Buccal bone dimensions and aesthetic outcome at maxillary incisors replaced by conventional dental implants. A case series with a 5-year follow-up

In the aesthetic field, successful replacement of a tooth with a dental implant requires blend and harmony within the existing dentition. The influence of the dimension of buccal bone at implant sites on aesthetic outcomes and the relation between buccal bone horizontal and vertical dimensions are unclear. The aim of the present study is to investigate the correlation between buccal bone thickness, buccal bone level and aesthetic outcome in conventionally placed implants – placed five or more years previously – supporting single maxillary incisors. Eight subjects with 8 implants and with periapical and parallel profile X-rays were clinically examined to assess the “Pink Aesthetic Score” (PES). Buccal bone level and thickness, together with the interproximal bone level, were measured. Implant survival was 100%. The mean time of implants function was 89.3 months (standard deviation 43, range 61-145). The mean PES value was 9.4. The mean interproximal bone level was located 1.3 mm apically to the implant abutment junction, while the corresponding buccal value was 1.6 mm. Buccal bone was mostly absent at the implant abutment junction; 2 and 4 mm apically respect to the junction the thickness was on average 0.44 and 0.89 mm, respectively. The dimension of buccal bone level was correlated to the buccal bone thickness at 2mm-level, to the interproximal bone level and to the soft tissue contour score. Conventional implant placement in pristine bone might lead to satisfactory long-term aesthetic results. The level of the facial mucosa and appearance of the alveolar process might emerge as critical aspects.