On the one hand, the variety of bone level changes in this study may be explained by different vertical soft tissue thicknesses, but cannot be validated due to these missing data. On the other hand, there are multiple confounding factors influencing the change in bone level, such as the size of the platform (mismatch), occlusal loading, and the microgap. Additional to the standard success criteria, patient-reported outcomes are important factors when evaluating an implant system [32]. In our study, if the patient was satisfied, no further radiographs were taken, and the implant was deemed successful. Furthermore, in some success criteria, overall patient satisfaction should be good or excellent for the treatment to be successful (Levi et al. cited in Papaspyridakos et al. [32]).

Our study reveals an exceptionally high level of patient satisfaction. The majority of patients reported excellent outcomes for all measured categories at each time point throughout the study, with most remaining patients reporting good outcomes (Fig. 4). No patient reported a poor outcome, and a maximum of three patients at any given time reported fair outcomes. The parameters assessed by patients are closely related to soft tissue outcomes, which reflect oral hygiene and soft tissue health. The soft tissue parameters assessed in our study were MPI, SBI, PPD, and Jemt papilla score. For MPI, a statistically significant increase was observed from loading to the 5-year follow-up; however, the MPI at 5-year follow-up was, at 0.38 ± 0.52, still very low, with 0 equaling no detection of plaque and 1 equaling plaque only detectable after running a probe across the smooth marginal surface of the implant [27]. Similarly, the SBI remained very low throughout the study, despite a significant increase from loading to 5-year follow-up.