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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 11  |  Issue : 4  |  Page : 64-68

Comparison of immediate and delayed loading of dental implants in mandibular posterior teeth: Clinical observations and review


1 Senior Consultant, Maxillofacial Surgery, Legend Hospitals, Hyderabad, India
2 General Dental Practitioner, Gurayat Specialised Dental Center, AlQurayyat, KSA
3 Clinical Head, Oral and Maxillofacial Surgery, Vijaya Santhoshi Dental Clinic, Kakinada, India

Date of Submission19-Dec-2020
Date of Decision06-Feb-2021
Date of Acceptance13-Apr-2021
Date of Web Publication16-Oct-2021

Correspondence Address:
Khadar Vali Shaik
Senior Consultant, Maxillofacial Surgery, Legend Hospitals, Hyderabad
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aihb.aihb_155_20

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  Abstract 


Introduction: The study is aimed to compare the clinical outcome of immediate and delayed loaded single tooth implants in replacement of mandibular posterior tooth in consideration with implant stability quotient, bleeding on probing, probing depth, implant mobility, marginal bone loss and peri-implant radiolucency. Materials and Methods: The study consisted of 20 patients who were divided into two groups and compared: Group A is an immediately loaded group with ten patients who received implants in the mandibular posterior tooth region along with abutment on the same day and acrylic crown placed within 48 h and the second group is a conventionally loaded group of ten patients who received the implant in the mandibular posterior tooth region in which the cover screw was placed and conventionally loaded after 3 months. Implant stability quotient, implant mobility, bone loss and peri-implantitis were assessed at 1st and 6th months after loading. All patients were evaluated for the parameters at 1st, 3rd and 6th months after loading in both the groups. Results: Probing depths obtained for all twenty patients after 1 and 6 months of loading were within the normal range (1–3 mm). In Group A, the mean probing depth after 1-month loading was 1.8 mm with a standard deviation (SD) of 0.63 and after 6 months of loading 1.2 mm with SD 0.42. In Group B, the mean of the probing depth after 1 month of loading is 1.8 mm with SD 0.42 and remained the same post loading after 6 months. Marginal bone loss was measured mesially and distally after 1 month and 6 months in both the groups. The standard intraoral periapical radiograph was used to evaluate peri-implant radiolucency. No patient showed peri-implantitis for 6-month follow-up after loading of implants. Conclusion: Immediate loading of an implant in a single mandibular posterior tooth can be an effective treatment modality and a promising alternative to delayed loading.

Keywords: Bone loss, delayed loading, immediate implant loading, implant mobility, probing depth


How to cite this article:
Shaik KV, Albilasi RM, Arqoub Albalawi BF, Alruwaili FA, Sanaka SR. Comparison of immediate and delayed loading of dental implants in mandibular posterior teeth: Clinical observations and review. Adv Hum Biol 2021;11:64-8

How to cite this URL:
Shaik KV, Albilasi RM, Arqoub Albalawi BF, Alruwaili FA, Sanaka SR. Comparison of immediate and delayed loading of dental implants in mandibular posterior teeth: Clinical observations and review. Adv Hum Biol [serial online] 2021 [cited 2021 Dec 4];11:64-8. Available from: https://www.aihbonline.com/text.asp?2021/11/4/64/328389




  Introduction Top


Implants are advantageous and predictable alternatives to edentulism that are becoming the standard of care within the dental community. Archaeologists have discovered during ancient civilisation that the lost teeth were replaced by anchored devices in the bone. Permanent molars are the most frequently affected by dental caries and their sequelae because of their early eruption time and exposure to the oral environment. Non-replacement of missing mandibular posterior teeth will affect the occlusion, gingival and periodontal tissues of surrounding teeth and temporomandibular joint ultimately. The first long-term follow-up study published by Branemark confirmed that the two requirements for osseointegration were primary stability and non-stress healing period. Over the next 10 years, several other authors contributed their experience to the literature and agreed that to obtain osseointegration, primary stability and period of submerged healing were required. This led to the development of a two-stage healing procedure, which has become the standard for dental implants.[1] The two-stage healing procedure included implant placement with primary stabilisation and then waiting for the period of 3–6 months before healing before prosthetic recovery. Results of edentulous patients restored with an implant-supported fixed prosthesis following a 2-stage healing protocol were promising. Success rates ranged anywhere from 95% to 99% over 6–15 years. Previously edentulous patients were happy with the newfound freedom in a predictable, stable prosthesis. However, the wait between implant placement and eventual loading was long, and patients began to complain about the conventional prosthesis; patients may be distressed by not only the functional concerns but also the psychosocial effects of losing all of their teeth.[2] Over time, the interest in immediately loading implants became patient driven [Table 1]. Histologic evaluation of bone surrounding both immediately loaded and conventionally loaded implants showed that not only osseointegration possible with immediately loaded implants but also there was increased quantity and quality of bone adjacent to these experimental implants. Immediate loading of implants has become increasingly significant in recent years for both partially or complete edentulous patients. The time to definitive prosthetic rehabilitation was not changed, but shortening the return to function was carried by immediately restoring the implants with provisional restorations. Recent methods have been published that not only immediately loading mandibular implants are successful but also result in a definitive restorative solution. Persistent shortcomings of immediately loading techniques include inabilities to use any implant system and to make the setup custom to the patient. As a result, immediately loaded implants are a feasible treatment choice that offers a permanent and functional restorative solution immediately after surgery 1. For both the types, the implant stability quotient (ISQ), bleeding on probing, depth on probing, implant mobility, marginal bone loss and peri-implant radiolucency were evaluated.
Table 1: Comparing balance of payments after 1st and 6th month in both the groups

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  Materials and Methods Top


Twenty patients with missing mandibular posterior teeth were included in the study, and they were randomly divided into two groups of ten patients in each group by coin toss method. All the patients were explained about the study, and written consent was obtained. The ethical clearance was obtained from the review board of the institution (DIR/2019/3456).

Group A obtained an implant in the mandibular posterior tooth area, as well as an abutment on the same day and an acrylic crown within 48 h. Group B is a conventionally loaded group with patients receiving implants in the mandibular posterior tooth region, in which the cover screw was placed and conventionally loaded after 3 months. Standard pilot drilling and implant bed preparation were used to thread the pre-selected implants into the prepared site under copious internal and external irrigation, with prompt angulation of the osteotomy drill accompanied by sequential drilling, resulting in good primary stability after implant placement. The abutments were placed on the same day of implant placement and left in place undisturbed until prosthetic procedure in Group A, whereas in Group B, the site was closed following cover screw placement.

Bleeding and periodontal depth was assessed using standard William's periodontal probe [Table 2] and [Table 3]. All patients were reviewed at 1st, 3rd and 6th months in both the groups for the stability quotient and mobility of the implant. Other than this, the marginal bone loss and peri-implant radiolucency were also evaluated. The implant's stability was assessed using the steel ISQ apparatus, which has a frequency range of 6–9 kHz and an ISQ range of 0–100 with different assessment values. With ISQ <60 (low stability), an implant was considered at risk, and the implant was monitored, ISQ 60–65 (medium stability) was full splint 2-stage traditional loading, ISQ 65–70 (medium to high stability) partial case 1 or 2 stages early loading, ISQ >70 (high stability) single case 1 stage immediate loading. Implant health could be assessed by mobility in the implant, and follow-up visits prompted implant stability. Intraoral periapical radiographs and Denta Scans were used to check for peri-implant radiolucency in the follow-up visits. Probing was an appropriate method to evaluate implant health and was performed at all the follow-up visits of the patient [Table 4].
Table 2: Comparing probing depth after 1st and 6th month in both the groups

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Table 3: Comparing probing depth at 1st and 6th month of crown cementation among both the groups

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Table 4: Comparison of Bone loss in mm at 1st months and 6th month of crown cementation on distal side in of Group A and Group B

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  Results Top


The present prospective clinical study included twenty patients in need of replacement of missing tooth, of which ten patients were subjected to immediate loading and the remaining ten patients to delayed loading technique of implant placement.

According to the clinical implant mobility scale at different points, there is no mobility of the implant noticed in both immediate and delayed implants. The Mann–Whitney U-test was used to compare bone loss in mm (after 1 month of crown cementation) in immediate and delayed implants on the mesial and distal sides.

Intraoral periapical radiographs were used to determine the peri-implant radiolucency. During the 6-month follow-up period after loading the implant, none of the twenty implants (0%) displayed peri-implant radiolucency.


  Discussion Top


The ISQ values were taken in both Groups A and B immediately, 3 and 6 months after implant placement in the current study. In Group A, the mean value of ISQ values at the time of placement was 73.75 with an standard deviation (SD) of 1.83 and a standard error means of 0.58. In Group B, the mean ISQ value after the placement was 72.90 with an SD of 2.77 and a standard error mean of 0.87. In comparison there was no significant difference between(p=0.428) between group A and group B after placement of the implant. At 3-month follow-up on comparison ISQ values between Group A and Group B, the mean ISQ value of Group A was 71.60, which is less than the mean value of after immediate placement, with an SD of 2.16 and standard error of 0.68; similarly in Group B, the mean value of ISQ was 72.35 which is almost similar to that of Group A value with SD of 2.40 and standard error of 0.76. On comparison of ISQ values of both the groups after 3 months, P value was 0.472 which shows the insignificant result. At 6-month follow-up, a comparison of ISQ values between Group A and Group B, the mean value of Group A was 73.80 with an SD of 2.91 and standard error of 0.92. In Group B, the mean ISQ value was 74.15 with an SD of 2.72 and standard error of 0.86 [Table 5]. On comparing the implant stability and bleeding on probing among the group, no statistically significant difference was observed in immediate loading and delayed loaded implant, which was in accordance with the study by Giovanni et al.[3] In Group A, the mean probing depth was 1.8 ± 0.63 mm and 1.2 ± 0.42 mm after the 1st and 6th months of loading [Table 2]. In Group B, the mean probing depth was 1.8 ± 0.42 mm after 1 month and remained the same even after 6 months of loading in relevance to Kees Heydenrijk.[4] After 6 months, the mean probing depth in Group A had decreased to 3.3 mm, down from 3.6 mm at 1 month after crown placement. However, there was no improvement in Group B, which stayed at 3.7 mm at both the stages.[4] Martin Lorenzoni[5] compared in his study and reported the implants with immediate loading and reference group showed no implant mobility and 100% survival rate [Table 5]. In their research, Schincaglia et al.[6] discovered that the bone level shift was 0.77 ± 0.38 mm for immediate loading and 1.2 ± 0.55 mm for delayed loading, which correlated to the hypothesis that micromovements induced by immediate loading have positive effects on osteoid deposition, as Vandamme et al.[7] demonstrated in an animal study. Kim et al.[8] observed in their study that after 6 months of crown placement, the bone loss in immediately loaded implants was 0.29 ± 0.19 mm.
Table 5: Comparing the values of implant stability in immediate loaded and conventional loaded implants after 3 and 6 months: Mean comparison between Group A and Group B

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Marginal bone levels vary with load distribution patterns in natural teeth and implants during initial healing, according to a study conducted by Chrcanovic et al.[9] They showed that an early functional loading during healing could reveal positive marginal bone levels. However, in terms of marginal bone loss, the current meta-analysis found no statistically significant difference (P = 0.74) between the techniques.

Kokovic et al.[10] conducted a study on a total of 274 implants, documenting a high risk of bias on 72 implants and showing substantial discrepancies between immediate and early loading protocols in single implant crowns in terms of survival rate at 1 (P = 0.990) and 3 years (P = 0.980). Overall survival rates were 97.3% in the 1st year and 96% in the 3rd year of immdeiate loading group and 97.5% in the 1st year and 97.0% in the 3rd year of early loading group. In this study, we evaluated the marginal bone loss on the mesial and distal aspects after 1 and 6 months of implant loading in both the groups. After 1 month of loading, for Group A, the mean value of the bone loss was 1.1 ± 0.56 mm and 1.15 ± 0.41 mm on mesial and distal aspects, respectively, and for Group B, it was 0.95 ± 0.49 mm and 0.82 ± 0.33 mm on mesial and distal aspects, respectively. After 6 months of loading, the Group A implants showed average bone loss of 0.10.21 mm on the mesial and 0.150.24 mm on the distal aspects, which is consistent with Kim et al [Table 6].[8]
Table 6: Comparison of bone loss in mm (at crown cementation) at 1st month and 6th month of crown cementation on mesial side of Group A and Group B

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The delayed loaded implants showed mean bone loss of 0.15 ± 0.24 mm and 0.15 ± 0.33 mm on the mesial and distal aspects, respectively, after a 6-month loading duration, which is in accordance with the findings of Giovanni et al.[3] The Wilcoxon matched-pairs test was used to compare bone loss 1 month after loading and 6 months after loading in Groups A and B separately. The results were statistically significant [Table 4].

The mean bone loss on the mesial side reduced from 1.1 ± 0.56 mm at 1 month after loading to 0.1 ± 0.21 mm at 6 months after loading (P value = 0.0051), and the average bone loss on the distal side decreased from 1.1 ± 50.41 mm at 1 month to 0.15 ± 0.24 mm at 6 months after loading (P = 0.0051) in Group A. In Group B, the average bone loss on mesial side decreased from 0.95 ± 0.49 mm at 1 month to 0.15 ± 0.24 mm at 6 months after loading (P = 0.0077), and on the distal side, it has reduced from 0.82 ± 0.33 mm at 1 month to 0.15 ± 0.33 mm at 6 months after loading (P = 0.0117). These results were similar to the study of Hahn,[11] Showed that there was a significant improvement of bone level during follow up visits in comparison to the bone level at the time of implant placement.

In the current study, all the 20 cases of implants, irrespective of techniques used, healed predictably. In both the groups, after 6 months of follow-up, no bleeding on probing (BOP) was observed, and the probing depth also was within the normal range. None of the cases reported implant mobility and peri-implant radiolucency. However, the major limitation of the study is the smaller sample size and the short duration of follow-up. Thus, we recommend a study with large sample size and long-term follow-up for predicting the success rate of implants in the above-mentioned techniques. Although the difference in implant success rates between immediate and delayed loading did not achieve statistical significance in our research, the findings indicate that single-tooth implant restoration in the mandibular posterior tooth with immediate loading technique can be used as an effective treatment modality and as an alternative to the traditional delayed loading technique.


  Conclusion Top


Single-tooth implant restoration in the mandibular posterior tooth with an immediate loading technique may be a promising treatment option and an alternative to the traditional delayed loading technique.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Charlest A. Babbush. Dental Implants – The art and Science, Saunders; 2011.  Back to cited text no. 1
    
2.
Worthington P. Osseointegration in Dentistry. 411 N Raddant Rd Batavia, IL 60510 Quintessence Publishing; 1994.  Back to cited text no. 2
    
3.
Salvi GE, Gallini G, Lang NP. Early loading (2 or 6 weeks) of sandblasted and acid-etched (SLA) ITI implants in the posterior mandible. A 1-year randomized controlled clinical trial. Clin Oral Implants Res 2004;15:142-9.  Back to cited text no. 3
    
4.
Heydenrijk K, Raghoebar GM, Meijer HJ, Van Der Reijden WA, Van Winkelhoff AJ, Stegenga B. Two-part implants inserted in a one-stage or a two-stage procedure. A prospective comparative study. J Clin Periodontol 2002;29:901-9.  Back to cited text no. 4
    
5.
Lorenzoni M, Pertl C, Zhang K, Wegscheider WA. In-patient comparison of immediately loaded and non-loaded implants within 6 months. Clin Oral Implants Res 2003;14:273-9.  Back to cited text no. 5
    
6.
Schincaglia GP, Marzola R, Giovanni GF, Chiara CS, Scotti R. Replacement of mandibular molars with single-unit restorations supported by wide-body implants: Immediate versus delayed loading. A randomized controlled study. Int J Oral Maxillofac Implants 2008;23:474-80.  Back to cited text no. 6
    
7.
Vandamme K, Naert I, Geris L, Vander Sloten J, Puers R, Duyck J. Influence of controlled immediate loading and implant design on peri-implant bone formation. J Clin Periodontol 2007;34:172-81.  Back to cited text no. 7
    
8.
Kim JH, Kim YK, Yi YJ, Yun PY, Lee HJ, Kim MJ, et al. Results of immediate loading for implant restoration in partially edentulous patients: A 6-month preliminary prospective study using Sinus Quick™ EB implant system. J Adv Prosthodont 2009;1:136-9.  Back to cited text no. 8
    
9.
Shibly O, Kutkut A, Paliu N. Immediate implants with immediate loading vs. conventional loading: 1 year randomised clinical trial. J Clin Implant Dent Relat Res 2010;6:1-8.  Back to cited text no. 9
    
10.
Kokovic V, Jung R, Feloutzis A, Todorovic VS, Jurisic M, Hämmerle CH. Immediate vs. early loading of SLA implants in the posterior mandible: 5-year results of randomized controlled clinical trial. Clin Oral Implants Res 2014;25:e114-9.  Back to cited text no. 10
    
11.
Hahn JA. Clinical and radiographic evaluation of one-piece implants used for immediate function. J Oral Implantol 2007;33:152-5.  Back to cited text no. 11
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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