EVALUATION OF ESTHETIC OUTCOMES OF M-SHAPED FLAP IMPLANT UNCOVERING TECHNIQUE VERSUS I-SHAPED INCISION AROUND SINGLE IMPLANTS IN THE ANTERIOR MAXILLA USING PINK ESTHETIC SCORE (PES) (Randomized Clinical Trial)

Abstract

Replacement of a single tooth in the esthetic zone with implant supported fixed restoration is a broadly recognized and approved option. The soft tissue manipulation in the second stage surgery is a crucial parameter to optimize the final esthetic appearance around the implant-supported prosthesis not only to uncover the implant cover screw for the necessary prosthetic procedures. Every implant exposure technique is unique, crucial and technique sensitive. The esthetic dental field is directed by principles and standards and it should be reviewed from both objective and subjective perspectives. A lot of tries have been carried out to produce an objective assessing tools for overall assessment of the aesthetic results of dental implant in the aesthetic zone. One of those tools is PES that was presented by Furhauser et al. It has been commonly used in assessment of the esthetic results of dental implants restorations. Aim: This study aims to evaluate the profile of soft tissue around restoration of single implant in the aesthetic zone using PES following uncovering of the implants by I-shaped incision, "M" flap and conventional uncovering techniques. Methods: 36 patients were randomly divided into 3 groups, a group for each uncovering technique. PES was evaluated through photos around the implant restoration at the time of the delivery of the prosthesis and after 3 months of loading. Results: Values recorded after 3 months of follow up (12.00±1.41), (11.33±1.66), (11.50±1.69) were significantly higher than values recorded at delivery day (9.80±0.79), (9.00±1.32), (8.88±2.23) in I-incision, M-flap and conventional techniques respectively. No significant difference was found between values recorded in different groups after 3 months. I-incision group showed the highest mean value followed by conventional group while M-flap group had the lowest mean value. Conclusion: As the results are comparable in the 3 groups and I-incision technique is the least invasive one , I-incision technique is recommended to be used for uncovering the implants in the anterior maxilla.