Soft tissue recessions frequently cause esthetic disharmony and dissatisfaction. Compared with soft tissue coverage around a tooth, the coverage of an implant site is obviously unpredictable. Particularly in the cases of thin mucosa, a significant greater amount of recession takes place compared to thick mucosa. To overcome this problem, this case report demonstrates a two-step mucosal dehiscence coverage technique for an endosseous implant.
A 33-year-old female visited us with the chief complaint of dissatisfaction with the esthetics of an exposed implant in the maxillary left cental incisor region. A partial-thickness pouch was constructed around the dehiscence. A subepithelial connective tissue graft was positioned in the apical site of the implant and covered by a mucosal flap with normal tension. At 12 months after surgery, the recipient site was partially covered by keratinized mucosa. However, the buccal interdental papilla between implant on maxillary left central incisor region and adjacent lateral incisor was concave in shape. To resolve the mucosal recession after the first graft, a second graft was performed with the same technique.
An esthetically satisfactory result was achieved and the marginal soft tissue level was stable 9 months after the second graft.
The second graft was able to resolve the mucosal recession after first graft. This two-step approach has the potential to improve the certainty of esthetic results.
Case report; Dental Esthetics; Mouth mucosa; Oral surgical procedures
The anterior region is a challenge for most clinicians to achieve optimal esthetics with dental implants. The provisional crown is a key factor in the success of obtaining pink esthetics around restorations with single implants, by soft tissue and inter-proximal papilla shaping. Provisional abutments bring additional costs and make the treatment more expensive. Since one of the aims of the clinician is to reduce costs and find more economic ways to raise patient satisfaction, this paper describes a practical method for chair-side fabrication of non-occlusal loaded provisional crowns used by the authors for several years successfully.
Twenty two patients (9 males, 13 females; mean age, 36,72 years) with one missing anterior tooth were treated by using the presented method. Metal definitive abutments instead of provisional abutments were used and provisional crowns were fabricated on the definitive abutments for all of the patients. The marginal fit was finished on a laboratory analogue and temporarily cemented to the abutments. The marginal adaptation of the crowns was evaluated radiographically.
The patients were all satisfied with the final appearance and no complications occurred until the implants were loaded with permanent restorations.
The use of the definitive abutments for provisional crowns instead of provisional abutments reduces the costs and the same results can be obtained.
Dental abutments; Dental implants; Dental marginal adaptation; Dental prosthesis
Periodontal diseases result in damage and destruction of the supporting structures of the teeth, including the bone and periodontal ligament. In some cases, there is loss of gingival coverage of the teeth in esthetic regions, with gingival recession and loss of interdental papilla. The surgical treatment in such situations is costly, requires prolonged healing time, and the results are often unpredictable; this makes it an unpopular choice. The reconstruction of these areas with prosthesis like gingival veneer can be useful to correct the deformities remaining after the control of periodontal diseases, especially in the maxillary anterior region. Dental practitioners can provide comfortable and accurately fitting gingival veneers, that are very stable and esthetically restore the interdental papilla and gingival recession defects. This method is an innovative treatment option for dealing with esthetic challenges and long-term dental health.
Acrylic resins; gingival veneer; periodontal attachment loss; resective osseous surgery
The emergence profile concept of an implant restoration is one of the most important factors for the esthetics and health of peri-implant soft tissue. This paper reports on two cases of gingival recontouring by the fabrication of a provisional implant restoration to produce an optimal emergence profile of a definitive implant restoration.
After the second surgery, a preliminary impression was taken to make a soft tissue working cast. A provisional crown was fabricated on the model. The soft tissue around the implant fixture on the model was trimmed with a laboratory scalpel to produce the scalloped gingival form. Light curing composite resin was added to fill the space between the provisional crown base and trimmed gingiva. After 4 to 6 weeks, the final impression was taken to make a definitive implant restoration, where the soft tissue and tooth form were in harmony with the adjacent tooth.
At the first insertion of the provisional restoration, gum bleaching revealed gingival pressure. Four to six weeks after placing the provisional restoration, the gum reformed with harmony between the peri-implant gingiva and adjacent dentition.
Gingival recontouring with a provisional implant restoration is a non-surgical and non-procedure-sensitive method. The implant restoration with the optimal emergence profile is expected to provide superior esthetic and functional results.
Dental implants; Dental restoration repair; Gingiva
Extensive defects of the ear require satisfactory cosmetic reconstruction to enable the patient to achieve full social integration. Although surgical procedures are the gold standard for reconstruction of the ear, in some cases they cannot be performed because of extended scars, threatening tumor, or congenital tissue abnormalities. Prosthetic reconstruction of the auricle is an established and reliable alternative technique to autologous surgical reconstructions. Since studies performed by Brånemark, osseointegrated implants have been widely used to provide a reliable and stable anchorage for a prosthesis (prosthesis anchored to bone). To allow good osseointegration of the titanium screw implants, two stages are necessary. After careful preparation for the surgical procedure (local and general examination, computed tomography scan, skin preparation), screws are implanted into bone, which are then covered by a skin flap. During the second stage, the skin is incised, and penetrating fixtures are attached to the screw implants, which allow fixation of the prosthesis. This procedure is reliable and reproducible, with good to excellent results and stability over time.
Prosthesis; ear; osseointegration; plastic surgery
To evaluate the papilla alterations around single-implant restorations in the anterior maxillae after crown attachment and to study the influence of soft tissue thickness on the papilla fill alteration. According to the inclusion criteria, 32 patients subjected to implant-supported single-tooth restorations in anterior maxillae were included. The patients were assigned to two groups according to the mucosal thickness: (i) group 1, 1.5 mm≤mucosal thickness≤3 mm; and (ii) group 2, 3 mm
esthetic outcome; papilla fill index; single-implant restoration; soft tissue thickness
Oral rehabilitation for a patient with severe loss of alveolar bone and soft tissue resulting from severe periodontitis presents a challenge to clinicians. Replacing loosening natural teeth with fixed prostheses supported by dental implants often requires either gingival surgery or bone grafting. The outcome of the bone grafting is sometimes unpredictable and requires longer healing time and/ or multiple surgeries. The presence of periodontal inflammation and periapical lesions often delay the placement of bone grafts as well as dental implants. Here we present a clinical case of a patient undergone full mouth reconstruction with implant-supported fixed prostheses. We demonstrated that early placement of implants (three weeks after extractions) with minimal bone grafting may be an alternative to conventional bone grafting followed by implant placement. We believe that primary stability during implant placement may contribute to our success. In addition, composite resin gingival material may be indicated in cases of large fixed implant prostheses as an alternative to pink porcelain.
Dental implants; Full mouth rehabiliation; Full mouth reconstruction; Periodontitis; Early implant placement.
The purpose of this study was to radiographically evaluate marginal bony changes in relation to different vertical positions of dental implants.
Two hundred implants placed in 107 patients were examined. The implants were classified by the vertical positions of the fixture-abutment connection (microgap): 'bone level,' 'above bone level,' or 'below bone level.' Marginal bone levels were examined in the radiographs taken immediately after fixture insertion, immediately after second-stage surgery, 6 months after prosthesis insertion, and 1 year after prosthesis insertion. Radiographic evaluation was carried out by measuring the distance between the microgap and the most coronal bone-to-implant contact (BIC).
Immediately after fixture insertion, the distance between the microgap and most coronal BIC was 0.06 ± 0.68 mm; at second surgery, 0.43 ± 0.83 mm; 6 months after loading, 1.36 ± 0.56 mm; and 1 year after loading, 1.53 ± 0.51 mm (mean ± SD). All bony changes were statistically significant but the difference between the second surgery and the 6-month loading was greater than between other periods. In the 'below bone level' group, the marginal bony change between fixture insertion and 1 year after loading was about 2.25 mm, and in the 'bone level' group, 1.47 mm, and in 'above bone level' group, 0.89 mm. Therefore, the marginal bony change was smaller than other groups in the 'above bone level' group and larger than other groups in the 'below bone level' group.
Our results demonstrated that marginal bony changes occur during the early phase of healing after implant placement. These changes are dependent on the vertical positions of implants.
Alveolar bone loss; Dental implants
Several parameters have been described for determining the success or failure of dental implants. The surface properties of transgingival implant components have had a great impact on the long-term success of dental implants. The purpose of this study was to compare the tendency of two periodontal pathogens to adhere to and colonize zirconia abutments and titanium alloys both in hard surfaces and soft tissues.
Twelve patients participated in this study. Three months after implant placement, the abutments were connected. Five weeks following the abutment connections, the abutments were removed, probing depth measurements were recorded, and gingival biopsies were performed. The abutments and gingival biopsies taken from the buccal gingiva were analyzed using real-time polymerase chain reaction to compare the DNA copy numbers of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and total bacteria. The surface free energy of the abutments was calculated using the sessile water drop method before replacement. Data analyses used the Mann Whitney U-test, and P-values below 0.05 find statistical significance.
The present study showed no statistically significant differences between the DNA copy numbers of A. actinomycetemcomitans, P. gingivalis, and total bacteria for both the titanium and zirconia abutments and the biopsies taken from their buccal gingiva. The differences between the free surface energy of the abutments had no influence on the microbiological findings.
Zirconia surfaces have comparable properties to titanium alloy surfaces and may be suitable and safe materials for the long-term success of dental implants.
Bacterial adhesion; Dental abutments
Aim of this report is to present a new surgical technique for the BAHA® system implant and to discuss the operational techniques and complications related to this type of surgery. The common technique for the positioning of the Bone-Anchored Hearing Aid (BAHA®, Cochlear Limited, Englewood, CO, USA) titanium implant into the temporal bone is based on the use of either a free or a pedunculated skin flap. Reported complications of this type of surgery include skin flap necrosis with healing by second intention, infection of the flap, skin growth over the abutment, failure of osseointegration and implant extrusion. In order to reduce the incidence of these problems, different types of surgery have already been presented over the years. Herewith, a new technique is proposed for implanting a BAHA® screw in the temporal bone, that is simple, rapid to perform, and does not require the use of a flap. This technique appears to offer two main advantages: i) the speeding up of the procedure; ii) the low risk of complications, such as infection and necrosis, within the skin surrounding the implant.
Hearing loss; Osseointegrated implants; BAHA®; Surgery
An integrated fixture mount/impression coping/ temporary abutment can provide many advantages for immediate loading of dental implants, such as simpler procedure, less chair time, cost reduction, and comfort for the patients.
Materials and Methods:
A newly designed dental implant fixture mount (DIFMA) can be used as an impression coping for taking an immediate impression. An immediate load provisional prosthesis can then be fabricated shortly after implant placement to immediately load the implants. This fixture mount can also serve as a temporary abutment for immediate chair-side fabrication of provisional prosthesis. Two clinical cases are presented.
A clinical case utilizing the fixture mount abutment (DIFMA)/implant assembly is presented. The precision of fitting between the impression copings and implants is secured with this system. The chair time for taking an immediate impression is greatly reduced. Less cost for the restoration is provided and patient comfort is delivered.
More patient satisfaction can be conferred by employing the fixture mount in the process of immediate impression taking and as an immediate provisional abutment.
Fixture mount; impression coping; implant; immediate load; provisional abutment
As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region. The resultant defect raises the need for advanced reconstruction techniques. The reconstruction in this region is aimed at restoring function and facial contour. The use of vascularised free flaps has revolutionised the reconstruction in the head and neck. Advances in reconstruction techniques have resulted in continuous improvement of oral rehabilitation. For example, endosteal implants are being used to restore the masticatory function by the way of prosthetic replacement of the dentition. Implant rehabilitation usually leads to improved facial appearance, function, restoration of speech and mastication. Suitable dental implant placement’s site requires satisfactory width, height and quality of bone. Reconstruction of hard tissue defects therefore will need to be tailored to meet the needs for implant placement.
The aim of this feasibility study was to assess the compatibility of five standard commercially available dental implant systems (Biomet 3i, Nobel Biocare, Astra tech, Straumann and Ankylos) for placement into vascularised fibula graft during the reconstruction of oromandibular region.
Radiographs (2D) of the lower extremities from 142 patients in the archives of the Department of Radiology in University College London Hospitals (UCLH) were analysed in this study. These radiographs were from 61 females and 81 males. Additionally, 60 unsexed dry fibular bones, 30 right sided, acquired from the collection of the Department of Anatomy, University College London (UCL) were also measured to account for the 3D factor.
In the right fibula (dry bone), 90% of the samples measured had a width of 13.1 mm. While in the left fibula (dry bone), 90% of the samples measured had a width of 13.3 mm. Fibulas measured on radiographs had a width of 14.3 mm in 90% of the samples. The length ranges of the dental implants used in this study were: 7-13 mm (Biomet 3i), 10-13 mm (Nobel biocare), 8-13 mm (Astra Tech), 8-12 mm (Straumann ) and 8-11 mm (Ankylos).
This study reached a conclusion that the width of fibula is sufficient for placement of most frequently used dental implants for oral rehabilitation after mandibular reconstructive procedures.
In today's world, people are very much aware about their looks and personality. They are getting more concerned about the esthetics and thus are not ready to compromise the appearance of black holes, especially in the anterior region of the mouth. Various techniques like orthodontic correction, prosthetic veneers and various periodontal surgical methods have been used to cover these unaesthetic open embrasures. In the present study, a variant technique given by Beagle in 1992 was used to cover these open gingival embrasures. The technique uses a gingival flap from the labial aspect to close the open gingival embrasures thus solving the problem of black holes.
Aims and Objectives:
This clinical study was aimed to reconstruct the lost or blunted interdental papillae with gingival tissue for esthetic purpose and for maintaining oral health with the objective to determine the extent to which the procedure can revert the maxillary esthetics.
Materials and Methods:
The patients selected were those who were having a complaint of at least one black hole in the maxillary anterior region with grade ‘0’ or ‘1’ type of contour of interdental tissues. A total of 39 open embrasures were surgically closed using this technique. Various indices were taken pre-surgically and then again post surgically.
Plaque index and gingival index showed an initial increase in the scores at the end of 1 week. Later, there was a gradual fall till the end of the study. Bleeding index significantly increased at the end of 12 weeks (P<0.001) but reduced to insignificant levels at the end of 24 weeks (P<0.09). The sulcus depth increased by about 1.19 mm. There was improvement in the contour of interdental tissues in 51% of cases and in 38.46% the interdental papillae completely obliterated the open embrasures.
The surgical technique used here for reconstruction of interdental papilla was fairly successful. However, use of bone grafts or soft tissue grafts would have improved the results further.
Black holes; gingival flap; open embrasures; periodontal plastic surgery; unaesthetic appearance
The major challenge for dental implants is achieving optimal esthetic appearance and a concept to fulfill this criterion is evaluated. The key to an esthetically pleasing appearance lies in the properly manage the soft tissue profile around dental implants. A novel implant restoration technique on the surface was proposed as a way to augment both soft- and hard-tissue profiles at potential implant sites. Different levels of roughness can be attained by sandblasting and acid etching, and a tetracalcium phosphate was used to supply the ions. In particular, the early stage attaching and repopulating abilities of bone cell osteoblasts (MC3T3-E1), fibroblasts (NIH 3T3), and epithelial cells (XB-2) were evaluated. The results showed that XB-2 cell adhesive qualities of a smooth surface were better than those of the roughened surfaces, the proliferative properties were reversed. The effects of roughness on the characteristics of 3T3 cells were opposite to the result for XB-2 cells. E1 proliferative ability did not differ with any statistical significance. These results suggest that a rougher surface which provided calcium and phosphate ions have the ability to enhance the proliferation of osteoblast and the inhibition of fibroblast growth that enhance implant success ratios.
The purpose of this study was to evaluate the soft tissue and bone change around two adjacent implants in one-stage implant surgery.
Eleven subjects (7 males, 4 females) who were needed placement of 2 adjacent implants in the molar area were included. The two implants were placed with the platform at the level of the alveolar crest. The interproximal bone between the 2 implants was not covered with gingiva. After surgery, an alginate impression was taken to record the gingival shape and radiographs were taken to evaluate implant placement. Using a master cast, the gingival height was measured at baseline, 4 weeks, and 12 weeks. In the radiograph, the alveolar bone level was measured at the mesial and distal side of both implants at baseline and 12 weeks.
The exposed bone was covered with gingiva at both 4 and 12 weeks. Loss of alveolar bone around implants was found in all areas. The alveolar bone level in the exposed bone area did not differ from that in the non-exposed area.
This study showed that the alveolar bone level and gingival height around 2 adjacent implants in the exposed bone area did not differ from that in unexposed bone area.
Alveolar bone loss; Dental implants; Dental papilla
Immediate implantation presents challenges regarding site healing, osseointegration, and obtaining complete soft-tissue coverage of the extraction socket, especially in the posterior area. This last issue is addressed herein using the double-membrane (collagen membrane+high-density polytetrafluoroethylene [dPTFE] membrane) technique in two clinical cases of posterior immediate implant placement.
An implant was placed immediately after atraumatically extracting the maxillary posterior tooth. The gap between the coronal portion of the fixture and the adjacent bony walls was filled with allograft material. In addition, a collagen membrane (lower) and dPTFE membrane (upper) were placed in a layer-by-layer manner to enable the closure of the extraction socket without a primary flap closure, thus facilitating the preservation of keratinized mucosa. The upper dPTFE membrane was left exposed for 4 weeks, after which the membrane was gently removed using forceps without flap elevation.
There was considerable plaque deposition on the outer surface of the dPTFE membrane but not on the inner surface. Moreover, scanning electron microscopy of the removed membrane revealed only a small amount of bacteria on the inner surface of the membrane. The peri-implant tissue was favorable both clinically and radiographically after a conventional dental-implant healing period.
Secondary closure of the extraction socket and immediate guided bone regeneration using the double-membrane technique may produce a good clinical outcome after immediate placement of a dental implant in the posterior area.
Bone regeneration; Dental implantation; Tooth socket
STATEMENT OF PROBLEM
Implant drivers are getting popular in clinical dentistry. Unlike to implant systems with external hex connection, implant drivers directly engage the implant/abutment interface. The deformation of the implant/abutment interface can be introduced while placing an implant with its implant driver in clinical situations.
This study evaluated the change of rotational freedom between an implant and its abutment after application of different insertion torques.
MATERIAL AND METHODS
Three kinds of internal connection implants were utilized for the current study (4.5 × 12 mm Xive, 4.3 × 11.5 mm Inplant Magicgrip, 4.3 × 12 mm Implantium MF). An EstheticBase, a 2-piece top, a Dual abutment was used for its corresponding implant system. The rotational freedom between an implant and its abutment were measured before and after applying 45, 100 Ncm insertion torque. Repeated measures ANOVA was used for statistical analysis.
Under 45 Ncm insertion torque, the rotational freedom between an implant and its abutment was significantly increased in Xive (P = .003). However, no significant change was noted in Inplant Magicgrip and Implantium MF. Under 100 Ncm torque, both in Xive (P = .0005) and Implatium MF (P = .03) resulted in significantly increased rotational freedom between the implant and its abutment.
The design of the implant/implant driver interface effectively prevented the deformation of implant/abutment interface. Little change was noted in the rotational freedom between an implant and its abutment, even though the insertion torque was far beyond clinical application.
The implant/abutment joint of internally connecting implants were quite stable under insertion torque in clinical situation.
Rotational freedom; Internal connection; Insertion torque; Implant driver
Initial stability of the implant is, in effect, one of the fundamental criteria for obtaining long-term osseointegration. Achieving implant stability depends on the implant-bone relation, the surgical technique and on the microscopic and macroscopic morphology of the implant used. A newly designed parabolic screw-type dental implant system was tested in vivo for early stages of interface reaction at the implant surface.
A total of 40 implants were placed into the cranial and caudal part of the tibia in eight male Göttinger minipigs. Resonance frequency measurements (RFM) were made on each implant at the time of fixture placement, 7 days and 28 days thereafter in all animals. Block biopsies were harvested 7 and 28 days (four animals each) following surgery. Biomechanical testing, removable torque tests (RTV), resonance frequency analysis; histological and histomorphometric analysis as well as ultrastructural investigations (scanning electron microscopy (SEM)) were performed.
Implant stability in respect to the measured RTV and RFM-levels were found to be high after 7 days of implants osseointegration and remained at this level during the experimented course. Additionally, RFM level demonstrated no alteration towards baseline levels during the osseointegration. No significant increase or decrease in the mean RFM (6029 Hz; 6256 Hz and 5885 Hz after 0-, 7- and 28 days) were observed. The removal torque values show after 7 and 28 days no significant difference. SEM analysis demonstrated a direct bone to implant contact over the whole implant surface. The bone-to-implant contact ratio increased from 35.8 ± 7.2% to 46.3 ± 17.7% over time (p = 0,146).
The results of this study indicate primary stability of implants which osseointegrated with an intimate bone contact over the whole length of the implant.
STATEMENT OF PROBLEM
Unlike screw-retention type, fixture-abutment retention in Locking taper connection depends on frictional force so it has possibility of abutment to sink.
In this study, Bicon® Implant System, one of the conical internal connection implant system, was used with applying loading force to the abutments connected to the fixture. Then the amount of sinking was measured.
MATERIAL AND METHODS
10 Bicon® implant fixtures were used. First, the abutment was connected to the fixture with finger force. Then it was tapped with a mallet for 3 times and loads of 20 kg corresponding to masticatory force using loading application instrument were applied successively. The abutment state, slightly connected to the fixture without pressure was considered as a reference length, and every new abutment length was measured after each load's step was added. The amount of abutment sinking (mm) was gained by subtracting the length of abutment-fixture under each loading condition from reference length.
It was evident, that the amount of abutment sinking in Bicon® Implant System increased as loads were added. When loads of 20 kg were applied more than 5 - 7 times, sinking stopped at 0.45 ± 0.09 mm.
Even though locking taper connection type implant shows good adaption to occlusal force, it has potential for abutment sinking as loads are given. When locking taper connection type implant is used, satisfactory loads are recommended for precise abutment location.
locking taper connection; abutment sinking; masticatory force; Bicon® Implant System
An esthetic revolution is occurring in dental profession. The esthetic treatment enhances appearance, improve smiles, restore function and raise self esteem. This is now well known that both teeth and gums make good smile and good facial esthetic. Sometimes while doing treatment in esthetic zone, impression procedure can cause strangulation of interdental papilla, causing loss of papillae. This article therefore describes a new impression technique that involves the matrix impression system and “every other tooth” technique.
Papilla preservation; Impression; Interdental papilla; Fixed prosthodontics
Spiral family implants are a root-form fixtures with increasing thickness of tread. This characteristic gives a self-tapping and self-condensing bone properties to implants. To study spiral family implant inserted in different bone quality and connected with abutments of different angulations a Finite Element Analysis (FEA) was performed. Once drawn the systems that were object of the study by CAD (Computer Aided Design), the FEA discretized solids composing the system in many infinitesimal little elementary solids defined finite elements. This lead to a mesh formation where the single finite elements were connected among them by nodes. For the 3 units bone-implant-abutments several thousand of tetrahedral elements having 10 parabolic nodes were employed.
Materials and methods
The biomechanical behaviour of 4.2 mm × 13 mm dental implants, connecting screw, straight and 15° and 25° angulated abutment subjected to static loads, in contact with high and poor bone quality was evaluated by FEA. A double system was analyzed: a) FY strength acting along Y axis and having 200 N intensity; b) FY and FZ couple of strengths applied along Y and Z directions and having respectively 200N and 140N intensity. The materials were considered as homogeneous, linear and isotropic. Then the FEA simulation was performed hypothesizing a linearity between loads and deformations.
The lowest stress value was found in the system composed by implants and straight abutments loaded with a vertical strength, while the highest stress value were found in implants and 15° angulated abutment loaded with a angulated strength. In addition, the lower is the bone quality (i.e. D4) the higher is the distribution of the stress within the bone.
Spiral family implants can be used successfully in low bone quality but a straight force is recommended.
Biomechanics; Finite element analysis; Spiral; Implant; Stress; Distribution
The aim of this study is to assess the influence exerted by the observer's dental specialization and compare patients' opinion with observers' opinion of the esthetics of maxillary single-tooth implants in the esthetic zone.
Forty-one adult patients, who were treated with a single implant in the esthetic zone, were enrolled in this study. Eight observers (2 periodontists, 2 prosthodontists, 2 orthodontists and 2 senior dental students) applied the pink esthetic score (PES)/white esthetic score (WES) to 41 implant-supported single restorations twice with an interval of 4 weeks. We used a visual analog scale (VAS) to assess the patient's satisfaction with the treatment outcome from an esthetic point of view.
In the PES/WES, very good and moderate intraobserver agreements were noted between the first and second rating. The mean total PES/WES was 11.19 ± 3.59. The mean PES was 5.17 ± 2.29 and mean WES was 6.02 ± 1.96. In the total PES/WES, the difference between the groups was not significant. However, in the WES, the difference between the groups was significant and prosthodontists were found to have assigned poorer ratings than the other groups. Periodontists gave higher ratings than prosthodontists and senior dental students. Orthodontists were clearly more critical than the other observers. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. However, the correlation between the total PES/WES and the VAS score for the first premolar was not statistically significant.
The PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.
Dental esthetics; Patient satisfaction; Single-tooth dental implants