A retrospective 10-year mean follow-up of zirconia implants rehabilitations in aesthetic areas

EZSWZ ePOSTER CLINICAL RESEARCH – SURGERY

Background: The increasing focus on implant aesthetics has led to the evaluation of the appearance of peri-implant soft tissue and implant-supported restorations using well-defined esthetic parameters like the Pink Esthetic Score (PES) and the White Esthetic Score (WES). The use of ceramic implants associated with all-ceramic prosthetic rehabilitations can allow to achieve excellent aesthetic results, reducing the risk of greyish titanium shadowing on thin's biotype or on shrinks case over time.

Aim/Hypothesis: The aim of our study is to evaluate the aesthetic result after 10 years of follow-up, using the PES and WES index, on one-piece zirconia implants placed in the aesthetic area.

Materials and Methods: Eight patients (6 males and 2 females) were treated with 12 one-piece zirconia implants partially stabilized with Yttrium (White-Sky, Bredent, Senden, Germany) placed in aesthetic areas. All implants were immediately restored with acrylic provisional crowns and after six months with a fixed ceramic prosthesis. The esthetic result was evaluated using the Pink Esthetic Score (PES), the White Esthetic Score (WES) and readjusting them as suggested by Belser in 2009 (PES and WES). For the evaluation, were selected 4 operators, who participated in the protocol and specialist in one of the following disciplines: Surgery, Periodontology, Prosthetics and Orthodontics. By using a periodontal probe, the same operator identified the following peri-implant soft tissue parameters: the modified plaque index (mPI), the modified bleeding index (mBI), and probing depth (PD). The success rate and aesthetic appreciation of the implants were expressed as averages and standard deviations.

Results: This clinical study presents the aesthetic results of 12 dental implants placed in the anterior area according to the concept of early loading. The cumulative survival rate was 100% after 10 years. All aesthetic evaluations relating to the soft tissues and implant crowns were performed by clinicians who had not been involved in any treatment. From clinical evaluation, periodontal indexes showed an overall good level of peri-implant health. The evaluation of the Pink and White Esthetic Score showed an overall successful result (PES/WES Mean 13.79 SD 4.54). When examining the results on PES and WES, 60.4% of our cases showed a very good result, 29% of all evaluations denoted an unfavorable result with PES inferior to 6 and 25% of the results could be considered a failure with WES inferior to 6. Overall aesthetic outcome combining the results of the PES and WES showed excellent results on 20.8% (PES WES greater or equal to 18) and aesthetic failures on 31.5% (PES WES inferior to 12).

Conclusions and Clinical Implications: The outcome of this 10-year study suggest that the treatment of one-piece zirconia implants may be considered a valuable and predictable option in terms of implant survival and hard and soft tissue remodelling. In this study, we excluded high-risk patients with a thin gingival biotype and/or buccal bone defect. The choice of selected cases, appropriate surgical and restorative procedures and clinical experience are also considered of pivotal importance.

Keywords: Zirconia, Ceramic Implant, Metal free