ABSTRACT
The present study aimed to evaluate the peri-implant tissue response and marginal bone levels of immediately loaded narrow diameter dental implants. In this study, 10 patients with single maxillary anterior edentulous space were included. Implants were placed and immediate provisional crown was given without any centric or eccentric contacts. After three months, a definitive restoration was placed. All the clinical and radiographical parameters were evaluated.
KEYWORDS: Immediate loading, narrow diameter dental implants, peri-implant mucosa
INTRODUCTION
Teeth play a vital role in maintaining the normal biting forces, there-by effectuating the chewing process and also preserving the surrounding bone in the jaws. Loss of teeth results in unwanted drifting of adjacent teeth, supra-eruption of opposing teeth, etc.Additionally, absence of anterior teeth in young adults will adversely impact social integration, esthetics, and phonetics. The treatment alternatives to replace missing teeth are removable dentures, tooth-supported crowns and bridges, acid-etched resin-bonded prosthesis, and/or implant supported prosthesis.[1] The single tooth implant has the highest success rate compared to any other treatment option to replace missing teeth with an implant-supported restoration. Use of dental implants to replace the natural missing tooth has become a common treatment option in restorative and surgical practice.[1] Multiple authors have reported favorable results when a single implant in the anterior edentulous sites were immediately provisioned with standard diameter implants, but studies reporting on the viability of immediate provisioning of narrow diameter implants are very few. Hence, the aim of the present study was to evaluate the success of immediate loading of narrow diameter dental implants, both clinically by peri-implant response and radiographically by marginal bone levels.
METHODOLOGY
This prospective study was conducted on patients from the outpatient department of the Department of Periodontics of Mamata Dental College, Khammam, Telangana. Ten patients with a single tooth missing in the maxillary anterior region were included in the study, consisting of eight males and two females of ages 21 to 40 years. Implants were placed and immediate provisional crown was given without any centric or eccentric contact. The bone type was assessed during the surgery. Before the commencement of the study, informed consent was obtained from the patients and the study protocol was approved by the institutional review committee for human research (MDC_T_D_148806020). The study was conducted in phases, including initial screening, initial therapy and ridge mapping, surgical therapy, and immediate provisioning. Definitive restoration was performed three months after implant placement. Re-evaluation was done at three and six months interval after implant placement.
Patient above the age of 18 years having good oral hygiene, a single-tooth edentulous space in the anterior region with adequate bone volume for placement of a narrow diameter implants (3 mm) were included in the study. Patients with history of smoking, drug or alcohol abuse, a history of extraction in the edentulous area in the past three months and having any medical, physical, or psychological reason affecting the surgical procedure or subsequent follow up treatment were excluded from the main study. The examination was performed using a mouth mirror, William’s probe, a tweezer, and pellets of cotton. Ridge mapping was done under local anesthesia with the help of bone mapping calipers. Alginate impressions were made and diagnostic casts poured for sectioning of the casts. The width of the edentulous ridge was correlated both clinically and on diagnostic casts. When the patients met the above selection criteria, the possible treatment plan was explained to them. All the patients voluntarily signed the informed consent before commencement of the study. A brief history of each patient was recorded on a case history pro forma. Statistical analysis was done based on the suitability of the tests using IBM SPSS Statistics version 25.
RESULTS
At three months, the intragroup modified plaque index [Table 1] score readings showed 10% of patients with scores 0 and 2, and 80% with 1, while at 6 months 10% of patients showed score 0 and 90% showed score 1. For intragroup modified bleeding index [Table 2], at baseline 30% of patients showed score 0 and 70% showed 1. At six months, 40% recorded a score of 0 and 60% recorded 1. The marginal bone level (MBL) [Table 3] at three months was − 0.30 ± 0.03 and − 0.55 ± 0.03 at six months. Intragroup comparison showed that six-month mean MBL was significantly higher than that of three months. Post hoc test showed that mean difference between 0 and 6 months was highest followed by 0 and 3 months, with the least being between 3 and 6 months.
Table 1.
Modified plaque index
| n | % | P | |
|---|---|---|---|
| MPI-3 | |||
| 0 | 1 | 10.0% | 0.317, NS |
| 1 | 8 | 80.0% | |
| 2 | 1 | 10.0% | |
| MPI-6 | |||
| 1 | 9 | 90.0% | |
| 2 | 1 | 10.0% |
Table 2.
Modified sulcus bleeding index
| n | % | P | |
|---|---|---|---|
| MBI-3 | |||
| 0 | 3 | 30.0% | 0.564, NS |
| 1 | 7 | 70.0% | |
| MBI-6 | |||
| 0 | 4 | 40.0% | |
| 1 | 6 | 60.0% |
Table 3.
Marginal bone level
| 3 months | 6 months | P | |||
|---|---|---|---|---|---|
|
|
|
||||
| Mean | SD | Mean | SD | ||
| MBL | 0.30 | 0.03 | 0.55 | 0.03 | <0.001, S |
Intragroup comparison of mesial and distal interdental papilla [Tables 4 and 5] at baseline, three months, and six months showed no significant difference in the distribution of mesial interdental papilla scores during the follow-up. The mean mid facial dimensions of the peri-implant mucosa [Table 6] was 3.15 ± 0.24 at three months and 3.25 ± 0.26 at six months. The mean mesial implant dimensions of the peri-implant mucosa were 5.4 ± 0.52 at three months and 5.55 ± 0.44 at six months. The mean distal implant dimensions of the peri-implant mucosa were 5.65 ± 0.47 at three months and 5.80 ± 0.35 at six months. The mean distal tooth dimensions of the peri-implant mucosa were 3.40 ± 0.52 at three months and 3.40 ± 0.52 at six months. The mean mesial tooth (MT) dimensions of the peri-implant mucosa were 3.55 ± 0.55 at three months and 3.55 ± 0.55 at six months. Intragroup comparison showed no difference in mean MT between three and six months. Gingival zenith (GZ) [Table 7] was 8.39 ± 0.62 at three months and 8.45 ± 0.63 at six months. There was overall significant difference in the mean GZ scores from three to six months (P < 0.001).
Table 4.
JEMT papilla index - MESIAL
| n | % | Mean rank | P | |
|---|---|---|---|---|
| JPI - M-B | ||||
| 1 | 1 | 10.0% | 1.85 | 0.223, NS |
| 2 | 3 | 30.0% | ||
| 3 | 6 | 60.0% | ||
| JPI - M-3 | ||||
| 1 | 1 | 10.0% | 2 | |
| 2 | 2 | 20.0% | ||
| 3 | 7 | 70.0% | ||
| JPI - M-6 | ||||
| 1 | 1 | 10.0% | 2.15 | |
| 2 | 1 | 10.0% | ||
| 3 | 8 | 80.0% |
Table 5.
JEMT papilla index - DISTAL
| n | % | Mean rank | P | |
|---|---|---|---|---|
| JPI - D-B | ||||
| 2 | 5 | 50.0% | 1.9 | 0.135, NS |
| 3 | 5 | 50.0% | ||
| JPI - D-3 | ||||
| 2 | 5 | 50.0% | 1.9 | |
| 3 | 5 | 50.0% | ||
| JPI - D-6 | ||||
| 2 | 3 | 30.0% | 2.2 | |
| 3 | 7 | 70.0% |
Table 6.
Peri-implant mucosa dimensions (mid-facial, mesial to implant, distal to implant, mesial tooth, distal tooth)
| 3 months | 6 months | P | |||
|---|---|---|---|---|---|
|
|
|
||||
| Mean | SD | Mean | SD | ||
| MF | 3.15 | 0.24 | 3.25 | 0.26 | 0.168, NS |
| MI | 5.4 | 0.52 | 5.55 | 0.44 | 0.081, NS |
| DI | 5.65 | 0.47 | 5.80 | 0.35 | 0.193, NS |
| DT | 3.40 | 0.52 | 3.40 | 0.52 | - |
| MT | 3.55 | 0.55 | 3.55 | 0.55 | - |
Table 7.
Gingival zenith
| Mean | SD | P | |
|---|---|---|---|
| GZ 3 | 8.39 | 0.62 | <0.001, S |
| GZ 6 | 8.45 | 0.63 |
DISCUSSION
The peri-implant dimensions of the present study are in accordance with a cross-sectional study conducted by Poomprakobsri et al.[2] where the peri-implant mucosal dimensions were evaluated in a single maxillary anterior implant with surrounding natural teeth after loading. According to Albrektsson et al.[3] and Shadid et al.,[4] an annual bone loss of less than 1.0 mm in the first year and 0.1 mm in the years thereafter and an annual bone loss of 0.2 mm at bone surfaces facing the implants are generally accepted as a natural biologic process. These results are in accordance with the results of Monje A et al.,[5] in delayed placement and early loading of narrow diameter dental implants. The limitations of the present study are the small sample size and less follow-up period. Further studies have to be carried out with a larger sample size and more follow-up to evaluate the efficiency of these implants.
CONCLUSION
At six months, the overall mean marginal bone loss was −0.55 mm. Good peri-implant hygiene was maintained throughout the study. The increase in papilla index scores throughout the study indicated that the implant papillae height were maintained. The stable position of gingival zenith indicated no recession. The peri-implant mucosa dimensions did not alter during the follow-up and indicated that the biological width was maintained. From this study, it can be concluded that narrow diameter dental implants placed in healed ridges often produce good results with good esthetic outcome.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Suárez-López del Amo F, Lin GH, Monje A, Galindo-Moreno P, Wang HL. Influence of soft tissue thickness on peri-implant marginal bone loss:A systematic review and meta-analysis. J Periodontol. 2016;87:690–9. doi: 10.1902/jop.2016.150571. [DOI] [PubMed] [Google Scholar]
- 2.Poomprakobsri K, Kan JY, Rungcharassaeng K, Lozada J, Oyoyo U. Exposure of barriers used in guided bone regeneration:Rate, timing, management, and effect on grafted bone—A retrospective analysis. J Oral Implantol. 2022;48:27–36. doi: 10.1563/aaid-joi-D-19-00252. [DOI] [PubMed] [Google Scholar]
- 3.Albrektsson T, Tengvall P, Amengual-Peñafiel L, Coli P, Kotsakis G, Cochran DL. Implications of considering peri-implant bone loss a disease, a narrative review. Clin Implant Dent Related Res. 2022;24:532–43. doi: 10.1111/cid.13102. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Shadid RM. Immediate implant placement with socket shield technique in the maxilla:A prospective case series evaluation at 1-year follow-up. Head Face Med. 2022;18:1–3. doi: 10.1186/s13005-022-00324-3. doi:10.1186/s13005-022-00324-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Monje A, Chan HL, Fu JH, Suarez F, Galindo-Moreno P, Wang HL. Are short dental implants (<10 mm) effective?A meta-analysis on prospective clinical trials. J Periodontol. 2013;84:895–904. doi: 10.1902/jop.2012.120328. [DOI] [PubMed] [Google Scholar]
