Esthetics of Flapless Single-Tooth Implants in the Anterior Maxilla Using Guided Surgery: Association of Three-Dimensional Accuracy and Pink Esthetic Score

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