J Periodontal Implant Sci.  2017 Oct;47(5):312-327. 10.5051/jpis.2017.47.5.312.

Bone-level implants placed in the anterior maxilla: an open-label, single-arm observational study

• Gao E
• Hei WH
• Park JC
• Pang K
• Kim SK
• Kim B
• Kim SM
• Lee JH

• KMID: 2392718
• DOI: http://doi.org/10.5051/jpis.2017.47.5.312

Abstract

PURPOSE
This study assessed marginal bone remodeling and soft tissue esthetics after the loading of single bone-level implants in the anterior maxilla.
METHODS
An open, single-arm observational clinical trial with 3 years of follow-up was performed, including 22 implants. The patients presented with a single tooth gap in the anterior maxilla (tooth positions 14-24), with natural or restored adjacent teeth. An implant was placed at least 8 weeks post-extraction and healed submerged for 6 weeks. After the second-stage operation, a fixed provisional prosthesis was provided. The final restoration was placed 6 months after the provisional restoration. The time of the provisional crown connection was considered to be the baseline in this study. Esthetic parameters and the marginal bone level were assessed at 6, 12, 24, and 36 months.
RESULTS
All implants were well integrated in the bone. A statistically significant increase was found in the mean implant stability quotient between the time of the provisional prosthesis and the time of the final prosthesis. Most implants (95.5%) revealed marginal bone resorption (<0.5 mm), and just 1 implant (4.5%) showed a change of 2.12 mm from baseline to 36 months (mean 0.07±0.48 mm), while the crestal bone level decreased significantly, from 2.34±0.93 mm at baseline to 1.70±1.10 mm at 36 months. The facial gingival margin and papilla were stable and the esthetic scores indicated high patient and dentist satisfaction.
CONCLUSIONS
Platform-switching bone-level implants placed in maxillary single-tooth gaps resulted in successful osseointegration with minimal marginal bone resorption. The peri-implant soft tissue was also esthetically satisfying and stable.

Keyword

Alveolar bone loss; Dental implants; Esthetics

MeSH Terms

Alveolar Bone Loss
Bone Remodeling
Bone Resorption
Crowns
Dental Implants
Dentists
Esthetics
Follow-Up Studies
Humans
Maxilla*
Observational Study*
Osseointegration
Prostheses and Implants
Tooth
Dental Implants

Figure

• 

  Figure 1 To calculate the change in bone levels, the distance between implant shoulder and bone contact (DIB; Am or Ad) and the distance from the implant shoulder to the alveolar bone crest (Cm or Cd) were measured in radiographs using a calibrated measuring tool.DIB: distance between the implant shoulder and the first visible bone contact, Am: distance from the implant shoulder mesial to the bone level, Ad: distance from the implant shoulder distal to the bone level, Cm: distance from the implant shoulder mesial to the bone crest, Cd: distance from the implant shoulder distal to the bone crest.

• 

  Figure 2 Changes of the interdental papilla and free gingival margin were measured using intraoral photographs. The crown length of an adjacent tooth was designated as the standard. The standard was used as the denominator in calculating the following variables: free gingival margin = length of A/length of standard, papilla mesial height = length of B/length of standard, and papilla distal height = length of C/length of standard.

• 

  Figure 3 Flow diagram of participants and implants placed.ISQ: implant stability quotient.

• 

  Figure 4 Implant stability at V2, V4, and V5. There was a statistically significant increase (P=0.002; Friedman test).V: visit, V2: the time of implant placement, V4: provisional abutment connection, V5: final restoration, ISQ: implant stability quotient.

• 

  Figure 5 Marginal bone level. There was no significant difference between the visits (P=0.931; Friedman test).V: visit, V4: provisional abutment connection, V5: final restoration, V6: 12 months, V7: 24 months, V8: 36 months.

• 

  Figure 6 Mean crestal bone level. The crestal bone level significantly decreased as time passed (P=0.004; Friedman test).V: visit, V4: provisional abutment connection, V5: final restoration, V6: 12 months, V7: 24 months, V8: 36 months.

• 

  Figure 7 Changes of the FG and PH compared to that at provisional crown connection (V4). Based on the baseline at V4, FG increased by about 4%–6%, and then decreased after an increase in PH by about ±2%–3%. However, no significant difference was found between visits (P=0.213, P=0.091 for FG and PH, respectively; Friedman test).FG: free gingival margin ratio, PH: papillary height ratio, V: visit, V5: final restoration, V6: 12 months, V7: 24 months, V8: 36 months.

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