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ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 6  |  Page : 278-284  

Clinical and radiological evaluation of delayed and early loading of single-tooth implant placement: A 6-month, prospective, randomized, follow-up clinical study


Department of Periodontics, JKK Nattraja Dental College and Hospital, Komarapalayam, Tamil Nadu, India

Date of Web Publication28-May-2019

Correspondence Address:
Dr. Santhosh Sekar
Department of Periodontics, JKK Nattraja Dental College and Hospital, Komarapalayam, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPBS.JPBS_12_19

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   Abstract 

Purpose: The purpose of the study was to compare delayed and early loaded single-tooth implant technique. Materials and Methods: A randomized, prospective clinical trial was conducted to evaluate the clinical and radiological parameters of delayed and early loading of single-tooth implant placement. Fourteen male or female patients were selected randomly, who had single tooth missing in mandibular posterior region. A delayed implant placement technique was followed in these regions. A Hi-Tech implant (Life Care Implants) was performed. The patients were divided into two groups: delayed loading group and early loading group. In delayed loading groups, implants were loaded after 3 months, and in early loading groups, implants were loaded within 7 days to 2 months. Soft tissue and radiological bone loss were assessed at baseline, 3 months, and 6 months. The parameters assessed were plaque index, gingival index, probing pocket depth, thickness of peri-implant mucosa, and bone loss (radiographically). Results: The results show that there was no statistical difference in indexes taken between delayed loading and early loading groups. Conclusion: In this study, after first 6 months there was no difference in success rate between delayed loading or early loading of implants. This study also showed that more bone loss occurred around delayed loading implants. So it can be concluded that early loading technique can be successfully practiced instead of delayed loading of implants.

Keywords: Delayed loading, early loading, mandibular posterior teeth, radiographic bone loss, single-tooth implants, soft-tissue analysis


How to cite this article:
Sekar S, Suthanthiran T, Thangavelu A, Karupannan SK, Prem F, Rajendran D. Clinical and radiological evaluation of delayed and early loading of single-tooth implant placement: A 6-month, prospective, randomized, follow-up clinical study. J Pharm Bioall Sci 2019;11, Suppl S2:278-84

How to cite this URL:
Sekar S, Suthanthiran T, Thangavelu A, Karupannan SK, Prem F, Rajendran D. Clinical and radiological evaluation of delayed and early loading of single-tooth implant placement: A 6-month, prospective, randomized, follow-up clinical study. J Pharm Bioall Sci [serial online] 2019 [cited 2019 Jun 18];11, Suppl S2:278-84. Available from: http://www.jpbsonline.org/text.asp?2019/11/6/278/258808




   Introduction Top


Modern dentistry has the goal to restore the patient to normal contour, function, comfort, esthetics, speech, and health by restoring caries tooth or replacing the missing tooth. Dental implant can fulfill most of the aforementioned goals.[1] These implants can be loaded in three types. These are immediate loading (i.e., within 1 week), early loading (i.e., between 1 week and 2 months), and delayed or conventional loading (i.e., after 2 months).[1] Studies show immediate loading of implant has higher failure rate.[2] But immediate or early loading protocols are practiced to reduce the interval between implant and prosthetic loading, which improves the patient comfort[3] and also allows the patient to return to their socioeconomic lives earlier.[4] Implant that is loaded after healing period (delayed loading) has high biologic stability, but it also has the disadvantage of prolonged treatment time.[5]

It would be worth comparing early versus delayed loading protocols to find if they have any meaningful difference. The soft and hard tissues around dental implants seem to have an important role in implant success. Monitoring marginal bone level and soft tissue around implants can help determine the success of implants.[6]

The aim of this study was to compare delayed versus early loading single-tooth implant placement technique.


   Materials and Methods Top


Fourteen partially edentulous patients in the age group of 20–50 years of either sex were selected from outpatient department of periodontics, JKK Nattraja Dental College, Komarapalayam, Tamil Nadu, India. These patients had single tooth missing in mandibular posterior region. These patients were divided into two groups: group 1 (delayed loading) and group 2 (early loading). Single-tooth implants were placed in these patients using either of the techniques mentioned earlier. Patients were excluded if they had any systemic conditions, insufficient bone quantity, inadequate opening of mouth, and insufficient vertical inter arch space to place the prostheses.[7] All the patients were evaluated radiographically [Figure 1]. On the basis of the analysis, the appropriate diameter and length of implants were selected. Delayed single-tooth implant placement was performed in mandibular posterior region [Figure 2]. In delayed loading group, the abutment and crown were placed after 3 months of implant placement [Figure 3]. In early loading group, the abutment and crown were placed after 7 days to 2 months of implant placement. The prosthetic crown was prepared and cemented with type II glass ionomer cement (GIC). Occlusal loading of an oral implant may result in loss of osseointegration.[8] So to avoid the risk of failure with early loaded implants, nonocclusal temporary prostheses are used as shown in [Figure 4], which can be followed by occlusal loading.[9]
Figure 1: Pre-operative radiograph with stent

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Figure 2: Implant placed

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Figure 3: Final abutment placement

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Figure 4: Cementation of prosthesis

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Clinical parameters

Soft tissue around implants was assessed by a single examiner after crown cementation at baseline, 3 months, and 6 months. The parameters assessed were plaque index, gingival index, thickness of peri-implant mucosa [Figure 5], probing pocket depth (PPD) [Figure 6], and bone loss (radiographically) [Figure 7]. The significance between the groups at different time intervals was analyzed using Student t distribution.
Figure 5: Thickness of mucosa (millimeter)

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Figure 6: Probing pocket depth (millimeter)

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Figure 7: Radiological measurement of peri-implant bone loss

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   Results Top


The results are shown in [Table 1], [Table 2], [Table 3], [Table 4], [Table 5] and [Graph 1], [Graph 2], [Graph 3], [Graph 4], [Graph 5]. Statistically there was no significant difference (P > 1) between the early and delayed loaded groups at either baseline, 3 months, and 6 months when comparing the parameters like plaque index, gingival index, thickness of peri-implant mucosa, PPD, and peri-implant bone loss.
Table 1: Plaque index

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Table 2: Gingival index

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Table 3: Thickness of peri-implant mucosa

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Table 4: Probing pocket depth

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Table 5: Peri-implant bone loss

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Graph 1: Plaque index

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Graph 2: Gingival index

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Graph 3: Thickness of peri implant mucosa

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Graph 4: Probing pocket depth

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Graph 5: Peri implant bone loss

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   Discussion Top


A study conducted by Muthukumar et al. showed that immediate loading has higher failure rate compared to early loading.[2] Thus, early loading protocol was used in this study rather than immediate loading protocol.

Bauman et al.[10] stated that plaque is considered to be a primary etiological factor in peri-implant tissue destruction. Thus, it is appropriate to monitor oral hygiene to assess peri-implant tissue destruction through plaque indices. In this study, [Table 1] showed that the plaque score was increased slightly from baseline in both the groups. But there was no statistically significant (P > 1) difference present in between mean plaque scores at 3 and 6 months. This could be because the patients maintained good oral hygiene and so there was only slight increase in plaque score. As per this study, there was no statistically significant (P > 1) difference in the mean gingival index at 3 and 6 months between the groups. But when compared to baseline, mean gingival index scores were increased in both the groups. Donati et al.[11] and Bauman et al.[12] stated that gingivitis was significantly correlated to plaque levels. So increase in mean gingival index score could be due to increased plaque score.

The study also showed that there was no statistically significant difference (P > 1) in mean thickness of peri-implant mucosa between the groups at 3 and 6 months. Both early and delayed loaded group had similar gingival biotype, i.e., 2mm of mucosal thickness (thick biotype) at baseline, and there was slight change in it at 3 and 6 months in both groups as in accordance with the study by Jung et al.[13] He reported that 2mm of mucosal thickness as thick biotype. A thick biotype is more fibrotic and has more vascularization, so it is more resistant to gingival recession and crestal bone loss. In thick biotype, less amount of crestal bone loss is caused when compared to thin biotype. Because the gingival biotype (thick) was the same, its effect on crestal bone loss difference between both the groups can be excluded. In this study, there was no statistically significant difference (P > 1) in mean PPD between groups at 3 and 6 months. PPD increased from the time of crown placement in both the groups, but not more than 6mm. This was in accordance with the study conducted by Behneke et al.,[14] who stated that increase in levels of probing depth could be noted from baseline. Bauman et al.[12] stated that increase in PPD was due to undetected subgingival plaque accumulation. Another possible explanation for increased PPD could be the process of remodeling of peri-implant soft tissue for maintenance of “biological width” as stated by Koutouzis et al.[15]

The results of the study also showed that there was no significant statistical difference (P > 1) in bone loss between the groups at 3 and 6 months, but bone loss assessed using Radio Visio Graph, showed slightly more bone loss in the delayed loading group compared to the early loading group at 3 and 6 months. These results were similar to a study conducted by Guruprasada et al.[16] Meijer et al.[17] stated that increase in bone loss in delayed loading group was mainly as a result of disuse atrophy. In our study, as very minimum bone loss occurred in both the groups, no implants were lost during the 6-month study period.


   Conclusion Top


From this study, the following conclusions can be arrived: (1)the success rate of single-tooth implants was the same in both the groups, (2) more bone loss can be seen in delayed loading group than in early loading group, and (3) very insignificant amount of bone loss occurred that did not affect the implant success during the initial 6 months of healing period.


   Declaration of patient consent Top


The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Mish CE. Contemporary implant dentistry. 3rd ed. Mary Land Heights, Missouri: Elsevier; 2007.  Back to cited text no. 1
    
2.
Muthukumar B, Gopichander N, Katare U. Clinical and radiographic evaluation of single unit implant-retained prosthesis with immediate and delayed loading. SRM J Dent Sci 2010;1:48-50.  Back to cited text no. 2
    
3.
Cordaro L, Torsello F, Roccuzzo M. Implant loading protocols for partially edentulous posterior mandible. Int J Oral Maxillofac Implants 2009;24(Suppl):158-68.  Back to cited text no. 3
    
4.
Chaushu GA, Chaushu S, Tzohar A, Dayan D. Immediate loading of single tooth implants: Immediate versus non immediate Implantation. A clinical report. Int J Oral Maxillofac Implants 2001;16:267-72.  Back to cited text no. 4
    
5.
Simunek A, Kopecka D, Brazda T. Development of implant stability during early healing of immediately loaded implants. Int J Maxillofac Implants 2012;27:619-27.  Back to cited text no. 5
    
6.
De Smet E, van Steenberghe D, Quirynen M, Naert I. The influence of plaque and/or excessive loading on marginal soft and hard tissue reactions around Branemark implants: A review of literature and experience. Int J Periodontics Restorative Dent 2001;21:381-93.  Back to cited text no. 6
    
7.
Avivi-Arber L, Zarb GA. Clinical effectiveness of implant-supported single tooth replacement: The Toronto study. Int J Oral Maxillofac Implants 1996;11:311-21.  Back to cited text no. 7
    
8.
Tawil G. Peri-implant bone loss caused by occlusal overload: Repair of the peri-implant defect. Following correction of the traumatic occlusion. A case report. Int J Oral Maxillofac 2008;23:153-7.  Back to cited text no. 8
    
9.
Esposito M, Grusovin MG, Willings M, Coulthard P, Worthington HV. The effectiveness of immediate, early, and conventional loading of dental implants: A Cochrane systematic review of randomized controlled clinical trials. Int J Oral Maxillofac Implants 2007;22:893-904.  Back to cited text no. 9
    
10.
Baumann GR, Mills M, Rapley JW, Hallmon WH. Clinical parameters of evaluation during implant maintenance. Int J Oral Maxillofac Implants 1992;7:220-7.  Back to cited text no. 10
    
11.
Donati M, La V, Billi M, Di Dino B, Torrisi P, Berglundh T. Immediate functional loading of implants in single tooth replacement: A prospective clinical multicenter study. Clin Oral Implants Res 2008;19:740-8.  Back to cited text no. 11
    
12.
Bauman GR, Mills M, Rapley JW, Hallmon WW. Plaque-induced inflammation around implants. Int J Oral Maxillofac Implants 1992;7:330-7.  Back to cited text no. 12
    
13.
Jung YC, Han CH, Lee KW. A 1 year radiographic evaluation of marginal bone around dental implants. Int J Oral Maxillofac Implants 1996;11:811-18.  Back to cited text no. 13
    
14.
Behneke A, Behneke N, d’Hoedt B, Wagner W. Hard and soft tissue reactions to ITI screw implants: 3 year longitudinal results of a prospective study. Int J Oral Maxillofac Implants 1997;12:749-57.  Back to cited text no. 14
    
15.
Koutouzis T, Koutouzis G, Gadalla H, Neiva R. The effect of healing abutment reconnection and disconnection of soft and hard peri implant tissues: A short randomized controlled clinical trial. Int J Maxillofac Implants 2013;28:807-14.  Back to cited text no. 15
    
16.
Guruprasada, Thapliyal GK, Pawar VR. A comparative analysis of periimplant bone level of immediate and conventionally loaded implants. Med J Armed Forces India 2013; 69:1-47.  Back to cited text no. 16
    
17.
Meijer H, Heijdenrijk K, Raghoebar G. Mucosal and radiographic aspects during the healing period of implants placed in a one-stage procedure. Int J Prosthodont 2003;16: 397-402.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Graph 1], [Graph 2], [Graph 3], [Graph 4], [Graph 5]
 
 
    Tables

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



 

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