Objectives: The important item of aesthetics is rarely included in evaluation studies. The aim of this study was to develop and validate an index for rating aesthetics of implant‐supported single crowns and adjacent soft tissues. Material and methods: Nine items were selected, which have an influence on the aesthetic result. The items are based on the anatomic form, colour and surface characteristics of the crown and on the anatomic form, colour and surface characteristics of the peri‐implant soft tissues. Two oral‐maxillofacial surgeons and two prosthodontists rated 24 implant‐supported single‐tooth restorations and adjacent soft tissues on a form with the nine items of the rating index. The rating was carried out twice by each of the examiners. Weighted Cohen's κ was calculated to express the intra‐ and interobserver agreement. Results: Intraobserver results indicated that the agreement between the first and second rating of both the prosthodontists was good (both 0.7) and that the agreement of the oral‐maxillofacial surgeons was moderate (0.49 and 0.56). The best interobserver agreement was found between the two prosthodontists (0.61, good agreement). Conclusions: The Implant Crown Aesthetic Index is an objective tool in rating aesthetics of implant‐supported single crowns and adjacent soft tissues. The rating is best be carried out by one prosthodontist to have the highest reliability.

The peri-implant mucosa is rated as less satisfactory than the implant-supported crown by both the dental professional and patients. The dental professional was less satisfied with respect to the total result and results of the crown than the patients.

The purpose of this study was to investigate the quality of bone at grafted implant sites in the anterior maxilla. Grafting of these sites was necessary because of insufficient bone volume in a buccopalatinal direction (width at the top of the crest 1-3mm). Reconstruction was performed with chin bone (N=5), chin bone and a resorbable Bio-Gide GBR membrane (N=5) or Bio-Oss spongiosa granules in combination with a Bio-Gide GBR membrane (N=5). Biopsies were taken prior to implantation, i.e. 3 months after grafting with chin bone, and 6 months after grafting with Bio-Oss. Evaluation was done by assessing the histological and histomorphometric characteristics of full-length biopsies taken from the actual implant site. Both areas with non-vital bone and areas with apposition of bone and remodelling phenomena were observed in the chin bone group at the time of placement of the implants. Similar results were observed at implant sites reconstructed with a chin bone graft covered by a membrane. In the chin bone group without and with a GBR membrane, the mean total bone volume (TBV) was 55.2+/-6.8% and 57.7+/-11.5%, respectively; the marrow connective tissue volume (MCTV) was 44.8+/-6.8% and 42.3+/-11.5%, respectively. Remnants of the resorbable GBR membrane were not detected. In the Bio-Oss((R)) group, at implant placement some newly formed bone was observed in the connective tissue surrounding the Bio-Oss((R)) particles (mean TBV (newly formed bone) 17.6+/-14.5%), but most particles were surrounded by connective tissue. No convincing signs of remodelling were observed (mean remaining Bio-Oss volume 40.5+/-9.3%; mean MCTV 41.9+/-13.1%). No implants were lost during follow up (12 months). At the time of placement of the implants the grafting material (either chin bone or Bio-Oss is still not fully replaced by new vital bone. In case of Bio-Oss, most of the grafting material is even still present. Despite these differences, the 1-year clinical results were very good and comparable between the various grafting techniques applied.

Clinical, radiographic, aesthetic and patient centred outcomes were very favourable after 10 years and did not differ between the groups with different bone augmentation techniques.