Original study - ZZI 02/2011

Evaluation of the influence of preoperative factors
on soft tissue consolidation around single tooth implants
in the esthetic zone – A pilot study

The photos were assessed by five dental students. After an interval of four weeks, the evaluation was performed a second time by the same students. The images were now presented in reversed order.

The Pink Esthetic Score (PES) [11] was employed to assess the periimplant soft tissue esthetics. This score includes seven variables (Fig. 1). Each variable can be given a score of 0 to 2 so that a maximum PES of 14 is assigned for an optimal esthetic outcome and a score of 0 for the worst outcome. A healthy reference tooth (the contralateral tooth in the anterior region and the neighboring tooth in the premolar region) is taken as esthetically optimal (PES 14) for the individual patient. The PES was then assigned to the implant tooth relative to the reference tooth.



All calculations were performed with SPSS 15.0 for Windows (SPSS Inc., Chicago, IL, USA). The patient-related data were presented as absolute and relative frequencies. The PES was represented as mean and standard deviation. The influence of patient-related factors on the esthetic outcome was first examined by univariate analysis using the Mann-Whitney test (U-test) for two samples and the Kruskal-Wallis test for several independent samples. Finally, multivariate testing was performed using linear regression analysis. Two-sided p values < 0.05 were regarded as significant.



Patient-, defect- and treatment-related variables

34 patients in total (23 [67.6 %] male, 11 [32.4 %] female) with an average age of 37.8 years (15–73 years) were selected for the study. These patients received 49 implants with a length of 10–15 mm and a diameter of 3.25–6.8 mm (BEGO Implant Systems, Bremen, Germany; Straumann Holding AG, Basel, Switzerland; Nobel Biocare Holding AG, Zürich, Switzerland). As regards defect etiology, periodontal/carious lesions predominated (21 defects; 42.9 %), followed by aplasia (16 defects; 32.7 %) and dental trauma (12 defects; 24.4 %).

41 implants (83.7 %) were inserted in the maxilla and eight (16.3 %) in the mandible. 25 (51.0 %) implants were inserted in single-tooth gaps, while 24 (49.0 %) were inserted to treat saddle gaps where more than one tooth was missing. In 25 (51.0 %) planned implant regions, radiographs showed adequate available vertical bone of 6–10 mm in the mandible and 10 mm in the maxilla, together with sufficient transverse bone of 4–6 mm in both jaws. In 15 (30.6 %) implant regions, pre- or intra-implant augmentation procedures were necessary in the form of unilateral sinus lift or onlay graft in two to three implant regions. The autologous bone grafts were obtained in the mouth in these cases. There were extensive bone defects in nine (18.4 %) implant regions. These had to be augmented prior to implantation by onlay or inlay of avascular bone grafts from the iliac crest. In eleven (22.4 %) implant regions, the thickness of the periimplant mucosa and the width of the fixed circular periimplant keratinized gingiva of 3–4 mm were sufficient before implantation. A single-stage procedure with transmucosal implant healing was chosen. In two (4.1 %) implant regions, a crestal incision opening/stretching with central tissue increase was used for uncovering the implant. An oro-vestibular transposition graft was performed with three (6.1 %) implants to increase the volume of the periimplant soft tissue, an oro-vestibular transposition graft with palatal de-epithelialized extension (palatal roll) was performed with 18 (36.7 %) implants (Fig. 2), and papilla regeneration with targeted interdental volume increase by means of an M-shaped incision technique with four (8.2 %) implants. To widen the vestibular, periimplant area of fixed keratinized gingiva, vestibuloplasty/apically positioned flap with a free mucosal graft from the hard palate was performed with eleven (22.4 %) implants. Review of the diagnostic data showed four (8 %) simple, 19 (39 %) advanced and 26 (53 %) complex cases when the SAC classification was used.

Three (6.1 %) implants were inserted immediately after minimally invasive tooth extraction, preserving the vestibular socket wall (immediate implantation). Three more implants (6.1 %) were placed four to 16 weeks after tooth extraction when soft tissue healing was complete but bony consolidation of the socket was incomplete (early and late delayed immediate implantation). The majority of the implants (43; 87.8 %) were inserted in sockets where bony consolidation had occurred, according to the late implantation concept. Four (8.2 %) implants were restored up to the tenth postoperative day (immediate restoration). With four (8.2 %) implants, the crowns were fitted between three and four months after implantation (“increasing loading”). The remaining 41 (83.7 %) implants were loaded four to six months after implant insertion.

Esthetic evaluation

PAGE: 1 | 2 | 3 | 4 | 5