Caroliene Meijndert

54 Chapter 3 observer, this would imply that there was a change in position of the surrounding dentition relative to the implant crown. This change in position has been confirmed in the literature and addressed in a systematic review by Papageorgiou and collegues (Papageorgiou et al., 2018). It is thought that eruption of teeth is most prone in adolescents and young adults and that this development decreases to a clinically insignificant proportion in the second decade of life (Fudalej et al., 2007). However, this was not supported by studies of Bernard et al (Bernard et al., 2004) and Huanca Ghislanzoni et al (Huanca Ghislanzoni et al., 2017) who studied continued eruption of natural teeth next to dental implants and found no correlation between age and infraposition of the implant crown. Nevertheless, clinicians need to be aware that long-term adverse effects of dental implants among natural teeth can be observed in terms of infraposition. Patient satisfaction was rated high in our study. Patients were more satisfied with the crown than with the formof the peri-implant mucosa. This is in contrast to the augmented population described by Pieri et al. (2013), who reported equal satisfaction between the crown and the surrounding mucosa. Gotfredsen (2004) reported high patient satisfaction on crown aesthetics, but no specific data on the satisfaction of the soft tissues. Themean PES in the present study was high, with a higher score in the non-augmented group. On the contrary, Pieri et al. (2013) reported slightly higher PES scores for his population with augmented patients but had no comparison group. The additional surgical procedure in the augmented group could have negatively affected the aesthetic outcome due to scarring of the mucosa, which may underlie the lower PES score. Nevertheless, the patient satisfaction scores and professional rating in both groups remained high at the T60 follow-up evaluation. A limitation of the study is that both patients needing and not needing an augmentation procedure were included in the study. A non-randomized controlled clinical trial would have been a better study design to explore a possible significant difference between the two subgroups. Another limitation of this study is that 10 patients (17% of the initial group) were lost to follow-up. Results of these patients could differ from the group which were seen for evaluation. Conclusion This prospective cohort study showed that peri-implant tissues were healthy, marginal bone loss was minor, patient satisfaction was high and aesthetic outcome was favourable. Thus, a bone level implant with conical connection is a reliable treatment option in single tooth replacement in the maxillary aesthetic zone.