Biological Oriented Immediate Loading: A New Mathematical Implant Vertical Insertion Protocol, Five-Year Follow-Up Study

Abstract

One of the current major challenges in implant therapy is to minimize marginal bone loss around implants, since it can trigger bacterial colonization of the implant’s neck, leading to its failure. The present study aimed (1) to scientifically validate a new mathematical rule based on soft tissues thickness, for choosing the correct implant position with respect to the bone level, in order to provide a better tissue adaptation to the abutment/implant surface to avoid bacterial invasion, and (2) to apply this mathematical rule to the Biological Oriented Immediate Loading (B.O.I.L.) surgical protocol, avoiding peri-implant bone resorption. N. 127 implants were inserted following B.O.I.L. protocol: implants were placed according to the mathematical rule Y = X − 3, which correlates the position of the implant from the bone crest level (Y) with the thickness of the soft tissues (X). All the implants were inserted in fresh extraction sockets, and immediately loaded with temporary abutments and prostheses. Bone levels were evaluated through radiographic examination just after surgical procedure (T0), and after 10 days (10D), 6 months (6M), 1 year (1Y), and 5 years (5Y). After 5 years, the implant survival rate was 100%, with a medium marginal bone loss around implants of 0.0704 mm (SD = 0.169 mm). One-way ANOVA, followed by Tukey’s multiple comparison test was performed for statistical evaluations (p < 0.05). This protocol provided a safe and successful procedure, with a good soft tissue seal against bacterial challenge. The application of the mathematical rule allows the implant placement in a correct vertical position from the bone crest, avoiding bone resorption and bacterial infiltrations. Moreover, the use of Multi Unit Abutment (MUA) determined a stable biological seal, favouring the implant healing and preserving the adhesion of hemidesmosomes to the titanium of MUA.

Histomorphometry of Bone after Intentionally Exposed Non-Resorbable d-PTFE Membrane or Guided Bone Regeneration for the Treatment of Post-Extractive Alveolar Bone Defects with Implant-Supported Restorations: A Pilot Randomized Controlled Trial

“…Intact buccal plate (Elian class 1 defect) has been considered a prerequisite for soft-tissue stability in the area surrounding the fixture and, therefore, for long-term esthetic results, particularly in case of high aesthetic demands [ 20 , 21 , 22 ]. Continuous resorption of the thin buccal bone plate may lead to a high risk of gingival resorption in time [ 5 , 20 ].…”

Marginal bone level change during sequential loading periods of partial edentulous rehabilitation using immediately loaded self-tapping implants: a 6.5-year retrospective study

“…Higher primary stability, nonocclusally loaded temporary restorations during a 3-month healing, splinted implants, and biocompatible prosthetic materials may reduce the risk of implant failure. 25 26 27 28 For partial prostheses, implants were splinted to support a preferable force distribution to the bone-implant interface under functional occlusion. The lateral forces were reduced by restricting working side contacts to the canines to retain implant micromotions.…”

Osteoblastic and Bacterial Response of Hybrid Dental Implants

“…There are many studies that show that poor hygiene and poor plaque control by the patient, pre-existing periodontal disease, and smoking are clear risk factors for the onset and establishment of the disease. Other related factors such as diabetes, genetic factors, absence of minimal keratinized gingiva, limited bone availability, occlusal overload, bone overheating, titanium particles, micromovement, biocorrosion, or microscopy and implant surface characteristics may play an important role in the onset and development of the disease, but their influence has not yet been defined [ 8 , 9 , 10 ].…”