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Journal of Oral Science & Rehabilitation Volume 2 | Issue 1/2016 69 E s t h e t i c e v a l u a t i o n o f i m p l a n t s a f t e r o r t h o d o n t i c s p a c e o p e n i n g t r e a t m e n t Introduction Dental agenesis is defined as the congenital ab- sence ofatooth bud. It is a condition ofunknown etiology, although some theories have been for- mulated.1 Its incidence varies among races and sexes. Maxillary lateral incisors are the second most frequent tooth type, after the second pre- molars and excluding the third molars, affected bythiscondition.2 Theestimatedrateofincidence of congenitally missing maxillary lateral incisors ranges from 5% to 8%.3 Dental agenesis occur- ring in the esthetic area has a high impact on smile attractiveness, impairingthe smile balance and harmony.4 Therefore, it must be carefully addressed and requires a team approach. Classically, congenitally missing lateral in- cisors can be restored in three ways.5 A camou flage treatment modality can be performed by mesialization ofthe canine intothe lateralincisor space and performing conservative reshaping of the canine to mimic the incisor.6 A second treat- ment possibility is a space opening orthodontic approach, aiming to create adequate space for the placement of an osseointegrated implant in the incisal area or to allow the seating of a fixed partial denture.5 The third option is orthodontic creation of space in the posterior area to allow theplacementofanimplantinthepremolararea.7 Implant therapy is an established treatment modalityfor the rehabilitation of single or multi- plemissingteethwithhighimplantsuccessrates in the long term.8 Dental implants are able to provide a high esthetic outcome inverydemand ing clinical situations, such as the rehabilitation ofmissingteeth inthe premaxilla.9 Inthe lastfew years, investigators havefocusedtheirefforts on determining a reliable method that is able to evaluate the esthetic outcome of an implant- supported restoration objectively.10 In the late 1990s, Jemt introduced the papilla fill index for assessing the size of the interproximal gingiva.11 Recently, Fürhauser et al. proposed an index called the pink esthetic score (PES) that evalua- tes different aspects of the soft tissue surroun- ding the implants.12 Unfortunately, this method focuses only on the outcome of the periimplant tissue and does not considerthe restoration.The final esthetic result of implant rehabilitation is the sum of many variables, including the soft tissue, and the restoration plays a pivotal role in thefinalresult.13 In 2009, Belseret al. introduced the pink esthetic score/white esthetic score (PES/WES), an index able to provide a compre- hensive evaluation ofthe esthetic outcome ofan implant-supported rehabilitation.14 This index allows the clinician to assess either soft-tissue variables or variables related to the restoration itself. A value of 2, 1 or 0 is assigned to every parameter.An evaluation of all ofthevariables is performed bydirect comparisonwiththe natural contralateral reference tooth. Thus, a final score is assigned that estimates the final degree of match or mismatch.14 The aim of the present retrospective study is to evaluate the five-year esthetic outcome of a singlecrownsupportedbyaMorsetaperconnec- tion implant used to replace a congenitally mis- sing maxillary lateral incisor after orthodontic treatment. Materials & methods P a t i e n t p o p u l a t i o n Twenty patients, 11 females and 9 males, with a mean age of 21.33 (range of 19.67–24.17) were identified from the patient chart and included in the study. They had been consecutively treated with Morse taper connection implants owing to congenitally missing maxillary lateral incisors after orthodontic space opening, from 2004 to 2009 at the dental clinic of the University of In- subria (Varese, Italy). Seven patients originally identified did not meet the inclusion criteria and were excluded. The inclusion criteria were – presence of natural teeth mesial and distal to the implant – presence of the contralateral lateral incisor – adequate bone height and width to place an implant of at least 3.3 mm in diameter and 10.0 mm in length. The exclusion criteria were – uncontrolled diabetes – poor oral hygiene – active periodontal infections – bruxism – smoking habit – presence of a thin-scalloped gingival biotype. The biotypewas determined bythetransparency of a periodontal probe through the gingival mar- Volume 2 | Issue 1/201669