title: Three-Dimensional buccal bone anatomy and aesthetic outcome of single dental implants replacing maxillary incisors.
abstract: OBJECTIVE
  This case series investigated by means of CBCT, buccal bone three-dimensional anatomy at delayed, two-stage implants in the maxillary incisal tooth region. Moreover, the relation between buccal bone anatomy and soft tissue aesthetics was assessed.
  
  
  METHODS
  Twelve implants were analysed after on average 8.9 years in function. Baseline and re-evaluation photographs were assessed using the pink aesthetic score (PES). Marginal bone changes were measured from intraoral X-rays. The buccal bone volume associated with the implant and the implant surface not covered by visible buccal bone was computed on CBCT data sets. Buccal bone thickness and level were assessed, as well as the thickness of the crest distally and mesially of the implant. Changes in soft tissue forms and correlation between aesthetics and bone anatomy were calculated by nonparametric statistics.
  
  
  RESULTS
  Buccal bone level was located 3.8 mm apical of the implant shoulder, and none of the implants had complete bone coverage. Buccal bone volume was 144.3 mm(3) , and 4.29 mm(3) in the more coronal 2 mm portion. PES did not differ at re-evaluation (9.7) and baseline (9.2). PES was directly correlated with crestal thickness mesially and distally of the implant shoulder. No other significant correlations were observed between bone anatomy and PES or buccal peri-implant health. Marginal bone gain over time was associated with greater coronal bone volume buccally and with greater buccal and marginal bone thickness, while loss was related to less or no bone.
  
  
  CONCLUSIONS
  Within present limitations, acceptable and stable aesthetics are not jeopardized by a thin or missing buccal bone.
authors.affiliation: Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Mario
authors.identifier: http://orcid.org/0000-0003-0544-3225
authors.initials: M
authors.lastname: Veltri
authors.affiliation: Department of Oral and Maxillofacial Radiology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Ekestubbe
authors.affiliation: Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Abrahamsson
authors.affiliation: Department of Periodontology, Institute of Odontology, The Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
authors.forename: Jan L
authors.initials: JL
authors.lastname: Wennström
mesh_terms: D000539:Alveolar Process / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D054893:Cone-Beam Computed Tomography; D019250:Dental Implants, Single-Tooth; D004955:Esthetics, Dental; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007180:Incisor; D008437:Maxilla
keywords: CBCT; aesthetics; alveolar process; dental implants