Esthetic evaluation and patient-centered outcomes in single-tooth implant rehabilitation in the esthetic area

The effect of a convergent transmucosal neck on soft tissues and radiographic outcomes: a 1-year follow-up randomized controlled trial

PURPOSE

The aim of this randomized controlled clinical trial was to evaluate peri-implant marginal bone levels (MBLs) and soft tissue dimension changes 1 year after loading. Patients in the control group received bone-level implants, whereas in the test group, tissue-level implants with a convergent transmucosal neck were used.

MATERIAL AND METHODS

MBLs were calculated by measuring the distance from the implant shoulder to the first visible bone-to-implant contact using standardized periapical digital radiographs. Baseline (day of loading) and follow-up digital models obtained with an intraoral scanner were used to quantify the changes in the peri-implant soft tissue dimensions with a best-fit algorithm.

RESULTS

The difference between final and baseline MBLs showed a mean bone loss of 0.16 ± 0.01 mm in the test group (n = 15) and 0.45 ± 0.09 mm in the control group (n = 14) (p > 0.05). Soft tissue contour at the level of the gingival margin (GM) increased by 1.96 ± 2.69 mm in the test group and 0.65 ± 0.42 mm in the control group (p = 0.167). Both groups showed a coronal displacement of the gingival margin with no significant differences among them.

CONCLUSIONS

The present study demonstrated peri-implant hard and soft tissues stability at both implant designs with no significant differences 12 months after loading.

CLINICAL RELEVANCE

There is still insufficient scientific evidence to demonstrate the role and advantages of the convergent transmucosal neck on the behavior of the peri-implant soft and hard tissues stability compared to a straight neck in bone-level implants 12 months after loading.

The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance

BACKGROUND

Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting.

PURPOSE

To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance.

MATERIAL AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC.

RESULTS

A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC.

CONCLUSIONS

Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.

Soft tissue features of peri‐implant diseases and related treatment

BACKGROUND

The need for soft tissue grafting at implant sites for preventing and treating peri-implant diseases is a currently investigated and debated topic.

PURPOSE

The aim of this manuscript is to explore the inflammatory mechanisms at the peri-implant soft tissue compartment, to distinguish the structural components of the peri-implant soft tissue phenotype and their role on peri-implant health, and to appraise the clinical indications and expected outcomes of soft tissue augmentation procedures at peri-implant diseased sites.

MATERIALS AND METHODS

This narrative review depicts the inflammatory biomarkers and mediators in the peri-implant crevicular fluid utilized to diagnose peri-implant disease and that have been shown to be associated with peri-implant soft tissue phenotype modification and disease resolution. The impact of the peri-implant soft tissue phenotype, involving keratinized mucosa (KM) width, attached mucosa (AM), mucosal thickness (MT), and supracrestal tissue height (STH), on peri-implant health, esthetic, patient's comfort and disease prevention are discussed. The manuscript also illustrates the use of ultrasonography for the detection of peri-implant health/disease and the evaluation of the treatment outcomes following surgical therapies.

RESULTS

Current evidence indicates that soft tissue phenotype modification at implant sites with inadequate KM width, AM and MT can be beneficial for promoting peri-implant health and improving patient's comfort and hygiene procedures. Treatment approaches and outcomes from the available literature on soft tissue phenotype modification in combination with conventional techniques at sites with peri-implant mucositis or peri-implantitis are presented and discussed in detail.

CONCLUSIONS

Soft tissue grafting can be beneficial in preventing and treating peri-implant diseases. Clinical recommendations based on the disease, soft tissue phenotype characteristics and bone defect morphology are provided for a comprehensive hard- and soft-tissue-oriented treatment of peri-implant disease.

The influence of thin as compared to thick peri-implant soft tissues on aesthetic outcomes: A systematic review and meta-analysis

Objectives

In systematically healthy patients with an implant‐supported fixed restoration (P), what is the influence of thin (E) as compared to thick (C) peri‐implant soft tissues on aesthetic outcomes (O)?

Methods

Following an a priori protocol, a literature search of six databases was conducted up to August 2020 to identify prospective/retrospective clinical studies on healthy patients with an implant‐supported fixed reconstruction. Measurement of the buccal soft tissue thickness and an aesthetic outcome was a prerequisite, and sites presenting with a buccal soft tissue thickness of <2 mm or shimmering of a periodontal probe were categorized as a thin phenotype. After study selection, data extraction, and risk of bias assessment, random‐effects meta‐analysis of Mean Differences (MD) or Odds Ratios (OR) with their corresponding 95% Confidence Intervals (CI) were conducted, followed by sensitivity analyses and assessment of the quality of evidence.

Results

Thirty‐four unique studies reporting on 1508 patients with 1606 sites were included (9 randomized controlled trials, one controlled trial, 10 prospective cohort studies, 8 cross‐sectional studies, and 6 retrospective cohort studies). The mean difference of the pink aesthetic score (PES) after the follow‐up was not significantly different between thin (<2.0 mm) or thick soft tissues (≥2.0 mm) or phenotypes (12 studies; MD = 0.15; [95% CI = −0.24, 0.53]; p = .46). PES changes during the follow‐up, however, were significantly in favour of thick soft tissues (≥2.0 mm) or phenotypes (p = .05). An increased mean mucosal thickness was associated with an increased papilla index (5 studies; MD = 0.5; [95% CI = 0.1, 0.3]; p = .002) and an increase in papilla presence (5 studies; OR = 1.6; [95% CI = 1.0, 2.3]; p = .03). Thin soft tissues were associated with more recession, −0.62 mm (4 studies; [95% CI = −1.06, −0.18]; p = .006). Patient‐reported outcome measures (patient satisfaction) were in favour of thick soft tissues −2.33 (6 studies; [95% CI = −4.70, 0.04]; p = .05). However, the quality of evidence was very low in all instances due to the inclusion of non‐randomized studies, high risk of bias and residual confounding.

Conclusion

Within the limitations of the present study (weak study designs and various soft tissue measurements or time‐points), it can be concluded that increased soft tissue thickness at implant sites was associated with more favourable aesthetic outcomes.

Assessment of the Socioeconomic Status and Analysis of the Factors Motivating Patients to Apply for Prosthetic Treatment by Students of Dentistry at the Poznań University of Medical Sciences

This study aimed to determine the motives for undertaking prosthetic treatment at the Prosthetics Clinic of the Poznan University of Medical Sciences (PUMS), pursued by fifth- and sixth-year medicine and dentistry students. The survey consisted of 18 questions, of which 1 to 11 concerned general patient data, while questions 12 to 18 concerned prosthetic treatment. The only open question in the questionnaire was one regarding the motives for the decision to receive treatment. The study group consisted of 153 patients (102 women—66.67% and 51 men—33.33%) of the Prosthetic Clinic. After collecting a total of 200 questionnaires, rejecting 47 (23.50%) due to the lack of answers to all questions (other than question 18), a total of 153 completed (76.50%) questionnaires were obtained. The main motivating factors for patients to undertake prosthetic treatment are functional and aesthetic considerations. In addition, it turned out, that the authority of the university unit is of greater importance than financial issues. Additionally, some patients undergo treatment by students because they can see positive aspects in it, both for them and for students. Hence, the evaluation of the treatment provided by students, as well as their communication skills and their attitude, are rated very highly, although, again, the evaluation was influenced by the education level.

Comparison of Classifications and Indexes for Extraction Socket and Implant Supported Restoration in the Aesthetic Zone: a Systematic Review

OBJECTIVES

The primary objective of the present systematic review is to test the hypothesis - the revision of the complexity of the extraction sockets morphology classifications will reveal the most important parameters for implant aesthetic and functional success in case of immediate dental implant placement in aesthetic zone. The secondary objective is to revise the most important parameters of aesthetic indexes created for implant-supported restoration in aesthetic zone.

MATERIAL AND METHODS

MEDLINE (PubMed) and Cochrane Library search in combination with hand-search of relevant journals was conducted including human studies published in English between 1 January 2005 and 1 February 2022. After evaluation of the titles and abstracts in accordance with the PRISMA guidelines, risk-of-bias assessment was evaluated and data was extracted from the full papers.

RESULTS

Electronic and hand searching resulted in 477 entries. Five systematic reviews, research syntheses and 7 prospective studies met the inclusion criteria and were included in the final data synthesis. Selected articles reported the different classifications complexity of the extraction sockets morphology and aesthetic indexes for implant supported restoration in aesthetic zone.

CONCLUSIONS

The most important parameters for implant aesthetics and functional success, incorporated in classifications of extraction sockets are facial soft tissue level and quality, gingival biotype, keratinized gingival, mesial and distal papillae appearance, buccal bone level and thickness, labial and buccal bone plates damage and bone lesions. The most important aesthetic indexes parameters are soft tissue contour position, including colour and texture, interdental papilla, mesial and distal interproximal bone height, gingival biotype.

Patient-reported outcome measures following soft-tissue grafting at implant sites: A systematic review

OBJECTIVES

To review the available literature on patient-reported outcome measures (PROMs) following soft tissue augmentation at implant sites.

MATERIALS AND METHODS

A comprehensive electronic and manual search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported PROMs, including post-operative morbidity, painkillers intake, quality of life, aesthetics and satisfactions.

RESULTS

Nineteen articles were included in the qualitative analysis. Autogenous grafts (free gingival graft and connective tissue graft), acellular dermal matrix and xenogeneic collagen matrix were utilized, either with a bilaminar- or an apically positioned flap approach. PROMs reported in the literature included perceived hardship of the procedure and pain during the surgery, post-operative morbidity, painkillers intake, number of days with discomfort, satisfaction, aesthetic evaluation, quality of life and willingness to undergo the treatment again. Most of the included studies showed similar PROMs between autogenous grafts and substitutes, in terms of post-operative morbidity, painkillers intake, quality of life, aesthetic assessment and satisfaction. Nevertheless, a trend towards lower post-operative discomfort was observed for graft substitutes. High scores for patient satisfaction and aesthetic evaluation were observed in all the interventions compared to non-grafted sites.

CONCLUSIONS

PROMs represent a crucial endpoint of clinical studies evaluating the outcomes of soft tissue grafts at implant sites. Most of the studies did not find significant differences in terms of patient morbidity and painkillers between autogenous grafts and substitutes. Soft tissue grafting can enhance patient satisfaction and aesthetic evaluation compared to non-grafted sites.

Is the timing of implant placement and loading influencing esthetic outcomes in single-tooth implants?-A systematic review

OBJECTIVES

To address the following question: "Is the timing of implant placement and/or loading influencing the esthetic outcomes of implant-supported single crowns?"

MATERIAL AND METHODS

A literature screening was performed in four electronic databases until June 2020. Randomized controlled clinical trials with a minimum of 10 patients and 1 year of follow-up and reporting on dimensional changes of the peri-implant mucosa (midfacial recession, papilla level) and esthetic indexes were included. Cochrane Risk of Bias Tool was used, and comparable trials were subjected to meta-analyses.

RESULTS

Out of 8549 articles, 72 full-text articles were assessed for eligibility and 18 were included. Nine trials evaluated the timing of implant placement, and nine trials evaluated the timing of loading. The included trials comparing immediate implant placement to delayed implant placement evaluating the midfacial recession reported heterogeneous findings. No differences were found at 1 and 2-years, when comparing midfacial recession and papilla level between immediate and early implant placement. In immediate and delayed implant placement, when comparing conventional and immediate loading, the midfacial mucosal margin change was not statistically significant at the 1-year follow-up. When evaluating the timing of implant placement and/or loading the included trials found no differences in the Pink Esthetic score, White Esthetic score, and Papilla Index between groups.

CONCLUSIONS

Both immediate and early implant placement protocols presented stable treatment results in terms of esthetic outcomes at the 1-, 2-, and 10-years follow-up. Loading protocols did not seem to influence esthetic outcomes in short- and medium-term follow-ups.

Esthetic outcome for implant therapy of a maxillary lateral incisor using prefabricated titanium and customized zirconia abutments: 4-year clinical reports

The reported clinical scenarios presented two patients, one managed with a prefabricated abutment and the other with a customized abutment, and both patients were pleased with the outcome. However, from a professional viewpoint, the esthetic outcome using the custom zirconia abutment was superior to that using the prefabricated titanium abutment.

Use of ceramic veneers for improving esthetics and extending the service life of an existing cement-retained implant-supported ceramic restoration: A clinical report with a 3-year follow-up

This clinical report describes an approach for improving the esthetics and extending the service life of a cement-retained implant-supported ceramic single crown by using a ceramic veneer bonded to the conservatively prepared facial surface. The restoration satisfied the patient without removing and replacing the unesthetic implant-supported ceramic crown.

Aesthetic Parameters and Patient-Perspective Assessment Tools for Maxillary Anterior Single Implants

Background

This review aimed to concisely describe the current aesthetic objective indices for a single-implant maxillary anterior crown. The secondary aim was to propose introducing a unified, standardized questionnaire for adequately collecting patient-reported outcome measures (PROMs) in implant dentistry.

Materials and Methods

A literature review was conducted using both EMBASE/Ovid and MEDLINE/PubMed databases by combining keywords and Emtree/Mesh terms related to “Esthetics,” “Self-Assessment or Surveys and Questionnaires,” and “Single-Tooth Dental Implants.”

Results

The most meaningful aesthetic objective indices for single implants in the literature are the Pink Esthetic Score (PES), the Papilla Presence Index (PPI), Peri‐Implant and Crown Index (PICI), PES/White Esthetic Score (PES/WES), the Implant Crown Aesthetic Index (ICAI), and a modified version of the ICAI (mod-ICAI) index. Clearly, PES/WES is still the most widely accepted tool. It is encouraging to observe that there is an increasing tendency in recent years to report PROMs more frequently in the implant dentistry literature. We proposed the implementation of a unified, standardized questionnaire using a self-administered visual analogue scale (VAS) scoring system, which evaluates overall satisfaction, comfort, tooth appearance, gingival appearance, function, and hygiene complexity. This tool should be validated in the oral implantology research context for its regular implementation or further development.

Conclusions

Conducting qualitative studies among dental implant patients who received few implants or single-tooth implant reconstructions in the aesthetic zone may help dental researchers understand better how to efficiently develop and validate a quantitative instrument. This standard tool would reduce heterogeneity bias by providing comparable data between studies.

Implant soft tissue Dehiscence coverage Esthetic Score (IDES): A pilot within- and between-rater analysis of consistency in objective and subjective scores

OBJECTIVES

To introduce an esthetic index for assessing the outcomes of peri-implant soft tissue dehiscence/deficiency (PSTD) coverage and test its within- and between-reviewer reliability.

MATERIALS AND METHODS

Photographs of 51 single PSTDs at baseline and after treatment were provided to four periodontists from three centers. The examiners were asked to rate each case at two timepoints with the Implant soft tissue Dehiscence/deficiency coverage Esthetic Score (IDES) that involved the evaluation of the post-treatment level of the soft tissue margin, peri-implant papillae height, mucosa color, and mucosa appearance (summing up to a total score of 10). Variance components analysis was conducted using multilevel regression fit in a Bayesian framework for obtaining uncertainty intervals for fractional variance contributions and intraclass correlation values (ICC) of the IDES, and for each of its four clinical variables.

RESULTS

Regression models showed reproducible esthetic evaluation among the examiners (inter-reliability) and negligible intra-reviewer variability (assessment of the same case at different timepoints). The ICC for the variability in the assessment of the overall IDES was 0.86, and for the individual components ranged from 0.78 to 0.87. Additionally, there was a strong similarity between the raters' IDES values, and their subjective esthetic response, by the same raters.

CONCLUSION

The IDES showed persistent judgment among the 4 reviewers, and only a slight intra-reviewer variability across timepoints. Within its limitations, this study suggests that the proposed novel score can be a reliable tool for evaluating the esthetic outcomes of PSTD coverage, which can aid in standardization of esthetic assessments following the treatment of a PSTD.

The peri-implant phenotype and implant esthetic complications. Contemporary overview

OBJECTIVE

To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications.

OVERVIEW

The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications.

CONCLUSIONS

While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications.

CLINICAL SIGNIFICANCE

Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.

Patient experience of autogenous soft tissue grafting has an implication for future treatment: A 10- to 15-year cross-sectional study

BACKGROUND

Patient-reported outcomes have received a great deal of interest in periodontal plastic procedures. However, their evaluation has mainly been short-term. Thus, the aim of this study was to evaluate the impact of soft tissue grafting procedures conducted over a decade ago on the willingness of a patients to undergo the surgery again.

METHODS

Subjects that received an autogenous soft tissue graft over 10 years ago were screened and invited for a survey. Their response was only analyzed if they were able to correctly identify the sites of the surgical procedures. Dichotomous questions and visual analogue scales (VASs) were used to assess self-reported pain, willingness to retreat and satisfaction.

RESULTS

Fifty-two patients were included in the analyses. Higher pain was reported for mandibular sites, and treated areas including ≥ 3 teeth (P < 0.01). Willingness to retreatment was 84.6% and it was negatively associated with self-reported pain measures, the arch location (mandible), and number of treated sites (≥3 teeth) (P < 0.01). Mean satisfaction rate was 86.9 ± 13.65 (VAS) and showed a positive correlation with willingness to retreat (P < 0.01). Having a complete root coverage at the recall visit was also significantly associated with higher patient satisfaction scores (P < 0.01).

CONCLUSIONS

Patient experience of previous autogenous soft tissue grafting has an influence on their decision to undergo future treatment. Willingness to retreat was negatively affected by mandibular sites, larger treated areas and the perceived pain, while presenting with complete root coverage was significantly associated with patient satisfaction.

Peri-implant soft tissue phenotype modification and its impact on peri-implant health: A systematic review and network meta-analysis

BACKGROUND

The peri-implant soft tissue phenotype (PSP) encompasses the keratinized mucosa width (KMW), mucosal thickness (MT), and supracrestal tissue height (STH). Numerous approaches to augment soft tissue volume around endosseous dental implants have been investigated. To what extent PSP modification is beneficial for peri-implant health has been subject of debate in the field of implant dentistry. The aim of this systematic review was to analyze the evidence regarding the efficacy of soft tissue augmentation procedures aimed at modifying the PSP and their impact on peri-implant health.

METHODS

A comprehensive search was performed to identify clinical studies that involved soft tissue augmentation around dental implants and reported findings on KMW, MT, and/or STH changes. The effect of the intervention on peri-implant health was also assessed. Selected articles were classified based on the general type of surgical approach to increase PSP, either bilaminar or an apically positioned flap (APF) technique. A network meta-analysis including only randomized-controlled trials (RCTs) reporting on PSP outcomes was conducted to assess and compare different techniques.

RESULTS

A total of 52 articles were included in the qualitative analysis, and 23 RCTs were included as part of the network meta-analysis. Sixteen RCTs reported the outcomes of PSP modification therapy with bilaminar techniques, whereas 7 involved the use of APF. The analysis showed that bilaminar techniques in combination with soft tissue grafts (connective tissue graft [CTG], collagen matrix [CM], and acellular dermal matrix [ADM]) resulted in a significant increase in MT compared to non-augmented sites. In particular, CTG and ADM were associated with higher MT gain as compared to CM and non-augmented sites. However, no significant differences in KMW were observed across different bilaminar techniques. PSP modification via a bilaminar approach utilizing either CTG or CM showed beneficial effects on marginal bone level stability. APF-based approaches in combination with free gingival graft (FGG), CTG, CM, or ADM showed a significant KMW gain compared to non-augmented sites. However, compared to APF alone, only FGG exhibited a significantly higher KMW gain. APF with any evaluated soft tissue graft was associated with with reduction of probing depth, soft tissue dehiscence and plaque index compared to non-augmented sites compared to non-augmented sites. The evidence regarding the effect of PSP modification via APF-based approaches on peri-implant marginal bone loss or preservation is inconclusive.

CONCLUSIONS

Bilaminar approach involving CTG or ADM obtained the highest amount of MT gain, whereas APF in combination with FGG was the most effective technique for increasing KMW. KMW augmentation via APF was associated with a significant reduction in probing depth, soft tissue dehiscence and plaque index, regardless of the soft tissue grafting material employed, whereas bilaminar techniques with CTG or CM showed beneficial effects on marginal bone level stability.

Patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone: A systematic review

OBJECTIVE

To determine patient satisfaction with esthetics, phonetics, and function following implant-supported fixed restorative treatment in the esthetic zone by measuring the Oral Health Related Quality of Life (OHRQoL).

MATERIALS AND METHODS

This systematic review follows the "Preferred reporting items for systematic review and meta-analysis protocols" (PRISMA-P) 2015 statement. Studies were searched in the databases Ovid, PubMed, Web of Science, Scopus, and the Cochrane Library. The quality of the studies included in the review was scored using the GRADE system. The impact of the findings was analyzed by calculating effect size and standardization of results across different OHRQoL measurements was achieved by calculating the percentage equivalent.

RESULTS

A total of 13 studies were selected to be included in his systematic review after application of the inclusion criteria. A total of six studies recorded pre- and post-treatment OHRQoL results, while the remaining seven studies provided only post-treatment results.

CONCLUSIONS

This review concluded that implant-supported fixed restorations in the esthetic zone have an overall positive impact on OHRQoL. However, patient satisfaction from this treatment reduced as the number of missing teeth replaced by implants was increased.

CLINICAL SIGNIFICANCE

When implant-supported fixed restorations are being planned in the esthetic zone, dentists need to consider the patient's perception and the subsequent impact of these restorations on the patient's quality of life. Clinicians can be assured that patient OHRQoL will increase; however, clinicians should also keep in mind the importance of the gingival frame. Furthermore, they should be aware of the challenges when planning cases with larger numbers of implants in the esthetic zone as this could lead to a lowering of a patient QoL.

Early implant placement and peri-implant augmentation with a porcine-derived acellular dermal matrix and synthetic bone in the aesthetic area: a 2-year follow-up prospective cohort study

The aim of this study was to evaluate the 2-year follow-up results of early implant placement with simultaneous peri-implant augmentation using an acellular dermal matrix (ADM) and a synthetic bone substitute in the aesthetic zone. Twenty subjects were enrolled in this study, they were either males (eight) or females (12), with a mean age of 47.8±4.45 years and each patient was treated with one implant. Simultaneous contour augmentation with guided bone regeneration was performed using synthetic bone particles (maxresorb®) and an ADM (mucoderm®). Keratinized mucosa width (KMW) and gingival thickness (GT) were assessed at baseline, 1, 3, 6, 12 and 24 months. Marginal bone loss, probing pocket depth, bleeding on probing and plaque index were also recorded. GT and KMW increased between baseline and 1 month, slightly decreased between 1 month and 12 months (P<0.001) and remained stable between 12 and 24 months (P<0.001). After 2 years, mean marginal bone loss level was 0.51 ± 0.63mm, with no probing pocket depth values >5mm and no concomitant signs of inflammation registered. Pink aesthetic score was 8.3. Combining an ADM and guided bone regeneration with early implant placement revealed a significant increase of 1.9mm for GT and 1.6mm for KMW after 2 years, showing good patient satisfaction regarding the aesthetic outcomes of soft tissues and prosthetic crown.

A randomized controlled study comparing guided bone regeneration with connective tissue graft to re-establish buccal convexity: One-year aesthetic and patient-reported outcomes

OBJECTIVES

To compare guided bone regeneration (GBR) with connective tissue graft (CTG) in terms of aesthetic and patient-reported outcomes (PROMs).

MATERIALS AND METHODS

Patients with a single tooth gap in the anterior maxilla and horizontal alveolar defect were enrolled in a single-blind RCT. All sites had a buccopalatal bone dimension of at least 6 mm, received a single implant and were randomly allocated to the control (GBR) or test group (CTG) to re-establish buccal soft tissue convexity. Primary outcomes were Pink Esthetic Score (PES) and Mucosal Scarring Index (MSI) assessed after 1 year. Secondary outcomes included PROMs registered during the early stages of healing and after 1 year.

RESULTS

Twenty-one patients were included per group (control: 11 females, mean age 51; test: nine females, mean age 48). Although there was no significant difference in the PES between the groups (control: 10.11; test: 10.48; p = .577), the MSI was significantly lower in the test (1.10) than in the control group (2.53) (p = .017). Based on descriptive statistics, the latter demonstrated wider scars, more colour mismatch and slightly more suture marks. However, these were not considered disturbing by the patients given similar VAS on soft tissue aesthetics (control: 84; test: 87). Oedema and haematoma were rated twice as high in the control group on at least two postoperative time points, and patients took more painkillers (7.10 vs. 4.86). OHIP-14 decreased in both groups between baseline and 1-year follow-up, indicative of less discomfort in daily life. Differences in MSI and PROMs between the groups may be explained by the need of a vertical releasing incision in order to achieve sufficient access for GBR, periosteal incisions and the use of biomaterials that may induce inflammation.

CONCLUSION

GBR and CTG resulted in favourable aesthetic outcomes as assessed by professionals and patients. However, given additional vertical and periosteal incisions, GBR resulted in more scarring, postoperative discomfort and a higher need for painkillers.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.