Implant rehabilitation of the esthetic area: A five-year retrospective study comparing conventional and fully guided surgery

Introduction: To compare the clinical outcomes of anterior single maxillary implants placed using conventional or guided implant surgery. Methods: In this retrospective clinical study 44 patients rehabilitated with a single anterior implant in the maxillary arch were included. Twenty-four implants were inserted applying a guided surgery approach (GS), and 20 applying a conventional freehand approach (CS). Outcome measures were: implant survival rate and complications; mean bone level (MBL) evaluated at surgery (T0), after 6 weeks (6 W), and after 1 year (1Y), 2 years (2Y), 3 years (3Y), 4 years (4Y), and 5 years (5Y); patients' satisfaction evaluated through a questionnaire filled out before surgery (BS) and at 1 week, 6 W, 2Y and 5Y; Pink esthetic score (PES) and white esthetic score (WES) evaluated at 1Y, 3Y and 5 Y. Significance of differences between groups were tested by Fisher's exact test, Mann-Whitney U test, and Wilcoxon's signed rank test. Results: During the 5-year follow-up there were no drop-outs and no implant failed. No significant differences between groups were found in MBL. A significant difference between groups was found in VAS scores regarding speech at 2 years, aesthetics at 6 weeks, confidence at 1 week and 6 weeks, satisfaction at T0 and at 1 W, pain/comfort at 1 W and at 6 W; all VAS scores resulted significantly improved compared to baseline. No significant differences in WES were found, while significant differences in PES scores between CS and GS groups were found at 3 and 5 years (p value = 0.023 and 0.004 respectively) with better outcomes for GS. A significant difference over time was found in PES between 5-year and one-year values. Conclusions: Guided surgery and conventional surgery implants did not show any difference in MBL during the 5-year observation period. Guided surgical procedure guarantee optimal esthetic outcome and seems able to guarantee better soft tissue result over time, even though more long-term studies are necessary to confirm this data.