Outcome Analysis of Implant Restorations Located in the Anterior Maxilla: A Review of the Recent Literature

Purpose: To document the literature regarding outcomes of implant restorations in the anterior maxilla to formulate consensus statements with regard to esthetics in implant dentistry, to provide guidelines to clinicians, and to articulate remaining questions in this area to be addressed by future research. Materials and Methods: The following areas of the recent literature were scrutinized: treatment outcomes of implant therapy for partial edentulism (including maxillary anterior tooth replacement); anterior maxillary single-tooth replacement; effect of implant design, diameter, and surface characteristics; soft tissue stability/contours around anterior implant restorations; ceramic abutments; influence of surgical techniques; and finally, evaluation of patient satisfaction. Results: The use of dental implants in the esthetic zone is well documented in the literature, and numerous controlled clinical trials show that the respective overall implant survival and success rates are similar to those reported for other segments of the jaws. However, most of the published studies do not include well-defined esthetic parameters. Currently, the literature regarding esthetic outcome is inconclusive for the routine implementation of certain surgical approaches, such as flapless surgery and immediate implant placement with or without immediate loading/restoration in the anterior maxilla. Considering anterior single-tooth replacement in sites without tissue deficiencies, predictable treatment outcomes, including esthetics, can be achieved because of tissue support provided by adjacent teeth. The replacement of multiple adjacent missing teeth in the anterior maxilla with fixed implant restorations is poorly documented. In this context, esthetic restoration is not predictable, particularly regarding the contours of the interimplant soft tissue. Discussion and Conclusions: This review has demonstrated that scientific documentation of esthetically relevant and reproducible parameters is rather scarce. Most of the reported outcome analyses primarily focus on implant survival. Elements of anterior implant success such as maintenance or reestablishment of harmoniously scalloped soft tissue lines and natural contours should be included in future studies.