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White Esthetic Score after immediate or early implant placement and immediate restoration – a RCT
EAO Online Library. RIEDER D. 10/09/18; 232686; P-PA - 8
Dominik RIEDER
Dominik RIEDER
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Implant-borne single-tooth restorations are a well-documented treatment for the anterior maxilla, showing superior long-term survival rates. Esthetic aspects of these rehabilitations have increasingly come into focus, and rating tools have been developed to evaluate the soft tissue around the implant as well as the prosthetic restoration itself. However, numerous options with regard to choice, combination, and timing of surgical and restorative steps may complicate the esthetic predictability.The objective of this study was to compare the White Esthetic Score for two standardized treatment approaches in a randomized clinical trial. The hypothesis was that the differing treatment modalities would not result in significantly different outcomes.24 patients with a single failing maxillary incisor were randomly assigned to receive an implant either directly after tooth extraction (Immediate Implant Placement, IIP, n = 12), or after a healing period of 6 weeks (Early Implant Placement, EIP, n = 12). The alveolar ridge was always grafted with a bovine bone substitute and a collagen membrane. All implants were provisionalized within 24 hours. Final restorations in both groups were delivered 12 weeks later and consisted of a customized zirconia abutment and a cemented all-ceramic crown. The same dental laboratory was entrusted with all cases. Approximately 6 months after completion of treatment, standardized photographs were taken, utilizing a special camera stand to ensure comparability. Five dental professionals assessed the esthetic outcome of the implant restorations with the White Esthetic Score after Belser. For statistical analysis, the Kruskal-Wallis test was applied.Due to one drop out in the IIP group, 23 cases could be analyzed. Scores for overall WES and single parameters were averaged over all five observers.**Overall WES showed a mean value of 6.36 (SD 2.57) for IIP, and 5.67 (SD 3.02) for EIP respectively. A p-value of 0.73 indicates that this difference was not statistically significant.**Evaluation of the single WES parameters yielded the following outcome-**1. General tooth form- 1.22 (SD 0.76) in group IIP vs 1.15 (SD 0.80) in group EIP, p = 0.99**2. Crown outline and volume- 1.24 (SD 0.74) in group IIP vs 0.85 (SD 0.73) in group EIP, p = 0.14**3. Color (hue and value)- 1.38 (SD 0.68) in group IIP vs 1.28 (SD 0.74) in group EIP, p = 0.95**4. Surface texture- 1.46 (SD 0.66) in group IIP vs 1.33 (SD 0.80) in group EIP, p = 0.97**5. Translucency characterization- 1.07 (SD 0.77) in group IIP vs 1.05 (SD 0.83) in group EIP, p = 1.00**For all five single parameters, results were slightly better in the IIP group, yet not significantly.Both methods rendered comparable esthetic results, by trend with a better outcome for IIP. A relatively large discrepancy was found for crown outline and volume. It can be assumed that the surrounding soft tissues exert a considerable influence on this parameter, which may contribute to these findings. The low values for translucency characterization in both groups may be explained by the difficulty to assess such a complex optical phenomenon on the basis of a photographic image.
Implant-borne single-tooth restorations are a well-documented treatment for the anterior maxilla, showing superior long-term survival rates. Esthetic aspects of these rehabilitations have increasingly come into focus, and rating tools have been developed to evaluate the soft tissue around the implant as well as the prosthetic restoration itself. However, numerous options with regard to choice, combination, and timing of surgical and restorative steps may complicate the esthetic predictability.The objective of this study was to compare the White Esthetic Score for two standardized treatment approaches in a randomized clinical trial. The hypothesis was that the differing treatment modalities would not result in significantly different outcomes.24 patients with a single failing maxillary incisor were randomly assigned to receive an implant either directly after tooth extraction (Immediate Implant Placement, IIP, n = 12), or after a healing period of 6 weeks (Early Implant Placement, EIP, n = 12). The alveolar ridge was always grafted with a bovine bone substitute and a collagen membrane. All implants were provisionalized within 24 hours. Final restorations in both groups were delivered 12 weeks later and consisted of a customized zirconia abutment and a cemented all-ceramic crown. The same dental laboratory was entrusted with all cases. Approximately 6 months after completion of treatment, standardized photographs were taken, utilizing a special camera stand to ensure comparability. Five dental professionals assessed the esthetic outcome of the implant restorations with the White Esthetic Score after Belser. For statistical analysis, the Kruskal-Wallis test was applied.Due to one drop out in the IIP group, 23 cases could be analyzed. Scores for overall WES and single parameters were averaged over all five observers.**Overall WES showed a mean value of 6.36 (SD 2.57) for IIP, and 5.67 (SD 3.02) for EIP respectively. A p-value of 0.73 indicates that this difference was not statistically significant.**Evaluation of the single WES parameters yielded the following outcome-**1. General tooth form- 1.22 (SD 0.76) in group IIP vs 1.15 (SD 0.80) in group EIP, p = 0.99**2. Crown outline and volume- 1.24 (SD 0.74) in group IIP vs 0.85 (SD 0.73) in group EIP, p = 0.14**3. Color (hue and value)- 1.38 (SD 0.68) in group IIP vs 1.28 (SD 0.74) in group EIP, p = 0.95**4. Surface texture- 1.46 (SD 0.66) in group IIP vs 1.33 (SD 0.80) in group EIP, p = 0.97**5. Translucency characterization- 1.07 (SD 0.77) in group IIP vs 1.05 (SD 0.83) in group EIP, p = 1.00**For all five single parameters, results were slightly better in the IIP group, yet not significantly.Both methods rendered comparable esthetic results, by trend with a better outcome for IIP. A relatively large discrepancy was found for crown outline and volume. It can be assumed that the surrounding soft tissues exert a considerable influence on this parameter, which may contribute to these findings. The low values for translucency characterization in both groups may be explained by the difficulty to assess such a complex optical phenomenon on the basis of a photographic image.
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