Background A successful implant reconstruction with optimal esthetics consists of a visually pleasing prosthesis and complete and healthy surrounding soft tissue. In the current literature, numerous indices used to qualitatively assess esthetics have been described. However, studies comparing the indices and their reproducibility are scarce. Purpose The aim of this study was to compare three different esthetic indices for the evaluation of single implant‐supported crowns. Materials and Methods A total of 10 prosthodontists (P), 10 orthodontists (O), 10 general dentists (G), and 10 lay people (L) independently performed the same assessment using 30 photographs and corresponding casts with three different esthetic indices (Peri‐Implant and Crown Index [PICI], Implant Crown Aesthetic Index [ICAI], “Pink Esthetic Score/White Esthetic Score [PES/WES]) and repeated the evaluations 4 weeks later. Results The PES/WES and the PICI showed significantly higher esthetic scores (pink, white, total) and clinical acceptance compared with the ICAI in all four groups and in both assessments. The highest intraobserver agreement was achieved using the PES/WES and the least with the ICAI. The mean Kappa per group ranged from 0.18 (group L with ICAI) to 0.63 (group G with PICI). Conclusion In comparison with the ICAI, the PES/WES and PICI were more reproducible. Therefore, PES/WES and PICI seem to be more suitable as esthetic indices for single implant crowns.

Patients' esthetic expectations are increasing, and the options of the prosthetic pathways are currently evolving. The objective of this randomized multicenter clinical trial was to assess and compare the esthetic outcome and clinical performance of anterior maxillary all-ceramic implant crowns (ICs) based either on prefabricated zirconia abutments veneered with pressed ceramics or on CAD/CAM zirconia abutments veneered with hand buildup technique. The null hypothesis was that there is no statistically significant difference between the 2 groups. Forty implants were inserted in sites 14 to 24 (FDI) in 40 patients in 2 centers, the Universities of Bern and Geneva, Switzerland. After final impression, 20 patients were randomized into group A, restored with a 1-piece screw-retained single crown made of a prefabricated zirconia abutment with pressed ceramic as the veneering material using the cut-back technique, or group B using an individualized CAD/CAM zirconia abutment (CARES abutment; Institut Straumann AG) with a hand buildup technique. At baseline, 6 mo, and 1 y clinical, esthetic and radiographic parameters were assessed. Group A exhibited 1 dropout patient and 1 failure, resulting in a survival rate of 94.7% after 1 y, in comparison to 100% for group B. No other complications occurred. Clinical parameters presented stable and healthy peri-implant soft tissues. Overall, no or only minimal crestal bone changes were observed with a mean DIB (distance from the implant shoulder to the first bone-to-implant contact) of -0.15 mm (group A) and 0.12 mm (group B) at 1 y. There were no significant differences at baseline, 6 mo, and 1 y for DIB values between the 2 groups. Pink esthetic score (PES) and white esthetic score (WES) values at all 3 examinations indicated stability over time for both groups and pleasing esthetic outcomes. Both implant-supported prosthetic pathways represent a valuable treatment option for the restoration of single ICs in the anterior maxilla ( ClinicalTrials.gov NCT02905838).

Objective: The aim of this randomized multicenter clinical trial was to evaluate and compare the performance of anterior all-ceramic implant crowns based either on prefabricated zirconia abutments veneered with pressed ceramics or on CAD/CAM zirconia abutments veneered with the hand build-up technique. The null hypothesis was that there is no statistically significant difference between the two study groups.Material and methods: Forty implants were inserted in sites 14-24 (World Dental Federation [FDI]) in two centers, the Universities of Bern and Geneva, Switzerland. Twenty patients each were randomized into either Group A and restored with onepiece single crown made of a prefabricated zirconia abutment with pressed ceramic, or Group B using an individualized CAD/CAM zirconia abutment with the hand-layered technique. After 3 years, clinical, esthetic, and radiographic parameters were assessed. Results: Group A exhibited one dropout patient and one failure resulting in a survival rate of 89% after 3 years and two failures for Group B (90%). Clinical parameters presented healthy peri-implant soft tissues. Overall, no crestal bone level changes were observed (mean DIB of 0.13 mm [Group A] and 0.24 mm [Group B]). There were no significant differences at baseline, 6 months, and 1 and 3 years for DIB values between the two groups. PES and WES values evaluated at all three time points indicated stability over time for both groups and pleasing esthetic outcomes. Conclusions: Both implant-supported prosthetic pathways represent a valuable treatment option for the restoration of implant crowns in the anterior maxilla. K E Y W O R D S bone implant interactions, clinical research, clinical trials, interactions, prosthodontics, soft tissue-implant

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