Journal

Discussion
31/03/2022
Influence of loading
and drilling on
marginal bone loss
around implants with
a Dynamic Bone Flavio Seijas Naya, Abel García García, Pablo Galindo-
Management design: Moreno, Francisco Gude Sampedro, Dolores Reboiras
López, Samuel Rodríguez Zorrilla, Pilar Gándara Vila, Cintia M
A single-blind, Chamorro Petronacci, Eva Otero Rey, José M Somoza
Martin, Andrés Blanco Carrión, Mario Pérez Sayáns
randomised, 12-
month clinical trial
Eligibility Criteria
Inclusion Criteria Exclusion Criteria

1. No systemic pathologies that could be considered grounds for
absolute contraindication,
2. Agreement to participate in the study and signed informed
consent,
3. Smoking <5 cigarettes/day,
4. Patients who were not completely edentulous,
5. Single/multiple tooth gaps in the posterior area, with or
without distal teeth,
6. Absence of teeth in the maxilla or mandible that did not
require the use of regenerative techniques,
7. Area of healed mature bone at least 6 months post-extraction,
8. Minimum torque of 25NCm for early loading, lesser torque
implant sinked, cover screw placed and eliminated from study.
1. Missing teeth in the aesthetic area
2. Agreement to participate in the study and signed
informed consent,
3. Smoking >5 cigarettes/day,
4. Bleeding index >30%,
5. <2 mm keratinised gingiva or need for soft tissue
grafting,
6. Cases in which safety margin greater than equal to 1mm
from the inferior alveolar nerve could not be
guaranteed,
7. Caries lesions or periodontal disease,
8. Pregnancy or lactation.
 Immediate
Study Design loading

Restorations
7 days

Provisional
Complete (n = 11)
Drilling
(n = 22) Early
loading
8 weeks
(n = 11) Definitive Month 12
crowns Radiographi
Immediate 6 months c evaluation
loading

Restorations
Straumann BLX 7 days

Provisional
3.37 x 10 mm Under (n = 11) Adverse Events
Screw Retained Abutment Drilling 2 implants failed
2.5 mm height (n = 22) Early
loading
8 weeks
(n = 11)
Primary Objectives – to evaluate MBL 6 & 12 months
after loading using dynamic bone management Randomization, allocation and
consignment – Randomization
Secondary Objectives – quantify primary stability of algorithm of SPSS 24.00 Macro
implants using modified drilling protocol, and to access Ethical Clearance – Participants chosen from used, sequentially numbered,
whether loading protocol had effect on MBL Spain January 2019 to July 2020, opaque sealed envelopes (SNOSE)
NCT03720236
Power Calculation – G-Power, alpha error 0.05 and 80% power (beta error), loss ratio of 5%

Primary Variables MBL (6months, 12 months), Primary Stability (RFA – ISQ)

Variables
Demographic variable, habits (smoking & bruxism),
topographic variables (tooth position, type of antagonist
Secondary Variables tooth), Periodontal variables (Gingival biotype, Bleeding
index, Plaque index, vestibular gingival thickness, drilling
type)

Statistical Analysis – Kolmogorov – Smirnov test for normalcy, Student t test, One way Anova,
Pearson Correlation (Periodontal Indices)

Clinical Evaluation – MBL evaluation using RVG using XCP p/4, and ISQ values
Results

Mean primary stability 60.6 ± 12.2 ISQ (21 – 75) irrespective of

drilling protocol, bone density or location.

Early loading had MBL of about 0.728 mm whereas immediate

loading did not show any MBL

When drilling protocol and loading was compared, complete

drilling protocol used in conjunction with an early loading
protocol resulted in lowest MBL at 12 months, and a bone gain
effect of 0.814 mm, given the short follow up period being the
only limitation.
THANK YOU