Caroliene Meijndert

72 Chapter 4 what the implant stability would be. Knowing that this implant scores high on both ISQ and IT values might help in considering immediate loading in future patients. One of the inclusion criteria for our participants was the presence of sufficient bone for implant placement. Despite this, the thickness of the labial bone wall was insufficient in 23 cases (77%) and had to be augmented to achieve a bone wall thickness of at least 2 mm, i.e. placement of tapered implants in sites where physiologic resorption has occurred does not always prevent the need for extra bone augmentation. The need for additional augmentation was also seen in other studies with unassisted healed sites in the aesthetic region. In the Zuiderveld (2019) study, 90% of the cases needed a bone augmentation procedure. If compared with a study with cylindrical implants in the maxillary aesthetic region, Boardman et al.(2016) reported that 90% of the healed site cases needed an additional bone augmentation procedure at implant placement. These percentages are very much alike, leaving the question if a tapered implant design diminishes the need for an additional bone augmentation unanswered. A thin bone wall (<2mm) labial to the implant tends to be more susceptible to resorption, leading to poor soft tissue support, which might lead to aesthetic failure as a consequence(Buser et al., 2017; Cosyn et al., 2017). The aesthetic outcome in our study was satisfactory, with an acceptable PES score of 6[4;7] (Belser et al., 2009) and small recession to the mid-buccal mucosa (-0.14±0.40mm) and papillae (+0.05 ± 0.60 mesial and +0.06 ± 0.53 distal). The median value of 6 for PES is rather low in the light that a possible score of 10 can be given for a perfect situation. Apparently, it is rather difficult in these healed sites to achieve an optimum result after physiologic resorption has occurred after removal of the tooth and flap surgery in combination with a local bone augmentation procedure. Comparison of the PES value with a study in which immediate implant placement was used in the maxillary aesthetic region reveals that this is a slightly higher, being a mean value of 6.8±1.5 (Zuiderveld et al., 2018). An explanation could be the flapless surgery in case of immediate implant placement. There was not a significant difference in mid-buccal mucosa level and in papilla height between the first month (T 1 ) and 12 months (T 12 ) after definitive crown placement, meaning that soft tissues are stable in the first year after definitive restoration placement. The mucosa changes of both the mid-buccal gingiva and the papillae are within the range of that previously found by the other authors (Cosyn et al., 2015; de Bruyckere et al., 2018; Zuiderveld et al., 2019) who also presented minor changes in the soft tissues, indicating that the BLT implant is comparable to the other, more or less equally shaped, implants and accompanied with