Healing differences in narrow diameter implants submitted to immediate and conventional loading in mandibular overdentures: A randomized clinical trial

Abstract

Background Biological responses to different loading protocols during the bone healing phase in subjects with long time since edentulism, rehabilitated with narrow diameter implants (NDIs) to retain mandibular overdentures (MOs), are still unavailable. Objective This randomized clinical trial compared the peri‐implant health, implant stability, and concentrations of pro‐ and anti‐inflammatory cytokines in the peri‐implant crevicular fluid (PICF) in mandibular edentulous patients under conventional (CL) and immediate loading (IML) during healing. Methodology Twenty totally edentulous patients received two NDIs (2.9 × 10 mm, Facility NeoPoros) placed in mandible anterior region and were randomly assigned to two loading protocols: CL (n = 10) and IML (n = 10). The following clinical outcomes were evaluated 1, 2, 4, 8, and 12 weeks after surgery: (a) peri‐implant tissue health (gingival index‐GI, plaque index‐PI, calculus‐presence CP, probing depth‐PD, and bleeding on probing‐BOP); (b) implant stability quotient (ISQ); and (c) IL‐1β, IL‐6, IL‐10, and TNF‐α levels in the PICF analyzed by ELISA. Results The CL group showed significantly higher CP scores at weeks 8 and 12. The IML group showed significantly higher GI from the first week onwards. The IML group presented significantly lower PD at all follow‐up times, and higher BOP rates than CL at week 12. The ISQ values of the CL group were higher than those of the IML group, except at week 4. The IML group released significantly more TNF‐α between weeks 1 and 4 and more IL‐1β during week 4‐12, while releasing less IL‐6 until week 8, mainly at week 2 (−47.6%). The release of IL‐10 was similar for both groups and increased progressively over time. At week 12, the IML group released 45.74% more IL‐10 than the CL group. The survival rates were 95% and 90% for CL and IML, respectively. Conclusion The IML group presented more favorable PD at all evaluation times; the differences between the other clinical parameters were less systematic. The implant stability and the inflammatory marker concentrations were more stable in the CL group.

Influence of Insertion Torque on Clinical and Biological Outcomes before and after Loading of Mandibular Implant-Retained Overdentures in Atrophic Edentulous Mandibles

“…This study found a weak correlation between IT and primary ISQ (P = 0.01; Rk = 0.252), which has previously been reported [39–41]. The present study also showed that there was a drop in ISQ values after primary stability establishment up to 6 months that was subsequently counteracted by the increase in secondary ISQ recording to baseline ISQ values (Table 3 and Figure 2), in accordance with most previously published results [13, 21, 24, 37]. The ISQ of G2 and G4 was approximately 7.5 times higher than G1 and 3 times higher than that of G3 (Table 3 and Figure 3).…”

“…The influence of IT on outcomes related to implant healing and stability during and after implant osseointegration is still controversial and dependent on factors such as bone availability, patient profile, surgical protocol, and implant macrogeometry [21, 24, 35–37]. Thus, this longitudinal clinical study evaluated the effect of IT values on implant success and survival during 1 year of function and mapped clinical and biological endpoints of NDI placed in the anterior region of totally edentulous jaws.…”

“…A study that followed implants with a IT of 30 Ncm with immediate loading found that the concentration of IL-1 β was initially low and it increased progressively until 12 months [48]. Thus, it is suggested that the functional loading of the implants favors IL-1 β release, interacting with the processes of bone remodeling and osseointegration [12, 37, 44].…”

Immediate vs conventional loading of Facility‐Equator system in mandibular overdenture wearers: 1‐year RCT with clinical, biological, and functional evaluation

“…31 A detailed description of this study's methodology with 3 months of follow-up can be found in a previous study along with the sample size calculation. 10 The study includes implant stability outcomes, peri-implant clinical health indices, cytokines in the periimplant crevicular fuid (PICF), and success/survival rates. Thus, the design of the present study and the outcomes already reported by Bielemann et al 10 will be briefly described, with a greater emphasis on the new outcomes included in the present study: the MP test results, OHRQoL data, and the prosthetic intercurrences.…”

“…Several factors can compromise the osseointegration process in these patients, such as bone quality and microarchitecture, bone availability, degree of mandibular atrophy, prolonged time since edentulism, and the presence of systemic or chronic diseases. [8][9][10] Systematic reviews still show divergent survival rates achieved by CL and IML when edentulous patients were rehabilitated using IMO. 1,[11][12][13] The meta-analysis by Alsabeeha et al 11 suggests that IML is a predictable treatment option that presents results comparable to CL in short-term studies.…”