Purpose: To evaluate and compare peri-implant tissue esthetics of single tooth implants in the anterior maxillary region using the pink esthetic score (PES) over a period of 1 year for different surgical and prosthetic treatment protocols.
Materials and methods: This cross-sectional descriptive study was conducted on 30 patients (eight women and 22 men) aged 20–55 years who had undergone rehabilitation with an implant-supported prosthesis in the anterior maxilla region—two screw-retained prostheses (SP) and 28 cemented prostheses (CP), corresponding to 22 central incisors, five lateral incisors, and three canine teeth. The prosthetic restorations were placed and had been followed up for a minimum of 12 months. Assessment of PES was made on seven variables vs a natural reference tooth and a numerical scoring system with numerical values; 0–2 was used, Intergroup comparison was done using a t-test to find any significant difference.
Results: The mean PES in this study was 8.97 ± 1.691 (range 7–13), which translated into an acceptable esthetic outcome. The mean PES score with the thick biotype was 9.62 ± 1.596 and 7.44 ± 0.527 with the thin biotype, and the difference is statistically significant. The mean PES score with a surgical technique involving flap exposure was 8.56 ± 1.315 and 9.43 ± 1.989 in flapless surgical technique, but the difference was insignificant. The mean PES score with immediate placement protocol was 9.60 ± 1.77 and 8.69 ± 1.59 in delayed placement protocol and the difference was statistically insignificant. The mean PES score with the immediate loading protocol was 10.14 ± 1.77 and 8.61 ± 1.53 in the delayed loading protocol and the difference was significant. The mean PES score for cement-retained prosthesis was 8.96 ± 1.753 and 9.00 ± 0.000 for SP, but the difference was insignificant.
Conclusion: A thicker biotype does produce favorable esthetics, but an interplay of placement protocol, loading protocol, type of restoration, and material also contributes to the outcome. The assessment of peri-implant tissues serves as a guide to deciding the surgical approach, implant placement, and loading protocol depending on the gingival biotype. Hence, it is recommended that PES be used as a mandatory evaluation tool in implant prosthodontics.
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