Aesthetic Evaluations after Implant Treatment of Narrow Single Tooth Gaps

Objectives: Implant treatment of single tooth gaps with narrow interdental space often represents a challenge. This study aimed at determining aesthetic outcomes after implant treatment with diameter-reduced implants over a period of three years.
Methods: In this prospective, single cohort clinical study, 30 patients with narrow single tooth gaps in the anterior region of the upper jaw (FDI 15-25) were included. Implants with reduced diameter (Straumannâ Narrow Neck CrossFitâ, Æ=3.3mm) were inserted after wound healing and final restoration was fitted three months after. Patients’ perceived aesthetics was assessed as a component of oral health-related quality of life (OHRQoL) by four questions of the 49-item Oral Health Impact Profile (OHIP). Dentists evaluated aesthetics using the Pink Esthetic Score (PES). For OHIP, implant placement was defined as baseline, while for PES insertion of crowns was considered as baseline. Both instruments were administered at baselines, and at 6-, 12-, 24-, and 36-month follow-up. Changes in the instruments’ scores from baseline to follow-ups were tested for statistical significance with repeated-measures ANOVA.
Results: All implants survived (survival rate: 100%). However, in eight patients crowns lost retention and were cemented again (success rate: 73%). Initially, from the patient perspective, aesthetics significantly improved after implant treatment (OHIP aesthetic: 2.9 to 1.2 points; p=0.019). At 12- and 24-month follow-up a further significant improvement was observed which remained stable on a high level after 36 months (OHIP aesthetic: 0.5/0.6/0.4 points; p=0.022). This was also reflected in the PES scores, with good evaluations of soft tissue aesthetics directly after implant insertion (PES: 6.8 points). Aesthetics continuously improved at follow-up visits (PES: 7.9/8.3/8.9/9.6 points; p=0.001).
Conclusions: Diameter-reduced implants inserted into single tooth gaps in the aesthetic zone provide highly aesthetic results. After tissue maturation and adaptation, aesthetic results further improve and remain stable over a period of three years.