title: Alterations in soft tissue levels and aesthetics over a 16-22 year period following single implant treatment in periodontally-healthy patients: a retrospective case series.
abstract: OBJECTIVE
  Long term studies on single implants are scarce and merely focus on clinical response parameters, complications and bone remodelling. The objective of this retrospective case series was to assess alterations in soft tissue levels and aesthetics over a 16-22 year period in periodontally-healthy patients.
  
  
  METHODS
  Patients who had received a single turned implant in the anterior maxilla/mandible at the Dental Specialist Clinic in Malmö between 1987 and 1993 were invited for a re-examination on the basis of a number of inclusion criteria. Both neighbouring teeth had to be present at re-examination and baseline clinical photographs (within the first year of function) had to be available for soft tissue evaluation. These photographs were superimposed onto final clinical photographs to assess longitudinal soft tissue alterations.
  
  
  RESULTS
  Twenty-one patients (nine females; mean age 23, range 16-41) treated with 24 single implants met the criteria for soft tissue evaluation. Peri-implant soft tissue levels (papillae, midfacial level) remained stable over a 16-22 year observation period (p ≥ 0.372). However, neighbouring teeth demonstrated midfacial recession and eruption pointing to a major distortion with the implant crown (> 1 mm) in 5/24 (21%) and 10/24 (42%) of the cases, respectively. Baseline aesthetics was considered poor (mean Pink Esthetic Score 7.42, mean White Esthetic Score 5.43), yet a significant time effect could not be demonstrated (p ≥ 0.552). Implant and tooth bone loss was low (mean 0.6 mm and 0.4 mm, respectively) over a 16-22 year period.
  
  
  CONCLUSIONS
  This limited case series demonstrated stable peri-implant soft tissue levels and aesthetics in the long term following single implant treatment in periodontally-healthy patients. However, midfacial recession and eruption may be expected at neighbouring teeth.
authors.affiliation: Department of Periodontology and Oral Implantology, Faculty of Medicine and Health Sciences, Dental School, University of Ghent, Ghent, Belgium.
authors.forename: Melissa
authors.initials: M
authors.lastname: Dierens
authors.forename: Evelyn
authors.initials: E
authors.lastname: de Bruecker
authors.forename: Stefan
authors.initials: S
authors.lastname: Vandeweghe
authors.forename: Jëno
authors.initials: J
authors.lastname: Kisch
authors.forename: Hugo
authors.initials: H
authors.lastname: de Bruyn
authors.forename: Jan
authors.initials: J
authors.lastname: Cosyn
mesh_terms: D000293:Adolescent; D000328:Adult; D016301:Alveolar Bone Loss / Q000145:classification / Q000000981:diagnostic imaging; D001641:Bicuspid; D003116:Color; D003442:Crowns; D003481:Cuspid; D019250:Dental Implants, Single-Tooth; D003774:Dental Plaque Index; D019094:Dental Prosthesis, Implant-Supported; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000033:anatomy & histology*; D005889:Gingival Recession / Q000145:classification / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007180:Incisor; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D023861:Photography, Dental / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult