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In-patient comparison of marginal bone loss after 4 months in immediately loaded, submucosal, and transmucosal dental
Armin Sokolowski1, Martin Lorenzoni1, Elisabeth Steyer1
1Division of Restorative Dentistry, Periodontology and Prosthodontics, Department of Dental Medicine and Oral Health, Medical University of Graz, Billrothgasse 4, Graz, 8010, Austria.
Objectives:
This prospective observational study aimed to evaluate the clinical outcomes and impact of different treatment protocols - immediate loading using a round gold bar retained overdenture on two implants, submucosal healing, and transmucosal healing - on circumferential marginal bone levels around dental implants.
Materials And Methods:
20 patients requiring six implants in the edentulous lower jaw were included. Within each patient, 2 implants were assigned to submucosal healing, transmucosal healing, or immediate loading protocols. Marginal bone loss (MBL) was evaluated using 3D scanning at implant placement and after 4 months while raising a full-thickness flap. Periotest values (PTVs), the oral health impact profile (OHIP-14) and regular clinical evaluations were conducted for up to 2 years.
Results:
The submucosal group exhibited the least mean vertical MBL (-0.22 mm), significantly lower than the immediate (-0.39 mm) and transmucosal (-0.36 mm) groups (P = .001). Peri-implant bone surface area reduction was lowest in the submucosal group (-0.87 mm²) compared to the transmucosal (-4.58 mm²) and immediate (-6.66 mm²) protocols (P = .002). One submucosal healed implant and two immediately loaded implants were lost. Immediate loading provided high patient comfort and demonstrated successful outcomes both in terms of clinical data (PTVs, MBL) and patient-reported outcome measures (OHIP-14, VAS).
Conclusions:
Submucosal and transmucosal healing protocols resulted in better marginal bone preservation compared to immediate loading. Although immediate loading enhanced patient comfort, it was associated with higher marginal bone loss.
Clinical Relevance:
This study highlights the potential advantages of submucosal healing for marginal bone preservation and supports the use of three-dimensional scanning for precise bone loss evaluation, guiding clinical decision-making in implantology.
Trial Registration:
ClinicalTrials.gov Identifier: NCT06408506.
