Esthetic Assessment following Ridge Augmentation, Late Implant Placement and Immediate Esthetic Reconstruction of the Atrophic Anterior Maxilla

Abstract

Purpose: Evaluate the esthetic outcome of ridge augmentation using cancellous bone-block allografts, late implant placement, and immediate loading in the atrophic anterior maxilla, by PES (pink esthetic score) and WES (white esthetic score) indexes. Materials and Methods: Retrospective cohort study. Inclusion criteria were bone loss of at least 3 mm horizontally and 3 mm vertically according to preliminary CBCT; ridge augmentation using cancellous bone-block allografts; six months later the implant insertion and immediately loaded. PES-WES index was used for esthetic assessment of soft tissues surrounding the final implant-supported prosthesis (ISP). Results: All twenty-five successive individuals were included. The mean follow-up was 12.1 ± 56 months (range, 42−90 months). The mean PES index and WES index were 7 ± 1.74 (range: 5−10) and 8.4 ± 2.12 (range: 5−10), respectively. The mean total combination of PES index and WES index (PES/WES) was 15.3 ± 2.85 (range: 12−20). All ISPs had an overall score >12 (the defined threshold of clinical acceptability). Conclusions: Ridge augmentation in the atrophic anterior maxilla using cancellous bone-block allografts and immediate loading allows a stable esthetic result of the soft and hard tissues over the years (follow-up of 42−90 months).

Keywords: PES/WES; allograft; bone-block; immediate loading.

Figure 1

Deficient alveolar ridge.

Figure 2

Cancellous bone-block fixation.

Figure 3

Block grafts incorporated into the surrounding bone.

Figure 4

Restoration interocclusal relation.

Figure 5

Mean PES value of each parameter.

Figure 6

Mean WES value of each parameter.

Figure 7

Mean total PES and WES value.

Figure 8

Tooth 22 was reconstructed. PES + WES score was16.