetic risk following type 1 implant placement. PES frequency, peri-implant condition and other risk factors for peri-implantitis are recommended to be reported for future studies. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the present systematic review was to estimate the survival rate of implants placed in fresh extraction sockets and immediately restored. Secondary aims were to compare it with the survival rate of implants placed in healed ridges and of implants restored according to a delayed protocol as well as to assess the influence of several other confounding factors on the clinical outcomes. Methods An electronic search was performed on MEDLINE, EMBASE, and CENTRAL databases in order to identify prospective clinical studies published from 1990 to October 2012. A hand search was also done. Studies were selected according to specific inclusion criteria. The effect of the following parameters on 1-year implant survival ( IS) was statistically evaluated: study design, risk of bias, prosthesis type, type of loading (occlusal or nonocclusal), type of incision (flap or flapless), presence of infection, and grafting material. A meta-analysis of studies comparing immediately restored implants placed in fresh postextraction sockets versus healed ridges was conducted. Results Seven randomized trials, three controlled trials, and 35 case series were included, accounting for 1170 patients and 1974 postextraction implants immediately restored. Twenty-eight studies had a low risk of bias. The overall 1-year IS was 97.6%. All failures occurred within 1 year of function. Meta-analysis showed a significant better outcome for implants placed in healed ridge ( IS = 99.4%) as compared with postextraction implants ( IS = 95.6%). No other parameter had a significant effect on clinical outcomes. Most variables, among which the esthetic aspect, could not be assessed as they were not systematically reported. Conclusion Though the conventional protocol still represents the gold standard, immediate restoration of implants placed in fresh extraction sites displayed an excellent implant prognosis. Such clinical approach can be successfully adopted in order to minimize the treatment time with a relevant impact on patient's satisfaction. [ABSTRACT FROM AUTHOR]

Objectives This study was undertaken to evaluate the influences of concave, machined and concave-roughened profiles of transmucosal implant designs on early peri-implant tissue responses. Materials and Methods Implants were used and classified by transmucosal profile and surface type as straight-machined implants (SM), concave-machined implants (CM), or concave-roughened implants (CR). A total of 30 implants (10 per each type) with matching transmucosal profiles were placed directly on alveolar crests in randomized order in the edentulous mandibular ridges of three beagle dogs. Healing abutments were connected 4 weeks after implant placement, and prostheses were connected 8 weeks after implant placement and functionally loaded. All animals were sacrificed at 16 weeks. Peri-apical radiographs were obtained and measured to evaluate peri-implant marginal bone levels. Histological specimens were prepared to measure bone resorption, connective tissue contact, epithelial tissue height, biological width, and length of implant-abutment junction to the apical portion of junctional epithelium. Results Radiographic and histometric analysis showed that least bone resorption occurred around CM implants and greatest bone resorption around SM implants ( P < 0.05). Histometric analysis showed that highest connective tissue attachment and shortest biological width had formed around CM implants. Conclusion Concave-machined profiled implants with a transmucosal design may induce less bone resorption and better connective tissue attachment around implants than the straight-machined profiled implants during the early healing phase. [ABSTRACT FROM AUTHOR]

Background: Procedures to improve peri-implant soft-tissue outcomes of single, immediately placed implants are a topic of interest. This systematic review investigates the effect of various surgical and restorative interventions on implant mid-buccal mucosal level. Methods: An electronic search of five databases (January 1990 to December 2012) and a manual search of peer-reviewed journals for relevant articles were performed. Randomized controlled clinical trials (RCTs), prospective cohort studies, and case series with at least nine participants were included, with data on midfacial mucosal recession (MR) of immediately placed implants following various surgical and restorative interventions with a follow-up period of at least 6 months. Results: Thirty-six studies, eight RCTs, one cohort study, and 27 case series were eligible. Six interventions were identified and reviewed: 1) palatal/lingual implant position; 2) platform-switched abutments; 3) flapless approach; 4) bone grafts to fill the gap between buccal plate and fixture; 5) connective tissue grafts; and 6) immediate provisionalization. Three studies consistently showed that palatally/lingually positioned implants had significantly less MR when using tissue-level implants. Mixed results were reported for interventions 2, 3, 5, and 6. One study was available for intervention 4 and did not show a benefit. Conclusions: Some interventions might be adopted to reduce the amount of MR on implants with the immediate placement approach, as suggested by the included studies, with various levels of evidence. The conflicting results among studies might be a result of differences in patient and site characteristics, e.g., tissue biotype and buccal plate thickness. Therefore, the use of these interventions might be reserved for patients with moderate to high risk of esthetic complications. [ABSTRACT FROM AUTHOR]

Purpose The aim of this prospective study was to evaluate the soft tissue changes around implants in the aesthetic zone, placed under a trimodal approach (immediate post-extraction placement, flapless, and immediate provisional restoration) and its relationship to gingival/periodontal biotype of the patient. Materials and methods The sample consisted of 14 patients from two private practices that were in need of a tooth extraction in the anterior maxillary region (cuspid to cuspid) and were candidates to a replacement with a dental implant. An initial measurement (baseline) of the position or the mesial and distal papillae and gingival zenith was made at this time, with a rigid dental-supported stent and an electronic precision caliper, able to the second tenth of a millimeter; after careful tooth extraction, the periodontal thickness, at a point 5 mm apical to de gingival buccal margin, with an analogical thickness gauge, able to one tenth of a millimeter. Once the implant was inserted an immediate provisional restoration was delivered. To evaluate the soft tissue changes measurements were repeated at 3, 6, and 12 months. A statistical analysis was performed to evaluate the changes in the gingival margin around the implant restorations and to identify a possible correlation to patient′s periodontal thickness. Results All 14 patients received Straumann ® implants (9 Tissue Level [TL] Regular Neck [RN], 2 TL Narrow Neck [NN], 2 Bone Level [BL] Narrow Crossfit [NC], and 1 BL Regular Crossfit [RC]). All implants integrated and none had any biological complications. Three provisional restorations presented screw loosening and retightened once and one loss retention and was recemented once. In one patient, with a severe bruxing habit, the final restoration suffered screw loosening and was retightened. Of the final restorations, 12 were screw-retained and 2 cemented on custom-made Zirconia abutments. A mean recession of the buccal margin of 0.45 mm was recorded at 12 months ( ± 0.25 mm). An acceptable papilla level was present in all cases at 1 year, with mean changes of 0.38 mm ( ± 0.60) for the mesial and 0.80 mm ( ± 0.90) of the distal papilla, respectively. No correlation could be established between the soft tissue changes and the periodontal biotype of the patient. Conclusions Within the limitations of this study, the good aesthetic outcome and minimal complications seem to validate the trimodal approach protocol as a reliable and simple protocol to place and restore immediate implants in the aesthetic zone. No correlation between the patient's gingival biotype and the soft tissue alterations could be established. Additional studies are needed to verify long-term aesthetic results with this approach and to better define and quantify biotypes. [ABSTRACT FROM AUTHOR]

Objective: The aim was to compare the clinical, aesthetic and radiological outcome of immediately placed implants in sockets with or without periapical pathology 5 years after placement. Materials and methods: Twenty-seven patients were followed 5 years after immediate implant placement (test-group: 12 patients with periapical pathologies; control-group: 15 patients without periapical pathology). Clinical (FMBS, FMPS, CAL, keratinized mucosa), aesthetical (length of clinical crown, Papilla index), and radiological (vertical distance implant shoulder to first bone to implant contact (IS-BIC)) parameters were assessed. Both 95% confidence intervals, as well as results of statistical tests (one-sample, two-sample, paired t-test) were provided. Results: After 5 years the implant survival rate was 100% for all 27 implants. In the test group the width of the keratinized mucosa increased significantly over the observation period (0.8 ± 1.0 mm). Concerning aesthetic parameters at the 3-month as well as at the 5-year examination no statistically significant difference could be found between the two groups. In the control-group the papilla mesial and distal to the implant increased statistically significant during the observation period by 0.5 ± 0.5 and 0.4 ± 0.6 index score points, respectively. The position of the gingival margin at the implant site and the two neighboring teeth remained stable. At the 5-year visit ISBIC measured between 1.4 ± 0.5 mm (mesial, control) and 1.7 ± 0.7 mm (distal, test), no significant difference could be found between the two groups. Over the observation period no statistically significant change of IS-BIC could be found in the test- as well as in the control-group. None of the examined radiographs revealed any signs of retrograde peri-implantitis. Conclusion: The replacement of teeth exhibiting periapical pathologies by implants placed immediately after tooth extraction can be a successful treatment modality with no disadvantages in clinical, aesthetical and radiological parameters to immediately placed implants into healthy sockets. [ABSTRACT FROM AUTHOR]

Aim To assess with a mean follow-up period of 33 months (median: 31 month, range: 11-89 month) the treatment outcome after immediate placement and provisionalization of single-tooth oral implants involving a definitive individual abutment and a provisional crown followed by later placement of a definitive crown. Materials and methods 68 patients with 68 single-tooth implants in the esthetic zone were consecutively treated; 55 of these patients were included in the study. The treatment involved tooth extraction, implant placement, placement of a definitive individual abutment, and a provisional crown in the same visit in private practice. The definitive crown was placed after a mean period of 7 months. The primary outcome measures included implant survival, definitive implant crown survival, and overall treatment survival. The secondary outcome measures included probing depth, bleeding on probing, peri-implant marginal bone level, marginal bone level of the neighboring tooth surfaces, biological complications, and technical complications. Results Of the inserted implants 98% survived and of the definitive crowns mounted a survival of 100% was observed. Consequently, the overall treatment survival was 98%. The mean probing depth was 2.9 mm at implant level and 63% of the implants were characterized by no bleeding on probing. The mean peri-implant marginal bone level was 2 mm. A significant mean peri-implant marginal bone level gain of 0.5 mm was observed from implant placement to the follow-up (95% CI: 0.07-0.89 mm, P = 0.022). No significant changes of the marginal bone level at the neighboring tooth surfaces were seen. Four episodes of peri-implant inflammation were identified in three patients, while 46 incidents of loosening of the provisional crown occurred in 33 patients. One abutment screw loosened before placement of the definitive crown. Finally, loosening of four definitive crowns occurred in four patients. Conclusions Immediate placement and provisionalization of single-tooth oral implants involving a definitive individual abutment and a provisional crown followed by later placement of a definitive crown were characterized by high survival of the implant crowns and implants as well as healthy peri-implant tissues, after a mean follow-up period of 33 months. Loss of retention of the provisional crown occurred frequently. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to evaluate and compare the osseointegration in rabbit tibiae of smooth and roughened powder injection moulded ( PIM) zirconia implants with or without (Ti,Zr)O2 surface coatings. Material and Methods Twenty-five rabbits received four types of external hex implants with identical geometry on the tibiae: PIM zirconia implants, roughened PIM zirconia implants, (Ti,Zr)O2-coated PIM zirconia implants and (Ti,Zr)O2-coated roughened PIM zirconia implants. The surface characteristics of the four types of implants were evaluated. Removal torque tests and histomorphometric analyses were performed. Results The (Ti,Zr)O2 coatings substantially changed the surface topography and chemical composition of the both type of PIM zirconia implants. There were statistically significant differences in the bone to implant contact ratios and removal torque values ( RT) among the tested implant types ( p < 0.001). The histological response favoured the coated surface at smooth PIM zirconia implants. The removal torque values favoured the rough surface whether coated or uncoated. Conclusions Within the limit of this study, the (Ti,Zr)O2 coated PIM zirconia implants, both smooth and rough, showed enhanced histological response (bone to implant contact) compared with uncoated ones. On the other hand, the mechanical anchorage ( RT) was higher for rough surface implants, coated or uncoated. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose: Many authors have emphasized that immediate loading protocols enable better esthetic results to be achieved compared with delayed loading, especially in the case of postextraction implants that are capable of maintaining the original esthetics of soft tissues. The aim of this study was to establish correlations between the interproximal crest, interproximal papilla, and marginal facial gingiva of immediately loaded postextraction implants by evaluating clinical and radiographic data. Materials and Methods: Fifty-eight consecutive patients underwent a tooth extraction and immediate implant placement with 64 postextraction implants, which were immediately loaded using a provisional single crown from June 2005 to December 2006. At 6 months after surgery, all implants were restored with a definitive single crown. Clinical and radiographic data were recorded at the time of surgery, at the time of definitive restoration, and after 3 years of functioning, in order to evaluate soft tissues esthetics and bone tissue condition. Statistical analysis was used to assess significant correlations between the interproximal crest, interproximal papilla, and marginal facial gingiva ( p = 0.05). Results: After 3 years of functioning, the implant success rate was 100% because no implants had failed. All parameters were stable and steady during the 3-year follow-up. The regression test revealed a statistically significant correlation between interproximal crest levels and interproximal papilla volume ( p = 0.0134), and also between interproximal crest levels and marginal gingiva levels ( p = 0.0226). Conclusions: Postextraction immediately loaded implants represent a predictable technique that should be considered the treatment of choice in cases of single anterior tooth restoration and other cases. Esthetic results seem to depend on correct positioning of the implants, considering the correlation between bone tissue and related soft tissues. Maintaining the original condition of both bone and soft tissues around the tooth to be removed is the key to obtaining optimal esthetic outcomes. [ABSTRACT FROM AUTHOR]

Background Type I immediate implant placement has gained popularity because it may reduce treatment time, number of surgeries and post-extraction bone loss. However, this is potentially challenged by inadequate keratinized mucosa for flap adaptation and difficulties in achieving primary stability. Moreover, it has been proven that post-extraction bone loss is an inevitable biological process, which affects treatment outcomes. Objectives To estimate survival and success rates of implants and the implant-supported prostheses, the prevalence of biological, technical and aesthetic complications, and the magnitude of soft and hard tissue changes following implant placement immediately into fresh extraction sockets. Material and methods An electronic search in MEDLINE ( Pub Med) and the Cochrane Library from 1991 to July 2010 was performed to include prospective studies on immediate implants with a mean follow-up time of at least 1 year. The survival rates were computed using the STATA statistical software. Weighted means of soft and hard tissue changes were obtained by the inverse variance method. Results A total of 46 prospective studies, with a mean follow-up time of 2.08 years, were included. The annual failure rate of immediate implants was 0.82% (95% CI: 0.48-1.39%), translating into the 2-year survival rate of 98.4% (97.3-99%). Among the five factors analysed (reasons for extraction, antibiotic use, position of implant [anterior vs. posterior, maxilla vs. mandible), type of loading], only the regimen of antibiotic use affected the survival rate significantly. Lower failure rates were found in groups that were provided with a course of post-operative antibiotics. The success of implant therapy was difficult to assess due to scarce reporting on biological, technical and aesthetic complications. Soft tissue changes occurred mostly in the first 3 months after the provision of restoration, and then stabilized towards end of the first year. Marginal bone loss predominantly took place in the first year after implant placement, with a magnitude generally less than 1 mm. Controversy on hard tissue preservation with platform-switching technique remained unsolved. Conclusions Despite the high survival rate observed, more long-term studies are necessary to determine the success of implant treatment provided immediately after tooth extraction. Special attention has to be given to aesthetic outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the reliability and failure modes of indirect composites as single-unit implant crowns. Materials and Methods: Thirty-eight custom-milled titanium alloy locking-taper abutments were divided into two groups (n = 19 each), and crown build-up of a mandibular molar was accomplished using two indirect composite systems (Ceramage, Shofu, Kyoto, Japan; Diamond Crown, DRM, Branford, CT). Three crowns of each material were loaded until failure for determination of the step-stress profiles. Reliability testing started at a load 30% of the mean load to failure and used three profiles with increasing fatigue loading (step stress). Weibull curves with 300 N stress and 90% confidence intervals were calculated and plotted using a power-law relationship. Weibull modulus 'Beta' and characteristic strength 'Eta' were identified, and a contour plot was used (Beta vs. Eta) for examining differences between groups. Specimens were inspected in polarized light and scanning electron microscope for fracture analysis. Results: Use level Weibull probability showed fatigue being a damage factor only for the Ceramage group (β= 3.39) but not for the Diamond Crown group (β= 0.40). Overlap in the confidence bounds resulted in no statistical difference. Irrespective of composite system, fracture initiated in the region immediately below the contact between the indenter and the cusp, with the crack propagating toward the margins of cohesive failure. Conclusions: No significant differences were observed in life and Weibull probability calculations for Ceramage and Diamond Crown veneered onto Ti alloy abutments. Failure modes comprised composite veneer chippings. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate soft tissue development at concave circular macro-grooved titanium abutments in healed sites. In a split-mouth pilot study 10 patients received two implants each at healed posterior sites in contralateral maxillary or mandibular jaw quadrants. Either circular macro-grooved concave study abutments or conventional convex control abutments were immediately provisionalized and received permanent crowns 3 months postimplantation. Marginal bone level, papilla index, modified plaque and bleeding index were recorded. The esthetic outcome was evaluated with standardized perpendicular pictures according to the Pink Esthetic Score (PES). Statistical analysis included the description of all variables by mean value, standard deviation and range. PES values were compared using the Wilcoxon signed rank test for paired data. Cumulative survival rate for all 20 implants was 100%. At the 1-year follow-up, there was no statistical significant difference of marginal bone levels between sites restored with the study (−0.11 ± 0.77 mm) vs. the control (−0.34 ± 0.53 mm) abutments ( P>0.05). Esthetic evaluation (PES) revealed statistically significant differences in scores between the study group [study abutment group] (7.2 ± 2.82, 8 ± 1.89) and the control group [control abutment group] (9.5 ± 1.58, 10.5 ± 1.72) at the time of prosthetic delivery and the 1-year follow-up. Whereas PES scores for mesial papilla at control sites at the 1-year follow-up demonstrated statistically significant higher values, both soft tissue level and soft tissue contour at control sites revealed statistically significantly higher PES values ( P<0.05) at time of prosthetic delivery and at 1-year follow-up when compared with study sites. Concave macro-grooved abutments in healed posterior maxillary and mandibular sites did not exhibit a superior soft tissue development compared with standard convex abutments. Weinländer M, Lekovic V, Spadijer-Gostovic S, Milicic B, Wegscheider WA, Piehslinger E. Soft tissue development around abutments with a circular macro-groove in healed sites of partially edentulous posterior maxillae and mandibles: a clinical pilot study. Clin. Oral Impl. Res. , 2011; 743-752 doi: 10.1111/j.1600-0501.2010.02054.x [ABSTRACT FROM AUTHOR]

Aim: 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. Material and Methods: 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). Results: 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 0.85 mm for IIT and 0.65 mm for CIT after 1 year (p = 0.144). Mesial papillae remained stable over time. Minute loss of distal papillae occurred following IIT (-0.38 mm) and a tendency for re-growth was found following CIT (0.60 mm). Midfacial soft tissues remained stable over time following IIT with only 7% showing advanced recession (>1 mm). Flapless surgery induced less midfacial recession than flap surgery (p = 0.023). Significant midfacial recession occurred following CIT (-1 mm). Overall, 24% were aesthetic failures (PES<8 and/ or WES<6) and 8% showed an (almost) perfect outcome (PE≥12 and WES≥9). The remainder (68%) demonstrated acceptable aesthetics. Conclusions: 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. [ABSTRACT FROM AUTHOR]

A successful implant restoration is one that will allow adequate function and esthetics. Soft-tissue management around implant-supported restorations continues to present a considerable challenge for the restoring dentist as well as the laboratory technician while fabricating the final prosthesis. This article presents a simplified and economical technique to direct gingival tissue healing, as well as create a removable gingival replica of the customized gingival emergence profile. The created profile can then be used in the dental laboratory to achieve a superior and predictable esthetic outcome for implant-supported fixed restorations. [ABSTRACT FROM AUTHOR]

Two-stage placement of a dental implant is a well-established method for restoring a missing anterior tooth; however, replacement of an anterior tooth by using two-stage implant surgery may result in changes in the interdental papilla height and loss of alveolar bone with compromised esthetic results. Alternatively, the use of a one-stage minimally invasive surgical technique followed by immediate provisionalization may facilitate achievement of esthetic and functional success with minimal discomfort and clinical time. This article presents a clinical case with a single anterior tooth replacement, illustrating ridge preservation with healing, delayed implant placement with immediate provisionalization of the implant to support the soft tissue, and a method of recording the soft-tissue contour in the final impression to achieve an optimal esthetic result. [ABSTRACT FROM AUTHOR]

Background: Clinical studies reporting immediate loading of endosseous implants for edentulous cases and for fixed partial restorations have been well documented with satisfactory survival rates. Implants with a recently developed, nanometer-scale surface topography (NanoTite®, BIOMET 3i, Palm Beach Gardens, FL, USA), created by discrete crystalline depositions (DCD) of calcium phosphate nano-crystals onto a dual acid-etched (DAE) surface, show enhanced early fixation in preclinical studies when compared with DAE-surfaced implants. These outcomes suggest DCD-surfaced implants may be advantageous for immediate loading approaches. Objective: The aim of this prospective, multicenter, observational study is to report clinical outcomes for DCD-surfaced implants placed in immediate functional support of single- and multi-unit restorations according to an immediate loading protocol. Materials and Methods: One hundred eighty-five patients enrolled at 15 international study centers received a total of 335 implants supporting 216 immediate provisionalizations consisting of 128 single-tooth restorations and 88 fixed restorations. Of the 335 implants, 77% are located in posterior and 23% in anterior regions with 55.5% of the total in mandibles and 44.5% in maxillae. Patients were evaluated for implant mobility, gingival health, symptomatology, and radiographic outcomes. Results: At the time of this 1-year interim report, a total of 17 failures have been observed in 11 patients, yielding a cumulative survival rate of 94.9%. Conclusion: Relative to other prospective, multicenter studies of immediately loaded implants with various surface enhancements, NanoTite implants perform comparatively well when immediately provisionalized with single-tooth and fixed restorations. [ABSTRACT FROM AUTHOR]

Purpose: With the increasing popularity and publication of loading implants at the time of placement, including at time of dental extraction and simultaneous with reconstructive procedures, the objective was to evaluate known variables identified for a traditional unloaded healing period and determine the applicability of these variables to immediate loading. Materials: A total of 124 published reports available as of January 2008 that contained information about loading from the time of surgery up to 3 months postsurgically were examined in light of published variables affecting osseointegration based on a 2 stage surgical approach. Methods: The articles were examined to differentiate between immediate loading (within the initial 48 hours) and early/delayed loading of implants. Success or survival criteria were noted, and where reasons for failure were available, categorized according to six variables considered as determinants for maintaining a long-term bone-to-implant contact. Results: Approximately 60 of the 124 reports described immediately loading implants within 48 with single-tooth, partial, and full-arch restorations, as well as implant overdentures. The implant success or survival rates ranged from 70.8% to 100%. Most studies considered implant survival to be the only criterion for success. Conclusions: Of six parameters identified in 1981 as influencing osseointegration, two parameters (the status of the bone/implant site and implant loading conditions) appear to have diagnostic implications, whereas three (implant design, surgical technique, and implant finish) may affect immediate loading positively or adversely. [ABSTRACT FROM AUTHOR]

Objective: The aim of this biomechanical study was to assess the interrelated effect of both surface roughness and surgical technique on the primary stability of dental implants. Material and methods: For the experiment, 160 screw-designed implants (Biocomp®), with either a machined or an etched surface topography, were inserted into polyurethane foam blocks (Sawbones®). As an equivalent of trabecular bone, a density of 0.48 g/cm3 was chosen. To mimic the cortical layer, on top of these blocks short-fibre-filled epoxy sheets were attached with a thickness varying from 0 to 2.5 mm. The implant sites were prepared using either a press-fit or an undersized technique. To measure the primary stability of the implant, both the insertion and the removal torques were scored. Results: Independent of the surgical technique used, both implant types showed an increased insertion and removal torque values with increasing cortical thickness, although >2 mm cortical layer no further increase in insertion torque was observed. In the models with only trabecular bone (without cortical layer) and with a 1 mm cortical layer, both implant types showed a statistically higher insertion and removal torque values for undersized compared with the press-fit technique. In addition, etched implants showed a statistically higher insertion and removal torque mean values compared with machined implants. In the models with 2 and 2.5 mm cortical layers, with respect to the insertion torque values, no effect of either implantation technique or implant surface topography could be observed. Conclusion: The placement of etched implants in synthetic bone models using an undersized preparation technique resulted in enhanced primary implant stability. A correlation was found between the primary stability and the cortical thickness. However, at or above a cortical thickness of 2 mm, the effect of both an undersized surgical approach, as also the presence of a roughened (etched) implant surface, had no extra effect. Besides the mechanical aspects, the biological effect of undersized drilling, i.e. the bone response on the extra insertion torque forces should also be elucidated. Therefore, additional in vivo studies are needed. To cite this article: Tabassum A, Meijer GJ, Wolke JGC, Jansen JA. Influence of surgical technique and surface roughness on the primary stability of an implant in artificial bone with different cortical thickness: a laboratory study. Clin. Oral Impl. Res. 21, 2010; 213–220. doi: 10.1111/j.1600-0501.2009.01823.x [ABSTRACT FROM AUTHOR]

Background: Sinus augmentation with simultaneous implant placement without bone graft material is a hotly debated technique. This technique could be improved and secured by the use of an autologous leukocyte- and platelet-rich fibrin (PRF) (Choukroun's technique) concentrate. The objectives of this study were to assess the relevance of PRF clots and membranes as the sole filling material during a lateral sinus lift with immediate implantation using radiologic and histologic analyses in a case series. Methods: Twenty-five sinus elevations with simultaneous implantation were performed on 20 patients with Choukroun's PRF as the sole filling biomaterial. For each patient, a presurgical exam and a 6-month postsurgical radiologic exam were performed with a panoramic x-ray and three-dimensional volumetric computed radiography (VCR) to evaluate the subsinus residual bone height and the final bone gain around the implants. In nine patients, 6 months after the sinus lift, bone biopsies were collected on the buccal wall of the alveolar ridge at the level of the osteotomy window, and evaluated by histomorphometry. Results: In this study, 41 implants from three different systems with different screw designs (Biomet 31 Nanotite, MIS Seven, Intra-Lock Ossean) were placed. All implants were inserted in residual bone height between 1.5 and 6 mm (mean ± SD: 2.9 ± 0.9 mm). The final bone gain was always very significant (between 7 and 13 mm [mean ± SD: 10.1 ± 0.9 mm]). No implant was lost. After radiologic analyses, the position of the final sinus floor was always in the continuation of the end of the implant. All biopsies showed well organized and vital bone. Conclusions: From a radiologic and histologic point of view at 6 months after surgery, the use of PRF as the sole filling material during a simultaneous sinus lift and implantation stabilized a high volume of natural regenerated bone in the subsinus cavity up to the tip of the implants. Choukroun's PRF is a simple and inexpensive biomaterial, and its systematic use during a sinus lift seems a relevant option, particularly for the protection of the Schneiderian membrane. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the bone loss pattern and soft tissue healing of immediately versus one-stage loaded 3.0-mm-diameter implants in cases involving a single missing lateral maxillary incisor. Methods: Sixty patients with a missing lateral incisor in the maxilla were randomized to one of the treatments: 30 patients in the immediate-restoration group and 30 patients in the one-stage group. All implants were placed in healed sites and had to be inserted with a torque >25 Ncm. The implants in the immediate-restoration group were fitted with a non-occluding temporary crown on the day of surgery. Both groups received a full occluding final crown 6 months after surgery. Mean marginal bone loss, probing depth, and bleeding on probing were assessed at 6-, 12-, 24-, and 36-month follow-up examinations by a masked examiner. Results: Sixty 3.0-mm-diameter implants were placed between July 2003 and February 2006; 27 (45.0%) were in men, and 33 (55.0%) were in women. All implants osseointegrated and were clinically stable at the 6-month follow-up. No statistically significant differences were observed for bleeding or plaque index. No implant fractures occurred. At the 36-month follow-up, the accumulated mean marginal bone loss and probing depth were 0.85 ± 0.71 mm and 1.91 ± 0.59 mm, respectively, for the immediate-loading group (n = 30) and 0.75 ± 0.63 mm and 2.27 ± 0.81 mm, respectively, for the one-stage group (n = 30). There was no statistically significant difference (P>0.05) for the tested outcome measures between the two procedures. Conclusions: In the rehabilitation of a single missing lateral maxillary incisor, no statistically significant difference was assessed between immediately and one-stage restored small-diameter implants with regard to implant survival, mean marginal bone loss, and probing depth. Three-millimeter-diameter implants proved to be a predictable treatment option in our test and control groups if a strict clinical protocol was followed. [ABSTRACT FROM AUTHOR]

Aim: The Implant Crown Aesthetic (ICA) Index evaluates the aesthetic outcome of implant-supported single crowns in the anterior zone by awarding nine points for the shape, color, and surface characteristics of the crowns and surrounding soft tissue. The aim of this study was to measure the reproducibility of the ICA Index and assess the influence exerted by the examiner's degree of dental specialization. Materials and Methods: Ten examiners (two general dentists, two prosthodontists, two oral surgeons, two orthodontists, and two dental technicians) applied the ICA Index to 23 implant-supported single crowns twice at an interval of 4 weeks. The inter- and intra-examiner ratings were analyzed. Cohen's kappa (K) was used to measure the interexaminer reliability of estimations by two appraisers at a significance level of p < .05. Results: Within the various parameters, the observer agreement ranged 53 to 81%. All the examiners achieved moderate agreement between the first and second ratings, whereby Cohen's kappa was 0.49 ( p < .001). The most agreement was obtained by surgeons (K = 0.62, substantial) and the least by orthodontists (K = 0.24, sufficient). The lowest level of agreement with other occupational groups was manifested by the orthodontists (≤44.3%). The ICA Index produced a moderate Cohen's kappa of 0.42 and agreement amounting to 67% between the two ratings within the occupational groups. There was minimum agreement among the occupational groups (Cohen's K = 0.11–0.37, observer agreement: 40.2–66.3%); again, the least agreement was between the orthodontists and others. Conclusions: The ICA Index resulted in poor to moderate intra- and interexaminer agreement. The validity and reproducibility of the ICA indexing as an objective tool in rating implant aesthetics is questionable. [ABSTRACT FROM AUTHOR]