Human clinical trial involving dental implants placed in the smile zone of the mouth comparing the aesthetics of the gum tissue around the implants restored with crowns using 2 different approaches.

Selection of healthy adults missing a tooth on each side of the same jaw confined to the smile window ( 2nd premolar to 2nd premolar ). Subjects will be treated with identical dental implants placed using same surgical protocol but the restorations will differ . Test implant will undergo the ONE ACT concept. The One Act concept refers to one abutment one crown at one time concept. This means at the time of implant placement surgery, an acrylic transfer jig will be made by fixing a transfer / impression coping onto the implant and then laying self curing acrylic over the adjacent natural teeth and around the transfer coping locking it in. This bridging/ jig is removed along with the transfer/ impression coping. The implant is then going to be buried under the gum by closure through sutures which is referred to as the first or two stage surgery approach. The transfer jig which was fabricated at the time of the surgery before closure is fitted onto a pre-prepared dental cast with a hole drilled out in the location where the implant was placed in the mouth. When this exercise is done a dummy implant is affixed to the transfer coping exactly as the real one was in the mouth and the dummy implant/ analog is set into the dental case with the hole filled with some self curing acrylic glue . Once set , the transfer coping is unscrewed and now we have our working model with an exact location of the implant as in the mouth transferred onto the cast. While the healing is taking place over 3 months , the laboratory will work with the model and create an abutment and a definitive, anatomically contoured crown all ready to go in at the same time. When 3 months have lapsed after initial surgery , at the time of second stage surgery , the definitive abutment and the definitive crown will all be inserted and finished at one time , thereby adhering to the one abutment one crown at one time concept. The crown will be contoured to match the tooth as nature would have and the soft tissue is expected to heal and mature around the predefined shape of the crown. With this concept the whole treatment can be finished at the second stage surgery. For the purposes of the study the first two visits will be used up in preliminary assessments and consent including preliminary data collection. On the third visit the dental implant will be placed and then the fourth visit will involve a review and removal of sutures. The fifth visit at 3 months after first stage surgery, at the second stage surgery, the treatment will be completed. Dental X rays and Photographs will be recorded at 6 and 12 months as part of assessment and comparison on which intervention resulted in better bone levels and soft tissue aesthetic outcome.