Publications by authors named "Robert Noelken"

13 Publications

  • Page 1 of 1

Peri-implant defect grafting with autogenous bone or bone graft material in immediate implant placement in molar extraction sites-1- to 3-year results of a prospective randomized study.

Clin Oral Implants Res 2020 Nov 22;31(11):1138-1148. Epub 2020 Sep 22.

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Objectives: To evaluate the survival rate, the orobuccal bone resorption and stability of peri-implant hard and soft tissues following immediate implant placement of wide diameter implants in molar extraction sites and peri-implant defect grafting with autogenous bone (AB) or biphasic bone graft material (BBGM) with 1- to 3-year follow-up examinations.

Material And Methods: Fifty wide diameter implants were placed in 50 patients immediately into molar extraction sockets by a flapless approach. Peri-implant defect augmentation was performed randomized with either AB or BBGM. Primary outcome variable was implant survival. Marginal bone level changes, orobuccal width of the alveolar crest, probing depths, and implant success were considered as secondary parameters.

Results: One implant of the BBGM group was lost, 1 patient withdrew from the study (drop-out). The remaining 48 patients were still in function at a follow-up period up to 31 months after implant insertion. Interproximal marginal bone level regenerated from -7.5 mm to the level of the implant shoulder (AB + 0.38 mm, BBGM + 0.1 mm) at final follow-up. The width of the alveolar crest changed by -0.08 mm (AB) and +0.72 mm (BBGM) at 1 mm, -0.36 mm (AB) and +0.27 mm (BBGM) at 3 mm, -0.36 mm (AB) and +0.31 mm (BBGM) at 6 mm apical to implant shoulder level. Success rate was 87.5% in the AB and 56.3% in the BBGM group (p = .058).

Conclusions: Medium-term results prove a high survival rate, a favorable amount of bone generation in both groups and a low amount of orobuccal resorption in immediate molar implant insertion.
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http://dx.doi.org/10.1111/clr.13660DOI Listing
November 2020

A modified surgical approach for hard and soft tissue reconstruction of severe periimplantitis defects: laser-assisted periimplant defect regeneration (LAPIDER).

Int J Implant Dent 2020 Jun 10;6(1):22. Epub 2020 Jun 10.

Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Background: The main problem in periimplantitis is often the combination of severe periimplant bone loss with a contaminated implant surface and an insufficient soft tissue situation. Classic surgical concepts with crestal access to the bony defect and debridement of the surface most often lead to partial defect regeneration and a soft tissue recession. An incision directly above the pathologic bony lesion is contrary to general surgical treatment rules.

Aim: To overcome this problem, a new surgical concept was developed which allows to clean the implant surface, reconstruct the bony defect, and improve soft tissue height and thickness without cutting the papilla complex. This publication presents the innovative regenerative treatment approach for severe periimplantitis defects.

Material And Methods: After diagnosis and non-surgical pre-treatment of a severe periimplantitis lesion, the following treatment protocol was applied: horizontal mucosal incision 5 mm apical to marginal mucosa, supraperiosteal preparation in apical direction, cutting through periosteum at the level of the implant apex, subperiosteal coronal flap elevation, exploration and cleaning of the periimplant defect, thorough debridement of the implant surface with the Er:YAG laser, subperiosteal grafting with connective tissue, grafting of the bony defect with autogenous bone chips from the mandibular ramus, and bilayered suturing of periosteum and mucosa. Implant survival, marginal bone levels, periimplant probing depths, recession, and facial mucosa thickness (PIROP ultrasonic measurement) were evaluated in a pilot case at 1-year follow-up examination.

Results: Inter-proximal, oral, and buccal marginal bone levels increased significantly to the level of the implant shoulder from pre-operative to 1-year follow-up examination. No signs of suppuration or periimplant infection were present. Probing depths and recession decreased significantly, while the facial mucosa thickness improved from pre-operative to final examination.

Conclusions: Marginal bone levels and soft tissue improvement suggest feasibility for the regeneration of severe periimplant hard and soft tissue deficiencies by this new treatment approach. With the use of this concept, the simultaneous implant surface cleansing and improvement of hard and soft tissue seem to be possible and unfavorable postoperative exposition of titanium surface might be prevented. Comparative studies are planned to quantify the effects of this new surgical protocol.
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http://dx.doi.org/10.1186/s40729-020-00218-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7283420PMC
June 2020

Retrospective cohort study of a tapered implant with high primary stability in patients with local and systemic risk factors-7-year data.

Int J Implant Dent 2018 Dec 17;4(1):41. Epub 2018 Dec 17.

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Augustusplatz 2, 55131, Mainz, Germany.

Objectives: This retrospective study examined the mid- to long-term clinical and radiographic performance of a tapered implant in various treatment protocols in patients with local and systemic risk factors (RFs).

Material And Methods: Two hundred seven NobelActive implants were inserted in 98 patients in the period from 10/2008 to 02/2015. The subdivision of the cohort was defined by local (n = 40), systemic (n = 6), local and systemic (n = 8), or without any RFs (n = 44) to analyze implant survival and marginal bone levels.

Results: Fifteen implants failed within the follow-up period. The mean follow-up period of the remaining implants was 34 months (range 12 to 77 months). The cumulative survival rate according to Kaplan-Meier was 91.5%. The survival rate for 93 implants in 45 patients with no RFs was 94.8% whereas it was 94% for 83 implants in 48 patients with local RFs (p = 0.618), 81.3% for 14 implants in 6 patients with systemic RFs (p = 0.173), and 76.5% for 17 implants in 6 patients with local and systemic risk factors (p = 0.006). The interproximal marginal bone level was - 0.49 ± 0.83 mm at the mesial aspect and - 0.51 ± 0.82 mm at the distal aspect in relation to implant shoulder level and showed no relevant difference in the various risk factor groups.

Conclusions: It can be assumed that the negative effects of the local or/and systemic risk factors were partially compensated by the primary stability and grade of osseointegration of the NobelActive implant.

Clinical Relevance: The use of this system in patients with risk factors and immediate loading procedures.
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http://dx.doi.org/10.1186/s40729-018-0151-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6295441PMC
December 2018

Influence of soft tissue grafting, orofacial implant position, and angulation on facial hard and soft tissue thickness at immediately inserted and provisionalized implants in the anterior maxilla.

Clin Implant Dent Relat Res 2018 Oct 9;20(5):674-682. Epub 2018 Aug 9.

Department of Oral and Maxillofacial Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Background: Resorption of hard and soft tissues following immediate implant insertion is frequently reported. Data regarding the influencing factors on facial tissue thickness are rare.

Purpose: This retrospective study investigated the impact of connective tissue grafting, the orofacial angulation and position of immediately inserted and provisionalized implants on the facial hard and soft tissue thickness in the anterior maxilla within a 1- to 5-year follow-up.

Material And Methods: Implants with the prerequisite of having preoperative and postoperative cone beam computed tomography (CBCT) and a follow-up of 1 to 5 years were included. Facial bone deficiencies were grafted flaplessly with autogenous bone in all sites. In a subgroup of implants additional connective tissue grafting was performed, whereas the remaining implants were not grafted with soft tissue. The orofacial tooth and implant angulation, the change of horizontal position and the facial bone thickness were measured by CBCT, the facial mucosa thickness by an ultrasonic device.

Results: In total, 76 implants were placed in 55 patients. Sixty-nine sites showed a facial bone defect. Thirty-eight received a connective tissue graft additionally. All implants were still in function after a mean follow-up of 36 months. The mean thickness of the facial mucosa was 1.72 mm at 1 mm, 1.63 mm at 4 mm, 1.52 mm at 6 mm, and 1.66 mm at 9 mm apically to mucosal margin. The bone thickness was 0.02, 0.25, and 0.36 mm initially and 1.32, 1.26, and 1.11 mm finally at 1, 3, and 6 mm apically to implant shoulder level. Mixed model analysis revealed an impact of the preoperative bone status on the facial bone increase. The facial soft tissue thickness was significantly influenced by the gingival biotype.

Conclusions: The results indicate that an initial severe hard tissue defect allows for significant bone regeneration. The facial soft tissue thickness is primarily influenced by the gingival biotype.
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http://dx.doi.org/10.1111/cid.12643DOI Listing
October 2018

Clinical and esthetic outcome with immediate insertion and provisionalization with or without connective tissue grafting in presence of mucogingival recessions: A retrospective analysis with follow-up between 1 and 8 years.

Clin Implant Dent Relat Res 2018 Jun 24;20(3):285-293. Epub 2018 Mar 24.

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Germany.

Background: Recessions following immediate implant insertion are frequently reported in the literature. Data regarding implant installation in presence of mucogingival recessions are rare.

Purpose: This study observes soft tissue level changes following immediate implant insertion and provisionalization of implants with or without connective tissue grafts in the anterior maxilla in patients with initial mucogingival recession within a follow-up period between one and eight years.

Materials And Methods: Twenty-six patients with marginal gingival recessions, which were designated for extraction and immediate implant insertion in the anterior zone of the maxilla (13-23), were included. Out of a larger group of immediate implants only single tooth replacements with 1 to 3 mm recession and a pre- and post-op CB-CT were selected. Facial bone deficiencies were grafted flaplessly with autologous bone in all sites. In a group of 13 patients the recessions (mean 2.3 ± 0.7 mm, range 1.0-3.0 mm) were grafted additionally by connective tissue (ABG + CTG), in the remaining 13 patients no soft tissue grafting (mean recession 1.8 ± 0.6 mm, range 1.0-3.0 mm) was performed (ABG). The marginal hard and soft tissue level, the width of the keratinized mucosa, the PES, and implant success were evaluated.

Results: After a mean follow-up period of 45 months the recessions were significantly reduced in the ABG group from 1.8 to 0.9 mm. The improvement was even more pronounced in the ABG + CTG group (from 2.3 to 0.5 mm). The PES improved significantly in both groups. At final examination all implants were still in function. Within the observational period, in 5 of 13 implants a marginal bone loss of more than 1 mm was noticed in the ABG, but in none of the ABG + CTG group.

Conclusions: These clinical results provide evidence that immediate implant placement might improve the facial soft tissue level. This was more evident in cases with a greater recession and an additional treatment with connective tissue grafts.
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http://dx.doi.org/10.1111/cid.12595DOI Listing
June 2018

Immediate and flapless implant insertion and provisionalization using autogenous bone grafts in the esthetic zone: 5-year results.

Clin Oral Implants Res 2018 Mar;29(3):320-327

Department of Oral and Maxillofacial Surgery - Plastic Surgery, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.

Objectives: As the 2-year results for immediately inserted and provisionalized implants have been reported, it remained an open issue, whether the initially high success rates and the esthetic outcome remain stable for longer observation periods. Therefore, this prospective study examines the 5-year hard and soft tissue changes at implants placed in the anterior maxilla.

Material And Methods: Meanwhile, 37 microthreaded implants were placed in 21 patients into extraction sockets with and without facial bone deficiencies by a flapless approach. Facial gaps and bony defects were grafted with autogenous bone chips. The implants were immediately provisionalized. The primary outcome parameters were the interproximal marginal bone level and the thickness of the facial bony wall. Implant success and Pink Esthetic Score (PES) were considered as secondary outcome parameters.

Results: Two patients with four implants withdrew from the study (dropouts), and the remaining 33 implants were still in function at a follow-up period of 68 months. Marginal bone height averaged 0.04 mm coronal to the implant shoulder. The thickness of the facial bony lamellae increased significantly between pre-op examination and 1-year follow-up (p = .002) and thereafter remained stable. Within 5 years of follow-up, 24 of 33 implants were clinically stable, free of signs and symptoms, and showed bone loss less than 1 mm. The mean PES ratings improved slightly from 10.7 pre-operatively to 11.7 at the last follow-up (p = .02).

Conclusions: Interproximal marginal bone levels, survival rates, and esthetic results remain stable at the 5-year follow-up in implants used in an immediate insertion, reconstruction, and provisionalization concept. Facial marginal bone levels decreased slightly; however, this reduction did not affect the PES so far.
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http://dx.doi.org/10.1111/clr.13119DOI Listing
March 2018

Immediately provisionalized OsseoSpeed(™) Profile implants inserted into extraction sockets: 3-year results.

Clin Oral Implants Res 2016 Jun 24;27(6):744-9. Epub 2015 Aug 24.

Department of Oral and Maxillofacial Surgery, Johannes Gutenberg University of Mainz, Mainz, Germany.

Objectives: A sloped shoulder might improve the congruence between extraction socket and dental implant and may add to a better circumferential support of the peri-implant structures. Therefore, this study evaluates the 3-year clinical outcome (survival and success rates, marginal bone levels, and Pink Esthetic Score (PES)) of immediately inserted and provisionalized OsseoSpeed(™) Profile implants in the anterior maxilla.

Material And Methods: Twenty-one implants were inserted in 16 patients. All implants were immediately placed into extraction sites with and without facial bone deficiencies. A flapless procedure was utilized, and the implants were provisionalized immediately. Facial gaps were grafted with autogenous bone chips from the mandibular ramus. Implant survival and success, the interproximal bone levels, the thickness of the facial bony wall, and the PES were evaluated.

Results: After a mean follow-up period of 43 months, 19 implants were still in function. One patient with 1 implant did not follow the study protocol (dropout) and 1 implant was lost at 10 weeks. Interproximal marginal bone levels measured -0.2 ± 0.4 mm (range, -1.0-0.4 mm) apical to the implant shoulder. The mean PES ratings were 11.9 ± 1.4 (range, 8-14) at the final examination.

Conclusions: Clinical and radiographic results provide evidence that sloped implants can preserve the marginal bone circumferentially and are able to maintain soft tissue esthetics when inserted and provisionalized immediately, even in the presence of facial bony wall defects.
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http://dx.doi.org/10.1111/clr.12651DOI Listing
June 2016

Maintenance of marginal bone support and soft tissue esthetics at immediately provisionalized OsseoSpeed implants placed into extraction sites: 2-year results.

Clin Oral Implants Res 2014 Feb 14;25(2):214-20. Epub 2013 Jan 14.

Private Practice for Oral Surgery, Lindau/Lake Constance, Germany; Department of Oral and Maxillofacial Surgery, University of Mainz, Mainz, Germany.

Background: Placement of implants into extraction sockets targets the maintenance of peri-implant hard and soft tissue structures and the support of a natural and esthetic contour. The main advantages of immediate implant insertion in comparison with delayed implant placement protocols are as follows: a reduced treatment time, less number of sessions, and, thus, the less invasive procedure. This study examines the clinical performance (survival rate, marginal bone levels and Pink Esthetic Score [PES]) of OsseoSpeed implants placed into extraction sockets with immediate provisionalization in the anterior maxilla after a follow-up of at least 12 months.

Methods: Twenty patients received a total number of 37 OsseoSpeed implants which were immediately inserted into extraction sockets with or without facial bone deficiencies of various dimensions. A flapless procedure was applied, and the implants were immediately provisionalized with temporary crowns without occlusal contacts. Facial gaps between implant surface and facial bone or the previous contour of the alveolar process were grafted with autogenous bone chips. Implants in diameters 3.5, 4.0, 4.5, and 5.0 with lengths of 11-17 mm were used in the study. During the course of the study, interproximal marginal bone levels, the thickness of the facial bony wall, implant success rate according to the criteria established by Buser, and the PES were assessed per implant.

Results: One patient with three implants did not continue the study after prosthesis delivery, the remaining 34 implants were still in function at the final follow-up (survival rate: 100%). The mean follow-up period was 27 months (range, 12-40 months). Marginal bone height at the level of the implant shoulder averaged -0.1 ± 0.55 mm (range, -1.25 to 1.47 mm) at the final follow-up. The mean PES ratings were 11.3 ± 1.8 (range, 6-14) at the final follow-up. In 78% of the patients, the PES was preserved or even improved.

Conclusions: Success rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of marginal bone height at immediately placed and provisionalized OsseoSpeed implants after a follow-up of at least 12 months. Even implant sites with facial bony deficiencies can be successfully treated with a favorable esthetic outcome using the immediate implant insertion, immediate reconstruction, and immediate provisionalization technique.
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http://dx.doi.org/10.1111/clr.12069DOI Listing
February 2014

Soft and hard tissue alterations around implants placed in an alveolar ridge with a sloped configuration.

Clin Oral Implants Res 2014 Jan 5;25(1):3-9. Epub 2012 Dec 5.

Private Practice, Lindau/Lake Constance, Germany; Lake Constance & University of Mainz, Mainz, Germany.

Aim: The aim of this study was to evaluate soft and hard tissue alterations around implants placed in healed, sloped ridge sites.

Materials And Methods: In this prospective multi-center study, 65 patients between 20 and 74 years of age and with a need for a single tooth replacement were included. All patients presented with a recipient implant site demonstrating a lingual-buccal bone height discrepancy of 2.0-5.0 mm and with a neighboring tooth on its mesial aspect. Implant placement (OsseoSpeed™ Profile implants; Astra Tech AB, Mölndal, Sweden) was performed using a non-submerged installation procedure. The implants were placed in such a way that the sloped part of the device was located at the buccal and most apical position of the osteotomy preparation. As the buccal rim of the implant was positioned at the crestal bone level, the lingual rim became situated either below or at the level of the lingual bone crest. Clinical assessments of bone levels at the buccal and lingual aspects of the implant were carried out immediately after implant installation and at a surgical re-entry procedure performed 16 weeks later. Crowns were placed at 21 weeks after implant placement. Radiographs were obtained immediately after implant placement, at 16 and 21 weeks and at the 1-year re-examination. Clinical assessment of probing pocket depth and clinical attachment levels were carried out at 21 weeks and at 1 year of follow-up.

Results: The alterations of the bone levels that occurred between implant placement and the 16-week surgical re-entry were -0.02 mm (lingual) and -0.30 mm (buccal). The average change in interproximal bone levels between implant placement and the 1-year re-examination was 0.54 mm. Clinical attachment level changes between the 21 week and the 1-year examinations varied between 0.1 mm gain and 0.1 mm loss.

Conclusion: Implant placement in an alveolar ridge with a sloped marginal configuration resulted in minor remodeling with preserved discrepancies between buccal and lingual bone levels.
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http://dx.doi.org/10.1111/clr.12079DOI Listing
January 2014

Immediate nonfunctional loading of NobelPerfect implants in the anterior dental arch in private practice--5-year data.

Clin Implant Dent Relat Res 2014 Feb 29;16(1):21-31. Epub 2012 Feb 29.

Private practice for Oral Surgery, Lindau/Lake Constance, Germany and research fellow, Department of Oral and Maxillofacial Surgery, University of Mainz, Germany Professor and head of clinic, Department of Oral and Maxillofacial Surgery, University Hospital of Bochum, Germany Consultant, Department of Orthodontics, University Hospital of Mainz, Germany Professor and head of clinic, Department of Oral and Maxillofacial Surgery, University Hospital of Mainz, Germany.

Background: The concept of scalloped implants to maintain the natural contour of the alveolar ridge has been a source of controversy for many years.

Purpose: This study examined the long-term clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate loading in the esthetic zone).

Materials And Methods: In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants in a private practice and followed for up to 78 months. Twenty-one implants were placed immediately after extraction, seven implants were placed after osseous consolidation of the extraction sockets, and three implants were placed secondary to extended alveolar ridge augmentation procedures. All implants were provisionalized on the day of implant placement and adjusted to clear all contacts in centric occlusion and during eccentric movements. Outcome variables were success rates, marginal bone levels, and pink esthetic score (PES) assessed per implant.

Results: One implant failed after 1.4 months. Five patients with six implants in total were scored in the 5-year follow-up as dropouts. Mean follow-up period of remaining 24 implants was 65 months (range, 55-78 months). Cumulative success rates according to the criteria specified by Smith and Zarb were 96.8%. Marginal bone levels averaged 1.1 mm above the first thread. Mean PES ratings were 10.5 (range, 3-13).

Conclusions: Survival rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of the interproximal bony lamella with a scalloped implant design in long-term data.
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http://dx.doi.org/10.1111/j.1708-8208.2012.00449.xDOI Listing
February 2014

Does thread design influence relative bone-to-implant contact rate of palatal implants?

J Orofac Orthop 2011 Jul 10;72(3):204-13. Epub 2011 Jul 10.

Department of Orthodontics, University Hospital Mainz, Augustusplatz 2, 55131 Mainz, Germany.

Aim: To determine histologically whether (a) changing the thread design between first- and second-generation palatal implants (Straumann, Basel, Switzerland) influences the bone-to-implant contact (BIC) rate of palatal implants subjected to conventional loading, and (b) whether histological evidence of peri-implantitis appears in this setting.

Patients And Methods: Patients who had received an orthodontic palatal implant for skeletal anchorage between January 1998 and December 2007 were examined. First-generation palatal implants (Straumann, Basel, Switzerland) 3.3 mm in diameter and 6 mm or 4 mm long were used, as were second-generation implants 4.1 mm in diameter and 4.2 mm long. After completion of active orthodontic treatment, the implants were removed and prepared for histological investigation. This study was designed as a comparative analysis of a series of two cases: 28 explanted first-generation (n = 14) and second-generation (n = 14) palatal implants were analyzed.

Results: Bone healing was achieved with all implants. Both types of implants revealed a mean bone-to-implant contact (BIC) rate that was nearly equal: 80.7% (SD 10.7%) for the first-generation and 81% (SD 13.1%) for the second-generation implants. Bone resorption was only observed in 5 palatal implants (3/14 of the first, and 2/14 of the second generation).

Conclusion: Despite differing thread designs, second-generation palatal implants revealed similar bone-to-implant contact rates as did those of the first generation. Few patients presented bone resorption in the peri-implant bone.
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http://dx.doi.org/10.1007/s00056-011-0020-9DOI Listing
July 2011

Immediate implant placement and provisionalization after long-axis root fracture and complete loss of the facial bony lamella.

Int J Periodontics Restorative Dent 2011 Apr;31(2):175-83

Department of Oral Maxillofacial Surgery, University Hospital Mainz, Mainz, Germany.

The aim of this research was to explore the performance of a flapless surgical approach for immediate implant placement, simultaneous alveolar ridge augmentation, and immediate provisionalization in patients with complete loss of the facial bony lamella resulting from long-axis root fracture. Eighteen NobelPerfect implants were placed in 16 patients (follow-up, 13 to 36 months) who had sustained complete loss of the facial bony lamellae. Implants were inserted simultaneous to subperiostal bone augmentation with autogenous bone chips and underwent immediate provisionalization. Outcome variables included implant success, marginal bone levels, and pink esthetic score (PES). All implants achieved excellent primary stability. There were no implant losses. On average, interproximal marginal bone levels stabilized at 1.0 to 1.3 mm above the first thread. Postoperative cone beam computed tomography scans were available for 16 implant sites and confirmed restoration of the facial lamella in the vast majority of patients. Marginal esthetics, as assessed by the PES, was by and large preserved (mean postoperative PES, 12.5). Oral hygiene was highly predictive for the esthetic result. Survival rates, marginal bone levels, and esthetic results suggest a proof-of-principle for the new flapless immediate implant placement technique in patients with complete loss of the facial bony lamella. Oral hygiene status may be considered as a negative prognostic factor for the esthetic outcome.
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April 2011

Immediate function with NobelPerfect implants in the anterior dental arch.

Int J Periodontics Restorative Dent 2007 Jun;27(3):277-85

Department of Oral and Maxillofacial Surgery, University of Mainz, Germany.

This study examined the clinical performance of the scalloped NobelPerfect implant in a one-stage procedure (immediate provisionalization in the esthetic zone). In 20 patients, immediate prosthetic restorations were placed on 31 NobelPerfect implants and followed for up to 27 months. Outcome variables were success rates, marginal bone levels, and Pink Esthetic Score (PES) assessed per implant. One implant failed (success rate: 96.8%). Marginal bone levels averaged 1.7 mm above the first thread and remained stable during the observation period. Mean PES ratings were 11.3 (range, 8 to 14). Survival rates, marginal bone levels, and esthetic results suggest proof of principle for the preservation of the interproximal bony lamella with a scalloped implant design.
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June 2007
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