3D Orthodontic Optimization of Implant Sites and Its Influence on Implant Position, Peri-Implant Tissue Health, and Prosthetic Esthetics: A Prospective Clinical Study

Abstract

Background:

Precise implant positioning is essential for achieving favorable peri-implant tissue health and prosthetic esthetics. Orthodontic optimization of the implant site may improve the spatial conditions required for accurate three-dimensional (3D) implant placement.

Aim:

To evaluate the influence of 3D orthodontic optimization of implant sites on implant-position accuracy, peri-implant tissue health, marginal bone changes, and prosthetic esthetic outcomes compared with conventional implant planning.

Materials and Methods:

A total of 40 patients requiring maxillary anterior implant rehabilitation were included and divided equally into two groups. Group A (n = 20) underwent 3D orthodontic optimization before implant placement, whereas Group B (n = 20) received conventional implant planning. 3D deviations between planned and achieved implant positions were assessed, including coronal, apical, vertical, mesiodistal, buccolingual, and angular deviations. At 6 months, peri-implant tissue parameters, marginal bone changes, implant survival, complications, and esthetic outcomes using the Pink Esthetic Score (PES) and White Esthetic Score (WES) were evaluated. Correlation and multivariable regression analyses were performed to identify factors associated with PES.

Results:

The optimized group demonstrated significantly lower coronal, apical, vertical, mesiodistal, buccolingual, and angular deviations than the conventional group (p ≤ 0.002). A greater proportion of implants achieved the predefined positional accuracy criteria in the optimized group. At 6 months, Group A showed lower modified plaque index and probing depth and greater keratinized mucosal width and mucosal thickness (p < 0.05). Mean marginal bone change was also significantly lower in Group A (0.29 ± 0.17 mm vs. 0.46 ± 0.24 mm; p = 0.008). PES, WES, and combined PES + WES scores were significantly higher following 3D optimization (p ≤ 0.005). Angular deviation and coronal deviation were negatively correlated with PES, whereas mucosal thickness showed a positive correlation. Regression analysis identified 3D orthodontic optimization and mucosal thickness as positive predictors of PES.

Conclusion:

3D orthodontic optimization of implant sites was associated with greater implant-position accuracy, more favorable peri-implant tissue characteristics, reduced marginal bone changes, and improved prosthetic esthetic outcomes at 6 months. Integrating orthodontic site optimization with 3D implant planning may enhance the predictability of anterior implant rehabilitation.