Guided surgery and custom abutments produce immediate esthetic results

Soft tissue evaluation of an immediate esthetic zone single implant with a stereolithographic guide using 3D reconstruction and a CAD/CAM customized titanium anatomic abutment

By: Tae-Heung Kim, You-Kyoung Oh, Chang-Mo Jeong, Edward Chengchuan Ko, George K. Sandor and Yong-Deok Kim


The purpose of this study was to evaluate the changes in the soft tissue following an immediate implant procedure using guided surgery in combination with a computer-aided design and computer-aided manufacturing (CAD/CAM) customized titanium anatomic abutment in the esthetic zone.

Materials & Methods

Study design: Retrospective clinical study

Subjects and Outcomes of the study

Period : between April 2017 and May 2018(The mean follow-up period was 14.7 months, and the minimum follow-up period was one year)

Patients : 13 patients who consisted of five males and eight females with a mean age of 49.6 years

Implants : TS III 13 implants

Outcome measures : The changes in the soft tissue dimension, interdental papilla, and esthetic score


1) Soft Tissue Dimension

There was no statistically significant change in the midfacial mucosa (p-value: 0.028).The loss of the mesial papillary height was 0.32 0.83 mm (p-value 0.203), and of the distal papillary height, 0.10 0.060 mm (p-value: 0.594). The mean horizontal change in the midfacial soft tissue volume was 0.32 0.83 mm.

Table 1. The Change in the Soft Tissue Dimension

Parameters Amount of Change p-Value
Midfacial mucosa level 0.27 ± 0.42 0.028
Mesial papilla level 0.35 ± 0.83 0.203
Distal papilla level 0.01 ±  0.06 0.594
Horizontal change in the labial soft tissue
Mean standard deviation
0.32 ±  0.83 0.06


2) Jemt’s Index

There was no significant dierence in the mesial and distal papilla index between the measurements made prior to the extraction and at one year of follow-up, according to the Wilcoxon signed-rank test (p-value: 0.180, 0.157) (Table 2).

Table 2. The jemt’s Index.

Parameters Amount of Change p-Value
Mesial papilla -1.342* 0.18
Distal papilla -1.414* 0.157

*: Z value


3) PES

The mean and standard deviation of the PES and of each variable are depicted in Table 3. The overall score was 11.16 2.17 before treatment, and 10.25 1.42 after the follow-up period. There were two cases with a total score of 8 or less in both the pre-operative and follow-up periods, which can be regarded as esthetic failures.

Table 3. The Pink Esthetic Score

PES Parameter Pre-Operative Follow-Up p-Value
Mesial papilla 1.33 ±  0.49 1.25 ± 0.45 0.586
Distal papilla 1.42 ±  0.51 1.58 ± 0.51 0.438
Midfacial mucosa level 1.67 ± 0.65 1.42 ± 0.51 0.117
Midfacial contour 1.58 ± 0.51 1.33 ± 0.49 0.191
Alveolar process deficiency 1.33 ±  0.78 1.16 ± 0.72 0.504
Soft tissue colour 1.58 ± 0.51 1.42 ±  0.51 0.339
Soft tissue texture 1.50 ± 0.52 1.42 ± 0.51 0.586
Total score 10.58 ± 1.97 9.83 ±  1.34 0.137


The immediate post-extraction placement of an implant in the esthetic zone should satisfy the esthetic and functional demands. The clinical case series in the present study provides clinicians with a scientific basis for an immediate placement procedure using a 3D reconstruction stereolithographic guide and restoration protocols with a CAD/CAM titanium anatomic abutment. This advanced technique provides an option with predictable outcomes for the replacement of teeth in the esthetic zone.


Leave a Reply

Your email address will not be published. Required fields are marked *