Fernando Zarone Prosthetic treatment of maxillary lateral

Roberto Sorrentino
Francesco Vaccaro
incisor agenesis with osseointegrated
Simona Russo implants: a 24–39-month prospective
clinical study

Authors’ affiliations: Key words: agenesis, implant–prosthetic treatment, lateral incisor, non-submerged im-
Fernando Zarone, Roberto Sorrentino, Francesco
plants, prospective study
Vaccaro, Department of Fixed Prosthodontics,
University of Naples ‘Federico II’, Naples, Italy
Simona Russo, Department of Pedodontics, Abstract
University of Naples ‘Federico II’, Naples, Italy
Objectives: The present study aimed at evaluating the marginal bone resorption and the
Correspondence to: peri-implant tissue conditions around Narrow-Neck ITI implants in the implant–prosthetic
Prof. Fernando Zarone
treatment of the agenesis of maxillary lateral incisors.
Dipartimento di Scienze Odontostomatologiche e
Maxillo-Facciali – Ed. 14 Material and methods: Thirty patients affected by monolateral or bilateral agenesis of the
Università degli Studi di Napoli ‘Federico II’ maxillary lateral incisors were selected. Thirty-four ITI-SLA Narrow Neck implants were
Via Pansini, 5-80131 Naples
Italy inserted and loaded about 4 months after the surgical procedure. The final restorations
Tel.: þ 39 081 746 3018 were realized using Aureo Galvan Crowns veneered with feldspathic ceramics. The follow-
Fax: þ 39 081 746 3018
e-mail: zarone@unina.it
up period ranged from 24 to 39 months. Both marginal bone resorption and soft tissue
quality were evaluated. The data were statistically analysed using analysis of variance
(ANOVA) for repeated measures, one-way ANOVA and Tukey’s post hoc test (P ¼ 0.05).
Results: During the 24–39-month follow-up period, no implant showed either pain and
sensitivity or mobility. After 39 months of functional loading, a cumulative survival rate of
97.06% and a cumulative success rate of 94.12% were calculated.
Conclusions: In case of maxillary lateral incisor agenesis, the implant–prosthetic approach
has proved to be a reliable and predictable treatment for both re-establishment of function
and aesthetics. Satisfactory values of marginal bone resorption over time and optimal
conditions of peri-implant tissue around Narrow-Neck ITI implants were found.

Date:
Accepted 17 March 2005
To cite this article:
Zarone F, Sorrentino R, Vaccaro F, Russo S. Prosthetic
treatment of maxillary lateral incisor agenesis with
osseointegrated implants: a 24–39-month prospective
clinical study.
Clin. Oral Impl. Res. 17, 2006; 94–101
doi: 10.1111/j.1600-0501.2005.01188.x
Copyright r Blackwell Munksgaard 2006
Dental agenesis is the absence or failure of
formation of a tooth (Glossary of Prostho-
dontic Terms 2005). According to Kennedy
(1999), between 2% and 10% of the popu-
lation is affected by dental agenesis. The
absence of permanent maxillary lateral in-
cisors represents about 20% of all cases of
agenesis; this anomaly is more frequently
bilateral (Stamatiou & Symons 1991). Al-
vesalo & Portin (1969) reported a preva-
lence of maxillary lateral incisor agenesis of
0.52–8.4%, although studies on the North-
western European population showed a
lower congenital prevalence, from 1% to
2% (Robertsson & Mohlin 2000).
Dental agenesis is often associated with
tooth ectopias and/or other abnormal den-
tal conditions (Peck et al. 1996; Baccetti
1998) like a smaller or a conoid tooth on
the opposite side of the arch. In such cases,
the canines are often mesially or lingually
positioned, compared with their normal
position, the midline being deviated to-
wards the side affected by the agenesis.
The deciduous maxillary lateral incisor
often remains in the dental arch for a longer
time than its physiologic falling (Kennedy
1999).
From an aesthetical point of view, the
lack of maxillary lateral incisors always

94

causes considerable problems (Robertsson
& Mohlin 2000).
To date, the treatment of maxillary lat-
eral incisor agenesis has comprised the
following therapeutic choices:
(1) Conservative approach:

performing neither orthodontic
nor prosthetic treatment, but so-
lely an aesthetic remodelling of
the deciduous maxillary lateral in-
cisor by means of composite resin
(Millar & Taylor 1995). This ther-
apeutic approach, however, should
be considered a short-term solu-
tion.
(2) Orthodontic approach:

closing the space of the missing
permanent tooth by an intercept-
ing treatment (Millar & Taylor
1995; Zuccati 2004);

closing the space of the missing
permanent tooth by an orthodontic
treatment. The canines are moved
into the place of the lateral incisors
and the adjacent premolars and
molars are moved mesially (Millar
& Taylor 1995; Kennedy 1999;
Sabri 1999).
(3) Prosthetic approach:

applying an adhesive bridge (noble
alloy with sandblasted and electro-
tinned adhesive surfaces) or a
Maryland bridge (non-noble alloy
with sandblasted and electroche-
mically etched adhesive surfaces)
(Hebel et al. 2000) in order to
replace the missing tooth; and

applying an FPD (ceramo-metal or
all-ceramic) supported by the max-
illary canine and the maxillary cen-
tral incisor (Millar & Taylor 1995;
Sabri 1999; Robertsson & Mohlin
2000).
(4) Implant approach:

osseointegrated implant-supported
restoration. Sometimes, an ortho-
dontic adjustment of the prosthetic
space is required (Scher 1990; Zuc-
cati 1993; Millar & Taylor 1995;
Sabri 1999; Hebel et al. 2000; De
Dominicis 2002; Zuccati 2004).
Both the orthodontic closure of the eden-
tulous space and the implant treatment
seem to be the patients’ most favoured
choices, as the conventional fixed pros-
thetic option involves tooth preparation
Zarone et al. Prosthetic treatment of maxillary lateral incisor agenesis
and porcelain-fused-to-metal bridge re- As for non-submerged implants, Moberg
storation, considered to be more invasive et al. (1999) performed a study on ITI
(Robertsson & Mohlin 2000). According to implants, obtaining a 96.7% success rate
Sabri (1999) and Richardson & Russell after a mean observation time of 3.4 years
(2001), the implant-supported replacement of function.
of an agenetic maxillary lateral incisor can A recent clinical prospective study
be considered the most conservative and proved the predictability of 3.3 mm ITI
widespread treatment. implants in replacing maxillary lateral in-
Scientific evidence confirmed that the cisors (Zinsli et al. 2004).
success rate of submerged and non-sub- The present study aimed at evaluating
merged implants can be considered com- the marginal bone resorption and the peri-
parable (Moberg et al. 1999; Mericske- implant tissue conditions around Narrow-
Stern et al. 2001). Short- and medium- Neck ITI implants in the implant–pros-
term studies on single-tooth implant restora- thetic treatment of both monolateral
tions reported success rates over 95% for and bilateral agenesis of maxillary lateral
submerged implants (Schmitt & Zarb 1993; incisors.
Haas et al. 1995; Mericske-Stern et al. 2001)
and of 97% for non-submerged implant–
Material and methods
prosthetic systems (Moberg et al. 1999).
As for submerged implants, Andersen
This prospective clinical study comprised
et al. (2001) pointed out that a single
30 patients (19 females and 11 males)
missing tooth in the anterior maxillary
affected by maxillary lateral incisor agen-
region can be replaced by means of narrow-
esis, to be submitted to implant replace-
or standard-diameter submerged implants
ment of the missing teeth. The age of the
with comparable results. Avivi-Arber &
patients ranged from 21 to 45 years. In 26
Zarb (1996) observed a failure rate of 2%
patients (16 females and 10 males), the
in an 8-year follow-up study on 49 osseoin-
anomaly was unilateral (86.7%), while in
tegrated Brånemark implants: the compli-
the other four (three females and one male)
cations were mainly related to prosthetic
it was bilateral (13.3%) (Figs 1–5). All of
problems (abutment mobility, screw loos-
the patients were in good general health;
ening, crown fracture). Other authors pub-
seven were smokers (23.33%), and three
lished 5-year or longer follow-up studies
showed occlusal parafunctional habits
showing similar results using Brånemark
(10%). Patients were provided with a con-
implants (Enquist et al. 1995; Henry et al.
sent form and a written explanation regard-
1996). Some studies showed the surgical
ing alternative techniques, the nature of
success of the treatment of a single missing
the treatment, associated procedures and
tooth using submerged implants but pros-
risks. The patients were also provided with
thetic complications mainly because of abut-
a consent form to participate in the study.
ment or screw failure (Jemt & Pettersson
The study was performed by specialists
1993; Ekfeldt et al. 1994; Laney et al. 1994;
working in the Department of Fixed
Haas et al. 1995). Considerable improve-
Prosthodontics of the Univesity ‘Federico
ments were obtained with the torque-control
II’ of Naples (Italy); an ethical review was
screw tightening, the cementation of the
stated by the university.
crowns and the introduction of new abut-
The selection of the patients was
ment typologies (Andersson et al. 1992;
carried out according to inclusion and
Scheller et al. 1998). A study on submerged
exclusion criteria reported in the literature
implant–prosthetic systems with a follow-
for implant–prosthetic treatment; six pa-
up of more than 10 years pointed out that
tients were excluded from the study. The
prosthetic complications represent 18.8% of
following inclusion criteria adapted from
the whole complications in the implant
Schmitt & Zarb (1993) and Smith & Zarb
treatment of a single missing tooth; the
(1989) were adopted (Avivi-Arber & Zarb
most frequent causes of failure were the
1996):
following: screw loosening (7.1%), loss of
retention (5.4%), prosthesis failure (1.8%),
single tooth space(s);
screw fracture (1.8%), prosthetic margin ex-
adjacent teeth: intact; restored with
posure (1.8%) and porcelain fracture (0.9%) functionally and aesthetically good re-
(Priest 1999). storations; restored with prostheses
95 | Clin. Oral Impl. Res. 17, 2006 / 94–101
Zarone et al. Prosthetic treatment of maxillary lateral incisor agenesis
Fig. 1. Bilateral agenesis: post-surgical implant sites in regions 12 and 22, buccal view.
Fig. 2. Bilateral agenesis: post-surgical implant sites in regions 12 and 22, occlusal view.
precluding the addition of the missing
tooth;

patient reclutance of preparation of ad-
jacent teeth; and

demonstrated maladaptive experience
or psychologic reclutance to wear a
removable partial denture.
The following exclusion criteria adapted
from Schmitt & Zarb (1993) and Smith &
Zarb (1989) were used (Avivi-Arber &
Zarb 1996):

inability to undergo a minor oral surgi-
cal procedure;

history of substance abuse;

psychoses;

unrealistic aesthetic expectations;

insufficient bone quality or compro-
mised health of the local site as deter-
96 | Clin. Oral Impl. Res. 17, 2006 / 94–101
mined by radiographs and clinical
inspection before implant placement;

insufficient bone quantity, precluding
placement of at least 3.3  10 mm
Narrow-Neck ITI implants, as deter-
mined by radiographs and clinical in-
spection, palpation and probing;

inadequate mouth opening to allow for
the minimum 4 cm of hardware neces-
sary for implant placement;

insufficient vertical interarch space to
accommodate the prosthodontic com-
ponents available; and

incomplete facial growth and tooth
eruption.
Before the surgical procedures, both the
quantity and the quality of the bone tissue
were analysed by means of clinical exam-
ination, Rinn standardized periapical radio-
graphs (Irix 70, Trophy Radiologie,
Vincennes, France) and CT Dental Scan.
Standardized periapical radiographs were
taken according to the long cone technique
with parallel rays. All of the edentulous
ridges showed a B2–B3 bone quality (Bråne-
mark et al. 1985) and an average bone
thickness from the buccal to the lingual
aspect of 5  1 mm. Bone height mea-
sured about 13  2 mm, estimated from
the margin of the alveolar ridge to the floor
of the nose (Razavi et al. 1995).
The edentulous space, estimated from
the distal aspect of the central incisor to
the mesial aspect of the canine, measured
6  0.5 mm.
According to the bone crest height, 34
ITI-SLA Narrow Neck implants (Institut
Straumann AG, Waldenburg, Switzerland)
were used, as reported below:

Nine Narrow-Neck implants 3.3 
 10 mm;

Seventeen Narrow-Neck implants
3.3   12 mm; and

Eight Narrow-Neck implants 3.3 
 14 mm.
According to the technique described by
Buser & von Arx (2000), the implants were
surgically inserted with a crestal incision
located slightly on the palatal aspect, so as
to assure a sufficient vascularity of the
buccal flap in the papillary area. The inci-
sion was extended through the sulcus of
the adjacent teeth to both the buccal and
palatal aspect of the alveolar ridge. Buccal-
relieving incisions were performed only in
10 cases. Subsequently, the buccal and
palatal muco-periostal flaps were elevated
with a fine tissue elevator to ensure low-
trauma soft tissue handling.
During the healing time, the implants
were covered with Narrow-Neck protec-
tive copings with an internal occlusal
screw (048050, Institut Straumann AG).
In 19 patients (one with bilateral agenesis),
a resin denture tooth (Jet Kit, Lang Dental
Mfg. Co., Wheeling, IL, USA) supported by
a fake orthodontic appliance was used as a
temporary prosthesis; the other 11 patients
did not wear any temporary restoration
during the healing time.
The osseointegrated implants were
loaded about 4 months after the surgical
procedure. A fixture-level impression was
taken by means of impression transfers and
polyether materials (Permadyne Penta H,

Fig. 3. Bilateral agenesis: peri-implant soft tissue aspect before and after 25 days of temporarization in regions
12 (upper and lower left side) and 22 (upper and lower right side).
Fig. 4. Definitive aureo-galvan crowns veneered with feldspathic porcelain.
Permadyne Penta L, 3M ESPE, Seefeld,
Germany) with custom autopolimerizing
acrylic resin trays (SR-Ivolen, Ivoclar,
Schaan, Liechtenstein). A thin layer of an
adhesive specific for polyethers was spread
on such trays (Polyether Adhesive, 3M
ESPE). Thirty-four titanium standard hol-
low abutments with a height of 9 mm
(048505, Institut Straumann AG) and ce-
ment-retained acrylic temporary crowns
(Jet Kit, Lang Dental Mfg. Co.) were care-
fully prepared by a dental technician. The
final restorations were realized using Aureo
Galvan Crowns (AGC) (Gold bath AGC
electroforming, Wieland, Pforzheim, Ger-
many) veneered with feldspathic ceramics
(Noritake Super Porcelain EX-3, Noritake
Co. Inc., Nagoya, Japan).
After 25 days of function with interim
prostheses, the provisional crowns were
removed, the AGC copings were carefully
Zarone et al. Prosthetic treatment of maxillary lateral incisor agenesis
seated onto their abutments and the final
positional impressions were taken using
the same materials and procedure as pre-
viously described. The final AGC/ceramic
crowns were made, tried in and cemented
with a zinc-phosphate luting agent (De-
Trey Zinc Crown & Bridge Fixodont
Plus, Dentsply DeTrey GmbH, Con-
stance, Germany).
Patients were followed for a minimum
period of 24 months to a maximum period
of 39 months. Follow-up controls were
performed 1 month after loading, 6 months
after loading and then every 12 months.
The present study evaluated both the
marginal bone resorption and the peri-im-
plant soft tissue quality. Osseointegration
has been evaluated as a clinically asympto-
matic rigid fixation of alloplastic material
achieved and maintained in bone during
functional loading (Zarb & Albrektsson
1991). The clinical success of the crowns
replacing missing maxillary lateral incisors
has been established by means of the fol-
lowing parameters:

standardized periapical radiographs (Irix
70, Trophy Radiologie);

Four-point peri-implant probing (i.e.
mesial, buccal, distal and palatal);

pain and mobility of osseointegrated
implants; and

peri-implant soft tissues conditions.
The four-point peri-implant probing was
determined after removing the crowns. As
for peri-implant tissue conditions, the fol-
lowing periodontal parameters have been
considered: gingival index (GI) (Loe 1967),
plaque index (PI) (Loe 1967), bleeding on
probing (BOP) (Esposito et al. 1998), and
papilla index score (PIS) (Jemt 1997). PIS
describes the quantity of the existing pa-
pilla in order to evaluate its conditions and
is made up of five levels:
PIS 0 – no papilla;
PIS 1 – less than half papilla in the vertical
direction compared with the other teeth;
PIS 2 – less than half papilla in the vertical
direction compared with the other teeth
but not in harmony with the contiguous
papillas;
PIS 3 – papilla filling the interdental space
and in harmony with the contiguous papil-
las; and
PIS 4 – hyperplasic papilla covering the
restoration.
The collected data were statistically ana-
lysed using the software SPSS 12.0 (SPSS
Inc., Chicago, IL, USA). The Kolmogorov–
Smirnov test was used to verify the nor-
mality of the data distribution. Analysis of
variance (ANOVA) for repeated measures
was performed to evaluate differences in
the marginal bone resorption and four-
point peri-implant probing over time.
One-way ANOVA and Tukey’s post hoc
test for comparisons were used to reveal
differences among the different aspects of
each implant over time. For all the statis-
tical tests, the level of significance was set
at P ¼ 0.05.
Results
Osseointegration has been achieved for
all 34 implants. Just one patient was
97 | Clin. Oral Impl. Res. 17, 2006 / 94–101
Zarone et al. Prosthetic treatment of maxillary lateral incisor agenesis

followed only for 10 months after the
load application, because of relocation
to another city. As for the other 33
fixtures, no implant failed during either
the healing period or the 24–39-month
follow-up period. No difference has been
found between male and female patients.
No differences related to age have been
noticed.
One year after prosthetic loading, stan-
dardized periapical radiographs showed a
marginal bone resorption ranging from
0.46 to 1.32 mm. After 24 months of
function, the marginal bone resorption in-
creased by 0.1–0.2 mm (Table 1). These
radiographic data have been confirmed by
means of four-point peri-implant probing:
after 24 months of functional loading, the
clinical examinations have pointed out a
mean mesial probing of 3.1  0.2 mm,
a mean buccal probing of 2.1  0.1 mm,
a mean distal probing of 3  0.1 mm and a
mean palatal probing of 2.1  0.2 mm
(Table 1).
During the 24–39-month follow-up per-
iod, no implant showed either pain and
sensitivity or mobility.
The Kolmogorov–Smirnov test revealed
that the data distribution was normal
(P40.05).
As for marginal bone resorption, the
ANOVA for repeated measures showed
significant differences 1 and 6 months after
the load application (Po0.05) (Table 1); no
differences were evident after 12 and 24
months of function (P40.05) (Table 1). As
for the four-point peri-implant probing
on both the buccal and palatal aspects of
each implant, the ANOVA for repeated
measures showed significant differences 1
and 6 months after the load application
(Po0.05) (Table 1); no differences were
evident after 12 and 24 months of func-
tion (P40.05) (Table 1). In contrast, as for
the four-point peri-implant probing on both
the mesial and distal aspects of each
implant, the ANOVA for repeated mea-
sures showed significant differences 1
month after the load application (Po0.05)
(Table 1); no differences were evident after
6, 12 and 24 months of function (P40.05)
(Table 1).
The one-way ANOVA and Tukey’s post
hoc test revealed no significant differences
over time between the buccal and palatal
aspects (P40.05) and between the mesial
and distal aspects (P40.05) of the implants
(Table 2). On the contrary, the statistical
tests showed significant differences be-
tween buccal vs. mesial (Po0.05), buccal
vs. distal (Po0.05), palatal vs. mesial
(Po0.05) and palatal vs. distal aspects
(Po0.05) of the implants after each control
(Table 2).
As for the peri-implant tissue conditions,
at the 24-month follow-up, 31 restorations
showed a GI ¼ 0 and two crowns showed a
GI ¼ 1 (Table 3); 27 prostheses revealed
a PI ¼ 0, while six restorations showed a
PLI ¼ 1 (Table 3). BOP was negative for all
the implants. It has been possible to notice
a PIS ¼ 1 in two crowns, PIS ¼ 2 in
four crowns and PIS ¼ 3 in 27 crowns
(Table 3). The mean buccal recession of
peri-implant soft tissues measured about
0.4 mm after 6 months of functional load-
ing and 0.6 mm 12 months after the crown
insertion.
After 10 months of functional loading,
a cumulative survival rate of 100% and a
cumulative success rate of 97.06% were
found, whereas after 39 months of func-
tional loading, a cumulative survival rate of
97.06% and a cumulative success rate of
94.12% were registered. As for aesthetics,
just one implant was considered as not
being satisfactory, because of exposure of
about 0.2 mm of the titan neck of the
ITI implant.

Discussion

The congenital lack of a tooth causes

both aesthetic and gnathologic problems.
A multidisciplinary approach is required in
the treatment of maxillary lateral incisor
agenesis. A preventive orthodontic therapy
is often a condition necessary to achieve a
correct surgical placement of the implant to
Fig. 5. Bilateral agenesis: implant-supported definitive cemented crowns in regions 12 and 22. replace the missing permanent tooth. The

Table 1. Results of the one-way analysis of variance (ANOVA) for repeated measures for the interproximal marginal bone resorption and
the four-point peri-implant probing
t0 (load application) 1 month 6 months 12 months 24 months
a1 b1 c1 c1
Marginal bone resorption – 0.2  0.08 0.6  0.37 1  0.54 1.2  0.61c1
Buccal probing –a2 0.9  0.2b2 1.6  0.2c2 2  0.1c2 2.1  0.1c2
Palatal probing –a3 0.8  0.2b3 1.6  0.1c3 1.9  0.2c3 2.1  0.2c3
Mesial probing –a4 2.1  0.1b4 2.5  0.2b4 3  0.2b4 3.1  0.2b4
Distal probing –a5 1.9  0.2b5 2.4  0.1b5 2.9  0.2b5 3  0.1b5

Mean values  standard deviations (expressed in millimeters) are shown. Subgroups with the same superscripts are not statistically significant (P40.05).

98 | Clin. Oral Impl. Res. 17, 2006 / 94–101

 Zarone et al. Prosthetic treatment of maxillary lateral incisor agenesis

Table 2. Results of the one-way analysis of variance (ANOVA) and the Tukey’s post hoc test by other authors (Grunder 2000). Small
for the interproximal marginal bone resorption and the four-point peri-implant probing & Tarnow (2000) noticed higher values
Time Aspect Mean difference P-value
when the buccal recession was measured
t0 (load application) B vs. P – – 6 and 12 months after the placement of
B vs. M – –
the healing abutment (0.85 and 0.88 mm,
B vs. D – –
P vs. M – – respectively).
P vs. D – – The anatomy and the health conditions
M vs. D – – of papillas improved in time: 6 months
1 month B vs. P 0.1 40.05
after the application of the prosthetic load,
B vs. M  1.2 o0.05
B vs. D 1 o0.05 10 restorations showed satisfactory mor-
P vs. M  1.3 o0.05 phology of papillas (29.41%), while after
P vs. D  1.1 o0.05 24 months of functional loading it was
M vs. D  0.2 40.05
possible to observe optimal conditions of
6 months B vs. P 0 40.05
B vs. M  0.9 o0.05 interproximal soft tissues in 27 crowns
B vs. D  0.8 o0.05 (81.82%). This result is probably because
P vs. M  0.9 o0.05 of the conservative design of the surgical
P vs. D  0.8 o0.05
M vs. D 0.1 40.05
flaps and the correct application of tempor-
12 months B vs. P 0.1 40.05 ary acrylic resin restorations. New inter-
B vs. M 1 o0.05 dental tissues are more likely to grow
B vs. D  0.9 o0.05 between an osseointegrated implant and a
P vs. M  1.1 o0.05
P vs. D 1 o0.05 natural tooth rather than between two
M vs. D 0.1 40.05 implants (Andersen et al. 2001).
24 months B vs. P 0 40.05 All the fixtures showed satisfactory os-
B vs. M 1 o0.05
seointegration, and no patient suffered
B vs. D  0.9 o0.05
P vs. M 1 o0.05 from inflammation, pain or discomfort.
P vs. D  0.9 o0.05 The peri-implant soft tissue conditions
M vs. D 0.1 40.05 were evaluated, in spite of some studies
Mean differences (expressed in millimeters) are shown. having pointed out that there is little cor-
relation between osseointegration and
health of soft tissues (Henry et al. 1996).
Table 3. Gingival index (GI) score, plaque index (PI) score and papilla index score (PIS) All the abutments were surrounded by
1 month 6 months 12 months 24 months healthy and stable peri-implant soft tis-
(n ¼ 34) (n ¼ 34) (n ¼ 33) (n ¼ 33) sues, thanks to the correct design of the
GI 0 34 34 32 31 final restorations and the maintenance of
GI 1 0 0 1 2 good oral hygiene. These data have been
GI 2 0 0 0 0
confirmed by the optimal values shown by
GI 3 0 0 0 0
PI 0 34 32 29 27 all the periodontal parameters considered to
PI 1 0 2 4 6 evaluate the conditions of peri-implant
PI 2 0 0 0 0 tissues (i.e. GI, PLI, BOP, PIS).
PI 3 0 0 0 0
PIS 0 0 0 0 0
In the first year after prosthetic loading,
PIS 1 17 5 2 2 the values of marginal bone resorption were
PIS 2 9 19 3 4 comparable with those reported in other
PIS 3 8 10 28 27 studies (Goodacre et al. 1999), measuring
PIS 4 0 0 0 0
about 0.89 mm. After 12 months of func-
tional loading, this mean value improved to
implant–prosthetic treatment is the most tion of the implant (Avivi-Arber & Zarb less than 0.2 mm/year, with no evidence of
biological conservative approach in case of 1996). The prosthetic restoration has to be radiotransparency between bone and fix-
maxillary lateral incisor agenesis and offers manufactured with respect to the peri-im- tures as demonstrated by standardized peri-
the best cost/benefit ratio. plant soft tissues and the papillas, in order apical radiographs.
The implant has to be surgically inserted to achieve the best aesthetic result. As shown by the results of the statistical
into the bone after both the orthodontic Unfortunately, the buccal recession of analysis, the functional loading of the im-
therapy and the end of the cranium-facial peri-implant soft tissues is a frequent oc- plants progressively reduced the interprox-
growth (at about 21 for males and 15 for currence in case of implant-supported fixed imal marginal bone resorption and the four-
females) (Kennedy 1999; Richardson & prosthetic restorations. In the present point peri-implant probing. Such a phe-
Russell 2001). After the placement of study, values of peri-implant buccal reces- nomenon became particularly evident 6
the recovery screw, a period of about 4–6 sion of 0.6 mm after 12 months were months after the prostheses placement. In
months is necessary to obtain osseointegra- collected, confirming the data published particular, the loss of interproximal bone

99 | Clin. Oral Impl. Res. 17, 2006 / 94–101

Zarone et al. Prosthetic treatment of maxillary lateral incisor agenesis
tissue was more severe than the bone
remodelling of both the buccal and palatal
aspects of the implants, achieving good
aesthetic results.
The data collected in the present study
have confirmed evidence pointed out by
Cochran et al. (1997): the use of a non-sub-
merged implant–prosthetic system has
proved to be very reliable and predictable
in obtaining long-term success in aesthetic
restorations. The rough surface of ITI fix-
tures promotes the osseointegration while
the surrounding peri-implant tissues easily
surround the smooth surface of the implant
neck.
Conclusions
The replacement of missing teeth by
means of osseointegrated implants has
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