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Journal of Oral Science & Rehabilitation Issue 01/2016

Journal of Oral Science & Rehabilitation Volume 2 | Issue 1/2016 75 implant, so that an evaluation of periimplant crestal bone stability was gained with time. In order to correct for dimensional distortion in the radiograph, the apparent dimension of each im- plant (directly measured on the radiograph) was compared with the true implant length, in order to establishwith adequate precisionthe eventu- al amount ofvertical bone loss at the mesial and distalsitesoftheimplant.TheDIBwascalculated by means of an ocular grid. The established cri- teriaforimplant–crownsuccesswereasfollows: (a) absence ofpain orsuppuration;(b) absence of clinically detectable implant mobility; (c) absen- ce of periimplant radiolucency; (d) a DIB of < 1.5 mm after 12 months of functional loading and of ≤ 0.2 mm for each following year;17 and (e) absence of prosthetic complications at the implant–abutment interface. E s t h e t i c f o l l o w - u p e x a m i n a t i o n In order to examine the esthetic outcome of the implantsobjectively,intra-oralphotographswere criticallyanalyzedusingthePES/WESindex.14 All of the implant crowns were photographed with a digital camera (Nikon D100, Nikon, Tokyo, Ja- pan)anda105mmlens(AFMicroNikkor105mm 1:2.8 D, Nikon) with a ring flash (Nikon SB-29S Macro Speedlight, Nikon). Forassessing anterior tooth replacements, the reference contralateral tooth had to be completely and symmetrically represented in orderto ensure comparability. For this purpose, the photographs were centered at the midline, in order to facilitate the subsequent analysis, which was primarily based on symme- try.Inaddition,standardizedclinicalphotographs were taken of each implant site and of the con- tralateral tooth (Figs. 2–4). These additional photographs were used as tools for a more de- tailed evaluation. All of the photographs were taken slightlysuperiortothe occlusalplane, cen- tered at the contact region. Photographs were then viewed on a 42 in. monitor (PPM42S3Q Plasma Display Panel Monitor, Samsung, Seoul, South Korea). Study casts, produced in Type IV stone, were finally fabricated for each of the 20 patients involved in the study. Study casts were fabricated to facilitate a direct and objective as- sessment related to the PES/WES index. The clinical photographs and the study casts were used to perform the esthetic evaluation. The esthetic evaluation was performed by an independent calibrated observer who was not part of the treating team, by means of the PES/ WES index 1 h after seating of the definitive restoration (three months after implant place- ment), and three years and five years after im- plant placement (follow-up), respectively.18 In order to reduce bias and to achieve good repro- ducibility, the evaluation was carried out twice, on different days. Inthe case ofdiverging scores, the observer carefully re-evaluated the photo- graphs and the study casts prior to making his final decision. A score of 2, 1 or 0 was assigned to each PES/WES parameter. The highest pos- sible PES scorewas 10,which represented a clo- se match of the periimplant soft-tissue condi- tions, and the highest possible WES score was 10, representing a close match of the clinical single-tooth crown compared with the respecti- ve features of the natural contralateral tooth. D a t a a n a l y s i s Forthe PESandWESevaluation,descriptive sta- tistics, including mean values, standard devia- tions,medians and range, were analyzed. More- over, in order to compare the differences in PES andWESassessmentsbetweenthebaselineand follow-up,theWilcoxon rank-sumtestforpaired datawasperformed.Thelevelofsignificancewas set at 0.05. All statistical analyses were run on the SPSS statisticalpackage (Version 17.0; SPSS, Chicago, Ill.,U.S.). Results Data from 20 patients were examined, with a mean time from surgery to evaluation of five years. No implants were lost. With regard to os- seointegration, all 20 anterior maxillary sin- gle-tooth implants fulfilled the success criteria, with an implant–crown success rate of 100%. All of the implants showed stable osseointegra- tion, with absence of pain or suppuration, ab- sence of clinically detectable implant mobility, absence of periimplant radiolucency, a DIB of < 1.5 mm during the first year of function, and absence of prosthetic complications at the im- plant–abutment interface. The mean DIB was 0.44 ± 0.14 mm (95% CI:0.41–0.47) at the five- year follow-up. The five-year PES/WES values are shown in Tables1–6.The mean PESwas 8.35 ± 1.63.With respect to the PES index, there was a significant 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 Volume 2 | Issue 1/201675

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