ABSTRACT
Background:
This randomized controlled trial aimed to compare the aesthetic outcome and patient perception of immediate versus DL of implant-supported single crowns.
Methods:
A total of 60 patients with a single missing tooth were enrolled and randomly assigned to two groups: immediate loading (IL) and delayed loading (DL). Each group consisted of 30 patients with a total of 30 implants. In the IL group, crowns were loaded onto implants immediately after placement, while in the DL group, a healing period of 3 months was observed before crown placement. Aesthetic outcome was assessed using the Pink Esthetic Score (PES) for soft tissue and the White Esthetic Score (WES) for the crown. Patient perception was evaluated through a visual analog scale (VAS) for satisfaction, comfort, and overall experience.
Results:
The IL group demonstrated comparable aesthetic outcomes to the DL group, with mean PES and WES scores of 10.2 ± 1.5 and 8.7 ± 1.2, respectively, in the IL group, and 10.5 ± 1.3 and 8.5 ± 1.4 in the DL group. Patient perception in terms of satisfaction, comfort, and overall experience was similarly high in both groups, with VAS scores above 8 for each parameter.
Conclusion:
This randomized controlled trial suggests that both IL and DL of implant-supported single crowns result in favorable aesthetic outcomes and high levels of patient satisfaction.
KEYWORDS: Aesthetic outcome, delayed loading, dental implants, immediate loading, patient perception, single crowns
INTRODUCTION
Aesthetic outcomes play a pivotal role in implant dentistry as they contribute to patient satisfaction and psychological well-being. The Pink Esthetic Score (PES) evaluates soft tissue aspects, while the White Esthetic Score (WES) assesses crown-related parameters.[1,2] Achieving optimal aesthetics around implant-supported crowns is challenging, and the loading protocol might influence the success in this regard.
Patient perception, encompassing satisfaction, comfort, and overall experience, significantly influences treatment success.[3] Understanding patient preferences and experiences can guide clinicians in making informed decisions about treatment planning and timing. Previous research suggests that patient perception can be influenced by the timing of crown loading, yet more evidence is needed to draw definitive conclusions.[4,5]
The aim of this randomized controlled trial was to compare the aesthetic outcome and patient perception of immediate versus DL of implant-supported single crowns. By analyzing these parameters, this study contributes to the ongoing discussion surrounding the optimal timing for crown loading in implant dentistry.
MATERIALS AND METHODS
Design and Participants: This randomized controlled experiment followed the Declaration of Helsinki. A dental implant clinic recruited 60 patients aged 18–65 with one missing anterior maxilla tooth. Systemic disorders that could impair implant healing, bone quality, or soft tissue were excluded from the study. Computer-generated randomization sequences assigned individuals to instant loading (IL) and delayed loading (DL) groups.
Implant implantation and loading protocol: Both groups had normal surgical implant implantation. The IL group loaded implants immediately after implantation. DL patients healed for three months before crown insertion. Resonance frequency analysis (Osstell ISQ) tested implant stability immediately after implant insertion and before crown placement.
Crown fabrication and aesthetic evaluation: All crowns were produced utilizing established methods to maintain consistency. The PES for soft tissue around the implant and the WES for crown-related parameters assessed aesthetic outcomes. Two calibrated and blinded examiners separately scored the PES and WES.
VAS was used to assess patient perception. Patients rated their satisfaction with the cosmetic outcome, crown comfort, and treatment experience on a scale from 0 (extremely dissatisfied/uncomfortable) to 10 (very satisfied/comfortable).
Clinical and radiographic parameters: Both groups had resonance frequency analysis-measured implant stability. Periapical radiographs at crown implantation and 1 year post-loading examined peri-implant bone loss. An independent blinded radiologist examined the radiographs.
Descriptive statistics summarized demographic data. Depending on data distribution, independent t-tests and Mann–Whitney U tests compared continuous variables between the IL and DL groups. 0.05 was the significance level.
RESULTS
Participant characteristics
Sixty participants were enrolled in the study, with 30 assigned to each group: immediate loading (IML) and delayed loading (DL).
Aesthetic outcome
Aesthetic outcomes were assessed using the PES for soft tissue and the WES for the crown. Both IL and DL groups demonstrated comparable aesthetic outcomes, with mean PES scores of 10.2 ± 1.5 and 10.5 ± 1.3, respectively, and mean WES scores of 8.7 ± 1.2 and 8.5 ± 1.4, respectively [Table 1].
Table 1.
Aesthetic Outcome Scores
| Aesthetic Score | Immediate Loading (IL) | Delayed Loading (DL) |
|---|---|---|
| Pink Esthetic Score | 10.2±1.5 | 10.5±1.3 |
| White Esthetic Score | 8.7±1.2 | 8.5±1.4 |
Patient perception
Patient perception was assessed using a visual analog scale (VAS). Both IL and DL groups reported high levels of satisfaction, comfort, and overall treatment experience. The mean VAS scores for satisfaction were 8.6 ± 1.2 in the IL group and 8.8 ± 1.1 in the DL group. For comfort, the IL group had a mean VAS score of 8.4 ± 1.3, while the DL group had a mean score of 8.7 ± 1.2. The mean VAS scores for overall treatment experience were 8.5 ± 1.0 in the IL group and 8.6 ± 1.1 in the DL group [Table 2].
Table 2.
Patient Perception Scores (VAS)
| Perception Score | Immediate Loading (IL) | Delayed Loading (DL) |
|---|---|---|
| Satisfaction | 8.6±1.2 | 8.8±1.1 |
| Comfort | 8.4±1.3 | 8.7±1.2 |
| Overall Experience | 8.5±1.0 | 8.6±1.1 |
Clinical parameters
Implant stability, assessed using resonance frequency analysis (Osstell ISQ), showed no significant difference between the IL group (72.6 ± 4.8) and the DL group (71.8 ± 5.2) (P = 0.312). Peri-implant bone loss was minimal in both groups, with mean values of 0.8 ± 0.3 mm in the IL group and 0.7 ± 0.4 mm in the DL group.
DISCUSSION
Implant dentistry’s aesthetics affect patients’ pleasure and mental health. The equivalent PES and WES scores in the IL and DL groups show that both loading techniques produce similar aesthetic results. Previous investigations have found equivalent esthetic outcomes for IL and DL scenarios.[1,2] In implant dentistry, soft tissue shape and crown aesthetics are difficult to achieve, but the present study’s results allay concerns regarding rapid loading’s potentially harmful effects.
Patient perspective determines therapy success and satisfaction. Both the IL and DL groups had high VAS values for satisfaction, comfort, and overall treatment experience, indicating patient satisfaction with implant-supported single crowns. Previous studies found significant patient satisfaction with dental implants regardless of loading techniques.[3,4] Patient compliance and long-term treatment success depend on favorable patient experiences.
Implant stability is a significant predictor of effective osseointegration, and the comparable resonance frequency analysis (ISQ) values in both groups show that both IL and DL methods produce equivalent stability. Studies have found no significant difference in implant stability between IL and DL.[5,6]
Peri-implant bone loss affects implant-supported crown longevity. The little bone loss in both the IL and DL groups suggests that both loading procedures can produce stable peri-implant conditions. These findings confirm modest peri-implant bone loss rates in IL and DL.[7,8]
CONCLUSION
In conclusion, this randomized controlled trial suggests that both IL and DL of implant-supported single crowns lead to favorable aesthetic outcomes, high levels of patient satisfaction, similar implant stability, and minimal peri-implant bone loss.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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