Objectives: The important item of aesthetics is rarely included in evaluation studies. The aim of this study was to develop and validate an index for rating aesthetics of implant‐supported single crowns and adjacent soft tissues. Material and methods: Nine items were selected, which have an influence on the aesthetic result. The items are based on the anatomic form, colour and surface characteristics of the crown and on the anatomic form, colour and surface characteristics of the peri‐implant soft tissues. Two oral‐maxillofacial surgeons and two prosthodontists rated 24 implant‐supported single‐tooth restorations and adjacent soft tissues on a form with the nine items of the rating index. The rating was carried out twice by each of the examiners. Weighted Cohen's κ was calculated to express the intra‐ and interobserver agreement. Results: Intraobserver results indicated that the agreement between the first and second rating of both the prosthodontists was good (both 0.7) and that the agreement of the oral‐maxillofacial surgeons was moderate (0.49 and 0.56). The best interobserver agreement was found between the two prosthodontists (0.61, good agreement). Conclusions: The Implant Crown Aesthetic Index is an objective tool in rating aesthetics of implant‐supported single crowns and adjacent soft tissues. The rating is best be carried out by one prosthodontist to have the highest reliability.

The peri-implant mucosa is rated as less satisfactory than the implant-supported crown by both the dental professional and patients. The dental professional was less satisfied with respect to the total result and results of the crown than the patients.

The purpose of this study was to investigate the quality of bone at grafted implant sites in the anterior maxilla. Grafting of these sites was necessary because of insufficient bone volume in a buccopalatinal direction (width at the top of the crest 1-3mm). Reconstruction was performed with chin bone (N=5), chin bone and a resorbable Bio-Gide GBR membrane (N=5) or Bio-Oss spongiosa granules in combination with a Bio-Gide GBR membrane (N=5). Biopsies were taken prior to implantation, i.e. 3 months after grafting with chin bone, and 6 months after grafting with Bio-Oss. Evaluation was done by assessing the histological and histomorphometric characteristics of full-length biopsies taken from the actual implant site. Both areas with non-vital bone and areas with apposition of bone and remodelling phenomena were observed in the chin bone group at the time of placement of the implants. Similar results were observed at implant sites reconstructed with a chin bone graft covered by a membrane. In the chin bone group without and with a GBR membrane, the mean total bone volume (TBV) was 55.2+/-6.8% and 57.7+/-11.5%, respectively; the marrow connective tissue volume (MCTV) was 44.8+/-6.8% and 42.3+/-11.5%, respectively. Remnants of the resorbable GBR membrane were not detected. In the Bio-Oss((R)) group, at implant placement some newly formed bone was observed in the connective tissue surrounding the Bio-Oss((R)) particles (mean TBV (newly formed bone) 17.6+/-14.5%), but most particles were surrounded by connective tissue. No convincing signs of remodelling were observed (mean remaining Bio-Oss volume 40.5+/-9.3%; mean MCTV 41.9+/-13.1%). No implants were lost during follow up (12 months). At the time of placement of the implants the grafting material (either chin bone or Bio-Oss is still not fully replaced by new vital bone. In case of Bio-Oss, most of the grafting material is even still present. Despite these differences, the 1-year clinical results were very good and comparable between the various grafting techniques applied.

Clinical, radiographic, aesthetic and patient centred outcomes were very favourable after 10 years and did not differ between the groups with different bone augmentation techniques.

Background: There is a growing need to evaluate the esthetics of implant‐supported crowns and bridges. An important tool for such an evaluation is standardized assessment of the soft and hard peri‐implant tissue levels.Methods: A simple acrylic device has been developed for reliable and reproducible assessment of soft and hard periimplant tissues using standardized color slides and standardized dental x‐rays. With this device, changes in both the soft and hard tissues around implant‐supported crowns can be evaluated as a function of time. The reproducibility of the technique was tested on color slides as well as on dental x‐rays in a series of implant‐supported crowns and their neighboring teeth. Results: The reproducibility of this technique was excellent. The measuring errors for repeated measurements of the soft and hard tissues were 0.14 ± 0.02 mm and 0.13 ± 0.01 mm, respectively.Conclusions: The device is a reliable tool to assess changes in both soft and hard tissues around crowns and implants over time. Likewise, it is suggested that this technique also can be used to objectively assess soft and hard tissue changes around natural teeth with or without prosthetic restorations. J Periodontol 2004;75:646‐651.

None of the three applied augmentation technique procedures influenced the characteristics of the MGL and MBL or the implant survival of single-tooth replacements. Peri-implant hard and soft tissues were very stable in the first year after loading.

This study aimed to assess the prevalence of seven periodontal marker pathogens, before implant placement and 1 yr after loading, in periodontally healthy individuals and to assess the long-term effectiveness of pre-implant reduction of pathogens to below threshold levels. In 93 individuals needing single tooth replacement, pooled subgingival microbiological samples from standard sites were cultured and analyzed before implant treatment and 1 yr after loading. Threshold levels commonly used in periodontology to predict periodontal breakdown were applied. Subjects with levels of pathogens above these thresholds received initial periodontal treatment including systemic antibiotics when indicated. At baseline, 49.5% of periodontally healthy subjects harboured one or more marker pathogens above threshold levels. Periodontal treatment reduced the pathogen levels below threshold values in 78.3% of these initially colonized subjects. In all cases Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis were reduced to below threshold. At 1 yr after loading, periodontal pathogens were present above threshold levels in 74.1% of all subjects. It is concluded that in almost half of periodontal healthy individuals the subgingival biofilm harbours periodontal pathogens above threshold values. Long-term effectiveness of pre-implant reduction of the selected marker pathogens appeared limited in our patient population, making pre-implant reduction unpredictive for post-implant levels of these pathogens. Thus, considering the applied microbiological criteria, generalized pre-implant microbiological testing is not contributory in periodontally healthy subjects.

Aim: To prospectively assess surgical and prosthetic care and aftercare related to the placement of implant-retained dental crowns after local bone augmentation in patients missing one tooth in the maxillary aesthetic region.Methods: Ninety-three patients were randomly allocated to one of three local augmentation groups: (1) chin bone; (2) chin bone covered by a Bio-Gide® membrane (Geistlich, Wolhusen, Switzerland); and (3) Bio-Oss® covered by a Bio-Gide® membrane. After local augmentation, implant placement (ITI) and fabrication of an implant-retained dental crown (cemented metal-ceramic dental crown) was performed. Prosthetic and surgical care and aftercare was scored from the first visit until 5 years after the augmentation of the implant region. Results:The need for care and aftercare was comparable between the local augmentation groups. Three implants were lost (5-year implant survival rate: 96.7%). Surgical aftercare was needed in 9% of patients and consisted of care related to peri-implant tissue problems. Prosthetic aftercare was needed more often: all patients needed periodic routine inspections; 63% needed supplemental oral hygiene support; and 16% needed additional prosthetic care, mainly consisting of fabricating new crowns (12%). Conclusion:Placing an implant in the maxillary esthetic region after local bone augmentation is a safe and reliable treatment option not needing much specific aftercare other than periodic preventive routine inspections, routine oral hygiene care, and fabrication of a new crown in one out of every eight to nine patients in 5 years. The method used for augmentation was irrespective of the patients' need for aftercare.