Aesthetic versus Surgical Success of an Anterior Dental Implant

Background: Anterior maxillary implantation is a challenging treatment for both surgeon and prosthodontist due to the high esthetic demands in this area. Purpose: To examine the success of a single dental implant in the anterior maxillary region according to accepted surgical and novel aesthetic criteria. Materials and methods: Between the years 1991-1998, 48 patients (29 females and 19 males; mean age 36 years) were treated with 52 implants to replace a missing single anterior maxillary tooth. The average implant length and diameter were 15.02 mm and 3.82 mm respectively. Bone augmentation was used in 25 implants (48%). Second stage surgery was performed after an average period of 7.46 months. Mean follow–up was 37.5 months. Marginal bone loss (MBL) was measured on radiographs using the implant threads as a dimensional reference. Aesthetic parameters (interdental papilla, free gingival margin (FGM), attached gingiva, and smile line harmony) were examined. The examiners satisfaction from the aesthetic outcome was also checked. Aesthetic success rate was determined according to these parameters. Results: The total surgical survival rate was 98.1%. One implant was lost before exposure. The total surgical success rate as determined by MBL was 96.1%. The average examiners’ aesthetic satisfaction rate was 86.3%. The average aesthetic success rate was 82.4%. No correlation was found between surgical success rate (according to MBL) and aesthetic success. Aesthetic failure was mostly due to FGM defect followed by a papilla-shaped defect. Conclusion: Implantation in the anterior maxillary area is a predictable procedure with a high surgical survival and success rate, as well as a considerably high aesthetic success rate. The high surgical success and survival rates cannot predict aesthetic success.