Single Implant Treatment in Healing Versus Healed Sites of the Anterior Maxilla: An Aesthetic Evaluation

Purpose: The aim was to compare and document in detail the aesthetic outcome of single implant treatment in healing sites (early implant placement) with fully healed sites (conventional implant placement) of the anterior maxilla. Materials and Methods: A cross-sectional study in patients who had been treated by two periodontists and two prosthodontists in 2006 and 2007 was conducted. Surgical treatment involved standard flap elevation without releasing incisions and restorative procedures included cemented crowns in all patients. Only straightforward single implant treatments using Nobelreplace tapered TiUnite (R) implants (Nobel Biocare, Goteborg, Sweden) in healing sites (68 weeks following tooth extraction) and fully healed sites (=6 months following tooth extraction) were considered with both neighboring teeth present and without the need for hard and/or soft tissue grafting. The aesthetic outcome was objectively rated using the pink esthetic score (PES) and white esthetic scrore (WES) by a blinded clinician who had not been involved in the treatment. Patients rated aesthetics by means of visual analogue scales. Results: Twenty-one out of 22 early and 25/27 conventional implant treatments were available for aesthetic evaluation after on average two and a half years of function (range 1741 months). There were no significant differences for any of the criteria between the treatment concepts. Overall, papillae were most easy to satisfy, whereas alveolar process and tooth color most difficult. A thin-scalloped biotype was associated with low distal papillae (p = .041) and alveolar process deficiency (p = .039). Twenty-six percent of the cases were aesthetic failures (PES < 8 and/or WES < 6) and 13% showed an (almost) perfect outcome (PES = 12 and WES = 9). The remainder (61%) demonstrated acceptable aesthetics. There was no significant correlation between objective and subjective ratings. Conclusions: Early and conventional single implant treatment yielded comparable aesthetic outcome. Albeit all treatments had been performed by experienced clinicians and only straightforward cases had been selected, 1 out of 4 cases were aesthetic failures and only a strict minority showed perfection. Research is required on the aesthetic outcome of alternative surgical procedures especially in high-risk patients with a thin-scalloped biotype.