Ultrasonic Imaging for Estimating the Risk of Peri-Implant Esthetic Complications

Dental implants have been introduced for more than 50 years and benefited millions of patients with missing teeth. Initially for full arch rehabilitation, dental implants are now also used for restoration of partial edentulism and single missing teeth. Macrostructure and microstructure advancements have improved the implant survival rate significantly. As integration of implants to the host bone is highly predictable, the dental community is working diligently to improve the next level of success, optimal esthetics. To be esthetically appealing, implant restorations and peri-implant tissues should be in harmony with the adjacent hard and soft tissues. The most common and noticeable esthetic complication is facial soft tissue recession. Few risk factors have been identified, e.g. inadequate soft and hard tissue volume and improper implant positioning, etc. Recently, the role of restoration design on soft tissue level stability has also been actively investigated. Ultrasound, being non-ionizing, point-of-care, and cross-sectional, possesses tremendous advantages for evaluating peri-implant tissues, implant positioning, and the restoration contour that may dictate the esthetic outcome in-situ both as a research tool and for patient care. In this chapter, we contrasted between cohorts with and without facial recession implant-, tissue-, and restoration-related factors that were derived from high-resolution ultrasound imaging. Preliminary data suggested the mucosal margin angle and soft tissue thickness strongly correlated with the occurrence of facial recession. Optimal implant-abutment and abutment-crown angles exist for sustaining the soft tissue level. The role of facial bone thickness may become more prominent for maintaining the soft tissue level as implants’ service time increases. Ultrasound has a potential as an adjunct to radiographs for identifying patients at risk of developing esthetic complications and for assisting dentists to make clinical decisions. These exciting observations will need confirmation from more research with larger sample sizes and longitudinal follow-ups.