Single tooth implants in the esthetic zone following a two-stage all flapless approach: A retrospective analysis

Due to chronic inflammation or trauma facial bone is frequently missing after tooth loss in the esthetic zone. As a consequence, procedures to augment or at least to preserve bone are frequently necessary prior to implant placement.

The aim of this retrospective case series is to demonstrate the applicability of a staged all-flapless concept to establish satisfactory implant restorations following situations of partial missing facial bone in the esthetic zone.

Radiological/clinical data of 25 patients were analyzed and an esthetic evaluation of 24 patients was performed. The staged concept included ridge preservation at time of tooth extraction and delayed guided implant placement. Marginal bone loss was measured radiologically and esthetic evaluation was performed based on standardized photographs using the Pink Esthetic Score as well as the Papilla Index.

Implant success rate revealed 100%. The mean radiological peri-implant marginal bone loss measured 1.16 mm (SD: 0.16). Regarding the esthetic outcome 71% of patients were evaluated with a Pink Esthetic Score higher or equal to 10 constituting satisfactory esthetics (median pink esthetic score: 10). The mean follow-up time for clinical and radiographic analysis was 1.3 years (SD: 0.6 years) and 1.2 years (SD: 0.6) for esthetic evaluation.

Although marginal bone loss cannot be avoided, the staged concept of flapless ridge preservation and subsequent delayed flapless guided implant placement carries the potential to improve esthetics of single-tooth implants in the anterior maxilla.