Bone regeneration around implants in periodontally compromised patients: a randomized clinical trial of the effect of immediate implant with immediate loading.
BACKGROUND
This 2-year randomized clinical trial compared bone regeneration and esthetic outcome between immediate and conventional loading of dental implants placed immediately after extraction in patients with a history of periodontal disease.


METHODS
Patients were randomly assigned to receive immediate implants with either immediate loading or conventional loading after 3 months. Both groups received a periodontal flap, tooth extraction, implant placement, allograft bone, and membrane placement. 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, and 24 months. Evaluation included radiographic bone changes, papillary esthetic outcome, and implant survival rate.


RESULTS
Seventy-two patients were recruited into the study. However, 60 patients received immediate implant placement after extraction: 30 with conventional loading and 30 with immediate loading. In the immediate loading group the implant survival rate at 2 years was 96.7%, and the mean bone gain was 1.19 mm. The corresponding figures in the conventional loading group were 93.3% and 1 mm. The gain in bone level occurred mainly from baseline to 1 year postoperatively in both groups (P <0.001). The papilla index decreased from baseline to 1 year in both groups (P <0.001) and changed only slightly thereafter. There were no significant differences between the two groups in the amount of bone gain or papilla index change during 2 years.


CONCLUSIONS
Immediate loading of a single implant placed in a fresh extraction site in periodontally compromised patients resulted in similar bone gain and soft tissue esthetic outcomes compared to delayed loading. Primary closure and delayed loading to ensure bone regeneration around implants were not critical in this study.
Shibly
Othman
O
Center for Dental Studies, Department of Periodontics and Endodontics, School of Dental Medicine, University at Buffalo, Buffalo, NY 14214, USA. shibly@buffalo.edu
Patel
Nishith
N
Albandar
Jasim M
JM
Kutkut
Ahmad
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000539:Alveolar Process / Q000000981:diagnostic imaging; D001861:Bone Regeneration / Q000502:physiology*; D016025:Bone Transplantation / Q000379:methods; D003442:Crowns; D015921:Dental Implants; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D004955:Esthetics, Dental; D005260:Female; D005500:Follow-Up Studies; D005881:Gingiva / Q000473:pathology; D016557:Guided Tissue Regeneration, Periodontal / Q000379:methods*; D006801:Humans; D057893:Immediate Dental Implant Loading / Q000379:methods*; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications*; D011859:Radiography; D016037:Single-Blind Method; D013524:Surgical Flaps; D015996:Survival Rate; D014081:Tooth Extraction; D020390:Tooth Socket / Q000601:surgery; D016896:Treatment Outcome
D015921:Dental Implants; D008567:Membranes, Artificial