Abstract
Objective: To evaluate the peri-implant hard tissue change at 6 and 12 months after implant placement between definitive abutment placed at the same time of implant surgery, never removing it, and healing abutment disconnected and reconnected three times until the placement of the final rehabilitation. Material and methods: Each partial edentulous patient could receive between 1 and 4 platform-switched implants in the posterior regions. If the implants had primary stability—implant stability quotient (ISQ) equal to or greater than 50, they were randomized to the test group with the abutment inserted at the same time of implant placement (DA) or to the control group, receiving a healing abutment (PA). At 6 and 12 months after surgery, data related with vertical bone level changes (primary outcome) and other clinical parameters (implant mobility, bleeding on probing, probing depth, plaque index) were assessed. Results: 53 implants were included in the trial and completed 12 months follow-up (overall survival rate: 100%). All implants achieved primary stability, with an average ISQ value of 80.9 on the day of surgery. From surgery to 6 months, the mean bone loss was 0.14 ± 0.18 mm for the DA group and 0.23 ± 0.29 mm for the PA group, without statistical significance difference. Between 6 and 12 months, the mean bone loss was 0.14 ± 0.21 mm for the DA group and 0.21 ± 0.27 mm for the PA group, also without statistical significance between the two groups. There were no statistically significant differences (p = 0.330) in total bone loss after 12 months between the control and the study groups. Conclusions: The one abutment one time protocol has at least an equivalent effect on the peri-implant bone level changes when compared with the use of healing abutments that are disconnected and reconnected at least three times.
Highlights
From the beginning, dental implantology always pursued osseointegration
Even if marginal bone loss (MBL) is minimal, it remains clinically relevant mainly because it may be accompanied by soft tissue recession, compromising long-term esthetic, especially if we are considering the anterior region [5]
The present study, considering an implant with conical connection and platform switching installed in healed alveolar ridges, submitted to a delayed loading protocol and rehabilitated with screw-retained crowns, demonstrated that the placement of the definitive abutment immediately after the implant surgery and no longer removing it was equivalent to the conventional protocol in which the abutment was disconnected and reconnected at least three times during the period comprehended between implant placement and connection of the definitive abutment (p = 0.442; group DA: 0.14 mm vs. group PA: 0.23 mm), as well as between 6 and 12 months (p = 0.330; group DA: 0.14 mm vs. group PA: 0.21 mm)
Summary
Dental implantology always pursued osseointegration. Successful osseointegration from the clinical standpoint is a measure of implant stability, which occurs after implant integration [1]. One of the most important factors to achieve osseointegration is primary implant stability that can be defined as the mechanical stability between the implant and the surrounding bone [2]. The implant stability quotients (ISQ values) are used as an indicator for mechanical implant stability and are believed to have predictive power for clinical outcome [3]. One of the main goals of modern implantology is the long-term stability of the periimplant hard and soft tissues in way to achieve and maintain esthetically optimal results [4]. Even if marginal bone loss (MBL) is minimal, it remains clinically relevant mainly because it may be accompanied by soft tissue recession, compromising long-term esthetic, especially if we are considering the anterior region [5]
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