Long-term comparison of bone regeneration between immediate and conventional loading of implants placed in fresh extracted sockets in periodontally compromised patients: 6-year randomized clinical trial
Alqahtani, Nabeeh Abdullah
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Objective: This long-term randomized clinical study compared the stability of native and regenerative bone around immediate implants with immediate loading vs. immediate implants with conventional loading in periodontally compromised patients after 6 years of function. Methods: Sixty patients who met the anatomical surgical criteria were randomly assigned to receive immediate implants with either immediate loading or conventional loading after 3 months. Periodontal flap, tooth extraction, implant placement, allograft bone and membrane placement were utilized in both groups. The immediate loading group received a temporary crown. In the conventional loading group primary closure was achieved. All patients were followed up at 3, 6, 12, 24 and 72 months. Evaluation included radiographic bone changes, papillary esthetic outcome and implant survival rate. Repeated measurement analysis was used to account for the correlation between bone level measurements made at the same sites over multiple visits. The analyses were performed using the SAS software. Results: Forty-one patients were available at 6 years for evaluation. The implant survival rate at 6 years was 96.7% for the immediate loading (IL) group and 93.3% for the conventional loading (CL) groups. The mean bone levels were 0.95± 0.34 mm and 0.76± 0.36mm coronal to the implants shoulder at baseline for (IL) and (CL) groups, respectively. At 6 years postoperatively, the bone was 2.09± 0.38mm and 1.58± 0.38 mm apically to the implant shoulder for (IL) and (CL) groups, respectively. For both groups, the plaque index was 20% and bleeding upon probing was 14%. The papilla index increased gradually from year 1 to year 6 (2.23 in IL group and 2.25 in CL group) (P=0.11). There were no significant differences between the two groups in the amount of bone loss and papilla index change during 6 years. Conclusions: Immediately loaded implant is an acceptable modality of treatment, even for patients with a past history of periodontal disease. At 6 years, there were no differences between the IL and CL groups in terms of bone level and esthetic outcomes.