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Four modalities of single implant treatment in the anterior maxilla: a clinical, radiographic, and aesthetic evaluation

Jan Cosyn UGent, ARYAN EGHBALI UGent, Lore Hanselaer UGent, Tim De Rouck UGent, Iris Wyn, Mehran Moradi Sabzevar, Roberto Cleymaet and Hugo De Bruyn UGent (2013) CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH. 15(4). p.517-530
abstract
Purpose: To document the outcome of single implants in the anterior maxilla following 4 routine treatment modalities when performed by experienced clinicians in daily practice using the same implant system and biomaterials. Material and methods: A retrospective study in patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 was conducted. The 4 treatment modalities practically covered every clinical situation and included standard implant treatment (SIT), immediate implant treatment (IIT), implant treatment in conjunction with guided bone regeneration (GBR) and implant treatment in grafted bone harvested from the chin (BGR). All implants were installed via flap surgery. Patients were clinically and radiographically examined. Complications were registered and the aesthetic outcome (Pink Esthetic Score (PES), White Esthetic Score (WES)) was rated. A blinded clinician who had not been involved in the treatment performed all evaluations. Patient’s aesthetic satisfaction was also registered. Results: One hundred and four out of 115 eligible patients (44 SIT, 28 IIT, 18 GBR, 14 BGR) received at least 1 single NobelReplace tapered TiUnite® (Nobel Biocare, Göteborg, Sweden) implant in the anterior maxilla and were available for evaluation. Clinical parameters (implant survival: 93%, mean plaque level: 24 %, mean bleeding on probing: 33 %, mean probing depth: 3.2 mm) and mean bone level (1.19 mm) did not differ significantly between treatment modalities. Postoperative complications were more common following GBR/BGR (> 61 %) when compared to SIT/IIT (< 18 %) (p < 0.001). BGR was in 4/14 patients associated with permanent sensory complications at the donor site. Technical complications occurred in 9/104 patients. SIT and IIT showed similar soft tissue aesthetics (PES: 10.07 and 10.88, respectively), however major alveolar process deficiency was common (> 15 %). PES was 9.65 for GBR. BGR showed inferior soft tissue aesthetics (PES: 9.00; p = 0.045) and shorter distal papillae were found following GBR/BGR (p = 0.009). Periodontal disease (OR: 13.0, p < 0.001), GBR/BGR (OR: 4.3, p = 0.004) and a thin-scalloped gingival biotype (OR: 3.7, p = 0.011) increased the risk for incomplete distal papillae. WES was 7.98, all patients considered. Poor agreement was found between objective and subjective aesthetic ratings. Conclusions: All treatment modalities were predictable from a clinical and radiographic point of view. However, advanced reconstructive surgery, especially BGR, increased the risk for complications and compromised aesthetics. Research is required on the prevention and minimally-invasive treatment of buccal bone defects at the time of tooth loss to avoid complex therapy.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
bone augmentation, single-tooth, guided bone regeneration, Dental implants, pink esthetic score, immediate, 4-YEAR FOLLOW-UP, TOOTH EXTRACTION, SOFT-TISSUE, PERI-IMPLANTITIS, SPONTANEOUS PROGRESSION, BONE, PLACEMENT, IMMEDIATE, RESTORATIONS, MORBIDITY
journal title
CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH
Clin. Implant Dent. Relat. Res.
volume
15
issue
4
pages
517 - 530
Web of Science type
Article
Web of Science id
000322580400006
JCR category
DENTISTRY, ORAL SURGERY & MEDICINE
JCR impact factor
2.796 (2013)
JCR rank
9/83 (2013)
JCR quartile
1 (2013)
ISSN
1523-0899
DOI
10.1111/j.1708-8208.2011.00417.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1999782
handle
http://hdl.handle.net/1854/LU-1999782
date created
2012-01-23 12:17:02
date last changed
2015-04-02 09:29:29
@article{1999782,
  abstract     = {Purpose: To document the outcome of single implants in the anterior maxilla following 4 routine treatment modalities when performed by experienced clinicians in daily practice using the same implant system and biomaterials.
Material and methods: A retrospective study in patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 was conducted. The 4 treatment modalities practically covered every clinical situation and included standard implant treatment (SIT), immediate implant treatment (IIT), implant treatment in conjunction with guided bone regeneration (GBR) and implant treatment in grafted bone harvested from the chin (BGR). All implants were installed via flap surgery. Patients were clinically and radiographically examined. Complications were registered and the aesthetic outcome (Pink Esthetic Score (PES), White Esthetic Score (WES)) was rated. A blinded clinician who had not been involved in the treatment performed all evaluations. Patient{\textquoteright}s aesthetic satisfaction was also registered.
Results: One hundred and four out of 115 eligible patients (44 SIT, 28 IIT, 18 GBR, 14 BGR) received at least 1 single NobelReplace tapered TiUnite{\textregistered} (Nobel Biocare, G{\"o}teborg, Sweden) implant in the anterior maxilla and were available for evaluation. Clinical parameters (implant survival: 93\%, mean plaque level: 24 \%, mean bleeding on probing: 33 \%, mean probing depth: 3.2 mm) and mean bone level (1.19 mm) did not differ significantly between treatment modalities. Postoperative complications were more common following GBR/BGR ({\textrangle} 61 \%) when compared to SIT/IIT ({\textlangle} 18 \%) (p {\textlangle} 0.001). BGR was in 4/14 patients associated with permanent sensory complications at the donor site. Technical complications occurred in 9/104 patients. SIT and IIT showed similar soft tissue aesthetics (PES: 10.07 and 10.88, respectively), however major alveolar process deficiency was common ({\textrangle} 15 \%). PES was 9.65 for GBR. BGR showed inferior soft tissue aesthetics (PES: 9.00; p = 0.045) and shorter distal papillae were found following GBR/BGR (p = 0.009). Periodontal disease (OR: 13.0, p {\textlangle} 0.001), GBR/BGR (OR: 4.3, p = 0.004) and a thin-scalloped gingival biotype (OR: 3.7, p = 0.011) increased the risk for incomplete distal papillae. WES was 7.98, all patients considered. Poor agreement was found between objective and subjective aesthetic ratings.
Conclusions: All treatment modalities were predictable from a clinical and radiographic point of view. However, advanced reconstructive surgery, especially BGR, increased the risk for complications and compromised aesthetics. Research is required on the prevention and minimally-invasive treatment of buccal bone defects at the time of tooth loss to avoid complex therapy.},
  author       = {Cosyn, Jan and EGHBALI, ARYAN and Hanselaer, Lore and De Rouck, Tim and Wyn, Iris and Sabzevar, Mehran Moradi and Cleymaet, Roberto and De Bruyn, Hugo},
  issn         = {1523-0899},
  journal      = {CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH},
  keyword      = {bone augmentation,single-tooth,guided bone regeneration,Dental implants,pink esthetic score,immediate,4-YEAR FOLLOW-UP,TOOTH EXTRACTION,SOFT-TISSUE,PERI-IMPLANTITIS,SPONTANEOUS PROGRESSION,BONE,PLACEMENT,IMMEDIATE,RESTORATIONS,MORBIDITY},
  language     = {eng},
  number       = {4},
  pages        = {517--530},
  title        = {Four modalities of single implant treatment in the anterior maxilla: a clinical, radiographic, and aesthetic evaluation},
  url          = {http://dx.doi.org/10.1111/j.1708-8208.2011.00417.x},
  volume       = {15},
  year         = {2013},
}

Chicago
Cosyn, Jan, ARYAN EGHBALI, Lore Hanselaer, Tim De Rouck, Iris Wyn, Mehran Moradi Sabzevar, Roberto Cleymaet, and Hugo De Bruyn. 2013. “Four Modalities of Single Implant Treatment in the Anterior Maxilla: a Clinical, Radiographic, and Aesthetic Evaluation.” Clinical Implant Dentistry and Related Research 15 (4): 517–530.
APA
Cosyn, J., EGHBALI, A., Hanselaer, L., De Rouck, T., Wyn, I., Sabzevar, M. M., Cleymaet, R., et al. (2013). Four modalities of single implant treatment in the anterior maxilla: a clinical, radiographic, and aesthetic evaluation. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, 15(4), 517–530.
Vancouver
1.
Cosyn J, EGHBALI A, Hanselaer L, De Rouck T, Wyn I, Sabzevar MM, et al. Four modalities of single implant treatment in the anterior maxilla: a clinical, radiographic, and aesthetic evaluation. CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH. 2013;15(4):517–30.
MLA
Cosyn, Jan, ARYAN EGHBALI, Lore Hanselaer, et al. “Four Modalities of Single Implant Treatment in the Anterior Maxilla: a Clinical, Radiographic, and Aesthetic Evaluation.” CLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH 15.4 (2013): 517–530. Print.