Esthetic Evaluation of Materials Used to Fill Access Holes of Screw-Retained Implant Crowns

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The access hole of screw-retained dental implant crowns presents an esthetic obstacle for the restorative dentist. Few if any studies have compared the different materials used for access hole restoration. Our objective was to investigate the esthetic value and acceptability of both commonly used and innovative access hole filling materials from the perspectives of both the patient and the dentist. One cement-retained crown and 5 screw-retained crowns were prepared on maxillary models. Access hole filling materials included dentin composite, resilient composite (F), enamel composite, dentin composite with opaquer, and resilient composite with opaquer (FO). Subjects for this study were recruited from a convenience sample of laypersons (n = 50) and dentists (n = 25). All subjects evaluated the 6 restorations on a visual analog scale (VAS) and determined the acceptability of each. Dentists yielded equal or higher mean acceptability ratings compared to laypersons for all casts; dentist ratings were an average of 18% more acceptable. Dentists also yielded higher mean VAS esthetic values on all casts, with an average value that was 7.5 points higher than that of laypersons. Resilient composite coupled with opaquer, compared to resilient composite alone, yielded improved values. Visual analog scale esthetic values increased from 13.8 and 24.6 (F) to 63.5 and 65.6 (FO) between laypersons and dentists, respectively. Acceptability improved from 12% and 36% (F) to 76% and 88% (FO) between laypersons and dentists, respectively. Both laypersons and dentists are able to detect significant esthetic differences in the materials used to fill the access holes of screw-retained dental implants. The data showed that using a small amount of opaquer in combination with filling materials makes a significant esthetic improvement in the implant restoration.

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