A Relaxed Implant Bed: Implants Placed After Two Weeks of Osteotomy With Immediate Loading: A One Year Clinical Trial
A waiting period of 2 weeks after osteotomy increases the surrounding tissue activity to its maximum level as collagen formation and neoangiogenesis represent a relaxed and acceptable implant bed configuration. The aim of the present study was a clinical and radiologic evaluation of early osteotomy with implant placement delayed for 2 weeks with immediate loading in the anterior and premolar region with minimally invasive approach. Seven GS II implants (Osstem) were placed in 6 patients. Osteotomy was done followed by flap closure without placement of the implant. After waiting for approximately 2 weeks, implant placement was done, which was loaded immediately with provisional crown in implant protected occlusion. It was replaced by definitive restoration after 6–8 weeks, which was considered baseline. Implant stability and marginal bone levels were assessed with clinical and radiologic parameters at baseline, 6- and 12-month intervals. None of the implants were found mobile during the 1-year period. The average mean marginal bone loss was 0.4 mm over the 1-year follow-up period. In the present study, early osteotomy with delayed implant placement showed negligible crestal bone loss with no mobility.
Figure 1 . Buccal view of edentulous site selected for implant placement. Figure 2. Paracrestal mucoperiosteal flap reflection of the implant site. Figure 3. Osteotomy preparation of the site (#14) with 2-mm drill. Figure 4. Osteotomy preparation of the site (#15) with 2-mm drill. Figure 5. Use of paralleling pins to verify the angulation. Figure 6. Occlusal view of the osteotomy sites (#14 and #15).
Figure 10 . 3.5-mm implant (#14 and #15) with torque-controlled hand wrench. Figure 11. Occlusal view of the implants placed at the osteotomy sites. Figure 12. Buccal view of the immediate implant abutments placed. Figure 13. Provisional crowns cemented after 24 hours. Figure 14. Plastic impression caps placed for abutment level impression. Figure 15. Elastomeric impression with abutment analogs on impression caps.
Figure 18 . Postoperative intraoral periapical (IOPA) radiograph at 6-month follow-up visit. Figure 19. Postoperative IOPA radiograph at 12-month follow up visit. Figure 20. Radiograph at baseline (after the definitive crowns cemented). Figure 21. Radiograph showing with paralleling pins in the osteotomy sites. Figure 22. Preoperative IOPA radiograph of the implant site (#14 and #15).
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