Long term evaluation of non-submerged immediate implants with early loading in fresh extraction socket of single rooted teeth

The purpose of this study was toevaluate long-term stability and tissue integration of non-submerged immediate implant placement with early loading. Patients and methods: Fifty-fiveimmediate implants (2 parts) were inserted in 30 patients,
(17 males has 35 implants and 13 females with 20 implants). The patient’s age ranged from 22 to 55 y. with mean of 38.08±10.18. These implants were placed in fresh extraction sockets of maxillary and mandibular single rooted teeth, (40 implants in aesthetic zone and 15 implants in premolar region). Clinical and radiographic evaluation were done immediately, 1 and 10 weeks, 6 months, and  once yearly for 4 years after implant insertion. Postoperative evaluation was done to assess pain, peri-implantitis, probing depth (PD) and plaque index(PLI).  In addition, bleeding index(BI) and distance between implant shoulder and mucosal margin(DIM) were assessed.  Primary and seating torque, percussion test and ISQ were done to assess stability of the implants immediately and 10 weeks. Crestal bone level and bone density was assessed radiographically with parallel cone technique using digital IOPA and CBCT. After 10 weeks, implant were tested for stability with torque at 35 Ncm and with Osstell, and a final prosthesis were inserted.  Results: All implants were stable and osseointegrated without any mobility, at the time of abutment placement but 2 implants get stable after 6 months. Four patients (5 implants) were missed after 3 months from prosthetic insertion.  Radiographic examination showed only 0.5-1mm marginal bone loss around the implants. Clinically, good, successful results were detected with assessment of plaque and bleeding indices, gingival rescession and probing depth. Conclusion: Non-submergedimmediate implants can be placed successfully with good tissue integration infresh extraction socket and can be early loaded without bone graft to fill gap around non-submerged implants.