How to treat two adjacent missing teeth with dental implants. A systematic review on single implant‐supported two‐unit cantilever FDP's and results of a 5‐year prospective comparative study in the aesthetic zone

To conduct a systematic review on the clinical outcome of single implant‐supported two‐unit cantilever FDP's and to conduct a 5‐year prospective comparative pilot study of patients with a missing central and lateral upper incisor treated with either a single implant‐supported two‐unit cantilever FDP or two implants with solitary implant crowns in the aesthetic zone. Medline, Embase and the Cochrane Central Register of Controlled Trials were searched (last search 1 August 2016) for eligible studies. In the comparative pilot study, an implant‐cantilever group of five patients with a single implant‐supported two‐unit cantilever FDP (NobelReplace Groovy Regular Platform) was compared with an implant‐implant group of five patients with two adjacent single implant‐supported crowns (NobelReplace Groovy Regular Platform) in the aesthetic zone. Implant survival, marginal bone level (MBL) changes, pocket probing depth, papilla index and patient satisfaction were assessed during a 5‐year follow‐up period. Five of 276 articles were considered eligible for data extraction. Implant survival ranged from 96·6% to 100%. Marginal bone level changes were higher in the anterior region than in the posterior region. Technical complications occurred more often in the posterior than anterior region. In the 5‐year comparative pilot study, no clinically significant differences in hard and soft peri‐implant tissue levels occurred between both groups. Single implant‐supported two‐unit cantilever FDP’s can be a viable alternative to the placement of two adjacent single implant crowns in the aesthetic zone. Due to technical complications, placement of two‐unit cantilever crowns in the posterior region can be considered unwise.     

Early loading of single crowns supported by 6‐mm‐long implants with a moderately rough surface: a prospective 2‐year follow‐up cohort study

Aim: To evaluate prospectively the clinical and radiographic outcomes after 2 years of loading of 6 mm long moderately rough implants supporting single crowns in the posterior regions. Material and methods: Forty SLActive Straumann^® short (6 mm) implants were placed in 35 consecutively treated patients. Nineteen implants, 4.1 mm in diameter, and 21 implants, 4.8 mm in diameter, were installed. Implants were loaded after 6 weeks of healing. Implant survival rate, marginal bone loss and resonance frequency analysis (RFA) were evaluated at different intervals. The clinical crown/implant ratio was also calculated. Results: Two out of 40 implants were lost before loading. Hence, the survival rate before loading was 95%. No further technical or biological complications were encountered during the 2‐year follow‐up. The mean marginal bone loss before loading was 0.34±0.38 mm. After loading, the mean marginal bone loss was 0.23±0.33 and 0.21±0.39 mm at the 1‐ and 2‐year follow‐ups. The RFA values increased between insertion (70.2±9) and the 6‐week evaluation (74.8±6.1). The clinical crown/implant ratio increased with time from 1.5 at the delivery of the prosthesis to 1.8 after 2 years of loading. Conclusion: Short implants (6 mm) with a moderately rough surface loaded early (after 6 weeks) during healing yielded high implant survival rates and moderate loss of bone after 2 years of loading. Longer observation periods are needed to draw more definite conclusions on the reliability of short implants supporting single crowns. To cite this article:
Rossi F, Ricci E, Marchetti C, Lang NP, Botticelli D. Early loading of single crowns supported by 6‐mm‐long implants with a moderately rough surface: a prospective 2‐year follow‐up cohort study.
Clin. Oral Impl. Res. 21 , 2010; 937–943.
doi: 10.1111/j.1600‐0501.2010.01942.x     

A 10‐year retrospective analysis of marginal bone‐level changes around implants in periodontally healthy and periodontally compromised tobacco smokers

Aim: To compare the 10‐year marginal bone loss rates around implants supporting single‐unit crowns in tobacco smokers with and without a history of treated periodontitis. Materials and methods: In this retrospective controlled study, 40 tobacco smokers were divided into four groups of 10 patients each. Two groups of periodontally compromised (PC) patients and two groups of periodontally healthy (PH) patients were established. PC patients had been treated for their periodontal conditions before implant placement. All patients were enrolled in a regular, individually tailored maintenance care program. For the rehabilitation of PC and PH patients, two different types of implants were used (Nobel Biocare AB; Straumann^® Dental Implant System). The radiographic bone loss rate was calculated by subtracting the bone levels at the time of crown delivery from the bone levels at the 10‐year follow‐up. Results: The mean age, mean full‐mouth plaque score and full‐mouth bleeding score and implant location were similar for the four groups. Implant survival rates ranged between 70% and 100%, without statistically significant differences between the four groups (P>0.05). Implants placed in PC patients yielded statistically significantly higher marginal bone loss rates compared with those in PH patients (P<0.05), independent of the implant system used. Conclusion: After 10 years, implants placed in tobacco smokers with a history of treated periodontitis and enrolled in a supportive therapy program yielded lower survival rates and higher marginal bone loss rates compared with those of implants placed in PH smokers. These outcomes were independent of the implant system installed or the healing modality applied. To cite this article:
Aglietta M, Iorio Siciliano V, Rasperini G, Cafiero C, Lang NP, Salvi GE. A 10‐year retrospective analysis of marginal bone‐level changes around implants in periodontally healthy and periodontally compromised tobacco smokers
Clin. Oral Impl. Res. 22 , 2011; 47–53.
doi: 10.1111/j.1600‐0501.2010.01977.x     

Controlled orthodontic extrusion to create gingival papilla: a case report.

Prosthetic dental restorations alone do not produce esthetics. They must be in harmony with the surrounding gingiva, especially the gingival papilla. This case report describes the enhancement of the gingival papilla between an implant replacing the maxillary left central incisor and a provisional crown on the maxillary left lateral incisor. Esthetic harmony was disrupted by the absence of an interproximal papilla. First, provisional crowns on the implant and adjacent tooth were used in an attempt to remodel the interproximal gingival tissue, but the esthetic result was not satisfactory. The second attempt involved orthodontic extrusion of the lateral incisor in an incisal direction. The gingival tissue migrated incisally, thus restoring the deficient papilla and establishing restorative and gingival harmony. Both the implant and the lateral incisor were restored with ceramic crowns.     

A 10‐year retrospective analysis of radiographic bone‐level changes of implants supporting single‐unit crowns in periodontally compromised vs. periodontally healthy patients

Aim: To compare the 10‐year peri‐implant bone loss (BL) rate in periodontally compromised (PCP) and periodontally healthy patients (PHP) around two different implant systems supporting single‐unit crowns. Materials and methods: In this retrospective, controlled study, the mean BL (mBL) rate around dental implants placed in four groups of 20 non‐smokers was evaluated after a follow‐up of 10 years. Two groups of patients treated for periodontitis (PCP) and two groups of PHP were created. For each category (PCP and PHP), two different types of implant had been selected. The mBL was calculated by subtracting the radiographic bone levels at the time of crown cementation from the bone levels at the 10‐year follow‐up. Results: The mean age, mean full‐mouth plaque and full‐mouth bleeding scores and implant location were similar between the four groups. Implant survival rates ranged between 85% and 95%, without statistically significant differences (P>0.05) between groups. For both implant systems, PCP showed statistically significantly higher mBL rates and number of sites with BL≥3 mm compared with PHP (P<0.0001). Conclusions: After 10 years, implants in PCP yielded lower survival rates and higher mean marginal BL rates compared with those of implants placed in PHP. These results were independent of the implant system used or the healing modality applied. To cite this article:
Matarasso S, Rasperini G, Iorio Siciliano V, Salvi GE, Lang NP, Aglietta M. A 10‐year retrospective analysis of radiographic bone‐level changes of implants supporting single‐unit crowns in periodontally compromised vs. periodontally healthy patients.
Clin. Oral Impl. Res. 21 , 2010; 898–903.
doi: 10.1111/j.1600‐0501.2010.01945.x     

Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study

Objectives: The aim of the present study was to evaluate the dimensional changes of peri‐implant tissues obtained by implant placement, bone and soft tissue augmentation, prosthetic reconstruction and 1 year of function using a new, non‐invasive method for volumetric measurements. Materials and Methods: In 16 patients, the missing central or lateral maxillary incisor was reconstructed with an implant‐supported single crown. Impressions were taken before (t1), after implant placement with guided bone regeneration using DBBM and a PTFE membrane (t2), after soft tissue augmentation (t3), immediately after crown placement (t4) and 1 year later (t5). The cast models were optically scanned and digitally superimposed allowing qualitative and quantitative analysis of alterations of the labial peri‐implant tissue contour. In addition, the crown length and papilla height were measured at crown placement (t4) and after 1 year (t5). Results: Fifteen patients were available for recall after 1 year. During therapy, a mean gain in distance in the labial direction of 1.27±0.67 mm was observed after the surgical procedures. One year after crown insertion, a mean loss of 0.04±0.31 mm in the labial direction was recorded. During the same period, the crown length increased by a mean of 0.22±0.57 mm and the papilla height by 0.07±0.61 mm. The degree and pattern of tissue change following crown insertion were highly variable between individuals, irrespective of the amount and quality of previously augmented tissues. Conclusions: The clinical procedures were effective in augmenting peri‐implant tissue volume that remained stable to a high degree within 1 year after crown insertion. Large inter‐individual variations regarding the tissue alterations were observed. To cite this article:
Schneider D, Grunder U, Ender A, Hämmerle CHF, Jung RE. Volume gain and stability of peri‐implant tissue following bone and soft tissue augmentation: 1‐year results from a prospective cohort study
Clin. Oral Impl. Res. 22 , 2011; 28–37.
doi: 10.1111/j.1600‐0501.2010.01987.x     

Factors affecting soft tissue level around anterior maxillary single‐tooth implants

Background: Peri‐implant soft tissue recession is a major esthetic concern for the anterior implants. The aim of this study was to determine the factors that affected the facial marginal mucosal level and papilla level around single‐tooth implants in the anterior maxilla. Methods: Forty single‐tooth implants in the anterior maxilla were studied. Variables possibly associated with the soft tissue level were obtained from clinical measurements, study models, peri‐apical radiographs, and computerized tomograms. Fisher's exact test, analysis of variance, and binary logistic regression analysis were used to determine the influence of each factor on the facial marginal mucosal level and papilla level. Results: The majority of the implants (75%) replaced the upper central incisors. The facial mucosal margin of the implant was 0.5±0.9 mm more apical than that of the contralateral tooth. Half or more of papilla fill was observed in 89% of the samples. More apical level of the facial mucosal margin at the implant sites was significantly influenced by many factors including a thin peri‐implant biotype, a proclined implant fixture angle, more apical level of the facial bone crest, increased distance from the contact point to the bone crest, contact point to the platform, and contact point to implant bone. A thin biotype was the most significant factor in determining the facial marginal mucosal level. Increased distance from the contact point to the bone crest was the only factor significantly associated with less papilla fill. Conclusions: The papilla level around single‐tooth implants in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth. Facial marginal mucosal level, on the other hand, was affected by multiple factors including the peri‐implant biotype, the facial bone crest level, the implant fixture angle, the interproximal bone crest level, the depth of implant platform, and the level of first bone to implant contact. To cite this article:
Nisapakultorn K, Suphanantachat S, Silkosessak O, Rattanamongkolgul S. Factors affecting soft tissue level around anterior maxillary single‐tooth implants.
Clin. Oral Impl. Res. 21 , 2010; 662–670.
doi: 10.1111/j.1600‐0501.2009.01887.x     

Interproximal tissue dimensions in relation to adjacent implants in the anterior maxilla: clinical observations and patient aesthetic evaluation

Objectives: This clinical study aimed to assess (i) interproximal tissue dimensions between adjacent implants in the anterior maxilla, (ii) factors that may influence interimplant papilla dimensions, and (iii) patient aesthetic satisfaction. Material and methods: Fifteen adults, who had two or more adjacent implants (total of 35) in the anterior maxilla, participated in the study. The study design involved data collection from treatment records, clinical and radiographic assessment, and a questionnaire evaluating aesthetic satisfaction. Results: The median vertical dimension of interimplant papillae, i.e., distance from tip of the papilla to the bone crest, was 4.2 mm. Missing papilla height (PH) at interimplant sites was on average 1.8 mm. Median proximal biologic width at interimplant sites was 7 mm. The most coronal bone‐to‐implant contact at implant–implant sites was located on average 4.6 mm apical to the bone crest at comparable neighbouring implant–tooth sites. The tip of the papilla between adjacent implants was placed on average 2 mm more apically compared with implant–tooth sites. The contact point between adjacent implant restorations extended more apically by 1 mm on average compared with implant–tooth sites. Median missing PH was 1 mm when an immediate provisionalization protocol had been followed, whereas in the case of a removable temporary it was 2 mm. Split group analysis showed that for missing PH≤1 mm, the median horizontal distance between implants at shoulder level was 3 mm. Patient satisfaction with the appearance of interimplant papillae was on average 87.5%, despite a Papilla Index of 2 in most cases. Conclusions: The apico‐coronal proximal biologic width position and dimension appear to determine papilla tip location between adjacent implants. There was a significant association between the provisionalization protocol and missing PH, which was also influenced by the horizontal distance between implants. Patient aesthetic satisfaction was high, despite a less than optimal papilla fill.     

影响上颌中切牙单个种植修复体龈乳头高度的因素分析

目的分析影响上颌中切牙单个种植修复体龈乳头高度的因素，探讨促进种植修复美学效果的相关因素。方法选择16例上颌中切牙单个种植修复患者（30个龈乳头），通过分析临床资料、口内照片、X线片和研究模型，得到龈乳头高度及相关因素数据，采用多重线性回归方法进行分析。结果16例患者中切牙种植修复体龈乳头高度为（4．01±1．85）mm，影响龈乳头高度的相关因素按作用由大到小的排列顺序为：种植修复体外冠接触点高度、邻近天然牙邻面牙槽嵴顶高度、邻近天然牙邻面牙槽嵴顶到外冠接触点的垂直距离、种植修复体外冠邻面凸度、种植体基台与邻牙牙根距离、冠根长度比例、种植修复体邻面牙槽嵴顶高度、种植修复体外冠唇面凸度、探诊深度。结论中切牙种植修复体龈乳头高度受多种因素影响。     

Long-term vertical changes of the anterior maxillary teeth adjacent to single implants in young and mature adults. A retrospective study

AIM: To evaluate the effects of the tooth eruption process on the position of teeth adjacent to implant-borne restorations in adult patients compared to patients in their late adolescence. SUBJECT AND METHODS: The sample included 28 patients divided into two groups. A "young adult" group consisting of 14 patients, aged from 15.5 to 21 years, and a "mature adult" group consisting of 14 patients, aged from 40 to 55 years. All patients presented missing anterior teeth, requiring insertion of 40 implant fixtures (16 central incisors, 12 lateral incisors, 12 canines). The implants were of the Straumann Dental Implant System, clinically and radiologically re-evaluated 1 year or more after the surgical procedure (mean interval=4.2 years). Assessment of the eruption of the adjacent teeth was performed using the implant as a stable point of reference: measurements of the different reference points were compared after implant placement and at follow-up examination. RESULTS: In the "young adult" group, all patients showed infra-occlusion of the implant-supported crowns: the vertical step measured on radiographs varied between 0.1 and 1.65 mm. In the "mature adult" group, all patients showed a vertical difference between the teeth adjacent to the implant-supported crown and the implant: the measured step ranged from 0.12 to 1.86 mm. No difference was found in the amount of vertical eruption between male and female patients, nor according to localization of the implant. CONCLUSION: Mature adults can exhibit major vertical steps after anterior restorations with osseointegrated fixtures to the same extent as adolescents or "young adult" individuals with residuous growth potential.     

Evaluation of peri-implant bone levels and soft tissue dimensions around zirconia implants—a three-year follow-up study

The aim of this study was to measure bone levels around zirconia implants during follow-up of up to 3 years. Additionally, the effect of clinical contact point positions on the papilla deficit was evaluated. Eighty-one patients with 105 zirconia implants were examined at the 3-year follow-up. Bone levels were measured on the date of implant placement and at 3 months, 1 year, and 3 years thereafter. Distances between the first bone–implant contact and the contact point of the crowns and between the bone level at the adjacent tooth and the contact point of the crowns were assessed. The effect of the clinical contact point position on the papilla deficit was also assessed. Significant reductions in the distances between the bone–implant contact and the implant shoulder, as well as the contact point of the crowns, and between the bone level at the adjacent tooth and the contact point of the crowns, were found. A significant association was found between the papilla deficit and the height of the contact point. Implant survival was 100% and implant success was 95.4%. While zirconia implants presented little bone loss up to 1 year, significant bone apposition was observed up to 3 years. Low contact points correlated with full papillae, whereas high contact points were associated with a papilla deficit.     

Congenitally missing maxillary lateral incisors and orthodontic treatment considerations for the single-tooth implant

Implant restorations have become a primary treatment option for the replacement of congenitally missing lateral incisors. The central incisor and canine often erupt in less than optimal positions adjacent to the edentulous lateral incisor space, and therefore preprosthetic orthodontic treatment is frequently required. Derotation of the central incisor and canine, space closure and correction of root proximities may be required to create appropriate space in which to place the implant and achieve an esthetic restoration. This paper discusses aspects of preprosthetic orthodontic diagnosis and treatment that need to be considered with implant restorations.     

Mandibular single‐implant overdentures: preliminary results of a randomised‐control trial on early loading with different implant diameters and attachment systems

Objectives: To determine surgical and prosthodontic outcomes of mandibular single‐implant overdentures, opposing complete maxillary dentures, using a wide diameter implant and large ball attachment system compared with different regular diameter implants with standard attachment systems. Materials and methods: Thirty‐six edentulous participants (mean age 68 years, SD 9.2) were randomly assigned into three treatment groups (n=12). A single implant was placed in the mandibular midline of participants to support an overdenture using a 6‐week loading protocol. The control group received Southern regular implants and standard ball attachments. One group received Southern 8‐mm‐wide implants and large ball attachments. Another group received Neoss regular implants and Locator attachments. Parametric and non‐parametric tests of a statistical software package (SPSS) were used to determine between groups differences in marginal bone loss, implant stability, implant, and prosthodontic success (P<0.05). Results: Implant success after 1 year was 75% for Southern regular implant (control) group; and 100% for the Southern wide and Neoss regular implant groups (P=0.038). Mean marginal bone loss at 1 year was 0.19 mm (SD 0.39) without significant differences observed. Implant stability quotient (ISQ) at baseline was significantly lower for the Southern regular (control) group than the other two groups (P=0.001; P=0.009). At 1 year, no significant difference in implant stability was observed (mean ISQ 74.6, SD 6.1). The change in implant stability from baseline to 1 year was significant for the control group (P=0.025). Prosthodontic success was comparable between the groups but the maintenance (41 events overall, mean 1.2) was greater for the Locator and the standard ball attachments. Conclusions: Mandibular single‐implant overdentures are a successful treatment option for older edentulous adults with early loading protocol using implants of different diameters and with different attachment systems. To cite this article:
Alsabeeha NHM, Payne AGT, De Silva RK, Thomson WM. Mandibular single‐implant overdentures: preliminary results of a randomised‐control trial on early loading with different implant diameters and attachment systems.
Clin. Oral Impl. Res. 22 , 2011; 330–337.
doi: 10.1111/j.1600‐0501.2010.02004.x     

A 4-year prospective clinical and radiological study of maxillary dental implants supporting single-tooth crowns using early and delayed loading protocols

Background: Recent studies have showed that immediate/early loading of dental implants is a clinically feasible concept with results similar to those for standard two‐stage procedures, especially in the mandible. However, there are only a few studies regarding the immediate/early loading of maxillary implants supporting single‐tooth crowns. Purpose: The aim of this study was to compare the clinical and radiological outcomes of early‐ and delayed‐loaded dental implants supporting single‐tooth crowns in the maxilla. Materials and Methods: Twenty‐nine patients were consecutively treated between 2000 and 2002 with 59 Brånemark System MK III TiUnite implants (Nobel Biocare AB, Göteborg, Sweden) in the maxilla. Two groups were formed according to the loading protocols. In the test group, definitive implant‐supported single crowns were delivered to 19 patients 6 weeks after the implant placement. In the control group, definitive implant‐supported single crowns were delivered to 10 patients 6 months after the implant placement. Clinical and radiographic parameters were recorded at baseline, 1 to 4 years. Implant stability measurements have only been performed at 4‐year follow‐up recall. Results: Overall, three implants were lost during the study period. Two implants were lost in the test group including 36 implants, which indicated a survival rate of 94.4%. One of the lost implants was replaced and then osseointegrated successfully. One implant was lost in the control group during the healing period, which indicated a survival rate of 95.7%. The average marginal bone loss was 1.11 mm for 56 implants after 4 years. There were no significant differences in marginal bone levels, insertion torque, and resonance frequency values between the two groups. Conclusion: The results of this study indicate that 6 weeks of early loading period for TiUnite‐surface titanium implants in the maxilla is reliable and predictable for this patient population and may offer an alternative to the standard loading protocol.     

Esthetic outcomes with porcelain-fused-to-ceramic and all-ceramic single-implant crowns: a randomized clinical trial

Objectives: The aim of this randomized‐controlled clinical trial was to compare the objective and subjective esthetic outcomes of two types of screwed‐retained single‐implant crowns. Materials and methods: Participants were randomly assigned to the test (all‐ceramic) and control [porcelain‐fused‐to‐ceramic (PFM)] groups and were seen under investigation at baseline (B), crown insertion (CI), 1‐year follow‐up (1Y), and 2‐year follow‐up (2Y). Objective parameters were assessed by an intra‐oral digital photograph (1 : 1 ratio), a study cast, a standardized radiograph, periodontal/peri‐implant measurements, and questionnaires were obtained for the subjective parameters. In addition, pink esthetic score (PES) and white esthetic score (WES) were calculated for both groups. For the subjective evaluation, a visual analogue scale (VAS) questionnaire was used to assess the level of patient satisfaction regarding the esthetic outcome. Then, nine expert clinicians visually inspected and assessed subjective evaluation at the professional level. Statistical analysis was used to compare between groups and investigational appointments. Results: Twenty patients were included in the study, 10 allocated to the all‐ceramic group and 10 to the PFM group. No statistically significant differences were observed for the objective measurements comparing the test and control groups. Minor chipping of the ceramic veneering material was observed in the two patients of control group. The mean difference for all groups comparing objective parameters revealed an increase of papilla height between time points. A slight recession (0.26 mm) of the peri‐implant mucosal margin at the implant site was observed between 1Y and 2Y. Mean values for PES and WES were 13.9 and 13.1 for the PFM group and for the all‐ceramic group, respectively. These values were not statistically significant. Implant crown volume, outline, translucency, and characterization showed major discrepancies with the contra‐lateral natural teeth. As for subjective parameters, VAS patients' responses regarding their perceptions of the esthetic outcome showed no statistical differences betwen groups and clinicians' accuracy scores were 50% and 47% for PFM and all‐ceramic crowns, respectively. Conclusion: PFM and all‐ceramic single‐implant restorations may be indistinguishable from each other regarding the objective/subjective assessment of esthetic integration. The material chosen for fabricating an implant crown per se does not ensure an optimal esthetic outcome if other esthetic parameters are not present. To cite this article:
Gallucci GO, Grütter L, Nedir R, Bischof M, Belser UC. Esthetic outcomes with porcelain‐fused‐to‐ceramic and all‐ceramic single‐implant crowns: a randomized clinical trial.
Clin. Oral Impl. Res. 22 , 2011; 62–69.
doi: 10.1111/j.1600‐0501.2010.01997.x     

Aesthetics of implant-supported single anterior maxillary crowns evaluated by objective indices and participants' perceptions

Aim: The objective of this study was to evaluate the aesthetics of implant‐supported single crowns in the anterior maxilla using objective indices and patients' perception. Methods: Fifty participants, former patients (mean age 31.3 years) at the Dental Hospital, University of Bergen, or at Haukeland University Hospital in Bergen, Norway, who had implant‐supported single crowns replacing upper anterior teeth lost due to trauma or agenesis during 2006, were included. One year after placement of the crown, an evaluation was carried out using the Pink Aesthetic Score (PES), the Implant Crown Aesthetics Index (ICAI), a modified version of the ICAI (mod‐ICAI), and the index of the Californian Dental Association (CDA). The participants rated their satisfaction with the crowns and adjacent soft tissue. Results: The form of the crown was satisfactory for 88% and the colour for 84% of participants, while 72% were satisfied with the adjacent mucosa. A statistically significant bivariate correlation was found between the PES and the ICAI and mod‐ICAI. A weaker association was found between the CDA and the ICAI, mod‐ICAI and PES. A positive correlation was found between the mod‐ICAI index and satisfaction with the form and colour of the crowns and with the sum of ratings of responses to the questions about the form and colour of the crowns and the form and colour of the adjacent mucosa (P<0.05). Although most participants were satisfied, objective evaluation showed that a good aesthetic outcome for single implants was related to the quantity of the peri‐implant mucosa. Conclusion: The mod‐ICAI index correlated with responses to questions about the form and colour of the mucosa. Other significant correlations were found between the participants' aesthetic perceptions and the ICAI and the mod‐ICAI. The mod‐ICAI combined best objective and subjective assessment of aesthetics related to implant‐supported crowns. To cite this article:
Vilhjálmsson VH, Klock KS, Størksen K, Bårdsen A. Aesthetics of implant‐supported single anterior maxillary crowns evaluated by objective indices and participants' perceptions.
Clin. Oral Impl. Res. xx , 2011; 000–000.
doi: 10.1111/j.1600‐0501.2010.02128.x     

Immediately restored one-piece single-tooth implants with reduced diameter: one-year results of a multi-center study

Objectives: The aim of the present multi‐center study was to evaluate the treatment outcome of immediately restored one‐piece single‐tooth implants with a diameter of 3 mm after 1 year. Material and methods: A total of 57 one‐piece implants (NobelDirect^® 3.0) were inserted in 47 patients (26 females, 21 males) with a mean age of 31 years (range: 17–76 years) at five different centers. The implants replaced maxillary lateral incisors and mandibular incisors. The implants were placed either in conjunction with tooth extraction or in healed sites, and all implants were immediately restored with a provisional resin crown. If needed, the abutment part of the implant was prepared before crown cementation. The permanent crown was placed after 1.9–14.5 months. Radiographs were taken at implant insertion as well as after 6 and 12 months to evaluate the peri‐implant marginal bone level and bone loss. Moreover, plaque, bleeding on probing and complications were assessed. Results: A total of 44 patients (23 females, 21 males) with 54 implants were available for the 1‐year follow‐up. One implant was lost, thus the 1‐year implant survival was 98%. A statistically significant mean marginal bone loss was observed between baseline and 6 months (1.1 mm, range: ?0.7 to 4.4 mm; n=49) and between baseline and 12 months (1.6 mm, range: ?0.8 to 4.6 mm; n=50). A total of 18% of the implants were characterized by a bone loss of more than 3 mm. No bleeding on probing was observed around 83% of the implants. Plaque was registered at 15% of the implants. The most common complications were related to the provisional crown, i.e. fracture (n=3) and loss of retention (n=3). Conclusions: A high 1‐year implant survival was observed in the present study. However, the excessive peri‐implant marginal bone loss around several implants indicates that this implant should be used with caution until further studies have been conducted. To cite this article:
Zembi? A, Johannesen LH, Schou S, Malo P, Reichert T, Farella M, Hämmerle CHF. Immediately restored one‐piece single‐tooth implants with reduced diameter: one‐year results of a multi‐center study.
Clin. Oral Impl. Res. 23 , 2012; 49–54.
doi: 10.1111/j.1600‐0501.2011.02174.x     

Immediate maxillary lateral incisor implants with nonocclusal loading provisional crowns.

This clinical report series describes a treatment modality involving immediately placed dental implants in maxillary lateral incisor sites using noncemented immediate provisional crowns retained with calcinable copings (prosthetic complement used in preparing the metal for the definitive prosthesis). Ten implants were placed in eight patients for the replacement of maxillary lateral incisors: two immediate and eight corresponding to cases of agenesis. All were subjected to immediate rehabilitation with provisional acrylic resin crowns in nonocclusal loading. One implant failed 3 weeks after placement due to acute local trauma. The other nine remained functional within the mouth, with normal clinical and radiological characteristics after a minimum of 12-month follow-up. Immediate placement of implant fixed provisional restorations retained by friction in maxillary lateral incisors offers an esthetic solution, eliminates the need for a removable provisional restoration, and avoids implant failures associated with excess cement or screw loosening. Moreover, in the case of extractions, immediate placement and provisionalization of implants in maxillary lateral incisors can effectively optimize the peri-implant esthetic results by maintaining the existing hard and soft tissue architecture of the replaced tooth. As no cement or screws are required, and the provisional crowns are placed in nonocclusal loading, the risk of complications is minimized.     

The effect of different implant neck configurations on soft and hard tissue healing: a randomized-controlled clinical trial

Objective: To compare the soft and hard tissue healing and remodeling around tissue‐level implants with different neck configurations after at least 1 year of functional loading. Material and methods: Eighteen patients with multiple missing teeth in the posterior area received two implants inserted in the same sextant. One test (T) implant with a 1.8 mm turned neck and one control (C) implant with a 2.8 mm turned neck were randomly assigned. All implants were placed transmucosally to the same sink depth of approximately 1.8 mm. Peri‐apical radiographs were obtained using the paralleling technique and digitized. Two investigators blinded to the implant type‐evaluated soft and hard tissue conditions at baseline, 6 months and 1 year after loading. Results: The mean crestal bone levels and soft tissue parameters were not significantly different between T and C implants at all time points. However, T implants displayed significantly less crestal bone loss than C implants after 1 year. Moreover, a frequency analysis revealed a higher percentage (50%) of T implants with crestal bone levels 1–2 mm below the implant shoulder compared with C implants (5.6%) 1 year after loading. Conclusion: Implants with a reduced height turned neck of 1.8 mm may, indeed, lower the crestal bone resorption and hence, may maintain higher crestal bone levels than do implants with a 2.8 mm turned neck, when sunk to the same depth. Moreover, several factors other than the vertical positioning of the moderately rough SLA surface may influence crestal bone levels after 1 year of function. To cite this article:
Tan WC, Lang NP, Schmidlin K, Zwahlen M, Pjetursson BE. The effect of different implant neck configurations on soft and hard tissue healing: a randomized‐controlled clinical trial.
Clin. Oral Impl. Res. 22 , 2011; 14–19.
doi: 10.1111/j.1600‐0501.2010.01982.x     

Immediately restored, single-tapered implants in the anterior maxilla: prosthodontic and aesthetic outcomes after 1 year

Background: Conventional implant protocols advocate a two-stage technique with a load-free, submerged healing period. Recent studies suggest that immediate restoration of single implants may be a viable treatment option. Purpose: The purpose of this study was to evaluate prosthodontic and aesthetic peri-implant mucosal outcomes of immediately restored, Southern single-tapered implants in the anterior maxilla after 1 year. Materials and Methods: Participants (mean age: 43.25 years; range: 23–71 years) satisfying specified inclusion criteria were randomly allocated to conventional two-stage restoration (control group; n=14) and immediate restoration groups (test group; n =14) in a randomized controlled clinical trial. Tapered, roughened-surface Southern implants were placed using a standardized technique, and implant level bone impressions were made. Provisional screw-retained crowns, out of occlusion, were placed at second-stage surgery after 26 weeks for the conventional restoration group, and within 4 hours of implant placement for the immediate restoration group. Both groups had definitive screw-retained metal-ceramic crowns placed in occlusion 8 weeks later. Peri-implant mucosal response and papilla index were recorded 4 weeks after definitive crown placement to allow for mucosal maturation and at 1 year. Prosthodontic and aesthetic outcomes were assessed using established criteria. Results: There were no significant differences within, or between, the control and test groups for age, gender, bone quality or quantity, implant stability measurements at surgery, or implant length. There were no significant differences in the implant success rate as determined by radiographic bone loss and stability tests after 1 year. There were no significant differences in prosthodontic maintenance, peri-implant mucosal response, and papilla index between the two groups over 1 year. Conclusions: Tapered, roughened-surface implants immediately restored with single provisional crowns at surgery and definitive crowns 8 weeks later were as prosthodontically and aesthetically successful as conventionally restored two-stage implants during the first year of service. Restoring single implants immediately with screw-retained crowns is an efficient procedure, but the short-term outcome is by no means superior to a conventional two-stage approach.