title: Impact of placement and restoration timing on single-implant esthetic outcome - a randomized clinical trial.
abstract: OBJECTIVE
  The objective of this randomized clinical trial was to investigate the influence of the time of implant placement (immediate vs. early) and the time of restoration (immediate vs. early) on esthetic outcome in maxillary anterior single implants.
  
  
  METHODS
  Forty-eight patients with a single failing incisor in the maxilla and a natural contralateral site were randomly distributed into four groups. Treatment variations affected the time of implant placement (immediate or early) as well as the time of restoration (immediate or early) - in detail, group 1a with immediate implant placement and immediate temporary restoration, group 1b with immediate implant placement and early restoration, group 2a with early implant placement and immediate temporary restoration, and group 2b with early implant placement and early restoration. All patients received the final prosthetic restoration 10-12 weeks after implant placement. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES after Fürhauser. For statistical analysis, the Kruskal-Wallis test and Dunn's post hoc test were applied. Interobserver reliability was evaluated by Krippendorff's alpha.
  
  
  RESULTS
  The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 1a), 7.93 (SD 3.21, group 1b), 6.62 (SD 3.24, group 2a), and 8.10 (SD 3.25, group 2b). The differences between groups 2a and 1a and between groups 2a and 2b were statistically significant (P = 0.015 and P = 0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity.
  
  
  CONCLUSIONS
  Immediate implant placement and restoration appear to be a viable alternative to early implant placement if an experienced surgeon is entrusted with the implantation procedure.
authors.affiliation: School of Dental Medicine, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Rieder
authors.affiliation: Private Practice, Weiden, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Eggert
authors.affiliation: Private Practice, Weiden, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Krafft
authors.affiliation: Department of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine, Boston, MA, USA.
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Weber
authors.affiliation: School of Dental Medicine, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Manfred G
authors.initials: MG
authors.lastname: Wichmann
authors.affiliation: School of Dental Medicine, University of Erlangen-Nuremberg, Erlangen, Germany.
authors.forename: Siegfried M
authors.initials: SM
authors.lastname: Heckmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019250:Dental Implants, Single-Tooth; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000379:methods*; D007180:Incisor; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
keywords: Pink Esthetic Score; controlled clinical trial; early implant placement; early restoration; esthetic outcome; immediate implant placement; immediate restoration; single implant