This study demonstrated that anterior maxillary single-tooth replacement, according to the concept of early implant placement, is a successful and predictable treatment modality, in general, and from an esthetic point of view, in particular. The suitability of the PES/WES index for the objective outcome assessment of the esthetic dimension of anterior single-tooth implants was confirmed. However, prospective clinical trials are needed to further validate and refine this index.

It has been postulated that the wound healing in a closed submerged location is one of the prerequisites for osseointegration of dental implants. The purpose of the present study was to evaluate the tissue integration of intentionally non-submerged titanium implants inserted by a one-stage surgical procedure. 100 ITI implants were consecutively placed in 70 partially edentulous patients. After a healing period free of masticatory loading for at least 3 months, the implants were examined. The clinical status showed for all implants neither detectable mobility nor signs of a peri-implant infection. Therefore, prosthetic abutments were inserted, and the patients were restored with fixed partial dentures. All patients were regularly recalled at 3-month intervals, and no patient dropped out of the study. Thus, all 100 implants were re-evaluated 12 months following implantation. Plaque- and sulcus bleeding indices, probing depth, clinical attachment level, width of keratinized mucosa, and periotest scores were assessed. In addition, standardized radiographs were analyzed for the presence of peri-implant radiolucencies and for the location of alveolar bone levels around the implants. Based on predefined criteria, the implants were classified as successful or failing. 98 implants were considered successful, and 1 implant failing. The remaining implant exhibited a peri-implant infection requiring local and systemic antimicrobial treatment. The results of this short-term study indicate that intentionally non-submerged ITI implants yield a high predictability for successful tissue integration.

The soft tissue reactions to non-submerged unloaded titanium implants were examined. A total of 24 implants were placed in 6 beagle dogs. The implants differed in their crestal area by having either a rough sandblasted, a fine sandblasted, or a polished surface. After 3 months, all implants were firmly anchored in the bone and had no clinical signs of peri-implant inflammation. Undecalcified histologic sections demonstrated that all implants achieved osseointegration with direct bone contact. The epithelial structures showed a peri-implant sulcus with a non-keratinized sulcular epithelium and a junctional epithelium. None of the sections exhibited epithelial downgrowth to the alveolar crest. In the supracrestal area, a direct connective tissue contact to the implant post was observed. An approximately 50 to 100 microns wide zone of dense circular fibers was found close to the implant surface. It was free of blood vessels and resembled closely an inflammation-free scar tissue formation. This zone was surrounded by a looser connective tissue with a 3-dimensional network of collagen fibers running in different directions. No significant differences concerning soft tissue reactions were found between the 3 implant surfaces. In particular, the length of direct connective tissue contact was similar. Concerning bone reactions, a significantly shorter distance from the top of the implant to the most coronal bone-implant contact was observed for rough surfaces. It is concluded that non-submerged unloaded titanium implants achieved a complication-free tissue integration with a dense connective tissue in direct contact to the implant surface in the supracrestal area, and epithelial structures similar to those around natural teeth. The different surface textures did not influence the healing pattern of the soft tissues, but had an influence on the location of the most coronal bone-implant contact.

Full-arch digital implant impressions using True Definition scanner and Omnicam were significantly more accurate than the conventional impressions with the splinted open-tray technique. Additionally, the digital impressions with the True Definition scanner had significantly less 3D deviations when compared with the Omnicam.

This retrospective study demonstrated successful treatment outcomes for all 45 implants examined. The mid-term follow-up of 2 to 4 years also showed that the risk for mucosal recession was low with this treatment concept. Prospective clinical studies are required to confirm these encouraging results.