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Background: Few long-term studies are available comparing immediate and conventional loading protocols of implant-supported single-tooth replacement., Purpose: The aim of the present randomized controlled clinical trial was to evaluate prospectively the 5-year clinical and radiological outcome of immediate functional loading implants used in single-tooth replacement., Materials and Methods: One hundred fifty-one subjects, who required single-tooth rehabilitation in the area from position 15 to 25 and from 35 to 45, were enrolled in eight private clinics in Italy. A randomization protocol was applied to allocate the implants in three treatment groups: one control group and two test groups. In the control group, implant placement was performed according to a conventional drilling procedure, and the implants were submerged for 3 months before abutment connection and loading. Implants allocated in the test group 1 and 2 followed an immediate functional loading protocol. While in test group 1, implant placement was performed according to conventional drilling procedure, in test group 2, a modified implant installation procedure (osteotome technique) was applied. Clinical and radiographic examinations were performed during the 5-year follow-up, and technical and biological complications were registered., Results: Although four implants (three in the test group 2 and one in the test group 1) were lost in the immediate functional loading groups in the first year of follow-up, no further implant loss occurred in any of the treatment groups in the following monitoring period up to 5 years. No significant differences on marginal bone level changes were observed between the treatment groups. About 52% of all implants showed bone gain in the period from 1-year to 5-year follow-up. The percentage of all implants that in the same interval of time showed bone loss was about 28%. Although few technical complications were recorded in the period of time up to 5 years, implants showing biological complication were 5.7%., Conclusion: It is suggested that implants installed with a conventional installation technique together with an immediate functional loading protocol may be considered as a valid treatment alternative in a long-term perspective when used in a single-tooth replacement in an esthetic area., (© 2013 Wiley Periodicals, Inc.)

Objective: To analyze hard tissue reactions to immediate functionally loaded single implants that were installed either with a conventional drill preparation procedure or with an osteotome preparation technique., Materials and Methods: Thirteen subjects with two sites requiring single tooth rehabilitation by means of implants volunteered for the study. Each subject received one test (immediate functionally loaded) and one control (non-loaded) implant. In six subjects (group 1) the implants were placed using a conventional drilling procedure, whereas in the remaining seven subjects (group 2) an osteotome preparation procedure was performed. Block biopsies containing test and control implants and peri-implant bone tissues were collected at 1 month in four of the subjects in group 1 and in five subjects of group 2. The remaining implant sites were sampled at 3 months after implant placement. The biopsies were prepared for histological examination., Results: Two implants of the test-2 group (osteotome preparation) representing 1 month of healing and another test-2 implant representing 3 months of healing failed to integrate. A multilevel multivariate statistical analysis demonstrated that no differences in bone-to-implant contact (BIC)% were found in between test and control implants, the density of newly formed peri-implant bone was significantly higher around test than control implants at 1 and 3 months of healing. Sections representing osteotome technique sites showed fractured trabeculae and large amounts of bone particles., Conclusions: It is suggested that immediate loading of implants does not influence the osseointegration process, whereas the density of newly formed peri-implant bone at such sites appears to be increased in relation to unloaded control implants. The use of an osteotome preparation technique during installation results in damage of peri-implant bone and enhances the risk for failure in osseointegration., (© 2012 John Wiley & Sons A/S.)

Objectives: The aim of the present study was to evaluate the outcome of immediate functional loading of implants in single-tooth replacement using two different installation procedures., Material and Methods: One hundred and fifty-one subjects, who required single-tooth rehabilitation in the area of 15-25 and 35-45, were enrolled in eight private clinics in Italy. The implant sites were randomly allocated to one of the following treatment groups. In the control group, in which a standard preparation procedure for implant placement and submerged healing of the implant was used, abutment connection and loading of the implants were performed 3 months after installation. In the test group 1, a standard preparation procedure for the implant placement and immediate functional loading of implant was carried out. In the test 2 group, however, a modified implant installation procedure (osteotome technique) was used followed by immediate functional loading of the implant. Clinical and radiographic examinations were performed at 3 and 12 months of follow-up at all sites., Results: Three implants (5.5%) from the test 2 group (osteotome preparation) and one (2%) from the test 1 group (conventional drill preparation) failed to integrate and were removed one and three months after implant installation. The mean marginal bone loss assessed at 12 months was 0.31 mm (test 1), 0.25 mm (test 2) and 0.38 mm (control) (no statistically significant differences were found between the three treatment groups.), Conclusion: It is suggested that immediate functional loading of implants that are placed with a conventional installation technique and with sufficient primary stability may be considered as a valid treatment alternative in a single-tooth replacement.