Caroliene Meijndert

108 Chapter 6 The patient described in case 3 started with no crown to score for PES/WES, therefore PES/WES was not rated prior to treatment. The patient was very satisfied with aesthetic and functional abilities at the 12-month follow-up. Bleeding on probing was not detected. The peri-apical radiograph showed good maturation of bone with minimal change in bone level. Overall, implant survival rate was 100%. Mean bone level increased with 0.24±0.30mm. Mean PES score improved from score 4.0 at T pre to 7.0 at T 12 , WES improved from 3 at T pre to 7.3 at T 12 , patient satisfaction improved from 55.7 at T pre to 90.0 T 12 on the VAS scale. No technical or biological complications occurred up to 1-year follow up. Discussion This case series presents the results of three patients that were treated with the new Straumann BLX tapered bone level implant, immediately after tooth extraction. After 15 months in function, both patient reported outcome and aesthetic score were much improved compared to the pre-treatment situation. The three patients presented with satisfying hard and soft peri-implant tissues. Radiographic images 12 months after definitive crown placement (the implants were 15 months in function at this time) show a mean bone level change of +0.24±0.30 mm, which implies a bone ˋgainˊ. De Bruyn et al. (2012) reported a bone change of +1.3mm after 1year in an immediate implant placement group. They attributed this bone gain to healing of the extraction socket. It is not unlikely that a similar mechanism applies here. The implant is also equipped with features that, in other studies, have shown to be favourable in the preservation of cortical bone around the implant. For example a platform switch (Hsu et al., 2017; Strietzel et al., 2015) and a conical implant-abutment connection ( Mishra et al., 2017; Caricasulo et al., 2018;). There is not much known about the effect of the connection configuration on the aesthetic outcome in the anterior region. Cooper et al. (2019) compared three different connection configurations in the anterior region. They found the least bone loss in the conical connection group but found no statistical significant difference in the papillae level change or the PES score. They stated that more research on the effect of implant-abutment interface design is needed. This is also acknowledged by Barwacz et al. (2016). The three studied patients in this report presented with satisfying improvements as expressed in a PES score of 7.0 and patient questionnaire score (VAS-scale score) of