Conventional, early and immediate single implant treatment in the anterior maxilla: diagnostic considerations and results

Student thesis: Doctoral Thesis


The impending loss of a single tooth in the aesthetic zone can be a distressing experience. There are several treatment options to restore a single tooth gap, such as removable partial denture, fixed partial denture and implant-supported fixed prostheses. Since success rates and predictability of dental implant applications for single- tooth replacements have improved over the years, the latter has become more and more the treatment of choice. However, the success is not only determined by implant survival rate, but also by the quality of survival. To achieve this ultimate goal, various implant treatment strategies have been proposed.
The main objective of the present thesis was to assess the medium-term outcome of single implant treatment in the anterior maxilla following conventional, early and immediate implant installation. Special attention was paid to predictability from a biological and aesthetic point of view. Key questions in this respect were related to diagnostic considerations (chapters 3 and 4) and treatment outcome (chapters 5, 6 and 7).
In reference to diagnostic considerations, the gingival biotype is of particular interest for the clinician, as patients with a thin-scalloped biotype present a higher risk for aesthetic failure. As a result, the gingival biotype has become one of the selection criteria for immediate implant treatment. The prevalence of the different gingival biotypes was previously investigated in chapter 3. Out of a large group of young adults 3 clusters with specific features were identified using simple diagnostic methods. In an attempt to evaluate the precision and accuracy of simple visual inspection as a method to indentify the biotype, we conducted a study based on the same subjects. As a result, simple visual inspection could not be considered as a valuable method to identify the gingival biotype (chapter 4).
In our medium-term clinical studies it was demonstrated that conventional, early and immediate single implant treatment may be considered valuable and predictable options in terms of implant survival as well as in terms of hard and soft tissue remodelling. A thin-scalloped biotype was associated with low distal papillae and alveolar process deficiency. In general, papillae were easy to satisfy, whereas alveolar process and tooth colour most difficult. Although all treatments were performed by experienced clinicians and only straightforward cases were selected, 1 out of 4-5 cases were aesthetic failures and only a minority showed perfection (chapters 5, 6 and 7). Nevertheless, the score on the patient's aesthetic satisfaction remained high, irrespective of the treatment protocol indicating lower and possibly less critical standards. Careful case selection with respect to the gingival biotype, appropriate surgical and restorative procedures and clinical experience are considered of pivotal importance. More long-term prospective studies with data relating to aesthetic aspects of conventional, early and immediate single implants are essential.
Date of Award16 Jun 2011
Original languageEnglish
Awarding Institution
  • Vrije Universiteit Brussel
SupervisorJan Cosyn (Promotor), Roberto Cleymaet (Promotor), Hugo De Bruyn (Co-promotor), Peter Bottenberg (Jury), Kristiaan Collys (Jury), Alain Dupont (Jury), Mehran Moradi Sabzevar (Jury), Laurence Den Hartog (Jury), Peter De Coster (Jury) & Wim Teughels (Jury)


  • dental implant
  • single tooth
  • conventional
  • immediate

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