A three‐year follow‐up report of a comparative study of ITI Dental Implants® and Capelli M. Influence of the 3‐D bone to implant relationship on esthetics. One of the most challenging tasks in implant dentistry is to fulfill the esthetic expectations of patients. While implant positioning and adequate .. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant relationship on esthetics . Staging in Esthetic Implant Therapy: connection will ultimately influence the . 3. It augments the crestal alveolar bone and overlying gingival tis-.
The lateral incisor had worst prognosis and there was no provision to plan for a post core because of the difficulty to get a ferrule, hence extraction and prosthetic replacement were the treatment of choice. He was informed about the possibilities of removable denture, fixed prosthesis, and implant therapy. As patient was interested in implant therapy, and as we felt him to be an ideal patient, we planned for immediate placement of implant after extraction of the tooth.
Under local anesthesia, a platform switched 0. Radiographs taken immediately after placement of implant, in 3 months, 1 year, and 2 year follow up are represented in [Figure - 4] and clinical picture in the 2 year follow up in [Figure - 3] b. The primary tooth was extracted and a platform switched implant of length 11 mm and 3. Radiographs taken pre-operatively, immediately, and 3 months after placement of implant and 1 year after loading are represented in [Figure - 5].Immediate implant placement - factors influencing the esthetic success
Radiographs taken immediately and 3 months after placement of implant; and 6 months and 1 year after loading are represented in [Figure - 6].
Radiographs taken pre-operatively and immediately after placement of implant; and 1 year after loading are represented in [Figure - 7].
The patient satisfaction has more importance when we have the restoration located in the esthetic zone. However, the esthetics associated with the final implant restoration is greatly affected by both the soft and hard tissue changes.
Thus, if we can take care of the shrinkage of the adjacent interdental papillae and the loss of the scalloped tissue contour around the implant restoration and minimize the crestal bone loss; the anterior implant restoration will have good esthetics.
Crestal bone remodeling and resorption during the first year following immediate implant placement leads to compromise in the treatment outcome that are reported in literature,  and ways to overcome this also described. Neither periapical infection nor periodontal is responsible for extracting the tooth, which might be the first and foremost reason. Another positive factor in case selection was the thick tissue biotype. The surgical trauma was also minimal as there was careful extraction of the tooth and no flap elevation procedure.
Sand blasted, large grit, acid etched implant with a diameter 2 mm less than the diameter of extraction socket and with a conical abutment-implant connection Morse taper was selected. Conclusion Platform switching is not the only way to control circumferential bone loss around dental implants, but it is one of the ways to get a better results. 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. This score includes seven variables Fig. 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. 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. Results Patient- defect- and treatment-related variables 34 patients in total 23 [ These patients received 49 implants with a length of 10—15 mm and a diameter of 3.
The autologous bone grafts were obtained in the mouth in these cases. There were extensive bone defects in nine These had to be augmented prior to implantation by onlay or inlay of avascular bone grafts from the iliac crest. A single-stage procedure with transmucosal implant healing was chosen. An oro-vestibular transposition graft was performed with three 6. Three more implants 6. The majority of the implants 43; The remaining 41 Esthetic evaluation The mean implant PES was 6.
As a result of the small size of the group, however, no further multivariate analysis took place. Implants in the maxilla had a PES of 6.
Influence of the 3-D bone-to-implant relationship on esthetics.
The difference was not statistically significant. Implants in single tooth gaps had a PES of 6. Implants inserted in local bone demonstrated a PES of 7. A PES of 8. The PES was 4.
None of the treatment-related factors had a significant influence on the PES. Multivariate analysis In summary, the relationships between the individual para-meters in the complex interplay were found by linear regression. The cause of the tooth loss and also the incision chosen for uncovering the implant were not necessary for description of the PES. Discussion Our results show that there are highly significant statistical differences in the PES of single tooth implants compared with restorations of neighboring implants.
An explanation for this might be the bone resorption described by Tarnow between neighboring implants and the resulting deficiency of hard and soft tissue [27, 28]. Resorption of the interimplant bone leads to shortening of the papilla and ultimately to impairment of red and white esthetics. The preoperative defect size, due, for instance, to atrophy and trauma, had a crucial influence on the final esthetic result of implant-borne rehabilitation.
Extensive hard and soft tissue defects required extensive reconstructive measures prior to implantation. The esthetic outcomes depending on the SAC classification are analogous. The influence of different surgical protocols [8, 10, 13, 23, 24] and prosthetic loading concepts [4, 6, 8, 12, 13] on estheti-cally successful implant restorations is also discussed.
However, objective esthetic parameters have hardly been considered hitherto, so that comparison of the results was not possible [12, 21]. Using the Pink Esthetic Score, our study showed that neither the surgical time management nor the prosthetic loading concept have a statistically significant influence on the final esthetic outcome. This is in line with the studies of Jokstad and Carr, who also found no esthetically significant difference between immediately and conventionally loaded implants .
Despite numerous single case reports, there are so far no evidence-based data on incision techniques, flap design and indication for soft tissue augmentation [5, 9]. The present study found highly significant associations between the exposure concept and PES on univariate analysis. On multivariate analysis, however, a significant influence could not be confirmed, possibly because of the small number of cases.
Influence of the 3-D bone-to-implant relationship on esthetics. - Semantic Scholar
Surgical procedures such as papilla reconstruction and palatal roll, which can increase the volume of the soft tissue, achieved good esthetic outcomes in our study. Lower scores were assigned for implants that were uncovered by a simple crestal incision. The causes of this were a reduced soft tissue level and incomplete papillae, especially in the case of neighboring implants in the premolar area.
In eleven patients The aim of this technique is to create a minimum circular periimplant width of fixed keratinized gingiva of 2—3 mm .
Although there is insufficient evidence according to recent review articles , it is assumed that oral hygiene is improved by the fixed keratinized gingiva and plaque accumulation is reduced .
This ensures the long-term esthetic and functional result. A systematic review article by Thoma et al. To minimize problems of donor site morbidity, allogeneic and xenogeneic substitute materials have been introduced and tested .
Studies by our research group have shown that this shrinkage after use of allogeneic materials can be attributed to increased and prolonged recruitment of macrophages in the early healing periods with subsequent fibrocontractile tissue remodeling .
From the esthetic aspect, the FMG outcomes are usually unsatisfactory as a result of color mismatch and should, in consequence, be employed only in the mandible, posterior maxillary region or in wearers of overdentures . Conclusions Within the limitations of a pilot study employing a small sample size, it was confirmed that insufficient hard and soft tissue represents the greatest challenge for the implantologist.
Current developments in minimally invasive hard and soft tissue management techniques might help to enhance the esthetic outcomes for these patients in the future.
Soft tissue integration in the neck area of titanium implants — an animal trial. J Physiol Pharmacol ;59 Suppl 5: