Caroliene Meijndert

161 Summary In chapter 3 we describe a study assessing the clinical, radiographic and aesthetic outcomes, and the satisfaction of patients treated with single implant restorations in the maxillary aesthetic region five years after the final restoration. Sixty patients (29 male/31 female, mean age 37 years) with a missing anterior tooth in the maxilla received a bone level implant with a conical connection. In 29 patients, a bone augmentation procedure was necessary before implant placement (autogenous bone grafts mixed with spongiosa granules). All the implants were loaded after 3 months of submerged healing. The restoration consisted of an individually designed full-zirconia abutment veneered with porcelain. Follow-ups, including clinical and radiographic assessments, were conducted up to 60 months after the final restoration. The aesthetic outcome of the restoration was determined with the Pink Esthetic Score/White Esthetic Score (PES/ WES). Patient satisfaction was assessed with a VAS scale and satisfaction questionnaire. Fifty patients completed the 5-year follow-up. The implant survival was 100% and the restoration survival was 98%. The mean bone level change was −0.13 ± 0.66 mm, with a median (IQR) pocket probing depth of 2.75 [2.25; 3.25]. The mean PES and WES scores were 6.6 ± 1.7 and 7.8 ± 1.5, respectively. The patient satisfaction was high (92.1 ± 7.8 on 100 mm VAS scale). There were no differences between patients with or without a bone augmentation procedure. It was concluded that bone level implants with a conical connection are a reliable treatment option for single tooth replacements in the maxillary aesthetic zone. Bone level tapered implants have an advantage in terms of stability and less need for additional bone augmentation procedures in the healed sites, which might be advantageous for the maxillary aesthetic zone. In the study described in chapter 4 , the clinical, radiographic and aesthetic performance of bone level tapered implants placed in healed maxillary aesthetic sites was assessed during a one-year follow-up. Thirty participants (15 male, 15 female, mean age 38 years) with a single tooth diastema, that had healed without assistance for at least 3 months, received a bone level tapered implant. Buccal bone augmentation procedures were performed at implant placement if the buccal bone wall was less than 2 mm. A provisional restoration was connected after a healing phase of 3 months. A definitive restoration was placed 3 months after the provisional restoration. All the placed implants demonstrated good stability. A buccal bone augmentation procedure was needed in 77% of the cases. The median implant stability quotient value was 73 [68;76] at implant placement and had increased to 79 [76;81] when the definitive restoration was inserted (p<0.005). All the patients attended the follow-up one year after the definitive restoration was placed and none had lost an implant. The mean marginal bone loss was 0.07±0.10 mm, mid-buccal mucosa level A